Audio transcript (edited)

CHRIS: Well good afternoon everyone and welcome to today's webinar, working with parents affected by alcohol and other drug use, considering the needs of children in practice. This webinar is co-produced by CFCA and Emerging Minds. Hi, my name's Chris Dolman and I'm the senior workforce development officer at Emerging Minds. The National Workforce Centre for Child Mental Health. And in today's presentation we'll be discussing the important of not overlooking, in fact, attending to the needs of children affected by parental substance use. And how practitioners can enhance their child focussed practice. So yeah, welcome to you all. I'd like to begin from the start by actually introducing our great team of panellists today. We have four really experienced presenters that are bringing quite diverse perspectives into this issue. Firstly I'd like to introduce Gill Munro. I know you've read or had a chance to read their bios so I won't go through that. But I'd just like to firstly introduce Gill Munro, she's a social worker who's worked in this area for many years. And Gill, you have worked in this field for a number of years, what is it that's kind of you know, drawn you to this area? What is it that's sustained you kind of, in this area of work?

GILL: Hi everybody, what's sustained me, I actually love this working in the drug and alcohol field. It's been a really challenging but wonderful experience I guess over the years that I've been working in the field. I think that there's such a – it's just a really interesting area to practice social work I suppose. I love working with people who experience significant social disadvantage I guess. And really doing some advocacy work around that. But I also love the drug and alcohol sector because there's – it's always been to my mind quite an innovative sector to work in. It's a fairly open sector, it's new practices and so on, so that's also been you know, something that's sustained me in the role I guess.

CHRIS: Yes, yeah great, thank you Gill. And Lisa you've been a senior social worker at Jarrah House for a number of years as well. What is it that's kind of captured your interest about this area of work over such a long period of time?

LISA: Oh hi Chris, hi everybody who's joined us. Ah look child protection has always been my focus in my social work career and as part of that, drug and alcohol because it does impact on so many families. I was lucky enough to work with Gill recently in Emerging Minds to develop an online learning course specifically around drug and alcohol and its impacts on parents or parenting. And that's just a real passion for me. So I'm happy to be here today, share some knowledge and ideas.

CHRIS: Yeah we're glad that you're contributing today as well and Yinka Olaitan, you've had lots of experience in working with parents and are currently studying a masters in social work and working at Jarrah house. What is it that's captured your interest around this area of work in particular, do you think?

YINKA: For me personally it's just being in the space of women who would like the, I guess the (indistinct) of hope to be the focus. You know I think sometimes it comes a space where they don't have a lot of hope in their lives. And I think we're able to kind of be a space where we can give them some hope and some strategies to kind of overcome where they're at and so they can make different choices long term. So that's what's kind of sustained me and that's why I've also drawn me, because I'm a social worker as well.

CHRIS: Thank you, thank you Yinka, yeah welcome and I'd also like to welcome Sarah Kendrick who is a mother and has lived experience of alcohol and other drug use and mental health issues. And Sarah yeah we're really delighted that you're a part of this presentation as well. How come you decided to accept the invitation to join Lisa and Yinka and Gill in this webinar? What was it that interested you in that?

SARAH: Thanks Chris, I went through Jarrah House and completed the program last year. And yeah I have a soft spot for Jarrah, you know, they really helped me get back on my feet. And I'm at a place in my recovery now where I, you know, I feel like I want to give back and share the knowledge that I have with other people. And maybe help – yeah.

CHRIS: Yeah terrific, well thank you, yeah for your generosity and yeah offering your knowledge for us all today as well. Alongside our other presenters. So yeah in terms of – there are a few housekeeping things I need to actually run through before we go ahead that we acknowledge country now, that might be a good step. So I'd like to also acknowledge on behalf of Emerging Minds and CFCA, the Traditional Custodians of the lands right across this country upon which our webinar presenters have gathered and all the participants are located. We would like to pay respect to the Elders past, present and emerging for the memories, the traditions and the culture and the hopes of Indigenous Australia. So following that acknowledgement there are a few housekeeping matters that I'd like to sort of bring to peoples' attention.

Of course as you know if you've been a part of CFCA webinars in the past that one of the core functions of the CFCA information exchange is to share knowledge. And so we'd really like to invite you all to submit questions via the chat box at any time during the webinar. And yeah we hope to respond to these questions and the end, in the last section of the presentation. I'd just like to say, if we don't get to any of your questions that we'll publish those along with your first name on the CFCA website and there'll be a response provided on the website as well after the webinar. If you don't want your question or your name published, yeah please mention that. And we'd also really like to continue this conversation that we begin today and so we'll be setting up a forum on the CFCA website where you can discuss the ideas and the issues that are talked about today or raise additional questions for our presenters. Or you know, there'll be other resources that will be available for you on there as well.

So we'll send you a link to all of that after today's presentation. At the end of the webinar today as well there'll be a short survey window that will open. And yeah we'd really appreciate your feedback that helps us all get better at what we do. So if you can do that that'd be terrific. Please remember that this webinar is being recorded and so the audio, the slides, yeah the transcript will also be made available on the CFCA website. And also the CFCA YouTube channel as well in the next couple of weeks, next little while. So yeah having kind of mapped that out, I'd also like to just run through the learning objectives for todays' webinar. So you know kind of what's ahead. And so today's panel will be looking at like a definition of child mental health and what is supportive of child mental health. And also gain a clear understanding of how parental substance use can impact on children, as well as some of the, you know, complexities and other issues to consider that interest with that. And also how, you know, providing support for parents can have a huge and significant impact on children and families as well in terms of how they navigate through these waters.

We'll also be looking at how child focussed practice can be used to identify and actually strengthen families. And as I mentioned, there'll be time for questions as well. So the overall, I guess objective of this webinar workshop is really to be understanding the impact of parental alcohol and other drug use, how that may be impacting on parenting. And of course children social and emotional wellbeing and the role that practitioners can play in supporting the mental health of children in those circumstances. So that's a bit about what's ahead in this next little while. The next 50 minutes or so. So I'd now like to hand over to our presenters. And Gill is going to begin, so thank you Gill.

