www.edu.monash.edu

A model of care

for families where

parents have

drug/alcohol and

mental health

issues

Dr. Andrea Reupert

A/Professor Darryl Maybery

Ms. Mel Goodyear

Ms. Ingrid Vet

The program and research was funded by

FaHCSIA, The Ian Potter Foundation,

Rotary Australia and NSW Health

www.edu.monash.edu

www.edu.monash.edu

Objectives

• Describe the model of care developed by

Northern Kids Care – On Track

Community Organisation (NGO)

• Present some preliminary evaluation

data about the model

• Discuss some of the implications when

working with families with complex

needs

www.edu.monash.edu

Why focus on family? • Parental mental illness and substance

abuse is highly prevalent and can

adversely impact on children

• Family interventions have empirical

support

– Benefits the parent with the problem

– Benefits to children

• Financially it makes sense

• Australian government policy

www.edu.monash.edu

It all started with......

Reupert, A., Green, K., & Maybery, D.

(2008). Family care plans for

families affected by parental mental

illness. Families in Society: The

Journal of Contemporary Social

Sciences, 89(1), 39-43.

www.edu.monash.edu

Vision for

Northern Kids Care:

On Track Community Programs

Increased health and wellbeing of

children, young people and parents

living in families affected by parental

mental illness or dual diagnosis through

the development of a best practice

outreach service delivery model

www.edu.monash.edu

Theoretical framework of model

1. Family centred practice (Allen & Petr,

1998; Dempsey & Keen, 2008; Law, et

al., 2003)

2. Strength based case management

(Brun & Rapp, 2001; De Jong & Miller

1995; Rapp, 1997; 1998)

“not all families are strong, but all have

strengths” (Dorothy Scott)

3. Family care planning (Reupert, Green &

Maybery, 2008)

www.edu.monash.edu

Components of the model

Family fun days Peer support groups Home visiting service

Least intensive Most intensive

The different levels of intensity allow:

– Families to become familiar with services & workers

– Opportunities to meet with other parents and children

– For workers to get to know families

www.edu.monash.edu

Family fun days

• An opportunity to have fun and interact

socially with similar families.

• To learn more about the service and

workers before committing to the more

intensive aspects of the program

• Over the three sites there were 189

participants attending family fun days

from 2008-2010.

www.edu.monash.edu

Peer support groups for young people

and parentsAimed to:

• Increase social connections

• Provided with information

• Develop and practice new skills

Various groups for children of different ages,

such as SMILES, Koping (n=414)

Various groups for parents (n= 81)

www.edu.monash.edu

Home visiting service

Case manager works with individuals and family in

the home using a strength based case management

model

A focus on planning rather than crisis using family

care plans with 11 pre-determined goals in areas such

as parenting, education, connectedness (within family

and community)

Each family “reviewed” every four months over a 12

month period (extended for some families)

www.edu.monash.edu

Home visiting service

Inclusion criteria

•Parent has a diagnosed

mental illness OR

•Parent has a diagnosed

dual diagnosis (co-existing

mental health disorder and

substance/abuse problem)

•Cares for dependent

children (0-18 years)

•Young person are included

with informed parental

consent

Exclusion criteria

•Parents whose children are

less than 20% at the parent’s

residence are not included

•If drug and alcohol is the

primary problem families are

referred to drug and alcohol

centres

•Current issues of violence,

sexual assault and/or abuse

excluded

•Young people in acute

stages of psychosis

ineligible

www.edu.monash.edu

Community approaches

• SKIPS (Supporting Kids in Primary

Schools)

• Professional development days

• MOUs with other agencies re referral,

case management, coordination

• Partnerships with others when running

peer support programs and in case

coordination

www.edu.monash.edu

Evaluation consisted of a participatory,

action research design

• Individual interviews with

children, parents and

workers

• Family care plans analyzed

• Every six months data

presented to workers and

management:

– What does this mean for our

service? For management?

