Presentation on theme: "Building Bridges Back Home with Parents in Recovery: The Right Decisions at the Right Times Presented by Kim Sumner-Mayer, PhD, LMFT Children of Alcoholics."— Presentation transcript:
Building Bridges Back Home with Parents in Recovery: The Right Decisions at the Right Times Presented by Kim Sumner-Mayer, PhD, LMFT Children of Alcoholics Foundation and Joan Hajjar Phoenix House New York, NY
2 Substance Abuse and Child Welfare: Statistics 8.3 million children live with substance-abusing parents (HHS/ASPE, 1999) CWLA: 40-80% of parents with children in CW system have substance abuse problems serious enough to affect parenting (Young, Gardner, & Dennis, 1998)
3 Substance Abuse and Child Welfare: Statistics SA likely a factor in ¾ of all out-of-home placements CW-involved families with SA problems have more family problems than other CW- involved families SA associated with significantly higher rates of RE-entry into CW system
4 Substance Abuse and Child Welfare: Statistics Children from SA families: More likely in out-of-home care Longer foster care stays Less likely to leave foster care within 1 year More likely to have case plan of adoption
5 Substance Abuse and Child Welfare: Statistics Problem use of alcohol MUCH more prevalent than use of illicit drugs (HHS/SAMHSA, 1998) Parenting and custody issues are a major motivator for SA treatment
6 Substance Abuse Treatment and Child Welfare Systems: Disconnects & Misconnects SA approach to treatment: Multidimensional Tailored to individual needs (intensity, duration) Acceptance of relapse as part of recovery process in most models Often does not consider family relationships/ parenting
7 Disconnects & Misconnects Between Systems (contd) SA approach to treatment: Lacks emphasis, understanding of child safety issues and reunification process May limit or prohibit contact with children until later in treatment Perceived info-sharing problems
8 Disconnects & Misconnects Between Systems (contd) CW approach to SA problems: Negative worker attitudes toward parents Negative worker attitudes toward SA treatment system as a whole SA treatment as one-shot, one- strike-youre out
9 Disconnects & Misconnects Between Systems (contd) CW approach to SA problems: One size fits all treatment ASFA timelines do not allow waiting for full recovery CW workers often hand clients a list of treatment providers without reference to the type of treatment offered and waitlists
10 Recovery is a Family Process Parents Recovery Process A process, not an event. Redefinition of Self Partner support important Spirituality, social support, relapse prevention Relapse usually part of recovery. Aftercare very important! Parenting Education
11 Recovery is a Family Process Familys Recovery Process Parents and children must relate without substances. Reshuffling roles, boundaries, & authority Denial at the family level Family members dont understand parents need for continued focus on sobriety
12 Reunification Begins with Separation: Parents Experiences Two losses: Children, and Status as an able parent
13 Reunification Begins with Separation: Parents Experiences Reactions: Anger, Grief, perhaps Relief Hold on to maternal role Grief + Relief Drug binge, deepening of addiction Replacement pregnancy
14 Childrens Experiences of Separation Short-term reactions look different than longer-term adaptations Age of child influences their presentation More placements, more severe reactions AD/HD overdiagnosed, PTSD overlooked Behavior appears willful but is actually survival-oriented
15 Childrens Experiences of Separation (contd) Implications for Practice Sibling contact extremely important to sense of continuity Contact and Continuity with Parent is important Childrens support needs are great Caregivers need help understanding childrens behavior
16 Reunification Continues with Visitation: Parents Awkwardness common Not permitted normal parenting responsibilities Parent viewed as failure
17 Reunification Continues with Visitation: Parents Hard to enjoy/play with/be with child Guilt + Overcompensation Poor boundaries AMBIVALENCE
18 Visitation: Childrens Issues Conflicting feelings Loyalty splits Circumstances of visit can influence childs mood and response to parent Childrens responses to visits can be very challenging to caregivers.
19 Other Visitation Dynamics Visits may not be regular Tx program may restrict contact Pre- or post-visit upsets push for less visitation Birthparentcaregiver dynamics
20 Other Visitation Dynamics Parent concern re: childs adjustment to care cut back on visiting Longer in care less confident in parenting Family develops new homeostatic balance around childs absence
21 Working With Ambivalence (contd) 3: Seek to understand its causes and refer to therapy & additional help No bond use visits to build bond Fear incompetence teach Fear relapse add supports
22 Working With Ambivalence (contd) 4: Explore options and proceed with concurrent planning that is grounded in parents participation in making the plan.
23 Case Practice Guidelines Develop relationships/referral agreements for parent education, family therapy, and aftercare services Refer for family therapy Dont wait until reunification date is in sight Encourage parent and kinship caregiver/foster parent collaboration. Expect CW agencies to do same. Set the bar high.
24 Case Practice Guidelines Encourage parents to be increasingly involved in day- to-day aspects of their childrens lives (school- related appointments, doctor visits, recreational events, clothes shopping and haircuts, etc.) Convey to CW and SA treatment agencies that this is an important and expected part of parents service plan.
