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TRANSCRIPT
Eyes Open:
Building Parental
Capacity, Minimizing
―Collateral Damage‖
Kim Sumner-Mayer, PhD, LMFT Center on Addiction and the Family
(646) 505-2063
SELECTIVE ATTENTION
VIDEO
Today’s Themes• Assessing Parental
Capacity: We are part of the equation!
• Parenting on Drugs
• Building Parental Capacity: Raising Resources
• Minimizing Harmful Effects of Our Interventions
Assessing Parental
Capacity
Assessing Parental Capacity
• HOW we see what we see
• Circularity, Complementarity, &
Inviting Competence
• Problems don’t tell the whole
story
WE are Part of the Equation!
When we assess or intervene with a family,
we are NEVER viewing the family by itself:
Professional (Family)
Rather, we are viewing:
Professional (Family + Professional)
Using your SELF Powerfully
• CIRCULARITY
• COMPLEMENTARITY
• (INVITING) COMPETENCE
Inviting Competence
• Strengths always exist, but we don’t always capitalize on them.
– Skills, abilities, resources, protective factors
– Exceptions to the problem: Shining moments
• Inviting Competence:
– Privileging the family’s voice
– Making room for parents to do the work
– Intervening in respectful,
capacity-building ways
Visualize…
PARENTING ON
DRUGS
Families: Key Features
• Interdependent
• Seeks homeostasis (stability)
• Cycles of stability and instability
• Competency
– Strengths
– Resources
• Complementarity and circularity
– Among family members
– Also with ―systems‖
Features of Family Organization
• Roles and responsibilities
• Subsystems and alliances
• Power and authority
• Hierarchy
• Communication
• Interaction with ―Systems‖
• Patterns
Parent Responsibilities
• Protection and safety
• Nurturing and love
• Teach morals and values
• Provide home, food and clothes
• Encourage independence and uniqueness
• Foster self-esteem
• Teach appropriate behavior
• Share cultural values, traditions and identify
Families We See
• Do not get to write their own stories
• May look chaotic – interference from social
interventions
• Multiple systems involvement
• Workers may become part of family patterns
• Mutual affection and bonding overlooked
And Then Come Drugs..(aka The Effects of Active Addiction on
Children and Families)
When Substance Abuse Enters…
• Alcohol/Drugs – centrifugal force
• Homeostasis may be interrupted
• Loss and grief
• Basic functions compromised
– Safety
– Economic security
– Parenting
– Communication
– Identity building and supporting
How Drugs Affect Parenting
• Lowered inhibitions
• Extreme discipline
• Low frustration tolerance
• Unrealistic expectations
• Role reversal
• Illegal activity
• Isolation
• Mood swings
• Inconsistency
• Less responsive/ neglectful
• Focused on parent’s needs
• Closed communication
• Blame child
• Problems w/ affection, problem solving
Family Rules
• Don’t talk, don’t trust, don’t feel
– Wait for the right time
– Don’t be direct
• Don’t have expectations
• Be in control at all times
• Don’t be selfish
• Always be right, do the right thing
• If things don’t go as planned, blame someone else
Complicating Factors
• Parent’s own experience with
parental substance abuse
• Child’s personality,
temperament, and needs
If Parent Involved
with Illegal Drugs
• Drug subculture
• ―Counter‖ values
– ―beat the system‖
– Disdain for authority
– Focus on money and materialism
• Exposure to drug sales, violence, theft, prostitution
• Avoidance of help that could bring unwanted attention Isolation
• High stakes consequences
• Systems involvement
Consequences for Children
• Ignored
• Schoolwork suffers
• Parentified
• Afraid to bring friends
home
• Pulled into conflicts
• Hard to concentrate
• No access to
emergency services
• Chaotic family structure
• Lack good role models
• Family violence
• Neglect
How Children Feel
• Sad
• Afraid
• Lonely, invisible
• Traumatized
• Angry
• Worried
• Love parent
• Ashamed
• Guilty, responsible
• Embarrassed
• Parental
• Confused
• Depressed
• Anxious
• Loyal to parent
• Hopeful
Behavior Problems:
Younger Children
• Eating
– Overeating, hoarding food,
failure to thrive
• Sleeping
– Nightwaking, night terrors,
refuse to go to sleep alone,
refuse going to bed
• Toileting
– Encopresis. Enuresis,
refusing to use toilet
• Difficult to manage
– Tantrums, overactive, self-
endangering behavior,
indiscriminate social
behavior
• Aggression
– towards caregiver, towards
peers
• Sexualized behavior
– Masturbation, simulating
