Mothering and Substance Use Responses to mothers with substance use problems and their children, on the part of the child welfare and addictions treatment systems. Ideas arising from a community of practice
The project involves virtual discussion of 6 key topics related to women s substance use in Canada with the aim of building consensus on avenues for improving services to women, as well as policy and research in these areas.
Project sponsors British Columbia Centre of Excellence for Women s Health Canadian Women s Health Network Canadian Centre on Substance Abuse With funding from Health Canada, Drug Strategy Community Initiatives Fund Check out the new website at: http://www.coalescingvc.org
Communities of Practice Communities of practice (CoPs) are voluntary forums for collective learning. In CoPs people collaborate directly, use one another as sounding boards, teach each other. What holds them together is a common sense of purpose. CoPs can involve diverse stakeholders working on an issue in a way that builds collaboration and supports co-construction of knowledge and consensus.
Topic discussed in this community: Weaving together support for mothers and children, in substance use treatment and child protection contexts Mothering and substance use connections Info sheet 1 Mothering with substance use problems and the child welfare system Info sheet 2 Mothers, children and the addictions treatment system Info sheet 3 Systemic level work Info sheet 4
Technical support The community used a virtual workspace allowing us to share documents and weblinks, participate in online discussion, and plan meetings Periodically we participated in online meetings, which involved calling into a toll-free number and using a shared virtual workspace.
Mothering and Substance Use Virtual Community Participants Ayotte, Danielle Breton House Sault St. Marie ON Campbell, Andre Addiction Services Sidney NS Carver, Virginia Consultant Ottawa ON Chaim, Gloria Centre for Addiction and Mental Health Toronto ON DeMarchi, Gina Breaking the Cycle Toronto ON Ferriss, Anita Camosun College Victoria BC Foster, Deborah Athabasca University and Portage College Lac La Biche AB Huisman, Ruby Interested individual, former civil servant Terrace BC Keith, Barb Vancouver Coastal Health Authority Vancouver BC Kruk, Edward University of British Columbia Vancouver BC Lake, Gundel Amethyst Women s Addiction Centre Ottawa ON Leishner, Chris PEERS Victoria BC Macphail, Susan WOTCH Toronto ON Madsen, Kirsten Yukon Women's Directorate Whitehorse YT Moore, Wendy Umbrellas Program, Pinewood Centre Whitby ON Mulcahy, Meghan Antigonish Women's Resource Centre Guysborough NS Poole, Nancy BC Centre of Excellence for Women's Health Vancouver BC Powell, Beth Centre for Addiction and Mental Health London ON Richards, Sharron Children's Aid Society Toronto ON Ridley, Barbara Iris Addiction Centre Sudbury ON Smylie, Diane Jean Tweed Centre Toronto ON Tomkins, Meaghan social work student Dawson Creek BC Weaver, Sydney Fir Square Combined Care BC Women s Hospital Vancouver BC
Mothering and Substance Use Connections Info sheet 1
Mothering and Substance Use Connections Info sheet 1
Stigma Mothers with substance use problems are highly stigmatized Often they are seen as deliberately harming their children, or not caring, or not worthy of support, not able to make use of support Often the babies mothers won t accept what their addiction has done to another human being. They re almost always in denial about any impact to the baby. Rescuing infants from the depths of Victoria s crystal meth crisis Globe and Mail, Friday January 19, 2007
In order to maximize the potential support of mothers and children, and realize the most positive outcomes for both, a paradigm shift away from prejudice and pressure, and towards support of pregnant women and mothers who use substances is needed. A paradigm shift
Some facts on mothers who use substances and the impact on children Mothers have reported that they have not felt able to access treatment for their substance use problems because they are afraid that their children will be apprehended (62%) (Poole, N. and B. Isaac, Apprehensions: Barriers to Treatment for Substance-Using Mothers. 2001, British Columbia Centre of Excellence for Women's Health: Vancouver, BC). Mothers have also reported feeling discouraged with how the child welfare system uses child apprehension as its primary response to substance use (Greaves, L., et al., A Motherhood Issue: Discourses on mothering under duress. 2002, Status of Women Canada: Ottawa, ON). Aboriginal mothers are particularly affected. Aboriginal children are placed in care at a rate of 1 in 10 whereas non-aboriginal children are placed in care at a rate of 1 in 200 (Assembly of First Nations, Leadership Action Plan on First Nations Child Welfare. no date, Assembly of First Nations: Ottawa, ON).
