2.7: Addressing the Substance Abuse Challenges of Homeless Families
Addressing the SubstanceAbuse Challenges of Homeless Families Deborah Werner Advocates for Human Potential, Inc, This presentation is made possible with support from the Substance Abuse and Mental Health Services Administration
Substance Use Abstinence Experimental Use Responsible Use Episodic or Situational Abuse Chronic Abuse Dependence Responsible use = moderate, legal consumption in low-risk settings 2
Not all Use is Addiction Use of Illicit Substances Heavy consumption Binge drinking Poor coping strategy High-Risk Settings Driving under influence While caring for child Episodical/Situational Abuse Common co-occurrence with intimate partner violence Interventions include: education, brief interventions, 3 harm reduction, alternative activities, coping skills
Addiction and Dependency Brain disorder Brain impacted Cravings Tolerance The individual becomes controlled by thesubstance at a cellular level. Use continues despite catastrophic consequences. – Nora Volkow, MD, paraphrased 4
The Substance Use and MentalDisorders Landscape is Changing
Reforms Ensures consumer Allows states the option of protections in the insurance continuing Medicaid market. coverage to former foster care children up to the age Creates immediate options of 25 years old. for people who can’t get insurance today. Ensures free preventive services. Expands health insurance coverage to 32 million Small business owners and Americans. employees will be insured Adds 16 mil with incomes Reduces uncompensated below 133% of the federal care. poverty level to Medicaid.
Impact of Reform & Parity Creates guaranteed access to mental health and substance use disorder services at parity in most major public programs including Medicaid and Qualified Health Plans (QHPs) to cover the uninsured and small businesses. Provides changes to the Medicaid program to continue and expand home and community-based services for individuals with mental health and substance use disorders. Allows state Medicaid programs to establish health homes for those with chronic illnesses. States that seek this option must consult and coordinate with SAMHSA regarding the prevention and treatment of mental illness and substance use disorders among those with chronic illnesses.
Impact of Reform & ParityIncludes mental health and substance use disorder services as essential health benefit services for qualified health plans (QHPs) offered in the state- based exchanges. Provides for grants to community mental health programs for co- locating primary and specialty care. Creates a grant program for school-based health clinics to provide mental health and substance abuse assessments, crisis intervention, counseling, treatment and referrals. Anticipate reductions in residential services over time. Increased need for mental health and substance use treatment agencies to collaborate with housing programs
Whilesubstance use/abuse in and of itself is not child abuse – behaviors associated with substance use/ abuse can put children at significant risk
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 10 substance use problems themselves.
Lessons from the Treatment Field Each family is different and their solutions are unique. Children often have service needs of their own. Developing motivation for recovery is a service not a pre-requisite. Many women with SUDs experienced childhood trauma and/or poor parenting which can significantly effect their relationships with their own children but effective supports and parenting programs are available. Relapse is common. Prognosis/relapse the same as for hypertension or diabetes. Early intervention can end a relapse. 12 Recovery communities have powerful synergy.
Ending the Cycle Accessible Gender-Responsive, Trauma-Informed Behavioral Health Services Children’s Assessments, Developmental Services, Education Comprehensive Services for Families and Family Members An array of safe, affordable housing options Recovery residences Supportive housing Service-enriched housing “mainstream” safe, affordable housing Clean/sober communities Accessible recovery support Opportunities for growth, economic and social well-being 13
We all want to: Help families access supports and resources Strengthen/support families and family members Preserve individual rights and self-determination Support recovery and reduce risks associated with use See children thrive Create wellness focused communities 14
Voluntary/Mandatory Continuum Least restrictive Most restrictiveNo services Service Most Services fall in here. Mandatory Mandatory Housing Coordinator Case Plan Participation Participation only checks in Contracts, agree to attend In Services in all Standard regularly. certain services, contingency Relapse services. lease client management, drug testing, addressed, Removal ifprovisions decides on relapse does not necessarily may result in use alcohol no special service or result in loss of participation discharge /drugs rules objective related to No alcohol or abstinence drugs requirements Where are you? 15The Werner Hartman Group, 2006
Approach Varies Depending on Agency mission, values philosophical framework Availability of collaborative partners and quality community services Funding agency requirements/constraints Individual Family Needs Sense of urgency What works for one family won’t necessarily work for another. Our villages benefit from having an array of options. 16
Program Variations – depending on population, philosophy and options Acknowledging alcohol or drug use may vary depending on policies, legality of use, drug testing policies, client service plan Response to alcohol or drug use may vary by type of use, risk to children, mental health status, resources available, “rules,” perceived risk to other residents, Policies on if or when to evict family when householder is using. Respect parental authority and roles when you see marginal care of children you care about. Focusing on strengths when needs are so visible 17
Resources The Treatment Improvement Exchange http://www.tie.samhsa.gov/ http://womenandchildren.treatment.org/ Homeless Resource Center http://www.homeless.samhsa.gov National Institute on Drug Abuse http://www.drugabuse.gov/ Join Together http://www.jointogether.org/ Werner, D., Young, N.K., Dennis, K, & Amatetti, S.. Family-Centered Treatment for Women with Substance Use Disorders – History, Key Elements and 18 Challenges. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2008.