The Lighthouse Foundation & Connections Uniting Care Home for Mothers and Babies Program Brief

Date: 20th August 2009

Lighthouse Home for Mothers and Babies Program

The Lighthouse Home for Mothers and Babies Program was developed in response to the needs of pregnant young women who have lived within Lighthouse Therapeutic Family Model of Care over the years, and the needs of young homeless mothers and their infants in the community, to have access to a program that could assist in their transition into motherhood, and provide infants the opportunity to build a healthy attachment with their mothers, which is vital for the healthy development of the child.

The program has been collaboratively designed with the input of the young people at Lighthouse Foundation, Lighthouse Care Services team, and Connections Uniting Care. Lighthouse is currently unable to provide support to young mother’s in the current model of care, but has identified that young mothers and their infants are the most vulnerable in the community, and that Lighthouse needs to play a significant role in developing programs that can cater for this vulnerable group, as a preventative model of care, that can break the cycle of child maltreatment and in turn homelessness.

A research project conducted on young homeless pregnant women by Keys (2007) highlighted the following:

The Lighthouse Mother and Baby program aims to meet some of the service gaps and recommendations identified in the research by Keys (2007). These include:

Housing, accommodation & support

• Young pregnant and parenting women relate best to youth services and SAAP youth services should provide targeted accommodation and support to this population
• A youth friendly response for this group must respond to both their relationship with their birth family and their new role as a parent
• Medium or long term outreach support should be available for vulnerable young mothers leaving crisis or medium term SAAP accommodation
• Social support is as crucial to positive outcomes as practical assistance such as shelter; reducing social isolation should be core business for homelessness services working with young mothers
• Pregnancy, birth and early motherhood should be recognized as key points for investigating the possibility of family re-connection with appropriate assistance provided to deal with unresolved issues in order to maximize the possibility of successful long-term connection
• New ways to assist young mothers to purchase and/or maintain a car or otherwise increase mobility should be investigated including the provision of dedicated brokerage dollars not linked to education and employment
• Volunteer mentoring and peer-support and leadership programs, managed by paid staff should be more available

Children & parenting

• Services accommodating and supporting young mothers need resources to respond to the needs of accompanying children, including the provision of children’s workers and access to therapeutic programs for children
• Children should be fully acknowledged as clients in their own right and their case management should be funded and counted towards agency targets.
• Working with young mothers requires a non-judgmental approach that demonstrates confidence in the young woman’s ability

Health & wellbeing

• Greater awareness of postnatal depression should be fostered in the youth
• homelessness service sector
• Young mothers who have given up substance use during pregnancy need proactive, systematic outreach follow-up in the first year after birth, when relapse often occurs.
• Appropriate training in recognizing intimate partner violence and dealing with disclosure should be provided for all workers in SAAP services, Maternal and Child Health Services and specialist services for young mothers
• Young mothers sit uneasily between the health and homelessness sectors. There is room for improved collaboration between maternity hospitals, especially those with young mothers clinics, to facilitate knowledge sharing around practice and effective referrals.
• SAAP services, Maternal and Child Health Services and other community services, including specialist services for young mothers, should develop closer working relationships and existing innovative ways of working together should be more widely adopted.

Education, training & employment

• In the early years of motherhood mothering commonly takes priority; support to re-engage with education, training or employment should take this into account.
• Flexible models of education and training should be developed for young mothers through cross sector collaboration. Such models may comprise some modules available off-campus, in association with SAAP or other services and include a mentoring component

The Young mother’s who would access the program, would predominantly come from a background of long term neglect and abuse, are at risk of homelessness and may have a history of complex issues such as mental illness, substance abuse, self harming, suicide risk, poor education, limited life and social skills and difficulties with maintaining and building healthy relationships. As such without intensive care and support, they may pose a risk to themselves and to their babies in a period that is vital in the development of the infant.

"Protecting children is everyone's responsibility"

Description of partner agency

Connections is a community welfare agency of the Uniting Church’s Uniting Care network in Australia, supporting people in need and empowering them to live more fulfilling lives as valued members of the community. Our services respond to the needs of children, young people, families, couples and individuals throughout Melbourne’s eastern and southern suburbs. In undertaking this work we prioritise the rights of children and young people, to be protected against all forms of harm, abuse and exploitation.

