Mary Lagaay - What happens in the long term? A qualitative investigation into the long-term experiences of mothers who completed the "POCAR" intervention for Substance Misuse

1. ‘Parenting Our Children, Addressing Risk’
The long-term experiences of women following
completion of the ‘POCAR’ intervention for
maternal substance misuse.
Mary Lagaay
5th
September 2013

2. Parenting Our Children, Addressing Risk
(‘POCAR’)
• Multi-agency intervention for substance misusing mothers
• Referrals from social services
• Intensive 16-week psychosocial programme
• Crèche available to enable access to services
• Between 2006-2011:
- 40% of mothers whose children were living in foster/kinship care had their children returned
to them following completion of POCAR
- 95% of mothers whose children were living at home at the start of the programme still had
their children living with them following completion of POCAR

3. Research questions
• How do women experience their recovery from substance misuse
following completion of the POCAR programme?
- What do they experience as barriers or challenges to sustaining
change in relation to their substance misuse, child protection and
parenting?
- What do they experience as helpful to their recovery?

4. Methodology
• Qualitative investigation: 9 semi-structured, face-to-face, depth interviews.
• Followed up a sample of mothers who completed the POCAR programme between approx. 1-3 years
ago, assessed as suitable to remain living with their children, or have them returned to their care.
• Aimed to recruit two groups of women with different long-term outcomes:
- Group 1: remained living with their children who no longer required a Child Protection Plan
- Group 2: no longer living with their children or children still required a Child Protection Plan
• Used topic guide containing open-ended questions related to long-term experiences of recovery, the
POCAR programme and Social Services.
• Participants identified using information recorded in client files and following discussions with staff at
the Brighton Oasis Project.

5. The final sample
• The final sample consisted of 9 mothers…
• 4 mothers who remained living with their children in the long term, whose
children no longer required a Child Protection Plan.
• 2 mothers who continued to live with their children, however, they continued to
require a Child Protection Plan.
• 3 mothers who did not live with their children in the long-term.
• Interviews recorded and transcribed, thematic analysis conducted.

6. The final sample
Name Substance
misuse
Child/children’s status at
start of POCAR
programme
(CPP = Child Protection
Plan)
Child/children’s status at end of
POCAR programme
Time since
completed
POCAR
(approx.)
Child/children’s status at point of long-term follow up
Julia Heroin,
crack
CPP in place, remained in
mothers care
Remained with mother
(CPP still in place)
3 years Remained with mother, CPP no longer required
Alice Alcohol,
cannabis
No CPP required,
remained in mothers care
Remained with mother 1 year Remained with mother
Danny Alcohol No CPP required,
remained in mothers care
Remained with mother 1.5 years Remained with mother
Lucy Alcohol CPP in place, removed
from mothers care, living
with father / aunt
Not returned to mothers care at end
of programme, but returned at a later
date following mothers attendance at
residential rehab
2.5 years Remained with mother, CPP no longer required
Bryony Heroin CPP in place, remained in
mothers care
Remained in mothers care
(CPP still in place)
1 year Remained in mothers care, CPP still in place
Sandra Alcohol,
cannabis
CPP in place, removed
from mothers care, living
in foster placement
Returned to mothers care
(CPP still in place)
1 year Remained in mothers care, CPP still in place
Katie Heroin CPP in place, removed
from mothers care, living
in foster placement
Not returned to mothers care at end
of programme, but plans for return in
place
1 year Never returned to mothers care: plans for reunification withdrawn
due to mother re-establishing a relationship with a violent partner.
Currently having supervised contact. Mother’s relationship with
partner now ended. Awaiting a final court hearing on whether child
will be returned to mothers care
Nancy Alcohol CPP in place, removed
from mothers care, living
with father
Returned to mothers care
(CPP still in place)
2 years Recently removed from mothers care due to the revelation of an
extended period of relapse, now living with father long-term,
contact with mother every other weekend.
Maria Alcohol CPP in place, removed
from mothers care, living
with father
Unsupervised contact / shared
custody agreed at end of programme.
2 years Child not currently having contact with mother following mothers
relapse during unsupervised contact. Currently living with father.

