Substance use and child-aware practice – part 2
Narrator Welcome to the Emerging Minds podcast.
Gill Munro [00:00:08] Welcome, everyone. My name is Gill Munro from Emerging Mines. The following podcast is the second 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 learnings practise papers and webinars on this topic that can be found on our website www.emergingminds.com.au.
Just to recap, in our first podcast in this series, we discussed the effects of parental substance use on children. Children as motivators in parent recovery and the issue of stigma in mothers who use substances. When we left our first podcast on this topic, we examined some ways to create safety and trust for mothers, particularly where they felt shame and stigma about the effects of their substance use on their children.
In this second podcast, we will discuss the effects on children where parents have substance use issues that coexist with family violence, past trauma or mental health issues, and how these factors can often be intergenerational. We will further examine good practise with parents and also look at the key messages to provide children, where they access a service with their parents. Today we begin by joining Sarah Watson, who is the Senior Manager of Community Services at Uniting Communities in South Australia. Sarah discusses the high instances of mothers who present to services with coexisting issues.
Sarah Watson [00:01:46] And a lot of women who come into drug and alcohol services have experienced high rates of sexual abuse, childhood sexual abuse, trauma, domestic and family violence, homelessness, mental health, and also for parents working with child protection services. So the compounding nature of all of those issues together make it really, really its challenging to work through. Where do you start with that? And again, the shame and the stigma that gets attached to women who are trying to do their best and try and receive some help.
We quite often see going through the generations, the impact of trauma that, that’s had on families and that doesn’t go away. There’s learnt behaviours and learnt ways of coping. And the narratives that go through the family play a really big part. And, you know, if you grow up in a family where when mum or dad used substances heavily, there’s this little attachment with the children. There’s physical violence or sexual abuse going on in the, in the home. It seen as a norm. And, you know, there’s a there’s a view on the world that then, this is the way things are and there’s not much else outside that family unit, especially if they’re really isolated. So that that’s a picture of the world, that they see. So then developmentally, that’s how they then live within their life. And until that cycle is broken and there’s other evidence that there’s other ways of doing things, there’s support for the family and it’s really, really difficult.
Gill Munro [00:03:32] Suzie Hudson is the clinical director of the Network of Alcohol and Other Drug Agencies in New South Wales. She discusses the impacts for mothers and children who come to services experiencing coexisting issues.
Suzie Hudson [00:03:45] The impact of trauma is frequently an issue for people, whether that’s been as a result of childhood experiences, violence, sexual abuse sometimes and certainly too into adult life, whether they’ve been using substances to help cope with traumatic situations. Certainly, with a lot of our Aboriginal and Torres Strait Islander clients, there’s the impact of colonisation, stigma and discrimination, as a, as an impact of the trauma they’ve experienced as Aboriginal people. And certainly, to the isolation that sometimes alcohol and drug use, when it becomes problematic, can present for people compounding with, you know, experiences of mental health. And I suppose being engaged in, say, the criminal justice system as well.
Gill Munro [00:04:37] Lisa Hofman is a social worker and Child Inclusive Practice Coordinator at Jarrah House in New South Wales. Lisa discusses the many coexisting issues that mothers in her service present with and how these issues and ways of coping with them are often passed down the generations of the family.
Lisa Hofman [00:04:56] I think for us, certainly with what we call co-morbidity and meaning that we were always keeping in mind any mental health concerns, any diagnosis or even just presenting behaviours. Some women may not have a diagnosis, but they’re presenting with some of those behaviours. Whether that’s early postpartum psychosis or other mood instability. It is about monitoring carefully through a variety of different psychosocial tools like the postnatal Edinburgh scale, the DAS, which are measurement tools to monitor mum’s mood, either in pregnancy or post birth. And really keeping in mind intergenerational trauma. So when I’m working with a mother, I know I’m not just working with mum, I’m working with her parenting past. And we refer to that sometimes as the ghosts of the parenting past or in sets of security terms, shark music. So looking at her needs and how they were met or not met as a child and how that might be impacting on her capacity to meet her own child’s needs in the present. And in terms of trauma, also looking at the trauma of being involved with the child protection system. And perhaps the fear that’s there in terms of losing future children into care and the reluctance to engage. And keeping all those things in mind in terms of how we try and build rapport and how we try and engage with mums here.
