Safe relationships, safe children: Making the “Invisible” visible

1. Safe relationships, safe children: Making the “Invisible” visible Family-Centred Practice and Collaboration

2. Working Together to support Families Services to support parents, children and families facing issues related to MH, SU & IPV will best be enhanced within an infrastructure that invites collaborative, family-focused practice and that: • Involves children, youth, adults and families in planning for services and supports; • Recognizes that each individual has unique strengths and needs that should be considered when developing a service plan to meet their needs; • Develops approaches that address the safety concerns of children, parents and other family members; • Ensures that interventions are trauma informed and culturally safe and competent; • Encourages the strengthening of cross-sector relationships built on mutual respect and trust.

3. Care Pathway – Steps for Engagement Step 1: Think Parent • Identify Adults in a Parenting Role • Engage Parent on Potential Needs Related to Three Core Issues Step 2: Think Child • Inquire about Child Needs • Identify Risk and Protective Factors for Children Step 3: Think Safety • I Identify Emergent/Urgent Issues that Require Immediate Action • Stabilize and plan for Future Safety Step 4: Think Family • Collaborate with Parents and Others to Actively Connect Families to Required Supports • Share Information to Support Safety and Wellbeing Step 5: Think Outcomes • Monitor Risk and Review Goals and Progress • Reflect on Progress and Practice

4. It Doesn’t Hurt to Ask • Client’s don’t mind being asked: Research with women in healthcare settings has found that the vast majority do not mind being asked about experiences of abuse (they have the choice not to disclose if they are not ready or comfortable yet) • Client’s often want to be asked - because they don’t know how to start the conversation themselves. • Asking about an issue can generate the client’s confidence and trust - in a worker’s ability to deal with an issue. • You may be the only person to ask - never assume that someone else has asked or will in the future. We all have a part to play in supporting vulnerable people to get the help they need.

5. Children’s Risk Factors • MH and SU symptoms and/or witnessing domestic violence can have an impact (e.g., attachment, relationships, functioning, children’s development) • Societal factors, e.g., shame and stigma • Untreated MH, SU, DV demonstrates a significant increase of risk both short and long term, e.g., intergenerational, cumulative harm to children

6. Children’s Risk Factors • Parents: • In MH, SU symptoms can have an impact and witnessing DV can have an impact • Illness can impact parent’s ability to form attachment and relationship • Societal factors, shame and stigma of MH, SU, DV – impact how parent and child feels • Can impact Developmental Challenges of children

7. Children’s Risk Factors • Co-occurrence of untreated MH, SU, IPV demonstrates a significant increase of risk both short and long term • Cumulative Harm to children: profound, exponential, covering multiple dimensions of a child’s life • The presence of multiple factors present greater risk, than one particular factor • Risk factors are: Complex – systemic, family, individual Dynamic – change over time, interact with protective factors Preventable – we CAN influence the outcome Children whose safety, sense of stability and well being has been reduced, should be linked early and effectively to support

8. Children - Thoughts • Children of parents impacted by untreated MH and SU and/or DV: • Describe their family life as difficult because of the problems and associated challenges (e.g. poverty, fighting, uncertianty) • Often have deep loyalties to their parents • Develop a range of coping strategies to respond to their circumstances • Describe having to care for parents, siblings and themselves

9. Parents - Thoughts • Parents often caught in the gaps between systems – help them bridge the gaps • MH, SU, IPV viewed as individual problems – but they often co-occur and overlap and impact the whole family, which belong to the community as does the provision of support • “Being a Parent” is often cited by parents as the most important thing they do – honour it • Provide support to assist family – if family has to separate, help them maintain contact

10. How do we ask the questions? • Initiate Strength-based and Family centred Conversations about Child Needs related to Parental Issues • Express awareness that parenting can be challenging even at the best of times. • Acknowledge and honour the concern and effort of the parent in relation to the children. • Display sensitivity to any shame/stigma in relation to identified parental issues by adopting a non-judgmental and supportive stance. • Begin a conversationabout the children. Ask about their interests/strengths. Ask about impacts of identified MH, SU, IPV issues • If appropriate to your role ask to speak to the children. Ask about any worries/ concerns, how they cope, who helps them

