A significant proportion (4%, Australian Institute of Health and Welfare, 2008) of children and young people in Australia live in some form of residential care, usually in small group‐homes staffed by residential care workers in shifts. However, as Hawkins‐Rodgers (2007) points out, these placements are often not resourced to heal the effects of trauma and multiple attachment disruptions in their residents. The lack of an archetypal ‘family’ has led in the past to family therapists considering that there is little work to be done with such clients. This leaves such placements to be supported most frequently by clinicians who specialise in behaviour management and other linearly founded models of practice. The Alternate Care Clinic (ACC) is the first mental health service in New South Wales dedicated entirely to children and young people in out of home care with a high level of complex needs. This article examines the systemic therapeutic model the clinic has developed in the last two years. In particular, the article seeks to explore the importance of ‘meaning making’ in a diffuse parental system, particularly with regards to the term ‘family’. The complexities of working in this area and possible ways forward are illustrated with a closely worked case study.
This paper describes a systemic, trauma and attachment model for a parenting program for fathers in residential substance abuse treatment. It emphasises the complex nature of delivering parenting programs in this context and the importance of going beyond simple linear principles of reward and punishment, upon which many other parenting programs are predicated.Keywords: fathers, parenting program, substance abuse, residential treatment Key Points1 Fatherhood in the context of substance abuse is a neglected area in research and treatment. 2 Parenting is important to substance-abusing fathers and they recognise the need for parenting help. 3 Trauma experiences and attachment difficulties play a powerful role in parenting responses of fathers in residential substance abuse treatment. 4 Systemic thinking can orient practitioners to deal with complex issues in residential substance abuse treatment settings. 5 A framework for a preliminary program for fathers in residential substance abuse treatment is proposed.This paper is divided into three main sections. The first section presents an overview of the literature on the parenting challenges of fathers in the context of substance abuse treatment systems. The second section sets out how systemic thinking can orient practitioners in responding to the parenting concerns of fathers within such complex systems. This background establishes guidelines for proposing the development of a treatment program based on systemic principles, which forms the last section of the paper. Fathers in Substance Abuse Treatment SystemsThere is growing appreciation, supported by research, of the contribution of fathers in the lives of families. Fathers can have a positive impact on the developmental outcomes of children in emotional, behavioural, and social cognitive ways that are unique to this relationship (Lamb, 2010;Phares et al., 2005) and they can be a valuable source of emotional support for partners. In recent decades, an increase in the proportion of mothers in paid employment from 55% in 1991 to 65% in 2011 (Australian Institute of Family Studies, 2013) has influenced societal perceptions of the role of fathers. A broader, more inclusive perspective, recognises their involvement in different aspects of parenting that is not limited to financial provider, but also includes equally significant roles in developing children's attachment and play experience (B€ ogels & Phares, 2008).
BackgroundSuicide is a major public health issue worldwide. Those who have made a recent suicide attempt are at high risk for dying by suicide in the future, particularly during the period immediately following departure from a hospital emergency department. As such the transition from hospital-based care to the community is an important area of focus in the attempt to reduce suicide rates. There is a need for evaluation studies to test the effectiveness of interventions directed to this stage (termed ‘aftercare’ interventions).MethodsA controlled non-randomised two group (intervention vs treatment-as-usual control) design, using an intention-to-treat model, will evaluate the effectiveness of a suicide prevention aftercare intervention providing follow-up after presentations to a hospital emergency department as a result of a suicide attempt or high risk for suicide. The intervention is a community-based service, utilising two meetings with a mental health clinician and follow-up contacts by peer workers via a combination of face-to-face and telephone for four weeks, with the option of extension to 12 weeks. Seventy-five participants of the intervention service will be recruited to the study and compared to 1265 treatment-as-usual controls. The primary hypotheses are that over 12 months, those who participate in the aftercare follow-up intervention are less likely than controls to present to a hospital emergency department for a repeat suicide attempt or because of high risk for suicide, will have fewer re-presentations during this period and will have lower all-cause mortality. As a secondary aim, the impact of the intervention on suicide risk factors for those who participate in the service will be evaluated using pre- and post-intervention repeated measures of depression, anxiety, stress, hopelessness, belongingness, burdensomeness, and psychological distress. Enrolments into the study commenced on 1 November 2017 and are anticipated to cease in November 2019.DiscussionThe study aims to contribute to the understanding of effective interventions for individuals who have presented to a hospital emergency department as a result of a suicide attempt or at high risk for suicide and provide evidence in relation to interventions that incorporate peer-workers.Trial registrationACTRN12618001701213. Registered on 16 October 2018. Retrospectively registered.
