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Lizzie’s miracle:
“I’d come home from school and
Mum would have cooked my favourite, Shepherd’s pie. My
brother, Mark would come home 15 minutes later giving me
time to chat to Mum and Dad about my day before he
starts taking the mickey out of me! We’d all sit down
for tea together with my younger sisters and giggle and
laugh with each other. After tea we’d play X Factor and
I would win because I have the best voice! My prize
would be to direct a show with all my family in, even
Mark. Then Mum and Dad would put my sisters to bed and
I’d cuddle on the sofa with Mum watching Eastenders. Dad
and Mark would take the mickey out of Eastenders while
me and Mum tell them to shut up! We’d all have some
cocoa and then go to bed early so we can get up on time
for school.”
Less than a year ago Lizzie and
her brother and sisters were about to be removed into
Local Authority Care due to their Mother, Sandra’s
drinking. When I first met Lizzie and her family this is
the picture of her family she described, how it would be
if it worked at it’s best. All in the family described
how it had been before Sandra’s drinking became
problematic. The picture was one of a family who loved
each other dearly, and enjoyed sharing laughter and fun.
A family who best communicated through humour. However
all described a how in recent months their family
communicated through raised angry voices and slammed
doors. Mark told how this parents, Sandra and Neil, now
“scream and shout in shades of black and blue, not
talk in pinks and yellows like before”. He and
Lizzie wanted their parents to have a good relationship
and spend more time with them not arguing. So did Sandra
and Neil.
Listening to their children
describe their vision of their happy family, allowed
Sandra and Neil to share their hopes for the future of
their family. This was instrumental to them both feeling
less defensive and blaming, and more hopeful and open to
making changes for their family. Sandra was able to look
honestly at and identify the link between her drinking
and her aggressive behaviour. Without concentrating on
the amount she was drinking, Sandra was able to consider
ways in which she could minimise the potential for
arguments with Neil. Neil responded positively to
Sandra’s effort to communicate differently with him and
stopped blaming her drinking. Instead he was able to
look at his own contribution to the relationship and
look at strategies to keep all his family together.
By concentrating on their
strengths and helping them look for solutions and
strategies our work together facilitated Sandra and
Neil’s ability to try new ways of communicating and
being around each other. By the end of the 6-week
intervention Lizzie invited me to the “World Premier
of the All New Lizzie Show”. It was an all singing
all dancing extravaganza although Mark refused to take
part until after the interval!
Rhian, Paul,
Paula and
Lee
Rhian had been involved with the
social services department for a number of years. Due
to her chaotic lifestyle, a consequence of her
amphetamine habit, her two young children Paula and Lee
had been placed in the care of their father. Her
contact with them had all but ceased as her dependency
on the drug had increased.
She met Paul at a Psychiatric
hospital where they were both receiving support for
their addiction. On their release from hospital their
relationship developed and they moved in together. At
that time they were not able to deal with their
dependency and became involved in petty crime to finance
their increasing drug usage.
In May of 2002 Rhian discovered she
was pregnant just prior to receiving a custodial
sentence for fraud. On her release from prison and
following non-attendance for a number of antenatal
appointments the department was alerted. Repeated
attempts to engage the couple failed and at that stage
the department were intent on seeking legal authority to
remove the unborn child at birth.
____________________________________
"Made us feel warm and that we were someone ...
They
listen, they advise, they work with us not against us."
Mother on service evaluation form
____________________________________
With the consistent and determined
effort of the social worker involved the couple
eventually agreed to work with Option 2. After some
initial resistance they worked with the therapist to
explore their hopes for the future and decided that
against all the odds they would make a determined effort
to change their lifestyle in the hope they would be
considered ‘fit’ to care for the unborn child –
something they both desperately wanted.
The couple overcame their distrust
of the department and started to attend the meetings
that were set-up. Similarly they began to meet their
antenatal and health appointments. Rhian especially was
able to demonstrate a marked reduction in her use of
amphetamines. Paul found this much more difficult. As
a couple they began to prepare for the baby’s birth by
decorating the flat, buying equipment and sorting out
utilities – in spite of the fact that it was undecided
as to whether the baby would stay in their care.
The department were impressed by
the changes that Rhian especially had made and by her
confidence and positivity. They still had concerns
regarding Paul and whether he would jeopardise the
progress that had been made. It was decided that Rhian
would be admitted to the ‘Welcare Adult and Baby Unit’
when the baby was born. She could receive support from
the unit and the baby’s development could be monitored.
