Transcript Integrating Infant Mental Health in a Residential Drug

Integrating Infant Mental Health in a
Residential Drug Treatment Program
The F.I.R.S.T. Program
(Families in Recovery Staying
Together)
Arlene Purcell, MSW
Director of Project Pride
A Division of East Bay Community Recovery Project
Ayannakai Nalo, LCSW
Coordinator, F.I.R.S.T. Program
Children’s Hospital & Research Center at Oakland
Jackie Schalit, MFT
Lead Clinician, F.I.R.S.T. Program
Children’s Hospital & Research Center at Oakland
Karen Tanner, MA
Infant Development Specialist
Children’s Hospital &Research Center at Oakland
Jill Rian,LCSW
SEED 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
ACDCFS
Project Pride
Drug
Counselors
Case Management
ECMH
SEED
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PHN
Co-occurring Disorder
Treatment
Child Enrichment Staff
CHO
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= F.I.R.S.T.
CVC
Social
Workers
SEED
Expressive Art
Therapy
FAMILIES IN RECOVERY STAYING TOGETHER
It Takes a Team to Build a
Collaboration
Project Pride-East Bay Community
Recovery Project
Project Pride
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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
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History
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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
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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
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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
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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?
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Recognition that children need help and treatmentmay have already been impacted by loss or trauma
Increase the tools in the toolbox
Recognition that addiction is beyond just the mothercommitment 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 RelationshipBased Approach
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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
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Personal reflection
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Using relationship
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Holding the baby with the others
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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
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Short-term discomfort vs. Long-term gain
SEED client
Services provided
Treatment issues
Interventions
Dyadic, Family and Group
Work with Women and ChildrenBreaking Cycles-Changing Lives
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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 Vignette
Points of Collaboration
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Referral from Director
Concerns of mother’s
trauma history and
impact on daughter
Therapist’s observations
Collaborating with drug
treatment staff
The Work Begins
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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
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Joint clinical meeting with
Project Pride staff to
share assessment
Port of entry with tattoos
Family reconnections
From Avoidant to Secure
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Progress..She’s looking
for mommy!
Success in school
Mom signs up for
Sleepy Time Group
Preparing for discharge
What We Have Done Together
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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
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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
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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
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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