sex with peers or toys
Resulting from: emotional distress, role models, neglect
Behavior Problems:
Older Children and Teens
• Experiment with AOD
• School problems
• Social problems
• Run away
• Withdraw/ignore
• Perfectionism
• Alternative relationships– Gangs
– Romantic partners
– Destructive friendships
• Lack of trust
• Hypervigilant
• Hoards
• Aggression/anger
• Behavior problems
• Psychosomatic
problems
• Anxious/depressed
• Humor
Resiliency, Protective Factors, and
Coping Skills
• Resiliency– Successful adaptation despite challenges
– Personality traits + environment
– Dynamic process
Enhanced by protective factors
Coping mechanisms– Survival skills
– Contextual
– Developed because of negative experiences
BUILDING PARENTAL
CAPACITY
Building Parental Capacity
• Using your SELF Powerfully
• Surfacing Parents’ Hidden Truths
– Grief and Ambivalence
• Family-Empowering Tools
– Supportive Inquiry
– V-C-R Model
– Visit preparation & debriefing; Coaching
– Effective parent education referrals
Using your SELF Powerfully
• Self-Awareness
• Active Engagement
• Transparency
The Gorilla Video, Redux
http://www.youtube.com/watch?v=IGQmd
oK_ZfY&feature=related
Surfacing Parents’ Hidden
Truths
GRIEF AND
AMBIVALENCE
Parents’ Grief
Two losses:
• Children (tangible), and
• Status (intangible)
Reactions:
• Anger, Grief, Relief
• Hold on to parental role
• Grief + Relief Drug binge, addiction
deepens
• ―Replacement pregnancy‖
• Difficult to grieve unclear loss
Parental Ambivalence
Ambivalence =
Mixed feelings +Uncertainty
Parental Ambivalence
• Ambivalence = Mixed feelings and
uncertainty
• Shown by:
– expressing doubt re: parenting
ability or desire OR
– behavior inconsistent with stated
reunification plan
• Aggravated by ―all or nothing‖ view of
permanency options
The Permanency Continuum
• Full-time return to parent’s care
• Shared Family Care
• Kinship care (formal or informal)—liberal
visitation/coparenting
• Nonrelative foster care—liberal visitation
• Independent Living
• Kin or other legal guardianship without adoption
• Surrender parental rights/ open or conditional
adoption
• TPR and adoption, little visitation/co-parenting
Parental ambivalence
• Is NORMAL.
• Does NOT mean reunification will fail or should not be pursued.
• Can sabotage recovery and reunification if not acknowledged, worked through; therefore,
• GOAL = Recognize, Resolve ambivalence
What keeps ambivalence
underground?
• Fear of judgment
• All-or-nothing mindset re: permanency options leads to denying ambivalence
–Parent self-image, concern that child will feel unloved
• Family pressure to ―step up‖ keeps parent from acknowledging uncertainty
Working With Ambivalence
1. Understand relationship between ambivalence and noncompliance/ permanency plan failure
2. Normalize ambivalence
3. Seek to understand causes & offer additional help
4. Explore options and proceed with planning
Parent ambivalence:
Reasons and possible responses
–Concern about parent/child bond• Use visits to strengthen bond
–Sense of incompetence• Parent education
• Therapeutic visiting
–Concerns about potential relapse• Parenting-specific relapse prevention plan
• Parent support group connection
Child’s Ambivalence about
Reunification
• Anger about past
• Scared about relapse
• Avoid promises – lack of trust
• Don’t want rules and structure
• Feelings about sibling’s living arrangements
• Scared that have lost place in family
• Strong bond with caregiver
• Reluctance to leave alternate home or neighborhood
• Don’t want to leave friends or school
Reunification: Adolescent View
• Issues around authority
• May resent new limits, new
consequences, new role
• May be ambivalent
• May be controlling
Caregiver ambivalence• Not convinced full-time reunification is
best for child
• Eager to give up caregiving, but senses child has mixed feelings
• Caregiver wants parent to move in to her home, but parent doesn’t want to
• Difficulty separating own personal needs from needs of the child or the parent
• Fears ―empty nest‖ issues
• Worried about possible relapse
FAMILY-EMPOWERING TOOLS
–SUPPORTIVE INQUIRY
–THE V-C-R MODEL
–VISITING TOOLS:
• Preparation and Debriefing
• Visit Observation Form
• Visit Coaching
–QUALITY PARENT EDUCATION REFERRALS
Supportive Inquiry is…
• A way to ask and listen that:
–helps people gain and share insight
–plays a role in activating assets and
focusing on solutions
–demonstrates respect
• Model developed by Family Justice, Inc.