25 Case Practice Guidelines Obtain information about the quality and context of visits. Assure that a Relapse Plan has been developed once unsupervised visits are instated. Refer for parent education that is evidence-based and effective
26 Quality Parent Education Gold standard = both parents and children involved in the service. Examples: Strengthening Families (http://www.strengtheningfamilies. org/html/programs_1999/06_SFP.ht ml)http://www.strengtheningfamilies. org/html/programs_1999/06_SFP.ht ml Celebrating Families (http://www.preventionpartnership. us/families.htm) (developed for a FDTC and replication studies currently underway)http://www.preventionpartnership. us/families.htm for more model programs
27 (Re)Unification: ParentChild Interactions Honeymoon period, then Testing & Acting Out Children hypervigilant re: dishonesty, broken promises, etc. Childrens grief & loss issues re: previous caregiver Childrens anger & fear surface
28 (Re)Unification: ParentChild Interactions Parents trying to assert authority for perhaps first time Parents high expectations of self, kids rigid or inappropriate rules Role changes for kids are confusing and threatening Children rebel, regress Parents surprised, confused by kids behavior
29 (Re)Unification: ParentChild Interactions Parents may be reluctant to seek helpfear children will be removed again At same time, parent has new people, places, & things in their life and kids have to adjust to all of these There may be new children
30 (Re)Unification: The big picture Parent simultaneously coping with relationships with substitute caregiver(s), partners, employment, housing, finances, any continuing legal issues, and maintaining sobriety. Is it any wonder that relapse vulnerability is high right about now?
31 Relapse A normal part of recovery for most people A process, not an event, ending with substance use Not all relapses are the same Not all relapses involve a return to pre-treatment level of functioning Family may react more negatively due to sense of disappointment and failure
32 Relapse Planning Clean or dirty urine is not the only or even necessarily the most reliable indicator of child safety. Sobriety is an important measure of safety, but its not the only measure!
33 Relapse Planning Just because the parent loses their clean time, it doesnt necessarily mean they lose all the actual progress theyve made in altering their thoughts, feelings, behaviors, and relationships.
34 Relapse Planning (contd) Can have clean urine while child is still in danger of being abused, neglected, or hurt. A parent can have a dirty urine but be taking better care of their child than they were before.
35 Relapse Planning (contd) Clean urine for the drug of choice does not preclude use of another drug (most commonly alcohol) in a way that might be dangerous for a child.
36 Relapse Planning (contd) Lets be smart about the place of urine testing in making visitation and reunification decisions! Parenting is multi- dimensional and so should our decisionmaking be. Relapse Planning should be a part of parents treatment
37 Relapse Planning (contd) Should include discussion of plan for child safety in case parent relapses Requires involvement of parents support system to provide child safety and/or monitoring & reporting of parent behavior
38 Relapse Planning (contd) Swift reporting of relapse should be looked upon with respect Relapse should be viewed as indicating a need for additional support
39 Case Practice Guidelines Recognize parents specialized aftercare needs. Develop referral agreements with family therapists and Aftercare programs that provide parenting-specific support. Encourage the development of additional child, parent, & family services to meet reunification needs in your community partner with funders and issue or answer RFPs for services
40 Case Practice Guidelines Recognize childrens special support needs as children of substance abusers. Develop relationships with service providers who meet these needs via support groups, therapeutic recreation, psychotherapy, developmental services, etc. during FDTC Planning process.
41 Case Practice Guidelines Assess parents readiness to reunify using multiple measuresabstinence or lack thereof is not an adequate measure
42 Case Practice Guidelines Encourage parent and kinship caregiver/foster parent collaboration. Expect CW agencies to do same. Set the bar high. Refer for family therapy if you have not already Assure that Relapse Plan has been updated to reflect reunification realities.
43 Indicators of Readiness/ Safety: North Carolina Family Assessment Scale Reunification (Kirk, 2001) Developed for Intensive Family Preservation Services programs serving reunification cases Available at
44 North Carolina Family Assessment Scale for Reunification (NCFAS-R) 7 Main Areas of Focus: Environment Parental Capabilities Family Interactions Family Safety Child well-being Parent/ Child Ambivalence Readiness for Reunification
45 Indicators of Readiness/ Safety: Parent/Child Ambivalence Parent Ambivalence Responds appropriately to child verbally & nonverbally Receptive & responsive to services to bring parent and child closer Parent acknowledges responsibility for role in family difficulties leading to removal
46 Indicators of Readiness/ Safety: Parent/Child Ambivalence Child Ambivalence Comfort with parent Child responds appropriately to caregiver affect, expressions of love, limitsetting, etc. Age-appropriately expressed desire to live with caregiver Acknowledges any responsibility child had for family difficulties leading to removal Responsive to services aimed at facilitating reunification
47 Indicators of Readiness/ Safety: Parent/Child Ambivalence Caregiver Ambivalence Supports reunification even if they have some reservations Will give parent a fair chance Disrupted Attachment Eagerness to repair relationship from both parent and child
48 Indicators of Readiness/ Safety: Parent/Child Ambivalence (contd) Visitation Positive anticipation of visits Activities planned and executed Increased duration & frequency and decreased supervision needed Incidents during visits are processed Re-establishing roles and limits
49 For more information Kim Sumner-Mayer, PhD, LMFT Children of Alcoholics Foundation 164 West 74 th Street New York, NY (646) tel. (212) fax Joan Hajjar Phoenix House/ AmeriCorps Program 55 Flatbush Avenue, Brooklyn, NY (718)