Gill Munro [00:06:15] We have spent some time considering the impact on children and mothers where there are multiple coexisting issues for the parent, including trauma and how these issues can often be intergenerational. This leads us to the question of entry points and opportunities for practitioners to include children in conversations about case plans and service needs. How can practitioners constantly open the opportunities so that children can be considered in service delivery and get connected with the early intervention or prevention support that they need? Lisa describes her work in her role as a Child Inclusive Practise Coordinator.
Lisa Hofman [00:06:53] We’re working on a new project here, so my role is the Child Inclusive Co-ordinator, but we’re also now starting to focus a lot more on family inclusively. And I think mental health did this a long time ago. And I think child protection, maybe we’ve just been a bit slower on the uptake. To realise that when you’re working with a mother, you’re not just working with the mother and her child. You’re often working with a mother who has kinship systems, support systems or not, you know, older children, if perhaps even aged out of the child protection system already. So that provides a real opportunity that where maybe the system may even determine mum’s not in a situation to look after the child. Maybe there’s family, maybe this kinship. Who can? And I think particularly when we’re working with the CALD community or Aboriginal families, particularly, that sense of focus on the community, raising the child is very important. And so we’ve tried to implement a lot more of that here.
And so ideally, if Daddy’s involved and if there’s, if it’s safe and okay to involve him, then we will try and do that. And not just dad, but that extended family and community as much as possible. And I think child protection in terms of these perinatal family conferences are also following that same approach. You know and trying to get as much family and community around the table to work toward the common goal of how we can keep children safe and how we can keep children at home with their families, whether that’s mums specifically or whether that’s extended family for a while. If mum’s not in a situation to be able to parent safely. That that’s a far better system then than having children in the out-of-home care system.
When mums come through the door sometimes, particularly if they’ve just come from hospital and, you know, they’ve just had a baby. It’s a time where most mums, you know, want that sense of community, you know, relatives sending gifts, family coming to visit at the hospital. And instead, these women have quite often come from remote areas, possibly never been to Sydney or a big city before. And they’re uprooted from hospital. And they brought with a tiny newborn baby to a place not familiar with it all. And with the stigma of it being a rehab, you know, and they’re here for this substance misuse. So there is a lot of fear and a lot of reluctance about engaging. And yet they, because they truly love and are devoted to their children and they want to keep them in their care.
So sometimes that motivation can wane a bit. You know, when the struggle starts, when it’s hard, when it’s hard to be away from family or when there’s interpersonal issues, maybe with other clients, because you’re talking about 24 women living together. That you know, or they’ve just got some ambivalence around ceasing their substance use. That’s a really difficult place to be as a mother, you know. And we’ve had women come and surrender their children to us here. And then we’ve had to support them into their next stage of treatment, whatever that may look like. And the children end up going to family or into care. And that’s from Mum’s own decision.
So sometimes it doesn’t mean that they’re not trying hard enough, but sometimes if having the children be with them is their only incentive. We find sometimes it’s not enough to keep them here. And that’s why I think I referred to before. What we often try and help them to find is the motivation to do it for themselves. Because at the root of it, that’s why recovery really lies. You know, children can be an incentive to get them through the door. But to keep them here, they really have to connect to that sense of wanting a life that’s worth living and wanting a life that’s free of substance use.
Gill Munro [00:10:36] Suzie Hudson discusses the importance of working with mothers from an early stage to create the expectation of a child focussed service, but also to help mothers discuss any anxiety they may have about discussing what is happening for their children.
Suzie Hudson [00:10:51] I think 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 team behind that, to support that person. And that may include Family and Community services or other types of services. So that’s really upfront. And there’s that transparency with a client about wanting to support them in all aspects of their lives. And I think that honesty and that 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.
