What we are dealing with

Making headway... parental substance misuse in pregnancy: best practice in early intervention and child protectionKerry Moore & Miriam GlennonBarnardos 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 2011-2012 and 2012-2013 from 9.0/1000 to 9.8/1000

• 27% 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.


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


“...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 ProgramPlaygroup

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...”



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.”

Documents

What we are dealing with