Domestic Abuse Substance Misuse Parental Mental Ill Health.

• Domestic Abuse

• Substance Misuse

• Parental Mental Ill Health

• Abuse & neglect are often a feature of a range of family difficulties and problems

• Often compounded by poverty, house moves & eviction• Cumulative harm• A wicked problem• Reconceptualisation

Bunting & Toner (2012); Devaney & Spratt (2009)

• Adverse Childhood Experiences & their relationship to Adult Health and Well-Being– Child abuse & neglect– Growing up with domestic violence, substance

abuse, mental illness, crime.– 18.000 participants– 10 year study

Anda, R., & Felliti, V., (2010) The Adverse Childhood Experiences (ACE) Study: www.acestudy/org

Top 10 Risk Factors:

•smoking, •severe obesity, •physical inactivity, •depression, •suicide attempt, •alcoholism, •illicit drug use, •injected drug use, •50+ sexual partners, •history of STD (sexually transmitted disease).

Adverse Childhood ExperiencesAdverse Childhood Experiences

Social, Emotional, & Cognitive Impairment

Adoption ofHealth-risk Behaviors

Disease, Disability

EarlyEarlyDeathDeath

The Influence of AdverseChildhood Experiences Throughout Life

Death

Birth

• Increased risk of lung cancer

• More auto immune disease

• Increased prescription drug use

• Importance of ecological frameworks• Mirroring: families and agencies• Exclusion of fathers• Fixed thinking• ‘Start again syndrome’• The rule of optimism• Silo practice• Disguised compliance• Vulnerability of older children and adolescents

• Sidebotham, P., (2012) What do serious case review achieve? Arch Dis Child 97 (3): 189-192

• Family Characteristics• Minority previously known to CSC• The invisible child• Failure to interpret the information• Poor recording of information and decisions• Decision making• Relations with family• Thresholds

Sidebotham, P., (2012) What do serious case review achieve? Arch Dis Child 97 (3): 189-192

Domestic Abuse

•Domestic abuse is a major issue and accounts for 25% of all recorded violent crime (police statistics)

•On average 2 women a week are killed in England and Wales by partners - ex partners ( home office)

•24.8% 18 to 24 yr. olds witnessed DV

at some time during childhood

Children are affected

Children who live with domestic abuse are significantly affected and this can be manifest in a number of ways, including,

• Physical injury• Disruptive behaviour• Difficulties at school• Depression, resentment, anger• Sleep disturbances• Sense of loss• Bed wetting and nightmares• Guilt, confusion, sadness, self blame• PTSD

• 300,000 children in the UK (Scotland 59,600)• Conflation of ‘substances’• 1100 children pa die as a direct result• Children four times more likely to develop a dependency• Prevalent in cases of DA and child protection• Strong links between alcohol and violence• Little evidence that substance use alone is a risk factor• SG Statistics (2011); Best (2011) Scottish Drug Recovery Consortium; ACMD 2007; Forrester and• Harwin (2008)

• Effects on Parents• Physical Ailments (e.g. infections, injuries)• Psychological impairments

– Withdrawal symptoms– Psychoses– Serious memory lapses

Most short lived

Manifestation: mental health; psychological impact of drug; self- expectations; personality; type, dosage, admin method

• Neglect• Physical abuse, sexual abuse etc• Exposure to dodgy adults• Unstable and violent environment• Feel second to drugs• Exposure to noxious hazards• Criminality• Health issues

• About on in four adults is affected by mental illness• Most cases will be mild or short lived• Sometimes severe (e.g. schizophrenia or manic depression)• Many more live with long term personality disorder or long

term depression• 40-60% of people with a severe mental illness have children• Around a third of children subject to CPP (CPR NI &

Scotland)

• The Psychiatrist (2003) 27: 117-118 doi: 10.1192/pb.27.3.117

• Effects on ParentsEmployment

Income

Relationship strain

Links to substance misuse ad violence

• Separations• Insecure relationships• Neglect• Maltreatment• Carer role• Upset , frightened, ashamed• Bullied • Hear unkind things• Risk of mental illness• Revenge Killing

What a challenge!!

• What children say about living with parental substance misuse

Children’s Voices

FEDUP (Family Environment Drug using Parents)

• A family approach to supporting children who live with parental substance misuse

• Group work programme with children• Individual work with parents• Come together for safety planning

• Based on the Erica Pitman Programme• Twin track programme working with children

and their parents to reduce the risk of harm to children who live with parental mental ill health.

Evaluation

FED UP & Family SMILES : Summary of findings so

far

Specific aim Tool Perspective

To enhance parents’ protective parenting/ to improve the safeguarding of children & young people.

Child Abuse Potential Inventory (CAPI) &Evaluation Wheel

Parent

To enable children and young people to feel better about themselves.

Self Esteem Scale (based on Rosenberg)

Child

To reduce children and young people’s emotional & behavioural problems.

Goodman’s Strengths and Difficulties Questionnaire (SDQ)

Child/ Parent

HoNOSCA Practitioner

To enable children and young people to process their thoughts and feelings.

Evaluation wheel Children

Overall aim: To improve the well-being of children and young people and reduce isolation

Overview of the evaluation tools

To enhance parents’ protective parenting/ to improve the safeguarding of children & young people.

• For both FED UP and Family SMILES there has been a decrease in total CAPI score between T1 and T2 which is statistically significant for both programmes. This indicates that for both programmes parents are reporting a positive change in their parenting behaviours related to improving the safeguarding of their children.

• The change in five out of seven subscales on the CAPI was statistically significant for FED UP suggesting that parents’ levels of distress, unhappiness, problems with the family, loneliness and ego strength have all improved. For Family SMILES , the distress, unhappiness and ego strength subscale are statistically significant

Interim Findings ( October ‘11 to February ‘13)

Note: For both FED UP and Family SMILES number of Time 1 and Time =19, Statistical significance at 95% confidence levels using a one tailed test

To enhance parents’ protective parenting/ to improve the safeguarding of children & young people: Evaluation wheels with parents

FED UP

Note: The rating of 1 to 5 where 1 is low and 5 is high

To enable children and young people to feel better about themselves

Levels of self esteem amongst children as reported on the adapted Rosenberg scale increases on both programmes. In Family SMILES, this change is statistically significant.

FED UP Family SMILESN = 28 (T1 and T2) N = 20 (T1 and T2) Mean at T1 = 19.6, Mean at T2 = 20.8 Mean at T1 = 19.05, Mean at T2 = 21.5

P value = 0.102 (one tailed t-test) P value = 0.009 (one tailed t-test)The change is not statistically significant The change is statistically significant

To reduce children and young people’s emotional & behavioural problems.

FED UP Family SMILES

Self Report SDQ No statistical significance between T1 and T2 (n=27)

No statistical significance between T1 and T2 (n=29)

Parent completed SDQ

No statistical significance between T1 and T2 (n=18)

No statistical significance between T1 and T2 (n=9)

HoNOSCA ( completed by practitioner)

Statistically significant change from Time 1 and 2

No statistical difference

At present the evaluation is not showing any statistically significant change in reducing emotional and behavioural problems as reported on the SDQ on either the FED UP or the Family SMILES programmes. Practioners on FED UP have reported change that is statistically significant using the HoNOSCA

To enable children and young people to process their thoughts and feelings: Children’s evaluation wheels

FED UP Family SMILES

The world is a dangerous place to live. Notbecause of the people who are evil, butbecause of the people who don’t do anythingabout it(Albert Einstein)

Thank You for ListeningDi [email protected]

AcknowledgementsProfessor Julie TaylorDr. Prakash Fernandes