An overview of an innovative family model of care for parents and children where a parent has a dual diagnosis. Feedback about the model will be presented from children and parents, as well as from workers regarding implementation issues by PhD Andrea Reupert. The conference Developing Strength and Resilience in Children, 1-2 Nov. 2010 in Oslo.

1. www.edu.monash.edu
A model of care
for families where
parents have
drug/alcohol and
mental health
issues
Dr. Andrea Reupert
A/Professor Darryl Maybery
Ms. Mel Goodyear
Ms. Ingrid Vet
The program and research was funded by
FaHCSIA, The Ian Potter Foundation,
Rotary Australia and NSW Health

2. www.edu.monash.edu

3. www.edu.monash.edu
Objectives
• Describe the model of care developed by
Northern Kids Care – On Track
Community Organisation (NGO)
• Present some preliminary evaluation
data about the model
• Discuss some of the implications when
working with families with complex
needs

4. www.edu.monash.edu
Why focus on family?
• Parental mental illness and substance
abuse is highly prevalent and can
adversely impact on children
• Family interventions have empirical
support
– Benefits the parent with the problem
– Benefits to children
• Financially it makes sense
• Australian government policy

5. www.edu.monash.edu
It all started with......
Reupert, A., Green, K., & Maybery, D.
(2008). Family care plans for
families affected by parental mental
illness. Families in Society: The
Journal of Contemporary Social
Sciences, 89(1), 39-43.

6. www.edu.monash.edu
Vision for
Northern Kids Care:
On Track Community Programs
Increased health and wellbeing of
children, young people and parents
living in families affected by parental
mental illness or dual diagnosis through
the development of a best practice
outreach service delivery model

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Theoretical framework of model
1. Family centred practice (Allen & Petr,
1998; Dempsey & Keen, 2008; Law, et
al., 2003)
2. Strength based case management
(Brun & Rapp, 2001; De Jong & Miller
1995; Rapp, 1997; 1998)
“not all families are strong, but all have
strengths” (Dorothy Scott)
3. Family care planning (Reupert, Green &
Maybery, 2008)

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Components of the model
Family fun days Peer support groups Home visiting service
Least intensive Most intensive
The different levels of intensity allow:
– Families to become familiar with services & workers
– Opportunities to meet with other parents and children
– For workers to get to know families

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Family fun days
• An opportunity to have fun and interact
socially with similar families.
• To learn more about the service and
workers before committing to the more
intensive aspects of the program
• Over the three sites there were 189
participants attending family fun days
from 2008-2010.

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Peer support groups for young people
and parents
Aimed to:
• Increase social connections
• Provided with information
• Develop and practice new skills
Various groups for children of different ages,
such as SMILES, Koping (n=414)
Various groups for parents (n= 81)

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Home visiting service
Case manager works with individuals and family in
the home using a strength based case management
model
A focus on planning rather than crisis using family
care plans with 11 pre-determined goals in areas such
as parenting, education, connectedness (within family
and community)
Each family “reviewed” every four months over a 12
month period (extended for some families)

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Home visiting service
Inclusion criteria
•Parent has a diagnosed
mental illness OR
•Parent has a diagnosed
dual diagnosis (co-existing
mental health disorder and
substance/abuse problem)
•Cares for dependent
children (0-18 years)
•Young person are included
with informed parental
consent
Exclusion criteria
•Parents whose children are
less than 20% at the parent’s
residence are not included
•If drug and alcohol is the
primary problem families are
referred to drug and alcohol
centres
•Current issues of violence,
sexual assault and/or abuse
excluded
•Young people in acute
stages of psychosis
ineligible

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Community approaches
• SKIPS (Supporting Kids in Primary
Schools)
• Professional development days
• MOUs with other agencies re referral,
case management, coordination
• Partnerships with others when running
peer support programs and in case
coordination

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Evaluation consisted of a participatory,
action research design
• Individual interviews with
children, parents and
workers
• Family care plans analyzed
• Every six months data
presented to workers and
management:
– What does this mean for our
service? For management?
• Refinements to model made
accordingly

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Demographic Parents with mental illness Parents with dual diagnosis
# Parent - clients 10 10
# with partner 8 (2 with a mental illness, 1
alcohol abuse)
3 (1 also with a dual diagnosis
and one with “unspecified drug
use”)
Mean age parent 41.4 yrs 36.3 yrs
Gender parent 9 Females: 1 Male 8 Females: 2 Males
Ethnicity All white Australian 8 white Australian, 2 Indigenous
Parent diagnosis 2 Schizophrenia; 2 Bipolar; 1
Depression; 1 PTSD; 1
Anxiety; 3 depression &
anxiety
3 Schizophrenia; 2 Depression;
4 Bipolar; 1 OCD & Depression
Substance abuse
of parent-client
5 marijuana, 2 alcohol, 2 alcohol
& marijuana, 1 heroin.
Family violence in
last 3 years
5 families 3 families
# Children 24 30

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Children
• Peer support programs reduced isolation
• Acquired effective coping strategies
• Enhanced knowledge about mental
wellbeing and illness
• Strengthen family relationships but
wanted more support for their parent,
especially around drug use:
We need to change what mum does.... Mum needs to stop taking
drugs (11 year old girl).
[I need] someone who could come and talk regularly about how to
help my mum more and not just to keep it going (12 year old
girl).

