marianna: â hello everybody, and thank youfor joining us for today's webinar, "implementation of the nurturing program for families in substanceabuse treatment and recovery." i'd now like to pass it over to mr ken decerchio.ken decerchio: â thank you marianna, and welcome everybody. my name is ken decerchio, i'm withchildren and family futures national center for substance abuse and child welfare, andwe welcome you to today's webinar. "the nurturing program for families in substanceabuse treatment and recovery." this webinar is the fourth in a series of webinars on evidencebasedpractices, brought to you by the national center on substance abuse and child welfare.we are planning additional webinars in the coming months, hoping to bring you "the matrixmodel," and another webinar, "motivational
interviewing," and we'll probably be planningseveral others as well that we'll keep you informed of.the national center on subs abuse and child welfare is supported by the subs abuse ofmental health services administration, center for subs abuse treatment and the administrationon children, youth and families, children's bureau on the office of child abuse and neglect.having the privilege of operating the national center, we couldn't do it without the supportof both samhsa and the children's bureau. and i've like, with that, to turn it overto elaine stedt, our federal project officer for the national center in subs abuse andchild welfare from the children's bureau. elaine?elaine stedt: â thanks, ken. as ken said,
i would like to welcome everyone on behalfof sharon amatetti, who is my counterpart at samhsa, and also catherine nolan, who ismy boss at the children's bureau, the office on child abuse and neglect.we are thrilled that we are able to have ms. bogage and ms. christmas on as presenterson this very important topic. we know that this is something that is of great interestto the children's bureau, and really looking at issues around implementation, fidelity.and understanding how programs work best to serve children and family that are impactedby substance abuse disorders. we are really looking forward to the discussion throughthe chat function as well as your responses to the polling questions that will come upduring the webinar.
and i really encourage you to engage withthe national center in sub abuse and child welfare, as they have many resources thatare available to you. with that, i will turn it back over to ken. thanks, ken.ken: â thanks, elaine. we appreciate your joining us today. it was a pleasure to haveyou. today's agenda is around the implementation of the nurturing program for families in substanceabuse treatment and recovery. today's webinar as well as the series of webinarsthat we have brought you around evidence based practices is not intended to train you inless than 90 minutes and how to implement this particular program.but it is intended for jurisdiction's, cites, grantee's for those of you who are grantee'swho have selected this program who may be
implementing it now or are contemplating implementingthe program. our focus is around the implementation issueson the nurturing program, if you will. terry and diana are going to talk about their experiencein implementing the program. we want to spend some time today talking about and presenting,monitoring the fidelity of the nurturing program. we all know that that's a critical componentof the implementation of evidence based practices, and then measuring the impact and outcomesof nurturing program for families in substance abuse treatment.today's webinar, again, is to focus on the implementation issues and the experiencesof these two tremendous presenters and the experience they bring in implementing thenurturing program and what their implementation
experience can do to help your implementationexperience. as you are implementing this program or you'reconsidering implementing the nurturing program. with that, i'd like to take a few minutesto introduce our speaker. both terry and diana are with the institute for health and recoveryout of cambridge, massachusetts. the institute for health and recovery is apartner and provider of the commonwealth of massachusetts regional partnership grant programcalled the family recovery project. in partnership with the department of children and families.and the bureau of substance abuse services and advocates for human potential and thatprograms currently being implemented in southeast massachusetts and they have experience inimplementing that regional partnership program
in massachusetts going for seven years rightnow. our first presenter will be terry bogage withthe institute for health and recovery and our second presenter, and they're teamingon this one, is diana christmas, also with ihr. terry is the director of family and childrenservices at the institute for health and recovery. a statewide policy program, systems developingtraining services and research organization. diana christmas, our second presenter todayhas extensive experience in the areas of substance abuse disorders, parenting, hiv aids and maternalchild health. she serves as the parentchild services coordinatorfor the institute for health and recovery's parent and children services component, whereshe cofacilitates parenting groups for families
in substance abuse treatment and recovery.as well as provides local and national training on substance abuse disorders, child developmentand parenting issues. with that, it is my pleasure to introduce terry bogage and dianachristmas from the institute for health and recovery and turn it over to terry to beginour presentation. welcome terry, thank you.terry bogage: â thank you, ken. welcome, to everybody. it's great to be here. good afternoon,if you are from eastern part of the country and good morning if you are not from the westernpart of the country. wanted to say thanks to the children's bureau,the national center for substance abuse and child welfare, to all of you guys, ken, lariana,elaine and nancy who helped us get set up
to do this.we are excited to get to talk about the nurturing program. we hope to hear from folks, answerquestions and have, somewhat of an interactive conversation, although, that's a little difficulton a webinar. i wanted to start off, by acknowledging thatthere has been some confusion about which nurturing program we are talking about. wehave done a lot of training on the nurturing program...we are here, and i am going to giveyou a picture of the cover in a few minutes and you will see the curriculum.but the nurturing program for families and substance abuse treatment and recovery andyou can move onto the next slide, is a trauma informed curriculum and it really integrateswhat we know about substance abuse, recovery,
mental health issues, as well as child development.originally, i am going to talk a little bit about the history and development. diana'sgoing to get into a lot of the implementation details but i want to...i feel like the backgroundof how this came to be, is useful for people to understand.originally, the curriculum was developed through a pregnant and parenting women and infantscenter for substance abuse prevention demonstration project in the early 90's.at that time, it was piloted at two residential women and children's program. what was piloted,was based on dr stephen bavolek's nurturing program for parents of children birth to five.which, at that time, was on csap's promising practices list. those lists have changed overthe years though.
now we are part of nrap, but at that time,it was chosen by the staff who were here because it was a welldocumented curriculum. it wasaimed at reducing abuse and neglect, which is what the aim of this demonstration projectwas. it did have an evaluation instrument thatadultadolescent parenting inventory connected, so we were happy to have that, which i willtalk more about that in a little while. we are now on our third edition of the nurturingprogram, and again, you will see the cover in a few slides.that was published a couple of years ago and really incorporates learning over the past,almost 20 years, since we first published it around. especially around trauma, mentalhealth, and parenting issues. that has all
been incorporated into this third edition.we have a couple of different ways we are going to try to clarify and figure out forall of the participants. which curriculum, if you are using one that you are using andif it is the same one that we are talking about. if you could go onto the next slide.as i said, during the demonstration project, the stephen bavolek's nurturing program waschosen. it was difficult to find the curriculum that really addressed the impact of substanceabuse, cooccurring disorders and trauma. dr bavolek's curriculum has had, and has excellentcore values and guiding principles. it was not specifically a design to address the issuesspecific to parents and families with substance abuse and cooccurring disorders. there areseveral ways in which our curriculum.