7. Ethics
• Details of local support services provided at the end of each interview.
• Full ethical clearance obtained from the Board of Trustees at Brighton Oasis
Project and the London School of Economics Ethics Committee prior to the
research taking place.
• Confidentiality and anonymity of participants was guaranteed (names
changed/identifying factors removed).
• All participants fully briefed on research aims and asked to sign an informed
consent form prior to research taking place.

8. Findings: contextual information
• A history of entrenched substance misuse.
• Multi-faceted, complex problems surrounding substance
misuse.
“Pre my daughter, lots and lots of drugs, lots and lots of alcohol, lots of
smoking, lots of self destructiveness, death, people dying on me, being
raped, being beaten up, just, things like that.” (Alice)

9. Motivation
• Fears of having children removed.
• Motherhood: a ‘window of opportunity’ / ‘turning point.’
Interviewer: What would you say motivated you [to attend]?
Alice: Umm, having my child taken away from me!

10. Relationships with services
• Initial relationship with Social Services challenging, feelings of
coercion into attending the programme.
Julia: I was made to come here my Social Services, because me and my
boyfriend was on heroin…it was only when Social Services made me
come here. But I wanted to come anyway, to keep my child. So it wasn’t
that they ‘made’ me come, but I had to come, it wasn’t a choice.

11. Relationships with services
• Avoidance of help due to fear of social services involvement.
Nancy: I guess, I could have asked for help beforehand, but, there’s that
whole Social Services thing, that they just don’t help, it’s just that
whole fear of ‘well, they’ll just take them away’ and so what’s the
point, so I’ll sort it out, I’ll sort it out, I’ll sort it out, you know.

12. Relationships with services
• Relationships with Social Services remain adversarial, despite
acceptance of why they had intervened.
Katie: Everyone’s on my side except for the social worker….I understand
because they are doing their job.
Danny: But he was really, really nice. Because I was like ‘ah social worker!
Oh no!’ But he was really, really supportive, and I didn’t feel that I was
sort of being threatened with anything at all. It was a pleasant surprise
really, a relief!

13. Relationships with services
• POCAR programme played a mediating role within the
interagency work taking place.
• ‘Policing’ aspect of social work buffered by an external agency.
Sandra: … the reason I carried on coming and not walking is because it
was the only place that, if I turned up three or four times a week, at
least people whose opinion would be respected by the Local Authority
would be able to say, at least on those occasions every week, she turned
up, she was sober, she was sensible, she engaged.

14. Identity and judgement
• Women-only space helpful to recovery.
Nancy: I liked the fact that it was all women…I think that if there had
been men, I would have found it really hard to open up, and I don’t
think I would have felt as safe, I definitely think the dynamic would
have been totally different.

15. Identity and judgement
• A strong awareness of the judgement of others and the stigma
attached to female substance misuse.
Danny: …it made me feel a complete failure, as a mother…It felt like
because I was a woman, I was being singled out, which in a way, made
it worse again.
Lucy: I felt everything. Embarrassment. Shame. Anger. That’s why
women don’t go for help.

16. Identity and judgement
• Damage qualification / damage acceptance.
Lucy:…my children were well taken care of, despite everything. You know,
they went to school every day, they were clean, they were fed, the house
was always clean…everything was normal... I mean people are on
drugs and they’re not taking of the kids, but it wasn’t like that.
Lucy: I feel sorry for him, and it makes me feel guilty. Because he’s the one
that’s seen all the shit over the years. He’s seen me drunk, he’s seen my
try to kill myself, he’s seen all sorts, he’s seen my arms cut up…he’s
seen all that. What can I do? You know, he throws it back in my face a
lot, and I say to him ‘I can’t change it, I can’t’ and I wish I could, for
him.

17. Structure, learning and strategy
• Continuing to have structure within their lives presented as an
important feature of long-term recovery.
• Continuing relationships with Brighton Oasis Project was an
important aspect of long-term recovery e.g. volunteering.
Katie: [volunteering] gives me something to do and I’ve got
structure in my life.
Lucy:…because if I do need someone to talk to. I’ve got people, cos I’m
here doing the volunteering… then you can, like, kind of slowly move
on.

