Transcript for
Substance use and child-aware practice – part one

Narrator Welcome to the Emerging Minds podcast.

Gill Munro [00:00:08] Welcome, everyone. My name is Gill Munro from Emerging Minds. The following podcast is the first in a series of two which explores child focussed ways in working with parents affected by substance use. We would like to acknowledge the insight and experience of the featured practitioners in this podcast. Their insights, along with many other practitioners and parents with lived experience of substance use, contributed to a suite of e-learnings, practice papers and webinars on this topic that can be found on our website. emergingminds.com.au. Sally Riley is a child and adolescent psychotherapist at Catholic Care Sydney’s Family Recovery Programme. Sally talks about the effects that she commonly observes in children who have a parent with an issue of substance use.

Sally Riley [00:00:56] So some of the problems we get, mainly with the children, that their needs are not met. They may be witnessing erratic behaviour. They may have a lot of stress and anxiety, not knowing how to cope with what’s happening in the house and with parents. They tend to sort of mask the problem. We usually are working with maybe the non-using family member that may recognise that there’s this problem and it needs addressing now. So they might come in for support. So the children, they tend to tell me that they don’t get invited to things like birthday parties. They feel a bit ostracised. They tend to be left out a lot at school, and at home they’re really sort of confused, and they tend to blame themselves. Most of the children or practically all of the children, I’d say, would think it’s something to do with them. That this problem in the family is something to do with them not being good enough or sort of causing these issues in the family.

So it’s very hidden, the problems that happen in the family. But when we are engaging with the family, the children tend to listen. It tends to be like three particular rules in the House. There’s the don’t talk rule. So it’s whatever’s happening in that house, no matter how chaotic, keep it a secret. It’s our secret. And we don’t need to share that with the outside world. There’s don’t sort of trust anyone. So it’s around. They’re disappointed. So mum or dad be promising things and they’ll never see through that promise. And therefore, there’s that sort of I can’t trust what anyone says is real. And they don’t trust outsiders either because the parents are sort of instilling this, you know, it’s not safe to talk to people and therefore don’t trust anyone. And don’t feel, so as a result because of the family, who’s the person that’s using, they pushed down all their feelings with their substance. And the children learn role modelling behaviours, that I, my feelings are not important. So I can’t show my anger. So I can’t show my sadness. I can’t show my fear.

Gill Munro [00:03:12] Susie Hudson is the clinical director of the Network of Alcohol and other drug agencies in New South Wales. Susie discusses the impacts of children living with a parent who is regularly using substances.

Suzie Hudson [00:03:25] Unfortunately, substance use can really get in the way of connection. For most people, that’s the common experience. And that means that particularly where children are concerned, there’s that difficulty with really connecting. Understanding the child’s point of view, being able to juggle a lot of the things that that children need in terms of routines, being able to respond in ways it’s helpful when children are themselves distressed. Substance use, while often as a coping mechanism for adults, can often exacerbate people’s ability to respond to the needs that the parenting presents. So I think it can also really compound their availability, I suppose, to children and knowing that particularly for very young children, that need to be the centre of things and considerations given to their needs. It can be very, poses a very difficult situation for a lot of parents to be out of juggle all those things.

Gill Munro [00:04:29] Suzie talks about the importance of engaging parents in ways that help them understand the effects of their substance misuse on children.

Suzie Hudson [00:04:37] I think that’s very important for us to make visible the children that are in in people’s lives. For a lot of clients, even if they’ve had child children removed or they’re not currently caring for that child, they’re very much a part of that person’s experience. And so by ignoring that or not having questions and not asking about that, we almost silence a part of that person’s experience. And so it would really be an invitation to all workers to talk to people about all of the people in in in their lives to unearth the possible connections that might need to be grown again. To really, I suppose, focus on the things that are going to sustain change. And that’s often the people in someone’s life. And children are a huge part of that. And so those barriers are often or concerns that a worker might have actually sit with the worker and not with the client themselves. Clients do want to talk about their children, whether they’re in their care or not. They do want to engage in conversations about the type of parent they would like to be and be supported in that.

And one of the things that we’ve got an opportunity to do is to really break down some of those barriers around parenting that we all are working out how to be a good parent. That it’s not an innate ability that you’re born with, that you need to learn these things. And then we can support people through their journey in drug and alcohol treatment, around gathering the skills to be the best parent that they can be.

