Making headway... parental substance misuse in pregnancy: best practice in early intervention and child protection Kerry Moore & Miriam Glennon Barnardos South Coast Centre

What we are dealing with... From 2010 to 2013 across Australia there was a 29% increase in children who were the subjects of child protection substantiations In NSW the rates of substantiations of child protection reports rose between and from 9.0/1000 to 9.8/ % of the substantiations were for children aged 0-4 years and 46% of the kids admitted to OOHC were in this age group The 2012 NSW Child Death review revealed that parental alcohol and/or drug misuse was the most commonly reported concern about the families of the children who had died who were known to Community Services. Over two-thirds of first time entries to care are substance abuse related

What we are dealing with…. The peak life stage for substance dependence are the years 18 to 35 – the child bearing years The prevalence of neonatal withdrawal syndrome has markedly increased over the last 25 years Over two thirds of women entering substance abuse treatment are mothers of dependent children. This rises to 80% of women entering opioid pharmacalogical treatment

What we are dealing with…. domestic violence, mental health conditions, socio economic disadvantage and high rate of removal of previous children typically co exist with substance misusing pregnant women

Messages from research US research has concluded that children of families with substance abuse problems tend to come to the attention of child welfare agencies younger than other children, are more likely to be placed in care, and once in care are likely to remain in care longer These children are also more likely to have been the victims of severe and chronic neglect, are more likely to move from one placement to the other more frequently and less likely to return home to their biological parents

Messages from Research Recent British research on outcomes of restoration found that 81% of children who had been reunited with substance misusing parents had returned to care within 4-5 years

Messages from Research and Practice Improvements in parenting circumstances are most likely prenatally then the first 6 months of a child’s life. Change is then much less likely in the child’s developmental time scale Given the importance of early childhood development and the prevalence of parental substance misuse in child protection cases, identifying unborn children at risk is crucial

Messages from research & practice Decisions about risk of significant harm must be focused on the child’s developmental needs and safety Many welfare workers find that there are tensions between adults’ interests and the rights of children to safety and the opportunity to develop normally

Good practice tells us…. For family support services, particularly intensive family based services, substance abuse poses a dilemma, as extra time is needed for consolidation of change and relapse prevention and management. There are likely to be many relapses before sustained change occurs – this has significant implications for permanency planning – how long can a child wait?

Research, good practice & common sense tell us……. To have any chance of helping substance dependent mothers to parent, comprehensive integrated services are needed which include mental health services, trauma treatment, parenting education and counselling, pre natal education, medical treatment, child care and children’s services

SUPPS Substance Use in Pregnancy and Parenting Service unique to the Illawarra

How SUPPS is making headway Provides sustained and co- ordinated services across the health, child protection and non government sectors for pregnant substance dependent women and their families

Builds opportunities for attachment development under extraordinary circumstances Provides a continuum of comprehensive service delivery from pregnancy until the child reaches 3 years

SUPPS & Child Protection Tough decisions must be made in the child’s developmental time frame SUPPS partners with child protection workers CP instruments - parent capacity orders & parent responsibility contracts

Evaluation Outcomes and Best Practice 2013 evaluation of the SUPPS program (by Inca Consulting). A 3 part questionnaire was developed for clients, case workers and external stakeholders. In depth interviews with 9 current and 6 past clients of the service. Six Caseworkers interviewed and 9 staff from external services. A triangular method of review was utilised for each client. Interviews were conducted independently of SUPPS.

Responsive & effective Culturally competent Staff interested & able Collaborative & strengthening Whole child focussed Accessible & attractive Integrated SUPPS Family Support Best Practice

Case Study A young mother, Linda, is referred by Health Service. She is due to have her baby in 3 & has a history of cannabis & amphetamine use for 5 years. She says she has stopped since she became pregnant. She has 3 other children in care on permanent orders due to Linda's drug use and neglect of children. The father of the baby is currently in jail on assault charges while intoxicated on alcohol. He is due to be released 3 months after baby's birth. She has strained relationships with her parents & siblings Linda currently lives in a refuge.

Collaborative and Strengthening Case Study During the engagement process assessment will be conducted using SCARF which identifies strengths & areas of need. Action plans will be identified & a parenting agreement signed. The process of setting goals & responsibilities will be negotiated & agreed upon by the case worker and the family.

Collaborative and Strengthening Evaluation Findings “...The SUPPS family support model uses a strength based approach which acknowledges the positive aspects of the family by enquiring & remaining open to receiving information about family strengths...” “...Families report that they respect & trust the caseworkers & that they show a genuine interest in the positive aspects of their lives...” Inca Consulting

Collaborative and Strengthening “...I got heaps out of it. There was no judgment. It taught me that I am doing the right thing sometimes and staff were easily approachable...” Client Feedback

Whole Child Focused Evaluation Findings “Barnardos SUPPS staff are clear that, in reality the SUPPS family support client is the child. The welfare of the child is the primary concern” Inca Consulting

Whole Child Focused Case Study SCARF child assessment cover aspects of the whole child. Children in the program are assessed throughout the program. Both by the caseworker but also by psychologists at playgroup. Further assessments are conducted by health professionals if concerns continue. All assessments are grounded in child development.

Accessible and Attractive Home visits Transport to pre-natal appointments Assistance with housing especially to view properties. Playgroup very attractive to parents and central for access. Case Study

Accessible and Attractive Client Comment “It’s good for one on one time with other parents & it gave me time to be with my kids when it wasn’t a struggle because there is painting, games & songs” “It means a lot of free time for me & gave me insights into parenting, hints & tips. I get to meet other mums in a similar situation. I don't have to go but I always want to”

Integrated Case Study The SUPPS Program has 3 components which Linda will be able to access. Each component can be tailored to meet Linda’s unique needs. Case Management Parenting Program Playgroup

Integrated Case Study Support to attend Hospital clinic with D&A nurse in partnership with Maternity, early childhood nurses and social workers. Close working relationships with Community Services to support joint strategies. Very transparent to parents. Internal referrals within Barnardos e.g. volunteer HV, respite and temporary foster care. Strong links with housing, D&A services, counsellors, OTS & physiotherapists.

Integrated Evaluation “ I think (SUPPS) works on all levels. Its not only helping the kids its helping the parents. These are damaged adults trying to nurture children, it teaches the adults to talk to kids not to blame them for things kids do naturally. It talks about the importance of play & not parking the kids.” Stakeholder Interview

Staff are Interested and Able Client Comment “...I know I can call at any time if I'm having a bad day. She’ll always answer. She's an awesome worker. She always makes it positive and tells me I am doing a great job. I've got help in everything, housing, prem baby... I also get to have a bitch, have a say...”

Staff are Interested and Able Client Comment “...I couldn't have got this far without the one on one support. Its all been good, intense, but confronting - which is good and bad...”

Responsive and Effective Evaluation “...In the case of SUPPS family support, its information gathering appears to be dynamic, incremental, targeted and purposeful, and ongoing...”

Responsive and Effective

Client Comment “...Its brilliant she supports me to look at things differently. There's only a couple of people in my life who can do that and she is one of them. There isn’t a question, and there hasn’t been a situation that I have been in, that I haven't got assistance for. There is always someone to speak to...”

Culturally Competent Staff have been trained in cultural competency but D&A users have a sub-culture of their own. Of particular importance is for workers to help parents to understand the impact of D&A abuse on children

Culturally Competent Client Comment “It hit home for me that your fooling yourself if you think you can do it (D&A).” “It definitely affects the kids. You don't realise how much it affects their behaviour. Your being a parent but you are not all there.” “You might be there physically but you wont be there emotionally to function for your child.”