Sunflower Garden Project - Edinburgh

The pilot project provides a child-focused service working with children aged from birth to end of primary school who are affected by drug use. The service receives referrals from midwives, health visitors, social workers, schools, drugs services, children’s services, Working Together, GPs, clients of Simpson House Drugs Counselling Service and self referrals. Where appropriate initial home visits (or appropriate venue) are undertaken as part of the assessment process. Children are at the centre of this process, with their welfare being paramount and their input / views being actively sought. The service offers interventions including: infant massage, one to one work, children’s groups (ages 4 to 6, 7 to 10 and 10 to 12). The service works with parents, carers and grandparents using counselling, groups and a drop-in to support and assist the child-focused work. A crèche facility is also provided. Parent and child work was recently added and play therapy and family therapy is being developed along with working with pregnant mothers. The project will continue (2006/2009) to develop using learning from the pilot and undertake work with children affected by alcohol use. The project is and will continue to uphold all the “principles” and “characteristics” outlined by the Initiative.

The Action Team for Alcohol and Drugs in Edinburgh has identified a range of local priorities.

These priorities address the needs of “priority groups” in the city. The work of the Sunflower Garden Project clearly demonstrates a willingness and expertise base to tackle these priorities for action.

The Corporate Action Plan 2005/2006 for Edinburgh identifies a range of national priorities which must be addressed at a local level which fit with the Sunflower Garden

The Sunflower Garden Project plans are in accordance with the City of Edinburgh Council Children’s Services Plan 2001 – 2004. The plan is currently being updated. When the revised plan is updated any additions will be incorporated into the project plan.

Description of project

INTRODUCTION: Who will you work with? What area will the service cover?

The overall aim is to continue the project after the pilot period (2003/06) by providing a child-focused service working with children aged from birth to end of primary school age who are affected by substance use. The project will also work with parents, carers, grandparents and families in a variety of ways but all with the aim of impacting positively on children’s’ lives. The service is offered to people throughout the geographical area covered by both Edinburgh City local authority and Action on Alcohol and Drugs in Edinburgh.

Where is the project located?

The project is based at Simpson House, 52 Queen Street and shares facilities with Simpson House Drugs Counselling Service and Rankeillor Initiative (support/outreach substance misuse service). The Sunflower Garden Project occupies the lower ground floor and comprises of an art room, group room, crèche facility, counselling room, kitchen, toilets and child friendly courtyard. The project has an administration office on the 2 nd floor and the use of meeting rooms. The project seeks to deliver the service in other parts of Edinburgh to bring the service nearer to clients and also because there is a shortage of space to increase client numbers / sessions. It needs to be appreciated that whilst some clients would prefer a venue in their locality, other clients value the anonymity that a city centre venue offers. The project has secured appropriate space on a Friday afternoon in the Haymarket area to provide additional one to one sessions when most Edinburgh schools are on a half-day. Discussions have been ongoing with the Harbour Project in terms of running groups in different localities. A suitable venue in Broomhouse has been identified and others are being sought.

What exactly will the project do?

The service will continue to draw referrals from midwives, health visitors, social workers, schools, drugs services, children’s services, Working Together, GPs, clients of Simpson House Drugs Counselling Service and self referrals. Where appropriate initial home visits (or appropriate venue) are undertaken as part of the assessment process. Children are at the centre of this process, with their welfare being paramount and their input / views being actively sought. The service also makes an assessment of the carer / parent / family so as to support the child more fully. Partnership work with families has developed and the service will offer interventions including: infant massage, one to one sessions and children’s groups (ages 4 to 6, 7 to 10 and 10 to 12). The service will work with parents, carers and grandparents using counselling, groups and a drop-in (for grandparents) to support and assist the child-focussed work. A crèche facility is also provided. Parent and child work will be further developed along with play therapy, art therapy, family therapy and work with pregnant mothers. All packages for children and families will be tailor made within this menu of activities taking account of often-complex situations for the child and their families. The project actively seeks the involvement of other agencies when compiling a package for children and their families.