• Refinements to model made

accordingly

www.edu.monash.edu

Demographic Parents with mental illness Parents with dual diagnosis

# Parent - clients 10 10

# with partner 8 (2 with a mental illness, 1

alcohol abuse)

3 (1 also with a dual diagnosis

and one with “unspecified drug

use”)

Mean age parent 41.4 yrs 36.3 yrs

Gender parent 9 Females: 1 Male 8 Females: 2 Males

Ethnicity All white Australian 8 white Australian, 2 Indigenous

Parent diagnosis 2 Schizophrenia; 2 Bipolar; 1

Depression; 1 PTSD; 1

Anxiety; 3 depression &

anxiety

3 Schizophrenia; 2 Depression;

4 Bipolar; 1 OCD & Depression

Substance abuse

of parent-client

5 marijuana, 2 alcohol, 2 alcohol

& marijuana, 1 heroin.

Family violence in

last 3 years

5 families 3 families

# Children 24 30

www.edu.monash.edu

Children

• Peer support programs reduced isolation

• Acquired effective coping strategies

• Enhanced knowledge about mental

wellbeing and illness

• Strengthen family relationships but

wanted more support for their parent,

especially around drug use:We need to change what mum does.... Mum needs to stop taking

drugs (11 year old girl).

[I need] someone who could come and talk regularly about how to

help my mum more and not just to keep it going (12 year old

girl).

www.edu.monash.edu

Parents

• Developed adaptive coping strategies for

managing mental illness

• Family fun days and peer support groups

reduced isolation

• Strengthened family relationships

• Requested more support in terms of specific

behavioural parenting strategies

www.edu.monash.edu

Case managers

Seven different case managers plus manager

• Predominately young and open to new ideas

and ways of doing things

• Background in social work, welfare

• Worked previously in mental health, child

protection, rehabilitation

Data includes

• Interviews conducted every four months

• Feedback sessions

www.edu.monash.edu

Case managers• Engagement, change and improvement can be

very slow

• Some parents with a substance abuse have less

insight into impact of disorder on children, are

more difficult to work with b/c of multiple issues

(exception are those parents with borderline pdo)

• Skills required in varied areas

• Important to establish and maintain relationships

with multiple agencies

• Need to screen for substance abuse for all parents

• Not taking sides, boundaries and “seeing double”

is an ongoing issue that requires supervision

www.edu.monash.edu

20 family care plans were analysed

In two ways:

1. What do children and parents see as the

most important things to work

towards?

2. What areas do children and parents

progress in? In what areas is little or no

progress recorded?

3. (Differences in types of families?)

www.edu.monash.edu

Family care plansPre-determined goal areas

for children and parents:1. Family connectedness

2. Mental health knowledge

3. Child development

4. Education

5. Interpersonal skills

6. Substance abuse

7. Lifestyle, diet and exercise

8. Community and social connectedness

9. Finances

10.Family health and wellbeing

11.Accommodation

12.Other

www.edu.monash.edu

What do children want to work towards?

• Enhance interpersonal skills, e.g.

Learn to express frustration in an appropriate

way

• Learn more about mental illness and

wellbeing, e.g.

Learn the difference between mum’s physical

and mental health symptoms

• Education, e.g.

Attend school on a regular basis

Get help with homework

www.edu.monash.edu

Most progress

Mental health knowledge

Accommodation (e.g. child

to have her own room)

Substance abuse (e.g.

better understanding of

mum’s methadone

program)

Least progress

Finances (e.g. child to

receive pocket money)

Interpersonal skills

Family health and

wellbeing

www.edu.monash.edu

Child goals and progress

Goal Area Goal No (Prop) Change score

MI DD MI DD

Family Connectedness 25 (15) 23 (13) 1.40 2.42

Mental health knowledge 24 (14) 24 (14) 2.25 2.21

Child development 16 (10) 14 (8) 1.88 2.43

Education 26 (15) 34(20) 1.81 2.29

Interpersonal Skills 26 (15) 24 (14) 1.85 1.67

Substance Abuse 2 (1) 5 (3) 2.00 2.40

Lifestyle, diet and exercise 16 (10) 22 (12) 1.88 2.09

Community and Social Connectedness 13 (8) 16 (9) 2.15 2.13

Finances 7 (4) 2 (1) 2.14 1.00

Family Health and Wellbeing 9 (5) 6 (4) 1.44 1.33

Accommodation 4 (2) 1 (1) 2.75 3.00

Total 168 (100) 171 (100) 1.88 2.14

www.edu.monash.edu

What do parents want to work on?

