Transcript for
Parental substance use and child-focused practice

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and today I am speaking with Gill Munro. Gill is a social worker and part of the Workforce Development team at the National Workforce Centre for Child Mental Health. Gill has several years experience working in homelessness and alcohol and other drug sectors. Most recently, she was manager of a large specialist drug and alcohol service, where she took a particular interest in the roles, that stigma and trauma play in the recovery of people with substance use issues. Gill has a strong sense of social justice and enjoys working alongside practitioners, clients and families to develop places, activities and communities where people can start to feel safe and a sense of belonging to a positive community of like minded people. In today’s episode, we discuss child focussed and parent sensitive practice in the alcohol and other drugs sector.  In particular, drawing on Gill’s recent conversations with leading practitioners in the field, as part of the Emerging Minds suite of resources for working with parents who use substances.

[00:01:05] Thank you very much, Gill, for joining me today for a podcast episode.

Gill Munro [00:01:09] It’s a pleasure.

Sophie Guy [00:01:10] Welcome. I think, first of all, it would be really great to hear a bit about your experience working in the alcohol and other drugs and homelessness sectors. Could you tell us a bit about that?

Gill Munro [00:01:21] Sure. So I worked for many years as manager of a specialist drug and alcohol treatment service, and we provided treatment across a continuum of care. So there’d be drop-in sessions, there’d be counselling and groups and intensive day programs. And then a residential rehab component where people would spend time in the wider community, share and like share housing in the wider community. But with a full therapeutic program wrapped around, them kind of thing. And before that, I worked in the homelessness sector for a while as well. And then kind of the two things in tandem, we had some sort of double funding, if you like. And I think that experience was quite pivotal for me just, in really, there’s something about working with people who are significantly disadvantaged that I just really started to develop a passion for.

[00:02:18] So I guess, you know, most of the people that would come for drug and alcohol treatment as well, they’re at that real pointy end of substance use. And so many of them, its the same sort of client group. There’d be quite a lot of overlap between homelessness and drug and alcohol service attendance. And so similar sort of factors that people were facing, inter-generational stuff often, poverty disadvantage, mental health issues, and just that total social exclusion really, particularly with the homelessness people attending homelessness services. But also intergenerational trauma. You really noticed that as well. And you know, I suppose it became important to me to try and understand that more.

Sophie Guy [00:03:01] And when you say that you felt it was important to understand that. How did you explore intergenerational trauma within your work?

Gill Munro [00:03:08] It was hard often to go into that in huge depth, but just the beginnings of understanding, I think all practitioners can do, and it’s important to have that understanding, to actually support people, to engage with services. I mean, it’s where the stigma sort of comes from. I guess if you have no understanding that this person has a trauma background and that it’s probably an intergenerational trauma background, then you’re just looking at behaviours. If you’re not looking at something through a trauma lens, you’re just sort of working with those presenting behaviours, which can be quite difficult. It puts a whole new understanding on it. If you’re looking at this as intergenerational trauma, how do we provide safety, welcoming, compassion for this person basically in order to stop the cycle, really? So it might not be that the service does all of that trauma work, but at least they can do that initial understanding, safety, compassion, empathy that allows the person to attend that service. And it might be that you refer to somewhere else for some deep trauma work. But I think that just having that ability to really accept the person at that level goes a really long way towards starting a journey of recovery.

Sophie Guy [00:04:26] Okay. And to what extent was understanding of trauma or trauma informed care embedded in the services that you worked in?

Gill Munro [00:04:35] Increasingly so. I think it was kind of always there. There was an understanding of it. But over the years, the understanding developed. It was embedded sort of through the organisation, this idea that we needed to have a trauma lens, but it didn’t always peter right down to the front line. And I think for me, it was noticing that particularly with women. So women seem to be affected by trauma in ways that is even more debilitating, perhaps. I don’t know if I can say that, but I’ve just said it. So perhaps more debilitating than it can be for men. So there’s an additional layer of marginalisation for women. And also there may be sexual trauma and domestic violence and so on, that actually layers additional trauma onto them.