the first one, dr bavolek's curriculum andone of which is obviously that focus on substance abuse, cooccurring disorders and trauma. also,in that we really begin with a focus on the parent and the challenges of parenting whenyou are also struggling with all of these other issues.a lot of parenting programs, including bavolek's, start with the child. so the big differencein this one, is that it starts with the parent. a big focus in our curriculum is again, onthe parentchild relationship. we will talk more about that throughout the webinar butthat is a very big focus of ours. those are a couple of the main differences.the curriculum explores the needs of individuals struggling with substance abuse disordersin a variety of ways. each of the topics,
and hopefully we will get into some of thedetails of this, is explored in the context of being in recovery and parenting.for example, how do you help your child with selfesteem issues when you need to focus onyour own self esteem issues? we start with the parents and their selfesteem issues.another example is how do you play with your children or teach your children about playwhen you really never had the experience of playing yourself? each topic focuses on theparents' perspective on that topic and then, it moves on to the child.it talks a lot about helping parents understand how they were parented and that huge impactthat that has on how they're parenting their children. we all know that we can [inaudible11:38] parents, hear our parents' voices sometimes
when we're talking to our children.and that's certainly the case for all parents. we try to help participants understand thoseimpacts on how they're parenting their kids today and again, strengthening that parentchildbond so that families can heal together. if we can go to the next slide, we wantedto ask people, there's a polling opportunity a couple of times throughout the webinar.we wanted to ask people to try to clarify how many people are using the nurturing programfor families and substance abuse treatment and recovery.it would help us to know who in the call is using this curriculum. people could answerthat question and then, we'll find out what the results.marianna: â we have 36 percent of the folks
who responded are using the nurturing programfor families and substance abuse treatment and recovery. 54 percent are not and 11 percentare not sure. terry: â that's helpful. more than half ofyou are not using this program. this is an opportunity to learn about it and over a thirdof you are using it. hopefully, if you have specific questions or concerns or issues thathave come up, we can try to address some of those.for the not sure group, hopefully you'll know by the time we're finished. the next questionis this, are you using another nurturing parent program?marianna: â those results terry, of those who responded, 21 percent say they are usinganother nurturing parent program. 57 percent
say no and 21 percent say they're not sure.terry: â this is helpful. we have an idea that there are about a third of you who areusing this and over half that are not. some of you aren't sure so again, hopefully you'llbe sure by the time we're finished. i'm going to talk a little bit about the informationalcultural model because it's really the theoretical underpinning of the model, of the curriculumwe've developed at the stone center at wellesley college. many of you are probably familiarwith it. it's important to mention it briefly becauseit underlies the curriculum in every way. the model really shifts the emphasis fromseparation from psychological growth being through separation individuation to psychologicalgrowth happening through connection.
that's really the basis for growth and development.the goal of development being to enhance connections with other people and being toured into apersonal connection and interaction. you'll see that throughout the curriculum,that's what we're aiming for. connection, relationship between facilitators and participants,between participants, each other, between parents and their children.i'm going to move to briefly talking about trauma on the next slide. there's been a lotof focus which is great, an emphasis in the field on trauma and understanding the verystrong correlation between histories of trauma and substance abuse, cooccurring disorders.this is an old study, from [inaudible 15:03] but i still like to use it because it's sorelevant. women in community samples record
a lifetime history of physical and sexualabuse that ranges from 36 to 51 percent while women with substance abuse problems reporta lifetime history ranging from 55 to 99 percent. we approach everyone in our group, women andmen with the assumption that there may be a trauma history, the universal precautionapproach. we assume that participants have experienced trauma, we treat everyone in avery respectful and traumainformed way. it's an important statistic and an understandingthat most of us have now that trauma plays such a key role in so many of the participantsthat we're working with live. i'll move now to the guiding values of the nurturing program.i don't want to read through all of these but you can read them. the experience of beingin the groups and diana will talk about this
when she talks about implementation, is initself a very nurturing experience. we hope that parents can internalize someof that nurturing and feel and really understand the benefits of taking care of yourself. thenthe importance of taking care of yourself first, so that you have the reserve and yourtank is filled up so that you can better take care of your children.on the next slide, there's a lot of opportunities for having fun within the curriculum. there'srespect for yourself and others in all aspects of your life. we talk about respecting whereyou live, where you work, where you bring your kids to child care or day care.we try to talk about that respect in all of the environments that you may be in. a bigpiece of one of our guiding values is about
recovery happens in families and in relationshipsas well as in the individual. everyone hopefully by this point knows thatthis is a family disease and recovery is a family process. one of the guiding valuesis that this is the process that happens within families. doing work around parenting andparents and children together is a very important piece of that.from the next slide talks about nurturing the parent and the way that the curriculumdoes that. there's many ways that the nurturing program...nurtures group participants. thecurriculum sessions are very structured. it each begins the same, ends the same, hasa similar structure so that people can know what to expect each week. there's lots ofopportunities to build connections within
the curriculum.as i said, between participants, between participants and facilitators, we can talk if there's time.hopefully there will be, to talk about a children's curriculum that we're about to complete thatcan be used in conjunction with this. so, there's opportunities to build those connectionsbetween parents and children. there's lots of opportunities to create that safe placefor selfexploration. we talk about the importance and i'll talk in diana more about this laterbut helping to build the ability to communicate well with your kids.being honest with your kids, not avoiding conversations, this is one of the questionsthat may have come in about talking to kids about your substance abuse. there are placesin the curriculum that help with how to have
those conversations depending on the child'sage. their developmental stage but really how tobuild those connections and have those honest conversations. again very participatory, forthose of you who are using the curriculum, it's very interactive.there is very little didactic facilitators standing up and talking at the participantsvery hands on and it's lots of fun and creativity. one of the other things i want to add hereis that the approach throughout the curriculum is very nonjudgmental.we are expecting parents as the experts on their children and at such we expect the parentsto come in as the experts on their children. not only is there a nonjudgmental approach,we are looking to parents and saying, "you
