Me and My Kids: Exploring Substance Use and Parenting

1. Me and My Kids:Exploring Substance Use and Parenting A learning opportunity for Moms presented by Addiction Services of Thames Valley, heartspace program and London-Middlesex Children’s Aid Society

2. Who’s Involved? • Community Addiction Assessment, Referral and Treatment Services • Children’s Aid Society • Academic Community

3. What Me & My Kids Is Not • Not a therapy or treatment group • Not about participants personal stories • Not about CAS workers collecting information about participants • Not a judgment about participants You (clients and workers) are here – that is great!

4. What Me & My Kids Is • Respectfully providing information about women and substance use • Providing information about when substance use becomes a problem and how to reduce related harm • Reducing stigma and shame attached to substance use problems – so change/help are possible

5. What Me & My Kids Is • Showing some ways to think about making changes if a problem has begun • Letting you know that your situation is understandable • Demonstrating “services” working together to help – help is available • Fostering hope – nothing is hopeless

6. Why is Me & My Kids a group for “Precontemplators?” • Stages of Change model • Engagement vs alienation (due to requiring too much change too soon) • Recognizes where the woman “is at” • Every stage requires different strategies and approaches

7. Stages of Change Model Prochaska & DiClemente, 1983, 1986

8. Working with Precontemplation • Stages of Change Model uses Motivational Interviewing (MI) • MI requires a Harm Reduction (HR) approach – as opposed to a purely abstinence based model • HR includes abstinence as one option along a continuum

9. Motivational Interviewing • Seeking to understand the person's frame of reference, particularly via reflective listening  • Expressing acceptance and affirmation  • Eliciting and selectively reinforcing the client's own self motivational statements expressions of problem recognition, concern, desire and intention to change, and ability to change 

10. Motivational Interviewing… • Monitoring the client's degree of readiness to change, and ensuring that resistance is not generated by jumping ahead of the client.  • Affirming the client's freedom of choice and self-direction • http://motivationalinterview.org/clinical/whatismi.html

11. Harm Reduction

12. Why Harm Reduction? • Minimizing harm • Enhancing health • Do what is best for now • Keeps person active in change • Best practices –WHO • Research very positive in long-term

13. Examples of Harm Reduction • Exchange needles • Drink responsibly • Safer sex • Safer gambling • Methadone clinics • Safe Injection sites • Eat all food in moderation

14. Harm Reduction Abstinence is part of the continuum of harm reduction Use reduced harm use no use Risk reduced risk no risk Multiple risks may be involved – not just the substance

15. Why is Me & My Kidsfor women only? • Historically services for people with substance use/abuse issues were designed by and for men • Women have unique and complex issues that create problems with substances • which require an approach that honours women’s realities

16. Why Focus on Women? • More likely to suffer serious physical health problems • Imprisoned at higher rates, approx 80% of incarcerated women identify substance use • Multiple barriers to receive treatment • Judged more harshly for addiction • Tendency to take on addictive patterns of their partners Women’s Addiction Workbook, Lisa M. Najavits, Ph.D.

17. Why Focus on Women? • More socially isolated • Significant emotional health problems which are often inadequately treated • Impact on reproduction • Women’s substance use is increasing • Increased financial difficulties • Twice as likely to die from alcohol-related problems Women’s Addiction Workbook, Lisa M. Najavits, Ph.D.

18. The Good News

19. The Good News for Women • More likely to benefit from treatment • Once in treatment, decrease in drug use and criminal arrests • Treating women effectively can have positive impact on children • Women have more awareness about substance use, talk to children more • Women who keep children in their care are more likely to do well Women’s Addiction Workbook, Lisa M. Najavits, Ph.D.

20. Mental Health or Illness HIV/AIDS Making the Connections Incarceration Disability Isolation Poverty Substance Use and Addiction Sexual Orientation Experience of Loss Age Experience of Violence/ Trauma Racism Access to housing and health care Motherhood status Public policy on violence, substance use and mothering Relationship status Friendships Resilience Source: Coalescing on Women and Substance Use Linking Research, Practice and Policy

22. From Me & My Kids Conference…

23. Thinking about Change Bracelet A personal reminder An exercise embodying the Stages of Change Model and creating a lasting, concrete, visual reminder – so people can be motivated at any time

24. Effects of Substances on Parenting

25. Continuum of Use and Risk Things do happen to all kids BUT The risks increase if the caregivers are focused on other needs and not attentive to the children INTERACTIVE EXERCISE (voluntary)

