Yale, New Haven

My last week in New Haven at the Yale Child Study Centre was extremely rich.  I spent time with the Intensive Family Partnership Team and was welcomed into their team meeting. It was like the team meeting I would attend within Circle in that there was lots of food! The team work with vulnerable families who have Child Protective Services involvement to prevent children being removed from the family home. This team does not work with families affected by substance use specifically however the team do have a large majority of cases where substance use is an issue. I learn that New Haven has a problem with a drug called PCP or Angel Dust. This substance is a strong tranquiliser and can have varying effects on the user from hallucinations to disassociation. Heroin is also an issue and many people continue to describe the Opiate Epidemic that is sweeping the whole country. Many people who use opiates have started with opiate based pain killers which then leads to heroin and this cuts across all classes. Cannabis and alcohol are also issues in the State. Connecticut is a small state however it is rich in high quality services, many of which are based in the Yale Child Study Center.

I spend a day outside of the centre in the ‘Moms ‘n’ Kids’ research program lead by Nancy Suchman. Nancy has worked for a long time exploring the effects of maternal reflective functioning.  Women who attend the program see a counsellor weekly for twelve weeks and address the stresses in their life. The program aims to nurture the capacity of the Mothers involved to make sense of and manage emotional distress in parenting and to make sense of their child’s emotional needs to promote a secure attachment. The ‘Moms ‘n’ Kids’ program has seen an improvement in almost all Mothers capacity to understand and manage their own distress to provide more consistent parenting at the end of the twelve weeks.

I also meet with Justin Rogola who is a consultant with the Department of Children and Families (DCF) in the field of substance use and mental health. Social Workers can meet with Justin and discuss a case they are not sure how to progress with. Justin will examine the details of the case and make recommendations on what the next steps should be. This can sometimes lead to recommendations for residential treatment for parents. Karen Hanson is also attending this meeting and we have an interesting discussion about what makes a good quality, successful residential program. Justin explains the difference between a sober house and a good quality residential program and highlights the point residential programs will not work for everyone.  Residential programs for pregnant and parenting women are expensive and are often reserved for Mothers who have tried many other interventions and this is a last chance for achieving sobriety.  Thorough intake assessments are necessary to ensure the women accessing this type of treatment have a genuine motivation to change and are willing to work hard to achieve a sober lifestyle.

I met with Kim Ruzbarsky who is a DCF investigative social worker and Jeanette Radawich from the Family Based Recovery team. Kim investigates cases that have been phoned in to a central point where a potential risk has been identified to a child. It is clear Jeanette and Kim have a very good working relationship both understand and value the work of each other. Kim gives me a great understanding of how the child protection system works in Connecticut and how assessments are made when a child may need to be removed.  Jeanette and Kim are very passionate and committed to their jobs and to the families they work with which makes for fascinating discussions. We all agreed if we were to rule the world we would have the place in ship shape in no time!!

 

During my time in New Haven I decided to do a walking tour of the Yale Campus. The campus is beautiful with lots of old buildings, cobbled streets and big oak trees. I learned that one library on campus has been built to replicate a church. It looks from a distance like a church however the writing and the statues that have been carved into the building represent educational and historical figures and languages. When entering the library it resembles a church hall however the stain glass windows depict significant moments in history rather than scenes from the bible.

The  Beinecke Rare Book & Manuscript Library is on Yale Campus too which is a beautiful building made of marble. The marble allows only a certain amount of sunlight through into the building in order to preserve the rare books which includes a rare copy of the Gutenburg bible, the first major book printed in the 1450s.

Over the weekend I took a trip to Boston and followed the Freedom Trail. I loved Boston and the architecture is similar to the buildings in Yale however it is on a much larger scale! The Freedom Trail follows the significant monuments, buildings and sites of the American Revolution which began in Boston. The trail took me through Quincy Market where I watched ‘Kilted Colin’ who was an American, bag-pipe playing, uni-cycling street performer! I got on the ferry back to the main center and enjoyed a meal before heading back to New Haven on the night train.

 

I have one more day in New Haven before I head to New York for a few days. Then my adventure will be over and I will be back in Scotland!

Yale Child Study Center

I arrived in New Haven after a long and restless overnight flight. I was on the tiniest plane from Philadelphia which may have been more fun if I hadn’t been so sleep deprived!

I dumped my bags in my new place and headed out to explore New Haven. I found the New Haven Green which is a large, grassy park in the center of town with a fountain as a focal point. There are various events on the Green such as music gigs and outdoor film screenings throughout the summer. The architecture in New Haven is very pretty and a lot of the buildings are made of brick work, unlike the buildings in Seattle. This almost reminds me of home. It is certainly taking a bit of adjustment being on my own in the city but the nice thing about New Haven is it’s small so I can walk everywhere without having to navigate public transport. For those who know me well enough, navigation and map reading are not my biggest skills!

On Friday I have my first meeting at the Clifford Beers Clinic with Betsy Perry the Child First program manager. I am very excited about this as the clinic made an appearance in the ‘Resilience’ documentary that was screened across Scotland not long before I left for my trip regarding the Adverse Childhood Experiences study. I went to see this documentary with my colleagues and got very excited when Clifford Beers appeared on the screen!