know the most about your children, let's bringthat into the equation." the quote that we like to use, 'we teach whatwe know but we replicate who we are'. this is something that is mentioned in guidingvalues and i'll talk about it a little bit here. many curriculum sessions begin as isaid before with parents, how a particular issue impacts the parents.and then it moves to the impact on the children and the understanding that impact on the children.hopefully i'm not upside, we are having a slight technical thing here, i'll fix it,ok, sorry about that. we go back to what's familiar when we are parenting our kids andwe know that parents do that too. what we experience in childhood is what'sfamiliar to most of us. hopefully that makes
sense, sorry there is a little bit of backgroundnoise there. we had a slight technical moment here but we are fine.if you want to move on to the next slide, briefly the curriculum is very much designedto be adopted which is why it says 12 to 17 session. each session is designed to be 90minutes, we have a variety adaptations already developed because of different projects we'vedone over the years. we have a shorter version, 12 session version,the full curriculum is 17 sessions but we work with the programs and providers figureout what it is that would be most useful for their participants and we can tailor sessionsby the needs of the program. as i mentioned before, each session is designedin the same way, information for the groups'
facilitator they always begin with an icebreakerand close with a wrap up. they also, i think was very helpful, is include additional informationon issues or concerns that might come up. there is a particular topic we've anticipatedfrom doing this for long, issues that have come up during those session topics and talkabout those in the introduction to that particular session. the curriculum is unfortunately onlyavailable in english at this time. but it does respond to an array of learningstyles, there is not a lot of intensive reading or didactic work as said. people with multipleintelligences and literacy levels have had success with their curriculum and it's reallyquite accessible to a wide range of people. lots of opportunities to explore culture bothof your own culture as well as the cultures
inherited as of other participants in thegroup through different crafts and sharing and activities on a variety of topics.in the next slide, i'm not going to read through each topic but as a couple of examples thenext two slides list all these topics. we always start with hope, that is quite intentional.a lot of people in early recovery come into our group unnecessarily thrilled to be there.we do say it's a voluntary group but if you are living in a program where group participationis mandatory, it's not all that voluntary sometimes but it's a session that does builda sense of hope, we are hopeful that you are in the room, we are hopeful that you are there.often people leave that session feeling much more positive about being in the group thanwhen they came in...diana?
diana christmas: â ...this also add that itsets the tone because some of the basic things that people assume that someone who is inrecovery will totally understand, is that hope is a new transition for moving from activeaddiction to what hope means. they may have had some of that experiencewhen they were younger but that whole slant in culture of actively using changes the wholeperspective of what words mean and experiences mean. they are not always clear, it's somethingthat's basic as hope, everybody knows what hope is.but not necessarily if you are coming from a place where it's been part of your activeaddiction process to deny hope. you do not believe that hope is existing that's why youallow to continue to stay actively using because
it's hopeless.we spent quite a lot of time talking about that and connecting moving from active thinkingto getting a more positive perspective and hope is the first one that sets that tone,it's totally important. terry: â thanks diana and for example communicationi talked about before we talk about how to talk to your children about those difficulttopics like why you may have to go away for a while if you are in treatment. again dependingon the age and developmental level of your children.but we really tackle those difficult topics that people haven't talked about but in avery safe and nonjudgmental way. if you go on to the next slide those are the rest ofthe topics and each one again starts with
the parents, there is lots of specific concreteways to practice. for example managing stress we practice breathing,we practice having a very nurturing experience that you can take with you outside of thegroup. people talk about that a lot as something that's been really helpful for them.in recovery love and loss, we again purposefully have that towards the very end because that'swhere we really tackle all of the losses that may have occurred due to your experience withsubstance abuse. diana: â before you move on, hi it's dianaagain, wanted even though i'm going to talk a little bit about later on, want to pointout the alternative sessions for the fathers that are listed there because as we were doingthis curriculum and doing the groups.
often men gave us a lot of feedback aroundsome of the specific issues that may be going on with them. we really took some time inworking with them and developing some sessions that might lean more, closer to the pointsin perspective that men might be struggling with.not only due to their recovery and being involved in the criminal system but the messages theymight have gotten early in life around what it might mean to be a parent and that someof that needs to be revisited that they can feel like they could be involved with theirchildren. and if they have something to bring to thetable, even though they might not be employed at this time. but the priority was reallywas being involved in their child's life and
how do you do that? give them some of therestrictions of what men are going through at this point in time.terry: â thank you. on the next slide i thought we would stop for a minute and asking youall another question. we are used to doing this kind of training in person and havinga lot of interaction and discussions. it's a little bit of a different experiencefor diana and i to be doing this on a webinar but we thought it would be a nice opportunityto get people stops on this question or this statement. participants should have some cleantime or sobriety before attending parenting group.marianna: â terry as you can see the response categories, seven percent of respondents saythat they strongly agree with this statement,
45 percent say that they agree, three percentsay that they don't know, 31 percent say they disagree with the statement.and 14 percent say that they strongly disagree with that statement.diana: â interesting, that's a quite a broad range.terry: â a pretty even split between every... diana: â hi it's diana and the reason whywe even ask this question is given that this whole curriculum is a partnership betweenthe participants and the staff and the staff have to buy into it for it to really workthe way that it needs to. that we need to also work with staff aroundgetting some clarity of having them work through whatever their issues might be around whetherthey believe clients already give them whatever
their treatment process might be ready toeven begin this process. often a lot of the work that has to happen,is working with staff with people who are going to be implementing this to work throughsome of their challenges and their barriers and that happens even before we begin to talkabout what their facilitation skills might be.that it's really important to begin to do that and that the agency buys into, or theleaders of the agency, buys into this whole nurturing process. because that's what willsustain it over a period of time. it's important to address that and it can come from any wayand that's fine. that's part of the work that needs to be done.terry: â i'm going to turn it over to diana
