Mary Lagaay - What happens in the long term. pocar
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Mary Lagaay - What happens in the long term? A qualitative investigation into the long-term experiences of mothers who completed the "POCAR" intervention for Substance Misuse

Mary Lagaay - What happens in the long term? A qualitative investigation into the long-term experiences of mothers who completed the "POCAR" intervention for Substance Misuse

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  • These measures were selected as an indication of whether mothers sustained the changes required for them to safely parent their children in the long-term, and allow for a basic comparison between the experiences of those who did, and those who did not, sustain change within their recovery. This research does not assume that whether or not children are living with their mothers is a direct measure of child wellbeing, as this would be another research question entirely. However, the variable of whether mothers remain living with their children is used as an indicator of whether changes based around their substance misuse and parenting are sustained, which could facilitate greater child wellbeing. It is acknowledged that other factors, unrelated to substance misuse may have lead to renewed / on-going child protection proceedings and this shall be considered within the analysis of this data. Upon reflection on this sample, it was hoped that a greater number of participants would be recruited, particularly amongst mothers who were no longer living with their children in the long-term, however it is acknowledged that this is a particularly difficult group to engage. It was apparent that for the mothers whose children still had a Child Protection Plan in the long-term, rather than this being a symbol of them being unable to sustain change, it was more to do with their more recent completion of programme. Whilst a more coherent/uniform sample would have made analysis simpler, it is felt that this sample at least reflects the heterogeneity and complexities surrounding every mother’s experiences/circumstances.

Mary Lagaay - What happens in the long term. pocar Mary Lagaay - What happens in the long term. pocar Presentation Transcript

  • ‘Parenting Our Children, Addressing Risk’ The long-term experiences of women following completion of the ‘POCAR’ intervention for maternal substance misuse. Mary Lagaay 5th September 2013
  • Parenting Our Children, Addressing Risk (‘POCAR’) • Multi-agency intervention for substance misusing mothers • Referrals from social services • Intensive 16-week psychosocial programme • Crèche available to enable access to services • Between 2006-2011: - 40% of mothers whose children were living in foster/kinship care had their children returned to them following completion of POCAR - 95% of mothers whose children were living at home at the start of the programme still had their children living with them following completion of POCAR
  • Research questions • How do women experience their recovery from substance misuse following completion of the POCAR programme? - What do they experience as barriers or challenges to sustaining change in relation to their substance misuse, child protection and parenting? - What do they experience as helpful to their recovery?
  • Methodology • Qualitative investigation: 9 semi-structured, face-to-face, depth interviews. • Followed up a sample of mothers who completed the POCAR programme between approx. 1-3 years ago, assessed as suitable to remain living with their children, or have them returned to their care. • Aimed to recruit two groups of women with different long-term outcomes: - Group 1: remained living with their children who no longer required a Child Protection Plan - Group 2: no longer living with their children or children still required a Child Protection Plan • Used topic guide containing open-ended questions related to long-term experiences of recovery, the POCAR programme and Social Services. • Participants identified using information recorded in client files and following discussions with staff at the Brighton Oasis Project.
  • The final sample • The final sample consisted of 9 mothers… • 4 mothers who remained living with their children in the long term, whose children no longer required a Child Protection Plan. • 2 mothers who continued to live with their children, however, they continued to require a Child Protection Plan. • 3 mothers who did not live with their children in the long-term. • Interviews recorded and transcribed, thematic analysis conducted.