GILL: Yes so, what do we mean when we say child mental health, I think that sometimes we tend to jump to the pointy end of what we think child mental health might be. And that's around diagnosing and you know, formal interventions. But child mental health actually exists in a wider ecology, so it's about you know, parenting and secure relationships with others and community connections. And a whole range of things that support children to have good mental health. Much the same as adults really. So I mean it can viewed as a continuum of care kind of thing where you've got you know, really well rounded and good mental health at one of the spectrum with you know, children that are experiencing quite significant mental health problems at the other end of the spectrum. But really most children and infants actually experience good mental health and wellbeing. They can meet challenges and express and regulate a range of emotions, explore their environment and form secure relationships all within the context of their age and developmental stage.

LISA: So looking at the mental health difficulties for infants and children, I'd like to start by saying that children often show us about their mental health and how it's going through their behaviour because children don't have the language and the words obviously to describe their experience. So I'm going to refer now to the PuP integrated theoretical framework. Which is founded by Sharon Daw from Griffith University. And it's a program that is being run now through a number of services both here in Australia and also internationally. And here at Jarrah house we were lucky enough to be trained in the program about two years ago.

So the PuP integrated theoretical framework really acknowledges that if we look at the right-hand side where we can see a white box saying 'Child's development outcomes' that that's actually where we see the evidence of mental health concerns that might be happening for infants and children. And you can see inside of the large concentric circles where you can see a pink circle saying, 'Parental emotional regulation,' that there's a direct connection between parents mental health and how they're managing their feelings, their emotions and the development outcomes for children. And as part of development outcome s for children we are looking at emotional, behavioural, psychological health, which is obviously what we're talking about when we're talking about infant and child mental health.

And we can see that when there are pressures on parents who are trying to raise those children in terms of a disconnection maybe from community. Having substance use issues, having mental health issues, that that can have a direct impact in terms of their emotional availability to the children. And what we tend to then see is the impacts on infants and children in their behaviours. So I'm just going to go through a couple of examples of behaviours that we might commonly see.

The thing that I'd really like to point out in terms of the professionals participating today in the webinar is that, unfortunately often the problem behaviours are not picked up early enough. They're picked up by the time children are at school, as opposed to earlier. And what we know is that the outcomes of children are much improved the earlier we can pick it up. So what we're looking for are things like frequent or intense struggles with their emotions. So constant tantruming or really, really dysregulated emotional behaviour. Their thoughts, so their thinking patterns and their learning in relationships. So we start to see an impact, even in the very early years, particularly if children are attending daycare, pre-school, we start to see impact in terms their capacity to hold peer relationships and get along socially. They might have trouble controlling their moods and behaviour. And this is where it gets tricky because what child doesn't have problems controlling their moods and behaviour, most children do to some extent.

So as a professional, we have to be trying to hold that line of, what's normal for that developmental stage of that child. And where is it starting to become chronic and a problem. And we're looking there at how they can separate from their parent, whether or not they show healthy, secure attachment behaviours or whether there's a lot of excessive clinging and difficulty in being separated, even for short periods from their parent. We see things like trouble sleeping, eating problems, excessive crying or trouble engaging with their school, their daycare, their pre-school or their community. We can see – it's a bit of a spectrum, we can see over compliance and a need to please which is what we can refer to as parentification, where the child's learnt to really be too good, if there is such a thing. There is. And also then on the other end of the spectrum sometimes we can see a lot of really acting out behaviours and you have difficulty in complying and following rules. We also see disassociation in the more extreme end of things. So shut down and a trauma response. Usually a lot of its non-verbal, we might see flat affect. We might also in the really extreme stage, see some self-harming, head banging sort of behaviours.

LISA: So the next slide you'll be seeing is one that is looking at what actually supports good child mental health. And while we know that professional intervention is really important and obviously primarily I guess the focus of what we're talking about today. What we also know is that there are certain factors that are really important for all children. And in fact, all parents we might add, to have positive good mental health. And they are having interests and hobbies which build self-esteem for the children. Having access to education, the opportunity for learning difficulties or early speech delays to be addressed so that they don't have too much of an impact on early peer relationships and getting on well at school.

We see the importance of community and I think we particularly see the important of community and family in working with Aboriginal and Torres Strait Islander families. And the extended kinship structure which is so important and integral in terms of forming of identity and support when times are difficult and there are struggles. Creating that sense of belonging to something greater than themselves for children is so incredibly important. And is part of that relationships and friendships. Attitudes and beliefs are obviously formed in the early years and what we see is, what we refer to in psychological terms as an internal working model. And that those early years and having needs met consistently are what help to form core beliefs for children, positive core beliefs that the worlds a safe place. And that when they struggle and when they need their needs met, they will be met. And if those factors aren't in place or if some of those balloons, as you can see in front of you right now, are not filled, then what we see is that that can have a really negative outcome for child and infant mental health.

GILL: So how does parental drug and alcohol affects the mental health social and emotional wellbeing of children. So infant mental health begins in utero. Babies who are exposed to drugs or alcohol in utero are also at risk of developing a neonatal abstinence syndrome. So when exposed to multiple drugs this risk increases. And smoking has been found to cause risk to miscarriage, harm to growth and development of the baby. And quitting as early as possible in pregnancy has been advised. Moving on to the next slide there, the impact of parents with substance use in children, while substance use can affect people in different ways, depending on the substance use itself, general health, the amount ingested et cetera, people generally act and think and feel differently under the influence of substances.

So parental substance use can impact on a parent's capacity to respond to their parent's[sic] with - emotional and behavioural consistently in a positive and supportive way. Parents can be distracted or less attentive to children's needs due to the cycle of drug use and the symptoms of intoxication and withdrawal. So as children grow and develop from infancy they learn to regulate and understand and express emotion through interaction with parents and trusted adults around them.