in a minute to talk about implementation butthe answer is on our poll, our very telling because that gives an example of what youmight walk into when you enter a program. staff come from a variety of places and thisis a big question for a lot of people. diana's point is important that, these conversationsshould happen beforehand so that you know everyone is on the same page or at least closeenough to the same page that they know what's happening in these groups.and can buy into it and support the participants even outside of the group.diana: â because often you can measure whether a program is being implemented and you cancheck off, "yes i did this, yes i did that," but if you are not emotionally tied into it,it's not going to work and you are not going
to get the outcome that you need to giventhe population that you are working with. you have to believe in the sense and the conceptof nurturing and believe in terms of this exchange, to even begin to operate it becauseyou'll go through the curriculum but that doesn't necessarily mean that people havegotten what they need. that's why this whole idea...terry: â can we go to the next slide, please? diana: â that's why this whole idea of whenthis curriculum was developed is that, it be flexible. yes it is too tiring for familiesand participants that are in treatment but the reality is, we have expanded it way beyondthat to work with populations that may have any issues.be it trauma, domestic violence. not only
because what we're really talking about isrecovering from some real difficult experiences that have impacted your behavior, your thinking,therefore your capacity around parenting. whatever those experiences are, you've beentaken away, or the client has been taken away from nurturing and it's almost like relearning,or maybe they never got it, and being able to get those pieces. that's what's so important,that it is flexible and terry mentioned it earlier.in terms that it can be adapted. some of the examples in some of the places that it's beenadapted is that it's used in outpatient services, not only used in residential. we've used itin homeless shelters. we've also used it in prisons because it is that flexible.people really do need to learn how to nurture
themselves. they think they know what thatis, but often they really, really don't. the other thing that is clearly extremely importantis that each of the topics, that each of the segments really promotes this psychological,emotional experience. that is nonthreatening and based on clientdirection of where they're at within the group. therefore, you may start off at one levelof talking about, say for instance growth and development and you talk about the differentstages of erikson. we don't only leave it at that point, thereason why we even begin to talk about it is, first, to help the parents, the clients,understand what their childhood experiences, may be putting them at risk or put them atrisk, or even the positive ones.
having them to understand what happened tothem, where they're at with that, what they need to gain and what they already have andhow do you build on that? the child development, erikson stuff usually is used to explain toparents where their child is at, given what stages of development they're at.but we first begin to do that with their own self, with their own childhood and that seemsto make a major, major difference, especially for people who are in early recovery, whohaven't really been connecting any of that emotional stuff.they know they feel inadequate but they're not real clear where that began. they thinkit began when they started using drugs, but it might be the other way around. they startedusing drugs because early on, their selfesteem
wasn't built the way it needed to be.we use those opportunities, at any given point, to be able to expand on what might be goingon with the client. terry: â could you go to the next side, please?diana: â the whole idea really is to provide a safe forum. it's important that the clients,the parents that are coming into the nurturing program, that they also have some other support.you want to think about that, whether they're getting counseling, whether they're in treatmentbut they're getting something else because the bottom line is that these programs, ourgroups, really are going to be a foundation to build on other things.it's important and to build this safe environment. why is an important because clients need tofeel safe, about being able to implement some
of the practices that we're going to be givingthem in the training as well. also, what happens is that there's these messagesabout, that someone should automatically know how to parent. so often, the feelings of feelinginadequate about parenting are kept secret, only because we're talking about a populationthat's becoming accustomed to keeping secrets. it's really important to normalize the feelingsthat one gets about not feeling like they know how to parent, which is all of us. anyonethat's a parent understands that. i don't care how many kids you've raised, each onechallenges your sense of inadequacy [laughs] on whether you.on how well you parent. coupled with the whole issues of being in early recovery. helpingthem to break those pieces out really, truly
makes a difference.terry: â and i'll add one point about that. this point of everyone has some difficultyin parenting, it really, it points to that many parenting struggles are universal. thatends up building commonality and reducing stigma for our participants.oftentimes, facilitators are also parents and so there's definitely a connection inthat way. these are universal struggles, so it's not an "us" as expert and "them" as students,it's really much more of a shared experience. diana: â it's really important that thereis a major focus on understanding all of what happens based on parental substance abuseand the residue when you come into recovery around really being able to handle anythingbeyond your own personal development.
what really is of value within this particularcurriculum is that we spend a lot of time helping people break these feelings up intoareas that they can begin to understand and also help them to work out some skills tobe able to address it. the first is being able to identify the feeling,the feeling of guilt, the feeling of shame and how that might trigger some other stuffuntil you're not able to. often, i'll quickly mention an example, is often, our motherswork with their children. and they've got an infant and this infanthas every little shoe that's guccilucci. they have an outfit for every half an hour andtheir whole focus is really on trying to make themselves feel more comfortable as a parent.so often what happens is that we have to help
them to break that out so they're not overcompensatingfor their shame and their guilt. something simple like the child crying can trigger somany things and the child may only be crying for maybe a minute.and we have to support the parent around, "time it so it doesn't feel like it's beena half an hour and it's really only been a couple of minutes. it's really ok, you don'thave to panic." helping them because every experience feels so intense when you're inearly recovery. can we move onto the next? some of the implementationchallenges that we have supported programs around, and it depends what kind of programs.some, it's not so much an issue of retention or recruit...ion?terry: â yes.
diana: â [laughs] because often, we are workingwith residential programs where there already is a captured audience, so that's not necessarilyalways an issue. since we have expanded it over the last five or six years to programsthat are dealing with parents that are outpatient. some of the issues that usually do come upis childcare, what is the best time to do the group, consistency, them being able toget there on a regular basis, or even get there. there's never been an issue as of yetthat i know, where people. once they've gone to a couple of groups don'treally be able to follow through, that they are interested in following through. they'refirst threatened by the whole idea of parenting and maybe be assuming that you're suggestingthat they're already inadequate.
