Debbie is the Strategic Lead for the National Addiction and Mental Health Surveillance Unit at Turning Point. She is a public health researcher with a nursing background and applies that perspective to the use of data to inform the development of policy and prevention strategies. Her research focuses on surveillance methodologies and the use of surveillance data to improve the understanding of the role of alcohol and other drugs in intentional injury (e.g. family violence, child maltreatment and suicide and self-harm), thereby reducing harms associated with their intersections. Debbie has collaborated with the World Health Organization (WHO), UNICEF and the International Society for Prevention of Child Abuse and Neglect (ISPCAN) on data quality issues and surveillance methodologies. Debbie is a member of the Australasian Injury Prevention Network (AIPN) Executive and the Chair of the AIPN Subcommittee on Alcohol and Drug Related Injury.
Working together to support families where a parent uses alcohol and/or other drugs
Working together to support families where a parent uses alcohol and/or other drugs
This webinar explored opportunities for using collaborative, family-inclusive approaches to support families where a parent uses alcohol and/or other drugs.
Audio transcript (edited)
DR QUINN: Hello everyone and welcome to today's webinar: Working together to support families where a parent uses alcohol and or other drugs. My name is Dr Brendan Quinn, I'm a research fellow here in AIFS Longitudinal and life course studies program where I mainly work on research on men’s health issues. But prior to AIFS I worked extensively in alcohol and other drugs research and I maintain a strong interest in this area. Before I go any further I'd like to acknowledge the Wurundjeri People who are the traditional custodians of the land on which I am speaking to you here in Melbourne. I would like to pay respect to the elders both past and present of the Kulin Nation and extend that respect to other indigenous Australians attending the webinar today.
Earlier in the year, CFCA ran a webinar on collaborative practise of child and family welfare. This webinar looked at how to build practitioner's collaborative competence when it comes to working with practitioners from different specialisations across the family and child welfare sector. Today's webinar builds on this by looking at collaborative practise that can really help with AOD clients. Families where a parent uses alcohol and or other drugs often need a range of different supports including from child protection and family support services. What the research tells us is that when collaboration between these agencies is limited, families are at greater risks of falling through the gaps.
Today our stellar cast of presenters are going to discuss research evidence on the intersections between parental AOD use and child protection concerns, principles and values that underpin the practise of professionals working in AOD and child protection, and opportunities and strategies for building cross-sector empathy and working together.
The elephant in the room that needs to be acknowledged is that collaboration can be challenging, so rather than share specific examples, we're going to use two case studies developed by Debbie Scott and her team. The case studies are great because we can use them to really test out how different family-inclusive approaches could be applied in realistic settings. If you haven't read them, they're available in the handout section of your go-to webinar dashboard or on the CFCA event page for this webinar.
Now to our presenters, today we're joined by Dr Debbie Scott, the strategic lead for the National Addiction and Mental Health Surveillance Unit at Turning Point, a national addiction treatment and research centre. Debbie's research focuses on surveillance methodologies and the use of surveillance data to improve the understanding of the role of alcohol and other drugs in intentional injuries such as family violence, child maltreatment and suicide and self-harm, thereby reducing harms associated with their intersections.
We also have Dr Shalini Arunogiri, deputy clinical director at Turning Point where she leads a multidisciplinary team of over 50 clinicians delivering addiction treatment across telephone, online and face-to-face modalities. In her spare time Shalini is a senior lecturer and deputy head of the Department of Psychiatry at Monash University and Chair of the RANZCP Bi‑national Faculty of Addiction Psychiatry. Her clinical and research interests include methamphetamine use and related mental health problems, and women's health and addictive disorders.
We also have Emma Bergwever, practise lead for Mental Health with Queensland Department of Child Safety, Youth and Women. Emma supports the development of resources, knowledge and skills to strengthen practise in working with children and families experiencing difficulties with mental health and mental illness. Emma is a strong advocate for practitioners in the field and is passionate about the role of supervision capability development and fair and just organisational cultures in enhancing outcomes for children and families. Welcome to you all.
Now I'll hand over to Debbie who is going to give you all a short intro to different AOD sectors in Child Protection and discuss findings of the AOD and Child Protection survey she recently undertook, thanks Debbie.
MS SCOTT: Thanks, Brendan. So firstly I'd like to acknowledge the traditional owners of the land on which we meet. I'm on the land of the Bundjalung People in Northern New South Wales, part of the oldest surviving continuous culture of the world. I pay my respects to their elders, past present and emerging, and acknowledge and pay my respects to other First Nation elders who may be participating in this webinar, and to the lands of the peoples where they are. I'd also like to acknowledge Associate Professor Vic Manning and Katherine Ross who have been instrumental in this research project. The survey that I'm about to speak about, I'd also like to acknowledge the respondents of the online survey that ended up providing the data.
So as Brendan said, I'm from Turning Point, a national addiction education, research and treatment centre based in Melbourne. Over a number of years we've had requests for information on how to support AOD workers with child protection and wellbeing, and from child protection and family support workers on how to try to address and respond to alcohol and drug concerns with families they care for.
Last year, DHHS funded us to try to identify what works and doesn't work between these two sectors. Covid has meant that we've had to adapt our plans so it's taken longer than we hoped, but today I'm presenting a really high-level overview of the results of this survey to try to set the scene for some of the practise-based discussions to follow. So to start with, in the alcohol and drug sector there were 77 respondents who answered all questions in the survey, and this included nine who worked in the AOD sector but in roles that were related to family reunification, family violence advisers, family counselling, maternal and child health services and youth, alcohol and drug outreach. There were 92 respondents in the child and family support service sector. The two sectors were remarkably similar in structure, mostly female, 84 per cent female in the alcohol and drug sector and 94 per cent in the child protection family service workers. The mean age for both groups: 35 and 33, and about nine years of experience in the jobs across both sectors so it's pretty similar across both.