A safe and reliable and nurturing parent/child relationship is crucial to the social and emotional wellbeing of children between the ages of nought to 12. Infants are known to communicate in ways with non-verbal language such as facial gestures and crying, very young children also communicate their needs through behaviours. Parents who use substances may not pick up on signals or behaviours that indicate that children are trying to communicate with them. And fluctuating moods can result in inconsistent parenting that at times be controlling and also neglectful at times. The unpredictable nature of these fluctuating moods can create uncertainty and sometimes undermine the parent/child relationship. Keeping this in mind can help you to understand that that impact of substance use on a parent's ability to disconnect and build a strong relationship with their child, and to also form a form of attachment in utero as well.

So routines can be structured, parents can be less engaged with their children for example, like playing stories and they may have never experienced I guess for themselves, regular routines themselves. And may not have the confidence to help children with their homework as well. I guess Sarah, you want to jump in here and talk about the impacts of parental substance use on children.

SARAH: Yeah, so I actually had the benefit of noticing the difference between two of children's behaviour. I had my daughter when I was quite a bit younger, when I was 20 years old and I started using when she was about eight months. And it, you know, in hindsight, I can look back and see how emotionally unavailable I was for her at that time. And she exhibited some of the symptoms that Lisa had mentioned earlier of the kind of being too good. You know, she was very, what's the word, like you know she just wanted to comply and she just wanted to make everybody happy. And I had my son four years ago and the situation was very different I was married and was very happy about him coming into the world and worked very hard to stay in recovery and address his emotional needs as well as his physical needs. And as a result of that I've been able like I said, I've been able to see the difference in being emotionally present and emotional unavailable and the effect that that has on children. I've also had a relapse, you know, in the last year and a half and I've noticed the difference in my sons' behaviour from when I was in recovery to when I started using again. And you know the difference is quite significant. He went from being very secure and happy, you know, to being whiny and tantruming all the time and hitting me and almost regressing in his you know, emotional development.

LISA: So looking at the impacts of parental substance use on children Sarah, did you want to talk to that a little bit in regards to the circles?

SARAH: Yeah I think we covered it with what I just said but - - -

GILL: M'hmm.

LISA: So what you were saying Sarah is really that you saw a difference in terms of how you perhaps, parented the - - -

SARAH: Yeah.

LISA: - - - kids at the time when you were under the influence of substances and that you could - - -

SARAH: Yeah.

LISA: - - - see that had a direct response in terms of how they then behaved or responded to you or others?

SARAH: Yeah, yeah I definitely had less patience, I didn't have the patience and the time and energy to you know, sit down and help them work through their emotions. It was, you know, it was just kind of – I don't know how to explain it.

LISA: It's difficult I guess - - -

SARAH: Yeah.

LISA: - - - what you're saying, difficult to be as consistent in terms of your availability to them?

SARAH: Yes.

LISA: And you saw an impact in terms of their behaviour had changed?

SARAH: Yeah and it was kind of like it bounced, like we bounced off each other, if that makes sense.

LISA: M'hmm.

SARAH: Like you know, they were more clingy and needed me more and I was less able to respond to that. So that would stress me out more and then my sort of reaction to that was to use more and to pull away. And, yeah it just kind of kept getting worse and it was a bit of a vicious cycle.

LISA: Which is really what we see on the screen in front of us at the moment. It really is a cycle.

GILL: Thanks Sarah that really illustrated that cycle really well I think. Nobody can explain it as well as somebody that's been through it in such a way. So that was really great thank you. So we're moving on to other points to consider. So – and I guess this is just that substance use doesn't always just exist in isolation which I think most people that work in the sector or who have worked with people with substance use issues would be aware of. But let's just recap anyway. So there's often things like mental health concerns, there may be family and domestic violence. But I mean also there's a lot of underlying trauma of them with people that access drug and alcohol treatment services or have issues with substance use basically. And that can impact people across all – the whole spectrum of society I suppose.

But I think when you're experiencing other disadvantages such as insecure housing, intergenerational disadvantage and poverty, you know, all of these things can really be cumulative harms that just make life so much more difficult and make it much more difficult to actually get into recovery from your substance use. And can just be additional stressors for parents which impact children of course. And if this cycle is not interrupted of course children can just develop substance use issues themselves in the future as a way of coping with the feelings of helplessness and hopelessness and trauma and all those things that they've experienced through the adversities of their childhood.

So as mentioned on the slide, other co-existing complexities often include things like physical health, long term chronic physical health concerns, intellectual and learning disabilities, cognitive impairment sometimes through long term chronic use. Low educational attainment, chronic pain I think we've mentioned. Stigma is another thing to be aware of as it's such a significant barrier for parents seeking support. You know, there's such a lot of judgment really that goes with substance use issues. And that can lead people, particularly mothers I think, to actually not seek the treatment that they really need. They're just so used to being judged and there's a great fear of you know, that continuing if you go and seek support for the substance use. Mothers in my experience anyway, seem to be more harshly judged. And I think it's around the dominant discourses around the good mum. That mum's when they have babies they're automatically going to love those babies. Know how to look after them and respond to them.

Put all their other stresses aside and focus on the baby. And of course that's not true for many, many women. It takes – it's a big adjustment to get used to having a baby in your life. But particularly if you have underlying trauma or you've got other issues that you're coping with. You know, such as financial disadvantage. You might have to do your compliance with Centrelink and I mean these sorts of stresses are huge when you're already under the pump basically. And of course all of this will be impacting children in the family. And the way that the mother or father, actually is able to attach and bond with their child. Pregnant women of course. Pregnant women that use substances probably face the strongest judgement because there's something really confronting about seeing a woman who's pregnant using substances. Sarah, yeah, yeah definitely jump in, definitely, go ahead.