so, it's really about developing this andcoming from the approach of healthier relationships. one first with yourself, then you'll be ableto have better relationships with your children, with your family, with your spouses.it's like where we come from with this, so that they can really begin to understand what'shappening. sometimes, often, what begins to happen is you have to think about the schedulein the group. sometimes you plan to do the orientation andthen it becomes a little more clientdirected around the time that the groups will be. theaverage group really may not always be 90 minutes.but the sessions are so flexible that you're able to pull out what makes sense to you withinthat session, given the knowledge level or
experience that you think your participantsmay need. often, if you're dealing with outpatient ormaybe a shelter, because we've worked with domestic violence or domestic partner programs,that often what'll happen is that we will begin the groups and instead of focusing onsubstance abuse. we would talk about recovering from some realdifficult experiences. usually by the time we're like 4th or 5th session, then they becomea little more flexible and then begin to selfidentify, often what would happen.then the other piece is really around facilitators becoming comfortable in the groups and thathappens, our specific training and how we do this is there's a cofacilitation piecethat happens. there is a premeeting before
the group and there is a postmeeting for thegroup. and normally what happens is we will discusswhat will happen within each group, what pieces they feel comfortable with taking on, whatpieces they don't feel like they're quite ready to do and as they continue to stay apart of that cofacilitation. because that's the program staff that's doingthis, they will begin to take on more and more. by the time you're at the 12th session,15th session, the facilitator is really doing the program and myself or my staff personare really supporting them around that cofacilitation piece.but it really is about supporting the staff and being comfortable with that model. so,also, in addressing the skills...
terry: â go to the next slide.diana: â oh yeah, i'm sorry, go to the next slide. now i got to tell somebody. [laughs]also, what beings to happen is that people wonder, "well, what kind of skills do youneed to have in order to do this group?" you should have some understanding, certainly,of substance abuse, no doubt. and a little bit of knowledge about childdevelopment would also really help, and having had experience doing groups before. the restof it can really be taught and supported over a period of time. it's really not that mandatedthat you need to have a counseling degree or anything on that order, really.it's really about your commitment and having some knowledge. is this the next slide? thenext slide please. i want to talk a little
bit about the adaptions to the nurturing program.what begins to happen is the signs, the parentchild interacting, things that we already have.we've looked at some other models that make sense to incorporate in there and so partof it is this whole idea of being able to selfobserve with your interaction with yourchild and being able to self or identify what is going on with your child.often, this work is important to do because people will have been actively using drugsfor a very long time, will be very selfcentered. it will be very difficult for them to be childcenteredwithout really getting some information and some support to be able to consider what isgoing on with the child. it's very interesting that sometimes you'llhear parents say, child is an infant, maybe
two months, three months old, and they'resaying, "she is doing this deliberately. every time i go to sit down, after i fed her andchanged her diaper and need to sit down and get some rest.she starts screaming and hollering. i know that she's doing that deliberately." the realidea is to help them to pull away from that selfcentered perspective and get them to understandthat children do that and it really has nothing to do with you or her trying to get afteryou. terry: â part of in the, this is terry. inthe third edition, how we've been able to address those issues is through incorporatingchildparent psychotherapy concepts, reflective functioning and some of the learning we'vehad through other projects here, that ucpp.
that really helps parents to see from theperspective of their child, which is really part of the third edition and diana's goingto talk a little bit more about the other specific changes in the third edition, interms of an adaptation. diana: â can i go back to addressing facilitationskills, because this is often a major concern in terms of how you measure that. terry, areyou going to talk about that later on, about how one measures that?[crosstalk] terry: â we do, we will, yeah.diana: â so the only thing i really want to say about this is that that is an ongoingpiece in terms of supporting staff around being able to really implement this with anemotional commitment. we found that you can
check, like i said earlier.you can check off and a facilitator can do everything that one expects or that is assignedin the curriculum. but for some reason, it still seems like it doesn't feel like it'smade that type of connection with their participants and often.it has to do with the facilitator needing additional support around really being involvedin that. the only other thing i would say that one of the things that we also have learnedis that you don't want to be too heavysided in terms of other experiences.or interaction that these clients have with the staff that are cofacilitating. you wantto think about that, are these counselors, is this there...a clinical person anyway?you want to be able to think about that and
how to be able to follow up on that.terry: â right, sometimes we've found that people are cofacilitating obviously have differentroles in the program. if your role is more about making sure rules are followed or ifpart of your role is following up and setting limits or taking away privileges.it can be hard to slip back and forth into cofacilitating the groups. we should probablymove ahead then to two slides around adaptation for parents and children interactions andon this slide, i'm going to...diana's going to talk about the well child curriculum.i want to say, one of the things that we did because we've heard a lot of people reallyinterested in, for good reason, worked with children as well. because this curriculumwas really developed for parents, unlike that...nurturing
parent programs that have side by side children'sgroups. this historically hasn't. although in certaininstances we have been able to include children in building family recovery. it was a projectyears ago that i worked on here where we created, with another organization, a children's curriculumto use as a companion that has. based on age of kids, similar session topics.the kids were working on that topic while the parents worked on the topic in their groupand then they came together for an activity. the well child curriculum is something thatis almost finished and ready for publication that diana's going to talk about in a minuteand that is another opportunity to work with kids as well as with the parents, doing thisparent group.