Rhian was overjoyed with the decision. She felt she had
been given a chance and that this was because of what
she had been able to achieve.
____________________________________
"(Therapist) put some fun back into my life,
especially with my son."
Mother on service evaluation form
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Rhian continues to go from strength
to strength at the unit and baby David is thriving. Her
relationship with Paul has unfortunately suffered as he
continues to be involved in drug usage. Whilst Rhian
holds out the hope the she and Paul can be together in
the future she feels that it is down to Paul to prove
himself a fit parent before any reconciliation is
possible.
Rhian is consistently surprised by the strength and
determination she has shown, which have helped her to
prioritise David’s care. On our last meeting she told
me she is feeling better about herself and beginning to
draw a line under her past behaviour. She is now having
regular contact with Paula and Lee and has begun to set
down the foundations for a new relationship with them.
WENDY’S CASE
STUDY
BACKGROUND INFO:
Mother, Father and 4 children
(10yrs, 7yrs, 5yrs, 2yrs and at the time of the referral
Mother was in the later stages of pregnancy with her 5th
child).
Father had been using drugs heavily
for approximately 16 years. Father also drank heavily
often consuming a litre bottle of vodka and 8 to 10 ten
cans of lager per day. Father has a long history of
offending behaviour and he has served a number of
custodial sentences as a result.
Given the Father’s continuous
dealings with known drug associates in the area, his
offending behaviour, police involvement and continuous
Police calls to the family home; the housing association
had evicted the Father from the family home.
The Mother was pregnant and living
in a very small, two bedroom council property with her
(at that time) 4 children. The home was extremely
overcrowded. Although the housing association said that
they did not want to evict Mum and the children they had
stated very clearly that they would not consider
re-housing her given historical issues. Mum was also
using heroin and benzo’s regularly. Earlier in the year
Mum also received a 12 month suspended sentence after
being caught for trying to smuggle drugs into prison for
the Father.
DETERIORATION
Concerns were further heightened
when it became apparent (via swabs/blood tests etc) that
mum was increasing her drug use during her most recent
pregnancy. At that time there had been concerns raised
in respect of mum’s lack of engagement with all
professionals, there was a noted deterioration in the
home conditions, there was a clear lack of parental
supervision and concerns regarding the children’s
unkempt appearance and low attendance and poor
punctuality etc in school. Regular drugs searches were
executed by the Police and the home was said to be in a
poor state and drugs paraphernalia etc were continuously
found.
Children’s services initiated a
further Child Protection Conference and the majority
of professional’s present were
requesting the children’s removal and Legal Orders to be
sought etc. Due to the family circumstances the Maternal
Grandmother was asked to move into the family home to
care for the children in the interim.
REFERRAL TO CHANGING TRAX
Changing Trax became involved days following the birth
of the 5th child. This was partly triggered
because the Maternal Grandmother broke down stating very
clearly that she could not manage the three youngest
children and she requested that they be accommodated.
Following this disclosure and the prospect of loosing
the youngest children both parents asked for support to
cease their substance use etc.
AIM OF THE INTERVENTION
was to enable the parents to change their behaviours and
safely parent their children.
* Parents to have an increased awareness of how their
chaotic lifestyle and
substance use was impacting on their parent capacity
* Set goals around specific behavioural changes i.e.
daily routines as well as
the parents having a safety plan in place to ensure
the children’s safety.
SERVICE DELIVERED
* Worked intensely with both Mother and Father
(daily) for the first 6 weeks. Visits
were then reduced to 3 times per week for a further
6 weeks etc.
INTERVENTION
* Involved both practical and therapeutic
support, ranging from: Emotional support,
family routines, organisational skills, parenting
skills, as well as debt/housing
issues. Further work also focussed on criminal
behaviour, substance use as well
as building individual family relationships.
* Empowered both parents to take charge of their lives
i.e. managing and attending
all appointments (individual as well as the
children’s appointments) as well as
spending quality time with the children.
* Building self confidence and self esteem
* Relapse prevention work
* Multi agency working with all professionals
including extended family members.
OUTCOMES
* All 5 children have remained at home & present as
very happy and well cared for.