Supportive Inquiry
• Goals of Supportive Inquiry:
–Enhance self-efficacy
– Forge and strengthen connection
– Stimulate insight
– Collect information
Supportive Inquiry
• Questions as Tools:
–Who was the last person to loan you
money?
–Where did you sleep last Saturday
night?
–Whose pictures do you carry in your
wallet?
Supportive Inquiry
• Types of Questions:
–Exception Questions
–The Miracle Question
–Scaling Questions
–Survival Questions
–Questions for Complainers
The V-C-R Model(Hardy & Laszloffy, 2005)
• VALIDATE and affirm emotion, intention, personal quality, or desire– Must be genuine
– Shows person you ―see‖ the good in them, respect them
– Earns the right to go to next step
• CHALLENGE gently– Express concern about current behavior as not aligned
with goals, or as hurting child or themself
– Preferably using a quality you affirmed while validating
• REQUEST behavior change– Specify what you’d like parent to do differently
– Preferably honoring the quality you affirmed in 1st step
LET’S PRACTICE
Visiting Tools
Visit Preparation and Debriefing
Visit Observation Form (Colapinto & NYC
ACS, 2002)
Visit Coaching (Marty Beyer)
Quality Parent Education
• How confident are you about the parent
education programs to which you refer
your clients?
• More info on powerpoint to be posted on
the web
Quality Parent Education:
Program Content
• Targeted to parents in recovery?
• Covers normal child development/ realistic
expectations
• Addresses how to handle child behavior
without abuse
• Covers parental stress management
• Helps parents improve relationships with
others
Quality Parent Education:
Program Design
• Targets many risk factors
• Targets knowledge, attitudes, skills, and
aspirations
• Practice skills in-session
• Strong, energetic leaders w/ group skills
• Accessible for limited literacy/ multi-sensory
learning
• Include pre- and post- measures to gauge
change and skills development
Evidence-Based Programs
• Clearly defined target populations,
interventions, and outcomes
• Outcome research backs up program
effectiveness
• Replicable
• SAMHSA’s 3 Levels:
– Model
– Effective
– Promising
Costs/Benefits
• Programs with both parent and child
components are highly effective and often
result in better engagement and
completion rates
• But they also require more personnel and
resources to run than parent-only or
computer-led programs
Evidence-Based Program
Registries
• SAMHSA: www.samhsa.gov
• Coalition for Evidence-Based Policy:
www.evidencebasedprograms.org
• Strengthening America’s Families
(delinquency prevention-focused):
www.strentheningfamilies.org
• OJJDP:
www.dsgonline.com/mpg2.5/mpg_index.htm
Programs Targeting Parents
in Recovery
• Celebrating Families (not yet SAMHSA-rated but
on its way)—developed for FDTC
• Strengthening Families (SAMHSA Model)
• Nurturing Parenting Program (SAMHSA
Promising)
• Focus on Families (SAMHSA Promising)
• Building Bridges (not SAMHSA rated; in use at
Phoenix Houses nationwide; accepted by some
courts for parent education requirements)
Quality Parent Education
• Gold standard = both parents and
children involved in the service.