18. Structure, learning and strategy
• Learning: incorporating strategies around relapse prevention
and parenting carried through and utilised into the longer term.
Julia: I did Triple P and it definitely helped, yeah, all that stuff about
setting and learning boundaries and stuff. Because I didn’t know about
being a Mum, and hearing other parents, like, and having key work to
talk about things that were hard. And I still use the Triple P stuff now,
especially the boundaries.

19. Social and cultural networks
• Substance misuse a major part of previous social and cultural
networks.
Julia: the other life, the drug life, with other users.
• Changing this key to long-term recovery.
• Networks often ‘recovery orientated’
Sandra: I built up new friends, some, just naturally straight people,
but quite a lot of people that are like me, some way down the
line.

20. Reintegration
• A desire to be ‘normal,’ get jobs or go to college to:
‘just lead a normal life’ / ‘be part of society again’
• Improved self-confidence and self-esteem continued to be a
barrier into the long-term.
• Reintegration hindered by: having a criminal record when
applying for jobs; lack of qualifications; economic difficulties;
wide availability of alcohol; problems with housing.

21. Limitations
• Trying to separate the experiences of mothers who did remain
with their children in the long-term with mothers who did not,
presented a challenge, as on a number of levels, both groups
reported similar experiences of the support, barriers and
challenges they faced.
• Would benefit from a larger sample / analysis alongside
quantitative data.
• The experiences of women who were not assessed as suitable
to care for their children may paint a very different picture.

22. Conclusions
• Endorses women only services.
• A complex blend of social, cultural, material and community resources
can support or hinder the recovery process for mothers who have
experienced a substance misuse problem.
• Value of multi-agency interventions and a specialist, holistic service for
women.
• Recovery from substance misuse is an individual, continuous journey.
• Recovery capital built and stimulated by POCAR programme.
• Interventions should offer a continuum of support.

23. Background
• Research highlights the widespread exposure of children
and young people to parental substance misuse
250,000 - 350,000 children under 16 have a parent with a serious
drug problem (Hidden Harm ACMD, 2003)
780,000 - 1.3 million children under the age of 16 live with parents
who misuse alcohol (PMSU, 2004).
• Correlation with a range of negative outcomes for children
• A common factor within child protection and care
proceedings

24. Background
• Evidence-base highlights the value of early, intensive, multi-disciplinary interventions
• Whilst evidence is promising, there is currently little available research into the long-term efficacy
of interventions, an important issue given the fragile nature of reunification between neglected
children and their parents

25. Research Aims
• To explore the long-term experiences of mothers
assessed as suitable to remain living with their
children or have them returned to their care
following completion of an intervention for
problematic drug or alcohol misuse.
• Used the POCAR (Parenting Our Children,
Addressing Risk) intervention programme at
Brighton Oasis Project as a case study.

26. Brighton Oasis Project
• Delivers services to women, children and young
people affected by drug and alcohol misuse in
Brighton and Hove:
women-only approach, recognising issues faced by
women who misuse substances and barriers accessing
treatment in male dominated services
Crèche for the children of all women accessing the
service, as lack of childcare a significant barrier to
women accessing treatment

27. A qualitative research strategy
• Allowed the opportunity for an exploratory, flexible, in-depth focus on women’s
experiences
• Fitted the research aim of understanding women’s experiences by providing the
opportunity to investigate ‘through their own eyes.’
• Allowed an emphasis on gaining contextual understanding of social behaviour and
on investigating recovery as a process: important for this research in terms of
understanding what might help/hinder such a process for mothers.
• Weakness: generalizability is not possible, as findings are only representative of the
experience of some women specific to the POCAR programme. However, generation
of theory from the findings could be built and a sampling frame could be developed
through further research, with the aim of achieving theoretical saturation allowing
for greater generalizability.
• In an ideal world: this would be a mixed methods strategy involving quantitative
analysis of variables and a control/comparison group alongside qualitative
investigation.