Moving into Family Inclusive Practice

1. Moving into Family Inclusive Practice Sian Kennedy - Bridging the Divide project officer, Family Drug Support 1

2. Overview • Introductions • Family systems theory • Assessment skills • Assisting families to understand drug use • Coping strategies for families 2

3. Family Drug Support MISSION STATEMENT To assist families throughout Australia to deal with drug issues in a way that strengthens relationships and achieves positive outcomes PHILOSOPHY Our energies are given in primarily supporting families struggling as a result of drug use. We aim to assist in any way possible to empower families to cope with the realisation of their situation and survive intact 3

4. FDS continued • CEO - Tony Trimingham AOM • Established in 1997 • Largely peer-based with some professional staff • 24/7 support line: 1300 368 186 • Support meetings held in NSW, QLD, ACT & VIC • Stepping Stones to Success course for families 4

5. Bridging the Divide • Bridging The Divide funded by Department of Health & Ageing (DoHA) • Increasing treatment opportunities and resources for families affected by AOD issues • Providing resources for workers within the AOD Sector • Increase capacity of AOD treatment services to respond to the needs of families 5

6. And me... • 10 years experience in the alcohol & other drug sector in Victoria • Worked in a variety of roles: detox units, residential rehab, supported accommodation, counselling as well as specialist consulting roles within child protection, psychiatric services & homelessness services • Particular interest in training & education - taught certificate IV in AOD work for years through Odyssey House & Victoria University & currently teach Bachelor of Social work at RMIT (in my spare time ;-) 6

7. Is it my job? • ‘core role only’ (‘it’s not my concern’) • ‘core role plus assessment of ‘other needs’, leading to referral’ (‘it’s a concern but someone else’s job – refer on’) • ‘other needs incidental but unavoidable’ (‘not my core role but I have to do it’) • ‘other needs’ intrinsic part of core role (‘it’s part and parcel of my job’) (McCaughey et al 1977) 7

8. Family Systems Theory “But I’m not a family therapist”... 8

9. What is family? • Family is a basic unit of understanding ourselves in society • Many people, not just our clients, spend much time trying to make sense of their own family experience • In Australia, two parent households with dependent children makes up about 1/3 of Australia’s families (ABS 2008) 9

10. Families often subject their own members to discrimination & oppression, and that families in turn, particularly those you are likely to encounter in your services, experience discrimination & oppression, in a pattern of oft repeated cycles. 10

11. Overwhelmingly, though not exclusively, being in a lower socio-economic bracket makes families more likely to have intervention from services & workers.The experience of ‘family’ is often challenging for most of us. 11

12. What are some of these factors? 12

13. Systems Theory • Systems theory focuses on individuals as part of a system • Incorporates the social with the psychological elements of practice • Systems interact with each other • Families are their own discreet system, operating as part of much larger societal systems 13

14. Types of systems • Natural systems: families, colleagues, friendship circles • Formal systems: trade unions, self-help groups • Societal systems: hospitals, schools 14

15. Mo D Fa S A description of a very basic family system 15

16. Systems are entities with definable boundaries & resources are more often shared within than across those boundaries Closed & open systems – as workers/women/men/Aboriginal/non-Aboriginal/family members etc some systems will be closed or open to us, depending on our own roles Systems have structure 16

17. Steady state: can incorporate change without changing its fundamental identity 17

18. Homeostasis: ability to maintain fundamental identity, even though external resources will alter us 18

19. Differentiation: that systems will grow more complex over time as new components are added 19

20. Non-summativity: systems are worth more than the sum of their parts 20

21. Reciprocity: if one integral part of the system changes, that change affects all the other components. Hence, they all change. 21

22. Some psychological theories Ones which apply to how we relate to others 22

23. Trauma Theory • Attributed to witnessing disasters, violence, assault, destruction, near-miss incidents & other mayhem • Creates a lasting sense of helplessness, vulnerability, loss of safety & trust • Lasting neurological impact , particularly in children • Intergenerational impact is poorly understood, often re-victimising survivor’s children (Stolen Generations & subsequent generation) 23

