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Begins with Separation: Achieving Preferred Outcomes in FTC with Families in Recovery Presented by Kim Sumner-Mayer, PhD, LMFT of the Children of Alcoholics Foundation New York, NY
Reunification Begins with Separation:
Achieving Preferred Outcomes in FTC with Families in Recovery
Presented byKim Sumner-Mayer, PhD,
LMFT
of the
Children of Alcoholics FoundationNew York, NY
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The Approach
Understand family recovery and reunification dynamics from a clinical perspective and develop court practice recommendations from there.
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The Philosophy
Reunification with inadequate preparation and subsequent serious problems is a horrible blow to parents and entire families, not just to children.
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The Philosophy
Therefore, gradual reunification preparation is preferred not just for the child’s best interests, but for the parent’s as well.
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What do you hope to learn
today?
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Gradual Reunification Preparation
BOTH
Abstinence/ reduction in use
AND
Improvements in the parent—child
relationship and overall family functioning
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Today’s Agenda
Values & Attitudes Clarification Exercise
Discussion: Why should a treatment court care about visitation?
Lecture: Recovery and Reunification as Family Processes
Case Examples: Identifying Preferred Outcomes
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Today’s Agenda
Lecture: Using Visitation Therapeutically
Activity: Developing Visit Planning and Reporting Guidelines
Lecture: Child Safety in the Context of Relapse Potential
Discussion: How will your court use these tools?
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Values and Attitudes Clarification Exercise
Reunification Begins with Separation
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Why should a Treatment Court
care about visitation?
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“Before” and “After” Portraits
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Why Should A Treatment Court Care
about Visitation?
Abstinence alone doesn’t guarantee child safety
Regaining custody is a key motivator for tx—and visitation is the major vehicle
Parenting & family stressors affect relapse vulnerability
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Why Should A Treatment Court Care
about Visitation?
Unresolved grief & loss affect relapse vulnerability
Ambivalence re: resuming parenting affects relapse vulnerability
Visitation raises grief/ loss and ambivalence issues. Good visitation and related services help to resolve these issues.
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Recovery is a Family Process
Parent’s Recovery Process A process, not an event. Redefinition of Self Partner support important Spirituality, social support,
relapse prevention Relapse frequently part of
recovery. Aftercare very important! Parenting Education
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Recovery is a Family Process
Family’s Recovery Process Parents and children must
relate without substances. Reshuffling roles,
boundaries, & authority Denial at the family level Family members don’t
understand parent’s need for continued focus on sobriety
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Reunification Begins with Separation:
Parent’s Experiences
Two losses: Children, and Status as an able parentReactions: Anger, Grief, perhaps Relief Hold on to maternal role Grief + Relief Drug
binge, deepening of addiction
“Replacement pregnancy”
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Children’s Experiences of
Separation
Short-term reactions look different than longer-term adaptations
Age of child influences their presentation
More placements, more severe reactions
AD/HD overdiagnosed, PTSD overlooked
Behavior appears willful but is actually survival-oriented
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Children’s Experiences of Separation (cont’d)
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 behavior
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What Courts Can Do
Contract with treatment agencies that allow and encourage visitation early on
Refer to mother/child programs as often as possible when residential treatment is indicated
Consider kinship caregivers, extended family members, and foster parents as resources
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What Courts Can Do
Order comprehensive neuropsychological and developmental evaluations of children to determine what special services may be indicated
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Reunification Continues with
Visitation: Parents
Awkwardness common Not permitted normal
parenting responsibilities Parent viewed as failure Hard to enjoy/play with/be
with child Guilt + Overcompensation
Poor boundaries Unresolved grief limits
parent’s responsiveness to child’s needs
AMBIVALENCE
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Visitation: Children’s Issues
Conflicting feelings Loyalty splits Circumstances of visit can
influence child’s mood and response to parent
Natural separation protest responses act out
Children’s responses to visits can be very challenging to caregivers.
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Other Visitation Dynamics
Visits may not be regular Tx program may restrict contact Pre- or post-visit upsets push
for less visitation Birthparent—caregiver dynamics Parent concern re: child’s
adjustment to carecut back on visiting
Longer in careless confident in parenting
Family develops new homeostatic balance around child’s absence
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What Courts Can Do
Specify visiting arrangements in court orders
Make sure caseworkers and/or tx staff responsible for carrying out visitation orders receive the specific orders, not just court action summaries
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What Courts Can Do
If minimally/ unsupervised visits would not endanger the child, pursue them—even pre-disposition
Visiting for newborns-18 months: at least 2x/ week
Discuss visiting progress at and before every court date
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What Courts Can Do
Visit plans should evolve AT LEAST every three months or document why remaining same.