Starting Out is a program run by Connections, and was established in 1992, specialising in the provision of individual and group-based support services for young parents (25 years and younger) and their children. Services are provided in an outreach/in-home capacity in addition to office-based programs in Ringwood. The multidisciplinary staff team includes professional backgrounds in social work, nursing/midwifery and maternal and child health, early childhood, and community welfare amongst others. The core elements of the program are funded through the Department of Human Services’ Integrated Family Services (IFS) and Support Accommodation and Assistance Program (SAAP) funding streams.

Description of project

Aims of the project

The pilot project is aimed at developing a model of supported accommodation for young women who are pregnant or parenting infants, and who are homeless or at risk of homelessness. Research conducted by Connections and Lighthouse indicated that there are few, if any, programs in Australia offering medium and long term supported accommodation to young women that provide a focus of support for the young mother while simultaneously providing an environment of enrichment and stability to enhance the development, across all domains, of the infant.

Safety, security, stability and optimal opportunity for the mother/child dyad are the basis on which the pilot is based, with a holistic and flexible service delivery that addresses:

• child development needs
• parenting skill development
• independent living skills
• risk factors for both infants and mothers
• community connectedness
• emotional and physical wellbeing

The program has an early intervention focus. We aim to support mothers and their babies during a critical transitional period, the transition into motherhood. This is a time of massive change for young women, and for those who are homeless the levels of risk can be greater. The program aims to support the most vulnerable in our community, with the view to breaking the cycle of child maltreatment and future homelessness. By providing a safe and caring environment, and strong community supports, the mother and their infant have the opportunity to build a secure attachment, which is the foundation for a healthy individual. We hope to provide mother’s an environment in which they can provide their own children the opportunities that may have missed out on when they were children. This can potentially break the cycle of child maltreatment and future homelessness.

Target Group

The project’s target group will be young women aged 15 - 22 years, who are at risk of homelessness, who are pregnant or who are parenting infants at the time of moving into the property.

Theoretical underpinnings of the Program

The program incorporates attachment theory which is fundamental to the Lighthouse Therapeutic Family Model of Care. The home will be called a Lighthouse home, and the residents will be part of the lighthouse ‘family’.

Key features of the Lighthouse Therapeutic Family Model of Care have been shaped by:

Attachment Theory which describes the biological and psychological need to bond with and relate to primary caregivers as fundamental to the survival of human beings. The ability to trust and to relate to others is established in infancy to early childhood through the quality of the infant/primary care giver relationship which influences and shapes development and behaviour in later life.
(Bowlby 1969; Becker-Wediman & Shell 2005; Bretherton 2007; Hardy 2007; Sonkin 2005)

Object Relations Theory which suggests that a prime motivational drive in every individual is to form relationships with others. The style of relationship that develops in early childhood becomes part of an internal blueprint or a learned way of relating to others that is replicated when we establish and maintain future relationships, which impact on our sense of identity (Dockar-Drysdale 1991; Scharff & Scharff 1991; Winnicott 1953). Young people from a deprived background may have difficulty in forming and maintaining constructive and healthy relationships with others. The more traumatic their early experience the more self-destructive some of their interpersonal relationships can be.

The Home

The home will accommodate two young women and their babies, with a third short-stay option. This will provide safe, supported accommodation for young women who can learn and be supported to parent effectively. The home will provide a stable home-like atmosphere for young women for whom the provision of stable, supported accommodation will enable them to learn the skills and develop the relationship required for them to move with their children into alternative ongoing independent accommodation.

Support Services

The Natural Setting (In home): The residents will be supported in the home by live in carers, who are available 24 hours a day to support the mother and infants in the home. The carers act as parenting role models for the young mother, but also provide practical advice and support around parenting and life skills development. They also provide the opportunity for the mother to have some respite.

Psychological Wellness: The young mothers in the program will have access to a team of psychologists who provide psycho-therapeutic and psycho-educational support. The Mother’s will receive attachment based psychotherapy, as well as skill based support to assist in them in developing emotional resilience and practical skills required to be a healthy mother. This will strengthen the mother’s capacity to meet the needs of the infant.

Case Management: Young mothers in the program will commit to participate in an Individual Development Plan. The Individual Development Plan is a mutual agreement of care between the young mother and the Lighthouse Foundation. The program provides a holistic approach to case management that covers the areas of education, employment, life management, recreational, relationships, physical wellbeing, psychological wellbeing, spiritual wellbeing, and emotional and psychological wellbeing.