SARAH: Yeah I, I have a good experience of being judged very harshly. As part of the intake process to come into Jarrah House as a resident here I needed to have a mental health report, filled out by a GP. Excuse me and I went to my local medical centre which I was a regular patient there. And most of the doctors, you know, knew me pretty well. So it was, you know, it should've been just a fairly straight forward procedure. I would like to mention, just as a bit of side note – my husband died of a drug overdose a couple of years ago and that preceded my relapse into my heroin use again. So I had, I'd been using for a few months, I was trying to get myself into rehab, I had already gone to a public clinic a public methadone clinic. And gotten myself onto the OTP. And I was stable on my dose and the GP decided to, you know, he informed me that he needed to make a child protection report even though I had already told him that the clinic had made a report when -you know I think it's just the standard procedure when someone is presenting at the methadone clinic they just ring VACs and kind of give them a heads up and you know, talk to them, what do you think? And VACs had actually said to them like we're not, we're not concerned you know - - -

LISA: So you'd had such a tragedy and you had had a relapse and then you were proactively seeking help.

SARAH: Yeah.

LISA: And you felt the response you got was quite judgmental. What could've been more helpful? I mean, what would you have preferred that GP to offer to you that would've felt less judgemental and more helpful?

SARAH: Perhaps just filling out the mental health report and you know, maybe taking my word for it that there'd already been a couple of reports made and VACs weren't concerned. Because I was actively seeking – you know, I got myself on the methadone, I was actually actively seeking to get into rehab.

LISA: So maybe some follow up care - - -

SARAH: Yeah.

LISA: - - - to follow up, make sure that your recovery was on track as opposed to kind of making assumptions at that time that you weren't - - -

SARAH: Yes.

LISA: - - - heading in the right direction.

SARAH: Yes, yeah that's right.

GILL: M'hmm, m'hmm.

SARAH: Yeah I think, yeah rather than you know, just really jumping to conclusions and oh well this mother's admitting to a certain amount of drug use, I need to call child protection because you know, the child's in imminent danger. You know the situations can be very nuanced and difficult - - -

LISA: M'hmm.

SARAH: - - - sorry not difficult different you know, every situation is different. It's, yeah it's not just a one size fits all.

LISA: You're spot on because one of the ways that we really assess risk is, how engaged is mum and - --

SARAH: Yeah.

LISA: - - - proactively seeking help, yeah and that's what you were doing. So we're going to look also now at trauma. We run a parenting program here at Jarrah House and what we've really noticed, we draw on circle of security a lot. We draw on PuP which I referred to earlier, the Parents Under Pressure program. And both those programs really acknowledge that Mum or Dad's mental health and ability to regulate their emotions has a massive impact on their capacity to be emotionally available for their children.

And when there's been significant trauma and to make a big generalisation, that after a decade here at Jarrah House working with drug and alcohol I can say that in the majority of cases people who end up with drug or alcohol struggles often are using drugs or alcohol to help to manage intense emotional affect and that's often informed by trauma.

So when we've got mums or dads who've had significant trauma and maybe have their own issues therefore and difficulties in regulating their own emotions, that can be really tricky when they're then trying to manage their children's emotions. And what we see a lot is that when mums or dads are going through difficult times the impact of certain substances can further limit their capacity to manage their emotions and they can, as Sarah's commented on already, just generally be a little bit more irritable, bit less patient and that tends to happen at a time when our children tend to be asking more emotionally from us. Because what we know is that when kids are going through unsettled times they tend to look to mum or dad or whoever's caring for them even more so for that stability and that security and that emotional availability. So it becomes a bit of a vicious cycle.

And what we do see is that sometimes that can then lead to parents being perceived as hostile or difficult where, in fact, they're actually dysregulated and what they need support with is managing their emotions. Women in particular, as Gill's already referred to, tend to get the hard stick with this. They tend to be judged more harshly because of all of the gender differences in terms of our expectations as a society of what we expect from women when they become mothers.

Women are also more likely to have experienced child sexual abuse and intimate partner violence and we see that correlation a lot here at Jarrah House. That a lot of our women who come through our program have had experiences of domestic violence which just sets them up to then have a little bit more struggle trying to manage what can be sometimes very typical early childhood behaviours of aggression and acting out. They can therefore sometimes have more difficulties in setting boundaries and forming healthy relationships and that includes healthy relationships with their children.

So trauma informed practice is being consistent with both a strength based approach and with a child focus practice. So trying to work collaboratively and create that safety between the parent and the practitioners so that parents can feel open to debrief and to talk about honestly how their relationship with their child is going.

So to what extent can children be a motivating factor for parents addressing their AOD use and I think there's no one better to answer that question than Sarah who's sitting with us here at the moment because she has a story about how her son became such a powerful motivator for her to make change and to approach Jarrah House for treatment. So did you want to comment on that at all, Sarah?

SARAH: Yeah, thanks Lisa. I – you know, as I said briefly before, you know, I'd relapsed and I was looking at – I have an older child and she lives with her father and that is because of my drug and alcohol use. I have a good relationship with her now but she – she's – yeah, she was taken from my care by his – her grandparents and I – you know, I found myself, having lost my husband had relapsed and was looking at potentially losing another child and I just – I couldn't let that happen. I was willing to do anything and I – I knew that I couldn't make the decision to go into a rehab and leave Isaac with someone else, for one. I didn't have anyone that I could leave Isaac with and you know, too, he – he wouldn't have coped with that. It was already extremely traumatic losing his father, even though he was quite young. He knew that – that something was wrong and I – like I said, I was just willing to do whatever I had to, to – to not lose my little baby. You know, he is – he has been the reason that I've gotten out of bed every day since I lost my husband, you know, and I'm just extremely grateful to programs like Jarrah House that actually enable me to seek treatment for myself and – and still have my child by my side.

LISA: And what we see a lot at Jarrah House in terms of substance use is that often women in particular I can comment on, you know, that long periods of substance use can erode that sense of self-esteem and that sense that they deserve a life that's more worth living, and so sometimes the way in for professionals is through that motivation of doing it for the kids and then what we hope and I think what, Sarah, you probably found here at Jarrah House - - -

SARAH: Yes.

LISA: - - - is that then you find recovery for yourself.