Sophie Guy [00:05:22] And is that what you mean when you say it can be more debilitating for women, those layers of domestic violence?

Gill Munro [00:05:30] Yeah, that’s right. And, you know, I think it’s, research really shows that women who have gone through childhood trauma, they actually will attract more of that, unfortunately, in their lives, dangerous relationships and so on. So without an understanding and again, of without having that trauma lens of being able to look with compassion at this woman. You can actually get some quite judged mental opinions, even amongst practitioners. And that was always interesting to me. How do we actually work with that to raise awareness amongst practitioners as well, that this is a trauma presentation. Really what you’re working with initially is trauma behaviours. And, you know, it takes a while to build trust, to build safety, to actually get beyond that.

Sophie Guy [00:06:20] Could you talk a little bit, instead of maybe give a bit of an example or what did trauma informed work look like when you’re meeting with clients?

Gill Munro [00:06:29] Yeah, sure. So I’ll talk mainly about women because I guess that’s particularly my area of interest, but also because as I’ve said, it seems it has a more debilitating effect on women. It might be that you need to take more time. You usually do. So you may not do this work in your initial half hour, hour session. You might need to just stretch it out a little bit. You might need to just delay the full assessment and do that over a couple of sessions rather than one session, while you actually seriously connect with the person. There’s some real empathy and connection going on. You’re listening for other things in that woman’s life. So she may be attending for drug and alcohol treatment, but she’s not going to actually engage with drug and alcohol treatment if she’s got no clothes. If she’s couch surfing, if she’s got nowhere stable to live, if, if she’s in an abusive relationship. So there might be that, there’s some physical needs that actually need to be met first. You can’t just go straight into an assessment and counselling. You know, there might be food is required or those basic human physical needs. To start to help her to feel safe and actually have the basic needs that she requires, you know, to have that place of safety to start any therapeutic work.

Sophie Guy [00:07:48] So today we’re going to talk a bit about child focussed practice. Could you describe what is meant by child focussed, practice in the AOD and homelessness sector?

Gill Munro [00:08:00] I think it started off with that phrase of making the child visible in the services, and that really became a well-known phrase. We kind of all knew we had to make the child visible somehow. How that actually happened was, I think, quite variable across services, in the sectors and the services. So I guess I will speak from my own experience managing the drug and alcohol service in particular. We realised, I guess, that we had to do this through every level of the service. You could talk about this as being an important thing in our practice meetings. We need to speak to people, parents about their children and so on. But unless that was supported by some kind of paperwork and processes, again, it’s hard to change practice without that. So we started to think, how can we embed this all the way through?

[00:08:51] And we had our lovely admin, reception guy, ask everybody that called in, you know, just a couple of questions. And one of them was. Are you pregnant? to Women, and do you have children under five or do you have children five to twelve? So that even informed the very beginning of that person’s journey. They parent, being asked about their children was normalised. We then put it onto assessment processes, there would be a fast tracking. So if his initial question, are you pregnant, was a yes, then there would be a fast tracking of a pregnant woman into treatment. Somebody would call her immediately, to get an appointment as soon as possible and there’d be a certain follow up. So we started to gradually embed it right the way through the service in that way. So, you know, it was on the assessment, as I say, we’d ask about children, their ages, their full names, which were often different. Not necessarily the same as the mothers.  Where they lived, custody details and so on. And just a simple question around, how are the kids going? And so at assessment, the parents started to get used to this is just something we do. Children, you know, in your family life will just be asked about in a fairly low key way from the very beginning. And we built into care plans as well. So each client would develop their own rehab plan covering various domains of their life. And parenting would be part of that.

Sophie Guy [00:10:20] How did parenting come into the care plans? How did that influence, you know, the way that our clients thought about their recovery?

