# Presentation: 580856

## Nurturing Program for Families in Substance Abuse Treatment and Recovery

***Nurturing Program for Families in Substance Abuse Treatment and Recovery***

***Norma Finkelstein, Ph.D.******Beth Marron, LCSW***

## Background
And
Development

***Background***
***And***
***Development***

## Coalition on Addiction,
Pregnancy and Parenting

CSAP Demonstration Project
1989 - 1994

**Coalition on Addiction,**
**Pregnancy and Parenting**
**CSAP Demonstration Project**
**1989 - 1994**

## Two Residential Women’s Substance Abuse Treatment Programs

***Two Residential Women’s Substance Abuse Treatment Programs***

## Goal:

**Goal:**

## Nurturing Program
For Parents Of Children
Birth To Five Years Old

Stephen Bavolek, Ph.D.

***Nurturing Program***
***For Parents Of Children***
***Birth To Five Years Old***
**Stephen Bavolek, Ph.D.**

## Well Known & Documented
Aimed At Reducing Child Abuse & Neglect
Evaluation Instrument - AAPI
Core Domains:
Appropriate Developmental Expectations 
Empathy
Alternatives To Corporal Punishment
Appropriate Roles

**Well Known & Documented**
**Aimed At Reducing Child Abuse & Neglect**
**Evaluation Instrument - AAPI**
**Core Domains:**
**Appropriate Developmental Expectations **
**Empathy**
**Alternatives To Corporal Punishment**
**Appropriate Roles**

***Rationale***

##  Demonstration Project Adaptations

** *****Demonstration****** ******Project Adaptations***

**Substantial Additional Information on Substance Abuse**
**Increase Focus on Empathy**
**Add Material on Self-Empathy & Mutuality - Relationship Building**
**Add Material Focused on Nurturing the Parent**
**Create Activities Calling for More Active            Participation**

## Summary of Outcomes 

***Summary of Outcomes***

**Program A**
**Statistically significant improvement on all 4 domains measured *****(Inappropriate expectations, lack of empathy, corporal punishment, and role reversal)***
**Program B**
**Statistically significant improvement in *****lack of empathy and role reversal***
**Increased scores in *****inappropriate expectations and corporal punishment***

## Relapse Risk Reduction

***Relapse Risk Reduction***

**Follow Up on Women Who Left Treatment**
**Survival Analysis on Relapse Rates:**
**Completion of Nurturing Program Related to Longer Lengths of Abstinence**
**Average Time to Relapse = 14.7 months for Completers vs. 9.4 Months for Non Completers**

## Publication of the Nurturing Program for Families 
In Substance Abuse Treatment and Recovery

**Publication of the *****Nurturing Program for Families ***
***In Substance Abuse Treatment and Recovery***

## Childhood Experiences
Parental Substance Abuse
Physical / Sexual Abuse
Shame & Guilt
Inadequate Self-Care Skills
Physical / Mental Health
Recognize & Manage Emotions
Calming, Self-Soothing

**Childhood Experiences**
**Parental Substance Abuse**
**Physical / Sexual Abuse**
**Shame & Guilt**
**Inadequate Self-Care Skills**
**Physical / Mental Health**
**Recognize & Manage Emotions**
**Calming, Self-Soothing**

-  ***Incorporates Understanding of Factors Related to Substance Abuse Which Affect Parent-Child Relationship***

## The Relational- Cultural Model

***The Relational- Cultural Model***

**Women’s Sense of  Self  is Organized Around Making and Maintaining Affiliations**
**Stresses Development Through Connections**
**Connections - Fundamental to Psychological Growth and Healing**

## Basic Principles

***Basic Principles***

**Nurture the Parent**
**Parenting is a Relationship Within a Family**
**Not Solely a Set of Skills**
**Maintain Nurturing Program**
**Domains:  Appropriate Developmental Expectations, Empathy, Alternatives to Corporal Punishment, Appropriate Roles**

## Nurturing the Parent

***Nurturing the Parent***

**Providing Structure**
**Encouraging Growth**
**Physical, Mental & Spiritual Nourishment**
**Create Opportunities to Build Connectedness**
**Create A Safe Place for Self-Exploration & Building Self-Awareness**
**Participation**
**Creativity and Fun**

## Responds To...

***Responds To...***

**Array of Learning Styles**
**Literacy**
**Multiple Intelligences**
**Exploration of Cultural Heritage**
**Providing Opportunities to Explore & Appreciate Both Own Heritage & Heritage of Other Participants**

