Family Centered Treatment Ohio 5 19 10 For Printing
Family- Centered Treatment for Women with Substance Use Disorders Columbus, Ohio May 19, 2010 Deborah Werner, MA This presentation is made possible with support from the Substance Abuse and Mental Health Services Administration
Overview Talk about families Talk about women with SUDs Explore a continuum of family-based services Discuss a comprehensive model of family-centered services
Based on SAMHSA FamilyCentered Treatment Papers Family-Centered Treatment for Women withSubstance Use Disorders: History, Key Elements and ChallengesFunding Family-Centered Treatment for Women with Substance Use Disordersand NiaTX Family Engagement Process Change InitiativeFamily-Based Service Providers and Families in Recovery
Public Health ApproachProblem exists when an Agent interacts with a Host in an Environment. Agent Alcohol, methamphetamine, heroin, triggers, etc. Host Individual who is susceptible to a problem. Often surrounded by families. Environment Family, social and community environment including media and peers.
Public Health InterventionsAgents • alcohol policy (formal and informal) • interdiction •Environments • supportive social networks • healthy community messages • • safe, affordable drug-free housing, school, work, recreation • • community support services • community education • reduce stigma •Families • appropriate roles • parenting skills and resources • communication and decision making • support network •Individuals • building protective factors • reducing risk factors • building self efficacy • intervention • treatment of substance use disorders • • treatment of co-occurring problems •
Family Networks parents siblings grandparents spouse godparents supportive long- children’s fathers term friends Families are childrensignificant others complex & partners aunts step-sisters/ brothers half-sibling step-parents
Families Families basis for household economic units provide basis for child-rearing, human interactions, and cultural traditions Most cultures use a collective vision of family. Extended family members are interdependent and work together to raise children, provide for economic needs, and meet family obligations. Families are complex in their definitions, roles, responsibilities, and interactions.
Edith Schaeffer provides an analogy between afamily and a mobile: “Each member is connected to the others through invisible strings. When the wind blows, all parts move individually and harmoniously. Mobiles are delicate. If one piece breaks, if a string is severed or becomes knotted, the whole mobile is affected. Similarly, the actions of one family member affect the entire family.”
Prevalence of Substance Abuse in Families with Children 6 million children under the age of 18 live with at least one alcohol or drug dependent parent (OAS, 2003). 5.5% of women ages 18 to 49 who have one or more children living with them are dependent on alcohol or illicit drugs (OAS, 2005). 70% of women and 50% of men entering substance use treatment report having children (Brady & Ashley, 2005).
Inter-Generational Cycle of Substance Abuse Substance use disorders affect the entire family unit and all the individual members. Parental substance abuse increases the likelihood that a family will experience: financial problems shifting of adult roles onto children child abuse and neglect, inconsistent parenting violence and disrupted environments Children of parents with substance use disorders have a significantly higher likelihood of developing substance use problems themselves.
Alcoholism and addiction havelong been described as a “family disease.” BUT Treatment has remained focused on helping the individual.
Women are often the glue that holds the family together. For women connections – family – is the priority and life motivator. For many women – being a mother is the most important identity. Women often have other family care-taking responsibilities. Women are relational. Supportive relationships are essential.
And yet Women, compared to men, are: More likely to report that their spouse/partners encouraged initial and current drug use and are less likely to pressure them to enter treatment Less likely to report help/support from family or friends More likely to report that family or friends used drugs in the past year (Grella & Joshi, 1999)
Family Centered Treatment Evolution Family-centered treatment for pregnant and parenting mothers with substance use disorders Family-centered treatment for adolescents Family-centered approaches in other service systems (e.g., dependency drug courts, children’s system of care, mental health) Recovery oriented systems of care
Adopting a Family-CenteredApproach Requires a Paradigm Shift
Initial Assumptions Family is important Family members can help and be helped Empowering women can occur while they are in relationships. (Not all women need or want to leave the men in their lives.)
Why Change? Improve outcomes for women Women recover in supportive relationships. Retention improves May leave or not enter treatment without children Builds a support system Improve outcomes for families Children’s needs Family system and family support
OutcomesIndividual outcomes for parent, child and other family members (e.g., changes in substance use, employment, health or mental health status, developmental progress, educational performance, improved resiliency)Relational outcomes for whole families and between members (e.g., parent-child relationship, family stability, attachment, relationship satisfaction, reunification, reduced violence, communication and parenting improvement)System or societal outcomes for the community (cost savings from improved employment, reduced criminal recidivism, improved prenatal and birth outcomes, reduced school problems, future health costs)
Continuum of Family Services Level 0Individually focused, no meaningful consideration of family
Continuum of Family Services Level 1 Family considered in treatment planning, family groupsIndividually focused, no meaningful consideration of family
Continuum of Family Services Level 2 Programs for woman with child care, parent education and periodic family sessions Family considered in treatment planning, family groupsIndividually focused, no meaningful consideration of family
Continuum of Family Services Level 3 Programs for women and their children Programs for woman with child care, parent education and periodic family sessions Family considered in treatment planning, family groupsIndividually focused, no meaningful consideration of family
Continuum of Family Services Level 4 Programs for women and children; some services for immediate family Programs for women and their children Programs for woman with child care, parent education and periodic family sessions Family considered in treatment planning, family groupsIndividually focused, no meaningful consideration of family
Continuum of Family Services Level 5 Family-based treatment Programs for women and children; some services for immediate family Programs for women and their children Programs for woman with child care, parent education and periodic family sessions Family considered in treatment planning, family groupsIndividually focused, no meaningful consideration of family
CSAT Model of Comprehensive Services for Women & Children Components Clinical treatment services for women Clinical support services for women Community support services for women Clinical treatment services for children Clinical support services for children Community support services for children Cultural Competence, Gender Competence and Developmentally Appropriate
Clinical Treatment ServicesFOR WOMEN FOR CHILDREN Outreach and engagement Intake Continuing care Screening Screening Medical Care and Services Pharmocotherapies Therapeutic Child Care Drug monitoring Development Services Treatment planning mental health Mental Health and Trauma services Services Detoxification Assessment Medical Care and Services Residential Care in Residential Assessment Settings Trauma Informed and Trauma- Case Management Specific Services Substance Abuse Education & Case Management Prevention Substance Abuse Counseling and Care Planning Education Crisis Intervention
Clinical Support ServicesFOR WOMEN FOR CHILDREN Life skills Primary health care services Advocacy Onsite or healthy child care Primary health care services Family programs Recovery community support services Parenting and child development education Advocacy Housing support Educational services Education remediation and Recreational services support Employment readiness services Prevention services Linkages with legal system and Mental health and remediation child welfare systems services Recovery community support services Life skills
Community Support Services Transportation Child care Housing services Family strengthening Recovery community support services Employer support services TANF linkages Vocational and academic education services Faith based organization support Recovery management
Woman Responsive Treatment Relational Strength-based, motivational Comprehensive Trauma informed Addresses the different pathways to use, consequences of use, motivation for treatment, treatment issues and relapse prevention needs Provided in an environment in which women feel safe and comfortable.
