Steven Ondersma, PhD

Steven J. Ondersma, PhD, Research-Educator

Room 120
Assistant Professor
Departments of Psychiatry and Behavioral Neurosciences and Obstetrics/Gynecology
Wayne State University School of Medicine
2761 E. Jefferson Ave.
Detroit, MI 48207

Phone: 313-577-6680

Fax: 313-993-1372

Email: s.ondersma@wayne.edu

Statement of Interests

My primary interest is in the intersection between substance abuse and child maltreatment. I have served as Director of two federally-funded programs for parents of drug-exposed infants and am presently Editor in Chief of the peer-reviewed journal Child Maltreatment. I specialize in motivational interventions, am a member of the Motivational Interviewing Network of Trainers, and was a protocol supervisor for a national multi-site study of Motivation Enhancement Therapy (under the NIDA Clinical Trials Network). My current program of research is in the area of brief motivational interventions in the perinatal period, and focuses on parents at risk of child maltreatment, especially those with substance use disorders. Ongoing major projects include a large Phase II clinical trial designed to evaluate the efficacy of a computer-based brief motivational intervention for substance abuse among post-partum women (funded by NIDA), and a randomized trial designed to evaluate a computer-based intervention supplement for new mothers receiving early home visitation services (funded by the CDC). I also have interests in treatment adherence, health promotion, and measure development, especially with respect to indirect detection of stigmatized risk factors.

Representative publications

Ondersma, S. J., Malcoe, L. H., & Simpson, S. (2001). Child Protective Services’ Response to Prenatal Drug Exposure: Results from a Nationwide Survey. Child Abuse & Neglect, 25, 657-668.

OBJECTIVE: This survey was conducted to: (1) document child protective services (CPS) agencies' actual practices regarding prenatal drug exposure; (2) examine urban and rural differences in CPS responses; (3) explore whether CPS practices varied as a function of county median income, birth rate, population size, or percent minority births; and (4) assess respondent satisfaction with their county's current responses. METHOD: Data were collected via a nationwide telephone survey of child welfare supervisors from two urban and two rural counties in every state (N = 200). RESULTS: Ninety percent of counties (100% of urban and 80% of rural) reported receiving referrals of infants with prenatal drug exposure. Among those receiving referrals, extreme variations in practice were found; all possible response options (from very inactive to very aggressive) were equally represented on key questions (e.g., filing court petitions, taking custody). Rural counties tended to have stronger responses than urban counties (t[175] = -2.26, p = .024). County response did not vary with county-level median family income, percent minority births, or birth rate. Despite wide variations in practice, the majority of respondents (69%) felt their county's response was appropriate. Of respondents who did indicate that their county's response was inappropriate, most (85%) felt that the county needed to do more to protect children. CONCLUSIONS: There is currently tremendous variation across US counties in CPS responses to, and beliefs regarding, the issue of prenatal drug exposure. Some of this variation is due to differences between urban and rural counties, with little variation explained by differences in median income or percent minority births at the county level. There is a need for research-based guidance and consensus building in CPS practice in this area.

Delaney-Black, V., Covington, C., Ondersma, S. J., Nordstrom-Klee, B., Templin, T., Ager, J., & Sokol, R. J. (2002). Violence exposure and school outcomes in urban children. Archives of Pediatric and Adolescent Medicine, 156, 280-285.

BACKGROUND: Exposure to violence in childhood has been associated with lower school grades. However, the association between violence exposure and performance on standardized tests (such as IQ or academic achievement) in children is unknown. It is also not known whether violence exposure itself or subsequent symptoms of trauma are primarily responsible for negative outcomes. OBJECTIVE: To examine the relationship between violence exposure and trauma-related distress and standardized test performance among early school-aged urban children, controlling for important potential confounders. DESIGN: A total of 299 urban first-grade children and their caregivers were evaluated using self-report, interview, and standardized tests. MAIN OUTCOME MEASURES: The child's IQ (Wechsler Preschool and Primary Scale of Intelligence--Revised) and reading ability (Test of Early Reading Ability, second edition) were the outcomes of interest. RESULTS: After controlling for confounders (child's gender, caregiver's IQ, home environment, socioeconomic status, and prenatal exposure to substance abuse) violence exposure was related to the child's IQ (P =.01) and reading ability (P =.045). Trauma-related distress accounted for additional variance in reading ability (P =.01). Using the derived regression equation to estimate effect sizes, a child experiencing both violence exposure and trauma-related distress at or above the 90th percentile would be expected to have a 7.5-point (SD, 0.5) decrement in IQ and a 9.8-point (SD, 0.66) decrement in reading achievement. CONCLUSION: In this study, exposure to violence and trauma-related distress in young children were associated with substantial decrements in IQ and reading achievement.

