Maternal Substance Misuse, Child Welfare Practice

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Maternal Substance Misuse, Child Welfare
Practice Intersectoral Collaboration

• learning from international experience in
  building local practice innovations
• Kerry Moore
• Barnardos South Coast Centre
• Wollongong NSW

kmoore_at_barnardos.org.au [phone]
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Introductory Comments

• Presentation to move between the local project
  level and international practice
• unanimous opinion in literature and with
  practitioners that the rate of maternal substance
  use is growing at an alarming rate
• babies born to drug dependent women at high risk
  - impacts of drugs, poverty and trauma

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Critical influences on international programming

• Fundamental attitudes to motherhood and pregnant
  mothers who misuse drugs
• political, legal, health and welfare service
  approaches to illicit drug use eg harm
  reduction vs abstinence models

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• The role of the state in provision of welfare
  services, income support, and broad based early
  intervention and prevention services

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• Where does parental substance misuse stand on the
  national agenda
• ?

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SUPPS

• Substance Use in Pregnancy and Parenting Service

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Substance Use in Pregnancy and Parenting Service
(SUPPS)
BARNARDOS NORTHERN ILLAWARRA FAMILY
SUPPORT SERVICE
SOUTH EAST SYDNEY ILLAWARRA HEALTH
SERVICE(SESIAHS) DRUG ALCOHOL, MENTAL HEALTH
SERVICES SESIAHS MATERNAL PAEDIATRIC
SERVICES WOLLONGONG HOSPITAL
DEPARTMENT of COMMUNITY SERVICES
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The Evolution of SUPPS

• SUPPS - the original pilot Health
  partnership
• - established 2001- Maternal and Paediatric,
  Drug and Alcohol Services nursing team

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The Evolution of SUPPS

• 2002/2003- Barnardos and Northern Illawarra
  Family Support Service joined the team
• 2 NGO Family Support services dedicated their
  service delivery to SUPPS
• DoCS has evolved as an integral partner in the
  team

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THE SUPPS MODEL ANTE NATAL STAGE
Identification and Referral Stage Primary and
Secondary Referral Agencies
Engagement Stage Drug and Alcohol, Maternal and
Paediatric, Mental Health Services Barnardos,
Northern Illawarra Family Support, Dept of
Community Services Any of the team act as first
port of call for referrals
CASE MANAGEMENT PHASE
DISCHARGE
Weekly SUPPS team in clinic
Monthly SUPPS team including DOCS - early
intervention and child protection
34 week planning meeting child and family nursing
service introduced to team others as needed
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• SUPPS ANTENATAL MODEL
• INTEGRATED PERINATAL CARE
• (broadening the base of integrated
  multidisciplinary antenatal service delivery to
  other vulnerable families)

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SUPPS MODELPOSTNATAL/EARLY YEARS PHASE
5 YEARS

• Discharge meeting
• 3 monthly reviews using case management approach
• core antenatal team evolves to include Child
  Family nurses, mental health, Family Support,out
  of home care, child care, housing services etc
• case plan evolves towards more mainstream service
  involvement

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SUPPS MODELPOSTNATAL/EARLY YEARS PHASE

• Evolving teams defined by child/family needs
• team approach continues with collective decision
  making as opposed to silo decision making
• childs safety, stability and development
  continue to be central priorities

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SUPPS MODELPOSTNATAL/EARLY YEARS PHASE

• SUPPS Playgroup has become the postnatal hub of
  the service
• Partnership between Barnardos and SESIAHS Drug
  Alcohol service
• D A counsellor, Family Support worker Child
  Care worker
• Sustains successful engagement function of SUPPS

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Family Support.

• facilitates more flexible service delivery to the
  women
• acts as a conduit between the hospital and the
  community
• assists the women to get to their antenatal
  appointments
• provides a continuum of care from pregnancy to
  age 3 years

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Family Support.

• Provides a broad range of psycho social services
• promotes permanency planning for babies who can
  not live with their parents
• works as part of the hospital team in the
  antenatal clinic

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Family Support.

• Most importantly, Family Support maintains the
  focus of the team on the needs of the child
  within her family and environment

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Evaluation

• Child and family development and welfare outcomes
  added to original health only data
• Early data indicated improvements in maternal and
  baby health outcomes at birth
• Child removal outcomes shortly after birth
  reduced from 22 to 14, after 1 year of Family
  Support involvement - initial indicator only

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Setting the Scene

• 18 to 35 years is a critical age category for
  illicit drug usage and bearing children
• 80 to 90 of women using opiates intravenously
  are of child bearing age

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Setting the Scene

• Substance misuse is one of the main reasons for
  the increasing number of children in the child
  protection system
• In NSW, in 80 of child abuse reports drug and
  alcohol abuse was present (2002)