Drug and alcohol workers have got a huge opportunity because the bulk of our work is around behaviour change. And we see that in terms of raising a child, you know, a lot of the work that is around parenting is around reinforcing behaviours, good behaviours or positive behaviours. And so actually, what can be quite helpful in in a therapeutic setting once a good therapeutic alliance has been built. So that relationship is a very positive a strong one is actually exploring parenting skills as a way of reinforcing other behaviour change in other areas of people’s lives.
It’s often a thing that someone can engage with, so a client would like to talk about themselves as a parent or their child. And there’s lots of opportunities, whether it’s in residential or community-based care, to actually start talking about healthy relationships. To talk about the needs of children. And in doing so frequently, there’s not a door is opened for that person to actually explore their own experiences as a child and what might have been more helpful for them in terms of their own experiences. So I think there’s lots of opportunities there to weave it into the work and to not only sure up and support them as parents, but also in the other choices they’re making in terms of their own, their own lives.
Gill Munro [00:13:41] Many of the drug and alcohol services that are Emerging Minds services talk with, like Lisa’s, are now trialling new and innovative ways of providing services to the whole family. Sally Riley is a child and adolescent psychotherapist at Catholic Care Sydney’s Family Recovery Programme. Sally discusses the benefits of working directly with children who are affected by their parent’s substance use issues.
Sally Riley [00:14:06] It’s like a weight has been lifted off their shoulders. Can see it when I do the groups with them. It’s like it’s finally like I can talk about this. It’s okay to talk about this and these other kids, these they’re happening to other children. It’s not just me. And it’s like they seem to stand up taller, their postures higher, and they’re actually sort of smiling and having fun. So it’s really, it’s really a drain on the children and a real burden to carry around that secret.
[00:14:35] The support systems, again, they require a parent to reach out. And we do get that with the non-using family, or the non-using parent. But if its, if all the parents are using, or all the adults are using in the house, they’re not going to reach out and get supports. And these sorts of families often do struggle financially also to hold down a job. They struggle with health issues and they’re often struggling with the law as well. And we’ve got to mention Community and Family Services. There’s a real sense that their children will be taken away if anything gets out. So reaching out to services is a risk for these families.
Most of the answers I get are, I’d like it to be how it used to be, where we used to go to the park, you know, when we used to have dinners together, when we used to laugh and play. So I think it’s that loss of connection. So they’re really searching and yearning for a connection with their parents again. Because often when parents see using substances, they’re not really there for their children. They might be physically there, but they’re not emotionally there, something’s a bit lost. And kids, because of the, the developmental stage, they just snap up or that sort of emotional or the differences in the emotional reactivity of their parents. And they know something’s not right. So connection they, they really want to talk about connecting with their parents because they love them.
Gill Munro [00:16:06] Sally also describes the process for engaging parents in family work.
Sally Riley [00:16:11] When we’re working, we work initially with the whole family. Whoever will come in, often the using family member won’t come in. But we’ll have a meeting with the family members and talk about how we going to support them. And then we’ll get permission from the, the family member that’s come in to take the child to the child therapy room. So we have permission to work alone with that child and that child’s given permission to talk about whatever’s happening.
At that assessment where I’m assessing a child, I’m assessing for any trauma responses because it’s very nerve wracking for a child to come and talk about these problems for the first time. And we use play therapy. We use sand tray therapy. And we also just want to assess whether that child is having any trauma triggers. So when we’re talking trauma triggers, we’re talking about that fight flight freeze response. And it’s quite, it can be quite difficult to assess that just in the 20 minutes that we have with the child. But through the group programme, we’re also constantly tracking for any trauma triggers. So that’s changes in behaviour that’s going into freeze mode that might be sort of looking for hyper vigilant type of behaviours. So seeking safety. And we don’t want to re traumatise children. We want to build up their strengths so they can be resilient because we can’t sort of trauma work is long term. We can address it and notice it. And then we can also support those children with individual therapy after the group work’s done. And hopefully maybe the family can engage in further work around that, too.