Substance-abusing fathers have reported parenting difficulties and there is a need for interventions that address these concerns and support these men. The present study conducted a feasibility trial of the Black Box Parenting Program for fathers in residential substance abuse treatment settings. The study had a mixed methods design that assessed for demand, implementation, preliminary efficacy, and acceptability. Measures included pre-and postquestionnaires on parenting self-efficacy and satisfaction, perceived closeness in the parent-child relationship, feelings of guilt and engagement, and satisfaction with treatment. In addition, semi-structured interviews were conducted with participants post-treatment. Across four groups, the 19 fathers successfully completed the program. Following the intervention, there was a significant decrease in feelings of guilt and a strong motivation to continue to seek help with parenting. Parental self-efficacy and perceived closeness in the parent-child relationship did not significantly improve from pre to post-treatment. Qualitative data indicate that fathers were very satisfied with the program. Satisfaction with treatment was strongly related to parental self-efficacy. Systemic barriers prevented delivery of the program at some treatment sites and parts of the program could not be implemented at multiple sites. Overall, the program shows promise in being able to reduce the barriers to help-seeking such as guilt and poor retention. However, it requires the right service structure to achieve successful implementation.
When you delve into the early history of Family Therapy, it could be said that there was something of a 'master and apprentice' model of learning. That is, therapists followed the great figures of the movement, whether it be Salvador Munuchin or Michael White, in a kind of discipleship. In some cases, it could be said that this created somewhat of a 'cult of personality', where the larger-than-life figures were afforded a sort of 'guru' status amongst the acolytes. This may well have suited the place Family Therapy occupied at the time as the questioning minority and kind of rebellious adolescent of the psychotherapy world. However, in recent times, I have noticed the invitation for family therapy to come in from the role of rebel to the mainstream. The value of systemic approaches has even been acknowledged by government departments and large non-government providers. Yet, the number of therapists trained purely as family therapists remains relatively small when compared to the numbers of clinicians registered as social workers, psychologists, psychiatrists and so on.How, then, does an inexperienced therapist, who is likely to have had training concentrated in much more linearly focused models, consider and perhaps embrace systemic thinking? This is a question I have been considering lately in my role as Deputy Director of Clinical Training at the School of Psychology, University of Wollongong. It could well be argued that the 'master and apprentice' model is not suited to training larger numbers of clinicians, particularly in this suspicious and evidence-based era. Therefore, this is one of the most important questions we as a community must answer at this time, if we are to accept the invitation to growth. If we are to see family therapy grow as a model of practice, I believe we need to take seriously the transition process for students who are trained and are perhaps submerged in individually focused ways of thinking.I remember clearly that one of the things that struck me during my first encounters with family therapy was the way in which all members of the family were considered worthy of a voice. Even the youngest child was given time to share their experience and their opinion was considered of value. If we are to consider this process with any useful insight, we need to give the youngest children of the family the chance to share their experiences. In this article, a therapist just at the beginning of his practice, shares with us his rich and insightful reflections on this process. During the Masters of Clinical Psychology program, I thoroughly enjoyed working with a student of Hamish Hill's reflective capacity. I believe this article has something for everyone who is or has been that newly fledged therapist, just taking their first hesitant steps. Also, there is much for those of us who are supervisors, senior
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