Integrating Infant Mental Health in a Residential Drug Treatment Program

1. Integrating Infant Mental Health in a Residential Drug Treatment Program The F.I.R.S.T. Program (Families in Recovery Staying Together)

2. Arlene Purcell, MSWDirector of Project Pride A Division of East Bay Community Recovery ProjectAyannakai Nalo, LCSWCoordinator, F.I.R.S.T. Program Children’s Hospital & Research Center at OaklandJackie Schalit, MFTLead Clinician, F.I.R.S.T. Program Children’s Hospital & Research Center at OaklandKaren Tanner, MAInfant Development SpecialistChildren’s Hospital &Research Center at OaklandJill Rian,LCSWSEED Child Welfare SupervisorAlameda County Department of Children and Family ServicesRobbin Rasbury, Psy.D.Clinician, /SEED Program F.I.R.S.T Children’s Hospital & Research Center at Oakland

3. Who We Are ACDCFS CHO Project Pride Drug Counselors ECMH SEED F.I.R.S.T. Case Management + + = PHN Co-occurring Disorder Treatment CVC Social Workers Child Enrichment Staff SEED Expressive Art Therapy FAMILIES IN RECOVERY STAYING TOGETHER

4. It Takes a Team to Build a Collaboration

5. Project Pride-East Bay Community Recovery Project

6. Project Pride • Project Pride • A Residential Drug Treatment Setting for Women & Kids 0-7 • CDCR Alternative • Co-occurring disorders

7. 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)

8. Alameda County Department of Children and Family Services • History • The Team

9. CHILDREN’S HOSPITAL & RESEARCH CENTER at OAKLAND

10. Children’s Hospital & Research Center at Oakland • Early Childhood Mental Health • Developmental Play Group • Center for the Vulnerable Child/SEED

11. Home of the F.I.R.S.T. PROGRAM

12. F.I.R.S.T. PROGRAM (View from Project Pride Playground)

13. The F.I.R.S.T. Program • 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

14. Internal Rumbling at Project Pride and ECMH -- The Pregnancy • Growing interest and focus on parent/child relationships and the family at Project Pride • Need for more resources to meet goals at Project Pride.

15. Project Pride Goals Related to Infant Mental Health-Common Ground for a Collaboration • 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

16. Why Child Mental Health Treatment within the Milieu? • Recognition that children need help and treatment-may have already been impacted by loss or trauma • Increase the tools in the toolbox • Recognition that addiction is beyond just the mother-commitment to breaking the intergenerational cycle • Desire to create a seamlessness between the various treatment services

17. Power of a Relationship-Based Approach

18. What We Mean By a Relationship-Based Approach • 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

19. Infant Development-It’s a Different World • Personal reflection • Using relationship • Holding the baby with the others

20. Working Together- An Evolution - Work in residential treatment settings by clinicians is only effective if it is lined up and done with program staff

21. Bringing it All Together- An Example • Short-term discomfort vs. Long-term gain • SEED client • Services provided • Treatment issues • Interventions

22. Dyadic, Family and Group Work with Women and Children-Breaking Cycles-Changing Lives • 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

23. The Sequence of a Clinical VignettePoints of Collaboration • Referral from Director • Concerns of mother’s trauma history and impact on daughter • Therapist’s observations • Collaborating with drug treatment staff

24. The Work Begins • 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

25. Other Interventions and Learnings • Joint clinical meeting with Project Pride staff to share assessment • Port of entry with tattoos • Family reconnections

26. From Avoidant to Secure • Progress..She’s looking for mommy! • Success in school • Mom signs up for Sleepy Time Group • Preparing for discharge

27. What We Have Done Together • 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

28. Differences that Have been Noticed by Treatment Staff • 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

29. Barriers to Collaboration Along the Way • 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

30. Lessons Learned about Collaboration • 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

31. Moving Our Worlds Closer Together