* All 5 children have 100% attendance/punctuality etc
in school
* Both parents attend all appointments and engage well
with professionals
* No Criminal behaviour/activities
* Both parents producing continuous clean samples
* Father controlled his alcohol intake and he is now
alcohol free.
* Children subject to Child in Need Plan – pending
closure by Xmas.
Click here to see the development of the drinking and
drugs diary.
 Milly and
Vanessa
... had one child, three year old Alex. Milly and
Vanessa were a lesbian couple, Vanessa worked as a
prostitute and there were concerns from the social
worker that ‘the house was being used as a brothel’.
Vanessa was a heroin user, currently on Methadone,
occasionally ‘topping up’ with heroin, and on the
waiting list for an inpatient detox. Milly was an ex
heroin user. The social worker was concerned that Milly
may be using again. The relationship was described as
volatile with reports of domestic violence. Alex had
recently had his name placed on the Child Protection
Register under the category of Neglect as he had started
a fire in the house while playing with a lighter. He was
also known to play outside the house without adult
supervision. The house was not child friendly with no
toys apparent, Alex was not yet potty trained. The
recommendation to refer to Option 2 came from the
Conference Chair.
This was a complicated story with some emotive
behaviours that created a real risk of damaging
assumptions being made about the family. We worked with
the family and the social worker to identify real risks
to Alex’s safety and development. This resulted in a
number of goals being set by the individuals involved.
The referrers goal for the family was that he would like
to be confident Alex was well supervised by a capable
and caring adult at all times. Milly’s goals were to
find someone to talk to about things that worried her,
to stay drug free and to get some education. Vanessa’s
goals were to find a nice house with a garden for Alex
to play safely in, to become drug free, to help Alex
with his education and development.
____________________________________
"A
service that has been evidenced as being highly
effective."
Case Conference Chair
____________________________________
After spending some time with the family it was clear
that Vanessa took on the caring role for her son and was
struggling with her parenting. She found it difficult to
manage or understand his behaviour. In the evenings when
Vanessa went out to work the streets, Milly was
responsible for looking after Alex. At these times Milly
was worried and preoccupied with Vanessa’s safety, she
also expressed feelings of jealousy. This was the key to
the relationships volatility. This was made complicated
by the fact that the family relied on Vanessa’s income
to maintain their standard of living. Vanessa’s view of
the impact of her prostitution on Alex was that she did
not want him to know and had a plan to work for two more
years and save some money then give up and get a job
when Alex was in school.
The adults’ needs had become the focus of attention in
this family and Alex’s needs had been sidelined. We
worked to put Alex back in the centre of the picture.
Exploring Alex’s needs as a three year old in the here
and now, and talking about what the adults meant when
they expressed a wish to support his development. The
couple realised that their personal frustrations had
taken all of their attention and Alex’s needs were being
neglected, Vanessa being focused on the future and Milly
being focused on her jealousy and fear.
 We enrolled the
support of Vanessa’s mother for childminding and with
the help of the social worker got Alex into nursery for
three mornings a week. We also did some work on a
variety of parenting skills including managing
behaviour. Vanessa went into detox, came out clean and
stopped using heroin. We also looked at Milly’s fear and
jealousy, Vanessa was adamant that she was not going to
stop working the streets so we looked at protective
factors centring around using her mobile telephone.
Milly agreed with Vanessa that it would be difficult to
reduce their standard of living and provide for a future
if Vanessa stopped working the streets.
Milly developed
some strategies that would help her to remain calm which
included exercise, taking Alex to his grandmothers and
playing and reading with him. Milly and Vanessa reported
being free of heroin and there were no indicators that
they were still using. Clients were not allowed at the
house and never had been. At the twelve month follow up,
Vanessa had completely focussed her attention on the
needs of her child, she had been to parenting classes
and was now attending follow up parenting classes for
older children. She had stopped working the streets, was
clean of street drugs, had split up with Milly, and was
living with Alex and her mother.
 Tanya
... was a single mum with two children John and Nona
aged 5 years old and 5 months old respectively, the
baby’s father was in prison for violently assaulting
her. Tanya had some very complex problems, she had been
a massive heroin user, she had been sexually abused
since childhood and worked as a prostitute. This
experience left her with persistent medical
problems which required constant
pain control.
Tanya was overly compliant and subject to
exploitation by anyone who came along who seemed
supportive. However in her efforts to take some control
of her life, she was from time to time aggressive, and
could have a defensive attitude toward professionals.
