Integrating Infant Mental Health in a Residential Drug Treatment Program

The F.I.R.S.T. Program

(Families in Recovery Staying Together)

Arlene Purcell, MSWDirector of Project Pride

A Division of East Bay Community Recovery Project

Ayannakai Nalo, LCSWCoordinator, F.I.R.S.T. Program

Children’s Hospital & Research Center at Oakland

Jackie Schalit, MFTLead Clinician, F.I.R.S.T. Program

Children’s Hospital & Research Center at Oakland

Karen Tanner, MAInfant Development Specialist

Children’s Hospital &Research Center at Oakland

Jill Rian,LCSWSEED Child Welfare Supervisor

Alameda County Department of Children and Family Services

Robbin Rasbury, Psy.D.Clinician, /SEED Program F.I.R.S.T

Children’s Hospital & Research Center at Oakland

Who We Are

F.I.R.S.T.=

Drug Counselors

Project Pride

Case Management

Co-occurring Disorder Treatment

Child Enrichment Staff

Expressive Art Therapy

ACDCFS

SEED

FAMILIES IN RECOVERY STAYING TOGETHER

ECMH

+ +PHN

Social Workers

CHO

CVC

SEED

It Takes a Team to Build a Collaboration

Project Pride-East Bay Community Recovery Project

Project Pride

Project Pride A Residential Drug

Treatment Setting for Women & Kids 0-7

CDCR Alternative Co-occurring disorders

Who are the Women in Treatment at Project Pride

Data drawn from EBCRP’s database, As May 2006. Women ranged in age from 19 to 43 years, with an average age

of 26.2 years. Ethnicity was 53% White, 35% African American, 5% Latina,

and 2% Native American. Most have histories of criminal justice involvement. Using the Beck Scale of Depression at intake, we have found

that 66% of the women have mild to severe depression. 62% of the women were poly-drug users, 60% use

methamphetamines, 40% use cocaine and alcohol, and 27% are heroin users (2003, EBCRP)

Alameda County Department of Children and Family Services

History

The Team

CHILDREN’S HOSPITAL & RESEARCH CENTER at OAKLAND

Children’s Hospital & Research Center at Oakland

•Early Childhood Mental Health

•Developmental Play Group

•Center for the Vulnerable Child/SEED

Home of the F.I.R.S.T. PROGRAM

F.I.R.S.T. PROGRAM (View from Project Pride Playground)

The F.I.R.S.T. Program

Born of a Collaboration between Project Pride, Children’s Hospital-Oakland and Alameda County Department of Children and Family Services

Child Protection and drug treatment Infant-Parent Mental health and drug

treatment Infant Development and drug treatment Common Cause for Children and Families

Internal Rumbling at Project Pride and ECMH -- The Pregnancy

Growing interest and focus on parent/child relationships and the family at Project Pride

Need for more resources to meet goals at Project Pride.

Project Pride Goals Related to Infant Mental Health-Common Ground for a Collaboration

Provide a comprehensive family program addressing recovery and mental health needs of whole family

Promote mother/child attachment Provide a solid clinical program to all those we serve Project Pride will provide high quality state of the art

services in all departments

Why Child Mental Health Treatment within the Milieu?

Recognition that children need help and treatment-may have already been impacted by loss or trauma

Increase the tools in the toolbox Recognition that addiction is beyond just the mother-

commitment to breaking the intergenerational cycle Desire to create a seamlessness between the

various treatment services

Power of a Relationship-Based Approach

What We Mean By a Relationship-Based Approach

Relationship as a necessary vehicle for service delivery Relationships with families that become a corrective,

emotional and healing experience Relationships between parents and children that promote

wellness Relationships among us as a community supporting

families

Infant Development-It’s a Different World

Personal reflection

Using relationship

Holding the baby with the others

Working Together- An Evolution

Work in residential treatment settings by clinicians is only effective if it is lined up and done with program staff

-

Bringing it All Together- An Example

• Short-term discomfort vs. Long-term gain• SEED client• Services provided• Treatment issues• Interventions

Dyadic, Family and Group Work with Women and Children-Breaking Cycles-Changing Lives

Parent-child therapeutic groups vs.. Developmental play groups

Parent groups focused on process, supporting reflection

Co-facilitated with Project Pride Child enrichment staff

Short term discomfort vs.. long term gain

The Sequence of a Clinical VignettePoints of Collaboration

Referral from Director Concerns of mother’s

trauma history and impact on daughter

Therapist’s observations Collaborating with drug

treatment staff

The Work Begins

Mother shares her story We have a shared goal Susie: demonstrating indiscriminate attachment The assessment: Susie has difficulty attending

to tasks,mother worries Susie has ADHD

Other Interventions and Learnings

Joint clinical meeting with Project Pride staff to share assessment• Port of entry with tattoos Family reconnections

From Avoidant to Secure

Progress..She’s looking for mommy!

Success in school Mom signs up for

Sleepy Time Group Preparing for discharge

What We Have Done Together

Created Parent/Child Groups with Mental Health, Development Specialists and Treatment Staff

Carried Out Joint Case Conferences, Training Carried out Celebrations and Field Trips Treatment staff provide support for kids during

parent groups Begun to look at research and data possibilities

Differences that Have been Noticed by Treatment Staff

Less yelling and harsh behavior with children Fewer reports of serious behavioral problems

with clients More interest in their role as mothers More cooperation around child care issues A greater sense of calm in the house Fewer sleep problems with babies

Barriers to Collaboration Along the Way

Differences in organization cultures, funding systems, training and point of view, histories

Fiscal-No money for planning or start-up Informational Operational-Finding space, clinicians

learning how to function within a CDCR contract system and therapeutic community philosophy

Lessons Learned about Collaboration

Identify key stakeholders Learn about one another’s systems Don’t expect perfection-Be patient Identify short- and long-term goals-dream big Mistakes will happen-Learn about repair Learn by doing & celebrate success Every Community has its non-believers, learn to

love yours

Moving Our Worlds Closer Together