• How to manage their mental illness, e.g.

Recognise early warning signs

Practice effective coping strategies, such as

regular exercise

• Enhance interpersonal skills, e.g.

Anger management skills

Learn how to stand up for myself with partner

• Enhance family connectedness, e.g.

Mum to develop shared interest with youngest

child

www.edu.monash.edu

Most progress

Mental health knowledge

(e.g. identify early

warning signs)

Substance abuse (e.g.

parent to ensure children

are not exposed to drug

use)

Community and social

connectedness (e.g.

attend community choir)

Least progress

Family connectedness (e.g.

mum to develop shared

interest with youngest

child)

Interpersonal skills (e.g.

manage anger)

Lifestyle, diet and exercise

www.edu.monash.edu

Parent goals and progress

Goal Area Goal No (Prop) Change score

MI DD MI DD

Family Connectedness 22 (15) 14 (9) 1.36 1.71

Mental health knowledge 32 (21) 26 (17) 1.84 2.12

Child development 8 (5) 9 (6) 2.12 1.78

Education 13 (9) 16 (10) 2.08 1.81

Interpersonal Skills 25 (17) 17 (11) 1.44 1.35

Substance Abuse 3 (2) 17 (11) 2.33 2.18

Lifestyle, diet and exercise 11 (7) 15 (10) 1.73 1.27

Community and Social Connectedness 17 (11) 12 (8) 2.06 1.92

Finances 10 (7) 12 (8) 1.70 1.67

Family Health and Wellbeing 7 (5) 5 (5) 1.71 1.88

Accommodation 2 (1) 7 (5) 2.00 1.71

Total 150 (100) 153 (100) 1.75 1.78

www.edu.monash.edu

Implications for practice

• Incorporate behavioural parenting strategies for all

parents in an ongoing manner

• Specifically ask about substance abuse upfront and

address addiction issues in the individual

• “Not all families are strong, but all have strengths”

• Recognise individual child and parent issues while

acknowledging the interrelationship between the two

• Recognise and use community supports

• Family care plans can assist in identifying, monitoring

and evaluating goals

www.edu.monash.edu

Families with multiple needs

require multiple strategies

Data indicate that there is no one single strategy or

program that can meet the needs of all family members

www.edu.monash.edu

Implications for policy and funding

• Protocols and procedures required between different

services

• Consideration required in regard to workers case loads

• Provide staff training for working with individuals and

groups, and on specific issues (addictions; borderline)

• Provide supervision around “seeing double”

• Provide flexible time arrangements for families

• Ensure ongoing funding to ensure stability of staff and

process

• Recognise alternative but rigorous evaluation

methodologies, especially those sensitive to the voices

of consumers and carers

www.edu.monash.edu

Implications for research

• Accurate prevalence estimates that includes sub-

groups

• Can workers see double? How do they do this?

• Measure the long term impact of interventions on

children’s functioning, parenting capacity and

family functioning/cohesiveness

– Also need to consider the relative impact of

various services provided (e.g. peer support vs

home visiting service) and different subgroups

(e.g. Parental diagnoses and substances)

– Cost analyses of interventions

www.edu.monash.edu

Future directions for us in this data set

• Quantitative data analysis

• Heterogeneous nature of groups, possible

service differences and child, parent and

family outcomes?

• Consider drop out rates

References available on request.

Happy to be contacted

andrea.reupert@monash.edu