The case management program will also assist the mothers and their children in their transition into independent living, which will include support with applications for housing and developing other supports that may be required when living independently. This may affordable private or public housing. They will also have access to an aftercare program through the Lighthouse Outreach Program, that can assist with mothers and children with the necessary support required for independent living.

Volunteer Services: The support provided by volunteers to each Lighthouse home is a critical component of this community based model of family care. This assistance can take a number of forms and includes raising funds to meet specific residential needs, mentoring, maintenance work, transportation and other types of support.

Community Committee: The home will have a Community Committee that is comprised of 8 to 10 members of the local community that volunteer their time to support the home. The committee plays an active role in helping the mothers and infants feel connected to their local community. The committee have partly a fundraising role for the home, as well as providing specific supports that are required for the home. The committee becomes part of the extended family of the residents, and are the link to the wider community. Discussions with members of the community have yielded great interest from local identities who would like to contribute to supporting the home.

Uniting Care Connections Starting Out Program: The residents will have access to a multidisciplinary team of professionals through the Starting Out Program, that can provide intensive specialist support with linkages into services, and access to parenting programs, Maternal and Child Health Nurses, mother’s groups, general health, and other services that are vital for the emotional and physical wellbeing of the mother and baby.

Duration

The pilot project will run for two years. Ideally the same client group will remain for the length of the pilot. The model will support young women and infants to remain in the home for two years. As the first two years of infant development are vital for the development for a healthy attachment bond between the mother and infant, and allows for the infant to move through important developmental milestones that will set a foundation for them to develop into healthy children.

Evaluation

The evaluation process will involve an independent external evaluation of the project, as well as an internal evaluation. The Lighthouse Foundation has partnerships with Victoria University, Monash University, and Australian Catholic University that can assist with the external evaluation of the program.

Lighthouse Foundation and Connections will jointly support an internal evaluation, to be undertaken in collaboration between the Lighthouse Psychological Wellness Team, and Connections Organisational Development Unit, with a reference group comprising of representatives of both agencies.

The internal evaluation will begin with the commencement of the project’s implementation, to enable an action research model to be used. This model will allow new information from ongoing evaluation to be incorporated into the model in a timely manner, and the effect of these adjustments to be further evaluated. The model also allows staff and service users to contribute actively to the research as participants, optimising the value of their input into the final evaluation.

The newly developed Lighthouse Foundation “On For Life Research Database”, has the ability to provide relevant data regarding the progress of all young people in Lighthouse programs.
Outcomes to be measured include;

• Physical health of mother and child (e.g. general overall health markers)
• Community supports accessed (e.g. how many community supports are accessed)
• Mental health (e.g. stabilisation of symptoms and coping mechanisms)
• Social measures (e.g. Social supports developed)
• Infant development milestones (monitor MCHN assessments of child development)
• Mother and baby attachment (attachment status of mother to child)
• Infant mental health

References

Becker-Weidman, A. & Shell, D. (2005). Creating capacity for attachment, Oklahoma City: Wood and Barnes.

Bowlby, J. (1969). Attachment, London: PIMLICO.

Bretherton, I. (1997). Bowlby’s legacy to developmental psychology. Child Psychiatry and Human Development, 28(1), 33-43

Docker-Drysdale, B. (1991). The provision of primary experience, London: Aronson.

Hardy, L.T. (2007). Attachment theory and reactive attachment disorder. Theoretical perspectives and treatment implications. Journal of Child and Adolescent Psychiatric Nursing, 20 (1). 27-39

Houlihan, L. & Drill, S. (2009, July 26). Angels’ Law. The Herald Sun, p. 6.

Keys, D. (2007). Opportunity for change: Young mothers and homelessness, Melbourne: University of Melbourne

McMillan, D.W., & Chavis, D.M. (1986). Sense of community: A definition and theory. Journal of Community Psychology, 14, 6-23.

Prilleltensky, I & Nelson, G. (2000). Promoting child and family wellness: Priorities for psychological and social interventions. Journal of Community Psychology, 10. 85-105

Sonkin, D.J (2005). Attachment Theory and Psychotherapy. The Therapist,

Sharff, D. & Sharff, J.S. (1991). Oxford: Rowman and Littlefield

Winnicott, D. (1953). Transitional objects and transitional phenomena, International Journal of Psychoanalysis, 34: 89-97