Talking to parents about substance use issues

Research has shown parental substance use negatively impacts children’s social and emotional development, relationships, education and safety (Roche et al., 2014), resulting in behavioural, emotional or cognitive problems (Moore, Noble-Carr, & McArthur, 2010). Negative outcomes are more likely to occur if service systems are unable to identify the signs of parental substance use issues early, and don’t take steps to reverse their effects on children.

Data shows parents (particularly disadvantaged mothers) who attend services often experience co-existing issues including family and domestic violence (FDV), substance use, child protection involvement, mental health difficulties, poverty, and a history of trauma (Bromfield, Lamont, Parker, & Horsfall, 2010; Heward-Belle, 2017). Practitioners who are aware of these interconnections and able to hold curious, respectful, non-judgemental conversations with parents are well-placed to provide critical prevention and early intervention support for children’s safety and mental health (McIntosh, Wells, & Lee, 2016; Wells, Lee, Li, Tan, & McIntosh, 2018). However, many service providers feel they lack the skills to engage in these kinds of conversations.

A guide for difficult conversations

The PERCS-AOD conversation guides were developed by Emerging Minds to support child-focused conversations between practitioners and parents/pregnant women with substance use concerns. They are designed to help practitioners to consistently ask questions about five important domains of a child’s life:

• Parent-child relationship
• Emotions and behaviours
• Routines
• Communication and meaning-making
• Support networks.

To evaluate the effectiveness of the PERCS guides, a pilot study was conducted with six practitioners across five services which work with adults in the context of problematic substance use.

Initial and post-pilot semi-structured interviews were used to assess practitioners’ understandings of substance use and its impact on children, their practice in engaging parents with substance use concerns, and their strategies for asking child-focused questions.

Thematic analysis of the interview transcripts was used to identify nine distinct themes, describing both participants’ familiarity with PERCS and the ways in which it contributed new knowledge and skills to their practice. Each theme was then further analysed and summarised to draw out the details and nuances of participants’ comments, before being compiled into a detailed analysis of the interviews.

Findings

Participants reported that the PERCS-AOD framework:

• extended their existing practice with practical strategies and tools for working in strengths-based and child-focused ways
• helped them to keep children’s needs in mind when working with parent-clients
• facilitated conversations that enhanced, rather than damaged, their relationships with parents
• enabled them to work with parents as a team to identify, explore and respond to risks and to focus on the child’s overall wellbeing
• aided them in developing plans with parents to work on specific areas of the child’s life
• offered a different way of framing the parent’s experience of recovery by bringing their children into every step of the journey, making the work more meaningful for parents
• gave them more scope to conduct child-focused conversations and ‘poke around in that space’
• guided them through supportive but purposeful conversations with parents who may not have been attending the service voluntarily
• helped them to work through child protection concerns with parents
• encouraged a wrap-around approach to treatment planning that incorporated the needs of children
• helped them to uncover and address the impacts of intergenerational substance use and disadvantage on parents, and the ways in which these cycles were continuing
• supported parents to make positive changes (where children were named by the parent as a motivating factor).

Limitations and future research

As well as a strong commitment to child-focused practice, all participants had strong support from their organisation and practice leaders in employing child-focused practice. Further investigation is needed into the organisational support systems that allow a conversation guide such as PERCS to be used effectively with parents affected by substance use.

The use of semi-structured interviews also relied heavily on practitioners’ reflections of their own confidence and skills. An extension of this pilot would include quantitative and qualitative data from clients to assess the outcome for children.

Conclusion

This pilot evaluation engaged a group of six practitioners to analyse the contribution of the PERCS-AOD conversation guides to their child-focused practice with parents affected by substance use. The results of the semi-structured interviews showed that for this cohort, the conversation guides enhanced child-focused practice with parent-clients.

This pilot has provided further confidence in the PERCS-AOD conversation guides, particularly where practitioner understandings and organisational commitment support child-focused practice. The next steps involve work with practitioners and organisations where confidence in child-focused practice is not as high, or where commitment has not been as strong. Findings suggest the conversation guides can be used as part of an overarching framework that supports practitioners to ask child-focused questions of parents who are experiencing substance use issues, as part of a prevention and early intervention strategy. Ultimately, this strategy should be tailored to improve the short- and longer-term outcomes for children’s mental health and social and emotional wellbeing.

References

Bromfield, L., Lamont, A., Parker, R., & Horsfall, B. (2010). Issues for the safety and wellbeing of children in families with multiple and complex problems: The co-occurrence of domestic violence, parental substance misuse, and mental health problems. NCPC Issues, 33, 1-24.

Heward-Belle, S. (2017). Exploiting the ‘good mother’ as a tactic of control: Domestically violent men’s assaults on women as mothers. Journal of Women and Social Work, 32(3), 374-389.

McIntosh, J. E., Wells, Y., & Lee, J. (2016). Development and validation of the Family Law DOORS. Psychological Assessment, 28(11), 1516–1522. Available here.

Moore, T., Noble-Carr, D., & McArthur, M. (2010). Who cares? Young people with parents who use alcohol or other drugs talk about their experiences with services. Family Matters, 85, 18-27.

Roche, A., Trifonoff, A., White, M., Evans, K., Battams, S., Adams, V., & Scarfe, A. (2014). From policy to implementation: Child and family sensitive practice in the alcohol and other drugs sector. Civic Square: Australian National Council on Drugs.  Available here.

Wells, Y., Lee, J., Li, X., Tan, E. S., & McIntosh, J. E. (2018). Re-examination of the Family Law Detection of Overall Risk Screen (FL-DOORS): Establishing fitness for purpose. Psychological Assessment, 30(8), 1121–1126. Available here.