11. Family centred Practice • A paradigm shift is required in which families are viewed as a key part of the solution as appropriate (safety) rather than as part of the problem. • Families are included at every level of the process as appropriate, and services are collaborative and integrated • Family centred Practice is NOT Family Therapy

12. Family centred Practice Family centred Practice is about bringing the family voice into the room and to the care team They many not always need to be physically present and no one agency needs to do all the work It is about identifying, assessing and making referrals so that the whole family is supported It requires incorporating Parenting concerns into the treatment, care plan of the client

13. Family centred Practice Sometimes what is described as family-centred practice is really mother centred practice (ignoring fathers), it can be nuclear family-centred (ignoring the role of extended family members such as grandparents), it may be parent-centred (rendering children invisible and inaudible) or it may be child-centred (reinforcing parental feelings of failure and shame). - Arney and Scott, 2010

14. From Thought to Practice True collaborative relationships with children and their families means: • Views families as equal partners, intervention is individualized, flexible and responsive to the family-identified needs of each and the family unit as a whole • strengths and capabilities of children and families are recognized and built upon • client expertise is recognized as contributing to the development of a safer mental health care system (Brickell et al. 2009), and one that is more responsive to the needs of children and their families. • seeing families as part of the solution (instead of part of the problem) • involving them in planning to build their confidence in their own strengths and capabilities • building trust by taking time, seeing and interacting with the children, and allowing all family members to talk openly Understanding where families come from and how they understand their own life is crucial

15. Resistance - Clients’/Family’s Factors • Feelings of shame and stigma • Misalignment / conflict of goals (e.g therapists move clients towards acceptance of responsibility while clients more inclined to strive for evasion of responsibility)(King, 1992) • There is a purpose for their symptoms (i.e. benefits of maintaining dysfunctional beliefs or behaviors far outweigh benefits of overcoming them) • Change is frightening, humans creatures of habit, and change may lead to resistant behaviors as a productive measure • Role of Therapist - maintain focus on feelings and thoughts underlying the disengagement of the individual or the family while also continually introducing engagement – ensures open and honest communication

16. Facing Resistance • Brainstorm pros and cons of continuing current behavior vs change - Foster collaboration between counselor and client • Empathize with client and their reason for feeling resistant - Understand what is behind it • Using language that mirrors that of client • Understand resistance = normal client reaction - may signify a particularly distressing issue • Maximize use of client self-direction • Gently persist when client unable or unwilling to proceed

17. Partnership Between Families and Direct Service Providers • Involve the family not just in language but actions - where child and family: • define desired outcomes • select individuals to add to the team • participate in collaborative decision-making that reflect family rather than therapist goals • provided accurate, understandable and complete info to make informed choices • Include other “carers” (foster parents/grandparents) as partners in the treatment of children in their care • A useful family-focused framework encourage staff to consider the parent, child and family as a whole when assessing needs and planning services – understanding the interconnections between parental MH, SU, DV, parent and family relationships, child development and the services in place to support them.

18. Many people worry about their mental health/alcohol use/drug use/safety from violence and find it helpful to know what help is available • How concerned are you about this issue? • How does it affect you? • How does it affect your parenting? • What do you hope for in relation to this issue? • What are the strengths and resources that help you manage this issue and might help you achieve what you hope for? • What do you need to support you and your family with this issue? Information about the issue and its typical impact on health and well-being within families and about available resources Plan for follow-up and/or referrals if necessary SUPPORTIVE PRACTICE FRAMEWORK

19. Family centred Practice Care Plan • Intake/Triage: • Parent/carer status & Responsibilities • Consider child safety/risk • Other parent/carer status - Action Plan • Assessment: • Parental Status • Current function/impact/supports • Risk Assessment – Child Safety • Impact of risks on parenting • Specific risks of child safety (neglect, attachment, involvement in homicidal ideation • Consider child development impacts