SARAH: Yes.

LISA: So recovery is not just about doing it for the children but that's a way in and we see that a lot in terms of using that as a motivating factor. So in order for that to be a motivating factor we have to work collaboratively with parents and we have to acknowledge them as parents and we have to keep children very much in mind even when we're working with the adult clients.

YINKA: Thanks, Lisa. So in what way does support for parents increase possibilities for addressing problems faced by children and families? Practitioners who work with adult focused services are well placed to make a positive difference in children's lives by adopting a child focused practice. Children's social and emotional wellbeing can be supported and it can be buffered by the impacts of parental substance use. For older children this can be achieved when parents are able to have conversations with their children about the difficulties they're facing which breaks the, I guess the culture of secrecy that often occurs in families where a parent has a substance issue.

Parents may feel significant guilt and shame about their parenting when it – can be very disempowering for some parents and I guess a child focused practice can help parents to build on their strengths and address challenges which in turn will strengthen the family overall. Working with parents who feel shame often offers opportunity to discuss what hopes and dreams they have for their children. Shame is often an indication of a gap between these hopes and dreams and what's actually reality and if a professional like ourselves can work from a place with curiosity in a way that offers support for parents and support the cause of these gaps and can help them make some kind of plan long term.

And I guess, Sarah, we've spoken a lot about kind of services you're able to access in the community and there's probably one or two services that worked kind of more in your favour than others.

SARAH: Yes.

YINKA: Would you like to talk to that?

SARAH: Yeah. I – I have found – can I name them, the service? Yeah, so there's – there's one - - -

GILL: Maybe not the ones that weren't so good.

SARAH: I wasn't going to go there. No, I was just going to mention the – the Junction Neighbourhood Centre in Maroubra Junction has been absolutely fantastic. They provide a real wraparound support and you know, that's – that's what I found was most helpful. Having someone – I had someone explain it to me that because I had FACS involvement and then they handed it over to Brighter Futures and they explained it to me that Brighter Futures was, in a sense, an advocate for Isaac and the Juncture Neighbourhood Centre was an advocate for me. They were, you know, someone that was supportive for – for me and that, you know, they would help me kind of get back on my feet and you know, they helped me with – with a range of – of different things. You know, from like financial advice to parenting tips to you know, not being able to take Isaac to swimming lessons, so driving me there. Sitting down and helping me open a bank account because I was really anxious about doing that and not knowing how to – how to do it without, you know, stuffing up. I wanted to make sure that I was getting the best deal with my bank account and my savings accounts. And you know, there was no kind of job that was too silly or too small for them to be helping me with and that's what I found was most useful.

LISA: So what you're saying is that what worked for you is a service. It was a bit of one stop shop.

SARAH: Yes.

LISA: And it was practical.

SARAH: Yes.

LISA: And it was able to look at the bigger picture.

SARAH: Yes.

LISA: Rather than individual specialised services that took you from pillar to post and you went to too many different appointments - - -

SARAH: Yes.

LISA: - - - and in the end didn't have milk and bread.

SARAH: Yep, yep.

LISA: Yep.

SARAH: Because yeah, for someone that has anxiety and depression, you know, if you have 10,000 appointments it just all seems too much and that's how you end up with no milk and bread because you don't get up and you know, go and - - -

LISA: And everyone assumes that someone else is doing it.

SARAH: Yeah, yeah. Yeah.

YINKA: Thank you so much, Sarah, for sharing that. Thank you. So – so how can a child focused conversation with parents identify and strength protective factors for their children? Respectful practice can sometimes be challenging where parents exhibit hesitancy. The parents can appear, I guess, secretive although they're putting substance ahead – like so they're putting their substance ahead of their children in some ways. This demonstrates in respect where their hesitancy is challenging but can still be possible within the context of a child focused practice.

So then looking onto the next slide there. How can child focused conversations with parents identify protective factors for children? Collaboration is key here. Using a strength based and hopeful approach supports parents to recognise their strengths where things are going well in their relationship with their children. Parents of substance use can sometimes leave – parents to – to develop this strong internal critique leaving them unable to see the positive in anything.

Building on parents' self-efficacy helps them think about possibilities for strengthening their relationship with their children. A collaborative approach (indistinct) for supporting parents to develop a constructive relationship with Child Protection workers and which in turn, I guess, empowers them in a way that where they want to make the contact and make reports on progress. This approach to working with parents focuses on A parents' skills and resources rather than on their shortfalls and their limitations.

LISA: And I guess to refer to the last slide, we can't shy away from making Child Protection reports. It's part of our responsibility as professionals when we're working with families. But as the slide states and as, I think, Sarah's shared with us clearly here today, doing that collaboratively and with follow up care is really important and recognising where the parent is at. If they're at a point of engagement and they're radically making changes that's not the best time to be making reports where it feels punitive. That's where collaborative care and follow up care can really be much more useful.

GILL: And that's the end of our formal part of the presentation.

CHRIS: Great, thank you.

GILL: You can ask questions.

CHRIS: Yeah, thank you very much Gill and Lisa, Sarah, Yinka. We've certainly had a number of questions coming through and comments really acknowledging all of your contributions including Sarah's so thank you. But yeah, I'd like to sort of relay to you some of the questions that have been coming through, relay to the panellists. Gosh, where do I start? There's a question really in relation to when practitioners are working with – are responding to parents who are living with that stigma that you referred to earlier and are living with kind of strong judgment about their circumstances and there's been some questions a bit about – a bit more about how practitioners respond to this. How do you kind of get off to a good start so that the stigma and the judgment doesn't get in – get in the way of your work? You know, what kind of enables a – what early on enables a good start? What good practices can be employed?

GILL: Do you want to talk to that Lisa?

LISA: I'm thinking in terms of where we start here at Jarrah House.

CHRIS: Yes.

