Treatment programme a good fit for children

Treatment programme a good fit for children of Kiwi families with addiction and other hardship issues

Dapaanz media release – embargoed until 4.15pm, 3 September 2015

There is ample evidence and widespread agreement that we are unlikely to improve outcomes for children in high risk families, including those where children have been place in state care, by focusing on a subset of issues alone, the Cutting Edge addiction conference was told today in Nelson.

Keynote speaker Prof Sharon Dawe, School of Psychology, Griffith University, Brisbane, said adverse outcomes for children can result from many causes including substance misuse, poverty, inadequate housing, social isolation and poor parenting skills.

“That means Interventions need to be multifaceted where there is potential for child abuse and neglect. Interventions that aren’t, usually fail spectacularly to change either parental functioning or child behaviour.”

Professor Dawe, who began her clinical career in New Zealand, said this was the general environment when she and co-developer Dr Paul Harnett (School of Psychology, University of Queensland) began work on the Parents Under Pressure (PuP) programme in 2000.

PuP is different in that it provides a unique family support/treatment plan individually tailored to areas of strength as well as difficulty.

“For one family the hardest thing may be homelessness. For another it might be addiction or that a child has been suspended from kindergarten for the third time. What PuP does is provide an individual approach backed up by a resources and tools contained in a Parent Workbook. We don’t necessarily begin at page one. We look at priorities and where we can start getting some runs on the board right away.”

Professor Dawe said PuP’s strengths-based focus is one of the keys to its success.

“A lot of the families have been told what they’ve done wrong over and over: your alcohol use is a problem; your kids are out of control; there’s domestic violence; you’re not a good mum.

“Those things may be true, but what we may have missed is that mum has managed to hold onto the house, the two eldest kids are still going to school, the baby’s well and meeting all her milestones. We don’t want not ignore the difficulties but we want to build on existing strengths as well.”

Professor Dawe said a number of recent clinical trials involving methadone patients, women leaving prison and in situations involving child abuse have shown PuP to have significantly better results than traditional approaches.

“We find that about a third of families have their lives transformed. A third make significant gains and about a third make no progress or deteriorate. We are working with the most high-risk and vulnerable families who often have very entrenched problems spanning generations. In some cases it’s just not possible to quickly shift family functioning.”

A small New Zealand PuP pilot began early this year at Lakes District Health Board involving about 12 PUP practitioners from a range of organisations. It’s early days yet, but Prof Dawe says it seems to fit well with families in services there.

“The potential for PuP to reduce child maltreatment in New Zealand is seriously worth investigation, especially in light of the recent report on Child Youth and Family by the office of the Children’s Commission. The rates of child abuse and neglect are high in families with parental substance abuse and the families are often involved in statutory services. Working together with families and child protection is feasible, using the PuP model may help make significant changes in children’s lives.”

Professor Dawe closed by saying the costs to society of child abuse and neglect are considerable; similar to the cost of smoking in the US and almost three times the estimated cost of obesity in Australia. In the randomised trial of methadone-maintained parents she mentioned earlier the cost per expected case of child maltreatment prevented by the PuP programme was compared with the estimated lifetime costs of maltreatment.

She said, assuming the most conservative estimate that just one in five cases of maltreatment were prevented, there would have been a net saving of around AU$3.1 million for every 100 families treated.

New Zealand currently has around 5000 children in care each year as a result of abuse or neglect.

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