1. Towards family Inclusive service delivery: highlights of the Supporting Parents Healthy Children Guideline implementation

2. Today you will hear about:
Context: The SPHC Guideline
Where it came from
Implementation: What we aimed to do
What we did: Two key interventions
What we need to do
Government focus area and government expectations: The Inquiry…

3. Thinking about parents in services…Firstly we must remember…
The majority of parents with mental health concerns or problematic substance use do not abuse their children
and
most adults who abuse children do not have problematic substance use or experience significant mental health concerns

4. However
Children who have a parent with mental illness or addiction are at increased risk of a number of poor outcomes including developing later mental health problems. They experience higher rates of suicidal ideation and interpersonal and behavioural problems.

5. And what we know…
A 2012 systematic review of preventative interventions in COPMIA concludes that the risk of mental illness in the child can be reduced by 40%: It’s not rocket-science…
Siegenthaler E, Munder T, Egger M. Effect of preventive interventions in mentally ill parents on the mental health of the offspring: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry2012; 51: 8-17. 

6. What Parents want To be asked about their families and whānau
To be offered information about parenting supports in the local community
To be supported to talk with their children about what’s going on
To ensure that it is safe to talk about their children
To be supported to attend to the practicalities

7. What Children want Provide information so that we know are not alone
Reassure us that it is not our fault when things are difficult
Don’t assume that abuse and neglect are happening, and don’t assume that it isn’t
Focus on our families’ strengths
Keep our families together

8. The Supporting Parents Healthy Children Guideline: The Vision- What we want
A Mental Health and Addiction Service delivery that:
Is family and whānau focused
Takes responsibility for promoting and protecting the wellbeing of children
Makes the rights and needs of children a core focus of all that they do

9. Because …. Enhanced Family/ whānau focused practice
Enhanced well-being for parents
Enhanced well-being for children and young people

10. Implementation requires a programme of change that embeds family/whānau focused practice within all services—particularly adult services

11. The Supporting Parents Healthy Children Guideline
Everybody’s responsibility: collaboration is key
Business as usual
Support Adult Mental Health and Addiction services to identify and support parents/ whānau
Use a strengths based approach
It’s about a workforce competent in culturally responsive family/whānau inclusive practice

12. Supporting Parents Healthy Children
It’s all about connection:
Parents and children,
Family/whānau with communities,
Services working together

13. Where we should be: Sept 2018: Organisational Essential Elements
Family and whānau focused Implementation plans are in place
Data is routinely collected (PRIMHD)
Leadership team includes an identified champion
Documented care and protection policies

14. Essential Elements: Service Level
A SPHC champion is in place to assist leadership, training, support
and advice
Family focused service delivery is regularly audited
Service Leaders working towards a family friendly environment
Directory of services is available
Resources for parents

15. Essential Elements: Practice Level
Conversations about children, parenting, family and whānau are routine
Family inclusive appts are made routinely
Family care plans developed as appropriate
Staff feel confident to have conversations about parenting
Service users are linked to local parenting and family support services

16. Essential Elements: Practice Level
Focused support available for pregnant and post-partum women
Coordinated systems for post partum service users
Access to specialist advice on care and protection issues
Interagency planning processes in place
Forms and documents family focused

17. By 2020: Best Practice Elements
The key performance indicator
The mental health and addiction sector workforce is confident and competent to address the needs of children with parents with mental health and/or addiction concerns

18. Implementation: What we have done…
Development of an Implementation Plan (Implementation Science)
Using the ‘Beacon’ strategy (The Bouverie Family Centre)
Adkar tools: Readiness Prosci, 1994
Workforce Programme support: Contact-liaison people
Steering/governance groups
Practice Champions
Web-sites, resources, Champions’ forums
Implementing interventions (5 Step, SSFC)
Champion’s network

19. Single Session Family Consultation (SSFC)
Brief process for engaging and meeting with families/whānau; evidenced informed (Hopkins et al, 2016;Poon et al., 2017). 
Aims to clarify how the family/whānau will be involved in the individual’s care and to help family/whānau members identify and address their own needs
Provides a clear, structured and yet flexible process, and can be facilitated by practitioners following training.
Training provides an opportunity to increase knowledge and skills in partnering with families/whānau