Gill Munro [00:10:28] So initially it was on the care plans of parents who were coming into the service for residential rehab. We had a stream of funding where we could take in single parents and their children, or women going through the reunification program, or men in fact. And so initially it was just around those families, which was only a couple of families. But that helped us develop some expertise, I guess. So we actually had the women and children on site or we were working with child protection to actually support reunification. And so there’d be an addition to the care plan around some reflective questions for the parents at the end of every week. And this we usually actually revolved around what was required from child protection. And it was things like, insight into parenting and how have you noticed substance use or mood affects parenting, you know, and what sort of skills have you, what have you learned this week to support your child emotionally or what sort of behaviours are difficult? So there were some specific sort of questions that the parent would reflect on at the end of every week. And then we would encourage, they would speak with their counsellor and then they would be encouraged to call child protection themselves and talk through the things that they’d learn, the reflections, the insights they’d developed and so on.

[00:11:48] So when we saw that gradually starting to work well, then it started to be rolled out more widely with other parents in the service. I mean, it’s a really busy service and there would have been well over a thousand people attending every year. So to actually do that, it it became a staged process and something that we built a bit of expertise with the people in residential. And then gradually where the need was most obvious, started to roll that out.

Sophie Guy [00:12:17] Okay. And so was this sort of parenting and the impacts of bringing the child into focus for parents and perhaps the impacts of their drug use on children. Was that something that was being explored or was there sort of particular programs that people in the service would be part of as well?

Gill Munro [00:12:38] There were other programs that parents would be linked him with. So we would provide a women’s group. We’d also provide one of our counsellors was actually trained in the circle of security. And so there’d be that course kind of ongoing for parents that were part of the service. And then usually if they’re part of the reunification process, then they would be working with reunification worker, child protection worker, psychologists and so on to actually support their parenting as well.

Sophie Guy [00:13:09] Okay.

Gill Munro [00:13:09] So it was kind of a wrap around approach, I guess.

Sophie Guy [00:13:13] Okay. Yeah, I guess I’m just curious. So the adults that come into your service, who who are parents, you know, what sort of awareness do they have around the impacts of their alcohol and drug use addiction on parenting and on their children?

Gill Munro [00:13:27] Yeah, I think various levels of awareness. I think some were all too aware of the way that substance use impacts their children. You know, and I mean that just when you’ve got that level of shame and guilt, it’s very hard to actually work from any kind of empowered place to actually support improved parenting. So there were definitely many parents who felt significant shame and guilt around the effects of their drug use.

Sophie Guy [00:13:56] So you’re saying that those people who were more aware and held a lot of shame that it was harder for them to work on their parenting?

Gill Munro [00:14:04] Yeah, well, I think it was hard. It really needed the strengths approach. I think. To actually point out things that were going well and times when they, you know, really did seem to understand what was going on with their child. They responded well to their child, but it’s about moving past that shame and guilt. Of course, it needs to be acknowledged. But you have to sort of sort of move past that and start to build a bit of self-efficacy, a bit of self-confidence as a parent. And some supports really around that. I mean, I guess there’s other parents who would be in a form of denial maybe, that, no, it’s not affecting. They don’t see it. We only ever use when they’re asleep or drink when they’re asleep or they’re not home or whatever. And I think sometimes that’s denial and sometimes that is possibly that they really don’t think that their substance use is affecting children because children don’t see it necessarily.

Sophie Guy [00:14:58] Okay. And I mean, it must be really hard for parents to really come to terms with that.