AIM

OUTCOMES

ACTIVITIES

Packages will be reviewed at least every six weeks involving the child, carer, referrer and other parties e.g. another service supporting the child or the school. The project has worked to create an environment where children move through and out of the service. The project will continue to strike a balance between providing long term, intensive contact with children / families and keeping contact for the sake of it. Clear goals are recorded at the initial assessment stage and at reviews. The project can offer the opportunity for children / families to make use of different aspects of the service at different times and then to signpost, refer and introduce / accompany them to different services. The project works to provide a safe, secure space with “stillness” for children / families whilst encouraging a sense of movement toward achieving their goals and potential.

Transport:

Transport is integral to most aspects of the service. Children attending one to one sessions and groups are offered a taxi from school / home and back again. To ensure safety and economy, children will be escorted and share taxis with other children. Volunteers are used to support this work and this will be developed further to recruit, induct and train a team of drivers using their own cars whilst upholding the strictest levels of safety. With the use of volunteer escorts the project can make greater use of public transport. Where possible, carers are encouraged to take responsibility for getting their child to and from the project. In reality, carers find it a challenge to undertake this. Infants and carers attending infant massage tend to manage to arrange their own travel but taxis are offered here also, particularly at the early stages of contact. Children attending the crèche facility where their carers are engaged in counselling undertake their own travel arrangements except in exceptional circumstances.

Several incidents have occurred where children being returned home have had to be taken to an alternative address because their primary carer was not able to look after them in that moment. Escorts have proved vital in ensuring children’s safety in these cases.

Infant massage: “ the quality of early care can have long lasting effects”.

Touch techniques are taught to parents / carers sensitively and appropriately depending on the baby’s response. Some babies may only tolerate still or containing touch at first. Massage itself usually begins with feet and legs and is built up gradually to include tummy, chest, arms, face and back. Some gentle stretching movements are included, and songs and games which babies begin to recognise and enjoy. Benefits include: reduction of stress levels for infant and carer. Infant Massage helps to soothe, comfort and relax, improve sleep patterns, relieve colic, constipation and improve physical well being, help the caregiver understand the baby better, improve confidence in handling and help attachment and bonding. Infant massage generally only continues until an infant starts to roll and crawl, however at the project contact has been maintained beyond this stage if it was assessed that a carer / child did not have and / or could not access further appropriate support. The project has been developing antenatal work with mothers. Dialogue has been ongoing with the Homeless Outreach Practice, Space 44, the maternity unit at the RIE hospital and local midwives. Engaging with this client group will be challenging and organised, efficient partnership work will be essential.

Crèche / play facility: “more than child care”.

The service is provided for children whose parents are using the Simpson House Drugs Counselling Service and for any parents, carers and grandparents who are using the Sunflower Garden Project facilities. The crèche / play facility has a high staff to child ratio so each child can receive one to one attention with a variety of play materials and activities. E.g. sand play or reading to a child. All members of the crèche team are able to work with children and babies Each child is an individual, and we are able to provide the right toys for their age group and level of development. The crèche is a bright, happy and friendly environment that provides another medium to meet with children and their carers in a relaxed atmosphere. The crèche is able to provide appropriate facilities so that carers feel happy leaving their child. The crèche runs on Mondays 11.30 – 4.30pm and Wednesdays from 9.30 – 12.30pm. Children can attend the crèche for up to three hours providing a carer with enough time to attend counselling or a group and “get some space”. The crèche /play facility is run by a part time Project Worker (SNEB trained) and two dedicated volunteers. The crèche is in the process of being registered with the Care Commission.

One to one sessions: “children need a safe space to be able to express themselves”.