26. Substance Use Continuum • No Use Experimentation Recreational Use Regular Use Problem Use Dependency ----------------Use--------------------------------Misuse ------------ Abuse-------------

27. Research • Pre-test, Post-test Questionnaire • Designed for the conference • Adapted from CSQ-8 • Workers and Clients Participated

28. Participants • 22 Women involved with CAS for substance use • 8 Social Workers from CAS and Family Networks • Pre-test: 22 Women, 8 Social Workers • Post-test: 19 Women, 6 Workers

29. Results • All participants indicated: “When I feel I have enough information to make positive choices, I feel better about myself” • 90% definitely or generally received information they wanted • Overall participants were satisfied and would recommend the conference

30. Results Continued • Relationship found between level of hopefulness and perceived support. • Level of hopefulness increased for four participants, decreased for one participant. Not statistically significant.

31. Participants’ Thoughts There is always hope, no matter how deep you are in. I found it good because you didn’t have to sit and talk about what you did and why you did it. I was just here to help my friend and got a lot more.

32. Limitations & Future Research • Small sample • Questionnaire Design • Questionnaire Distribution • Timing of Post-Test

33. Our Change Process • We change only what we can no longer tolerate • We learn what we teach: how to change • Parallel process clients/systems/workers • Research informed evolution of conference development (eg. bringing a friend, women liking the fact that SWs attended)

34. Parallel Process PRECONTEMPLATION: • Invisible problem, with no apparent solution, general community apathy, and denial (we don’t have a drug problem in our town) • Working in our “silos” of knowledge, experience, funding

35. Parallel Process CONTEMPLATION: • Increased community awareness of needs of hard to reach women and their children (Jordan Heikamp, “Creep in System,” media attention to drug use etc.) • Changes in legislation for CAS (DR) – find new ways • Obvious shared client base (90% of heartspace clients are CAS involved) & layers of overlap in client population • Reflection on drug testing budgets and philosophies

36. Parallel Process PREPARATION: • Community response heartspace established - 19 partners who recognize the problem – and desire change CAS was there! • Overwhelming response to heartspace indicates bigger need than anticipated (ONGOING ASSESSMENT) • Co-facilitation of Seeking Safety @ heartspace (getting our feet wet with each other)

37. Parallel Process • Collaborative lunches – CAS and heartspace – relationship building, reducing professional mystique/stigma (also maintenance!) • Strength based participation from agencies • CAS brings resources/assets – staff, funding, location, client base • Heartspace brings expertise in a specific areas, training for CAS staff (MI, Stages of Change, Women’s Issues, Strength-based language)

38. Parallel Process ACTION: • Created conference program (modified from existing materials) • Me & My Kids presented 1x, applied for funding – then presented 2x • Removed barriers to attendance (childcare, food, transportation, incentives)

39. Parallel Process • Invited other service providers (integrity of group rationale protected – we asked men not to come) • Invited referrals (via SWs) and chased them! • Efforts to change CW culture regarding substance use/abuse

40. Parallel Process MAINTENANCE: • Funding issues –community donations • Always a challenge • Research supports value of program and collaboration • Hope that we (workers) are making a positive difference –sustains • Sharing knowledge and experience with other service providers (this presentation)

41. Parallel Process RELAPSE: (potential) • Loss of funding • Lack of organizational support • Lack of referrals • Lack of willing martyrs (oops – eager staff) • (not a return to precontemplation)

42. Our Learned Lessons • Right people, right time, right positions • Ready, Fire, Aim • Looking past our biases/expectations • Must have mutual benefit • Our surprises

43. Mutual benefits Occurred on several levels: • Staff satisfaction • Maximize resources • Fills a gap in the community • Women see staff working together for their benefit • Staff and clients are educated at the same time (Mohammed and the mountain!) • Other partnerships get launched • Other dreams are being dreamed! (Day Tx)

44. NO WRONG DOOR! Helpful family Helpful friends Health care providers Doctors Nurse practitioners Public Health Nurses, Mental Health Workers, Addiction Workers Staff in Women’s or Family Shelters Kids’ teachers Minister or priest of a church or place of worship AA/NA – or any other support group Self Help Books – On-line supports

45. QUESTIONS?

46. Thanks for Participating…all the best in achieving your goals! GRATEFULLY ACKNOWLEDGES THE PINEWOOD CENTRE FOR THE USE OF THEIR PATHWAYS HANDOUT MATERIALS AS A STARTING POINT IN DESIGNING THIS PROGRAM.