Ondersma, S. J., Simpson, S., Brestan, E., & Ward, M. (2000). Prenatal drug exposure and social policy: The search for an appropriate response. Child Maltreatment, 5, 93-108.

Prenatal drug exposure continues to be a controversial topic. Views of what constitutes an appropriate response to drug-exposed infants vary, in large part due to the many complex issues endemic to perinatal substance use. The purpose of this article is to review the controversy surrounding prenatal drug exposure, outline the policy dilemmas that complicate attempts to respond appropriately, review current practice in this area and the effectiveness of those practices, and offer specific recommendations as a starting point for debate. It is suggested that earlier controversy regarding the sequelae of prenatal drug exposure may be decreasing as research identifies specific and subtle deficits in some affected infants. It is also suggested that the postnatal effects of parental substance abuse (e.g., in terms of abuse/neglect, attachment, and development) are the more appropriate focus of child protection efforts, and that different disciplines must collaborate to reach a consensus regarding the nature of these efforts.

Ondersma, S. J. , Chaffin, M., Berliner, L., Goodman, G., Cordon, I., & Barnett, D. (2001). Sex with children is abuse: Comment on Rind, Tromovitch, and Bauserman (1998). Psychological Bulletin, 127, 707-714.

B. Rind, P. Tromovitch, and R. Bauserman (1998) reported a meta-analysis of the relation between sexual abuse in childhood and adolescence and psychological functioning among college students. Several aspects of their work have proven to be highly controversial, including their assertion that the relation between child sexual abuse and adjustment is quite small and their questioning of whether child sexual abuse should be labeled abuse in scientific inquiry. In this commentary, the authors summarize the controversy that has ensued, place it in a historical context, discuss the limitations of B. Rind et al.'s findings, and critique the manner in which those findings are presented. The authors also argue for the appropriateness of the term abuse and for scientific terminology that reflects rather than contradicts consensual public morality.

Ondersma, S. J. (2002). Predictors of neglect within low-SES families: The importance of substance abuse. American Journal of Orthopsychiatry, 72, 383-391.

A case-control design (N = 203) was used to explore the relative ability of substance abuse, depression, social support, and negative life events to predict neglect status among low-socioeconomic-status families with and without substantiated neglect. Substance abuse emerged as the strongest predictor of neglect status as well as of parental disposition and adequacy of home environment.

Mullins, S. M., Suarez, M., Ondersma, S. J., & Page, M. C. (2004). The impact of motivational interviewing on substance abuse treatment retention: A randomized controlled trial of women involved with child welfare. Journal of Substance Abuse Treatment, 27, 51-58.

Previous studies have supported the efficacy of Motivational Interviewing (MI) in increasing treatment engagement and retention among people with substance abuse disorders. However, few studies have assessed the impact of MI with coerced populations, particularly women referred to drug abuse treatment by child welfare due to prenatal drug use. Seventy-one such women who used drugs during pregnancy were randomly assigned to either receive three MI sessions or to watch two educational videos and participate in a home visit. Treatment retention group attendance and random urine analysis results were evaluated in these women during the first 8 weeks of treatment. No differences were found between the two conditions on these variables. Possible reasons for these negative findings are discussed, as are ideas for future research with coerced populations.

Ondersma, S. J., Chaffin, M., Simpson, S., & LeBreton, J. (2005). The Brief Child Abuse Potential inventory: Development and validation. Journal of Clinical Child and Adolescent Psychology, 34, 301-311.

A brief version of the Child Abuse Potential Inventory (CAP) was developed using a development sample of N = 1,470, and cross-validated using an additional sample of N = 713. Items were selected to maximize (a) CAP variance accounted for; (b) prediction of future child protective services reports; (c) item invariance across gender, age, and ethnicity; (d) factor stability; and (e) readability and acceptability. On cross-validation, scores from the resulting 24-item risk scale demonstrated an internal consistency estimate of .89, a stable 7-factor structure, and substantial correlations with the CAP Abuse Risk score (r = .96). The CAP risk cutoff was predicted with 93% sensitivity and 93% specificity (area under the receiver operating characteristics curve = .98), and the Brief Child Abuse Potential Inventory (BCAP) and CAP demonstrated similar patterns of external correlates. The BCAP may be useful as a time-efficient screener for abuse risk.

Ondersma, S. J., Chase, S. K., Svikis, D. S., & Schuster, C. R. (2005). Computer-based brief motivational intervention for perinatal drug use. Journal of Substance Abuse Treatment, 28, 305-312.