CHILD FIRST

The Child First program is one of many programs within Clifford Beers and it works with children under the age of six which can include referral during the prenatal period. Referrals are made for children who are experiencing emotional, behavioural, developmental or learning challenges. Referrals will also be taken if a child’s living situation is considered a risk to their health and development such as domestic violence, parental drug use and poor mental health among other things. The aim of Child First is to reduce family stress, maintain stability and support the development of healthy, nurturing and protective family relationships. The program is a home visiting service focusing on the parent/carers emotional regulation and executive functioning. This essentially means the parent or carer is more available for the child to provide their full attention to their child’s development through play, education and socialisation. The intervention acknowledges the impact of a poor parent/carer-child relationship on the child’s social, emotional and behavioural health. Teachers and other significant adults in the child’s life are also involved in the intervention. The mental health clinician works alongside the teacher and helps the teacher to understand why the child is behaving in a certain way and together they develop strategies to meet the child’s needs. This is in order to provide consistency between the home and classroom environments. This program has many comparisons to the work that Circle carry’s out. Circle works closely with many community providers such as schools, early years centers and social work departments in order to provide a holistic package of care to families.

 

I have a quiet weekend as it seems all the travelling has taken its toll and I am trying to fight off a chesty cough and cold. I do manage to get out and have an explore of where my meetings are next week at the Yale Child Study Center. I came across a cool street with lots of bars restaurants and coffee shops so after spending $40 at the pharmacy on various decongestants I have a look around and treat myself to an iced coffee and the most amazing ice cream I have ever tasted! The ice cream is made fresh to order (I ordered the smores flavour) on a giant cold plate. It reminds me of how a crepe is made but with a cold plate rather than a hot plate. I get to choose my own toppings then the giant marshmallow is heated with a blow torch!!! This is a welcome distraction from feeling ill!

I arrive at my first meeting on Monday morning and Karen Hanson, the Assistant Clinical Professor for Social Work meets me at reception. Karen has put together a great itinerary for me whilst I am here and has even organised transportation for me between meetings. I am very grateful to Karen for this and as the week progresses Karen continues to go above and beyond to ensure I am taken care of.  Karen shows me around the center and introduces me to the people in the office. I am very excited when she hands me my schedule in the folder below with a free pen!!

FAMILY BASED RECOVERY

I attend the Family Based Recovery team meeting and discover the service is for families where children are at risk of being removed by Child Protective Services.  The program is an attachment-based parent-child therapy and contingency management substance use treatment.  The mission of FBR is to ensure that substance affected children thrive in drug-free, safe and stable homes with their parents.  FBR treats mothers and fathers who are actively using substances or who have recent history of substance abuse that are also parenting a child under the age of three. A new research trial has recently been funded within Yale using the FBR model with children aging from 3-6 years old. A family is allocated three clinicians who each carry out one home visit each per week, for one year. One clinician addresses the parent-child relationship, another provides substance use treatment and the third clinician is a Family Support Specialist providing general supports based on the needs of the specific family. Each clinician tests the parents for drugs at each visit so the parents are drug tested three times per week. The criteria for  a referral to FBR is that the parent has had a positive drug test within 30 days of the referral. This model is being replicated in many different areas across the county with Karen and the Yale Child Study Center providing quality assurance across the sites. In 2011, 84% of children remained in their homes at discharge from the FBR program.

In the afternoon I spent time with Michelle and Dale from FBR along with Karen and we looked at some of the practices used within the parent-child interventions. I was able to observe videos the clinicians had used with their clients when providing in home attachment sessions. The concept of one program addressing both parenting and substance use for a family seems obvious almost, however in Scotland many parenting services are a separate entity from drug services. When you compare that with figures of approximately 40-60 000 children living in Scotland with parental substance use and 65 000 living with parental alcohol use, it seems we are missing a trick here!

Later I meet with Helena Rutherford, PhD who has focused her research on the understanding of neurobiology of parenting. Helena’s interests are in the sensitivity of infant cues and how maternal addiction can impact the process. Helena talked about her recent research, which is still in the early stages however there would appear to be changes in the brain during pregnancy, likened to a pruning process. This would correlate to the thoughts that pregnancy can give some women a unique motivation to change and provides an opportunity to own a new and positive identity.

My first day at the Yale Child Study Center was fascinating and I was really looking forward to the rest of my week. After my long day I decided to reward myself by booking a day trip to Boston next weekend.

West Coast to East Coast

My time in Seattle is drawing to a close and I am not looking forward to saying Goodbye. All the professionals I have met with have been welcoming, friendly and keen to support my project in any way possible. I have learned that the Pacific North West is a mostly liberal area of the United States and Seattle is rich in resources for the most vulnerable in society. It is widely recognised here that substance use is heavily linked with trauma and poor mental health. There is a strong belief among the services I have visited that people can change and should be supported to make positive, healthy choices for themselves and their families.

I have visited several models delivering residential services of some kind, whether it be treatment services, detox services or supported housing. This has given me food for thought around the situation in Scotland and the lack of residential services for families. Many families are living in unstable, unsafe and inappropriate housing which is failing to meet their basic human needs if we consider Maslow’s hierarchy of needs. To sustain confident, independent and sober lifestyles families need safe housing. Group recovery is part of almost every program I have visited and the idea of learning from one another has been re-enforced with every visit. Group therapy and peer mentoring is a model currently used in many group recovery models and are successfully established in Scotland and the UK, however I think there could be a space for ‘Peer Parenting Mentors’. This could be to provide out of hours support and encouragement for parents who not only have the complex challenges of parenting, but parenting whilst in recovery.