One of her aggressive episodes led to her being struck
off her GP’s list and so her pain medication had
stopped, along with her anti-depressants. We received a
referral a couple of days later when Tanya was described
as ‘not coping’ with her children, ‘freaking out’ and
about to lose her children to the care system. The
situation was critical and a placement for the children
was being sought.
____________________________________
"Making us realise that our family is important -
most important - kept our family together."
Child on service evaluation form
____________________________________
I was able to visit on the day of the referral. Tanya
was clearly in a great deal of pain, withdrawing from
Dihydrocodeine and fighting against the decision to
return to heroin use. It was clear that pain management
was a priority as it was clear that she would not be
able to engage with anything else until that was under
control. We made some calls to find a local GP who had
space on the list. Tanya was offered an appointment in
four weeks time. We asked for an emergency appointment
and explained the situation, the receptionist spoke with
the GP and called us back saying that we could come to
the surgery to see a locum GP but he would not be able
to prescribe as he had no records. We visited the
surgery with the children and were asked to wait.
 Tanya
and I made the decision that we would not leave the
surgery without either a prescription or a police
escort. Tanya asked me to go in to see the GP with her
and again we explained the situation, when he started
talking about not being able to prescribe we told him
that we had been working on this all day and the only
way we would leave without a prescription was if we were
arrested. He sent us back to the waiting room while he
made a few telephone calls, then he gave Tanya a
prescription for DF118 lasting for two days. We made it
to the chemist in time and filled her prescription. A referral was made immediately to
the Community Addictions unit and with a few small
setbacks and visits to the new GP surgery, her
medication was stabilised.
We did some intensive work around her strengths and
values, her beliefs about who she was and her hopes and
dreams for the future. Tanya wanted to feel strong and
confident and independent, to be a mum to her children
and to learn how to accept and to be herself. We spent
many hours exploring who this person was, how she
behaved, what she wanted out of life and what she needed
to do in order to get there. Tanya began to think in
terms of taking responsibility and power for herself,
rather than relying on people to help her.
Tanya was
experiencing a variety of further problems including
managing her son John’s behaviour, being unsupported by
her supported housing, having inappropriate visits from
her support worker, living in conditions that were
unsafe due to a condemned gas cooker, the landlords had
also been dishonest in dealing with her property, having
disposed of some of it and claimed ownership of property
that she had paid for and had receipts for.
Tanya quickly made some clear goals around these issues,
we did some work on giving John a room of his own,
tidying the house so that he felt proud of it, and
strategies Tanya could use to manage his behaviour and
set routines. Tanya devised most of these new routines
and strategies herself with little guidance from me
other than reflection.
Together we worked on how Tanya
could approach professionals in the most effective way.
This involved doing a lot of work on her confidence,
exploring her strengths and values and talking about how
she would like it to be. Tanya learned some
assertiveness techniques and abandoned being subservient
and screaming and shouting as techniques as they clearly
had the opposite effect from the one she desired. She
became very interested in how she could use ‘psychology’
and ‘strategies’ to get what she wanted from others and
from her child. From then on she took control of the
intervention. Each time I visited she would have
collected library books and written reams of goals and
ideas and suggestions of how she could do things
differently.
She negotiated with the supported housing
organisation, made appropriate complaints against them
in writing to the board of governors, focussing on
allegations that she had evidence for and choosing not
to fight for things that she could not prove. Eventually
she moved to a new home. Occasionally she would contact
me ‘just for a chat to let me know how she was doing’.
Her case was closed to social services and she began a
new life in a new area. Tanya found the service so
valuable that she contacted and appeared in newspapers,
magazines, television and local radio saying that in her
many years of therapy, Option 2 had been the most useful
to her.
 Jane and
Bobby
... were both heroin users, they had three children
under six years old. Jane was being beaten and
prostituted by her partner in order to buy drugs.
Following a difficult time engaging with this couple,
the therapist visited and found them both beaten and
bloody. Bobby was clearly under the influence of heroin
and tried to eject the therapist who had been let in by
Jane. Bobby went back to bed and the worker was able to
speak with Jane alone. Jane and the children along with
a carload of their possessions were taken to a women’s
refuge in another district by the worker. The therapist
followed up and worked briefly with Jane to enable her
to access drug services in her new area. The case was
closed to Option 2 after five days.
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