Gill Munro [00:15:06] Yeah, I think it’s it’s extremely hard. You know, because you’ve got so much stigma that you’re facing anyway as a person with substance use. If you’re a parent with substance use issues, then there’s an even deeper levels of stigma attached to that and possibly even more again, if you’re a mother with substance use and children parenting. And if you’re pregnant, that’s the possibly the highest level of stigma at all. And I think that that’s really hard for anybody to understand. I mean, for practitioners to understand. We’ve got this kind of discourse of the good mother and mothering is something innate and natural and that you have a child and you just naturally drop all your bad habits and you’re a mum. But I think we all know that that’s not quite as easy as we think it is. It’s not necessarily a natural thing, becoming a mother, or being a parent. There are skills that can be learnt and so on. And it’s not that easy to drop all of your bad habits when you become a parent. But particularly when you’re somebody that has a background of complex trauma, inter-generational disadvantage, all those things that you’re struggling with as well. And substance use has been your only coping mechanism to actually feel in any way normal or to hide all this levels of pain that you’re experiencing. It’s not realistic to expect people to just suddenly stop when they become pregnant or have a child.

[00:16:46] They may want to and have the very best intentions in the world of wanting to do that. But the actual doing of it is something much more difficult. Because of course, when they stop using all of those horrible traumatic feelings will come back, with a vengeance. And so you’ve possibly got hormonal changes if you’re pregnant and, you know, flashbacks of trauma. It’s a lot to cope with, really. And I think having those kinds of understandings makes it a lot easier for practitioners as well to perhaps be more compassionate in their work with women.

Sophie Guy [00:17:24] To what extent do you think that child focussed practice has become more common in services that mainly work with adults?

Gill Munro [00:17:32] I think there’s definitely a willingness to adopt child focussed practices. And I think it is being adopted gradually and slowly. I’m talking about evolution, I guess again. There’s been some really good studies and research and supporting materials I guess for the drug and alcohol and homelessness sectors. Sometimes those don’t perhaps filter down again to the front line in these busy services. And I guess that’s what I found interesting about developing these resources with Emerging Minds. That we’ve got that ability to develop some really practical tools that can be used on the frontline to support child focussed practice, because people don’t always know how to actually do it in practice. You know, they’ll have this as a concept of we need to make the child visible, but it comes with a lot of fear as well around making child protection reports and so on. And I don’t know that practitioners always think about the positive side of it, where there’s a lot of work that they can do in these adult services to support parents in their parenting alongside working with substance use or whatever.

Sophie Guy [00:18:47] Could you talk a bit about the resources that you’ve been developing?

Gill Munro [00:18:50] Yeah, sure. That’s been really exciting, actually, because it’s lovely coming from a sector where you notice there’s possibly a little bit of a gap and then being able to come and work on that gap basically and harness all that wisdom that there is across the drug and alcohol sector in Australia.

Gill Munro [00:19:10] So there is some fantastic practice going on and it was great to be able to speak to some of those practitioners to actually inform these resources. So we’ve, we’re developing a drug and alcohol e-learning course which will support child aware and parents sensitive practice in the drug and alcohol sector, but also across generalist sectors as well. But basically to supporting parents with substance use issues. And it’s all around building children’s resilience and improved social and emotional wellbeing. And off of that e-learning course, there are some other additional resources and in particular a conversation guide to actually support frontline workers, to have conversations with parents across five domains in a child’s life, to actually again support children’s, social and emotional wellbeing.

Sophie Guy [00:20:03] Okay. And what are those domains?

Gill Munro [00:20:04] So it’s called the PERCS Conversation Guide. And the P is the parent child relationship. E is emotions and behaviour. So understanding the child’s emotions and responding to the behaviours R is routines. I love routine’s. I think it’s a really easy place to start. In many ways, to actually look at what are the routines in the family, are there any regular routines? What can we put in as routines? Because those are the things that actually give children safety, a sense of stability. Are there routines outside of the home? But that’s quite an easy little place to start. I always think routines in the family.

Sophie Guy [00:20:44] Yeah, not too threatening either.

Gill Munro [00:20:46] No, it’s not. You know, you can brush your teeth at the same time. You can have a story before bed or, you know, every family will be different in what they want to do. But there will be something there that will be fairly easy and achievable for a parent to adopt. And for a practitioner to kind of explore, with a parent. Communication is the C. And that’s just supporting parents in their communication with children. And I think importantly highlighting where they do do these things as well. So there may be times when they have great communication. How do we build on that? And the S is support networks. But I think it’s a really practical kind of resource. That just gives some example questions to guide practitioners in this kind of work, because I think it does seem a bit foreign initially. You know, although there is a willingness I think in the sectors, I think, how do we actually do it?

