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Eyes Open:

Building Parental

Capacity, Minimizing

―Collateral Damage‖

Kim Sumner-Mayer, PhD, LMFT Center on Addiction and the Family

(646) 505-2063

Ksumner-mayer@phoenixhouse.org

SELECTIVE ATTENTION

VIDEO

Today’s Themes• Assessing Parental

Capacity: We are part of the equation!

• Parenting on Drugs

• Building Parental Capacity: Raising Resources

• Minimizing Harmful Effects of Our Interventions

Assessing Parental

Capacity

Assessing Parental Capacity

• HOW we see what we see

• Circularity, Complementarity, &

Inviting Competence

• Problems don’t tell the whole

story

WE are Part of the Equation!

When we assess or intervene with a family,

we are NEVER viewing the family by itself:

Professional (Family)

Rather, we are viewing:

Professional (Family + Professional)

Using your SELF Powerfully

• CIRCULARITY

• COMPLEMENTARITY

• (INVITING) COMPETENCE

Inviting Competence

• Strengths always exist, but we don’t always capitalize on them.

– Skills, abilities, resources, protective factors

– Exceptions to the problem: Shining moments

• Inviting Competence:

– Privileging the family’s voice

– Making room for parents to do the work

– Intervening in respectful,

capacity-building ways

Visualize…

PARENTING ON

DRUGS

Families: Key Features

• Interdependent

• Seeks homeostasis (stability)

• Cycles of stability and instability

• Competency

– Strengths

– Resources

• Complementarity and circularity

– Among family members

– Also with ―systems‖

Features of Family Organization

• Roles and responsibilities

• Subsystems and alliances

• Power and authority

• Hierarchy

• Communication

• Interaction with ―Systems‖

• Patterns

Parent Responsibilities

• Protection and safety

• Nurturing and love

• Teach morals and values

• Provide home, food and clothes

• Encourage independence and uniqueness

• Foster self-esteem

• Teach appropriate behavior

• Share cultural values, traditions and identify

Families We See

• Do not get to write their own stories

• May look chaotic – interference from social

interventions

• Multiple systems involvement

• Workers may become part of family patterns

• Mutual affection and bonding overlooked

And Then Come Drugs..(aka The Effects of Active Addiction on

Children and Families)

When Substance Abuse Enters…

• Alcohol/Drugs – centrifugal force

• Homeostasis may be interrupted

• Loss and grief

• Basic functions compromised

– Safety

– Economic security

– Parenting

– Communication

– Identity building and supporting

How Drugs Affect Parenting

• Lowered inhibitions

• Extreme discipline

• Low frustration tolerance

• Unrealistic expectations

• Role reversal

• Illegal activity

• Isolation

• Mood swings

• Inconsistency

• Less responsive/ neglectful

• Focused on parent’s needs

• Closed communication

• Blame child

• Problems w/ affection, problem solving

Family Rules

• Don’t talk, don’t trust, don’t feel

– Wait for the right time

– Don’t be direct

• Don’t have expectations

• Be in control at all times

• Don’t be selfish

• Always be right, do the right thing

• If things don’t go as planned, blame someone else

Complicating Factors

• Parent’s own experience with

parental substance abuse

• Child’s personality,

temperament, and needs

If Parent Involved

with Illegal Drugs

• Drug subculture

• ―Counter‖ values

– ―beat the system‖

– Disdain for authority

– Focus on money and materialism

• Exposure to drug sales, violence, theft, prostitution

• Avoidance of help that could bring unwanted attention Isolation

• High stakes consequences

• Systems involvement

Consequences for Children

• Ignored

• Schoolwork suffers

• Parentified

• Afraid to bring friends

home

• Pulled into conflicts

• Hard to concentrate

• No access to

emergency services

• Chaotic family structure

• Lack good role models

• Family violence

• Neglect

How Children Feel

• Sad

• Afraid

• Lonely, invisible

• Traumatized

• Angry

• Worried

• Love parent

• Ashamed

• Guilty, responsible

• Embarrassed

• Parental

• Confused

• Depressed

• Anxious

• Loyal to parent

• Hopeful

Behavior Problems:

Younger Children

• Eating

– Overeating, hoarding food,

failure to thrive

• Sleeping

– Nightwaking, night terrors,

refuse to go to sleep alone,

refuse going to bed

• Toileting

– Encopresis. Enuresis,

refusing to use toilet

• Difficult to manage

– Tantrums, overactive, self-

endangering behavior,

indiscriminate social

behavior

• Aggression

– towards caregiver, towards

peers

• Sexualized behavior

– Masturbation, simulating

sex with peers or toys

Resulting from: emotional distress, role models, neglect

Behavior Problems:

Older Children and Teens

• Experiment with AOD

• School problems

• Social problems

• Run away

• Withdraw/ignore

• Perfectionism

• Alternative relationships– Gangs

– Romantic partners

– Destructive friendships

• Lack of trust

• Hypervigilant

• Hoards

• Aggression/anger

• Behavior problems

• Psychosomatic

problems

• Anxious/depressed

• Humor

Resiliency, Protective Factors, and

Coping Skills

• Resiliency– Successful adaptation despite challenges

– Personality traits + environment

– Dynamic process

Enhanced by protective factors

Coping mechanisms– Survival skills

– Contextual

– Developed because of negative experiences

BUILDING PARENTAL

CAPACITY

Building Parental Capacity

• Using your SELF Powerfully

• Surfacing Parents’ Hidden Truths

– Grief and Ambivalence

• Family-Empowering Tools

– Supportive Inquiry

– V-C-R Model

– Visit preparation & debriefing; Coaching

– Effective parent education referrals

Using your SELF Powerfully

• Self-Awareness

• Active Engagement

• Transparency

The Gorilla Video, Redux

http://www.youtube.com/watch?v=IGQmd

oK_ZfY&feature=related

Surfacing Parents’ Hidden

Truths

GRIEF AND

AMBIVALENCE

Parents’ Grief

Two losses:

• Children (tangible), and

• Status (intangible)

Reactions:

• Anger, Grief, Relief

• Hold on to parental role

• Grief + Relief Drug binge, addiction

deepens

• ―Replacement pregnancy‖

• Difficult to grieve unclear loss

Parental Ambivalence

Ambivalence =

Mixed feelings +Uncertainty

Parental Ambivalence

• Ambivalence = Mixed feelings and

uncertainty

• Shown by:

– expressing doubt re: parenting

ability or desire OR

– behavior inconsistent with stated

reunification plan

• Aggravated by ―all or nothing‖ view of

permanency options

The Permanency Continuum

• Full-time return to parent’s care

• Shared Family Care

• Kinship care (formal or informal)—liberal

visitation/coparenting

• Nonrelative foster care—liberal visitation

• Independent Living

• Kin or other legal guardianship without adoption

• Surrender parental rights/ open or conditional

adoption

• TPR and adoption, little visitation/co-parenting

Parental ambivalence

• Is NORMAL.

• Does NOT mean reunification will fail or should not be pursued.

• Can sabotage recovery and reunification if not acknowledged, worked through; therefore,

• GOAL = Recognize, Resolve ambivalence

What keeps ambivalence

underground?

• Fear of judgment

• All-or-nothing mindset re: permanency options leads to denying ambivalence

–Parent self-image, concern that child will feel unloved

• Family pressure to ―step up‖ keeps parent from acknowledging uncertainty

Working With Ambivalence

1. Understand relationship between ambivalence and noncompliance/ permanency plan failure

2. Normalize ambivalence

3. Seek to understand causes & offer additional help

4. Explore options and proceed with planning

Parent ambivalence:

Reasons and possible responses

–Concern about parent/child bond• Use visits to strengthen bond

–Sense of incompetence• Parent education

• Therapeutic visiting

–Concerns about potential relapse• Parenting-specific relapse prevention plan

• Parent support group connection

Child’s Ambivalence about

Reunification

• Anger about past

• Scared about relapse

• Avoid promises – lack of trust

• Don’t want rules and structure

• Feelings about sibling’s living arrangements

• Scared that have lost place in family

• Strong bond with caregiver

• Reluctance to leave alternate home or neighborhood

• Don’t want to leave friends or school

Reunification: Adolescent View

• Issues around authority

• May resent new limits, new

consequences, new role

• May be ambivalent

• May be controlling

Caregiver ambivalence• Not convinced full-time reunification is

best for child

• Eager to give up caregiving, but senses child has mixed feelings

• Caregiver wants parent to move in to her home, but parent doesn’t want to

• Difficulty separating own personal needs from needs of the child or the parent

• Fears ―empty nest‖ issues

• Worried about possible relapse

FAMILY-EMPOWERING TOOLS

–SUPPORTIVE INQUIRY

–THE V-C-R MODEL

–VISITING TOOLS:

• Preparation and Debriefing

• Visit Observation Form

• Visit Coaching

–QUALITY PARENT EDUCATION REFERRALS

Supportive Inquiry is…

• A way to ask and listen that:

–helps people gain and share insight

–plays a role in activating assets and

focusing on solutions

–demonstrates respect

• Model developed by Family Justice, Inc.

Supportive Inquiry

• Goals of Supportive Inquiry:

–Enhance self-efficacy

– Forge and strengthen connection

– Stimulate insight

– Collect information

Supportive Inquiry

• Questions as Tools:

–Who was the last person to loan you

money?

–Where did you sleep last Saturday

night?

–Whose pictures do you carry in your

wallet?

Supportive Inquiry

• Types of Questions:

–Exception Questions

–The Miracle Question

–Scaling Questions

–Survival Questions

–Questions for Complainers

The V-C-R Model(Hardy & Laszloffy, 2005)

• VALIDATE and affirm emotion, intention, personal quality, or desire– Must be genuine

– Shows person you ―see‖ the good in them, respect them

– Earns the right to go to next step

• CHALLENGE gently– Express concern about current behavior as not aligned

with goals, or as hurting child or themself

– Preferably using a quality you affirmed while validating

• REQUEST behavior change– Specify what you’d like parent to do differently

– Preferably honoring the quality you affirmed in 1st step

LET’S PRACTICE

Visiting Tools

Visit Preparation and Debriefing

Visit Observation Form (Colapinto & NYC

ACS, 2002)

Visit Coaching (Marty Beyer)

Quality Parent Education

• How confident are you about the parent

education programs to which you refer

your clients?

• More info on powerpoint to be posted on

the web

Quality Parent Education:

Program Content

• Targeted to parents in recovery?

• Covers normal child development/ realistic

expectations

• Addresses how to handle child behavior

without abuse

• Covers parental stress management

• Helps parents improve relationships with

others

Quality Parent Education:

Program Design

• Targets many risk factors

• Targets knowledge, attitudes, skills, and

aspirations

• Practice skills in-session

• Strong, energetic leaders w/ group skills

• Accessible for limited literacy/ multi-sensory

learning

• Include pre- and post- measures to gauge

change and skills development

Evidence-Based Programs

• Clearly defined target populations,

interventions, and outcomes

• Outcome research backs up program

effectiveness

• Replicable

• SAMHSA’s 3 Levels:

– Model

– Effective

– Promising

Costs/Benefits

• Programs with both parent and child

components are highly effective and often

result in better engagement and

completion rates

• But they also require more personnel and

resources to run than parent-only or

computer-led programs

Evidence-Based Program

Registries

• SAMHSA: www.samhsa.gov

• Coalition for Evidence-Based Policy:

www.evidencebasedprograms.org

• Strengthening America’s Families

(delinquency prevention-focused):

www.strentheningfamilies.org

• OJJDP:

www.dsgonline.com/mpg2.5/mpg_index.htm

Programs Targeting Parents

in Recovery

• Celebrating Families (not yet SAMHSA-rated but

on its way)—developed for FDTC

• Strengthening Families (SAMHSA Model)

• Nurturing Parenting Program (SAMHSA

Promising)

• Focus on Families (SAMHSA Promising)

• Building Bridges (not SAMHSA rated; in use at

Phoenix Houses nationwide; accepted by some

courts for parent education requirements)

Quality Parent Education

• Gold standard = both parents and

children involved in the service.

