Children of Parents with Mental

Illness and or Addiction

(COPMIA): Addiction workforce

development

Leadership Day

27th March 2014

WHAT ABOUT THE KIDS?

An update on COPMIA development in New Zealand

Workforce Development Project

• Led by The Werry Centre - Project Team: Bronwyn Dunnachie, Anna Nelson, Anne Brebner, Kahu McClintock, Hiran Thabrew

• Sponsored by Dr John Crawshaw

• Supported by Dr Arran Culver (MOH Portfolio)

• An Expert Advisory Group

Firstly…

• Congratulations to everyone who has

recognised the importance of

COPMIA-focused service delivery and

are planning or implementing

COPMIA initiatives

This project: Informed by:

• Extensive project work completed

by MOH in 2012:

Thanking: Dr John Crawshaw for

championing COPMIA

Acknowledging: Rick Williment,

Frances Goodstadt and Jess Allan for

their project work

• Project Plan: Deliverables

The starting blocks:

• Completing a scoping document

regarding COPMIA in the AOD area

(Putting the ‘A’ in COPMIA): Matua Raki

• Developing a document on the interface

between Whanau ora and COPMIA: Te Rau

Matatini

• Exploring 5 well-established COPMIA

initiatives in New Zealand,

interviewing key folks from these

programmes on strengths and

struggles, thematic analysis, and

documenting key findings

• Undertaking an analysis of current

Australian and other resources, including

guidelines, e-learning resources, posters,

leaflets etc. Amending for NZ context

where required, and making these

available to the sectors (work in progress)

More…

• Review of workforce competencies that would be required to fully adopt COPMIA principles

• Describing critical elements of a client pathway, how to manage engagement with both parents and the children involved, and associated social services etc

• Development and Implementation of a

National Strategic Plan incorporating all

of deliverables of project (September…)

Exciting possibilities…

• Stepped approach to best practice

• ‘Let’s Talk’… About Children

• Developed in Finland (Solantaus)

• Amended and trialled in Australia

(Maybery and Reupert)

• Strong evidence base

• Resource light

• Positive outcomes from trial to date…

COPMIA

Protecting children to ensure their safety

and wellbeing is everyone’s responsibility

(Medrano and Tabben-Toussaint, 2012: 1)

Acknowledgements

• Kina Families and Addictions Trust-

especially Trish Gledhill and the board.

COPMIA

Broad messages

• To realise family and whānau potential

Family Inclusive Practice (FIP) and

Whānau-centred Best Practice is

essential when working with

individuals, families and whānau

experiencing distress

Broad messages

• A variety of workforces who have

contact with individuals, families and

whānau have the opportunity to

intervene early and realise family and

whānau potential

Key messages for Mental Health

and Addiction Services

• Children of Parents with Mental Illness

and/or Addiction (COPMIA) while often

resilient and strong are at increased

risk from abuse, neglect and developing

their own addiction and mental health

issues

• Having mental health and addiction related

problems is not incompatible with being a

good parent, but is likely to affect parenting

ability

• There is a clear message from government

that we all have responsibilities for

protecting and enhancing the health and

wellbeing of children

• Families and whānau experiencing mental

health and addiction related problems are

more likely to live in economic deprivation,

be unemployed, have housing difficulties, and

live in isolation. Taking a holistic approach to

these complexities is likely to improve

outcomes for disenfranchised individuals and

whānau.

• Collaboration across systems is

imperative

• It’s time to change the way we work in

adult mental health and addiction

services

What does this mean?

A concerted workforce development

initiative ensures clinician’s and other MHA

[mental health and addiction] workers

have the confidence to facilitate access to

information that supports parents,

including assisting children to understand

their parents’ health problems. (Ministry of

Health, 2012b: 4).

Issues and concerns

• Not funded to do this work

• No KPI’s

• This work is not recorded anywhere

• No room to see families

• Many practitioners are not trained in working with

family or children

• Lack of confidence and fear about talking about

children

• Decreases engagement with service users

Issues and concerns

• Parent blaming

• Lack of trust in child protection services

• Information sharing concerns

In an Australian survey organisational issues were

seen as substantial barriers to the

implementation of child-parent sensitive

practice. These organisational barriers included;

• lack of access to resources and strategies to

assist clients with their parenting/caregiver

needs

• limited mutual exchange of information between

child/family welfare agencies and AOD agencies

• competing priorities (treatment needs of adults versus

needs of the child)

• lack of education/training on child wellbeing/welfare

issues relevant to substance using parents

• lack of linkages between AOD and child/family welfare

agencies (Trifonoff et al., 2010: 32).

