ship to the rest of the world: It is an empowering and healing process.

diversity in terms of race, ethnicity, age, disability, and sexual orientation serve as role models and mentors; and establishing self-help, job-seeking groups as a support network to help clients deal with the ups and downs of job searches. The power of these groups cannot be overestimated in helping women take the risks involved in finding employment. Working with the local state unemployment office to use its employment network and computers is also useful, as is setting aside time each week for a "resume roundup." During this time women can learn to develop job histories and to translate their life skills into data for their resumes.

It may be possible to have a representative of the local office of the department of labor or a vocational rehabilitation center assigned to the program to assist in vocational assessment and placements at the appropriate time in treatment. A representative of a local department of education and training may be available to evaluate needs, develop appropriate educational plans, and make arrangements for meeting the educational and training needs of clients. In addition, representatives from local financial institutions are often willing to conduct workshops about basic money management-budgeting, paying bills, saving money, and obtaining loans. Another effective approach is to hold training sessions on how to balance checkbooks, secure insurance coverage, find quality medical and child care, and shop wisely.

An example of a woman with economic difficulties presenting for treatment and strategies designed to address those difficulties is shown on the following page.

social and spiritual needs) help the woman to move from a sense of fear, despair, hopelessness and isolation to one of trust and belief; improve her self-knowledge and self-esteem; and empower her to be self-sufficient and interdependent upon completion of treatment. These goals can be an important part of the recovery process.

5.3.5 Retaining Women in Treatment

To retain women in treatment, the most important task is to ensure that the program is gender sensitive and that the broad spectrum of women's bio-psycho-social needs are met. This includes, for example, addressing their physical and mental health, housing, child care, and legal needs. These topics are addressed throughout this manual. Other specific approaches for retaining women in treatment include the following:

· Ensure that, if possible, women have their own "private
space" in the treatment setting. This could be, for example,
a separate recreation room or meeting area;
· Involve partners and family members as appropriate to
enhance women's recovery and reduce sabotage;
· Recognize the reality of women's lives and responsibilities;
· Find ways to help women take control of their own treat
ment so that they become invested in it;
· Help women feel successful as they move from one phase of
treatment to another;
· Provide positive female and male role models; and
· Eliminate barriers to retaining women in treatment that
are identified within the program itself. Feedback from
clients-particularly from those who leave treatment early
can provide useful information to identify such barriers.

5.3.6 Discharge

In the treatment process, the discharge plan is as important as the
initial assessment and treatment plan because this phase serves as a bridge
between the treatment process (whatever the modality of care or duration)
and continuing care. The discharge plan should be prepared before the
woman completes or leaves treatment. The determination about whether a
client is ready for discharge should be made jointly by the client and her
counselor, or with the treatment team, if the program uses such an arrange
ment.

The discharge plan should include the following:

· an evaluation of the woman's progress in treatment, specifically

- her treatment goals and the extent to which they were met;

- reason(s) for discharge;

- summary of successes and problems encountered during treatment; and

- factors that facilitated and/or hindered her progress.

· a discussion of the woman's current status with respect to

- alcohol and other drug use;

- physiological health in general;

- mental health;

- employment;

- living arrangements;

- vocational and educational needs;

- parenting ability and status of her children;

- other emotional support needs; and

- financial support needs.

· a summary of unresolved problems, which may include referrals for

- substance abuse counseling;

- medical and mental health services;

- family therapy, child care, housing, financial and other services; and

-

- sobriety support groups.

The program should make specific arrangements for continued contact with the client, including periodic visits to the program. This will reassure her that there is a "safe place" to visit in times of emotional, psychological, or physical distress and will also facilitate the follow-up process.

5.4 Cultural Sensitivity/Competence

All treatment program components and procedures should be reviewed regularly to ensure that they are culturally sensitive and culturally relevant. This includes outreach, initial contact, intake, the treatment process, discharge, and follow-up. Cultural competence and sensitivity as related to different ethnic and racial groups, age groups, disability groups, and sexual orientations should be reviewed so that appropriate responses can be ensured. For example, during client case presentations made to staff, issues raised by different population groups in treatment should be
discussed. Staff should be trained to avoid discriminatory language and behaviors. Moreover, specific rules should be established and enforced with respect to such language and behavior on the part of clients and staff members.