LISA: When – when mums arrive here at Jarrah House with their children, quite often we can see a lot of problematic behaviours in the children and mum will often report that you know they're not coping, that the child is having a lot of tantrums or lots of acting out behaviour and they don't really know where to start. And we use a tool here called KIPS which is the Keys Interactive Parenting Scale. And that looks at 12 key behaviours and it's a strength based tool. We video mum and child having a play for about 20 minutes and then we use that video footage to actually show mum what's going well. Because there's always something, whether it's just the way that they share a moment of delight in the 20 minutes, or whether it's that mum makes ongoing attempts even when it's difficult to try to sit next to the child and engage in play even if the child is acting out and they're needing to set limits at the same time.

There's always something positive to pull out. And then from that place of strength and focus on the positive we might choose just one area of the growth. And it's always helpful to employ the parent in those conversations and find out what they are wanting to change. So where are they in terms of the cycle of change, are they ready for change, are they seeing it as a problem. As opposed to the professionals telling them it's a problem. And you can guarantee that if a parent is presenting and disclosing substance use, they're seeing it as a problem. So not shying away from that, not being afraid to notice that parenting can be impacted negatively by substance abuse, giving parents an opportunity to speak to that. And then also drawing out their strengths and their courage in terms of seeking treatment. So just coming from that point of view of seeing what's going well, at the same time as looking at areas of growth or change.

GILL: Can I just quickly speak to it from a mainstream drug and alcohol treatment setting.

CHRIS: Sure.

GILL: So you know we would often have women, mainly women I guess who would turn up at the service with often quite difficult behaviours. So it might be quite aggressive, defensive, hostile, and that could be really judged, very easily to judge that. And I think the importance of a trauma lens is just so important in actually engaging women and – and some men as well, you know in treatment basically. So that's you know the stigma and the trauma behaviours I guess it's all about a nonjudgmental accepting, warm, genuine kind of approach to really build up some trust in the relationship. And to me that was the best way of actually engaging people into treatment.

LISA: And sometimes it is actually giving mums permission or dads, to say out loud that parenting is not something that they can continue to do day to day in that time, you know that maybe it's about conversations of looking at kinship structures and supports. So actually be willing to have that conversation because I think again as professionals sometimes we can shy away from that conversation. But sometimes it is actually to make it okay for the mother or the father to announce that you know at that time maybe they're not in a situation where they can continue to do the day to day caring and that they do need a bit of respite. Whether that's through - formally through the system, the Child Protection system, or through Kinship structures until they can get back on their feet again. Because what we know is that detoxing and you know going through rehabilitation and getting into early recovery with children alongside is challenging and we see that here. And sometimes it is about mums exploring other options, or dads.

CHRIS: Sorry Lisa, how do you kind of create a context for parents to be able to speak in those – on those terms though, you know to be able to sort speak to what you've just said and saying those things out loud? Like what contributes, what can services do to contribute to make it more possible thing for parents to speak.

LISA: I think it's about having those radical conversations and recognising just like we've talked about recognising children's behaviours as a cry for help or as an explanation for what might be happening with their mental health, recognising the same for adults. So when adults are acting out or disengaging from treatment or you know threatening to leave the program if it's here at Jarrah House, you know recognising that sometimes that is actually giving us the message that they're not ready, they're not quite ready to be here in treatment. And you know often the women who come through our program here already have Child Protection involvement and they know what it means if they walk through – out the door. And yet they're choosing to make the decision anyway, so allowing them that space and recognising that right now is maybe not a time where they can remain in recovery. They're not ready or able to give up substance use and that it already is about opening up those dialogues and exploring options for safe caring for the children in the meantime until they are in that space.

SARAH: That actually kept me here at Jarrah, um, I came back for a short stay for a few weeks and both times I didn't have – I don't think I had like specific four kind of full on FACS involvement but um you know I was aware that it would highlight to FACS that wasn't ready as such to do what I needed to do. And that was very apparent to me, you know that if I chose to discharge myself and that could be seen very negatively and I chose to stay. I many times packed my bag and then had to go and unpack it again two hours later because I decided that I actually needed to be here and that was the - my child was the most important thing going on at the bottom of everything.

CHRIS: Thank you Sarah. Yes and so Lisa for your response to that question. There has been a couple of other questions at least around the link I guess between parental substance use and trauma and Gill you spoke a bit earlier about bringing a trauma lens to this work and you know how among other things a nonjudgmental approach can contribute to building trust in the relationships. Does the trauma lens in your experience and your service's experiences, does that also shape kind of where you put the focus, what the sort of things you ask about or enquire about in any way as well that would be helpful for services to keep in mind?

GILL: Yes it does. I mean it underpins definitely underpins most practice really from you know and that's from a mainstream drug and alcohol setting that most people, or many, many people that walk through the door certainly have underlying trauma. So it's about sort of you know trying to create that place of safety and trust and adapting the service as far as possible to meet the person's needs where they are. And that is possible. So the small things can be done that can actually make somebody feel much more willing to engage or happy to engage, trusting to engage. And that might be things like additional follow up text conversations, quick chats in between appointments. It might be additional appointments. It might be sort of really talking to the person about you know what else is going on in your life.

CHRIS: Right.

GILL: If you're experiencing insecure housing, Centrelink compliance, don't have enough money to put any food on the table, don't have clothes then they're not going to start to be – well they're just not going to be able to start any therapeutic work. So it's also about being really mindful of those basic case management-ey type things that will actually take some of the chaos and pressure off for somebody to engage with treatment.

CHRIS: How important is that do you think to put that focus on that broader context given that often I guess a number of the people you will work with, the trauma is not past is it, it's kind of present.

GILL: Yes.

CHRIS: And they often say women are living in a context where they're quite vulnerable or ongoing suffering or oppression. Like do you – I'm interested in kind of what you've noticed about the difference those what you've just described, those kind of conversations can make for women and I guess for the practitioners working with them to be able to have those conversations.

