1. Come On In: Running Groups for Mothers and their Children Debra Bercuvitz, MPH Debra Bercuvitz, MPH Debbie Flynn-Gonzalez,M.Ed Debbie Flynn-Gonzalez,M.Ed Ruth Karacek, RN, MPH Ruth Karacek, RN, MPH

2. History of FRESH Start (FS) FRESH (Family Recovery Engagement Support of Hampden County) Start Joint initiative with Mass Dept. of Public Health and Mass Dept. of Children and Families since 2008 with funding from Children's Bureau (CB) through a competitive grants authorized by the Abandoned Infants Assistance Act (AIA) of 1988 Project builds upon and expands the state’s Substance Exposed Newborn initiative and the Regional Partnership Grant initiative

3. Service Model FS combines peer mentoring, a major component of the program, support, and advocacy with clinical guidance and treatment Staff provide case management, as well as direct recovery and parenting assistance. Staff partner with child welfare, early intervention, and substance use disorder tx providers to increase client engagement with their services

4. History of FS Groups Peer model works well in pre- contemplation and contemplation stages Clients benefit from peer support in a group context As clients move forward, need more from their community SENs bring a different dynamic to children in groups Often, groups are the first opportunity to actively mother or mother in sobriety

5. Groups follow client progression Run parent- child groups that promote attachment and recovery FS goal to move clients through Individual work with peer mentor Parenting groups (Active Parenting /infant massage less threatening) Nurturing Program (NP) - more introspective and intense Community based support groups (NA, MITH or MotherWoman)

6. Philosophy of Care Strength based Strength based Family focused Family focused Evidence based Evidence based Consumer directed Consumer directed Trauma informed Trauma informed Culturally relevant Culturally relevant

7. Groups Lessen isolation Lessen isolation Increase parent-child attachment Increase parent-child attachment Reinforce role of mother Reinforce role of mother Build recovery community for families Build recovery community for families Increase use of Early Intervention (EI) services Increase use of Early Intervention (EI) services Expose children to early education and care Expose children to early education and care

8. Recruitment Assess the client’s readiness for group Stage of recovery Stage of recovery Impulse control, self-regulation Impulse control, self-regulation Significant mental health issues Significant mental health issues Major depressionMajor depression Untreated bipolarUntreated bipolar Severe anxietySevere anxiety PTSDPTSD

9. Recruitment & Collaboration When 2 or more agencies collaborate on a group: Equal representation with facilitators Equal representation with facilitators Emphasis on team approach Emphasis on team approach Identify the “common thread”- ( i.e. we are all mothers here) Identify the “common thread”- ( i.e. we are all mothers here) Each agency staff recruit but no differentiation between participants Each agency staff recruit but no differentiation between participants

10. Getting there… Identify / Name group & talk it up! Identify / Name group & talk it up! Develop non-threatening flyer with welcoming name of group Develop non-threatening flyer with welcoming name of group Call providers to offer more info, get staff “buy in” Call providers to offer more info, get staff “buy in” Have staff bring in client for first group, meet client outside Have staff bring in client for first group, meet client outside Prepare clients for how they are getting there, reminders Prepare clients for how they are getting there, reminders

11. Opening the door… Prepare client for what to expect Prepare client for what to expect Who will be thereWho will be there What to expectWhat to expect Format of the group (don’t have to share, confidentiality)Format of the group (don’t have to share, confidentiality) Process of groupProcess of group Develop a “need a break” signDevelop a “need a break” sign Just “check it out”, if you hate it don’t have to come back! Prepare client for what to expectJust “check it out”, if you hate it don’t have to come back! Prepare client for what to expect

12. Engagement Once they are in, how do we keep them “in”? Create a welcoming environment Create a welcoming environment Have a welcome person at door, another parentHave a welcome person at door, another parent Ideally start with a family style meal, coffee / café styleIdeally start with a family style meal, coffee / café style Post or hand out schedulePost or hand out schedule Welcome “gift”Welcome “gift”