Now when we looked at the results, even without considering any of the previous research or work into this space, it was immediately apparent and I agree I'm starting to state the blatantly obvious that alcohol and drug and child wellbeing are inextricably linked across both sectors. When we spoke to the child and family workforce people, they said that the percentage of the clients that they identified as having an alcohol and drug issue was about 26 per cent. And of these, 43 per cent said that they felt alcohol and drug was actually impacting the wellbeing of the child.
The alcohol and drug sector identified that 49 per cent of clients, this was the main number that they were concerned about, had parenting needs and 16 per cent of those said that 100 per cent of their clients had parenting needs. So you can see that the two sectors really intersect with each other. When we started looking at what the commonalities and differences were across the two sectors, in the child and family work - child protection and family - I always get this, tongue-tied around this, the child protection and family support workers sector, two-thirds felt that clients were referred to them with an expectation that they would also deal with alcohol and drug needs, and almost as many felt that a large part of their time was actually spent on alcohol and drug issues.
The majority of respondents said that they had received training on how to identify or respond to alcohol and drug issues, and 90 per cent nearly noted that they would like more training in alcohol and drug. Only 13 per cent had received training in screening of alcohol and drug use. Most commonly, the other training was in mental health screening and assessment and information sharing obligations. Only 9 per cent had received training in harm reduction and recovery.
Those that identified a need for training identified harm reduction and recovery-oriented practise as a need. They also asked for training in how to respond to or support clients who used alcohol and drugs safely, how alcohol and drug use impacts on parenting and how to recognise alcohol and drug use dependence and problematic use as priorities for their training.
When we looked at the alcohol and drug workers again, two-thirds said that they had asked their clients if they were involved with child protection and 40 per cent of these said that where this was identified, they always followed up by connecting with child protection to corroborate what the client had disclosed to them. 65 per cent said that they always asked their clients if they felt their children were safe.
Of the responding alcohol and drug workers, more than half had received training in child protection and 60 per cent felt the training they'd received was adequate. This was mostly centred on mandatory reporting and information sharing requirements, and one in 10 said they'd had training and screening for risk of harm and risk assessment. 9 per cent had had training in family focus practise, and 4 per cent in building parenting capacity.
So then when we started looking at what the barriers were to referring to the opposite service, opposite to alcohol and drug referring to child protection, child protection referring to alcohol and drug.
The child protection and family support work course said in 44 per cent of them noted that there were client-based barriers that might actually prevent them from discussing alcohol and drug issues with their clients. These included most commonly not wanting treatment or a referral either because they didn't acknowledge they had a substance use issue or that they were attempting to reduce alcohol and drug use on their own. Safety concerns played a significant role. A fear for the worker's safety and a fear that there was potential for a client escalating the behaviour and thereby posing increased risk to children and or the client or an increased risk of family violence.
Stigma was also an issue with some saying that if the children or partner were present in the discussion they didn't even want to suggest treatment and that they were worried about harming the therapeutic relationship or not feeling they had sufficient rapport with the client yet to bring up alcohol and drug issues. When we spoke to alcohol - when we reviewed the alcohol and drug client barriers, similar issues were raised. It was remarkably similar across the two actually. The alcohol and drug workers felt that referring to family services or child protection might breach client confidentiality or derail or affect their therapeutic relationship. Again some clients felt that they didn't need a referral or that the worker felt the client had adequate support to keep their child safe.
Both work forces noted similar organisational and historical issues including reporter fatigue, so for instance where they had reported or referred a number of times but hadn't been successful or didn't understand what had happened to that referral. They also noted a lack of understanding of the processes around referral. Both felt that referring to the other service caused feelings of stigmatisation and that there was issues among communications and relationships between the two. Child and family workers felt that alcohol and drug services couldn't care for their client. That there was long wait lists, client complexity and access to services were impediments. They also found that there was an inability to find the right service and - or there was no relationship or direct link to alcohol and drug services so it was a difficult process to refer.
Alcohol and drug workers felt that child protection had a reputation of being punitive and not caring for the whole family. Many felt it was hard to comply with what child protection wanted their client to achieve. They noted that child protection was necessarily focused on the child, but almost impossible to do what was required of them. This one person particularly mentioned testing, so testing for - urine testing for substance use and saying that they were given very short notice and had to go across town to get the testing done and it was almost impossible for the client to comply with this sort of thing.
Some of this centred also on the child protection workload. They felt that child protection was doing the best they could but was limited with what they could do because their heavy workloads. One worker noted that, 'I have often found that child and family services are reluctant to take on the complexity of the alcohol and drug clients that I'd want to refer as they have multiple issues and the risk is too high. I've also had the challenge of trying to refer families where the parents are working as most are nine to five services.'
Another alcohol and drug worker found that the child protection approach was very different to how alcohol and drug services worked, and so this difference made it really difficult because they have a different view on alcohol and drug use and don't use a harm reduction or trauma informed approach. Some even commented that although the workers were amazing in some circumstances, it almost felt competitive between the two of them to try to advocate for clients.
So despite this, there was a lot in common in terms of what each sector felt was a facilitator or could be a facilitator to working together. Primarily, both noted the importance of relationships with services in the other sector and a common thing was direct and accessible lines of communication with specific workers and an improved understanding of each other's roles, and what they could offer their clients would make a huge difference. Some suggested networking or joint training, care team or joint meetings to build those relationships. Most importantly, both sectors noted the importance of information sharing and transparency regarding the process following referral and the consequences of the outcomes of those referrals.
So despite clear intersection between these two sectors, many felt that the training they'd had was valuable but that there were significant needs for inter-training - for additional training. There were common barriers to each sector reporting to each other, mostly centred around associated stigma and harm to the therapeutic relationship. Both sectors acknowledge the good work being done by the other sector but also noted that the different paradigms of how to approach service delivery made this a challenge because they felt their client issues and service approaches were very different.