  • The final sample Name Substance misuse Child/children’s status at start of POCAR programme (CPP = Child Protection Plan) Child/children’s status at end of POCAR programme Time since completed POCAR (approx.) Child/children’s status at point of long-term follow up Julia Heroin, crack CPP in place, remained in mothers care Remained with mother (CPP still in place) 3 years Remained with mother, CPP no longer required Alice Alcohol, cannabis No CPP required, remained in mothers care Remained with mother 1 year Remained with mother Danny Alcohol No CPP required, remained in mothers care Remained with mother 1.5 years Remained with mother Lucy Alcohol CPP in place, removed from mothers care, living with father / aunt Not returned to mothers care at end of programme, but returned at a later date following mothers attendance at residential rehab 2.5 years Remained with mother, CPP no longer required Bryony Heroin CPP in place, remained in mothers care Remained in mothers care (CPP still in place) 1 year Remained in mothers care, CPP still in place Sandra Alcohol, cannabis CPP in place, removed from mothers care, living in foster placement Returned to mothers care (CPP still in place) 1 year Remained in mothers care, CPP still in place Katie Heroin CPP in place, removed from mothers care, living in foster placement Not returned to mothers care at end of programme, but plans for return in place 1 year Never returned to mothers care: plans for reunification withdrawn due to mother re-establishing a relationship with a violent partner. Currently having supervised contact. Mother’s relationship with partner now ended. Awaiting a final court hearing on whether child will be returned to mothers care Nancy Alcohol CPP in place, removed from mothers care, living with father Returned to mothers care (CPP still in place) 2 years Recently removed from mothers care due to the revelation of an extended period of relapse, now living with father long-term, contact with mother every other weekend. Maria Alcohol CPP in place, removed from mothers care, living with father Unsupervised contact / shared custody agreed at end of programme. 2 years Child not currently having contact with mother following mothers relapse during unsupervised contact. Currently living with father.
  • Ethics • Details of local support services provided at the end of each interview. • Full ethical clearance obtained from the Board of Trustees at Brighton Oasis Project and the London School of Economics Ethics Committee prior to the research taking place. • Confidentiality and anonymity of participants was guaranteed (names changed/identifying factors removed). • All participants fully briefed on research aims and asked to sign an informed consent form prior to research taking place.
  • Findings: contextual information • A history of entrenched substance misuse. • Multi-faceted, complex problems surrounding substance misuse. “Pre my daughter, lots and lots of drugs, lots and lots of alcohol, lots of smoking, lots of self destructiveness, death, people dying on me, being raped, being beaten up, just, things like that.” (Alice)
  • Motivation • Fears of having children removed. • Motherhood: a ‘window of opportunity’ / ‘turning point.’ Interviewer: What would you say motivated you [to attend]? Alice: Umm, having my child taken away from me!  
  • Relationships with services • Initial relationship with Social Services challenging, feelings of coercion into attending the programme. Julia: I was made to come here my Social Services, because me and my boyfriend was on heroin…it was only when Social Services made me come here. But I wanted to come anyway, to keep my child. So it wasn’t that they ‘made’ me come, but I had to come, it wasn’t a choice.
  • Relationships with services • Avoidance of help due to fear of social services involvement. Nancy: I guess, I could have asked for help beforehand, but, there’s that whole Social Services thing, that they just don’t help, it’s just that whole fear of ‘well, they’ll just take them away’ and so what’s the point, so I’ll sort it out, I’ll sort it out, I’ll sort it out, you know.
  • Relationships with services • Relationships with Social Services remain adversarial, despite acceptance of why they had intervened. Katie: Everyone’s on my side except for the social worker….I understand because they are doing their job. Danny: But he was really, really nice. Because I was like ‘ah social worker! Oh no!’ But he was really, really supportive, and I didn’t feel that I was sort of being threatened with anything at all. It was a pleasant surprise really, a relief!
  • Relationships with services • POCAR programme played a mediating role within the interagency work taking place. • ‘Policing’ aspect of social work buffered by an external agency. Sandra: … the reason I carried on coming and not walking is because it was the only place that, if I turned up three or four times a week, at least people whose opinion would be respected by the Local Authority would be able to say, at least on those occasions every week, she turned up, she was sober, she was sensible, she engaged.
  • Identity and judgement • Women-only space helpful to recovery. Nancy: I liked the fact that it was all women…I think that if there had been men, I would have found it really hard to open up, and I don’t think I would have felt as safe, I definitely think the dynamic would have been totally different.
  • Identity and judgement • A strong awareness of the judgement of others and the stigma attached to female substance misuse. Danny: …it made me feel a complete failure, as a mother…It felt like because I was a woman, I was being singled out, which in a way, made it worse again. Lucy: I felt everything. Embarrassment. Shame. Anger. That’s why women don’t go for help.
  • Identity and judgement • Damage qualification / damage acceptance. Lucy:…my children were well taken care of, despite everything. You know, they went to school every day, they were clean, they were fed, the house was always clean…everything was normal... I mean people are on drugs and they’re not taking of the kids, but it wasn’t like that. Lucy: I feel sorry for him, and it makes me feel guilty. Because he’s the one that’s seen all the shit over the years. He’s seen me drunk, he’s seen my try to kill myself, he’s seen all sorts, he’s seen my arms cut up…he’s seen all that. What can I do? You know, he throws it back in my face a lot, and I say to him ‘I can’t change it, I can’t’ and I wish I could, for him.
