The International Journal of Psychosocial Rehabilitation

The Clubhouse Family Legal Support Project:
 A Framework for Replication and Development

 
Stephanie Hartwell, PhD
Associate Professor and Graduate Program Director
Department of Sociology
UMass Boston
100 Morrissey Blvd.
Boston, MA 02125-3393

 
Laura Watts, MA 
Applied Sociology
UMass Boston



Citation:
Hartwell S & Watts L. (2010). The Clubhouse Family Legal Support Project: A Framework
 for Replication and Development
. International Journal of Psychosocial Rehabilitation. Vol 15(1) 19-23




Abstract
This report highlights the Clubhouse Family Legal Support Project (CFLSP) that provides support and resources to parents with psychiatric disabilities facing legal barriers to participation in the parenting role.  The purpose is to describe the program and its potential for and barriers to expansion.  Two months of intensive observation in civil court and interviews with key program practitioners were conducted culminating with the presented logic model and case examples.  Taken together, both articulate the program framework and the complex custody issues experienced by parents with psychiatric disabilities.  Taken together both and provide an initial framework for program replication and future development. 

Key Words: parents with psychiatric disabilities, legal barriers, custody, logic model




Introduction
Over the last decade there has been a trend toward an increased restriction of familial rights, including marriage and parenting, for individuals with psychiatric disabilities (Hemmens, Miller, Burton, & Milner 2002).  Yet women and men with psychiatric disabilities are likely to be parents (Nicholson & Biebel, 2002).  Research on parents with psychiatric disabilities describes difficulties in managing: (1) the stigma of psychiatric disabilities; (2) day-to-day parenting; (3) psychiatric symptoms; and (4) contact or custody issues (Nicholson et al., 1998).  Park and Solomon (2006) report that mothers with psychiatric disabilities are three-times more likely than other parents to be involved with child welfare agencies and resultant out-of-home placements.  Parents with psychiatric disabilities are at a greater risk of losing custody of their children due to beliefs that they are inadequate parents (Jacobsen, 1998).  

Current research is beginning to question the perception that having a psychiatric disability is incompatible with parenting and is delineating models to aide and support the parenting role (see for example Hinden et al., 2006).  The Clubhouse Family Legal Support Project (CFLSP) is a statewide program in Massachusetts that provides legal representation, support and advice to low-income parents with psychiatric disabilities at risk of losing custody and/or all contact with their children.  The program was created through collaboration between Employment Options, Inc., and the Mental Health Legal Advisory Committee (MHLAC) and funded by the Department of Mental Health (DMH) and Massachusetts and Boston Bar Associations.  

While it seems to make sense that parents with psychiatric disabilities need support and services to manage their psychiatric illness and parenting role, existing services are sparse (Brunette, 2002; Park & Solomon, 2006).  Guided by the principal that relevant service interventions can improve parenting skills, the CFLSP has anecdotally demonstrated that integrated legal services have a positive impact on the preservation of families and parenting roles (Nemens & Nicholson, 2006).  This report builds an evidence base (Nicholson et al., 2007) for program replication and development by identifying the program’s logic model (Appendix A) and providing examples of actual parents served.    

Methods
Ethnographic methods including family/civil court observations, unstructured and informal qualitative interviewing, and record reviews were used to craft representative case examples and identify the program logic model to highlight variables for program evaluation, replication and development.  This study was approved by the University of Massachusetts Boston Institutional Review Board.
 
Findings
The CFLSP began in 1999 with the Employment Options, Inc. strategic planning committee’s recognition of the need for legal consultation, representation, education, and advocacy for parents with psychiatric disabilities involved with their Options Clubhouse.  The Options Clubhouse is one of more than 30 community-based psychiatric rehabilitation programs in Massachusetts that provides individuals the opportunity to participate in meaningful work and social relationships.   The non-profit organization is also at the forefront of providing a continuum of Family Initiatives programs for custodial and non-custodial parents that combine adult and child supports as well as legal services via the CFLSP.  

The target population of the CFLSP is low-income or indigent parents with psychiatric disabilities at risk of losing custody and/or all contact with their children.  Referrals are made to the CFLSP program via outreach to the Department of Mental Health (DMH), Department of Children and Families (DCF), bar associations, legal services and private bars, judges, courts, and community clubhouses across the state.  Staff lawyers visit clubhouses monthly to educate staff and clubhouse members about CFLSP services.  During these visits they compile client intake lists.  Finally, MHLAC has an intake referral phone line that can direct individuals to the CFLSP.