Despite all the differences and issues between the sectors. Both felt that the solutions or approaches resolving these issues were similar and focused on team approaches and training to approve the understanding of client responses and outcomes. So all of these responses and differences could be addressed through public health response, to alcohol and drug and child wellbeing. Importantly, early intervention and connection through universal services like maternal and child health, for example, and then collaborative targeted services supporting families where the risk was high before alcohol and drug issues put children at risk of removal would be the ideal. This isn't a new concept but it will require a concerted effort to fund early intervention and prevention to intervene before there is a need for child removal and family disruption. So I'll hand over to Shalini now and she can talk around some of the workforce stuff around alcohol and drug.
DR ARUNOGIRI: Thank you so much, Deb, that was a great overview of what we're going to discuss today and I think my perspective now is really to bring a little bit of the alcohol and drug conversation to light and talking through some of the case studies that we've also shared online and you know really kind of think about we might approach this on a day to day basis. So I guess first and foremost, to recognise and yeah we're all here talking about this because we all are you know on the same page really about knowing that substance use itself, alcohol and other drug use is a risk factor for families.
We know that from the statistics from decades of research, both from Australia and internationally, that if a family has a history of substance use, currently that those parents are at risk and the child is at risk. And so that is a lens that we bring to this from, no matter what sort of professional background we're bringing. And I think it's important to sort of take a step back and acknowledge that the statistic, you know in terms of that being a risk factor for our patients and for their children, regardless of where we're coming at this problem.
So that's why it's so important I think for us to be able to embark on this, being able to have a shared dialogue about this, because what we're actually all working towards is really preventing risk of harm and preventing kind of negative outcomes for the children but also parental and family negative outcomes. So through that context I think thinking through how drug and alcohol services work in this framework, I think it's important to kind of recognise that the whole range of different factors that impact our day to day practise.
There's factors that relate to the individual themselves, so that might be the client in front of us, it might be the parents themselves and then we're also thinking about the child or children as the case may be. And we're also thinking about then the organisational and system factors that might impact on this, the professional factors that might impact on this in terms of the clinician themselves and also the sort of framework and the organisation that they work with. And then I think there are probably some bigger picture societal factors that impact on how we practise.
Thinking through some of the, you know some of the nitty gritty of these issues, thinking about the case studies that we had available, I think the first case for instances of Ren and Leah bring some of these issues to light. So for instance, when we're thinking through the case I think you know what's important to note is that we're recognising that in this case study we've got an individual who is our client, Ren, in this case who we were seeing to assist with a particular problem in this case substance use of alcohol and cannabis, and so that's the lens that we're interacting with that individual with. But in this context we've also got sort of the child being brought to the appointment and it's relevant here that we're talking about sort of the second appointment into that interaction. So some of the factors that Deb talked about earlier on are really relevant here in the sense that we're really at a very early stage of kind of working with this client.
And that's why I think that that therapeutic engagement, the rapport is so important. And I think as a clinician we spend a lot of time working on how to forge that rapport, that therapeutic engagement. It's particularly critical that early on in the interaction. So for many clinicians, this is going to be what's going to be first and foremost in their interaction with their client. Then the next factor to sort of think through is in terms of individual level factors for that client. What we’re hearing is that certainly substance use is something that they're kind of coming to you for help with, but you're hearing also there might be a range of other sort of adversities that might be arising to.
Thinking - taking a step back and we understand individuals who have problematic substance abuse and work within a framework of child protection that we also know that for instance substance use may just be one of many intersectional risk factors that are relevant for that family and for that parent. So we know that many individuals who have substance use also may have other problems, other adversities that both arise as a consequence of their substance use or also maybe actually arising and promoting substance use. This includes things like unemployment for instance, or poverty or at risk of violence for instance. So all of these factors are all things that we need to kind of incorporate into the framework and all the substance use in itself might be the individual perspective that we're kind of narrowing down on.
We have to also kind of balance that with what else is going on for the individual. And I think within a clinical framework, I think that often is part of how we might formulate what's happening for the individual. So for instance thinking about Ren, I mean what we would be wanting to kind of think about is what else is going on for that person, we hear a little bit about their housemate for instance, what are their living circumstances, what else is going on within the household, what is bringing that person to treatment as well is relevant. So all of these contextual factors play such a bigger role in terms of us understanding the individual, and then I also understand the context in which they're coming to treatment.
Then taking a next step in terms of you know when we're actually understanding that individual and how they relate to their child, there are a few sort of alarm bells that sound in that particular consultation that make you think, 'Ah I might need to you know think about taking this further. 'And here what we're hearing is that you know concerns around how the person might be interacting with their child, concerns about potential neglect or concern for the child themselves. These are all things that I think for many clinicians make us very anxious within the room,because wereally worry about not only the child but also the parent that you're actually treating and what else is going on outside of the consultation room as well.
So I think for us as alcohol and drug practitioners, certainly for our work, one of the key things we would really be encouraging all of our clinicians to do is really kind of discuss that with supervisors, with colleagues. And really using that level of anxiety too as a bit of an alarm bell for yourself in thinking if I'm anxious about this then this is a cue for me to be able to talk to someone else about this, before necessarily feeling like you need to you know make a decision.
So there is always space in - and it's absolutely necessary I think to give yourself some space. To be able to take that to someone else, and that might be a formal supervision structure for instance that exists within the workplace. There might be a line management structure too that exists to be able to escalate risk issues. I think clinical governance is so important here and depending on where someone practises, risk issues might be dealt with differently but I think what's important is if you think about a case like this, who would you go to in that situation? Who would you be able to call on, pick up the phone and ring and say, you know I've got a colleague question, how can I talk it through?
I think that kind of leads us to kind of thinking what happens if supervision doesn't happen because I think supervision is really important in terms of dealing with the at-risk situation that's in front of you, but also kind of thinking about what happens with a professional when they leave the workplace that day. What are we carrying home with us in terms of our mental load and you know many of us hear very challenging stories in the workplace every day. And I think that sort of framework of sort of vicarious traumatisation of really being really carrying that on your shoulders and taking that home with you can really take a toll on practitioners, and I think we know that in both sectors, in drug and alcohol and child protection, that there are really high rates of sort of burn out and traumatisation. So that's really important that we kind of think about that proactively when we're going about our daily life.