One of the most useful things can be lots of honesty and consistency in terms of messaging. So that is to say that very early on in the process of rapport building, we talk about all the various aspects of someone’s life. So we’re bringing the children into the conversation early. That we are talking about, you know, working as a bit of a team behind that, to support that person. And that may include family, community services or other types of services. So that’s really upfront. And there’s that transparency with the client about wanting to support them in all aspects of their lives. And I think that honesty and being upfront and signalled very early on in a consistent way, so that is with every client that comes through the door. So we’re putting aside judgement about whether that person does have children, does want children. Any of those things. And we’re just we’re always asking questions about the possibility of, of children in someone’s life and that we are able to enlist the support and help of other services. And I think talking about it in those terms of the team that we might need as a worker, working together with the person, the client that we work with can be really helpful way of breaking through those some of those barriers or concerns that a worker might have.

Gill Munro [00:07:37] Melissa Shee is the Senior Practitioner of New Roads Drug and Alcohol Rehabilitation Service in South Australia. Melissa agrees with Susie regarding the importance of practitioner skill in having child focussed conversations with parents in substance use therapy.

Melissa Shee [00:07:53] I think it’s really important that practitioners are always focussing on the whole, the entire family unit and I think is from, the from the early outset of any therapeutic intervention. I think the child. If a practitioner is aware that a child is part of the family, that those conversations need to be taking place. I think it normalises, if that’s something that’s actually undertaken initially. It normalises that that the child is always going to be part of the conversation. I guess, as well, like knowing that children don’t actually get to execute a voice and don’t have a voice. I think it’s extremely important that the practitioner actually takes on that role for the child. Given the impacts around the emotional and social wellbeing of a child and how these could be lacking or potential sort of connection to external support services such as schooling, medical intervention, all of those things. It is extremely important that practitioners are always focussing on the impact to the child. Not to mention the legal and statutory, you know, mandatory reporting concerns that we have as practitioners as well.

Gill Munro [00:08:59] Melissa goes on to say that children are often a prime motivating factor in parents making change. And this is another reason that practitioners should focus on their social and emotional wellbeing.

Melissa Shee [00:09:11] I would say that a good 99 per cent of all clients accessing a some AOD services say that their children are the motivator. Often, unfortunately, they come, their presentation is a result of statutory bodies such as the Department of Child Protection getting involved or perhaps potentially it’s family members that are getting involved. And there’s a removal of a child that tends to be quite a motivator. But yes, I would say that most clients that have children would actually say that their children are their motivating factor.

Gill Munro [00:09:45] Sarah Watson is the Senior Manager of Community Services at Uniting Communities in South Australia. Sarah discusses the motivation of many parents to change so that they can experience better relationships with their children.

Sarah Watson [00:10:00] Parents often come with children in front of mind when they come in and talking about substance use, it can be a really big motivating factor for them to make some positive changes in their life. Most parents, they love their kids. They want to do what’s best for them. But sometimes, you know, parents may not have the coping skills they need to do. They haven’t had good role models by their own parents. They might be experiencing their own traumas and they just don’t have the skills. And what they want to be able to do is provide the safest and best environment for their kids. But they just don’t know how to do it. Through my experience, often people with substance abuse issues have a whole pile of stigma and shame that they carry around regarding their substance use. Most parents want to do right by their kids. They love their kids.

People don’t want to think that they’re failing as a parent. And when they’re struggling with stuff themselves, you know, the shame is attached. And as a society, I think we place a lot of stigma on people who use substance when they’re parents. And no one wants to feel bad about how they parent, and that includes people who use substances. So making sure that, you know, coming from a non-judgemental approach is not about condemning people for their substance use. It’s about opening up a conversation and engaging the person to then look at alternative options for how they cope with life.

Gill Munro [00:11:38] Lisa Hofman is a social worker and Child Inclusive Practice Coordinator at Jarrah House in New South Wales. Lisa discusses the level of shame and stigma that can be an obstacle to child focussed conversations, for mothers in particular.