Culturally Relevant Treatment Cultural competent staff Honors traditions and values Acknowledges cultural pain and racism Builds appropriate efficacy and support Reflective staff, management and Board Respects individuals Differentiates drug culture from culture Helps interested people learn or rekindle cultural traditions Relational Deborah Werner 2006
Identifying Family Factors to Consider Household Relationships of children Blood Emergency responders Historical family Lifetime relationshipsFamily as she defines them. Women often need support and tools toidentify who to involve, and how much. Sometimes women and theirchildren have different families.
Who is the Family? Elderly Auntie Cheryl Stable. Parents Susan Does not trust Partner, and Kyle – niece. concerned but periodically feels abandoned raising children. Actively using Angry and Long lost God spouse skeptical. Parent children’s fathers – want no contact Michael age 7 Families are with behavioral Celia – old complex problems.girlfriend/partnerand co-parent of John, I met him at children the AA meeting last Best friend Thursday from high Baby in school, 2 years fostercare sober with 2 Skeptical siblings Mother, married to jobs and 3 kids man who molested.
Involvement of Children Children are both an incentive and a barrier to participating in treatment Multiple studies have demonstrated that better outcomes are achieved by women who have all of their children with them Children often have their own treatment needs Parenting support allows for improved parenting, esteem and reduced stress
Involvement of Teen/Adult Family Members Family members often have their own service needs Need for engagement – they may not want to participate or change Assessing relationship dynamics, violence, safety and how to counsel members Multiple individuals, with differing treatment plans – priorities and family decision-making Balancing women’s need for identity development and family involvement
Types of Services - Engagement not Involvement Initial Engagement “if you just build it – they won’t come” Conocimiento and Assessment Listening and Respecting Supporting Connection Promoting Healing
When family is engaged: aNIATx view of engagement Tommie Ann Bower, Chief Clinical Officer, Gosnold, Inc.
Addressing Challenging Family Members Violent Children Resistant Children Angry and Cynical Family Members Abusive Family Members Uncommitted Family Members Different Stages of Change
How to Involve Family Members Dynamic – different members may come at different times Requires a new way of looking at clients Collaboration (and funding) across service systems Safety comes First Maintaining cohesive program structure and individualized, family-services
Treatment plans, case plans and action plans Women’s services Children’s services Family member services Parenting support Family and relationship counseling and decision making Community/Recovery support
Elements of Treatment Detoxification and Stabilization (includes pharmacology) Motivation and Engagement Assessment, Placement & Treatment Planning (co-occurring) Skill Building Programming Drug Resistance Skills Avoid Triggers & Cravings Problem Solving Skills Assertiveness Skills Life Style and Support Interpersonal Relationships Replace Drug Activities Safe and Health Environments Family Recovery Case Management Child Welfare Criminal Justice Family Support Housing Community & Recovery Support Economic Needs
Types of Services Services for Individual Groups Family Members Family Education Counseling Parenting Support Individual Family Multi-Family Significant Persons Relationship-based Special Topics Couples Reunification Support Parenting Education Wrap around Coaching Case Management/ Holidays, Recreation & Community Support Leisure Adapted from East Bay Community Recovery Program
Whole Family Approach Celebration/Reconnection Approaches Processing Tools for Families Communication Skills Reducing Stress Burden Mutual Support & Integrated Treatment Plans Mutual Priorities and Community Support Plan Building Family Strengths, Identity and Cohesiveness Holidays, Recreation & Leisure We’re Changing; so much to Change
Managing a Dynamic Program Individualized services Offering an array of services Strength-based, motivational approach Flexibility and collaboration Family members changing Multiple people, multiple treatment plans, multiple agencies Maintaining safety, harmony and community Visible structure and guidelines Diversity and respect
Transformation in the world happens when people are healed and start investing in other people.Michael W. Smith
Thank You. Deborah WernerAdvocates for Human Potential, Inc. PO Box 267 * Topanga, CA 90290 818/999-6985 firstname.lastname@example.org