Sophie Guy [00:21:42] So to do the child focussed and parent sensitive. Yeah. What does that actually look like?

[00:21:46] Exactly. And I I hadn’t heard the term parents sensitive before I came to Emerging Minds, and I love that term. So it’s just about being sensitive to the fact that the person in front of you might be a parent. And of course, that’s a really important role in anybody’s life, even if the children aren’t with them and they’re in, you know, child protection or something like that, they still often have contact and they like talking about their children. People generally like talking about their children. And children are such a motivator for them to make changes. I think that parents sensitive approach is lovely and can be really supportive in lots of work with people.

Sophie Guy [00:22:27] Mm hmm. Okay and you mentioned you had the opportunity to meet with and talk to other practitioners in this space. What did you learn from that? What are some of the main things you took away from that?

Gill Munro [00:22:39] I mean, I think it was things around this understanding of trauma again. So it’s things like, you know, that a parent with a trauma background will struggle with managing their own emotions. And then they have a child with big, strong emotions as well. All that does really it is just trigger their own sense of helplessness. And it’s this awful then kind of catch-22. They can’t manage their own emotions due to a background of trauma, and yet they are then expected to try and manage their children’s emotions.

[00:23:13] So there needs to be some work done on managing emotional regulation for people with background trauma, before they can really support their children effectively. Then we also interview people from, who work directly with children, the children of people with substance use issues. And that was fascinating to just to really get the feedback around children’s experience.

Sophie Guy [00:23:37] Yeah,

Gill Munro [00:23:38] The things that parents would always, children rather, would always say in the groups or the individual therapies that were being provided that they had these three kind of rules to keep it hidden. Don’t trust anybody and don’t speak about this. And that was really quite generic, apparently with children of parents, with substance use issues. That they’d often be a parent without a substance use issue, who would come and bring the children to something, you know, to seek support. And that was often the first time that those children kind of had permission to actually speak about the problems in the family.

Sophie Guy [00:24:14] And what kind of impact do you think? Did they say that could have on a child to keep a secret?

Gill Munro [00:24:23] So it was things like, you know, the child really often takes the responsibility for the problems in the family. They think that it’s something that they’ve done, that they’re not good enough, that they aren’t. And I guess it’s because there’s some fairly harsh parenting practices that can come out of, you know, when you’re struggling with substance use your self, and all the different moods around that and you are struggling with intergenerational trauma and poor parenting practices. There’s some pretty harsh parenting that can go on as a result. And so that sort of can compound children’s messages of feeling defective, worthless to blame and so on. And I think although we kind of know that intellectually, I think most practitioners would kind of know that it was actually really interesting for me to hear that from somebody that works direct with children. To actually hear those children’s voices. It just made it more real for me to actually speak to her about that experience.

Sophie Guy [00:25:26] Right, do you have any thoughts about what more needs to happen at, say, a policy level around ensuring that practitioners are working in a child focussed way?

Gill Munro [00:25:38] Yes, I guess I do. So I think certainly for the drug and alcohol sector, I think it would be useful if statistics were collected around how many parents attend services seeking substance, support for substance use. And at the moment, that’s not collected. So a lot of stats are but pregnant women that’s not collected, and neither is parenting status. And so when you’re trying to look at statistics around how many parents in Australia have substance use issues, you’re really relying on self-reporting, report for that. There’s nothing really collected that would inform how many parents are actually struggling with substance use issues. So I think that in itself would start to inform policy and service agreements and so on. So at the moment, service agreements tend to, they note child focussed practice as being this is one of the things that we want you to do. Adopt a child, focus practice. But there’s not really much measurement of that, really. It’s qualitative kind of measurement. I think there’s something about collecting quantitative stats around an issue that starts to change policy. Really, if we really knew how many parents were having problems with substance use issues, then it would start to inform the service agreements, policy, strategic health plans and so on.

