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Family- Centered Treatment for Women with Substance Use
DisordersColumbus, 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 Family Centered Treatment Papers
Family-Centered Treatment for Women with Substance Use Disorders: History, Key Elements
and Challenges
Funding Family-Centered Treatment for Women with Substance Use Disorders
and NiaTX Family Engagement Process Change Initiative
Family-Based Service Providers and Families in Recovery
Public Health Approach
Problem 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 … what does it mean today?
Family NetworksFamily Networks
children’s fathers
significant others & partners
step-sisters/ brothers
half-sibling
children
aunts
godparents
grandparents
supportive long-term friends
step-parents
siblings
spouse
parents
Families are complex
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.
FamiliesFamilies
Edith Schaeffer provides an analogy between a family 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 Prevalence of Substance Abuse in Families with Childrenin 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).
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.
InterInter--Generational Cycle of Generational Cycle of Substance AbuseSubstance Abuse
Alcoholism and addiction have long 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-Centered Approach 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.)
So Why Change?
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)
A Continuum of Family-Centered Services
Continuum of Family ServicesContinuum of Family Services
Individually focused, no meaningful consideration of family
Level 0
Continuum of Family ServicesContinuum of Family Services
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family
Level 1
Continuum of Family ServicesContinuum of Family Services
Programs for woman with child care, parent education and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family
Level 2
Continuum of Family ServicesContinuum of Family Services
Programs for women and their children
Programs for woman with child care, parent education and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family
Level 3
Continuum of Family ServicesContinuum of Family Services
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 groups
Individually focused, no meaningful consideration of family
Level 4
Continuum of Family ServicesContinuum of Family Services
Family-based treatment
Programs for women and their children
Programs for woman with child care, parent education and periodic family sessions
Family considered in treatment planning, family groups
Individually focused, no meaningful consideration of family
Level 5
Programs for women and children; some services for immediate family
Continuum of Family-Based Services
Components of Family-Centered Treatment
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 Services
FOR WOMEN Outreach and engagement Continuing care Screening Pharmocotherapies Drug monitoring Treatment planning mental health
services Detoxification Medical Care and Services Assessment Trauma Informed and Trauma-
Specific Services Case Management Substance Abuse Counseling and
Education Crisis Intervention
FOR CHILDREN Intake Screening Medical Care and Services Therapeutic Child Care Development Services Mental Health and Trauma
Services Assessment Residential Care in Residential
Settings Case Management Substance Abuse Education &
Prevention Care Planning
Clinical Support ServicesFOR WOMEN
Life skills Advocacy Primary health care services Family programs Parenting and child development
education Housing support Education remediation and
support Employment readiness services Linkages with legal system and
child welfare systems Recovery community support
services Life skills
FOR CHILDREN
Primary health care services Onsite or healthy child care Recovery community support
services Advocacy Educational services Recreational services Prevention services Mental health and remediation
services
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
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.
Woman Responsive 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
Culturally Relevant Treatment
Deborah Werner 2006
Components of Family-Centered Treatment
Identifying Family
Factors to Consider Household Relationships of children Blood Emergency responders Historical family Lifetime relationships
Family as she defines them. Women often need support and tools to identify who to involve, and how much. Sometimes women and theirchildren have different families.
Who is the Family?Who is the Family?
children’s fathers –want no contact
Celia – old girlfriend/partner and co-parent of
children
Mother, married to man who molested.
Michael age 7 with behavioral problems.
Elderly Auntie Cheryl Stable. Does not trust niece.
Long lost God Parent
Parents Susan and Kyle –periodically raising children. Angry and skeptical.
Skeptical siblings
Actively using spouse
Partner, concerned but
feels abandoned
Families are complex
Best friend from high school, 2 years sober with 2 jobs and 3 kids
Baby in fostercare
John, I met him at the AA meeting last Thursday
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: a NIATx 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 Family Members
Counseling Individual Family Relationship-based Couples
Parenting Education Coaching Holidays, Recreation &
Leisure
Groups Family Education Parenting Support Multi-Family Significant Persons Special Topics
Reunification SupportWrap aroundCase Management/
Community Support
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
Michael W. Smith
Transformation in the
world happens when
people are healed and
start investing in other
people.
Thank You.
Deborah Werner
Advocates for Human Potential, Inc.
PO Box 267 * Topanga, CA 90290
818/999-6985