we're going to stop here and the next slideis another polling question. again, to keep everybody awake and get your thoughts on someof these really tough issue that do impact the impact you can have doing groups, beingaware of people's thoughts on these topics. parents in residential treatment have betteroutcomes when their children are with them. marianna: â kerry and diana, if you can seethe results. about 70 percent of folks agree, that's split between 20 percent strongly agreeingand 50 percent agreeing. about 23 percent respond that they don't know and about sixpercent are in the disagree or strongly disagree categories.diana: â thank you. diana back. i want to quickly run over some of the major "it" pointsof the well child curriculum. what begins
to happen with this is that children needthe opportunity to be able to express themselves and learn exactly what they're feeling andwhat's going on. the well child curriculum and the groups arereally designed to help them to do that. if you go to the next slide, that's not the nextone. terry: â yep.diana: â that's not what i have. the well child begins to talk and focus on really helpingthe children to also recover from whatever trauma they may have been experienced. itdoes promote resilience, it helps them to learn how to break the secret of abuse inthe family and brings up. and gives them a safe forum to be able totalk about what might be going on with them,
in a safe environment. it's not as long asthe curriculum for the parents but if you go to the next slide, you'll get some ideaof what the sessions are. what we look at within those slides and eachof them, very much like the nurturing program, has a set of objectives, certainly lots ofactivities, that really help them to do that, and helps them to work through some of what'sgoing on. the world child curriculum is also prettyadaptable because what it will do is there are certain activities that are offered basedon the age of the children that may be involved in the curriculum.these are all the topics, but there are alternative activities that are much more age appropriate,give them whatever age per...whatever person,
the children will be coming into the groups.terry: â and if people are interested in the world child curriculum, we are happy to giveyou guys more information. we obviously can't spend that kind of time on it now, we wantedto let you know that it's out there and it's going to be available very soon for folks...diana: â we already talked about most of this stuff, in terms of the third edition. onething we haven't really talked about was the guide for individual use. in that there isa small pamphlet, a guide, where you can take the curriculum and use it to work with individualfamilies maybe in individual sessions. either in individual or outpatient. if a parentneeds maybe to have a little more support than what the group has offered, then youwill be able to take this guide and pull the
information from the curriculum.and be able to make it much more intense and address more specific whatever might be goingwith that. terry: â one of the ways we found it usefulis because people either aren't ready for any number of reasons, to sit in a group setting,or they may have missed a group or two. people may join late and we want to catch them upwith some of the topics. the individual guide can be used in a numberof different ways. the next part is about being a fathersession. which you have talkedsome about. diana: â i have the only thing that i wouldlike to add about this, like i said, there are specific issues that men need to dealwith and work through, being substance abusers
or not. that's what these three sessions do.we offer the three sessions either as alternatives and we identify where these alternatives mightfit. or you could add them on, because often they still do need to have some of that otherinformation that may be coming from the scheduled routines.those are the three sessions. could you move on and i thought you've talked about the individualguide. terry you wants anything more about that particular piece?terry: â no. if you can go to the next slide marianna, and we can see if there are anyquestions that have come up. by now we've done a lot of talking, so we'd love to hearif there's any questions from anybody in the audience.audience member: â thank you. we do have one
question. the first question is, "what agegroup participates in the, world child program? terry: â the curriculum was originally designedfor 5 to 10yearolds. we expanded it to go more like 4 to12yearolds. within that largerange, we have specific sessions for...it's divided up into four to six or sevenyearolds,and then seven or eight to 10yearolds, and then 10 to 12yearolds.there are different activities in each session broken by age, because that's a very largeage range as you know, but the general range is from about 4 to 12.audience member: â thank you. one more other question is, "as a follow up to your discussionabout facilitating and cofacilitating...you spoke about cofacilitation. could you talka little bit more about who those roles are
or who it is that cofacilitates the group?"you mentioned one might be treatment staff and is the other a trainer, a supervisor?could you talk a little bit more about that? diana: â yes. they usually are trainer orthey're someone that has more experience in doing the cofacilitating. one way or a coupleof things that we do is that, we go out to the different programs and we work with thestaff and do the whole 17 group cycle with them.another way is that we offer annual training's twice a year for people to come and learnhow to do or implement it. the other thing is that i have definitely gone out and terry,has specially gone across the country to other social agencies and trained a wealth of staffto be able to do it.
i've gone to atlanta and did all of the "substanceabuse and maternal and child staff," and then they went out to the different agencies throughoutthe states. they cofacilitated either with the clinical person, social worker, or...whatatlanta did, they took their "perinatal program." and their "substance abuse program" and theycoupled those two together. until they went out after they were trained by me in the twodaytraining. they went out different agencies and started training other couples off likethat. terry: â and in general it really dependson the program as diana mentioned earlier, there is not a requirement around educationallevel or particular background. we hope people have a commitment to parenting, have an understandingof substance abuse and child development.
and really want to be there and have an interestin the group. but in different programs, that could be the child care staff, that can betreatment staff versus the treatment program [inaudible 59:43] staff. it really variesfrom program to program. but when we are training folks around the country.our hope is that, people that have an interest and ideally are planning to stay there fora little while because it's a lot of working with each other and then when there is turnoverthe hope would be that, someone is always trained in the curriculum and so can thenwork with the next person. i hope that answers the question.marianna: â yes, thank you. and we have one more question for this quotient of the webinar.are there builtin times for the facilitator
to observe parentchild interaction?terry: â there aren't builtin times. it's through the curriculum, different programsagain do it differently so there are programs that build that time and have parentchildinteraction time, but it is not part of this curriculum that there is a parentchild togethertime. diana: â but often what will do, we meaningpeople, the staff...going over the next few working with the program. what we will dois that, if the clinical person, not the one that's in the actual groups, we will meetwith them to update them on what's going on with the children.and the parent at that particular point or what we have focused on with the parent andwhat we think, is where they need to be right
now in terms of application of what we'veshared in terms of information. often the clinical person might be one ofthe staff that will come into the act and be a part of the actual training.marianna: â that's it for now. we will have more time for questions as the webinar continues,if you'd like to move in to the fidelity section, terry and diana.terry: â thank you. this is terry, i am going to talk...you can go to the next slide aboutsome ways that we've monitored fidelity. there is a form attached to this slide that it'sproperly a little bit difficult to see for some of you. but we wanted to give an example,and this handout is available to all of you. one of the ways that you can monitor fidelitythat we've used in the past, where each session
you wait for an observer supervisor, ratedifferent components of the session. in massachusetts, as diana mentioned, what we do is we tendto meet before. when we are cofacilitating the parenting staffhere with the program we meet before and after the group to talk about preparation for thegroup before, what might come up, the content for the day, who's going to do which section,and then after to really go ever and reflect how the group went.if using a fidelity form, which can be really helpful, you can reflect on the reading. cofacilitators,with or without ihr staff involved, can be really helpful for each other to give eachother feedback and we encourage that about what went well ,where we might have lost people.what seems to really resonate with people.