So the group work we do the first two weeks is mainly around building trust, making them feel safe, getting to know each other and having fun. So often when children have experienced trauma, they’re constantly searching for threats. So we need to make the environment really safe for them. We need to make it have lots of different activities to do so that when we see sort of children becoming uncomfortable, we can change tact and we can go and do something fun, some colouring in or some games or mix it up, with.
When we’re looking at trauma, we’re looking at all the different ways to support the child. So not just cognitively, we’re looking at somatically. So often we’ll see a bit of a tensing up in a child. So we’ll mix it up by doing maybe some dancing to different sort of feeling music, or we’ll utilise some yoga pretzels games where they can stretch out their body and stretch out the tension and sort of get a sense that it’s okay to talk about things here and they can really sort of release all of that stuff from their body. And I know we’re doing a good job. We’re getting sort of some body movements, happenings, lots of sort of farting and trips to the toilet and things like that. We know we’re doing a job well if we sort of see some of those somatic things happening.
So we really need to collaborate with services to let them know that it’s a systemic problem and we need to support them systemically. So there is a lot of fear around bringing up the children. So while what I like to say is services need to have an antenna for the children, but they’ve got to come from not a judgement perspective, they’ve got to come from, sort of empathic with a little bit of genuine, empathic connection with a sense that there may be some child safety issues. Because if you address the child safety issue up front, you’re going to get a barrier put up immediately and they’re going to back pedal and they’re going to probably disengage. So I think being informed for other services to be informed of the child support in the area so that you can collaborate. Maybe make a warm referral with the family and gently bring up the children and how the children may be affected and also to look at family of origin stuff. I mean, we’re talking like typically where there’s substance abuse, you go back three generations and it’s been a constant issue in the generations of how people cope. So we want to really make big change here. So we’ve got to work out how we’re going to do it and how we’re going to all work together so that we don’t get people just back-pedal and check out of the services available. So that means rehabs, it means GPs maybe some of the AA support, knowing that their families can be supported as well as the using person in recovery.
Gill Munro [00:21:06] Melissa Shee is the Senior Practitioner of New Roads Drug and Alcohol Rehabilitation service in South Australia. Melissa’s services have a dedicated family service where parents receive residential and outreach therapy with children. She believes that this option is essential for child inclusivity and that all practitioners should learn to provide family inclusive support.
Melissa Shee [00:21:30] I guess some of the things that through my experience working with families that that I’ve seen is the impacts on the emotional wellbeing of children as a result of substance use tends to be the, I guess, the things that they’re exposed to. I think, you know, many, many parents that are using substances come into contact with people and places and things that a lot of families just wouldn’t. So there’s a lot of exposure. Quite often this trauma that leads to trauma for a child also there’s quite often attachment issues. Lack of lack of sort of early intervention around sort of any developmental issues and things like that.
Many people think that having those having those sticky conversations can be like opening a can of worms where when we’re looking at sort of the family and what’s happening within the family unit, especially in the context, I guess, event of an adult AOD service where we don’t often see the children, it probably would be much easier to just focus on the adult that sitting in front of us. However, I think, you know, we all have a duty of care to be speaking for those that can’t speak for themselves. And often, like if we’re not treating the person as a whole, which includes their family, we’re actually not really, we’re already sort of addressing the tip of the iceberg. It is definitely the best practise and encourage that New Roads that we always bring a child into the room wherever we can. We will, we start from that from intake all the way through to exit. And yeah, it’s there is an expectation that those conversations would be had.
Gill Munro [00:23:08] Thank you for joining us for the second of two podcasts that discussed the importance of child focussed practice when working with parents affected by substance use. We have covered a lot of ground today, including child focussed responses to parents who use substances, the effects on children where parents have substance use issues that coexist with family violence, past trauma or mental health issues, and how these issues can often be intergenerational. We have also examined examples of family inclusive practice with parents and children and looked at the key messages to provide children where they access a service with their parents. Thanks to Suzie, Lisa, Sally, Sarah and Mel for their practice insights and for sharing their thoughts on how practitioners can identify and respond to the effects of children of parental substance use. At Emerging Minds our hope is always that these podcasts are just the beginning of conversations about how best to support children and 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 Program.