Integrating Infant Mental Health in a Residential Drug Treatment Program The F.I.R.S.T. Program (Families in Recovery Staying Together)

Arlene Purcell, MSW Director of Project Pride A Division of East Bay Community Recovery Project Ayannakai Nalo, LCSW Coordinator, F.I.R.S.T. Program Children’s Hospital & Research Center at Oakland Jackie Schalit, MFT Lead Clinician, F.I.R.S.T. Program Children’s Hospital & Research Center at Oakland Karen Tanner, MA Infant Development Specialist Children’s Hospital &Research Center at Oakland Jill Rian,LCSW SEED Child Welfare Supervisor Alameda County Department of Children and Family Services Robbin Rasbury, Psy.D. Clinician, /SEED Program F.I.R.S.T Children’s Hospital & Research Center at Oakland

Who We Are F.I.R.S.T. = Drug Counselors Project Pride Case Management Co-occurring Disorder Treatment Child Enrichment Staff Expressive Art Therapy ACDCFS SEED FAMILIES IN RECOVERY STAYING TOGETHER ECMH + + PHN Social Workers CHO CVC SEED

It Takes a Team to Build a Collaboration

Project Pride-East Bay Community Recovery Project

Project Pride A Residential Drug Treatment Setting for Women & Kids 0-7 CDCR Alternative Co-occurring disorders

Who are the Women in Treatment at Project Pride Data drawn from EBCRP’s database, As May Women ranged in age from 19 to 43 years, with an average age of 26.2 years. Ethnicity was 53% White, 35% African American, 5% Latina, and 2% Native American. Most have histories of criminal justice involvement. Using the Beck Scale of Depression at intake, we have found that 66% of the women have mild to severe depression. 62% of the women were poly-drug users, 60% use methamphetamines, 40% use cocaine and alcohol, and 27% are heroin users (2003, EBCRP)

Alameda County Department of Children and Family Services History The Team

CHILDREN’S HOSPITAL & RESEARCH CENTER at OAKLAND

Children’s Hospital & Research Center at Oakland Early Childhood Mental Health Developmental Play Group Center for the Vulnerable Child/SEED

Home of the F.I.R.S.T. PROGRAM

F.I.R.S.T. PROGRAM (View from Project Pride Playground)

The F.I.R.S.T. Program Born of a Collaboration between Project Pride, Children’s Hospital-Oakland and Alameda County Department of Children and Family Services Child Protection and drug treatment Infant-Parent Mental health and drug treatment Infant Development and drug treatment Common Cause for Children and Families

Internal Rumbling at Project Pride and ECMH -- The Pregnancy Growing interest and focus on parent/child relationships and the family at Project Pride Need for more resources to meet goals at Project Pride.

Project Pride Goals Related to Infant Mental Health-Common Ground for a Collaboration Provide a comprehensive family program addressing recovery and mental health needs of whole family Promote mother/child attachment Provide a solid clinical program to all those we serve Project Pride will provide high quality state of the art services in all departments

Why Child Mental Health Treatment within the Milieu? Recognition that children need help and treatment- may have already been impacted by loss or trauma Increase the tools in the toolbox Recognition that addiction is beyond just the mother- commitment to breaking the intergenerational cycle Desire to create a seamlessness between the various treatment services

Power of a Relationship-Based Approach

What We Mean By a Relationship- Based Approach  Relationship as a necessary vehicle for service delivery  Relationships with families that become a corrective, emotional and healing experience  Relationships between parents and children that promote wellness  Relationships among us as a community supporting families

Infant Development-It’s a Different World Personal reflection Using relationship Holding the baby with the others

Working Together- An Evolution Work in residential treatment settings by clinicians is only effective if it is lined up and done with program staff -

Bringing it All Together- An Example Short-term discomfort vs. Long-term gain SEED client Services provided Treatment issues Interventions

Dyadic, Family and Group Work with Women and Children- Breaking Cycles-Changing Lives Parent-child therapeutic groups vs.. Developmental play groups Parent groups focused on process, supporting reflection Co-facilitated with Project Pride Child enrichment staff Short term discomfort vs.. long term gain

The Sequence of a Clinical Vignette Points of Collaboration Referral from Director Concerns of mother’s trauma history and impact on daughter Therapist’s observations Collaborating with drug treatment staff

The Work Begins Mother shares her story We have a shared goal Susie: demonstrating indiscriminate attachment The assessment: Susie has difficulty attending to tasks,mother worries Susie has ADHD

Other Interventions and Learnings Joint clinical meeting with Project Pride staff to share assessment Port of entry with tattoos Family reconnections

From Avoidant to Secure Progress..She’s looking for mommy! Success in school Mom signs up for Sleepy Time Group Preparing for discharge

What We Have Done Together Created Parent/Child Groups with Mental Health, Development Specialists and Treatment Staff Carried Out Joint Case Conferences, Training Carried out Celebrations and Field Trips Treatment staff provide support for kids during parent groups Begun to look at research and data possibilities

Differences that Have been Noticed by Treatment Staff Less yelling and harsh behavior with children Fewer reports of serious behavioral problems with clients More interest in their role as mothers More cooperation around child care issues A greater sense of calm in the house Fewer sleep problems with babies

Barriers to Collaboration Along the Way Differences in organization cultures, funding systems, training and point of view, histories Fiscal-No money for planning or start-up Informational Operational-Finding space, clinicians learning how to function within a CDCR contract system and therapeutic community philosophy

Lessons Learned about Collaboration Identify key stakeholders Learn about one another’s systems Don’t expect perfection-Be patient Identify short- and long-term goals-dream big Mistakes will happen-Learn about repair Learn by doing & celebrate success Every Community has its non-believers, learn to love yours

Moving Our Worlds Closer Together