1. A Multidisciplinary Supported Playgroup for Children of Substance Dependent Parents

2. MARCEL COTTAGE SUPPORTED PLAYGROUP Families with children age 0-5 years Parents are on the methadone programme Held at methadone clinic in Blacktown Supported by Clinical Nurse Specialist, Speech Pathologist, Occupational Therapist and Parent-Infant Therapist (Psychologist)

3. Project currently funded through the DoCS Early Intervention Programme Implemented by Sydney West Area Health Service – joint initiative of the PC & CH network and Area Drug and Alcohol Services

4. WHY THIS POPULATION? Vulnerable and at-risk families Increased likelihood of impaired parenting capacity and subsequent poor child outcomes (Barnard & McKeganey, 2004) Risk factors for children include: exposure to drugs prenatally; interruptions to, or poor, parent-child relationships; chaotic family life; increased risk of neglect, physical abuse and sexual assault (Patterson, Digiusto, Lord, Wales & Lamb, 2003)

5. Risk factors may result in: Developmental delay, Speech and language delays, Motor delays, Social and behavioural disorders, Learning disabilities, Hypersensitivity to environmental stimuli and increased risk of attachment disorders that can have significant long term consequences

6. Parents are less likely to access ante- and postnatal care, may avoid seeking help for parent-child problems, have fears around interventions by child protection authorities, and may be isolated from traditional health services (e.g., Patterson et al., 2003) Therefore these children are also at higher risk of remaining undetected and untreated until reaching school.

7. AIM OF PLAYGROUP Parents: provide support in an accepting environment build confidence develop healthier parenting practices and parent-child relationships develop social networks for themselves and their children improve access to services

8. Children : improve children’s developmental outcomes support with speech and language support with motor development Behavioural and emotional support play skills peer relationships school readiness experiencing a warm and nurturing environment

9. WHY A MULTI-D PLAYGROUP? Large numbers of young children and infants attending clinic with their parents Accessibility – playgroup is on-site and on the busiest day of the week Informal setting that is child-focussed reducing the negative associations many parents have about traditional intervention

10. Gives families the opportunity to access a “normal” family activity without feeling judged by their methadone status Wholistic approach to development and parenting from the different professions

11. HOW DOES IT WORK? One morning a week for two hours Play-based activities designed to stimulate child development Screening of developmental strengths and weaknesses conducted through observation and discussion with parents

12. Weekly case review : development is monitored and specific activities planned for children’s needs Support needs are addressed through interaction within the group setting

13. Parents are encouraged to stay and play with their children Modelling positive interaction and play with the children Staff focus on building trusting relationships with the parents and children

14. HAS IT WORKED? Average number of 13 children attending each week Average number of 10 parents attending each week Average length of stay is 39 minutes. 16 of the 33 different children who attended in Term 1 2006 were of ATSI background.

15. Relationship building with parents Parents approach staff with their concerns about children’s development or behaviour Parents approach staff with other concerns

16. Parental responsibility for, and ownership of, the playgroup Increase in families looking to access childcare and preschool after observing progress in children’s development at playgroup.

17. Children ask parents to take them to playgroup Children observed to participate in more functional play, attend and follow instructions better and demonstrate improved speech and language skills Parents report improved behaviour, speech and motor skills following regular attendance at playgroup

18. Clients of the methadone clinic bringing other clients’ children, or their grandchildren, after observing the group Extended family have attended the playgroup (3 generations) Parents are starting to network outside of playgroup and encourage each other to attend Four children who attended in 2005 now attending school and reported to be doing well

19. SAM AND MOLLY

20. KAREN AND ROSE

21. WHY IS IT WORKING? Focus on engaging with families – therapeutic relationship Flexibility in service delivery Multi-disciplinary team Recognition and awareness of children in an adult –focussed service Increased family-orientation in the future

22. REFERENCES Barnard, M. and McKeganey, N. (2004). The impact of parental problem drug use on children: what is the problem and what can be done to help?. Addiction, 99, 552-559. Patterson, G., Digiusto, E., Lord, B., Wales, P. and Lamb, R. (2003). Evolution of a healthy children’s programme for methadone treatment patients in Western Sydney. Neonatal, Paediatric and Child Health Nursing, 6 (3), 8-14.