Lisa Hofman [00:11:53] So often we get women here who were brought into the child protection system themselves as children, and there’s a stigma that comes with that, too. And then they become a parent. And when they have child protection knocking on their door, that brings a whole other level of, of shame and fear and stigma. So quite often there’s a huge reluctance to talk about their substance misuse. A lot of shame and unfortunately that prevents them from accessing the supports and the helps that they need.

So here we try very much to break down some of those barriers. We are very strengths based to try and get them through the door and to engage them. But unfortunately, that’s not always the experience of a lot of the women that we work with. You know, maybe they’ve access generalist services, maybe they’ve even presented pregnant for antenatal care. And sometimes in the past, by asking for help and disclosing about their substance use, they’ve ended up actually feeling quite judged and perhaps even lost children into the care system. And it’s not unusual that we have women here on to their seventh or eighth pregnancy and maybe they don’t have any of those earlier pregnancies, any of those children in their care. So there’s an awful lot of stigma and a lot of fear. I think that society still does have that expectation of women that somehow, even if prior to becoming pregnant, they were struggling with mental health issues or substance use, that if they just loved their children enough, those issues should just go away and make them a good mother.

And so for us, in the work that we do with the women, it’s really about creating safety for the women to realise that that good enough really is good enough. That none of us are actually good mothers in terms of how society might define it. You know, we’ve all got mistakes that we need to be repairing on a daily basis, most likely in terms of parenting, because it’s a hard job and we’re humans and imperfect. Yeah. None of us are perfect. But I think the image of, you know, perhaps a pregnant woman on the street, you know, engaging in injecting drug use. You know, it’s a shocking image still in mainstream society. And, you know, it should shock us because it obviously is a big issue we need to work on. But I think, unfortunately, sometimes the ways in which we try to make the intervention are so shaming. And unfortunately, what we know about substance use is that that can often lead to a slippery slope of more substance use. As opposed to coming from that strengths-based perspective and trying to help women to engage in the support services that are out there, that are available to get them away from substance use as being the only option.

Gill Munro [00:14:54] Suzie Hudson talks about the impact of shame on mothers when they’re discussing the effects of their substance use on children.

Suzie Hudson [00:15:01] Unfortunately, stigma is a is a huge issue for people using alcohol and other drugs. And what we know is that society is quite unforgiving about the sort of bringing together of parenting or mothering often and substance use. And so, there is that impact on people feeling very badly about what they are doing. And that then shapes often the way in which they may relate to their children. And so in terms of talking with people about that, we know that a lot of our clients, particularly those who’ve had experiences with child removal or interventions by family community services. There’s a real reluctance to speak about their children and their caring and their parenting because of that fear of stigma and judgement around their ability to parent. And so that can get in the way of absolutely engaging in treatment, reaching out for help when they need it. And also often can be a barrier for workers around actually raising the question about care of children.

We know certainly from a lot of the literature and anecdotal experience that society is particularly punishing on mothers who use substances. There’s lots of conflict, I suppose, around being a mother, being in that nurturing role and substance use, which is perceived to be a very selfish, self-pursuit or thing that people are engaging with. And people, I suppose, not being able to, the judgement then that comes with that. That stigma, particularly for mothers, has them very wary about reaching out for help when they need it, because there’s often this perception for mothers in particular that parenting is a natural or innate ability. And we know that that’s not really the case. And for many people, if they’ve not had the opportunity or the support of good parenting or supportive parenting in their own lives. It’s very difficult to then be able to parent themselves when they have their own children.

Gill Munro [00:17:22] Sarah Watson discusses the impacts of shame and stigma with mothers who are using substances.

Sarah Watson [00:17:28] You know, the role of women and especially mothers. There is a lot of pressure on them. And you throw in substance use and, you know, it just it just exacerbates that. And, you know, women are generally the primary carers for children and even if they’re going through family violence or, you know, homelessness, that’s then compounded with the shame and the stigma of what it means not to be able to be a good mum. So I think for women it is really difficult.

You know, there’s a lot of media and medical advice around, you know, drinking while pregnant. And I think to acknowledge that, you know, you’re really struggling with that and then you’re also putting your unborn baby at risk, is hugely shameful. And, you know, most mums, they want to do what’s best for their children, whether they’re still in utero or whether they’re with them. And being able to talk about that and face up to, hey, I’m not coping so well. You know, there’s a lot of shame attached to that.