GILL: Well I think they're essential because you're meeting the person where they're at rather than using your own agenda of where you think they should be going and what they need to focus on, it's really about listening more to the stressors in their lives and doing what you can to help. I mean obviously you're not going to be able to find houses or things like that necessarily but there's always something you can do that you know can help to start to mediate some of those initial stresses and crises that come with an initial engagement. And that also builds trust. When somebody feels like they're actually being listened to, then they're far more likely to keep coming back because these initial real you know really valid stressors in their lives are actually being listened to. And somebody is doing something about them. I mean I remember having a woman come in who'd lost her phone charger and it was as simple as being able to charge the phone.

CHRIS: Yep.

GILL: You know, just little things like that, find somebody else in the office that's got a phone charger and charger her phone for her, you know that might not be part of core business but it does – it's really easy to do. And there are many little things like that that can make a big difference really.

CHRIS: Yes thank you. Yeah that question of mine was based on a question from one of the participants in the webinar, so thank you for that. We're nearly out of time but I just wanted to ask a question too that's come through around how long term chronic use of substances can sometimes lead to cognitive impairment in parents which can in turn I guess limit sometimes people's capacity to participate fully in the programs or the services that are on offer. Like with this in mind how does this kind of – how does this affect practice or service delivery. Are there ways that this can be accounted for that don't kind of exclude people in some way?

LISA: We include a cognitive remuneration program here at Jarrah House for that exact reason.

CHRIS: Okay.

LISA: We don't even really know the long term impacts of methamphetamine use at this point. Alcohol it's sort of already emerging I guess in terms of the impact but other substances it's you know, we have less knowledge at this point. But what we do see anecdotally is that women have more chronic issues with emotion dysregulation, they're more likely to be impulsive in their behaviours, higher levels of irritation, less tolerance and patience. And all those things impact in terms of being a parent. Not to mention obviously the capacity to learn. So what we've found is that women definitely need intervention and there's services out there. We can do the MoCA assessments to work out if there's cognitive impairment but what we know for sure is that the brain is also able to regenerate. So getting mums and dads into treatment, getting them access to clean recovery time allows them to have the opportunity for that regeneration to occur. So that's a good starting point.

In terms of working with those behaviours in the meantime, we use the program of dialectical behavioural therapy here which we find to be very effective in working with women who do have cognitive impairment because it focuses very much on distress tolerance and emotion regulation skills. Which is often what's lacking, it's a skill deficit and then there's also the cognitive impact. So it's hopeful, it's not that that impairment has to be a permanent state and that it's not workable. But it is acknowledging that you are working with a level of I guess skill deficit whether that's a cognitive deficit point of view or whether it's also learned behaviours or the lack of opportunity to learn coping behaviours in the early years. But all of that adds complexity in terms of engaging people into treatment and keeping them in treatment and keeping them in recovery.

CHRIS: Great thank you. Thank you Lisa. Thank you. We need to actually finish the webinar there. So again I'd like to thank each of our - - -

GILL: Chris, before you finish, sorry can I just quickly mention and give a plug to Emerging Minds resources around a child focus practice with parents with substance use issues.

CHRIS: Definitely.

GILL: So there's some brand new set of resources on our website which are freely available and that's all thank you very much.

CHRIS: Yes and there'll be links available to that website as well on the CFCA web page. So no, but thank you for stating that Gill. Thank you Gill Munro, Lisa Hofman, Yinka Olaitan and Sarah Kendrick for your contributions to our understanding of this issue today. And thanks everyone for tuning in, for attending virtually this webinar and yes please follow the links on your screen and complete the survey as well. And yeah we look forward to you joining us, us joining you again next time. So thank you.

WEBINAR CONCLUDED

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Slide outline

1. Working with parents affected by alcohol and other drug use: Considering the needs of children in practice

Gill Munro, Lisa Hofman, Yinka Olaitan, Sarah Kendrick  
CFCA Webinar 16 October 2019

2. Working with parents affected by alcohol and other drug use: Considering the needs of children in practice  
Gill Munro, Emerging Minds  
Lisa Hofman, Jarrah House  
Yinka Olaitan, Jarrah House  
Sarah Kendrick, Lived Experience Advocate

3. Acknowledgement

We recognise the land on which we meet today and pay respect to Aboriginal and Torres Strait Island Peoples, their ancestors, the elders past, present and future from the different First Nations across this country.

We acknowledge the importance of connection to land, culture, spirituality, ancestry, family and community for the wellbeing of all Aboriginal and Torres Strait Islander children and their families.

4. Today’s agenda

Panel presentation:

• Definition of child mental health and what is supportive
• Impacts of parental substance use on children and other points to consider: Coexisting complexities, stigma and trauma
• Children as a motivation for change
• Impacts on children and families of support for parents
• How child focused practice can identify and strengthen families
• Questions

5. Workshop objective

Understanding the impact that parental alcohol and other drug use may have on parenting and children's social and emotional wellbeing and the role we can play in supporting the mental health of children.

6. What do we mean when we say child mental health?

Child mental health can also be referred to as the child’s social and emotional wellbeing. Most infants and children experience good mental health – they can meet challenges, express and regulate a range of emotions, explore their environment, and form secure relationships, all within the context of their age and developmental stage.

7. The PuP Integrated Theoretical Framework 
© Parents under Pressure www.pupprogram.net.au

Text description: This is an graphic depiction of ecological model called the The Integrated PUP Framework- PUP stands for Parents Under Pressure.

The outer circle depicts connections with community, family and culture and includes positive supports Neighbourhood resources, Daily duties, financial strains, housing problems, availability of drugs and employment.

The circle within depicts parental emotional regulation: ranging form acute situations to chronic issues. Emotional states include: relaxed, frustrated, calm, hostile, mindful, impatient, tolerant, irritable.

The innermost circle depicts behaviours and beliefs in the top half of the circle that impact child developmental outcomes including: parenting values and expectations, disciplinary strategies, monitoring and family routines. The bottom half of the inner circle depicting parental emotional availability and secure attachment.

Running through the middle of all three circles is a Childs temperament and developmental outcomes that include: physical, behavioural, emotional, social, intellectual, moral, spiritual and cultural outcomes.