Facts continued Some children of substance using parents do not develop any significant problems related to their parents substance misuse. The risks of adverse effects are higher if co-factors are operating, such as: domestic violence, both parents being substance misusers, exposure to criminal activity and witnessing someone injecting drugs. Actions such as improved parenting techniques; helping children learn to disengage from negative situations; and receiving support from school, family and other networks, can all make children more resilient to any negative impacts of parental drug or alcohol misuse. Velleman, R. & L. Templeton Understanding and modifying the impact of parents substance misuse on children. Advances in Psychiatric Treatment, 2007. 13: p. 79-89
Integrating responses: a paradigm shift The paradigm shift needs to be characterized by profound attitudinal and value shifts, reflected by: a value on early attachment and support for both mothers and children integrated, cross-systemic support, and cross-sectoral leadership; involvement of mothers, child protection workers, alcohol and drug service providers, and system planners in developing and defining appropriate responses
Mothers with substance use problems and the child welfare system Info sheet 2
Challenges for the Child Welfare System We discussed key historical and current barriers for the child welfare system in supporting mothers with substance use problems, including: Legislated mandate to focus exclusively on safety of child Problem focus, and focus on substance use as a primary problematic - versus strengths-based and holistic approach Unsynchronized time frames for decision making, recovery, and financial assistance, and unrealistic expectations placed on mothers Lack of engagement with mothers and their support systems
Promising directions Holistic, strengths-based approaches to assessment and support Differential Response model US SNAP assessment model Early support through home visitation Yukon s Healthy Families program
Promising directions Other early and ongoing support approaches that link support for mothers and children Maternity care supportive of the mother-child unit Fir Square Combined Care Unit Multi-faceted community-based programming Joint foster care and kinship care Stepped support to change
Fir Square Combined Care Unit A hospital-based medical stabilization, labour and delivery service which cares for substance-using women and substance-exposed newborns in a single unit Includes: A multidisciplinary team A holistic approach A harm reduction approach Collaboration with child protection to help mothers go home with their babies where possible
Promising directions Multi faceted, family-centered responses, tailored to risk Ontario s family-centered conferencing approach UK response to highest risk families: Think Family Community-wide and systemic responses coordination of the many services working with families Communities that Care model community wide prevention response
An Aboriginal perspective on promising directions Four types of Collaborative Practice 1. Family Group Conference: Referral to Ministry family group conferencing coordinator 2. Mediation: Professional mediator is brought in to resolve issues with a family. 3. Traditional Dispute Resolution: Aboriginal family chooses to have their community conduct a traditional process of problem solving. 4. Family Development Response: Short term intensive work with a family to keep children out of the child welfare system
Commitments and Role of Family Group Conference Participants: Put the child first Stay focused on the child s needs Share concerns and thoughts honestly Safety for everyone at the conference Everyone has a voice and is valued The family comes to consensus about a plan Recognition of collective and collaborative strengths is key Abide by guidelines set by family Children need to know the family & community they belong to
Family Group Conference Flowchart Child in need of protection Social worker considers family a candidate for FGC and the parent acknowledges the need for planning Social worker Explains FGC to parent & suggests possible referral to FGC May refer parent to community to consult and learn about FGC If social worker and parent agree to a FGC referral, referral made to FGC Coordinator
Positive and negative aspects of Family Group Conferencing as identified by Positive Family working together Information sharing Planning to make children safe Support shown between family members Preparation for children to return to family Focus on the children Everyone respected and had a voice through process Attitude and sense of hope for Negative Location Only partial family involvement Times when the process got off track Where the historical child protection concerns were the focus Family perception that social worker was non-supportive with the family planning Systemic barriers that interfered with the family s plan
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Mothering and the Substance Use Treatment System Info sheet 3
Challenges for the substance use treatment system in working with mothers and their children Mothers fear requesting support, afraid of losing their children Services are not readily accessible to mothers for example little or no funding to child care available for mothers who access treatment Treatment often focuses on the individual needs of the mother, neglecting the family or mother-child unit as a whole In Canada, there are few specialized treatment services that are supportive of women s role as mothers, and fewer where children are treated in concert with mothers
Women said gearing program to pregnancy issues will help women to focus on this part of their life during treatment it felt like I forgot I was pregnant Jean Tweed Centre Presentation at March 2006 consultation meeting
Promising Canadian directions in the delivery of substance use treatment for women and their children Respectful, collaborative counselling approaches Motivational Interviewing (MI) Appreciative Inquiry Community-based holistic engagement Enhanced Services for Women (ESW) - Alberta Ontario Early Childhood Development Addiction Initiative Pathways to Healthy Families - The Jean Tweed Centre Umbrella s Program - Pinewood Centre and other Central East Region agencies
Pathways to Healthy Families Objective: Increase access to substance use and child development services for pregnant and parenting women with substance use problems and their young children Model: Partnership Outreach Structure: Integrated Child Development Services Counsellors in community agencies Direct service (case management, counselling) Capacity building
Promising directions Specialized community-based programming for pregnant women and new mothers Breaking the Cycle, Toronto, ON Sheway, Vancouver, BC Maxxine Wright, Surrey BC Ontario Early Childhood Development Addiction Initiative programs e.g. Heartspace in London Ontario
Promising directions Intensive treatment and recovery programs Jean Tweed Centre day treatment for mothers (Moms and Kids Too) Peardonville Treatment Centre, Abbotsford BC residential treatment for mothers and children
Collaborative and Responsive Substance Use Treatment In order to improve the support and treatment of mothers with substance use problems targeted, collaborative, and inclusive programming needs to be further developed and implemented. Building on these innovative and responsive methods of support with a strengths-based harm-reduction focus will further the improvements in meeting the needs of pregnant women and mothers who use substances, and their children.