24. Evidence exists that parental trauma impacts on the ability to parent, despite a parents’ often best attempts to mask it • Trauma theory is not merely the diagnosis of PTSD as we are concerned with how trauma impacts on social interaction 24

25. An important distinction • PTSD is the description of a cluster of symptoms arising from exposure to a terrible event • PTSD is more common after an event caused by other people • PTSD is an Anxiety Disorder • Despite high probability of exposure to some form of trauma, PTSD is a low-prevalence disorder (~8% population) 25

26. All that said, people who have been in out of home care have higher rates of PTSD diagnoses than returned soldiers 26

27. Attachment theory • John Bowlby (1951) • Describes the relationship between caregivers & dependents, most commonly parents & children • First described during WWII & the experiences of children orphaned • Secure, avoidant, anxious & disorganised attachment 27

28. Attachment basically means a secure bond of affection between people • Important to understand that humans are interdependent – our social adaptability is one of our strongest evolutionary traits • Humans are one of the slowest mammals to mature • Secure attachment builds the confidence to be independent 28

29. 29 Ainsworth et al (1978)

30. Attachment theories are important when understanding our adult clients • Attachment types are reasonably stable, unless adult relationships heal earlier attachment issues • We understand ourselves largely through our social interactions & we understand others through our understanding of ourselves • In assessment, we use attachment to explore current relationships, family of origin & environmental stressors 30

31. Mo D Fa S significant prison time sexualised behaviours survivor childhood sexual assault conduct disorder Remember our white, nuclear, heterosexual family from before? 31

32. Mo Fa D S courts other family drug use poor health stigma child protection mental health insecure housing 32

33. It’s important as workers to understand the systems context when we are dealing with families 33

34. Some musings on power by Foucault • Power is exercised, not possessed • Power is both oppressive & productive: power over & power to • Power comes from the bottom up & we all have the ability to create it 34

35. INTAKE & ASSESSMENT “But our assessment tool is already soooo long” 35

36. How routine is assessment in your service? • Telephone screening • Initial screening • Specialist assessment • Full psycho-social assessment & history • Ongoing assessment & case planning 36

37. Here are some I prepared earlier... 37

38. Issues to be alert for during assessment • Drug use & • Problematic alcohol use • Family Violence • Child abuse – emotional/physical/sexual & environmental neglect issues 38

39. ASSISTING FAMILIES TO UNDERSTAND DRUG USE “they’re never going to get better...” 39

40. Common experiences • Shame & guilt • Blame • Fear • Isolation & loneliness • Despair that there is no solution • Trauma • High level conflict • Ignorance/misinformation about drugs/mental illness • Grief & loss • Profound sadness • Judgement 40

41. To start with • Explain that people use drugs for lots of different reasons • There aren’t a clear set of vulnerability criteria, ie: apportioning blame is difficult • We live in a drug taking society • Not everyone who uses drugs will become an “addict” • Mental illness affects 1 in 5 Australians during lifetime 41

42. If a history of drug/alcohol use/mental illness in the family was an accurate predictor, we would nearly all have a “problem” 42

43. But if the situation is further advanced than that... • Families won’t necessarily know what people are using, quantities, frequencies etcetera, so general drug information is useful but don’t frighten them unnecessarily • Preferably give written information as families coming to a service are likely to be in a period of high stress • Help families understand that only drug users can change their own behaviour 43

45. Understanding where the family is at with the drug use 45

46. Stages of change for families 46

47. Denial • Feelings of shock • Isolating from other friends/family networks • Uncertain about own role in other person’s drug use • Covering up for the drug user • Unlikely to seek help 47

48. Emotion • Reactive • Starting to understand the enormity of the problem • Strong shame/guilt/stigma/stress/anger • Feeling torn in multiple directions • Overwhelmed • Recognise the need for help, but still unlikely to seek it out 48

49. Control/Rescue • Acknowledge the drug use, think the solution is simple • “Do what I say” to fix the problem • Expect trust but are afraid to give it • You ‘know’ who and/or what is responsible • Trying to get help for the drug user 49

50. Chaos • Confidence is depleted • Family relationships are often falling apart by this stage • Exhaustion • Feel that everything has been tried & that nothing will work 50