8. Mental health difficulties in infants and children

• Might present as frequent or intense struggles with their emotions, thoughts, behaviours, learning or relationships
• May find it challenging to be separated from their parent
• Have problems with sleeping, eating, excessive crying, or engaging with school and their community
• Over-compliance, a need to please, and parentification are all often-overlooked signs of mental health difficulty in children
• Disassociation/shut down response/hypervigilance

9. What supports child mental health?

10. Social and cultural factors that impact a Child's wellbeing

Text description: Silhouette of a child carrying a bunch of balloon with words for different social and cultural factors that impact a child’s wellbeing. These factors include: community, family, relationships, friendships, attitudes, beliefs, interests, education

11. How does parental AOD use affect the mental health and social and emotional wellbeing of children?

From conception through the lifespan

• There is no safe level of alcohol consumption during pregnancy or whilst breastfeeding, and even a small amount of alcohol can harm the baby’s development and have lifelong effects.
• Drug, alcohol and tobacco use in pregnancy is associated with significant harm to mother and baby.
• Alcohol and most drugs will travel through the placenta into the baby’s blood stream.
• It is important to seek professional advice on how to stop using in a way that is safe for both baby and mother.

12. Impacts of parental substance use on children

The presence of substance use does not always mean that parenting is inadequate, but it does pose risks to infants and children such as:

• Trouble with bonding and attachment due to the (using) parent’s reduced emotional availability³
• Increased possibility of exposure to verbal abuse, inappropriate behaviour, and unsupervised or unsafe situations⁴
• Disruptions to family routines, leading to decreases in school attendance and academic achievement⁵

13. Impacts of parental substance use on children (part 2)

• Children may take on a parenting role for their parents and siblings ⁶
• There is more risk of separation due to parental hospitalisation or imprisonment
• Children may develop behavioural, emotional or cognitive problems
• They might blame themselves for the problems in the family
• Social exclusion and isolation can occur for the children and family

If there is no early intervention it can result in transmission of intergenerational patterns of substance use and/or mental health difficulties.

14. Impacts of parental substance use on children (part 3)

Text description: The images and arrows demonstrate the way parental substance use affects a parents mood, attention, response and engagement with their children which intern affects how the child/children respond to the parent which intern affects how the child behaves towards the parent, themselves and others which intern affects the way the parent responds to the child. This cycle can become quite negative and intern lead to an increase in parental substance use.

15. Other points to consider: Coexisting complex issues

Substance use, mental health concerns and family and domestic violence (FDV) are factors most commonly associated with child protection concerns. These factors frequently coexist and, along with trauma, insecure housing, intergenerational disadvantage and poverty, can indicate a child is at risk of developing substance use issues themselves in the future. ²

Other coexisting complexities often include:

• physical health concerns, intellectual and learning disabilities, cognitive impairment, low educational attainment and chronic pain.

16. Stigma

• Stigma can be a significant barrier to seeking support for parents due to judgement that they often experience or fear because of substance use.
• Mothers can be even more harshly judged due to dominant discourses around women as carers, nurturers and stereotypes of the ‘good mum’.
• Pregnant women can face the strongest judgement for similar reasons and for the perception that the mother ‘chooses’ to preference substance use over the health of her child.

17. Trauma

Trauma symptoms can cause parents to be perceived as hostile, ‘difficult’ or resistant to treatment and support. Other factors to consider:

• Difficulties with emotional regulation
• Gendered differences - women more likely to experience child sexual abuse and intimate partner violence
• Difficulties setting boundaries and forming healthy relationships

Trauma-informed practice is consistent with both a strengths-based approach and with child-focused practice - both involve a collaborative relationship between the practitioner and parent.

18. To what extent can children be a motivating factor for parents addressing their AOD use?

• Children are often a powerful motivator for parents to make changes
• Many say that they would love to make changes for their children’s sake
• They often state they want more for their children
• Many are referred by child protection services

Working in a child-focused way can support parents to break intergenerational patterns of substance use.

19. In what ways does support for parents increase possibilities for addressing problems faced by children and families?

• Child focused practice will support parents to develop insight into how their substance use affects their children.
• Support for parents and families can highlight strengths, build upon them and reduce the impact of parental substance use on children.
• When parents get the support they need, there is a greater possibility that any problems the child and the family may be experiencing will be addressed.
• Earlier support for a family can help to divert them away from involvement with child protection services, thereby helping to keep families intact.
• Parent-sensitive practice may assist in understanding the barriers that can affect the success of a client’s treatment, such as parenting stresses that can trigger relapse.

20. How can child-focused conversations with parents identify and strengthen protective factors for children?

• Child-focused practice is a collaborative approach where practitioner and parent work as a team.
• It is a strengths approach that supports parents to recognise their own strengths and resources and ways in which things are going well and to build self-efficacy.
• It also explores and highlights other supports in the child’s life – extended family, friends, clubs, community, school, cultural or spiritual connections, beliefs, attitudes.
• Respectful practice assumes parents want the best for their children and helps them to become clear about how they can improve children’s wellbeing.

21. How can child-focused conversations with parents identify and strengthen protective factors for children?: Child protection concerns

• Some parents may be worried about what they tell you in case you need to make a child protection notification. In some cases, this is obviously unavoidable.
• Child and family partners at Emerging Minds report that open and transparent conversations about consent and the limits of client confidentiality at the start of treatment can make parents feel much clearer about what they will disclose.

22. Thank you

2 https://elearning-demo.emergingminds.com.au/masterBlock/course-18/view/module-1/page-5

3 https://elearning-demo.emergingminds.com.au/masterBlock/course-18/view/module-1/page-6

4 https://elearning-demo.emergingminds.com.au/masterBlock/course-18/view/module-1/page-6

5 https://elearning-demo.emergingminds.com.au/masterBlock/course-18/view/module-1/page-6

6 https://elearning-demo.emergingminds.com.au/masterBlock/course-18/view/module-1/page-6