My time in Seattle has been very special because I have been lucky enough to spend my free time with my brother, who moved here four years ago, his partner and my husband. Even on my last few days in Seattle we were able to meet with good friends of ours from Scotland who were on a road trip which ended in Seattle. During the month I’ve gone to a baseball game, an American Football training camp, gone on a roadtrip to Vancouver, flown to Las Vegas and San Francisco, been paddleboarding on various lakes in Seattle, made smores on a beach at sunset and loads of other really cool experiences. I’ve certainly made the most of my time here!

I am devastated to be leaving, if truth be told and would happily stay here forever. However Connecticut is waiting for me and whilst I am apprehensive about this part of my trip, I am looking forward to the experience. I am lucky to have the opportunity to spend time within the Yale Child Study centre and I know this will provide lots of material for the reccommendations I will be making as part of my report.

Parent-Child Assistance Program

My last visit in Seattle was to one of the Parent-Child Assistance Program (PCAP) sites. I was really looking forward to meeting the team because I have heard so many good reports regarding PCAP from other agencies.  Among many other roles Therese Grant, PhD is the Director of the PCAP program and she has been very helpful in the run up to my fellowship by providing contact details to arrange additional visits to specific agencies during my stay in Seattle. Therese is also a Professor in Fetal Alcohol Disorder Spectrum and the Director of the Fetal Alcohol and Drug Unit at the University of Washington. Sadly, I will not meet Therese today however I have scheduled a call with her next week after my visit to this PCAP site.

The PCAP is a home visiting, case management intervention model for women who use alcohol or drugs during pregnancy. The primary goals of the program are to support families to achieve and maintain recovery, build healthy family lives and prevent future alcohol/drug exposed births. This is done by building trusting relationships with mothers, connecting clients with community services and teaching them to believe in themselves.  As I learn more about PCAP I can see direct similarities between the program and the work that Circle does in Scotland. Circle and PCAP have similar values with both being strength based and understanding of the importance of building trusting relationships with parents. The program is an evidence based model and workers are allocated to families for 3 years in order to bring about sustainable change. The program will not close a case due to non-engagement and instead remains a source of support to parents, kin carers, foster carers and other wider family members. Workers support Mothers to prioritise their needs including family planning, crises planning and positive behaviour modelling. Mothers work with their PCAP worker on goal sheets every 4 months and use a variety of assessment tools to create personalised support plans.

When I arrived at the PCAP office I was greeted by Lena, the energetic program supervisor. Lena shows me around the office and advises that the team meeting this morning will be dedicated to my visit and was the time for me to spend with the workers gaining an insight into the day-to-day practices of the program. Again much like Circle, the team had gone to a lot of effort and had brought in home-made cakes, salads and cookies (biscuits!).  I was almost embarrassed by the effort that had been gone to for my visit to the site, however as it turns out, it was actually Lena and another member of staffs birthday which explained the cake! I happily chimed in with the birthday songs and thoroughly enjoyed the cakes, not mentioning I initially thought it had all been for me! I spent several hours with the team and got an understanding of how dedicated the workers are to the women and children they support. We had an interesting discussion regarding the concept of workers suffering with ‘compassion fatigue’. This is best described by a Doctor at Tulane University –

“Compassion Fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

Dr. Charles Figley
Professor, Paul Henry Kurzweg Distinguished Chair
Director, Tulane Traumatology Institute
Tulane University, New Orleans, LA

Workers are provided with 2 supervision sessions per month both lasting 2 hours. The first hour is dedicated to the client caseload and the second hour is purely for the worker to talk through any anxieties or triggers they have experienced. We agreed we could all identify a time we had experienced ‘compassion fatigue’ and how important the support of our colleagues and supervisors were. The team were clearly close and spoke highly of each other personally and professionally which was humbling to see. I took time to acknowledge how competent and supportive my team are and made a mental note to take more time to check in with my colleagues in future, regardless of how busy I feel I am.

I was able to sit in on a supervision session in the afternoon and was astounded at how complex the cases are that the workers are dealing with. The housing crises in Seattle is so extreme that PCAP workers are providing tents and sleeping bags for some clients who are sleeping on the streets. I shared my observations of the visible homelessness in Seattle and how distressing it is to see. PCAP workers can continue supporting Mothers who do not have the care of their children and the main goal will be to stabalise the Mother or at least let her know she still has a source of support. A conversation I have had with my colleagues on many an occasion is the lack of support for parents who lose the care of their children. Many parents do not meet the criteria for supports once they have lost the care of their children and as a result are left to process the devastating impact of losing their child/ren without any support to work through this.

I felt very comfortable in the PCAP office as it felt so familiar to my working environment at home that I was reluctant to leave…….then I remembered I was going on a road trip to Vancouver this evening so decided it was best I left!

The PCAP visit was my last in Seattle and I feel very connected to the city and every visit opens up another avenue to research. I know I will be sad to leave the city in a few days time and all the people I have met and places I have been.