20. Cultural adaption for use within Aotearoa New Zealand.
Addition of a cultural focus and a child module in the E-Learning (pre- requisite to face to face training)
SSFC training is now conducted regularly in Aotearoa New Zealand
We have 25 Trainers nationally, with over 500 people having attended trainings across services and sectors in NZ

21. The 5-Step Method Structured, short term counselling approach
Evidence-based intervention & assessment tools for Family Members in their own right
Stress – strain – coping – social support (SSCS) developed by researchers
Model suggests coping may play moderator role in relationship between Family Members stress and experiences (strain)
Includes client & practitioner workbooks

22. Background
Matua Raḵi and Addiction and the Family International Network (AFINet)
Pilot training delivered May 2017
16 people participated

23. What is in each step?
Step 1: Describe their experiences of living with a relative (colleague or friend) with an addiction/ gambling problem; complete family member questionnaire
Step 2:Provide useful information – targeted to addiction and other areas
Step 3:Explore options for coping
Step 4:Explore social support – Social network diagram
Step 5: Summary and planning for additional support; couple, family or individual counselling; facilitation to another service
Copello, Templeton, Krishnan, Orford, Velleman 2000, 2010; George & Bowden-Jones 2015, Velleman et al 2011

24. Accreditations 7 accredited practitioners 4 accredited trainers
1 accredited assessor .

25. Family ethnicity

26. Change over time for families

27. What’s next? Completing evaluation and analysis
Increasing accredited practitioners
NZ assessors
Supporting trainee participants
Further training 2019….

28. SPHC: How do we know we are making a difference
Practitioner Survey (Mayberry and Reupert)
Outputs: trainings, forums etc
Audits: files, interviewing staff, interviewing service users
Data
Evidence in annual district plans
International networks, discussion

29. How well are your services doing?

30. It’s all about whānau…

31. What we want to see…

32. What we want to see:
Jill, a 33 year old mother of 3, whose youngest child is 18 months old, and oldest 6 years old, has been referred to her local integrated community mental health and alcohol and drug service for an appointment by her GP.
Jill is phoned by a person from the service and invited to suggest appointment times that suit her and her whānau.

33. What we want to see:
The appointment can occur at home, or anywhere suitable to Jill and her whānau.
The person on the phone asks Jill who is in her whānau as part of the phone conversation. She is also asked her ethnicity, and if there are other people she would like involved in the contact with the service.

34. What we want to see:
Jill decides to come into the service. She brings her 18 month old and her 3 year old children. Her partner is working and is unable to attend.
She arrives, along with her children, all are welcomed warmly.

35. What we want to see:
She and her children are shown to a whānau room with a kitchenette with fruit, snacks and drinks available. The room has bean-bags, toys and games, and comfortable chairs, and family posters on the wall.
Jill and her children are introduced to the practitioner for the appointment. The practitioner checks if there is anything Jill needs for her children.
Jill is offered that the children may stay in the whānau room with a worker if she would prefer, or is told they are welcome in the practitioners office with her.

36. What we want to see:
The practitioner’s office is equally well equipped for
Jill and her children.
The practitioner engages Jill in a conversation about the reasons she has attended.
The practitioner is clear about what she would need to do if she had any concerns for the children, and she is equally clear that Jill can be a good mother even if she has addiction/mental health issues.

37. What we want to see:
The practitioner hears that Jill is engaged with a service that offers her whānau support, and that Jill has let this service know of her appointment today.
The practitioner is confident talking to Jill about her mental health and addiction problems as well as her family and whānau, parenting and any concerns she might have about her children.

38. What we want to see:
The practitioner is confident in talking to the children in a friendly and welcoming way (if they were older she would be able to help them understand their mothers issues in an age appropriate way)
Jill feels that it is OK to continue contact with the service and feels able to talk about her children and her partner, who is able to attend the next appointment.

39. Involving and valuing children, family and whānau is everyone’s responsibility.
Kei a tātou te tikanga.

40. Contact:
Dr Bronwyn Dunnachie Senior Advisor: Werry Workforce Whāraurau Emma Wood National Manager, Practice: Te Pou o te Whakaaro Nui