I think that the final thing to kind of reflect on is really sort of system and organisational issues that can impact on how we deal with situations like this. Many of us work in many different sort of organisations, the size of the organisation but also the work practises that are relevant. I think it's really important and incumbent of us as clinicians to be able to understand and be familiar with the jurisdictional legislation that kind of impacts on mandatory reporting, that impacts on you know information sharing within your context. But then thinking also about what this specific organisational system factors are for you and your workplace, how does your workplace kind of deal with these sort of situations in terms of risk and governance. Do you have the capacity and space to be able to share that with colleagues?
Particularly in terms of a multidisciplinary perspective. I think we simply value lots of different perspectives in the lens in which we understand people and the framework from which they come from. So I think any opportunity to be able to do that really can add and show value. I think, thinking about the two different system frameworks that are relevant in both child protection and drug and alcohol, I think that collaboration is so important in this space but it isn't necessarily incentivised and it can be really challenging to do both in terms of time and workload requirements of which can be intense on both sides, workload requirements as we've heard as well. It's certainly something that I've noticed and benefited from during Covid, is this pivoting to online technology and the ability and the capacity to organise teleconferences where previously that was quite challenging.
So I think any opportunity to sort of engage in a shared dialogue with someone from the opposite sort of framework, the opposite system. Tt really gives you an opportunity to understand where those intersections lie, where you can actually work together and understand as well where there might be business information for instance that you weren't aware of that can actually assist for practitioners to work more effectively.
I think just a final comment to make before I kind of hand this over to Emma, is really kind of thinking about the bigger picture factors that impact on all our work. That you know the family in front of us is often a family at risk but also understanding that the family who's coming to us, whether that be through the child protection door or through the substance abuse door, is really a family that is asking for help in some way.
And so that is an opportunity for intervention, for an opportunity to assist, an opportunity to intervene, because we know that for many families at risk that this is a transgenerational issue for many families and so the capacity for them to be able to come to you as a practitioner is really our capacity to foster hope, to foster engagement, to be able to short circuit some of the cycle of vulnerability and of really marginalisation, so if we can actually use that opportunity to intervene, that is a tremendous opportunity.
And I think you know, putting that in context we know that it takes over 18 years on average for someone to come forward and get help for a substance use problem. So we know the amount of shame and stigma that people are holding before they actually come forward for help, so once they're actually through that door I think it's recognising that and keeping that very much at front and centre. And you know in the rest of the work outside of that clinic room, taking that time to actually engage in whatever advocacy we can to be able to minimise the stigma that people carry as well. So on that note, I might hand over to Emma.
MS BERGWEVER: Thank you very much Shalini and thank you also to Debbie. I'm just fiddling around with my notes here. So thank you so much for having me today. I'm joining you from Brisbane and I'd like to acknowledge the Turrbal and Jagera Peoples ah who are the traditional custodians of the lands that I'm joining you from today. I pay my respect to their elders, past, present and emerging and pay respect too to my Aboriginal and Torres Strait Islander colleagues joining here today and pay respect to the nations you're joining us from. Thanks Debbie and Shalini, I'm really looking forward to having some more conversation with you after my short presentation here.
It's a real honour to be part of the conversation and it's a great opportunity to reflect upon collaborative practise. And I wanted to acknowledge that what I plan to kind of touch on and discuss today is based on the collected and collective wisdom from many families and practitioners and researchers and theorists that I've worked with and come across along many years of practising within the field. So I hope that you hear some of your own wisdoms and reflections and observations shared back with you today and I thank you for that.
So when I was asked to participate in today's webinar, and thinking about working together with families where a parent using alcohol and drugs, and where there are child protection concerns, I had two narratives going through my mind and lots of hand ringing and swinging wildly between: 'There's nothing new to say here, everybody knows how to do this, I'm going to be just saying what people already know, this is going to be the worst talk of my life.' followed quickly by, 'This is such a complicated area of practise. No one knows how to do that. We don't know what to do, we don't know how to do it. It's so difficult. This is going to be the worst presentation ever.' And then I thought, ah there's something interesting in this kind of swinging between perspectives that that's telling me about the work in this space, the collaboration, that intersection between our different sectors. It's such a parallel to what we do every day.
So we're trying hard to kind of hold these divergent views, to encourage us and ourselves and our colleagues to walk in the middle, to approach situations with kindness and compassion for both ourselves, in our practise, for our clients, the parents, the children that we work with, and our colleagues who work in other sectors. So it's that position of curiosity and empathy that I hope to kind of weave through our conversation today to help think about that collaborative practise together. So whilst I was infused with mild panic, I did learn something, something from that. There's always something to learn.
So over the next five or 10 minutes or so, I'll hopefully help us to arrive at that middle road. How can we work together and see each other's perspectives. So I'll talk a little bit about the principles and values that underpin child protection work, particularly in the statutory child protection space. And kind of talk, as I said, about that empathy that we might have for ourselves and for others. I'm going to focus particularly on the case study of Leah and Ren and in doing that, so hopefully it's just a little short paragraph so if you wanted to follow along you can pull it up there from the notes section.
So in terms of the principles and values of the child protection sector, so I've drawn some ideas from the very excellent paper that was referenced in the last webinar in March this year. That's 'Working together to keep children and families safe: strategies for developing collaborative competence.' So that's a CFCA paper with the lead author of Rhys Price-Robertson. And Nicky Patterson talked a lot about - ah sort of talked about this paper during the presentation.
There's a particular quote from there that I'd like to share that I think is just ah really summarises nicely what we're trying to arrive at. So, 'Many practitioners simply do not work in ideal collaborative environments, and are left to navigate the 'street-level' complexities of imperfect systems with little explicit training or advice. Even when practitioners do work in environments in which cross-sectoral collaboration is supported, it is unlikely that 'top-down' efforts at collaboration will provide them with all they need to bridge professional silos.'
