Responding to Substance Use Disorders and Trauma among Parents Involved in the Child Welfare System

Transcription

1 Responding to Substance Use Disorders and Trauma among Parents Involved in the Child Welfare System National Conference on Child Abuse and Neglect May 2,2014 Kim Bishop-Stevens, LICSW Terri Bogage, LICSW Norma Finkelstein, Ph.D 1

2 Massachusetts Department of Children and Families Kim Bishop-Stevens, LICSW Substance Abuse Manager

3 3 DCF at a Glance Organizational Structure 4 Regions: Regional Offices / Regional Directors 29 Area Offices: Director of Areas (oversee 2 offices), Area Clinical Managers, Area Program Managers, Supervisors, Social Workers Units: Intake Screening (Hotline for after hours) & Investigations/Initial Assessment, Short Term Stabilization, Ongoing Specialty Units: Substance Abuse, Mental Health, Domestic Violence, Medical, Housing, Education, Legal, Fatherhood, Community Connections, Training

4 4 Department of Children and Families 83,805 reports (51A s) received 54% are screened in for Investigations/Initial Assessment At any given time during the year: 67,334 total consumers 19,024 open clinical cases 34,114 children under 18 7,302 were in placement (21%) Calendar year 2012, DCF Internet Approximately 68% of DCF cases involve parental substance abuse

5 5 DCF Ongoing Initiatives DCF Substance Abuse Unit Policy Development Tool Kit Training Family Resource Centers Massachusetts Child Trauma Project

6 6 DCF and DPH Collaboration Governor s Interagency Council on Substance Abuse and Prevention Regional Partnership Grants Family Residential Treatment Centralized Intake DCF Intake Policy and Medication Assisted Treatment

7 Nurturing Program for Families in Substance Abuse Treatment and Recovery (included in the National Registry of Evidence-based Programs and Practices) Terri Bogage, LICSW Director, Children and Family Services 7

8 Why the Nurturing Program? People parent based upon their own parenting experiences Parents cannot give what they don t have Knowing how to nurture comes from being nurtured Internalizing nurturing experiences helps parents to recognize the emotional needs of their children 8

9 History/Philosophy Trauma-informed curriculum that integrates substance use/abuse, recovery, mental health issues, parenting, and child development Curriculum origin and development, components, theoretical background Erickson s eight themes of growth spanning life cycle The Stone Center s Relational-Cultural Theory 9

10 Curriculum Origin Developed through PPWI-CSAP demonstration project, Piloted at 2 residential women & children s programs Based on Dr. Stephen Bavolek s Nurturing Program for Parents of Children Birth to 5 on CSAP Promising Practices Well documented, aimed at reducing abuse & neglect; had evaluation instrument - AAPI 10

11 Relational/Cultural Model Shifts emphasis from separation to Relational Self as basis for growth and development Connections are fundamental to psychological growth and healing Goal of development is to enhance connection Development is toward interpersonal connection & interaction 11

12 Women s sense of personhood is grounded in the motivation to make and enhance relationships to others. We observe that women tend to find satisfaction, pleasure, effectiveness, and a sense of worth if they experience their life activities as arising from and leading back into a sense of connection with others. -Jean Baker Miller 12

13 Guiding Values of Nurturing Program Parenting is a relationship, not only a set of skills Nurturing oneself is the first step toward nurturing others 13

14 Guiding Values of the Nurturing Program Love of life & learning Respect for self, others & the environment Fun & laughter Recovery happens in families & in relationships, as well as in the individual 14

15 Purpose To address the impact of substance abuse, mental illness and trauma on parenting and the parent-child relationship Begin with focus on the parent and challenges Build the relationship between parent and child 15

16 Responds To Array of learning styles Literacy Multiple intelligences Exploration of cultural heritage Providing opportunities to explore & appreciate both own heritage & heritage of other participants 16

17 Topics Hope Growth & trust Families Feelings Making connections Communication Problem solving Body talk What babies teach us Self-esteem Building structure Managing stress Setting boundaries Schedules & routines Safety Guiding behavior Knowing our values Recovery: love & loss Having fun 17

18 Nurturing Program 3 rd Edition Trauma-informed curriculum that integrates substance use/abuse, recovery, mental health issues, parenting and child development 3 new sessions for working with fathers & men Incorporates concepts: Child-Parent Psychotherapy (Alicia Lieberman and Patricia Van Horn) Reflective Functioning (Nancy Suchman, et al.; Peter Fonagy) Guide for individual use In home-based, residential or outpatient settings With individuals or individual families 18

19 Being a Father Sessions The sessions are designed to enhance the existing Nurturing Program for Families in Substance Abuse Treatment and Recovery curricula May serve as alternatives for three other sessions Families and Substance Abuse Body Talk Schedules and Routines 19

20 Nurturing Program Individual Guide Purpose: To expand the settings for using the NP In-home treatment Individual Counseling Family Therapy To be used as a stand-alone treatment or as a supplement to an NP group To provide complimentary activities, alternative exercises, and ideas on how to modify the NP To respond to the various needs of the clients, the strengths of the facilitators, and the guidelines of the treatment settings 20

21 Work with Children Working on children s curriculum to use simultaneously while parents participating in group Based on children s sub-study of Women, Co-occurring Disorders and Violence study Family Activities Manual to Nurture Parents and Children 21

22 Evaluation Adult-Adolescent Parenting Inventory (AAPI-2) Session Evaluations may also be used, such as surveys and assessments 22

23 AAPI Core domains: Appropriate developmental expectations Empathy Alternatives to corporate punishment Appropriate roles Oppressing children s power & independence (added 1999) 23