Gill Munro [00:18:48] The challenge for practitioners lies in being able to have conversations with mothers about the impacts of substance use on their children, while not increasing their sense of shame. Lisa Hoffman discusses how her programme attempts to build trust with mothers so that they can discuss the social and emotional wellbeing of their children.

Lisa Hofman [00:19:08] The number one thing I like to do here is to create the right environment of safety so that mums can build that trust to be reflective. To look at what’s working and what perhaps they might like to do differently. For me, that’s just the key of the parenting programme that we’ve created here. And I use a tool called KIPS, which is the keys to interactive parenting styles, and it’s a way to measure Mum’s emotional availability to her child.

So it’s a way of looking at the mum child relationship. And we do film mum and child having a play together in quite a normal natural kind of setting, as natural as being filmed can ever be, I suppose, for mums. They feel some self-consciousness for as much as possible we try and help them to forget the camera’s there. And then what we do is, that KIPS tool is strengths based. So instead of looking with Mum at all the things she needs to change, which is often until now what her experience has been, the judgement, the fear, the child protection system, perhaps telling her she’s not a good enough mother and taking other children into care. Instead, we look at moments in time where the child is looking at mum and connecting and visual cues of connection because there’s always some. And we pull those out for mum, and we show her, look, look at what’s happening here. Look what’s going well. And then once we’ve built her sense of self-esteem, that there is capacity there, that she does have this connection, that her child is looking at her as being the most important person in the world. From that place, then we introduce like, maybe one, area for growth. And we normally find creating all that sense of safety and building that sense of self and strength. They’re more open, then, to looking at what might need to be done differently.

I also find that sometimes it depends how far along the line it is. I worked with a family recently where Mum had herself been in the care system. She then had her child restored and he wasn’t a baby, he was, you know, into his toddler years. And creating that sense of safety, she was then able to really acknowledge, you know what, this isn’t going so well. I’m wondering sometimes whether it’s the right thing that this child’s been restored to me. I’m not sure I can love them the way that I was hoping to. And just doing a lot of normalising. Normalising about the struggle and allowing it to be okay, which I think society still doesn’t let it be okay for mums to talk about how it’s not all good, that mothering is hard, and that sometimes it brings up an awful lot of emotions that belong in the past. But we’re bringing them into the present in terms of how we’re seeing our child and letting it be safe for mums to explore those issues. And that’s really the trauma lens, just allowing that past to be acknowledged and validated so that it’s doesn’t have as much of an intrusion on the present relationship between the mother and the child.

Gill Munro [00:22:09] Melissa Shee talks about some strategies that she uses to help mothers overcome stigma and shame when having conversations about the social and emotional wellbeing of their children.

Melissa Shee [00:22:20] I think the most pivotal thing is the rapport that a practitioner has with their client, and especially when we’re looking at parents and the relationship that they’re having with their children. It’s often very difficult. It’s often a very difficult conversation to have because of not only the shame and guilt that we’ve spoken about, but also that I guess the legal ramifications that can often come into play when we’re looking at children and where there’s potential child protection concerns.

Many parents, when they access the service, have concerns that if they’re completely honest about it, what’s actually happening and how they’re actually feeling, that that will result in a mandated report going through and subsequently the removal of their children. This often prevents people being completely honest. I think it’s this, it’s the report that’s built by the practitioner with the client that actually can, I guess, encourage, encourage a parent to actually talk openly in a way.

Gill Munro [00:23:23] Thank you for joining us for the first of two podcasts that discusses the importance of child focussed practise when working with parents affected by substance use. We have covered a lot of ground today, including the effects of parental substance use on children, children as motivators in parent recovery and the issue of stigma for mothers who use substances. Thanks to Susie, Lisa, Sally, Sarah and Mel for their practise insights and for sharing their thoughts on how practitioners can identify and respond to the effects of children of parental substance use and how they can meet the challenge of creating safety and trust for parents while maintaining a focus on the social and emotional wellbeing of children.

In our next podcast on Child Focussed Responses to parents who use substances, we will discuss the effects on children where parents have substance use issues that coexist with family violence, past trauma or mental health issues. We will further examine good practise with parents and also have a look at the key messages to provide children where they access a service with their parents.

Narrator Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce 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 Programme.