Friday, July 12, 2019

Rose Cuff #rcmentalhealth #satellite #families #fapmi #spaceforus

Rose Cuff

“The next witness to be called is Rose Cuff” [four minutes at the top of the hour].

“I sincerely declare” …

She is trained in brief therapy and occupational therapy.

1995 is where she began her work with children and families.

The parent has a mental illness - in particular she was part fo the development of

Strategy of FPHNE - 2007.

She is the Statewide Co-ordinator.

Blueberry Centre - integrated practice research centre in La Trobe University.

Her role is: “oversee implementation of the programme across the adult mental health services and partners in Victoria”. [6 minutes at the top of the hour]

Separately she is a voluntary holder of Satellite Foundation.

NGO organisation - voice and creative space for children and young people who have a mentally ill parents or parents.

It exists in adult mental health too - Rose explains:

it is an endeavour supported by the State Government to identify the parents as they go through the service - employment and mental health services of senior commissions - experience and shape the way services are shaped - how parents children and family members interact.

A powerful preventative opportunity - parents and children identified more routinely so there is less risk.

1: identification
2: validation
3: comprehensive assistance through understanding. [eight minutes at the top of the hour]

Strength and Vulnerability Framework versus a risk/deficit one.

A large number of people are seeking service, Cuff says. When children are involved it becomes very risk-oriented/orientated.

Children are necessarily at a risk [it is thought so].

Satellite tries to understand a more balanced view and passes it on to the services involved.

Upskilling the workforce through conversational work.

Strengthen support and resources - responding to risk when necessary. Services do need to know!

The co-ordinators support key support programmes for young people [like key worker types?]

Specific programmes young people can attend and participate in.

Targeted services for primary school children; teenagers and parents. Bringing children and parents together - bringing it into that family.

Hard to talk about within families and communities - children in particular struggle to understand.

Connected to other young people and children and then reach out to community supports which they connect with. [eleven minutes at the top of the hour].

IMPACT: is not a linear thing.

It is a bi-directional impact - nature; episodic?; developmental ages and stages of children

Should be viewed in a systemic whole-family way.

The impact - extremely traumatic for families to experience mental illness in a family member.

High rates of separation; divorce; family breakdown - especially if it is later-onset and happens when they are a parent.

Children can struggle to understand what is happening to their family - statistically they are at risk of significant mental health issues - twice as likely - without intervention / support.

Reducing the risk with early intervention.

Risk of cumulative harm - not always. [I think of a set of rocks and water].

Day-to-day parenting without adequately supported - no access to the things that young people need to help and develop.

Effective early intervention - explain this further - there aren’t easy-to-access programmes to assist.

For C and YP if you have a family with MI - C struggle with Issues - they don’t qualify for those three programmes - there is nothing.

Ongoing services - schools are very well provided - falling through the gaps - primary-school age children. 

The perinatal period too [peri- and post-natal depression].

Flying under the radar - becoming invisible.

Children become carers for many reasons.

  1. A term which is used extensively in the service system - I wonder if many people relate to it. They don’t see themselves - they see themselves DOING THE WORK. IN the absence of any other adult - single parent. Taking on the roles of cooking and shopping; paying bills; giving medication
  2. Because they have just always done it - normal? second nature? Rose has talked to many children who do extensive amounts of work and they miss school - nothing is wrong with this - ordinary children doing extraordinary things
  3. An absence of other social support and networks - invisiblilty is a big experience here. A “code of silence” - parents are very chary and fearful of reaching out for support for fear of judgement - THE BIGGEST BARRIER to help-seeking

Yes, help seeking is a big barrier for the children. It looks like there is food in the cupboard - there may not be.

This is the way children protect their parents. Reluctant to speak up with schools and with friends.

[schools and friends find out anyway].

And Rose talks about cultural backgrounds.
  1. Cultural families and norms - how caring is perceived within - caring for/caring about. Step up and it is just done in some families.
  2. Cultural background is enormously significant. When we talk about mental illness and cultural roles - the language is often very different - seek a listening and timerich space which is not currently in the Victorian system.
How it is understood and experienced by different

Mental illness is not often a term used by families. [twenty minutes at the top of the hour]

ATSI families would not talk about this - they don’t use the word - they speak their own language and terminologies - emotional wellbeing might be one of them.

Does it have the same family or YP understanding?

Talk about things that resonates with the family, not just with you lot [Satellite/Blueberry].

How is the system of support operating? Do they want or need support - what might that look like in the community?

Main challenges: struggling to go to school and access to school-based services.

Access to services for young children - many families are struggling with multiple challenges - running a car - public transport - parents interaction

Children benefit form social interaction - those are immensely challenging for parents. Young people and children don’t get to those things - those important social places tat provide protective factors.

Paid-for transport or community support. They can’t even volunteer transport - not legal for children to travel by themselves.

[What about Uber; Lyft and so on - it’s legal in SanFran and positively encouraged].

They miss out on not just education and work - friendships and social connections.

More at risk of being bullied for not getting to school or doing other things that children think children do.

Ostracised by their peers - looking different the parents.

Many stories of children finding school very lonely.

Children in caring roles experience a wide range of emotions like concern and anxiety.

Resentment and anger are big ones too - losing out on being different - peers and people.

Where do they take these things?