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Setting the Scene

• Parental drug use is one of the most serious
  issues confronting the child welfare system in
  the past 20 years..Future trends of parental
  drug use are likely to continue to adversely
  affect out of home care, with an increasing
  number of children requiring specialised, long
  term supports(Time to Invest report, 2002)

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Setting the Scene

• NSW Ombudsman report of reviewable deaths 2004
• Of the 72 children who were known to DoCS and who
  died in 2004, 30 (42) were the subject of a risk
  of harm report where the reporter identified drug
  or alcohol use as an issue

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Setting the Scene

• Chronic illicit drug use is commonly a symptom
  of a life comprising many traumas, recurring
  violence and deprivation
• Time lines of drug use and child development in
  conflict

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Setting the Scene

• Inconclusive research on direct impact of illicit
  drugs on the developing foetus
• It is clear from the evidence however, that the
  drug use cannot be separated from the environment
  in which the mother lives

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Setting the Scene

• Impact on the babys rapidly growing brain of
  poor parenting and violence

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Universal Recommendations for Maternal Substance
Misuse Models

• Comprehensive multidisciplinary teams across
  adult and child focussed services
• (see National Clinical Guidelines for the
  Management of Drug Dependency during Pregnancy,
  Delivery and the Early Years of the
  Newborn,2005)

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Universal Recommendations for Maternal Substance
Misuse Models

• Sustained and seamless service delivery across
  continuums of care
• throughout the early years of development

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International Lessons

• To examine projects which aim to prevent drug
  and alcohol related harm to the health and well
  being of the unborn baby, and improve the
  parenting skills of women engaged in drug
  treatment, starting during pregnancy and
  continuing through the childs early years

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Co-located Services

• Sheway- Vancouver, Canada
• large community located comprehensive
  multidisciplinary team
• pregnancy outreach service in Canadas poorest
  community
• staff from 3 agencies including statutorychild
  welfare, maternal and community
  health,medical,welfare,nutrition,social
  support,infant mental health
• prenatal to 18 months

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Co-located Services/Attachment

• Breaking the Cycle (BTC) - Toronto, Canada
• collaboration of 7 govt and non-govt
  servicesone stop shop
• addresses maternal addiction and the
  mother/child relationship in a comprehensive,
  cross sectoral model
• attachment relationship pivotal
• mix of centre home based service delivery
  from pregnancy to 6 years

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Attachment

• PRO Kids - Hartford, Connecticut,USAPromotes
  Resilience Optimal development
• hospital clinic based with strong attachment
  andrelationship focus
• parent/child relationship is the client
• family support home visiting and group work with
  child development/relationship curricula a focus
• regular child development and attachment
  assessment from birth to 5 years

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Collaborative Early Intervention Planning

• Vulnerable Babies Pilot (VBP)- Manchester,
  England-no mandatory reporting in
  UK-implemented in response to child deaths
  review-early multiagency case planning for
  vulnerable antenatal families and children under
  12 months

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Collaborative Early Intervention Planning

• VBP-referral criteria include substance misuse,
  dv,homelessness,social exclusion,mental health
  concerns, criminal justice involvement,developmen
  tal disability-voluntary-collaborative agency
  participation-case planning meeting convened
  within 2 weeks-develop package of support

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Social Disadvantage Impacts on Birthing Outcomes

• Womens Reproductive Health Service (WRHS)
  -Glasgow, Scotland
• Social model of health -in response to Glasgows
  very high levels of poverty and drug use
• comprehensive integrated continuum of
  reproductive care with addictions and social
  welfare services
• vulnerability and social disadvantage referral
  criteria
• case planning and assessment framework based
  using common assessment tool

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Social Disadvantage Impacts on Birthing Outcomes

• Womens Reproductive Health Service
• promotes engagement with hard to reach women
• emphasis on community outreach
• Neonatal Abstinence Syndrome viewed as a
  manageable transitory condition and placed in the
  context of the familys social environment

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Political Cultural Contexts of Services

• United States - time limited welfare- fee for
  service medical care- strongly residual welfare
  system- criminal sanctions for drug use in
  pregnancy- high child removal rates of babies
  testing positive to illicit drugs- zero
  tolerance approach to illicit drug use

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Political Cultural Contexts of Services

• United Kingdom- harm reduction philosophy- no
  mandatory reporting- high level of social
  service support to prevent out of home care
  placement- use of Framework for the Assessment
  of Children in Need and their Families common
  assessment tool throughout UK

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Where is Parental Substance Misuse on the
national agenda?

• Perinatal substance misuse and the impact of drug
  and alcohol misuse on children are firmly on the
  national agenda in the UK
• Hidden Harm -responding to the needs of problem
  drug users. Advisory Council on the Misuse of
  Drugs,2003, UK government
• Getting our Priorities Right-Policy and
  Practice Guidelines for working with children and
  families affected by problem drug use. Scottish
  Executive, 2003

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THANKYOU!