The CFLSP project staff includes 2 full-time lawyers who serve clients across Massachusetts.    From September 2008 through August 2009 the CFLSP opened 42 cases—20 “brief service” and 22 “full service.”  During that same timeframe the program closed 40 cases – 18 “brief service” and 22 “full service” for a total of 63 clients served during the year.  Brief service cases are triaged with service information and brief advice.  Full service cases include parent representation in substantive areas including divorce with custody and visitation features, custody and visitation for unmarried parents, and, to a lesser extent, guardianship and child support cases.  The legal processes for full cases include motion sessions, case management conferences, status conferences, pre-trial conferences, settlement negotiations, and trial.  The content of each case involves brokering, including explaining to parents, arrangements of court orders regarding custody and visitation as well as assuring the parent’s perspective is represented as a part of the court decision-making processes (see Appendix A).

The CFLSP integrates the principles of the legal system and public mental health services to protect the rights of parents with psychiatric disabilities.  Specifically, the program assures just legal representation within the framework of an accessible service with the goal of increasing self-sufficiency and psychiatric rehabilitation potential.  However, the program confronts parent and program barriers (see the Logic Model in Appendix A).  Parents with psychiatric disabilities are a diverse group with varying health and legal problems, cultural and religious beliefs, and resources.  The two examples below illustrate this and are representative of CFLSP full service cases.  Sixty-five percent of the full service cases (65%) are female and 35% are male.  Most involve increasing visitation for non-custodial parents with multiple complicating factors including employment, substance abuse, transportation, and housing problems.
 
Example One
Parent is in her mid thirties and has been diagnosed with bipolar and substance abuse disorders and major depression.  She has three children; a teenage son from a previous relationship and two young daughters ages six and eight.  She has part-time custody of her son and was reduced to supervised visits with her daughters after a suicide attempt.  She was referred to the CFLSP by a clinician who called legal aide on her behalf.  She believes her mental health issues have been “used against her” in court.  She is currently living in a homeless shelter because she was asked to leave her mother’s nursing home where she was living previously due to age restrictions.  Before going into court, the lawyer from the CFLSP informs the mother of the best and worst case scenarios of going before the judge and concludes by encouraging the mother that she has demonstrated everything she was suppose to including participating in daily dialectic behavioral therapy.  The CFLSP lawyer also advises the mother that their goal is to demonstrate to the court that both parents can “cooperatively parent” and have a “history of decision making that is in the best interest of the children.”  When they go before the judge for a status modification, the CFLSP lawyer informs the judge that the mother has been in treatment for more than 10 months,  continues more than 6 months of supervised visits with her children, and that she has been a consistently “loving and appropriate” parent.  The mother tells the judge, she’d like unsupervised visitation, but knows she needs a place to live.  The judge responds, “You could be living out of the back seat of a car and still be an appropriate parent.”  The judge grants unsupervised visits, but for limited increments of time so the mother can “ease into it” and adjust to unsupervised time with her daughters.

Example Two
This father is in his thirties and was recently diagnosed with Bipolar Disorder.  He has a history of incarceration and alcohol and drug abuse but has been sober 4.5 years.  He was born congenitally deaf and communicates solely by American Sign Language (ASL).  He  is seeking visitation with his children (six and eight years old).  Because neither child ‘speaks’ sign language, an interpreter must be available to translate when the father visits with them.  Currently the father’s ex-wife both supervises and interprets for the visit.  The father is seeking both the discontinuation of his ex-wife supervising visits and a transition towards unsupervised visits with an alternative interpreter.  In a lobby conference with legal counsel and the Judge, the Judge stated ‘nothing in the Guardian Ad Litem report indicates client is unfit to be with kids.’  The Judge advised counsel that both parties move towards a slow integration of unsupervised visits and that both attorneys ‘work out their client’s problems or go to trial’.  The CFLSP lawyer explained to the father what occurred in lobby conference adding the judge’s statement that ‘if the client does not maintain medication and treatment compliance’, he (the judge) will move for swift and severe consequences regarding the parent’s visitation.  A trial date was set, prior to which, both the father and his ex-wife were ordered to go to ‘Conciliation’, which is non-binding mediation.  