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Mothering and Substance Use: Making the Systems Work Info sheet 4
Connecting Systems In order to improve our response to substance using mothers we need to integrate our responses, connecting historically segmented systems. Shared values, integrated care, and strength-based harmreduction work are all promising ways to reduce the fragmenting of mothers and children, and the services they require. Expanding on the ties that bridge the child protection and addiction fields, expanding on existing successful training practices and approaches, and working holistically with mothers and children offers promise for a new perspective on substance use and child protection work.
Connecting Systems Cross-training for addiction and child protection workers Values-based cross training focused on collaboration Drabble, L., Tweed, M., & Osterling, K. (2006). Pathways to Collaboration: Understanding the role of values and system-related factors in collaboration between child welfare and substance abuse treatment fields. San Jose, CA: San Jose State University of Social Work Training to support integrated responses Institute for Health and Recovery www.healthrecovery.org Involving mothers in cross training Weaver, S. (2007). Shame Reduction: A Model for Training Child Welfare Workers on Best Practice with Substance-Using Mothers. In N. Poole & L. Greaves (Eds.), Highs and Lows: Canadian Perspectives on Women and Substance Use. Toronto, ON: Centre for Addiction and Mental Health. Multi-sectoral training approaches - ActNow BC Healthy Choices in Pregnancy www.hcip-bc.org
Connecting Systems Establishing Cross-Sectoral Protocols Expanding on Existing Successes: Integrating Policy and Practice Weaving together practice and policy (integrated planning) Using policy filters - Greaves, L., Varcoe, C., Poole, N., Morrow, M., Johnson, J., Pederson, A., et al. (2002). A Motherhood Issue: Discourses on mothering under duress. Ottawa, ON: Status of Women Canadahttp://www.swc-cfc.gc.ca/pubs/ 0662326791/index_e.html Using new technologies to share best practice
Source: Greaves, L., Varcoe, C., Poole, N., Morrow, M., Johnson, J., Pederson, A., et al. (2002). A Motherhood Issue: Discourses on mothering under duress. Ottawa, ON: Status of Women Canada.
Conclusion A paradigm shift towards valuing the linked needs of mothers and children, as well as a move to working from shared professional values is paramount to the continued work on integrating addictions treatment and child protection work. The virtual community saw that the paradigm shift might be grounded in: a value on early attachment and support for both mothers and children integrated, cross-systemic support, and crosssectoral leadership; involvement of mothers, child protection workers, alcohol and drug service providers, and system planners in developing and defining appropriate responses
Thanks for joining us this morning! Please contact us with comments, questions or suggestions Email: kclark2@cw.bc.ca The finalized information sheets (including French versions) and a media file of the webcast will be on the Coalescing project website in the near future www.coalescing-vc.org and links will be made through the websites of CWHN and CCSA www.ccsa.ca and www.cwhn.ca
The 6 topics for these learning communities are: 1. Violence services response to women with substance use problems Integrating support on substance use issues for girls and women into services that provide support on violence/trauma issues, as well as promoting integrated violence and addictions policy. 2. Prevention of Fetal Alcohol Spectrum Disorder from a women s health determinants perspective Integrating women-centred health approaches into prevention and policy initiatives designed to prevent Fetal Alcohol Spectrum Disorder (FASD). This community has evolved into a Network Action Team of the Canada Northwest FASD Research Network. 3. Mothering and substance use Weaving together support for mothers and children, in substance use treatment and child protection contexts 4. Women-centred harm reduction approaches Integrating women-centred approaches into our work on reducing harms for women accessing support from services, into drug policy and harm reduction frameworks for action. 5. Substance use treatment for First Nations and Inuit women This community will engage First Nations and Inuit women, service providers and policy makers in discussing how the addictions treatment system and related health and social services could better address the needs of First Nations and Inuit women at risk of having a child affected by FASD. This community is supported by the FASD Unit of the First Nations and Inuit Health Branch of Health Canada. 6. Addiction services response to women with experiences with violence/trauma This community will explore the integration of trauma-related support tailored to the needs of girls and women with addictions treatment settings, and systemic policy, guidelines, and frameworks.