## 

Nurturing Program 

Description

***Nurturing Program***** **
**Description**

## Format

***Format***

_**18 Sessions; 90 minutes each**_
**Each Session:**
**Information for Group Facilitator**
**Begins With Ice Breaker**
**Closes With Wrap-Up**
**Many Sessions - Additional Material on Issues or Concerns That May Come Up During That Session**

## Topics

***Topics***

## Hope

***Hope***

**Hope Tree**
**Exploring Cultural Values**
**Ritual Related to New Life & New Beginnings**

## Exploring Cultural Values and Rituals

***Exploring Cultural ******Values and Rituals***

**Description of Cultural Background**
**Ways Your Culture Celebrates New Beginnings**

## Growth and Trust

***Growth and Trust***

**Themes and Tasks of Human Development**
**Emphasis on  Development of Recovery and Parenting**

## Families

***Families***

**Diverse Forms of Families**
**Biases Faced by Families**
**Effects of Substance Abuse & Recovery on Families**

## Feelings

***Feelings***

**Explore Ways of Identifying and Expressing Feelings for Parents and Children**

## Self-Esteem

***Self-Esteem***

**Making Connections**
**Communication**
**Problem Solving**
**Body Talk**
**What Babies Teach Us**

## Building Structure

***Building Structure***

**Managing Stress**
**Setting Boundaries**
**Schedules and Routines**
**Safety**

## Guiding Behavior

***Guiding Behavior***

**Self-Calming**
**Time-Out**
**Re-Direction**

## Knowing Our Values

***Knowing Our Values***

**Exploration of Cultural Values**
**Value Game**

## Recovery: Love & Loss

***Recovery: Love & Loss***

**Losses Experienced Through Substance Abuse**
**Process of Grieving**
**Ways of Supporting Adults and Children in Grief**
**Loss Exercise**

## Having Fun

***Having****** ******Fun***

**Importance of Play in Recovery and Family Life**
**Play Party and Celebration**

## Statewide Dissemination

***Statewide Dissemination***

**2 statewide trainings per year (free for treatment program staff)**
**Parent-Child Specialists co-facilitate groups and provide supervision and technical assistance to publicly funded treatment programs statewide**

## National Dissemination

***National Dissemination***

**IHR Parent-Child Specialists provide training on the *****Nurturing Program***** to programs and sites as requested**
**Two full days of training is provided, utilizing a combination of didactic and interactive activities**

## Other Study Sites (which have shown positive results)

***Other Study Sites****** ******(which have shown positive results)***

**University of Miami**
**Sstarbirth, Rhode Island**
**Strengthening Solano Families**
**HART House, Tewksbury, MA**
**Harvard Street Neighborhood Health Center, Roxbury, MA**

## States Where Nurturing Program Replicated

***States Where Nurturing Program Replicated***

**34 states **
**3 Canadian provinces**

##  Participant Evaluations

** *****Participant Evaluations***

_**Family Relationships and Parenting**_**:**
- “Most of what I learned had to do with ways I thought I _**should**_ parent and that there really is no _**rulebook**_ or _**manual**_ to being a good parent.  I also spent time learning about my child’s boundaries.”
- “I’ve learned a lot of new ways to discipline, comfort, nurture, trust, love, care.”
- “[I’ve learned] patience with my children; to think on their level.”
- “I have learned that my child will learn different skills on her own time and not mine, and that I need to be patient and loving and supportive no matter what.”
- “I don’t yell as much; I use time-out instead of hitting.”
- “I don’t have to yell or get stressed out with my kids.  I have ways to relate.”

## Strengthening Recovery:

I learned:
“How to have fun as a clean and sober person, how to recognize certain 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, and feel comfortable with it.”
“How to handle many of life’s every day issues and problems.”
“What nurturing is, how to nurture and care for myself as well as others; that I am a truly worthwhile human being who deserves safety, respect and happiness.”
“To take the initiative in my recovery.”

_**Strengthening Recovery**_**:**
**I learned:**
- “How to have fun as a clean and sober person, how to recognize certain 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, and feel comfortable with it.”
- “How to handle many of life’s every day issues and problems.”
- “What nurturing is, how to nurture and care for myself as well as others; that I am a truly worthwhile human being who deserves safety, respect and happiness.”
- “To take the initiative in my recovery.”

## Adaptations

***Adaptations***

**Nurturing Families Affected by Substance Abuse, Mental Illness and Trauma**
**Twelve Session Program (designed for outpatient programs)**
**60 vs 90 minute-session Format **
**Building Family Recovery**

## Additional Materials

***Additional Materials***

*Family Activities to Nurture Parents and Children*