Barriers
CFLSP program development barriers include limited funds for program evaluation and personnel.  Additionally, the program has had difficulty identifying point persons (or boundary spanners) to coordinate and broker services across multiple agencies – clubhouses, legal services, child and parent services (Steadman, 1992).  Other program barriers include the lack of client eligibility criterion, a screening process, or a protocol for triaging brief and full service cases.  Finally, because the program is statewide, increasing increased attention should be paid to the diversity of referral sources, resources, and clubhouse populations.  A logic model was created (see Appendix A) that integrates the theory behind the program and its core features.  The model articulates program variables (intervention, outcomes, and barriers) relative to representing parents (clients) and future program development.
 


Conclusions
Parents with psychiatric disabilities are at risk of losing custody and contact with their children because they lack representation in the family court system.  Persons with psychiatric disabilities who are parents have identified the loss of contact with their children as a barrier to successful rehabilitation (Nicholson & Biebel, 2002).  Thus, legal representation is a critical issue for both parents with psychiatric disabilities and psychiatric rehabilitation.  The CFLSP attempts to assure the rights of parents with psychiatric disabilities are represented in the judicial system.  This report highlights features of the CFLSP, and the parents the program represents, as well as the barriers to achieving the promise of the program for the preservation of the parenting role for parents with psychiatric disabilities involved with the legal system.  


References
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Evenson, R. J., & Simon, R. W. (2005). Clarifying the Relationship between Parenthood and Depression Journal of Health and Social Behavior, 46(4), 341-358.

Haskett, M., Scott, S., Willoughby, M., Ahern, L., Nears, K. (2006). The Parent Opinion Questionnaire and Child Vignettes for Use with Abusive Parents: Assessment of Psychometric Properties. Journal of Family Violence, 21(2), 137-151.

Hemmens, C., Miller, M., Burton Jr., V. S., & Milner, S. (2002). The Consequences of Official Labels: An Examination of the Rights Lost by the Mentally Ill and Mentally Incompetent Ten Years Later. . Community Mental Health Journal, 38(2 ), 129-140.

Hinden, B., Biebel, K., Nicholson, J., Henry, A., Katz-Leavy, J. (2006). A Survey of Programs for Parents with Mental Illness and their Familes: Identifying Common Elements to Build the Evidence Base. The Journal of Behavioral Health Services & Research, 33(1), 21-38.

Jacobsen, T., & Miller, L. T. (1998). Mentally ill mothers who have killed: three cases addressing the issue of future parenting capability. Psychiatric Services, 49(5), 650-657.

Leventhal, A., Jacobsen, T., Miller, L., & Quintana, E. (2004). Caregiving attitudes and at-risk maternal behavior among mothers with major mental illness. Psychiatric Services, 55(12 ), 1431-1433.

Nemens, K., & Nicholson, J. (2006). The Clubhouse Family Legal Support Project for Parents With Mental Illness. Psychiatric Services, 57(5), 720-720.

Nicholson, J., & Biebel, K. (2002). Commentary on “Community Mental Health Care for Women with Severe Mental Illness Who Are Parents”-The Tragedy of Missed Opportunities: What Providers Can Do. . Community Mental Health Journal, 38(2), 167-172.

Nicholson, J., Hinden, B. R., Biebel, K., Henry, A. D., & Katz-Leavy, J. J. (2007). A Qualitative Study of Programs for Parents with Serious Mental Illness and Their Children: Building Practice-Based Evidence. Journal of Behavioral Health Services & Research, 34(4), 395-413.

Nicholson, J., Sweeney, E. M., & Geller, J. L. (1998). Mothers with mental illness: I. The competing demands of parenting and living with mental illness. Psychiatric Services, 49(5), 635-642.
Park, J. M., Solomon, P., & Mandell, D. S. (2006). Involvement in the Child Welfare System Among Mothers With Serious Mental Illness. Psychiatric Services, 57(4), 493-497.

Simon, R. (2008). The Joys of Parenthood, Reconsidered. Contexts, 7(2), 40-45.

Steadman, J. (1992). Boundary Spanners: A Key Component for the Effective Interactions of the Justice and Mental Health Systems. Law and Human Behavior, 16(1), 75-87.

Websites

http://www.employmentoptions.org/family_legal.htm

http://www.mass.gov/mhlac/






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