If a parent - if you can accept they can take on responsibility through the home - they feel valued in the role.

If a parent is receiving treatment in a intake facility - creates conflict within the family.

No way of that being communicated - service which can facilitated conversations around parental and child family roles. [twenty-five minutes into the hour]

Hopes and dreams for the future - [foreshortened future? moratorium?] Isolation doesn’t hope or dream it seems. You become used to managing things on your own.

Their trajectory is one of their parent perhaps not recovering - how do we discuss recovery and recovery-oriented approaches?

The sense of hopelessness - they wouldn’t go on to achieve in their own right or make friends.

They might not be able to leave their families - and feel or be like their parents.

You inherit this thing - it is a very common fear. Uncertainty about the future.

FAPMI - and Satellite.

Really working to improve the way that mental health services and respond and work with parents in the adult system.

Equip services + clinicians with conversation and the whole family. The parent comes into the service and they feel welcomed and less judged and discriminated against.

Mechanism are set up early on. Consultation and training and role-modelling with the conversations of the clinician and parent and child sometimes.

Satellite: fill a gap that harnesses the potential and strength and resources of young people and individuate and realise their hopes and dreams and do the things children and young people need to do.

Art and creativity taps into and gives them a voice. Children’s voices get lost in this narrative - they are hard to be heard and invisible.

In peer support - people get heard and seen and listened to.

The programmes aren’t routinely available across the whole state - some under FAPMI - not implemented state-wide as yet.

CHANCE programme was developed in the 1990s? 2000s? 8-12 year olds who have parents with mental illness - key component - peer support facilitated space for children to come together with a psychoeducation component.

They learn about self-care and self-compassion and share stories and have fun.

The programme has a parent component now because of a review. The children come in as the same time as their families [grandparnets; families; uncles; aunts; parents].

Much more open communication where they come home - most of the conversations are at home and within the family.

SPACE for US is for 13-18 year olds. A similar core aim have teenagers meet other teenagers.

Peer leader - young person with Lived Experience - co-lead the programme - they talk about their story.

Holiday programmes and a camp - after school-programmes of 8 weeks.

Schiz - Supporting Kids in Primary Schools - mental health promotion - not currently running because of funding - goes into primary schools 5 and 6 - teachers and parents and a person with Lived Experience and a young carer.

Spectrum of mental health - things children might notice - equip teachers - be more attuned to a student to whom this is happening. Children were able to approach teacheers.

MY.SPOT is a new online intervention - proof of concept stage - online 6-week programme for young adults 18-25 years. It runs online and has different topics each week with a chat facility.

Purpose of my spot - seeing they’re not alone - they have a core of “we’re not alone”/“you’re not responsible for your parents’ mental illness”/“there’s information you can get about what’s happening to you and your family”.

Programmes that might not be happening at present - routine identification [thirty-four minutes at the bottom of the hour]

Rose Cuff’s key message - Endeavour program - system change takes time.

Be on the look out to understand vulnerable parents - important to take time to engage with vulnerable parents and children - break that cycle of intergenerational trauma and vulnerability.

Planned respite used to be readily available - this idea is of key planning.

Families do bushfire plans. Family caring not so much! Everyone contributes to that care plan - children are part of it - they know very well what to do and attuned to the warning signs.

Going to stay with a family member; case manager; family meeting.

Less reactive; less crisis-driven. Stretched and reactive is the system at the moment.

Act early; plan better.

A lot of stigma around respite - it should be a strength - a parent made a decision to put things into place when they need to be put into place.

The next area she speaks of: potential area of change - clear access to services

When we talk about services - spaces and places in between which are not available for children young people and families.

“It takes a village”. Where do young people and children go? Where do they go to get information? How do they get practical support? Like shopping and cleaning.

Not just online support - younger children have a voice here and their families too.

Improving the online supports and Kids’ Helpline is not targeted enough for young carers - Rose encourages people to ring KH - could be enhanced.

Comes up in evidence - universal messages of recovery and possibility for children.

The fragmentation of the system in earlier statements - if we have community public health messages where people go routinely and they are up for these conversations with children and families about wellbeing.

Through to where there is serious and recurring - so many elephants in the room. Getting messages to young people - it’s OK to talk about it

Wherever you go you can talk about it.

Thank you RC.

Questions from the Commissioners

This one is about “powerful recollections” about challenges and resilience and determination and love - how do you navigate the triage system?

Adults coach others in how to use the right language. What is the advocacy involved that young people can access? Their families?

Rose Cuff: it should be part of the work at every level. C and YP in the Families should have consent and supported these skills of how to navigate systems. Taught how to get the right language for the right help.

Independent Mental Health Advocacy services - coaching not to be afraid and to take on those skills.

This is part of the Mental Health Act!

It can be quite confronting - maybe they feel they’re too young - maybe it’s the only way a young person can have agency.

The Family Health programme can advocate and support.

That would be good to have an advanced statement. [forty-three minutes at the bottom of the hour]

[There is a lot of rain and I cannot hear so well - I turned up the two bars].

May asked these questions and Rose can be excused.

There is morning break.

I think Jesse Morgan will be next and I will get his file up. During the break I will read the Cuff file.

I think witnesses also speak for 35 minutes and then there are questions that Commissioners may ask.

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