Set expectation that CW agency and other service providers will provide detailed info on quality and context of visits
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What Courts Can Do
Encourage parents to be increasingly involved in day-to-day aspects of their children’s lives
Convey to CW and SA treatment agencies that this is an important and expected part of parent’s Drug Court service plan.
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What Courts Can Do
Encourage CW and tx agencies to consider visit hosting to expand possibilities for frequency & setting of visits
Make preferential referrals to foster care agencies and tx providers who value parent—child visitation and facilitate frequent contact
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What Courts Can Do
Use handout, “Family Visiting Tips for Substance Abuse Treatment Service Providers” as guideline for evaluating tx providers’ helpfulness re: visitation
Issue handout to tx providers so they understand/ can respond to the court’s preferences
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What Courts Can Do
Encourage positive, supportive relationships between foster and birthparents
Never decrease visitation frequency or increase level of supervision for any reason other than child safety issues
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(Re)Unification: Parent—Child Interactions
Honeymoon period, then Testing & Acting Out Children hypervigilant re:
dishonesty, broken promises, etc.
Children’s grief & loss issues re: previous caregiver
Children’s anger & fear surface
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(Re)Unification: Parent—Child Interactions
Parents trying to assert authority for perhaps first time
Parent’s high expectations of self, kids rigid or inappropriate rules
Role changes for kids are confusing and threatening
Children rebel, regress Parents surprised,
confused by kids’ behavior
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(Re)Unification: Parent—Child Interactions
Parents may be reluctant to seek help—fear children will be removed again
At same time, parent has new people, places, & things in their life and kids have to adjust to all of these
There may be new children
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(Re)Unification: The big picture
Parent simultaneously coping with relationships with substitute caregiver(s), partners, employment, housing, finances, any continuing legal issues, and maintaining sobriety.
Is it any wonder that relapse vulnerability is high right about now?
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What Courts Can Do
Refer for family therapy—Don’t wait until reunification date is in sight
Refer for parent education that is evidence-based and effective
Encourage parent and kinship caregiver/foster parent collaboration. Expect CW agencies to do same. Set the bar high.
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Quality Parent Education
Gold standard = both parents and children involved in the service. Examples: Strengthening Families (
http://www.strengtheningfamilies.org/html/programs_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 model programs
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What Courts Can Do
Assure that a Relapse Prevention and Response Plan has been developed once unsupervised visits are instated.
Assess parent’s readiness to reunify using multiple measures—abstinence or lack thereof is not an adequate measure
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What Courts Can Do
Recognize parent’s and children’s differing special needs. Develop referral agreements for parent education, family therapy, parenting-specific aftercare services, child support groups, therapeutic recreation, psychotherapy, developmental services, etc.
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What Courts Can Do: Capacity-
Building
Encourage the development of additional child, parent, & family services to meet reunification needs in your community—partner with funders and issue RFPs for services; encourage CW, family service, and tx agencies to partner to provide services to Drug Court parents
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What Courts Can Do: Capacity-
Building
Support cross-training and partnership-building between child welfare, family service, and tx agencies
Play lead role in obtaining funding for cross-systems, cross-agency partnerships
Make preferential referrals to agencies with these types of partnerships
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Case Examples
What information are you missing?
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Visitation is the Workhorse of Reunification
Visitation should be:
• Goal-directed
• Planful
• Responsive to phase of
reunification preparation
• Responsive to changes in
parent and child status
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Purposes of Visiting
Preserve & build bonds
Assessment of reunification capacity & progress
Provide opportunity for intervention
Careful documentation
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Phases of Visitation
Should correspond with phase of placement
Initial/ Early Phase Reassure & Plan
Middle Phase Practice Makes Safety
Transitioning Phase Prepare for Real-World
life
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An Excellent Resource on Visitation
Teaching Family Reunification: A
Sourcebook
By B. Pine, M. Warsh, & A. MallucioCWLA Press (1994)
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Visitation: Initial Phase
Reassure child and parent
Assessment and goal planning
Build relationship between parent(s) and caregiver(s)
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Visitation: Middle Phase
Learn/ practice new ways of relating
Focus on specific case goals
Gradual resumption of parenting responsibilities
Address parent and child ambivalence
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Visitation: Transitioning
Phase
Continue to address ambivalence
Simulate post-reunification living conditions
Continue work on specific case goals
Safety Planning Plan for post-reunification
connections w/ caregiver(s) Identify & secure services
to stabilize reunification
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Visits Should Be Planful
Use of formal visit planning instruments
Match visit activities to phase of visitation and specific goals
Visit preparation and debriefing for parents and children
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Visitation:What to Observe
Timeliness of arrival Greeting Parents’ preparation Proximity throughout
visit Activities & level of
participation by both parent & child
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Visitation:What to Observe
Indicators of child’s comfort level
Parent’s ability to set boundaries
Separation behaviors at end of visit (p’s & c’s)
Children’s reactions to visit
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Visitation: Planning and Documenting
Develop an outline for visit planning and visit progress reporting guidelines/ forms for your drug court
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Relapse
A part of recovery for most people
A process, not an event, ending with substance use
Not all relapses are the same
Not all relapses involve a return to pre-treatment level of functioning
Family may react more negatively due to sense of disappointment and failure
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Continuing Care/ Relapse Prevention &
Response Planning
Clean or dirty urine is not the only or even necessarily the most reliable indicator of child safety.