We have developed this service in response to referrals for children who are not ready or able to talk about their experiences, feelings, and thoughts in groups. They may be going through particularly difficult times in their family and need immediate support or be too young for established group work. The service for children has principles which include the need for children to have a safe space to be able to talk or express how their parent’s drug use is affecting them, to be free them from guilt or dispel myths that children may have about drug use or the reasons for it happening to them. A big part of our work is also to give children space to be children (freeing them from caring responsibilities) and to have fun! Through recognition of research that shows that drug use is often a ‘secret’ in the home and that they are not to talk about it, we always ensure the drug use is openly acknowledged between the child and their parents before work commences. This is to ensure that children feel more able to talk freely about issues to workers without experiencing feelings of guilt or betrayal to their parents. The project recognises that a big part of many children’s experiences is the ‘emotional hurt’ that they experience when living with parents who use drugs. Children interviewed in research studies often say that this hurt is due to the feeling that parents are often ‘not there for them’. As a consequence many children can experience feelings of low self-esteem and lack of confidence in themselves. We provide a space for children where there is someone who is available for children to talk about their concerns, work through difficult issues, help with feelings of anger and guilt, and provide accurate information in a fun, secure place. We strive to help children regain confidence in themselves, develop their self-esteem, help them identify coping strategies as well as help develop their resilience. Some of the ways that we will help children do this, in individual work, is by the use of play, music, art and life story work. One to one sessions are not time limited but with regular reviews work only continues if appropriate and there is an identified need.

Children’s Groups: “safe, confidential, supportive therapeutic space”.

Groups provide a space to develop the self-esteem, resilience and coping strategies of children. It is essential that parents support their children’s involvement in the work of the group. The issues and ideas raised by the children are incorporated into the structure of the group. Groups aim to enable children to identify and express their feelings through focused group work, develop strategies for managing concerns and worries, learn methods for relaxation, establish options for children to use at times of crisis, provide information relevant to their needs and understanding, develop social skills, receive / provide support from / to children in similar situations and have some good fun. Children have been seen to “move on” in a number of ways including:

Parent and child work / family therapy:

From the projects experiences it became apparent that a therapeutic intervention was required to facilitate communication and promote healthy relationships between parents and children. It was also necessary to promote positive change in the home environment for children, especially those children attending one to one sessions or a group. A negative, unsupportive home life could reverse any positive work undertaken at the Sunflower Garden Project. The crossover between substance misuse, parenting, and the care and development of children requires a holistic response. In some cases constructive communication had broken down along with a dis-functional downward spiral that permeates every layer of family life. Parent and child work has focussed on developing communication between parent and child especially through the use of play. For many parents the simply act of play was very challenging with them feeling self conscious and “silly”. Services for the family, grandparents and carers are approached in a manner that encourages partnership between children and families. The project looks to develop therapeutic work with families.

Counselling and grandparents group / drop-in:

Counselling for carers either using drugs or affected by drug use is available through Simpson House Drugs Counselling Service. This service is supported by the crèche / play facility described above. Grandparents have become a key feature at the Sunflower Garden Project where their grandchildren are affected by the drug use of a parent, carer or family member. The group meets for support and advice, and is characterised by a genuine camaraderie between group members. So successful and enthusiastic was the original group that five grandparents became volunteers and helped set up and run a twice-weekly drop-in for other grandparents in a similar situation.

Rationale: Lessons learnt – 2003 to 2005

The project was initially developed in 2002 because clients attending Simpson House Drugs Counselling Service would often link their difficulties as adults with things that had occurred during their childhood. Furthermore, clients often explained that they had witnessed their parents / carers / family problematic drug and alcohol use with all of the consequences attached. At this time research was talking about “intergenerational substance use” and the Sunflower Garden Project was launched to work with children affected by drug use. The approach was very pragmatic and logical that by working with children affected by drug use then an outcome would be to deter / defer future drug use and therefore break the intergenerational cycle, thereby providing children with the ability to change the learned behaviour that they had experienced from their care givers.