Examples:
– Strengthening Families (http://www.strengtheningfamilies.org/html/progra
ms_1999/06_SFP.html)
– Celebrating Families (http://www.preventionpartnership.us/families.htm)
(developed for a FDTC and replication studies
currently underway)
– www.samhsa.gov for more model
programs
Building Bridges(COAF--Center on Addiction and the Family)
• Target Pop: Parents in drug tx with or w/o children
• 2 versions: 12 or 9 2-hour group sessions
• Discussion & workbooks
• Focus on separation, visits/contacts, and planning for future with children (possible reunification)
• Topics include connections between feelings, thoughts, & behaviors; grief related to separation; ambivalence re: parenting; parenting-specific relapse prevention planning; family r’ships; reunification planning
• Contact: COAF at www.coaf.org or 646-505-2063
MINIMIZING
“COLLATERAL
DAMAGE”
Collateral Damage
• Separation Trauma
• Lingering Placements
• Roadblocks for Parents to
Resume Parenting
Minimizing Separation Trauma
• REUNIFICATION BEGINS WITH
SEPARATION
• Clear information to child, parent
• Give parent time to pack child’s comfort
items
• Reassure child, parent of contact soon
• Usher parent into tx NOW
• Purposeful Visiting
Separation: Child’s
Experience
• Immediate reaction ≠ long-term adaptation
• Age of child affects presentation
• More placements, more severe reactions
• AD/HD overdiagnosed, PTSD underdiagnosed
• Behavior may seem willful but may be survival
oriented
• Regardless of permanency plan, need to deal with
child’s separation issues
Separation: Short-Term Effects
• Eating and sleeping disorders
• Depression
• Emotional withdrawal
• Acting out
• School problems
• Symptoms often misdiagnosed
Separation: Long-Term Issues
• Loss and abandonment
• Fearful re: parent
• Alternate caregiving
• Parental apologies
• Knowledge of parent’s location?
• Limited contact (tx imposed)
• Fantasies and expectations
• Come to terms with parent’s limits
Separation:
Implications for Practice
• Sibling contact extremely important to sense of continuity
• Contact and continuity with parent is important
• Children’s support needs are great
• Caregivers need help understanding children’s behaviors
• Caregivers need support for their own efforts
Intervening with Parents
• Grief + Relief Binge, deepening of
addiction
• Time is critical: Aggressive outreach to
ensure tx entrance
• Treatment program must respect need for
parent to fulfill parental role
Effects of Lingering Placements
• Bonds weaken
• Parents feel, become less competent
• New homeostasis around child’s absence,
more difficult reintegration
SOLUTION: PURPOSEFUL, PLANFUL
VISITING
Visiting, Done Wrong
• Visits in unnatural settings that don’t allow
for ―normal‖ parent—child interaction and
parenting behavior, activities
• Visits unjustifiably restricted or over-
supervised
• Visits don’t provide opportunities to
develop parenting skills or
work through ambivalence
Visiting, Done Right
• Visits provide opportunities to bond, practice new skills, work through ambivalence, and document soundly
• Every contact recapitulates the separation wound strong reactions to be expected
• Parents who seem underinvested may be responding to their own or child’s grief, ambivalence address as such
• Relapse should not automatically lead to restricted visits
Visits and relapse
• No reason to cancel or suspend visits (but no visits while actively intoxicated)
• May be a need to increase supervision
• Visits may be motivation to quickly respond to relapse
• Suspension of visits punishes child
• Explain relapse in age-appropriate terms to child
To summarize
• Inattentional blindness (the gorilla videos)
• WE are part of the equation
• Using your SELF powerfully
• Circularity, Complementarity, Competence
• Tools help us connect with parents, raise
new information, leverage strengths
• Our interventions can have negative side-
effects, which we can mitigate
Let’s Revisit the Original
DEC Raid Video
For More Information or
Additional Training
Kim Sumner-Mayer, PhD, LMFTSenior Advisor
Center on Addiction and the Family (COAF)
164 West 74 St., New York, NY 10023
(646) 505-2063 Th only
(845) 729-5697 cell
www.coaf.org www.phoenixhouse.org