Sobriety is an important measure of safety, but it’s not the only measure!
Just because the parent loses their clean time, it doesn’t necessarily mean they lose all the actual progress they’ve made in altering their thoughts, feelings, behaviors, and relationships.
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Continuing Care/ Relapse Prevention &
Response Planning (cont’d)
Can have clean urine while child is still in danger of being abused, neglected, or hurt.
Can have a dirty urine but be taking better care of child than before.
Clean urine for drug of choice does not preclude use of another drug (most commonly alcohol) in a way that might be dangerous for a child.
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Continuing Care/ Relapse Prevention &
Response Planning (cont’d)
Let’s be smart about the place of urine testing in making visitation and reunification decisions! Parenting is multi-dimensional and so should our decisionmaking be.
Continuing Care/ Relapse Prevention & Response Planningt should be a part of parents’ treatment and a part of the conversation in FDTC.
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Elements of a Relapse Prevention &
Response Plan
Identify parent’s triggers
Identify warning signs Develop an action plan
Signed by everyone
Prospective monitoring Retrospective review
& revision
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Continuing Care/ Relapse Prevention &
Response Planning (cont’d)
Should include discussion of plan for child safety in case parent relapses
Requires involvement of parent’s support system to provide child safety and/or monitoring & reporting of parent behavior
Swift reporting of relapse should be looked upon with respect
Relapse should be viewed as indicating a need for additional support
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Indicators of Readiness/ Safety:
Tools
North Carolina Family Assessment Scale—Reunification (Kirk, 2001)
Developed for Intensive Family Preservation Services programs serving reunification cases
Available at www.nfpn.org
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North Carolina Family Assessment Scale for Reunification (NCFAS-R)
7 Main Areas of Focus: Environment Parental Capabilities Family Interactions Family Safety Child well-being Parent/ Child
Ambivalence Readiness for
Reunification
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Indicators of Readiness/ Safety:
Parental Capabilities (NCFAS-R)
Supervision of children Disciplinary practices Provision of
developmental enrichment opportunities
Parent’s mental health Parent’s physical health Use of AODs [if any] does
not impair parenting
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Indicators of Readiness/ Safety: Family Interactions
(NCFAS-R)
Bonding with child Expectations of child Mutual support within the
family and/or “fictive kin” Relationship between
parent and caregiver(s)
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Indicators of Readiness/ Safety:
Parent/Child Ambivalence (NCFAS-
R)
Parent Ambivalence Responds appropriately
to child verbally & nonverbally
Receptive & responsive to services to bring parent and child closer
Parent acknowledges responsibility for role in family difficulties leading to removal
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Indicators of Readiness/ Safety:
Parent/Child Ambivalence (NCFAS-
R)
Child Ambivalence Comfort with parent Child responds appropriately
to caregiver affect, expressions of love, limitsetting, etc.
Age-appropriately expressed desire to live with caregiver
Acknowledges any responsibility child had for family difficulties leading to removal
Responsive to services aimed at facilitating reunification
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Indicators of Readiness/ Safety:
Parent/Child Ambivalence (NCFAS-
R)
Caregiver Ambivalence Supports reunification
even if they have some reservations
Will give parent a fair chance
Disrupted Attachment Eagerness to repair
relationship from both parent and child
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Indicators of Readiness/ Safety:
Parent/Child Ambivalence (NCFAS-
R)
Visitation Positive anticipation of
visits Activities planned and
executed Increased duration &
frequency and decreased supervision needed
Incidents during visits are processed
Re-establishing roles and limits
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Safety and Relapse Potential
How will your court use these
tools?
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For more information
Kim Sumner-Mayer, PhD, LMFT
Children of Alcoholics Foundation
164 West 74th StreetNew York, NY 10023(646) 505-2063 tel.(212) 595-2553 fax
www.coaf.org www.acde.org www.phoenixhouse.org