As the project looks to continue from 2006 to 2009 the basic motivation is the same but the full complexity of family circumstances is more fully appreciated. The project will continue to be child focussed but will pursue partnership working with carers and families with greater vigour. For the service to create a greater opportunity for children to choice a more healthy / positive life path then the home, school and community environment must form part of that change too. There is great value in working with children to create a safe therapeutic space to allow them to share and express thoughts, emotions and incidents. Children can develop greater self-esteem and enhance resilience but if a child then returns to an environment away from the project that lacks, support and encouragement, - then the process is hugely undermined.

The project draws on recent research and examples of best practice as referred to in the literary review attached. The project also refers to books such as: Substance Misuse and Child Care (edited by Harbin & Murphy), Parental Substance Misuse and Child Welfare (written by Kroll and Taylor), Effective Ways of Working with Children and their Families (edited by Malcolm Hill).

Assessment is paramount to ensure that children and families are provided with the package of support and therapy required. The range of interventions (menu) offered by the project and access / links with other related services makes such provision possible. This is important as different mediums and approaches appeal and suit different children and families. The review of progress along with line management & clinical supervision and liaison with other services will assist in keeping packages “on track” and reaching positive outcomes. child focussed but allied with the childs whole. This has lead the project to see how many children we are working with as more important that the number of appointments / group sessions. Sometimes remaining in contact with a child and family has to be seen as an achievement whilst there are other times when intensive work with a child and family can take place.

The project has been successful in referring children onto other services when appropriate and engaging in joint work. This has been particularly successful with primary schools. The kinds of services / activities that children have moved onto have included: after school clubs, breakfast clubs, befriending services, young peoples services, other children’s services if more appropriate and summer clubs. Most groups have been co-facilitated with other agencies and we have formal partnership agreements with projects including – the Harbour Project, Shelter Families Project, Edinburgh Young Carers’ Project. We are currently arranging a three-way meeting between Aberlour Outreach, Harbour and Sunflower Garden.

There has been a high incidence of cases where children have either been either on the “at risk” register or we have referred children to social work with child protection concerns. This has involved considerable work in sharing information, writing reports, attending meetings and working to maintain relationships with families.

Challenges & Risks:

The project is in a strong position because it has ran for 3 years and had the opportunity to work through some of the teething problems around setting up a new service. The team are in place along with the systems required to operate. The challenges & risks (and excitement) come from the direct work with children and families. The thrust of the next three years can focus solely of providing an effective, efficient, monitored and evaluated child focused service. A selection of challenges and solutions are listed:-

Challenges & Risks

Approaches & Solutions

Engaging with parents and babies for infant massage

Persevering / building on the work already established

Engaging mothers in antenatal work

Continuing to build links with related services. Becoming part of the “booking-in” process with maternity services. Working with CDPS.

Engaging with carers, parents, families to assist children

Use an “open-door” approach to build trust and purpose for meaningful engagement.

Fine tuning assessment process

Team approach, training, practice meetings.

Recruiting further volunteers

Use website, volunteer fair, publications (eg EKE Out)

Demonstrating effective, efficient practice

Rigorous monitoring & evaluation process.

Sunflower Garden Project Team:

The team will be multi-disciplinary and draw on the strengths and expertise of staff, volunteers and students alike. Glenn Liddall is the overall manager with responsibility for both Simpson House Drugs Counselling Service and the Sunflower Garden Project. Autumn 2005 will see the establishment of a third distinct project that will deliver diploma level training in counselling / play therapy with children and young people. This will benefit the Sunflower Garden Project with the provision of additional training for staff / volunteers and the supply of students on placement. This course will be accredited by Middlesex University. The Senior Project Worker will continue to manage the service on a day-to-day level. There is a structure of meetings and supervision that shape and directs the service and supports the team. Ongoing training and development of PQA’s, management certificate, supervision and art therapy is planned .