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DrugScope Conference 2011

DrugScope Conference 2011. Caring for the pregnant drug user Faye Macrory MBE. Manchester Specialist Midwifery Service. Consultant Midwife 4 Specialist Midwives Personal Assistant drug/alcohol use mental health/illness domestic violence/abuse

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DrugScope Conference 2011

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  1. DrugScope Conference 2011 Caring for the pregnant drug user Faye Macrory MBE

  2. Manchester Specialist Midwifery Service Consultant Midwife 4 Specialist Midwives Personal Assistant drug/alcohol use mental health/illness domestic violence/abuse prostitution/sex work criminal justice system safeguarding/child protection

  3. drivers for change: • Every Child Matters (DFES 2003, 2004) • Hidden Harm (ACMD 2003, 2006) • Think Family: improving the life chances of families at risk (2008) • Drugs: protecting families & communities. Action plan (2008-2011)

  4. Ten Pitfalls and how to avoid them (NSPCC 2010) • Safeguarding in the 21st Century - where to now? (2010) • The Munro Review of Child Protection: A Systems Analysis & Interim Report: the child’s journey (2011)

  5. Working together: (2010) • Early Intervention: the next steps (Allen 2011) • Saving Mothers’ Lives (CMACE 2011) • NICE SCiP Guideline (110)

  6. references • Why love matters: how affection shapes a baby’s brain (Gerhardt, S. 2004) • Ghosts from the Nursery: tracing the roots of violence (Karr-Morse, R. & Wiley, M.S. 1997) • Meeting Multiple Needs: Pregnancy, Parenting and Dual Diagnosis (Macrory, F).In Rasool G.H. (ed) Nursing Care of the Dual Diagnosis Patient (2006

  7. aims and objectives: • provide appropriate, accessible and family-focused services to improve health gain • embrace all aspects of a vulnerable and socially excluded lifestyle • to raise awareness of the impact of parental substance misuse on children and young people

  8. commonly used drugs in the UK include: • alcohol and………… • cannabis (hash & marijuana) • benzodiazepines (e.g. diazepam, temazepam) • opioids (heroin, methadone, dihydrocodeine, buprenorphine) • hallucinogens (LSD, acid, magic mushrooms) • stimulants (amphetamine, cocaine, ecstasy, mephedrone & other ‘legal highs’) • cyclizine, ketamine,‘GHB’, amyl-nitrate, anabolic steroids, anti-depressants, anti-psychotics • volatile substances (gas, glue, aerosols) • OTC drugs – codeine /DFII8

  9. encourage and enable clients to think beyond their immediate needs • emphasis on whole family approach – strengths and weaknesses • supporting families to stay together ? • breaking the cycle……………..

  10. ‘……….a proper understanding of our own beliefs and values is important, as our attitudes influence the work we do………..’ Mulleady (1992)

  11. the challenges ahead: • addiction & recovery • relationships & dependency • death & dying • love & loss • mental health

  12. recognizing the problems • barriers and obstacles to engagement • hostile and uncooperative families • disguised compliance

  13. setting realistic goals • initiating/sustaining change • risk reduction/harm minimization • confidentiality vs sharing information

  14. following the pathways • who to refer to ? how to ? • escalating concerns • accountability

  15. ethical dilemmas • coping with stress and burn-out • personal/professional boundaries • supervision/support & taking care of yourself

  16. parenting assessments: When does an adult’s • drug and/or alcohol use • mental health/illness • domestic violence/ and abuse ………….pose a conflict of interest within a family?

  17. how does parenting capacity become impaired in these circumstances? • what is a child’s capacity to tolerate the changed and often detrimental care they may receive? • when does it pose risks for the safety & well-being of the child/children?

  18. what about the parent/carer’s: • ability to provide a stable and nurturing environment? • sense of responsibility? • extended family and wider context ? • financial/housing status?

  19. commitment to maintaining the family? • health/emotional resources? • ability to communicate & work together? • history of violence or conflict?

  20. what about the child’s: • understanding of the substance misuse? • exposure to traumatic incidents? • fears, fantasies & level of confusion?

  21. is the child socially isolated? bullied? stigmatized? • what is the child’s total experience? what compensatory measures are used? • is the child the target of the parent’s paranoid projections? delusions? hallucinations?

  22. challenges for professionals: • how can these risks be assessed? How can they be managed? • who decides when these risks become acceptable? or unacceptable? • what services need to be available to meet the needs of both adults and children in these circumstances?

  23. how do those working in these circumstances need to be trained and supported? • what can be done to bridge the gulf between professionals trying to meet the needs of children & parents? • how can the different agencies involved ensure consistent practice & good communication between each other?

  24. see the adult…… ……and see the child

  25. How is it possible to convince a child of his own worth, after removing him from a home which is said to be unworthy, but with whom he identifies? Maya Angelou

  26. OPPORTUNITYISNOWHERE

  27. Contact details: Manchester Specialist Midwifery Service Zion Community Resource Centre 339 Stretford Road Manchester M15 4ZY Telephone: 0161 226 6669 Fax: 0161 226 7126 Email: faye.macrory@cmft.nhs.uk

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