24 Participant s Evaluations Family Relationships & Parenting: Most of what I learned had to do with ways I thought I should parent & that there really is no rulebook or manual to being a good parent. I also spent time learning about my child s boundaries. I ve learned a lot of new ways to discipline, comfort, nurture, trust, love, care. [I ve learned] patience with my children, to think on their level. I have learned that my child will learn different skills on her own time & not mine, and that I need to be patient & loving & supportive no matter what. I don t yell as much; I use time-out instead of hitting. I don t have to yell or get stressed out with my kids. I have ways to relate. 24

25 Participant s Evaluations I learned: How to have fun as a clean & sober person, how to recognize certain feelings & situations & how I can deal with them; how to interact with other people, & how to nurture myself, my family & friends, & feel comfortable with it. How to handle many of life s everyday issues & problems. What nurturing is, how to nurture & care for myself as well as others; that I am a truly worthwhile human being who deserves safety, respect & happiness. To take the initiative in my recovery. 25

26 Facilitation Skills Each segment opens with information for group facilitator Staff responsible should have the following experience: A solid understanding of substance use and its effects on families Fundamental knowledge regarding parent-child relationships and child development 26

27 Developing Trauma-Informed Organizations National Conference on Child Abuse and Neglect Norma Finkelstein, Ph.D Executive Director 27

28 Family-Centered, Trauma- Informed Treatment Is based on an understanding of impact of violence and victimization on Each family member Their relationships to each other The family as a whole 28

29 Staff knowledgeable regarding impact of violence; trained to behave in ways that are not re-traumatizing All family members have access to trauma-specific interventions 29

30 Trauma-Informed Treatment Focuses On: Safety (physical and emotional) Trustworthiness Voice/Choice Collaboration/ Mutuality Empowerment Fallot & Harris,

31 Institute for Health and Recovery s Developing Trauma Informed Organizations: A Tool Kit 31

32 Tool Kit Contents Principles for an Integrated Trauma-Informed Services System Template for Developing a Trauma Integration Strategic Plan Sample Trauma Policies Trauma-Informed Organizational-Assessments Staff Practice Survey Trauma Informed Supervision Guides and Tools 32

33 Steps Involved in Organizational Change 1. Identify champion for change Trauma Champion 2. Form change team 3. Team identifies and prioritizes targets for change 4. Develop Trauma Integration Strategic Plan 5. Conduct periodic self-assessments 6. Implement changes over a period of time 33

34 How Change Teams Work Build connection at multiple levels of organization with information flowing between levels Administrators, middle management, direct care staff, peer leaders Bring together diverse constituencies affected by proposed changes Direct care staff, participants (consumers), peer leaders 34

35 Using the Tool Kit Organization forms a Trauma Integration Team from all levels of organization Trauma Integration Team collects data To assist in setting goals and priorities To monitor change over time 35

36 Using the Tool Kit Trauma Integration Team Completes Trauma Integration Assessment, choosing ratings by consensus Administers Staff Practice Survey anonymously. How are staff doing with respect to: Staff Safety, Staff Empowerment, Self-Care, Knowledge and Competence, Trauma-Informed Attitudes, Trauma- Informed Practice 36

37 Using the Tool Kit Template for Creating Trauma Integration Plan 1. Trauma Integration Team uses template to identify goals in different areas (i.e., physical environment, staff training) 2. Goals are prioritized 3. Objectives, target dates and person(s) responsible for implementation developed 4. Team continues to move through goals at reasonable pace 37

38 Trauma Informed Supervision After staff trained in trauma-informed practice, Supervision Guides used to train staff in traumainformed supervision Supervisor Self-Check used by supervisors to self-assess their provision of supervision in a trauma-informed manner Supervisee Learning Review used by supervisors to monitor trauma-informed competencies in supervisees over time 38

39 Secondary Trauma Changes in the inner experience of service providers that come about as a result of empathic engagement with the participant s experience of trauma 39

40 Impact of Secondary Trauma Changes in: Beliefs about self, others, the world Sense of trust or sense of esteem in self or others Perception of safety of self or others Feeling connected Sense of control 40

41 Trauma Informed Supervision Creates a safe relationship so that staff can discuss concerns Builds reflective capacity and trauma competence Normalizes impact of secondary trauma Helps identify triggers 41

42 Trauma Informed Supervision Suggests Strategies Use of same skills as participants: emotional self-awareness, grounding, self-soothing Self-Care Plans: provide resources for self-care such as: peer support, time off, stress management resources, physical activities, counseling 42

43 How the Agency Can Help Educate all staff on vicarious traumatization Recognize that staff may be trauma survivors Incorporate concept into supervision and case discussions make it safe to talk about 43

44 Challenges of a Culture Shift Welcoming disagreement Do staff feel safe and empowered? Can staff talk about the impact of the work on themselves? How safe are staff with each other? Peer inclusion- finding appropriate boundaries, slowing down, allowing personal experience in the room, focus on strengths Balancing patience and accountability 44

45 Staff Response I am just learning, I may have been here 8 years but I am still, over the last year I m learning more about trauma in women and being more caring and less critical. I m not trying to get them to do my program anymore, I m trying to help them do their own program and teach them, that s what I do and same thing with the kids I m a lot softer this past year than I have ever been. 45

46 Additional Resources Tool Kits IHR s Developing Trauma Informed Organizations: A Tool Kit (second edition) click on services and products, click on products, click on trauma, click on see more trauma products The Trauma-informed Toolkit 2008 Klinic Community Health Centre, Canada Trauma Informed Organizational Toolkit for Homeless Services 46

47 Additional Resources Websites Community Connections National Center on Trauma 5.73" Informed Care National Child Traumatic Stress Network Listserv 47