Positives

• We already do this!

• Must see service users in their social contexts, not

merely as individuals

• Likely improved outcomes for services users and

families

• Working across sectors in collaboration is exciting

• Children’s safety is paramount ‘paramountcy principle’

• Fits with whānau ora

Protective factors

• A number of protective factors have been

found to protect children from some of

the worst outcomes in families where

parents experience addiction related

problems. The following conditions have

been shown to help determine whether

parents can parent effectively in stressful

situations;

• Concrete resources in times of need, for

example do parents have access to food,

housing, transportation and employment.

• A support system for the family, for

example a network of community

supports to reduce isolation.

• Emotional and psychological resilience (of

the parent).

• Parenting tips, information and skills

courses for the parent

• The child’s socio-emotional and cognitive

abilities (SAMSHA, 2012: 34).

What children say…

• Children are often more aware of problems

than parents realise, but they don’t always

understand what is happening and why.

• Children think that parents should talk to them

about alcohol and drug use and not hide it from

them.

• Children worry about their parents more than

may be recognised, particularly if they fear for

their parents safety

What children say…

• Children do not know where to go to get

formal help and rarely seek help of

professionals initially.

• Experience of contact with professionals

is mixed. Children’s concerns include

professionals not believing them, not

talking directly to them and not acting to

help them when asked.

What children say…

• Children say they want someone to talk to, who

they trust, who will listen to them and provide

re-assurance and confidentiality.

• Children’s most persistent plea is for more age

appropriate information to help them

understand what is going on in their family

(Joseph Rowntree Foundation (JRF), 2004: 1)

• Children believed that being in a family involves

parents and children loving one another no matter

what. This love is expected to be unquestioned and

unconditional.

Young people wanted to continue to love their parents

and over time many of them found ways to do so. This

involved understanding more about the nature of being

addicted to a substance and that it wasn’t necessarily

about choosing drugs or alcohol over them (LSHTM, 2011:

14)

Where to from here…

• Stepped approach to best practice

• Start with adding ‘Are you a parent?’ question to your

assessments

• Recording the work you are doing with families

• Finding out about children’s, parenting services in your

community-and referral pathways

• Basic risk management plans around keeping children

safe (e.g. locking away substances and paraphernalia)

• Basic resources like ‘Ruby’s Dad’ (available from HPA),

‘Gemma’s Journey’, ‘Think Parent’ posters.

The role of the workforce

centres • Infrastructure development e.g. policy, KPI’s?

• Organisational development e.g. leaders and managers

understanding requirements under Children’s Action

Plan, Models of Care

• Recruitment and Retention e.g. advocating for a

change in education content

• Training and development e.g. training and resources

for practitioners

• Information, research, evaluation e.g data collection

and evaluation

Watch this space…

anna.nelson@matuaraki.org.nz

References

Joseph Rowntree Foundation (JRF) (2004) Understanding what children say

about living with domestic violence, parental substance misuse or parental

health problems. [online] http://www.jrf.org.uk/sites/files/jrf/514.pdf

[retrieved 31 October 2013]

Ministry of Health (2012b) Scoping Paper for Ministry of Health: Proposed

focus on children of parents with mental illness or addiction (COPMIA).

Wellington: Ministry of Health (unpublished).

Substance Abuse and Mental Health Services Administration (SAMSHA) (2012).

Supporting Infants, Toddlers and Families Impacted by Caregiver Mental

Health Problems, Substance Abuse and Trauma: A Community Action Guide.

USA: SAMSHA

References

The London School of Hygiene and Tropical Medicine (LSHTM) (2011)

See me, not just the problem: Hiding, telling and coping with a

difficult family life. [online]

http://www.coap.org.uk/files/seemenotjusttheproblem2011.pdf

[retrieved 31 October 2013]

Trifonoff, A., Duraisingam, V., Roche, A. and Pidd, K. (2010) Taking

First Steps. What Family Sensitive Practice Means for Alcohol and

Other Drug Workers: A Survey Report. Adelaide: National Centre for

Education and Training on Addiction, Flinders University.