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Parents
• Developed adaptive coping strategies for
managing mental illness
• Family fun days and peer support groups
reduced isolation
• Strengthened family relationships
• Requested more support in terms of specific
behavioural parenting strategies

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Case managers
Seven different case managers plus manager
• Predominately young and open to new ideas
and ways of doing things
• Background in social work, welfare
• Worked previously in mental health, child
protection, rehabilitation
Data includes
• Interviews conducted every four months
• Feedback sessions

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Case managers
• Engagement, change and improvement can be
very slow
• Some parents with a substance abuse have less
insight into impact of disorder on children, are
more difficult to work with b/c of multiple issues
(exception are those parents with borderline pdo)
• Skills required in varied areas
• Important to establish and maintain relationships
with multiple agencies
• Need to screen for substance abuse for all parents
• Not taking sides, boundaries and “seeing double”
is an ongoing issue that requires supervision

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20 family care plans were analysed
In two ways:
1. What do children and parents see as the
most important things to work
towards?
2. What areas do children and parents
progress in? In what areas is little or no
progress recorded?
3. (Differences in types of families?)

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Family care plans
Pre-determined goal areas
for children and parents:
1. Family connectedness
2. Mental health knowledge
3. Child development
4. Education
5. Interpersonal skills
6. Substance abuse
7. Lifestyle, diet and exercise
8. Community and social connectedness
9. Finances
10.Family health and wellbeing
11.Accommodation
12.Other

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What do children want to work towards?
• Enhance interpersonal skills, e.g.
Learn to express frustration in an appropriate
way
• Learn more about mental illness and
wellbeing, e.g.
Learn the difference between mum’s physical
and mental health symptoms
• Education, e.g.
Attend school on a regular basis
Get help with homework

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Most progress
Mental health knowledge
Accommodation (e.g. child
to have her own room)
Substance abuse (e.g.
better understanding of
mum’s methadone
program)
Least progress
Finances (e.g. child to
receive pocket money)
Interpersonal skills
Family health and
wellbeing

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Child goals and progress
Goal Area Goal No (Prop) Change score
MI DD MI DD
Family Connectedness 25 (15) 23 (13) 1.40 2.42
Mental health knowledge 24 (14) 24 (14) 2.25 2.21
Child development 16 (10) 14 (8) 1.88 2.43
Education 26 (15) 34(20) 1.81 2.29
Interpersonal Skills 26 (15) 24 (14) 1.85 1.67
Substance Abuse 2 (1) 5 (3) 2.00 2.40
Lifestyle, diet and exercise 16 (10) 22 (12) 1.88 2.09
Community and Social Connectedness 13 (8) 16 (9) 2.15 2.13
Finances 7 (4) 2 (1) 2.14 1.00
Family Health and Wellbeing 9 (5) 6 (4) 1.44 1.33
Accommodation 4 (2) 1 (1) 2.75 3.00
Total 168 (100) 171 (100) 1.88 2.14

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What do parents want to work on?
• How to manage their mental illness, e.g.
Recognise early warning signs
Practice effective coping strategies, such as
regular exercise
• Enhance interpersonal skills, e.g.
Anger management skills
Learn how to stand up for myself with partner
• Enhance family connectedness, e.g.
Mum to develop shared interest with youngest
child

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Most progress
Mental health knowledge
(e.g. identify early
warning signs)
Substance abuse (e.g.
parent to ensure children
are not exposed to drug
use)
Community and social
connectedness (e.g.
attend community choir)
Least progress
Family connectedness (e.g.
mum to develop shared
interest with youngest
child)
Interpersonal skills (e.g.
manage anger)
Lifestyle, diet and exercise

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Parent goals and progress
Goal Area Goal No (Prop) Change score
MI DD MI DD
Family Connectedness 22 (15) 14 (9) 1.36 1.71
Mental health knowledge 32 (21) 26 (17) 1.84 2.12
Child development 8 (5) 9 (6) 2.12 1.78
Education 13 (9) 16 (10) 2.08 1.81
Interpersonal Skills 25 (17) 17 (11) 1.44 1.35
Substance Abuse 3 (2) 17 (11) 2.33 2.18
Lifestyle, diet and exercise 11 (7) 15 (10) 1.73 1.27
Community and Social Connectedness 17 (11) 12 (8) 2.06 1.92
Finances 10 (7) 12 (8) 1.70 1.67
Family Health and Wellbeing 7 (5) 5 (5) 1.71 1.88
Accommodation 2 (1) 7 (5) 2.00 1.71
Total 150 (100) 153 (100) 1.75 1.78

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Implications for practice
• Incorporate behavioural parenting strategies for all
parents in an ongoing manner
• Specifically ask about substance abuse upfront and
address addiction issues in the individual
• “Not all families are strong, but all have strengths”
• Recognise individual child and parent issues while
acknowledging the interrelationship between the two
• Recognise and use community supports
• Family care plans can assist in identifying, monitoring
and evaluating goals

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Families with multiple needs
require multiple strategies
Data indicate that there is no one single strategy or
program that can meet the needs of all family members

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Implications for policy and funding
• Protocols and procedures required between different
services
• Consideration required in regard to workers case loads
• Provide staff training for working with individuals and
groups, and on specific issues (addictions; borderline)
• Provide supervision around “seeing double”
• Provide flexible time arrangements for families
• Ensure ongoing funding to ensure stability of staff and
process
• Recognise alternative but rigorous evaluation
methodologies, especially those sensitive to the voices
of consumers and carers

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Implications for research
• Accurate prevalence estimates that includes sub-
groups
• Can workers see double? How do they do this?
• Measure the long term impact of interventions on
children’s functioning, parenting capacity and
family functioning/cohesiveness
– Also need to consider the relative impact of
various services provided (e.g. peer support vs
home visiting service) and different subgroups
(e.g. Parental diagnoses and substances)
– Cost analyses of interventions

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Future directions for us in this data set
• Quantitative data analysis
• Heterogeneous nature of groups, possible
service differences and child, parent and
family outcomes?
• Consider drop out rates
References available on request.
Happy to be contacted
andrea.reupert@monash.edu