Examples:

– Strengthening Families (http://www.strengtheningfamilies.org/html/progra

ms_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 more model

programs

Building Bridges(COAF--Center on Addiction and the Family)

• Target Pop: Parents in drug tx with or w/o children

• 2 versions: 12 or 9 2-hour group sessions

• Discussion & workbooks

• Focus on separation, visits/contacts, and planning for future with children (possible reunification)

• Topics include connections between feelings, thoughts, & behaviors; grief related to separation; ambivalence re: parenting; parenting-specific relapse prevention planning; family r’ships; reunification planning

• Contact: COAF at www.coaf.org or 646-505-2063

MINIMIZING

“COLLATERAL

DAMAGE”

Collateral Damage

• Separation Trauma

• Lingering Placements

• Roadblocks for Parents to

Resume Parenting

Minimizing Separation Trauma

• REUNIFICATION BEGINS WITH

SEPARATION

• Clear information to child, parent

• Give parent time to pack child’s comfort

items

• Reassure child, parent of contact soon

• Usher parent into tx NOW

• Purposeful Visiting

Separation: Child’s

Experience

• Immediate reaction ≠ long-term adaptation

• Age of child affects presentation

• More placements, more severe reactions

• AD/HD overdiagnosed, PTSD underdiagnosed

• Behavior may seem willful but may be survival

oriented

• Regardless of permanency plan, need to deal with

child’s separation issues

Separation: Short-Term Effects

• Eating and sleeping disorders

• Depression

• Emotional withdrawal

• Acting out

• School problems

• Symptoms often misdiagnosed

Separation: Long-Term Issues

• Loss and abandonment

• Fearful re: parent

• Alternate caregiving

• Parental apologies

• Knowledge of parent’s location?

• Limited contact (tx imposed)

• Fantasies and expectations

• Come to terms with parent’s limits

Separation:

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 behaviors

• Caregivers need support for their own efforts

Intervening with Parents

• Grief + Relief Binge, deepening of

addiction

• Time is critical: Aggressive outreach to

ensure tx entrance

• Treatment program must respect need for

parent to fulfill parental role

Effects of Lingering Placements

• Bonds weaken

• Parents feel, become less competent

• New homeostasis around child’s absence,

more difficult reintegration

SOLUTION: PURPOSEFUL, PLANFUL

VISITING

Visiting, Done Wrong

• Visits in unnatural settings that don’t allow

for ―normal‖ parent—child interaction and

parenting behavior, activities

• Visits unjustifiably restricted or over-

supervised

• Visits don’t provide opportunities to

develop parenting skills or

work through ambivalence

Visiting, Done Right

• Visits provide opportunities to bond, practice new skills, work through ambivalence, and document soundly

• Every contact recapitulates the separation wound strong reactions to be expected

• Parents who seem underinvested may be responding to their own or child’s grief, ambivalence address as such

• Relapse should not automatically lead to restricted visits

Visits and relapse

• No reason to cancel or suspend visits (but no visits while actively intoxicated)

• May be a need to increase supervision

• Visits may be motivation to quickly respond to relapse

• Suspension of visits punishes child

• Explain relapse in age-appropriate terms to child

To summarize

• Inattentional blindness (the gorilla videos)

• WE are part of the equation

• Using your SELF powerfully

• Circularity, Complementarity, Competence

• Tools help us connect with parents, raise

new information, leverage strengths

• Our interventions can have negative side-

effects, which we can mitigate

Let’s Revisit the Original

DEC Raid Video

For More Information or

Additional Training

Kim Sumner-Mayer, PhD, LMFTSenior Advisor

Center on Addiction and the Family (COAF)

164 West 74 St., New York, NY 10023

(646) 505-2063 Th only

(845) 729-5697 cell

ksumner-mayer@phoenixhouse.org

www.coaf.org www.phoenixhouse.org