I really liked that idea of navigating the 'street-level' complexities. It kind of gets down to that nitty gritty of the everyday work that practitioners are doing in the field. So it does reference that there's those systemic and organisational barriers that really speaks to the idea that there are things that we can do, I can do, you can do, in your everyday practise to flex your collaborative competence muscle to develop that muscle and to develop the skills that is needed to do the do in this field. So that paper talks about some key elements for collaborative practise being understanding, clarifying and communicating. it’s a really - it's a lovely little model. So I encourage you to have a look at that paper. It's just a little circle that says, 'The key elements of collaborative competence, understanding, clarity and communication.
So a key part about understanding today is for me to share with you some of the ideas about what it means, what this case study in particular of Ren and Leah might mean from a child protection perspective. So I'm going to put myself into the shoes of for example an intake worker that might be working in child protection who's come to know about this child Leah. And when I look at the information that's shared in a case study, I see that there's a one-year old child named Leah. My immediate worries for her are about neglect and possible physical injury maybe from neglect or physical abuse. I notice a worry that Dad is drinking alcohol every day. To me maybe that seems like a lot, and he's also seeming to leave his child, his small child, with a stranger for all I understand, Talia, while he goes to the pub.
So immediately my questions come to, 'Has this child been harmed or is she at significant risk of - unacceptable risk of harm, does this meet legislative threshold for me to need to act or to do something about it. I need to ah - I've got a really short amount of time to make a decision about those things. I need to make an assessment of the risk to this child safety and their wellbeing.
So from my lens which is very much child-focused, it's the safety and the wellbeing of the child is paramount. The Leah and her father haven't chosen to come and see me and have these thoughts thought about them from a child protection perspective so it's very much that they're accessing us as an involuntary client and I'm coming at it from a statutory legalistic kind of an approach and I'm very much interested in the risk factors and potential for harm to this child.
So with that in mind, as an intake worker, I might shoot off a quick request to the alcohol and drug service that I know is working with this family. So with the pressures that I'm under, I can be quite be dogged and determined in my approach. so I might ask three or four key questions of my colleague. I might say, 'Does this man attend your service?' 'What is the impact on his drinking to the safety of his one-year old daughter?' 'Can this man parent safely and is he meeting the safety and wellbeing needs of his daughter?' So that's very much me kind of engaging in that risk assessment approach.
So what we might, as the child protection service received back from our alcohol and drug colleagues is I don't know, yes he comes to our service, I don't know if his drinking's impacting on his daughter, we don't generally see his daughter, I'm not sure if Ren can parent safely and couldn't say if he's meeting the safety and wellbeing needs of his daughter. We're not - that's not generally the focus of the work that we do. So there's then this frustration that abounds from both sides of the of the picture here so there's frustration on behalf of the child protection service about how can they not know these things? Child protection is everybody's business.
We then really miss this key opportunity from the alcohol and drug service and from this child protection service to focus on the wellbeing needs of this family. So we can at times then lead us to overestimate risk to the child or underestimate risk to the child. And both of these things are in the child's best interests. It's not in the parents interests and it's not in the family's interests. And not in the child's interests, it sort of doesn't - it underestimates or overestimates the risk and then we might act in a way that doesn't kind of facilitate the safety and wellbeing of that child in the company of their parents.
Now I'm just aware of - looking at my time and going over time, but what I'd hoped to touch on next and maybe we'll do that in the questions when I hand back to Brendan is how perhaps as the child protection service we might be able to have the conversations a little bit differently with our alcohol and other drug colleagues and similarly how our alcohol and other drug colleague might be able to frame and talk to their child protection colleagues in a way that kind of helps bridge that those differences of understanding or different frameworks for how they might be approaching the work. So I'll hand over to Brendan now. Are you there?
DR QUINN: I am, can you see me can you hear me?
MS BERGWEVER: Sure can.
DR QUINN: This is such a weird way to communicate. Or to watch a seminar. I'd like to call Shalini and Debbie back as well if you guys are around. So thank you all for such interesting and insightful and useful presentations today. before we sort of jump into any questions or discussion, Emma thanks for mentioning the collaborative practise paper from the last webinar. I'd just like to let the audience know that it is available via the event page for today's webinar for those who'd like to access it.
Emma, did you want to continue discussing - you kind of cut yourself off because of time but we have some room to move here. Do you want to start that or answer that question yourself with regard to how as the child protection service you might be able to have those conversations differently with AOD workers to help bridge the gaps?
MS BERGWEVER: M'mm thank you. I am glad that we can get to continue talking about it. I think clearly what Shalini was talking about in her presentation was the framework that alcohol and drug services work from that that we're substance use is seen as a, is a health issue or a health problem and in making an assessment or a health assessment about drug use or substance use, alcohol and drug workers have such rich pictures of what's happening for both the individual parent and their families. They explore that context, they know a lot about the contextual factors that might be influencing the family and the child, so knowing what's making the family safer or alternatively what's making it riskier.
So kind of leaning into that knowledge and skill that the alcohol and drug worker services have so the child protection service might be able to, rather than asking very specific questions about safety and parenting, which the drug and alcohol worker might not feel as comfortable talking about cos it's not their specific area of knowledge, the child protection worker might be able to talk more generally about, 'Can you tell me about what the routines of the household are like?' 'Can you tell me about can this parent or family kind of attend to the needs of the day-to-day functioning of the household.'
The kind of factors that we know as child protection or people that are familiar with child development and parenting know that these are the kinds of things that help keep children safe. So we can kind of shape the questions in a way that kind of dove tails into that way that alcohol and drug workers collect their information.