20. Family centred Practice Care Plan • Care Plan: • Incorporating parenting concerns into goals and interventions • MH, SU, DV – impact on parent/child relationship, impact on parental functioning • Review: • Progress of parenting related goals and interventions • Impacts on safety/risk of child • Assess impact of treatment on parental functioning – current risk/protective factors – family experience • Referral/Transfer/Discharge: • Include parenting and child needs – current issues and recommended follow up • Considerations of child safety/risk/protective factors

21. Ways to Support • Foster personal resilience: I have, I am, I can! • I have people who: love me, set limits, model how to do things right, want me to learn to do things on my own, help me when I am sick/in danger, need to learn • I am a person people can like/love, glad to do nice things for others, respectful of myself/others, willing to be responsible for what I do, sure things will be all right • I can talk to others about things that bother/frighten me, find ways to solve problems, control myself when I feel like doing something not right, know when to talk to someone or take action, find someone to help me

22. We will never know if we don’t ask

23. Collaborative Practice “Fragmented Services create dangerous chasms into which both workers and children can fall.” (Taylor & Kroll 2004 )

24. Collaborative Practice • Working with high risk or vulnerable families requires working with other services particularly adult mental health, substance misuse, child protection and domestic violence services • Workers need to know they are working safely and will have access to supervision and management when needed

25. Lessons from our Community • “It is when we are faced with supporting and working with these often very complex families, that we as service providers need each other most” – Roz Walls, Facilitator Richmond Supporting Families • “I need a safe place where I can be honest about my mental illness, my fears as a parent otherwise I live in fear of being identified as mentally ill and losing my children” – a parent

26. Pilot Sites Vernon Developed community model of collaborative practice to address DV I.C.A.T. Richmond Developed community model of collaborative practice to work with families where a parent is impacted by MHSU concerns 26

27. SUPPORTING FAMILIES - RICHMOND Resilient Kids & Parent Group Life Lessons & Social Events Community Education Consultation Super Saturdays & Sundays Family Fun Nights

28. ICATInteragency Case Assessment Team (for Highest Risk Domestic Violence)

29. Potential Benefits of Collaboration • Enhanced capacity to support people with complex conditions; • Enhanced capacity in collaborating partners; • Improved access to services; • Earlier detection and intervention; • Clinical value in integrated care; • Improved continuity of care; • More satisfied healthcare consumers; and • Improved client–patient outcomes and reduced costs

30. Models of Collaboration • A need for effective linkages; • A high level of trust and reciprocity among participants; • A focus on a broad continuum of severity; • Multi-sectoral involvement; • Multiple levels of collaboration that align with different types of needs and levels of severity; • A distinction between service- and system-level initiatives.

31. Collaborative Practice (cont’d) Components of successful interagency partnerships: • communication • minimizing duplication • clear definitions of roles and responsibilities • referral pathways and inter-agency working protocols • who is the in the lead role

32. Collaborative Practice • True Collaborative Practice requires: • Making a referral and following up • Is the client truly engaged, if not – get feedback, provide additional support to engage and/or make a different referral

33. Current State - Outcomes • Richmond and Vernon improved emergency department relationships with community and increased use of Domestic Violence protocols • Community Resource Directory (Resource Day Treasure Hunt) • ICAT: Integrated Case Assessment Team • Collaborative Practice Table

34. Current State - Outcomes • Pilot Sites – Innovative Practice Initiatives and Existing Practice • Collaborative drop-in groups to address waitlist • MCFD/Adult MH – consults • ED – Transition House Consults • ED – Community youth collaboration • Roaming Activity Van - City subsidized recreation passes • Co-location of CYMH and GP/Primary Care • Public Health Nutritionists – cooking skills for youth/family groups • Public Health Nurse – youth group collaboration

35. SAFE RELATIONSHIPS, SAFE CHILDREN Provincial Implementation –October 2014 Questions? Discussion?