 

Evergreen Recovery Centre

I had a great day at the Evergreen Recovery Centre offices based in Everett, north of Seattle. The team were very welcoming and were keen to hear about my Fellowship and what my objectives were.

I met with Natalie Fryer who is the Director of Clinical Operations. Natalie gave me an overview of the organisation which has several residential treatment facilities and outpatient services across King, Pierce and Snohomish Counties.

Natalie explained that their Seattle program offering residential treatment for Pregnant and Parenting Women (PPW) had closed last month. The residential building was in much need of structural repairs and their funders could not afford the cost involved.  The organisation took the difficult decision to close the program as they felt, strongly that the building would not survive the winter.  The managers worked hard to ensure all of the women in treatment at the Seattle facility were moved to appropriate sites. Many of the women moved to the PPW site in Everett where I also visited. Natalie introduced me to some of the Management Team and Linda Grant, the CEO.

Next up I attended a budgeting meeting in order to understand some of the costings involved in a residential facility like the PPW program. The site offers a 14 bed unit and a 9 bed unit next door including day care facilities. The mothers involved can bring their children up to the age of 5 years old before they start school. During their stay women receive parenting support, mental health counselling, family counselling, relapse prevention planning and basic life skills. The day care facility offers play therapy, nurtures social skills, developmental assessments and observed interactive parenting. The program is funded mainly through medicaid dollars making this program unique and accessible for those on a low income.  This is only one facility across three Counties however so the demand is high.

The program began in 1999, and about 100 women go through every year. Comparing it to the 1,524 pregnant women reporting Opiate use across Washington State in 2014, it becomes clear why the program is in such high demand! The number of newborns diagnosed with Neonatal Abstinence Syndrome has increased from 114 cases reported in 2000 and 881 cases in 2014.  I have learned that Opiate use is a real issue in Washington State with many professionals describing it as an epidemic taking hold over the last decade which crosses all classes. The use of prescription pain killers is a big problem across America with many individuals beginning with Opiate based pain killers, building a resilience and leading to Heroin use.  The Evergreen Recovery Centre runs a detox facility near the PPW program and more than 70 percent of admissions are for Opioids.

I was lucky enough to be taken out for lunch by the lovely PPW Management team and had engaging discussions comparing Washington State’s Heroin and Opiate use to Scotland’s. Heroin has been an issue in Scotland for many years and of approximately 12,500 individuals who presented for treatment in 2015, 85% reported their primary problem substance to be Heroin. Approximately 12.8 per 1,000 women who presented with pregnancies in 2014/15 reported drug use, with 50 percent of those reported Opioid misuse in Scotland.

Studies of Evergreen Recovery Centers’ PPW program have found that babies born to residents have better prenatal care and 66 percent better birth weight. Mothers are less stressed about parenting and there are 35 percent fewer reports of inadequate parenting among women who took part in treatment.  The risk of premature delivery, low birth weight and infant death was lower for women in treatment, compared with women who were actively using.  The picture below celebrates that 15 children were reunited with their Mothers in 2017 so far and 8 healthy babies were born.

After lunch I was able to sit in on the weekly ‘Staffing Meeting’ where the residential team meet to discuss individual women within the program and their progress.  Each building provides the residents with a nurse and a counsellor, and the women are expected to meet with their workers and participate in group therapy. The women are also connected with a ‘peer sister’ when they arrive in order to support them to settle into the program. A ‘Recovery Support Leader’ is also identified in each building by the manager to run in-house recovery meetings. The program takes approximately 180 days if women have completed their individualised treatment plan although this timescale can be flexible if women complete their goals earlier than expected or cannot find suitable housing in time for their graduation. All of the women have to complete their ‘Prep Project’ before they leave which involves a written history of their drug use and its consequences, a personal piece to their recovery and a relapse prevention piece. For example, for her personal piece, one resident chose to write about Down Syndrome as her child had been recently diagnosed.  The second half of the meeting the childcare workers attend to update on the children within the child care facilities and how the women are engaging with their children and the workers.

I am then shown around the facility by Jennifer Walter, one of the very knowledgeable managers of the PPW program. I am shown the bedrooms, bathrooms and common areas. Each building has a monitor on duty at all times. These monitors can dispense medication (excluding opiate replacement medication) if needed, provide low level emotional support to the residents and are as highly trained in order to be as understanding to the needs of the residents as possible. Jennifer explained how important it was for every member of staff, from the Cooks to the Directors to be considerate and empathetic to the situations the residents have found themselves in. All staff are trained in Motivational Interviewing.

I found that the day was drawing to a close and I was sad to be leaving. The staff in the PPW program are so welcoming, supportive and passionate about making the program work that it makes for a great atmosphere. My husband came to pick me up and introduced himself to Linda (CEO) and Natalie (Clinical Operations Director) who took much amusement in his Scottish accent. Whilst they couldn’t understand much of what he said they were charming and respectful and agreed one day we might all meet up in Edinburgh! I assured the team I would be back in Seattle too so would come back and visit when I do.

 

Fetal Alcohol Syndrome Diagnostic Clinic

I attended the University of Washington’s one day observational diagnostics clinic. This clinic allows professionals to observe a full day of assessments and the diagnosis process for children who have suspected Fetal Alcohol Syndrome. The clinic has been running since the early 1990’s, with the University of Washington becoming the leading facility in research, diagnosis and prevention campaigns. Fetal Alcohol Syndrome (FAS) is a permanent syndrome caused by the consumption of alcohol during pregnancy.