13. Engagement Well, we’re here… First group should “sell itself” First group should “sell itself” Atmosphere of respect, strength basedAtmosphere of respect, strength based Focus on being mothers, not just people in recoveryFocus on being mothers, not just people in recovery Point out strengths, gently step in to offer help when neededPoint out strengths, gently step in to offer help when needed Members choose guidelines and pick topics of interest when appropriateMembers choose guidelines and pick topics of interest when appropriate Clear plan for next groupClear plan for next group

14. Engagement Been there…come back… Debrief with client after group Debrief with client after group Point out benefits to children Point out benefits to children Share positive observations Share positive observations Assign a “buddy” to remind about next group Assign a “buddy” to remind about next group Assign a group task Assign a group task Validate their presence in the group Validate their presence in the group “Thanks for sharing”, “what you said helped someone else”, “I know that was hard for you”, send a thank you note“Thanks for sharing”, “what you said helped someone else”, “I know that was hard for you”, send a thank you note

15. When it is not working… When someone is clearly not ready, do not see it as a failure When someone is clearly not ready, do not see it as a failure End with a success- what did you contribute, what did your child learn, introduction to a group experience, celebrate brief separation from child as successEnd with a success- what did you contribute, what did your child learn, introduction to a group experience, celebrate brief separation from child as success Identify other things to focus onIdentify other things to focus on See it as a future goal, point out different paths to recoverySee it as a future goal, point out different paths to recovery

16. Tackling the hurdles (the “Big Three” Childcare Childcare Transportation Transportation Food Food

17. Childcare Prepare for care of SENs, children with multiple traumas (foster care placement, parental d.v. and substance use, abuse & neglect), attachment disorders Prepare for care of SENs, children with multiple traumas (foster care placement, parental d.v. and substance use, abuse & neglect), attachment disorders Start with parent-child time, prepare for transitions Start with parent-child time, prepare for transitions Recognize parental difficulty with separation Recognize parental difficulty with separation Intro to early education & care Intro to early education & care

18. Childcare (cont’d) Including non-custodial parents/ arranging for visitation during groups Including non-custodial parents/ arranging for visitation during groups Get creative with childcare workers Get creative with childcare workers Identify existing community supports/services Identify existing community supports/services Gain a better sense of child’s development to help with service coordination Gain a better sense of child’s development to help with service coordination Conclude group with parent/child closing activity Conclude group with parent/child closing activity

19. Non-custodial visitation Use groups as opportunity for visit in community, modeling parenting skills New concept for child welfare workers— their trust in you, your sharing info Plan for child not showing up “Some people are here with their children and some people aren’t”

20. Transportation Give rides first time and then put other options in place Give rides first time and then put other options in place Encourage public transportation- give bus passes, plan out route, go together on bus as a home visit activity “dry run” Encourage public transportation- give bus passes, plan out route, go together on bus as a home visit activity “dry run” Connect neighbors, car-pooling Connect neighbors, car-pooling Van services from early education, Early Intervention transportation Van services from early education, Early Intervention transportation Consider weather, time of group, safety issues Consider weather, time of group, safety issues

21. Food Honoring diverse cultures Honoring diverse cultures Healthy food options Healthy food options Encouraging trying new foods Encouraging trying new foods Child friendly foods Child friendly foods Encourage & model family meal time Encourage & model family meal time Optional pot lucks with program providing main course Optional pot lucks with program providing main course Seeking out church groups, ladies groups, exchange clubs, to donate/serve meals Seeking out church groups, ladies groups, exchange clubs, to donate/serve meals

22. When it works… 2012 Graduates of Recovery Coach Academy

23. In Conclusion… “Nobody can go back and start a new beginning but anybody can start today and make a new ending”. Marla Robinson

24. Contact Information Debra.bercuvitz@state.ma.us Dgonzalez@startatsquareone.org Ruth.karacek@state.ma.us