that how, some of the ways we've used thefidelity form here. in terms of challenges, there are a number of those. one of them is,when we adapted the program, we encouraged adapting the program to meet your specificneeds, adapting the nurturing program. obviously that can sometimes be a challengeto fidelity that we stay aware of. i eluded to staff turnover and training issues that'sthe big challenge for our program. we will work with the program, they'll getthe training, i'm sure people are familiar with this, be our star facilitator and thenleave the program and we're back to square one again. staff turnover and retraining staffcan be a big challenge. client turnover or clients missing sessionsthroughout can also be a challenge to fidelity
because obviously, they're not getting thefull dose of the program. one of the biggest is having funds to be able to evaluate theprogram, doing follow up surveys. we have not had the opportunity to followpeople post nurturing program except for at the very end. we haven't been able to checkin six months or three months later to see if what we talked about has stuck so to speak.money for evaluation is certainly a challenge and a barrier. the lack of good parentingmeasures is another one. we haven't come across good tools to help measure what it is thatwe're trying to measure in terms of parenting and what folks are learning in the groups.if you go to the next slide, here's another example where this is for the whole session,so it's not just one week. the last slide
was for one session, this is the whole series.you can use this an instrument. again, you have copies of this, so don't worryif you can't see it, where you measure each of these. how did the icebreaker go? was itdone, was it not done, done a little, done a lot, all the way down through your engagingstyle, your ability to listen and the overall performance.lots of different things are measured each week in the program, so that's another exampleof a fidelity instrument that we've used. we can stop here, that's what i have to talkabout in terms of fidelity and if there are other questions, we'd be happy to answer themat this point. marianna: â terry and diana, one of the questionsthat did come through from participants was
how do you address fidelity when you're implementingthe nurturing program for families in a one on one setting or in home?terry: â great question and it's difficult. if you don't have someone there observingyou, one thing that we talk about doing is selfrating. using that form and trying torate yourself and using supervision to talk about the interaction.and how it went to get a sense of how well you were able to stick to fidelity.diana: â the only other thing is, that we have been working with the social workersthat would be going out and doing the individual and helping them to come up with some scalethat measures whether this is working or not. and whether they're comfortable with whataspects and what not.
bottom line [inaudible 67:14] is that we comeback and we talk about what happened, how did it go, what might have been the issues?what were you able to get to, what were you not able to get to and why?it's like adding discussion to the chart that terry showed you but meeting with the individualswho are going to meet with the family. doing a schedule and figuring out what the objectivesmight be based on the particular sessions they're going to do.each one of the sessions in the curriculum have their own set of objectives and a goal.if they choose that particular session, that one of the ways that they're going to measureis what was the outcome based on what you wanted to accomplish based on the goal ofthe objective of that particular session.
they begin off by first taking notes and thenmeasuring, trying to develop some measurement that makes sense for them.terry: â does that answer the question? marianna: â that's great and one more questionin this area, you made reference to the adaptability of the curriculum. is there a specific orperhaps minimum number of sessions that you would recommend?or maybe some key sessions that you would recommend people include when they're deliveringthe program? terry: â that's a great question and we'vetalked a lot about this. i feel it's hard to give a number. how we've done it in thepast was when we did the 12 session curriculum, the shortened version, this is years ago buti believe we had a cut off of you have to
be there at least seven or eight sessions.or something like that for the 12. depending on what the needs of the program are, i wouldrecommend someone talking to us directly about what sessions...i would hate to say this isthe required or that is not a required sessions. we certainly have thought about what we thinkare key sessions that we wouldn't want people to cut but it depends on the needs of theprogram. based on what they come up with, then we can work with them around...diana: â what to do and how to do it. terry: â and a minimum number of session requirements.diana: â that's something that we would do automatically with any program outside oftreatment because the reality is that often, you're not going to get someone who's notin the program or captured audience to come
for the whole 17 weeks. you really begin tothink about it. the other thing that we've been very creativeabout is sitting with programs and combining some of the sessions together.that there's a natural fit with feelings and selfesteem for example and what we'll do iswe would develop a session pulling from both of those that would make sense where you couldcapture both issues. does that help? marianna: â yes, thank you. i like to pointout we have about 15 minutes left. if we want to briefly cover these last few slides sowe can leave a couple of minutes for wrap up and any final questions.terry: â if you want to move to the next slide, i mentioned the adult adolescent parentinginventory. that was the tool also developed
by stephen bavolek that we have used a lotand a lot of programs use, to measure the effectiveness of the nurturing program.in the next slide, i'll show you the core domains but before that, i want to mentionthat we have used a lot of participant surveys or session evaluations. we get a lot of qualitativefeedback which we'll share at the end from participants. it is incredibly helpful sayingwhat's been most useful about this session. what's been least useful, what would peoplelike to see more or less of. participant surveys are a really great tool to use and we havesamples of those if anyone's interested for that qualitative feedback. if you go to thenext slide, i can show you briefly the core domains that the aapi measures.it looks at appropriate developmental expectation,
empathy, where the parent has empathy forchild alternative to corporal punishment, appropriate roles whether a child is in achild role or more like a parent role and then one he calls oppressing children's powerand independence. which we don't love the language there butit's about children having their own voice. those are the domains that aapi measures,we have had the challenges with the instruments which i will be happy to talk about more.i didn't have the time but it is useful in measuring attitudes and beliefs around parentingpractices. diana: â and we do a preimpose.terry: â right and we do a preimpose. the next slide is an example of a session of valuationthat you can use with the parent which i mentioned,
i forgot that it was in here and this againin much more readable print is available to you all.and this is an example of what we might ask participants after each group. you can makeit much shorter than this, this is a long one but did you learn anything new? i've youchanged any of your behaviors as a result of this group? that thing, that's an examplefor you to use. diana: â and we do this half way through thesession and then we do it at the end again. terry: â next is some resources, these aresome of the three articles that have been published related to the nurturing program,any of which i can get you copies of if anybody is interested. again as i mentioned, resourceissues we haven't been able to do the study
that where we have a control group.where we have a sample that gets the curriculum and a sample that doesn't. we haven't beenable to do a lot of post discharge follow up, there is a limitation to the resourcesand the studies we've been able to do but these are the articles.then finally some of the quality feedback, i love to share this with people because theseare what some of our many, many participants have said over the years to us. "i won't readthem all but i'll give you a couple of examples." "most of what i learned had to do with waysi thought i should parent and that there is really no rule book or manual to being a goodparent." "i also spent time learning about my child's boundaries." lots of great feedback,you can read through these yourself.