The day began with Susan Astley, Ph.D, Director of the clinic, providing a 30 minute lecture on Fetal Alcohol Syndrome, and what the clinic looks for in order to provide a diagnosis. Susan talked us very quickly through the diagnostic tools she has created during her career called the 4-digit code and the photographic analysis software.  When diagnosing Fetal Alcohol Syndrome the four areas considered are growth deficiency, facial anomalies, central nervous system dysfunction and prenatal alcohol exposure.  These are then coded under the FAS umbrella making the diagnosis as accurate as possible. Learning about these four areas of FAS has helped me to better understand the spectrum of the condition and how people can be placed on different parts of the FAS spectrum. Throughout the day that I attended I came to realise how progressive this clinic, and the state of Washington is, regarding the diagnosis and supports available for children and adults affected by the syndrome. Susan Astley really emphasised how important early diagnosis is due to the elasticity of the brain. Once a diagnosis has been established Susan’s multi-disciplinary team can provide recommendations on how best to address the identified challenges, even if the child assessed does not have a FAS diagnosis. The team is made up of experienced Social Workers, Psychologists, Occupational Therapists, Speech and Language Therapists and Pediatricians.

The next phase of the day, which followed the lecture was a profile of the children attending the clinic. This process allowed the other professionals and I to learn about the children and their history before their assessments took place. Usually there are 2 sessions in one day which includes a profiling process, assessment and a diagnosis with one in the morning and one in the afternoon. However on the day I attended the team were assessing twins so decided to do all the assessments in the morning and work on the diagnosis in the afternoon.

Throughout the morning there were 3 observation rooms where I could observe, sitting behind a one way mirror so the occupants could not see me.  The assessments were focussed on speech and language, occupational health, psychology and a care giver interview. The ‘care giver’ is most likely to be the biological parent or foster carer and can provide information regarding their child’s behaviours and actions in their care. Susan informed me that most care givers they see in the clinic are foster carers with only an estimated 15% of children attending the clinic with their birth mothers. The care givers are made aware there is an observer during the assessments however the children are not made aware, to prevent any potential changes in their behaviours or attention during the assessments.

The twins being assessed the day I attended were aged 12 and had a previous diagnosis of Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder.  It was also recorded that the twins had history of suicidal thoughts, poor memory, depression and anxiety. The twins have had disruptive and traumatic  early years experiences, spending a significant amount of time in the care system.  In terms of parenting children with these specific challenges, is extremely difficult, confusing and emotive.  However, having the understanding that a child is behaving a certain way due to a neurological disorder, opposed to ‘being bad’, can be liberating for many carers.

During the diagnostic process, the professionals came together to share the results of their individual assessments.  A report was written which detailed the findings of their assessments with recommendations for how to address the challenges for each twin. This report can be used to access social, physical and emotional supports for the twins and their care givers. On the day I attended both twins were diagnosed with ‘Alcohol Exposed Neurobehavioural Disorder’ which comes under the Fetal Alcohol Spectrum. This means the twins showed moderate central nervous system dysfunction and the team were able to confirm the twins had prenatal exposure to alcohol. The team asked the care givers to attend a meeting to explain the report they had written. The team explained they were concerned for one of the twins who presented as having less additional support needs than his brother as this made him vulnerable. The team explained they were concerned about this twin, potentially being easily persuaded by his peers to engage in criminal activities without having a full understanding of the consequences. This diagnosis was especially significant for this twin as it will open up educational supports as well as intellectual disability recognition.  The care givers extended their thanks to the team as they felt they were in a better position to understand both twins behaviours.

Susan advised this diagnosis process is as accurate as modern medicine will allow due to the complexities of diagnosing Fetal Alcohol Syndrome. She also explained the difficulties in determining the levels of alcohol that some children are exposed to in ‘utero’, this is while the child is developing in the womb.

The most recognisable characteristic of FAS to the untrained eye is the distinctive facial features-

However the facial anomalies form during a very specific point during pregnancies which is often difficult to determine. Therefore it can be difficult to identify FAS in children, like the twins I observed, who have a known exposure but do not present with the most recognisable features of the condition. Susan explained that Washington State is 30 years ahead in their knowledge of FAS and their ability to address and prevent the occurance of the condition. I have noticed during my time in Seattle that bars and restaurants have notices warning of the dangers of consuming alcohol during pregnancy.  These notices also extend to the restrooms (toilets!) and all bottles of alcohol.  The number of FAS diagnosis in Washington State has significantly reduced in the last ten years which can be attributed to the University’s prevention campaigns. Susan Astley acknowledged the difficulty some doctors, around the world have in naming the possibility of the condition in a child due to the judgments that surround alcohol consumption during pregnancy. However with Susan’s 4 digit code, it takes away the, perceived judgement of the doctor.

I had a fascinating day at the diagnostic clinic and I am excited at the prospect of sharing this information with my colleagues and others.  Thousands of professionals in Washington State have been trained by Susan and the specialist team within the University which has had a significant impact on the supports available to many children and families who are affected by FAS. I am thankful to have been offered the opportunity to attend this training which has broadened my knowledge on recognising the symptoms of FAS.