[00:27:09] So I think that, you know, it has appeared in strategic plans for the drug and alcohol sector in the different states and territories and so on. But a bit more probably needs to be done there to really embed it because that would then cause services to have to work more to a child aware approach. So at the moment, they’re just so busy. So, you know, I think is there is a willingness there without doubt. You can see the willingness. But I think that these services are just so busy that this seems a little bit perhaps like an add on sometimes.

Sophie Guy [00:27:48] In your interviews and conversations with practitioners for developing these resources were there some examples of promising practice that support children and parents, social, emotional being that stood out to you?

Gill Munro [00:28:04] Yes, there were. So there were definitely examples where practitioners really got the importance of all services asking about children. So not just drug and alcohol, homelessness services, but all adult services. There was some quite enthusiastic response around that from senior managers. And so that’s really encouraging because that’s you’re authorising environment. I guess, you know, individual organisations that this is seen as something useful and really worthwhile across all sorts of different services, whether that’s financial counselling, you know, emergency relief type services, whatever. So that was good. And then I guess it’s visiting those women’s services where you feel as though there’s such a wealth of knowledge there that it would be lovely to share more widely across mainstream services. And just the way that they work, basically. So that real strong understanding of trauma and stigma and how to work with that.

[00:29:14] I mean, they have the dialectical behaviour therapy there, which is not commonly used across the drug and alcohol sector, but is really useful for working with women with trauma.

Sophie Guy [00:29:26] Right. Okay.

Gill Munro [00:29:28] And things like. So they were doing things like videoing parenting. So, you know, just having parent and child 20 minute videos and then really pointing out the strengths in those videos, which starts to build self efficacy again in the parent, which I thought was quite lovely, really. And also I guess that giving people permission to feel bad about parenting. So I think, again, going back to that discourse of the good mother and the fact that, you know, you’ve now got this baby which you just automatically love and are really caring and nurturing of. And that’s not always the case for all women, or many women. But in the drug and alcohol services, I guess it was just about giving them the space to actually explore. I’ve got this baby now in my care. Am I in a fit place? Am I well enough to look after this baby? Do I want to? Did I want to have this baby?

[00:30:27] And having a bit of space around that, which would sometimes lead to women realising actually, no, I’m not in the right space for this at the moment. I really need to focus on my own wellbeing and healing, if you like. And so just not assuming that now that this person is reunified with their child, that’s all going to be fine and will work from this. You know, sometimes that’s not what’s the woman wants or is ready for, and so on. So, I thought that was quite an important thing to keep in mind as well. Just giving that space and being able to contain those conversations I think is really useful.

Sophie Guy [00:31:08] Yeah, that sounds very powerful.

Gill Munro [00:31:11] And just building that relationship between mother and child protection. I think that’s a key sort of takeaway as well. That it’s women are often so angry, and I’m focussing on women, men as well. We have many men come through the service that really wanted their children back in their care. And they had such a distrust and an anger, of course, with grief underneath it, you know, that their children have been taken into care. But you can’t sit in that space for too long. Then as a practitioner, it’s easy to do that, to kind of feel like you’re on the side, sitting in that space with a parent. But it’s not productive. It needs to kind of then be shifted on to more or less. How do we build this relationship with child protection so that you can start to get more access? You know, usually things are never a done deal. You can always do some more recovery, work yourself, build some more insight as a parent. And there’s always a bit of hope that you will start to get more access. You may even get re-unification.

Sophie Guy [00:32:10] Thank you for sharing so generously about your experience, both in your managerial of service role, but also the work that you’ve been doing at Emerging Minds.

Gill Munro [00:32:22] Pleasure. Thank you for the opportunity.

Sophie Guy [00:32:24] Pleasure.

Narrator [00:32:26] Visit our web site at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workfore Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.