And similarly, in reverse, when alcohol and drug workers might get very specific questions from child protection service, for example, can say, 'Well actually I know all this other stuff. You're not asking me about this but these are some other things that I know that can help you in the work that you're doing based on my understanding of your risk framework,' and we all kind of want that shared position of children being safe and cared for with their families. Does that make sense?
DR QUINN: Sure, Shalini, did you want to comment on that?
DR ARUNOGIRI: Yeah sure, yeah. I think - I mean I completely agree and I think often I think those very specific and narrow questions, you know when we shine a light on something quite specific the question is what we're missing in terms of the context and environment around that and no I think that's really true even as kind of in Ron's case, the second assessment session, with a clinician there are already a whole range of different things that could be salient to this case, this presentation, that would benefit both workers to really know.
And I think sometimes I think also that opportunity to actually engage in kind of an ongoing dialogue around this is also so valuable so you know rather than I think that on one hand you might get a very specific request that could be like a one-off you know conversation that really again becomes a very narrow focus on just one specific issue usually at risk, but then there's a whole range of other things that are opportunities for intervention, opportunities for engagement and a whole range of other sectors or supports that isn't being brought to light.
So I think where there's any opportunity to kind of open that up I think to be able to engage in a more ongoing discussion, engage in something that it could be a more productive and collaborative discussion is helpful. I completely agree, yeah.
DR QUINN: Thank you. Debbie did you want to add to that?
MS SCOTT: No I agree with Shalini, I think it's - we both - it's so obvious that both sectors have the same concerns and the same issues. And so it's just about opening that dialogue and really starting to have those conversations and making those connections, rather than seeing it as the other people.
DR QUINN: I agree, I mean I think Emma you mention we all want the same thing don't we? Positive outcomes for families and their kids Does that sound okay? Um, Emma I might throw this one to you first, how does the - can you comment on how the issue of confidentiality might impact on collaboration?
MS BERGWEVER: Certainly. I think there's lots of worries for professionals in both sectors about sharing information. Generally my understanding, certainly in Queensland, but nationally is that child protection legislation is very broad in terms of information sharing provisions and so the - there are worries I think from both parties about what does this information mean in terms of the relationship that I've developed with my client. What does it mean for therapeutic alliance so I think it speaks to me more about trust, about worries about confidentiality speaks about trust and the relationship that professionals have together. How is this information going to be used? To what end? Is it going to jeopardise my client's treatment or engagement with my service.
Yeah I think when we start to talk about worries about confidentiality, it makes me - cos like well yes there are, you know there's only - we share what we need to share to kind of get the outcomes that we need. And that can be pretty broad. The worry that kind of underlies those questions about confidentiality I think are related to trust and trusting what the other person is going to do with that information.
DR QUINN: Any extra thoughts from you Shalini or Debbie?
MS SCOTT: I agree. I think that frames it well.
DR QUINN: Terrific. Debbie I might ask you this question. Are there any ideas on how to approach collaboration as a voluntary approach as opposed to an involuntary approach where child protection and AOD are forced to collaborate?
MS SCOTT: I think some of the suggestions that came in as part of the - through the survey were really interesting and we've seen that inter-sectoral collaboration and training work well in other jurisdictions. I remember doing some work some time ago in Queensland and there was child protection and police and education all came together to do some education around what each sector did to try to understand better the role of child protection.
So I think that's something that we can do quite well and quite easily just have those joint training sessions and work together proactively and set those relationships, but it also sets up that person to person relationship that maybe if I'm concerned about a client, I can pick up the phone and ring him and say, 'Hey here's what I've got, do I need to be concerned or is this - should I just let this go for a while? Or when do I call you? What's the threshold?' So that face-to-face connection, that interpersonal relationship could make all the difference in the world.
DR QUINN: We've got another question here, Emma I might let you start with this one. In the statutory CP space we often ask - sorry parents to demonstrate abstinence before we feel assured their children will be safe enough. This probably sets them up to fail. How do we navigate parameters for levels of AOD consumption that could be considered acceptable?
MS BERGWEVER: This is such a challenging question and a challenging area of practise and I think the question hits the nail on the head, when we ask for abstinence it can set the parent up to fail, and the stress of being asked to remain abstinent, if that's not something that that person is wanting or ready to do can also contribute to increased stress for them and maybe increased substance use which in turn might increase the risk to the child.
I think it's a really thorny issue. My very personal opinion is about it's more about the behaviour than ah and the impact on the child than abstinence, per se, where if ah, for example, abstinence doesn't equate with safety necessarily and substance use doesn't necessarily equate directly with harm to children, it's kind of teasing out those two things.
So what is it that we're worried about for this child? Maybe it's that they're not getting to school or all the money is being spent on a particular substance so there's no money for food, but if those kinds of things are being addressed through whatever kind of interventions that we might put in place then it kind of disentangles it from the substance use, like the substance use might be continuing but these other factors that contribute to children safety or children harm can be addressed in other ways. Does that kind of make sense? I know that it's different - there's mandatory testing and there's all sorts of other policies and procedures that kind of make it tricky to practise in that way.
DR QUINN: You're right, and Shalini I see you nodding, do you have any thoughts on that question?
DR ARUNOGIRI: Yeah I absolutely agree that it's a thorny area and there's probably no clear answer. I think it was really helpful to raise that question I think. I think the - the bit that can be also tricky I think in clinical practise is also understanding you know abstinence is such a black and white sort of dichotomous yes or no outcome. Then when we've got sort of non-abstinence basically everything else in terms of the spectrum, it's kind of understanding, as Emma's pointing out, what the impact of that is on behaviour rather than necessarily having a dichotomous yes or no. And I think the use of sort of mandatory tests, for instance a urine drug screen, there's a whole range of other biological tests is - can be challenging in this space because interpretation of those tests can um, while there are objective markers, may not necessarily give you any objective marker or impact on behaviour.