  • Structure, learning and strategy • Continuing to have structure within their lives presented as an important feature of long-term recovery. • Continuing relationships with Brighton Oasis Project was an important aspect of long-term recovery e.g. volunteering. Katie: [volunteering] gives me something to do and I’ve got structure in my life. Lucy:…because if I do need someone to talk to. I’ve got people, cos I’m here doing the volunteering… then you can, like, kind of slowly move on.
  • Structure, learning and strategy • Learning: incorporating strategies around relapse prevention and parenting carried through and utilised into the longer term. Julia: I did Triple P and it definitely helped, yeah, all that stuff about setting and learning boundaries and stuff. Because I didn’t know about being a Mum, and hearing other parents, like, and having key work to talk about things that were hard. And I still use the Triple P stuff now, especially the boundaries.
  • Social and cultural networks • Substance misuse a major part of previous social and cultural networks. Julia: the other life, the drug life, with other users. • Changing this key to long-term recovery. • Networks often ‘recovery orientated’ Sandra: I built up new friends, some, just naturally straight people, but quite a lot of people that are like me, some way down the line.
  • Reintegration • A desire to be ‘normal,’ get jobs or go to college to: ‘just lead a normal life’ / ‘be part of society again’ • Improved self-confidence and self-esteem continued to be a barrier into the long-term. • Reintegration hindered by: having a criminal record when applying for jobs; lack of qualifications; economic difficulties; wide availability of alcohol; problems with housing.
  • Limitations • Trying to separate the experiences of mothers who did remain with their children in the long-term with mothers who did not, presented a challenge, as on a number of levels, both groups reported similar experiences of the support, barriers and challenges they faced. • Would benefit from a larger sample / analysis alongside quantitative data. • The experiences of women who were not assessed as suitable to care for their children may paint a very different picture.
  • Conclusions • Endorses women only services. • A complex blend of social, cultural, material and community resources can support or hinder the recovery process for mothers who have experienced a substance misuse problem. • Value of multi-agency interventions and a specialist, holistic service for women. • Recovery from substance misuse is an individual, continuous journey. • Recovery capital built and stimulated by POCAR programme. • Interventions should offer a continuum of support.
  • Background • Research highlights the widespread exposure of children and young people to parental substance misuse 250,000 - 350,000 children under 16 have a parent with a serious drug problem (Hidden Harm ACMD, 2003) 780,000 - 1.3 million children under the age of 16 live with parents who misuse alcohol (PMSU, 2004). • Correlation with a range of negative outcomes for children • A common factor within child protection and care proceedings
  • Background • Evidence-base highlights the value of early, intensive, multi-disciplinary interventions • Whilst evidence is promising, there is currently little available research into the long-term efficacy of interventions, an important issue given the fragile nature of reunification between neglected children and their parents
  • Research Aims • To explore the long-term experiences of mothers assessed as suitable to remain living with their children or have them returned to their care following completion of an intervention for problematic drug or alcohol misuse. • Used the POCAR (Parenting Our Children, Addressing Risk) intervention programme at Brighton Oasis Project as a case study.
  • Brighton Oasis Project • Delivers services to women, children and young people affected by drug and alcohol misuse in Brighton and Hove: women-only approach, recognising issues faced by women who misuse substances and barriers accessing treatment in male dominated services Crèche for the children of all women accessing the service, as lack of childcare a significant barrier to women accessing treatment
  • A qualitative research strategy • Allowed the opportunity for an exploratory, flexible, in-depth focus on women’s experiences • Fitted the research aim of understanding women’s experiences by providing the opportunity to investigate ‘through their own eyes.’ • Allowed an emphasis on gaining contextual understanding of social behaviour and on investigating recovery as a process: important for this research in terms of understanding what might help/hinder such a process for mothers. • Weakness: generalizability is not possible, as findings are only representative of the experience of some women specific to the POCAR programme. However, generation of theory from the findings could be built and a sampling frame could be developed through further research, with the aim of achieving theoretical saturation allowing for greater generalizability. • In an ideal world: this would be a mixed methods strategy involving quantitative analysis of variables and a control/comparison group alongside qualitative investigation.