King County Family Treatment Court

I visited the King County Treatment Court last week and had a great day observing court. When I stepped off the bus I was greeted by a very big hostel on the opposite side of the street from the courthouse. There was a lot of police around and many groups who belonged to the homeless community.

After going through the security checks to enter the court I met with Jill Murphy, the Family Treatment Court Program Supervisor. Jill’s office window looked out onto a square patch of grass that had been cordoned off with police tape. Jill explained that their is approximately 5000 homeless people in a city of 705,000 residents. The police had recently thrown the people staying in tents from the area, and other homeless individuals off the site in an attempt to clean up the area. Recently a Juror from the Court House had been attacked so it had received a lot of publicity and therefore pressure, to be seen to be addressing the issue. The big hostel opposite the Court House, I learned, was actually a Harm Reduction House which offers showers, toilets, washers and dryers, a day-and-night shelter, indoor meals and counselling services to homeless people in Seattle.

The state has the authority to step in and protect a child from harm in a procedure known as a dependency action. A dependency action begins when a written request is filed in Superior Court. This petition must allege that the child is “dependent” and has:

• been abandoned by his or her parent, guardian, or other custodian;
• been abused or neglected by a person legally responsible for his or her care; or
• no parent, guardian, or custodian capable of providing adequate care.

The Family Treatment Court is an alternative to regular dependency court and is designed to improve the safety and well being of children in the dependency system. The program provides parents with access to drug and alcohol treatment, judicial monitoring of their sobriety and individualized services to support the entire family.  Parents voluntarily enter the program and agree to increased court participation, substance use treatment and intense case management in order to reunite with their children. Court Hearings initially occur every other week and then become less frequent as parents progress through the program. Jill informs me that the court does not always plan for reunification of a child to their family, but will formulate a plan in order to ensure a child does not spend too long within the dependency system.  Through the regular dependency courts, approximately 30% of children are reunited with their family and in the Family Treatment Court, that rises to 50%. The multi-disciplinary team who support the family include, parents’ lawyers, assistant attorney general,  social worker, substance use counselor, Court Appointed Special Advocate (CASA), for the child and/or child’s lawyer, FTC treatment specialist, FTC program manager, and the judge. A new addition to the team, as of last year, are peer mentors who have successfully been through the process and graduated from the program themselves enabling them to provide support to parents currently involved in the process.

The program has 3 levels that parents need to complete before being referred for graduation. In the court there are 3 boards with children’s pictures on, which are the children involved in the FTC. Once a parent has moved up a level, they can move their child’s picture to the board on the level up.  When the Court is in session every parent stays for the duration of everyone else’s hearing. The idea behind this is that the parents in recovery can learn from one another and celebrate their successes.

In the morning, I was able to observe the case discussion held with the judge and the other professionals involved with each family. This allows the judge to be updated on each family’s current circumstance and what message should be conveyed in the Court session that afternoon.

Before the Court begins in the afternoon, parents can attend peer meetings, facilitated by the Family Recovery Support Specialist. This allows some time for any anxieties to be aired and any issues that need raised outside of, or before the court begins.

The Court Session got under way and it was a busy room filled with the 20 families currently involved in the program (including small children), various lawyers, social workers and CASA’s. The first case is heard and decision is made that the parents children may return to her care. This particular parent has made significant changes and the Judge asked the parent to share with the Court Room why they think they have succeeded. The parent declared she has been clean and sober for 90 days and the whole Court Room erupts into enthusiastic applause! As the session continues, so does the clapping. Every parent had to submit how many sober supports they have used this week, and as long as the number is above 0, the parent receives a round of applause. I am a little confused but I, politely, clap along anyway. By the end of the session, I am really enjoying the clapping and become keen to hear how many sober supports each parent has managed to use! I discussed this with Jill and stated how reserved we are in Britain because no-one claps in our courts of Children’s Hearings. With amusement Jill advises the Family Treatment Court is known as the ‘happy-clappy’ court, much to the exasperation of some of the lawyers in the Court Session.

I really enjoyed my day in Court and I admired the fast pace and structured intervention this program provides the families. The outcomes show this program provides positive outcomes for the children involved and supports parents to make better choices for their children. The values of this program remind me of the values that Circle works by such as acknowledging that improving circumstances for the parent will improve circumstances for their children and by providing a strength based, solution focused intervention allows for parents to have control over their own journeys. The Family Treatment Court also relies on peer led models to enhance the program and recognises the power of parents learning from one another.

Down Time

It’s Saturday morning in Seattle and I am thankful for a sleep in and a slow start to the day. I have had a very busy week, full of fascinating visits and I have lots of information to go through and reflect on. For now I am having down time before it starts again next week. I have been thinking about all the other opportunities I have had during this visit, outside of work.

Last weekend I spent in San Francisco and I fell in love with the city! Also known as ‘The City that Knows How’ we spent our first day walking around the centre and towards Fishermans Wharf at the bay.  San Francisco was an immigration destination after the Second World War, and saw the rise of several movements including the sexual revolution and the peace movement in opposition to the Vietnam War.  This history led to the Summer of Love and the gay rights movement making San Francisco the city of liberal activism in the U.S.  Wandering around this impressive city it is clear there is a diverse culture but I was struck by the homelessness in the city which is very visible. San Francisco is one of the most expensive cities in the U.S so affordable housing is an issue, especially after circumstances such losing a job or the break up of a relationship.  Many of the homeless community come to San Francisco, from other parts of the country for LGBTQ acceptance and access to homeless services.