So you know the abstinence of - this is particular true for some substances that might stay in the body for quite a while so it might remain positive. I know for instance cannabis use can be extremely challenging to kind of you know use a biological marker and think about impact on behaviour and on harms. So I think it does come back down to understanding behaviour and understanding you know using that clinical judgement as well and understanding the context and the formulation of what's going on and not having that the be-all and the end-all of what, you know what's going on for the person and for the family.
I think it can be really challenging for a whole range of different reasons as well in terms of thinking about how to achieve abstinence as well. In order to achieve abstinence that usually involves a whole range of different system factors to line up for some people so that might be a detox for instance or a rehab or a whole other range of sequelae. And you know in trying to achieve abstinence for that individual and thinking that that's the kind of goal or the destination that the person is getting to, thinking about all the other stops along that journey and thinking about, you know, what's the nuances and the grey areas that might happen before that final destination if that's what it is.
DR QUINN: Shalini, I might throw this one to you again given that you lead over 50 clinicians delivering addiction treatment across telephone, online and face-to-face modalities. In the context of Covid-19, so this I think is something we can all relate to, has it been easier or harder to build trust and rapport over telehealth in the context of collaborations?
DR ARUNOGIRI: Yeah that's a really good question. Just coming out of a whole bunch of meetings just this morning trying to think about how we move people, that's clinicians and clients, back into spaces. And you know it's been a really challenging year for lots of different reasons. I think when we're thinking about the telehealth framework, I mean one thing to think about is when we think of telehealth we're thinking about this sort of you know this ideal situation where everyone has good internet, boxes are aligned up, you can see and here. And in reality, at my clinical practise, that hasn't necessarily been how telehealth has worked. There are lots of people who you know have some level of digital divide and that really applies to our client groups I think, where internet connections, reception, all of those factors don't line up.
And I think in those sort of situations, it has clearly impacted on the capacity to you know conduct a comprehensive assessment, being able to forge trust, because I think there's one thing about the screen but when you know the connection is broken up you can't see facial reactions et cetera, it's very challenging.
I think where it has helped though I think is that point I was pointing out before when I was speaking about a collaboration, I think it has really provided an opportunity to bring teams together. In many cases where historically pre-Covid organising a case conference for you know a general practitioner, child protection worker, a drug and alcohol worker, you know a whole range of different services, to be somewhat semi available at the same time, it's very challenging. And yet now because to some extent we've all gotten very used to this framework, it's really provided an opportunity for many of you know our clients to have a case conference where that had never happened before. So I think that's been a real positive for us I think.
DR QUINN: In facilitating a working relationship between CP and AOD, child protection and AOD, when does AOD take the lead and when does CP take the lead? At this stage there is not a clear lead and both services have large caseloads.
MS BERGWEVER: I think it very much depends on the particular situation about who takes the lead and I guess that's part of those collaborative conversations that everyone's having together, is trying to negotiate what's the nature of our work together, who's doing what, what's the joint plan, what's in the best interests of this child and family.
DR QUINN: Next question, how do we increase workforce retention? The changing workforce appears to be destabilising for clients. Who would like to answer that one first, Emma?
MS BERGWEVER: I can give it a go. It's a perennial question isn't it about workforce retention in both in the health fields and in the child protection fields and child and family welfare fields. It is, its incredibly challenging work. It is, there's workforce shortages there's ageing workforce there are so many factors that contribute to workforce retention, including I think that the tension and stress in the relationships between agencies and feeling like you are always battling with other people to get the work done.
So in the context of this presentation and this chat I think collaborative working is another way of kind of addressing the workforce turnover but yeah absolutely it is destabilising for children and families.
DR QUINN: Shalini, did you want to comment on this, I know that you talked about ah vicarious trauma and burnout amongst staff. Do you have any else for that?
DR ARUNOGIRI: Yeah look I mean I think I agree with Emma, I think the workforce retention is you know a real issue, I think in both sectors, and I think the - yeah put in front and centre, the fact that all of this work is really challenging and we're hearing a lot of stories that can be very difficult to hear, especially within a system where you might not feel necessarily like you can intervene or you can achieve the best outcomes for your client in front of you. And I think that's where I think it's so important to be able to take that somewhere, that feeling of feeling both your anxiety about where the client's at, the anxiety about your own professional kind of capacity, the level of power agency yourself might have within the system.
These are all issues that kind of often in the context of our workloads being really high, that this stuff can kind of take back seat, but I think in terms of being able to kind of be an effective practitioner and be retained and actually feel valued and within the workplace, I think that those supervision structures, the capacity to have peer support and peer supervision is really critical in being able to continue to do an effective job really.
DR QUINN: Shalini, I might ask you this next question. Do you have any practise strategies for engaging resistant parents in conversations about risk around their alcohol use and the impact on their children?
DR ARUNOGIRI: Yeah it's a good question. I think particularly in the context of where you're seeing the client and why they've come to you, I think that's really relevant. If you're working in a voluntary framework in the capacity of trying to assist the person, I think it's trying to bring that back into the conversation about what the person's actually seeking assistance for. Trying to understand what the problem is that they're actually wanting to change. And it also kind of comes back to the core practises around sort of motivational interviewing as well, and utilising that space to be able to help the person kind of achieve what they want out of the conversation.
I think shining the light on where the child is in this framework, you really want to kind of be able to bring the person on board with this conversation rather than necessarily get engaged in an adversarial conversation about this. So I think it's being able to kind of work with where the person's at, recognising obviously that they might be that might be affected and trying to utilise that space to be able to bring that into the conversation I think. Emma, have you got anything to add on that?
MS BERGWEVER: Yeah I agree, and continuing just from what you've said I think fighting against resistance is hard work for you and it's hard work for the person that you're talking to. It's, in my experience in watching other people's practises, using the energy of the resistance to go with that and kind of harnessing that, maybe channelling it in to what are your hopes and dreams as a parent? What are you wanting for your child? What do you see in your child? What do you imagine their future would be like?
And kind of broadening out the focus to be what about my role as a parent and what helps me in my parenting and what sometimes might get in the way, and maybe approaching alcohol use that might be seen as risk to the child from that lens rather than kind of getting it head-on.