Computer-based brief motivational interventions may be able to reach a high proportion of at-risk individuals and thus have potential for significant population impact. The present studies were conducted to determine the acceptability and preliminary efficacy of a computer-based brief motivational intervention (the motivation enhancement system, or MES). In Study 1, quantitative and qualitative feedback from 30 postpartum women and 17 women in treatment for drug use were used to modify the software. In Study 2, 50 urban postpartum women who reported drug use in the month before pregnancy completed the intervention and provided repeated within-session ratings of state motivation. In Study 3, 30 women were randomly assigned to intervention or control conditions with 1-month follow-up. Overall, women rated the MES as highly acceptable and easy to use and reported significant increases in state motivation at postintervention and at 1-month follow-up (d = .49). These preliminary results are encouraging and suggest that further work in this area is warranted.

Ondersma, S. J., Delaney-Black, V., Nordstrom, B., Covington, C., & Sokol, R. J. (2006). The association between caregiver substance abuse and self-reported violence exposure among young urban children. Journal of Traumatic Stress, 19, 107-118.

This study examined the relative importance of caregiver substance abuse as a correlate of child-reported exposure to violence. A total of 407 female African-American primary caregivers and their children age 6 to 7 were evaluated. The association between child report of violence and exposure to substance abuse by others (both within and outside the home) was considered after controlling for variance accounted for by child characteristics, caregiver characteristics, home environment, and neighborhood environment (including neighborhood crime). Caregiver alcohol abuse, children's witnessing of drug use in the home, and children's witnessing of drug deals all explained significant additional variance in violence exposure. These findings suggest that for early elementary-age children, meaningful prevention of violence exposure may be possible via addressing their exposure to substance abuse in their home and community.

Ondersma, S. J., Svikis, D. S., & Schuster, C. R. (2007). Computer-based brief intervention: A randomized trial with post-partum women. American Journal of Preventive Medicine, 32, 231-238.

Background: Drug use among parenting women is a significant risk factor for a range of negative child outcomes, including exposure to violence, child maltreatment, and child behavior problems. Implementation of brief interventions with this population may be greatly facilitated by computer-based interventions. Design: Randomized clinical trial with 4-month follow-up. Setting/participants: Participants were 107 postpartum women recruited from an urban obstetric hospital primarily serving a low-income population. Women were randomized into assessment only versus assessment plus brief intervention conditions; 76 (71%) returned for follow-up evaluation. Intervention: A 20-minute, single-session, computer-based motivational intervention (based on motivational interviewing methods), combined with two nontailored mailings and voucher-based reinforcement of attendance at an initial intake/treatment session. Main outcome measures: Illicit drug use as measured by qualitative urinalysis and self-report. Results: Frequency of illicit drug use other than marijuana increased slightly for the control group, but declined among intervention group participants (p_0.05, between-group Mann–Whitney U; d_0.50); the magnitude of intervention effects on changes in marijuana use frequency was similar, but did not reach statistical significance. Point-prevalence analysis at follow-up did not show significant group differences in drug use. However, trends under a range of assumptions regarding participants lost to follow-up all favored the intervention group, with most effect sizes in the moderate range (odds ratios 1.4 to 4.7). Conclusions: Results tentatively support the efficacy of this high-reach, replicable brief intervention. Further research should seek to replicate these findings and to further develop the computer as a platform for validated brief interventions.

Currently Active Grants

Ondersma, S.J.,& Svikis, D. S. (2006-2010). Computer-based brief intervention for perinatal drug, alcohol, and tobacco abuse. RO1, National Institute on Drug Abuse/NIAAA/NCI, National Institutes of Health. Time: 50%. Total cost: $1,282,159; this budget period: $345,488.
Ondersma, S. J., Chaffin, M., & Martin, J. (2006-2010). A computer-based intervention to augment home visitation services. U49, Centers for Disease Control and Prevention/National Center for Injury Prevention. Time: 30%. Total cost: $1,600,000; this budget period: $400,000.

Teaching Highlights

Dissertation committee chair for four doctoral students (plus one recent successful defense) in the area of child maltreatment and computer-based substance abuse treatment and/or health promotion.
Three advisees have won major national awards (separate students have won a NIDA travel award, an NIAAA NRSA award, and a Canadian Tobacco Control Research Initiative dissertation award)

Service Highlights

Editor-in-Chief of Child Maltreatment (CM), a major peer-reviewed specialty journal. CM is indexed on PsycInfo and Medline, is listed by the Institute for Scientific Information, and is the journal of the American Professional Society on the Abuse of Children.
Ad-hoc Reviewer for other journals including the Journal of Consulting and Clinical Psychology, Archives of Pediatric and Adolescent Medicine, Journal of Substance Abuse Treatment, the Journal of Pediatrics, and the Journal of Traumatic Stress.
Regular participant in NIH study sections.

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