We decided to take a boat tour of the famous bay and we were not disappointed. We got close to Alcatraz, which was a former high security prison for San Francisco’s most dangerous criminals, and learned about its gruesome history. We went underneath the Golden Gate Bridge and were surrounded by several Whales and Dolphins! What a beautiful sight and another reason to love San Francisco ever more!

 

We walked across the Golden Gate Bridge and went to a dual piano battle where Broadway musicals and Disney were the order of the evening! The crowd tip the pianists in order to request a song- the bigger the tip, the more likely the song will get played. If a bigger tip or better song is requested to the second pianist, he takes over regardless of where the first pianist is in his song.

Since being in Seattle I have attended a Women’s MBA basketball game between Seattle and Chicago. Chicago stole victory from the Seattle team, however I thoroughly enjoyed my all American hot dog! The game was supported by the Planned Parenthood campaign and there was a demonstration outside the arena before the game. Planned Parenthood is a nonprofit family planning agency that provides high-quality, affordable reproductive health care for women, men, and teens many whom have no other health care available to them.

This weekend I have tickets to the Yankees v Mariners baseball game and I am having another go at paddle boarding!

I will be updating the blog again with my reflections on my other visits from last week so keep an eye on the page 🙂

 

 

Addiction Recovery Centre

I spent two days at the Swedish Addiction Recover Centre which took me out of my comfort zone being in a hospital setting, however it was an incredible experience! I met many amazing patients alongside passionate and committed Doctors, Counsellors and Educators.

I first arrived and was shown the ward by Dr James Walsh who is the Medical Director of the Addiction Recovery Centre. The ward has a specialist department for treating pregnant and post-partum women who are drug dependent.  Women voluntarily present themselves for a medically supervised detox. This can take many different forms depending on the individual woman’s circumstance, level of addiction, type of substance and where they are in their pregnancy.

Once a woman has been medically stabalised they can be placed on the 26 day in-patient program which involves 24- hour nursing care, intensive case management, after care planning, and intensive group therapy. Dr Walsh advised that 2 women are admitted to the program per day and according to state regulations, no more than 12 women should be in therapy at any one time. There are usually 8 women in the ward being medically detoxed waiting to join the treatment program. Approximately one third of women who enter the 26 day program leave before the end of their treatment, however, the program is held in high regard.  During my two days on the ward I spoke to several women who advised they had tried detox several times in the past and the Addiction Recovery Centre was the one place they had managed to remain in treatment.

I attended my first group and the theme for the group was core beliefs. I introduced myself to the the women, and they were very intrigued about how a pregnant woman in Scotland access treatment for substance use. The groups are facilitated by experienced Counsellors who direct and guide the conversation, however there is a strong emphasis on the women supporting each other and using their own experiences to advise and share with their peers. We discussed what our ‘self talk’ is when we are stressed and the theme that ran through all the women’s self talk was how stupid they felt and how they felt they had messed up every aspect of their lives. It struck me that when the women were asked who had grown up in a household affected by addiction and an abusive household, every single woman raised their hand.  From my experience this is common with the parents I have worked with, and there is often a link between childhood trauma and drug dependency. What became apparent was the group had built up trust during their time in treatment and were invested in not just their own recovery but their peers recovery too. When one of the women was struggling to think of positives in her life, her peers were quick to remind her of the positives in her life and remind her of her motivation for being in treatment. The Counsellor reinforced that staying in treatment contradicted everything the women thought about themselves.

The next group was a discharge planning meeting where the women were able to plan how to obtain their I.D’s, their proof of pregnancy to get TANF payments (benefits) and applying for longer term treatment placements. There are various community supports available to the women including access to a Public Health Nurse who will help during times of stress giving advice on lifestyle and behavioural risk factors, as well as assisting families with matters concerning health. There are Maternity Support Services the women can access involving support to access and maintain housing. There was a lot of discussion around the Parent Child Assistance Program who I will be visiting next week. I am pleased to hear the women have good things to say about the PCAP service which provides home visiting support to pregnant and parenting Mums who are drug dependent over a 3 year period.

My third group of the day was a Neonatal Abstinence education group. The significant message conveyed to the women during this group is that not all babies are born in withdrawals if they have been exposed to drugs in utero. This came as a relief to many women in the group who were extremely anxious about this however there is not a definitive way of determining which babies will experience withdrawal before the baby is born. Dr Jim Walsh stated the importance of giving this clear message to the women in treatment who believe they have in some way ‘broken’ their babies. Dr Walsh believes this can set women free of some of their anxieties and allow them to progress forward with their recovery. The Family Educator facilitating this group went on to demonstrate how to communicate with or stimulate and hold babies who were experiencing withdrawals which included speaking in low, hushed tones and ensuring babies were sitting in a V shape when held. The last exercise in the group was showing the women how to make informed choices regarding their healthcare and their babies healthcare by being assertive without being confrontational.

My second day at the hospital started at 7am and I was able to join some of the women for a ‘smudging ritual’ which is a Native American ritual to cleanse negative energy.