DR QUINN: Emma, I might ask you this question, children may be doing additional activities of daily life, for example extra chores and housework to support the parent or siblings I assume who are using alcohol and or other substances which impacts on their wellbeing, education, socialisation et cetera. Are young carers being identified at both sectors and linked in to support for themselves?
MS BERGWEVER: I think young carers it's a challenging area I think for both sectors probably to identify the role that children or young people might be playing as a carer within their families. And it's a role sometimes that's really important to children and young people as well where they get a lot of value and a lot of importance in their contribution to their family and the way their family is functioning. So it's not always a child protection concern necessarily and it's not always something that we want to stop from happening or kind of prevent. So like the question says, it's when it starts to get in the way of them being able to go to school or kind of do other age-appropriate or developmentally appropriate things that we might start to worry. So there are ways I guess that we can help to support families that might take the load off the young person or the child, a little bit, or a lot depending on what's happening to be able to attend to their needs as a young carer, does that make sense?
DR QUINN: Yeah definitely. This will probably be the last question and it's a lengthy one, I work with many clinicians who are concerned about talking about child wellbeing concerns with clients because they're worried about the impact on rapport. I feel that rapport is often so tenuous that we wait hoping it will improve but the client never really engages and so the conversation never takes place. Do you think there are ways of having these conversations that are less likely to have a negative impact on rapport, and if so what would that look like?
DR ARUNOGIRI: So I think that's a good point and I think bringing up you know difficult content in the conversation in a therapeutic role is always challenging. In terms of you know trying to understand why the person's there in front of you in terms of what they're trying to get help with, I think that helps ground the conversation and work you know on the same page with the individual towards what they're trying to achieve. I think the other thing around rapport and understanding this within the framework of the content you're wanting to discuss is giving the person really clear boundaries as well about the bounds of that conversation. Because I think towards building trust is also understanding what the framework is in which you're working.
So I think it's really important when you, you know, open up at conversations I think we're really careful to be able to tell people, to get their consent, engage in that conversation in the sense that you know if they're sharing content where for instance were concerned about risks to themselves or risks to others then that is something that you're going to have to take out of that room. And so I think that goes somewhere to be able to share these conversations and not have that impact on rapport if the person themselves understands what they're getting into in that conversation.
DR QUINN: Emma, did you have any last thoughts on that? You can say, 'No.'
MS BERGWEVER: Last thoughts, here here, yes.
DR QUINN: Great. Debbie is there anything you'd like to add before we sign off?
MS SCOTT: No, no that's great.
DR QUINN: Terrific, well I'd like to thank once again Debbie, Shalini and Emma for providing us with some really interesting and insightful and useful presentations today. I'd like to thank Debbie and Shalini and Emma for presenting it to us today and for spending some extra time to answer audience questions. So thank you all and have a terrific week.
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Questions answered during presenter Q&A
- How does the issue of confidentiality impact on collaboration?
- How can we start to build a culture of voluntary collaboration?
- How do we navigate parameters for levels of alcohol and/or other drug (AOD) consumption that could be deemed acceptable by AOD and child protection (CP) services?
- In facilitating a collaborative relationship between AOD and CP services, when does AOD take the lead and when does CP take the lead?
- What are some strategies for engaging resistant parents around the risk of alcohol use and the impact on their children?
- Are there additional supports being offered to children who are doing additional activities of daily life (ADL) to support their parent(s) who are using AOD?
- What are some strategies for maintaining rapport with clients when questioning them about child wellbeing concerns?
This webinar was held on Wednesday, 25 November 2020.
Families where a parent uses alcohol and/or other drugs (AOD) may need a range of different supports, including from child protection and family support services. Research indicates that when collaboration between these agencies is limited, families are at greater risk of falling through the gaps.
This webinar built on the learnings from Collaborative practice in child and family welfare: Building practitioners’ competence, focusing on the opportunities that family-inclusive approaches offer in supporting families where a parent uses AOD. In particular, this webinar outlined:
- Research evidence on the intersections between parental AOD use and child protection concerns
- Principles and values that underpin the practice of professionals working in AOD and child protection
- Opportunities and strategies for building cross-sector empathy and working together.
Drawing on case studies developed through a recent Turning Point survey, presenters will reflect on ways that collaboration between AOD and child and family welfare services can help to ensure families get the support they need.
This event is of interest to professionals working in the fields of AOD, domestic and family violence, child protection, family relationship services and related services.
- Working together to keep children and families safe
This practice paper, produced by CFCA in partnership with Emerging Minds, focuses on improving cross-sectoral relationships between child protection and child and family welfare practitioners.
- Collaborative practice in child and family welfare: Building practitioners’ competence
This webinar, produced by CFCA, explored strategies for improving cross-sectoral relationships between child protection and government and non-government partners.
- Working with parents affected by alcohol and other drug use: Considering the needs of children in practice
This webinar, produced by CFCA, discussed how practitioners working with parents affected by alcohol and other drug use can enhance their child-focused practice.
- Working with families with parental mental health and/or drug and alcohol issues where there are child protection concerns
This article, published in the journal Child and Family Social Work, presents a range of recommendations to improve collaboration between child protection workers and mental health/drug and alcohol clinicians.
- Parental influences on adolescents' alcohol use
This report, published by the Longitudinal Study of Australian Children, examines the association between parents' drinking and the drinking of their 14–15 year old children.
- Working with mothers affected by substance use: Keeping children in mind
This resource, published by Emerging Minds, explores approaches to working with mothers who present to adult-focused services with substance use and co-existing issues, as well as exploring some of the challenges for practitioners.
- The power of words
This practical guide and desktop flip book, developed by the Alcohol and Drug Foundation, are designed to support healthcare and other professionals working with people who use alcohol and other drugs to reduce stigma and improve health outcomes.
Featured image: © GettyImages/Drazen_