if you go to the next slide, i like this firstone. how to have fun, i learned how to have fun as a clean and sober person, how to recognizecertain feelings and situations and how i can deal with them.how to interact with other people and how to nurture myself, my family and friends andfeel comfortable with it. the other quote that i love, i love them all but i'll readthe third one, what nurturing is. how to nurture and care for myself as wellas others that i'm truly worthwhile human being who deserves safety, respect and happiness.that is what we have, we can move on to question and discussions in the remaining 10 minutes,marianna? marianna: â thank you. we'd also like to remindeverybody if we are not able to address your
question during the webinar, we will be ableto have some additional follow up with terry and diana to have them answer it.and we will post those by next week with the additional materials which will be availableon cpm for our pg grantees and also generally for everyone on the cfs website.a couple of questions in minutes that we have left, one of the questions is, how do yousequence in or perhaps phase in nurturing parents in treatment programs? when do youstart including people in groups, is it very early on in treatment or what have you foundto be successful? terry: â this again varies by program a lot,some programs have a requirement that people who enter the program have to participatein the groups, which wouldn't be our choice
to have people joining in the group but groupscan be mandated in programs and we work with that as best we can.in some programs we work with the program and their requirements. we don't have a requirementof a certain amount of clean time or recovery time. we welcome people in very early in recoveryas well as people who have substantial recovery time and often that works well together.do you want to comment that? diana: â also when i went to programs likeworking with the homeless population, we worked with people who are still active, who arestruggling to get some consistency sobriety. we'll work with clients like that as wellbut keeping that in mind. we will tailor each of the topics with thestruggle of trying to get some recovery and
what that will be like. the hope is that,you would get clean and what do you think you need to be able to do that and focusingin on the pieces. if the majority of the people in the roomwere not one only that they were still struggling with their sobriety. you would easily do that.i'll quickly say, if you have the support of a counselor or the program and understandingthat piece, then you can adapt it however you need to.terry: â part of what works well in the residential programs, when people join in with folks thathave been in the group for a while, is that the support that they build with each other,the peer support is incredible and more the experience members of the group in terms ofbeing part of the group.
but also having maybe more recovery time canreally be positive influences as everyone knows on the newer folks to the group. ithas worked out quite well in some circumstances but it is very program specif.marianna: â i'm going to try and squeeze in one more quick question before we give itover to ken here for final comments and that is, is the aapi limited to a specific agerange of kids? terry: â no it's not. it's not about specificdevelopmental issues, it's really focused on parenting attitudes and beliefs, the questionshave to do with as a parent do you think this or that particular way of being with yourchildren is good or bad? strongly agree to strongly disagree.it's not age specific to the kids.
marianna: â thank you. ken, over to you.ken: â thanks marianna and thanks terry and diana for sharing your experiences and bringingto life the realities and the challenges and the success and hope by implementing thiscurriculum. i thought it was interesting the differentsetting, in which you implement it or able to implement it in the modifications thatyou can implement this for folks, who are either in very early recovery or not treatmentat all as well as within a treatment program. perhaps maybe you want to comment, this couldbe a reinforcer, certainly it is a reinforce. but even maybe it could be away that a parentassesses how their own substance abuse or abuse is affecting their ability to parent.they could be motivating, is a better way
to frame it for furthering their commitmentto recovery or assessing whether they need to get into treatment as a result of participatingin this program, any comments on that? terry: â i would agree. we know that childrenare parents' most strongest motivator to get and stay in treatment and this group bringsto life a lot of those issues that parents are struggling with in a nonjudgmental wayand supportive way. it can really support and build on parentsinnate desire to parent their kids. diana: â exactly and that's been the experiencethat we have been exposed to base working with some of the recovery connections whichare drop in centers. we've done the parenting groups there and then we've motivated parentsin lots of different ways.
one, to either seek some other support, additionalsupport and seeking recovery. you are correct. ken: â i appreciate, thanks for that. as aperson in the past has a treatment background and then i fast forward to the work that weare doing in the national center and we come to recognize and you mentioned earlier dianaand terry about family centered treatment. and family centered approaches of which thisis really embedded in that context and the importance of that and you mentioned addictionas a family disease and for too long our addiction treatment, didn't offer enough family services.we have an opportunity, as parents enter treatment or as we have access to parents whether it'sin early treatment or whether it's in some other settings as you have spoken about, thatwe have an opportunity to engage those parents,
those care givers...in a way to look at theirparenting capacity. to engage them to strengthen their relationshipwith their children, to strengthen their parent capacity, we've accessed the parents...throughtreatment settings and almost an obligation responsibility to provide this service thatdeals directly with their ability to parent. we all have challenges in parenting and asyou've talked about it can be reinforcing to their recovery and it can also be a challengeto recovery, it can also be a trigger if we don't address a parent's confidence, a parent'sfeelings towards their own parenting capacity. and reinforce their ability to do it and givethem the skills set to do it. it's very compatible with treatment and recovery and as i justsaid, it's almost obligatory for us as we
provide treatment to parents, to be able toprovide this type of intervention, a parent child intervention.a strengthening the parenting capacity, because we become parents doesn't mean we know howto parent and because we may get to recovery doesn't necessarily mean we know how to parentand having skills and strategies that deal directly with our capacity to parent.and it builds our relationships with children, is now is a critical component of both individualparent recovery as well as family wellbeing. we appreciate your insights, sharing yourexperiences and your knowledge with us today. i want to thank you elaine for joining usas well today, i want to thank marianna and jonathan and children and family futures homeoffice for all of their preparation work in
putting this together.and i want to thank all of you participants and all 49 of you who have been with us forthis session for your time today. please feel free to access us through the national center,if we can provide more information and you see the contact information for institutefor health and recovery. between us we'll be glad to assist you withyour implementation challenges or other questions you might have that maybe triggered by today'swebinar. with that we hope you have a great rest of the week and enjoy the rest of thesummer, before schools starts and vacations are over.thank you and have a great day.