Smudging involves burning sacred herbs and washing your hands, eyes, ears, heart and brain in the smoke in order to cleanse negative energy.  We started the session by walking up to the roof of the hospital and each calling the corners of the earth which you can see in the picture. The Chaplin used a giant feather she had been gifted to direct the smoke over our heads, bodies and the base of our feet. Once this was done to everyone in the group the Chaplin then blessed the unborn babies. This ritual led me to think about the importance of mindfulness and taking time in a chaotic world or mind to gather our thoughts. I certainly felt more relaxed about the day ahead when we made our way back to the ward. During the walk down to the ward I was able to enjoy chatting with the women who were in good spirits and talked about their own pregnancy experiences with me. The women were intrigued by my accent and I am learning that speaking with  a Scottish accent has served me well on this trip! Most people I have met so far have been very complimentary about my accent and whilst some mistake me for Irish everyone has been curious about where I am from.

The next group was a Recovery Skills group and was intense. We were asked to think about something we were having trouble accepting. Some women chose not to share their issue however those that did disclosed personal and upsetting experiences. It really hit home how powerful this group recovery model is. Every woman who disclosed something were encouraged and supported at every opportunity. The women in this group were learning from each other due to the trust and the bond they had built up over the days and weeks they had spent together. This has made me think about some of the parents I have supported throughout my career and how much some would benefit from a supportive and encouraging peer group to offload anxieties about their parenting and the challenges that come with it.

I spent the afternoon chatting to families in the pre-natal drop in clinic in a location off site from the recovery centre. This is a clinic for women who may or may not have been through recovery treatment to seek medical support. I shadowed Angie the Birth and Family Educator who spent time with the women in the waiting room providing guidance, advice and emotional support. The women and other parents in the waiting room were clearly relieved of this more informal support during their wait to see the specialist doctors.

My time at the Addiction Recovery Centre was very informative, very fast paced and very thought provoking. I was exhausted after my visit but encouraged by the positivity of the women in treatment and commitment of all members of staff I met. Everyone on the ward has such belief in this model and there is clear evidence the women on the ward believed in their own recovery.

The Willows Transitional Housing Unit

What a first week!

Prior to my visit to the Willows I spent a lot of time reading relevant research into gender specific substance use which has given me food for thought regarding the report I will be writing with my findings. I am currently looking into the benefits of residential treatment for women specifically.

I also spent some time at the Willows Housing Unit for women with co-occurring poor mental health and Substance Use Dependency (SUD). SUD is the phrase used to describe the client group who are experiencing problematic substance use. I was initially shown around one of the 3 housing units by Joelle, the Willows manager. Each unit houses 5 families and each family has 2 bedrooms with access to a common living area and kitchen. There is a large outdoor garden with a child’s play area. Most women have babies and children up to 5 although currently, there is one family with a 17-year-old child. There is no limit to children’s ages when entering the program.  All women have been in a 6-month residential detox program before entering to the Willows, and the average stay for women is around 15-18 months. Women go through 3 treatment phases each lasting approximately 3 months, although the length of phase depends on how the woman completes the competencies expected of her.

Phase one involves a settling in period where the woman works alongside her Case Manager to set up her housing contract, find child care and engage with SUD, mental health and parenting support groups available at the Willows. Phase two is an expectation that women gain employment and continue to engage in the same supports as in Phase one. Phase three, the final phase, allows women to apply for government housing. All women on completion of the Willows program, and all three phases get priority for new housing under a government scheme which is a significant motivation for the women residing at the Willows. In Seattle and throughout King County, the average monthly cost of a basic apartment is approximately $1200, whilst families who are out of work are paid $325 from the Temporary Assistance to Needy Families grant (TANF).  When a family are ready to move onto independent living the woman will have completed an exit binder which she will keep.  It covers their individualised coping skills, crises planning, their support network, triggers and identified warning signs when they are not coping, among much more information with the intention of the women going on to maintain a stable and healthy lifestyle for themselves and their children.

During my visit to the Willows I was able to speak with the Manager and find out how successful the project was (95% of women graduate) and what the challenges are regarding funding. It seems there are a lot of similar challenges experienced by the Third Sector in Scotland and the Willows, in the sense that funding is often time limited and not guaranteed to continue. The Willows have received significant cuts which impact on staffing levels. I sat in on the team meeting, which involved discussions of the progress of individual residents in each of the three areas of mental health, substance use and parenting. This gave me a great opportunity to chat with the staff and find out about the day to day running of the project. I had the privilege of meeting one of the residents, who is a peer mentor at another site run by the Community Psychiatric Clinic (CPC). The CPC is the umbrella organisation that the Willows is under. The resident shared her story with me and told me how important a project like the Willows has been for her and how it has helped her move forward in her recovery. It made me think about the consequences for the women and children at the Willows if they lost their funding and how the outcomes for the children living here would be affected.

I have noted that speaking to various workers during my trip there is a lot of anxiety around the current political situation and how the Medicaid program (health insurance for those who are in most need) will affect current service provision. The Pacific North West is, generally speaking, a Liberal area and the city of Seattle in particular has a generous Medicaid package for the most vulnerable residents.

I will be returning to this project again this week so I can provide an update on my experience and the information I gather during this visit.