Presented by Kim Sumner-Mayer, PhD, LMFT of the Children of Alcoholics Foundation New York, NY

1. Reunification 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

2. The Approach Understand family recovery and reunification dynamics from a clinical perspective and develop court practice recommendations from there.

3. The Philosophy Reunification with inadequate preparation and subsequent serious problems is a horrible blow to parents and entire families, not just to children.

4. The Philosophy Therefore, gradual reunification preparation is preferred not just for the child’s best interests, but for the parent’s as well.

5. What do you hope to learn today?

6. Gradual Reunification Preparation BOTH Abstinence/ reduction in use AND Improvements in the parent—child relationship and overall family functioning

7. 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

8. 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?

9. Reunification Begins with Separation Values and Attitudes Clarification Exercise

10. Why should a Treatment Court care about visitation?

11. “Before” and “After” Portraits

12. 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

13. 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.

14. 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

15. 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

16. Reunification Begins with Separation: Parent’s Experiences Two losses: • Children, and • Status as an able parent Reactions: • Anger, Grief, perhaps Relief • Hold on to maternal role • Grief + Relief  Drug binge, deepening of addiction • “Replacement pregnancy”

17. 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

18. 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

19. 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

20. What Courts Can Do • Order comprehensive neuropsychological and developmental evaluations of children to determine what special services may be indicated

21. 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

22. 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.

23. 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 carecut back on visiting • Longer in careless confident in parenting • Family develops new homeostatic balance around child’s absence

24. 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

25. 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

26. 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

27. 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.

28. 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

29. 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

30. 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

31. (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

32. (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

33. (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

34. (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?

35. 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.

36. 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

37. 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

38. 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.

39. 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

40. 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

41. Case Examples What information are you missing?

42. 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

43. Purposes of Visiting • Preserve & build bonds • Assessment of reunification capacity & progress • Provide opportunity for intervention • Careful documentation

44. 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

45. An Excellent Resource on Visitation Teaching Family Reunification: A Sourcebook By B. Pine, M. Warsh, & A. Mallucio CWLA Press (1994)

46. Visitation: Initial Phase • Reassure child and parent • Assessment and goal planning • Build relationship between parent(s) and caregiver(s)

47. Visitation: Middle Phase • Learn/ practice new ways of relating • Focus on specific case goals • Gradual resumption of parenting responsibilities • Address parent and child ambivalence

48. 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

49. 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

50. Visitation:What to Observe • Timeliness of arrival • Greeting • Parents’ preparation • Proximity throughout visit • Activities & level of participation by both parent & child