To help ensure that the clients' culturally specific needs are met,
the program should offer clients the opportunity to attend 12-step or other
self-help meetings that are population-specific (e.g., for women of color or
lesbian women). This could be accomplished through referral, by schedul-
ing regular meetings at the treatment program's location, or by listing these
meetings as part of the program's regular activities.

Examples of strategies that relate to specific populations of women follow. They are grouped within the following categories:

· Age groups (adolescent and older women);

· Ethnic and racial minority group populations; and

· Other specific groups of women.

5.4.1 Age Groups

Adolescents

· Arrange for role models and provide materials specifically

geared to adolescent girls. Identification with appropriate

role models is critical for adolescents to gain hope and to

progress through treatment. It is also helpful to compile a

book that will foster a sense of hope using letters written by

young women in recovery.

· Conduct home assessments and encourage family involve

ment in the treatment process where appropriate. Meet

various persons who are involved in the adolescent's life,

including parents, grandparents, children, partners, other family members, probation or parole officers, social workers, guidance counselors, and teachers. During these meetings, program staff should try to ascertain if there appears to be sexual or physical abuse as well as substance abuse in the family. If possible, visit the young woman's last place of residence and meet the people; this should be done only with the knowledge and consent of the person in treatment.

· Pregnant teenage girls require special support while they are
in treatment to help ensure that they remain in school.
Strategies include day care services and special attention to
nutrition." In addition, girls who became pregnant as a
result of rape also need to receive psychological counseling
while they are in treatment." Provision of services to
address sexual abuse concurrent with treatment for the
client's substance abuse "ensures that the young women are
better able to remain drug and alcohol free." "

· Keep on hand personal care items (e.g., nail and hair care
supplies, stationery, and pens) as incentives or rewards for
the adolescent girls.

Older Women

· Work with appropriate senior service agencies to provide
safe, inexpensive, and accessible transportation options that
bring older clients to the treatment facility for scheduled
treatment activities. This is a critical first step in providing
care to this population. Schedule groups during the hours
that these agencies offer transportation.

· Work with a local senior center or an adult day care center to
arrange for space to hold groups at that facility. Establish a
relationship with the administrative personnel of the local
hospital to arrange for space to hold groups within the
hospital setting. The senior transportation program may
provide regularly scheduled transportation to these locations,
and the scheduling of groups can be coordinated around the
available public and senior transportation schedule.

Help train representatives of health agencies so they can identify older women with substance abuse problems and refer clients to the treatment program for services.

Ensure that the facility (both its entrances and furnishings) is accessible to older clients, including those with physical disabilities and/or sensory losses. For example, deep seats that are low to the ground are difficult for some older people to use.

The physical condition of some older people must be kept in mind. Frail older people bruise easily, their bones may be fragile, and their sense of touch may be diminished. Many older women have osteoporosis and generalized bone loss. For example, what might be a therapeutic hug to a young person could bruise or break the bones of some older women. Hearing and vision problems should also be diagnosed and recognized during individual and group therapy. Because thermoregulation does not occur quickly for some women who are much older, it may be appropriate to encourage some older women to wear sweaters during therapy and education sessions.

For homebound older women, regular telephone therapy groups facilitated by a substance abuse counselor may be an appropriate approach. On a specific day of the week, at a specific time of day, the counselor makes a conference call that may include, for example, three clients and the counselor/facilitator. The phone group should be closed, have specific discussion topics, and be of a set duration. Assignments to be completed between sessions need to be developed for each of the members. The group members can decide at the end of the formal, facilitated sessions (eight to 10) whether they wish to exchange telephone numbers and maintain informal telephone contacts. This approach can be extremely valuable: sensitive subjects can be discussed openly, given the degree of anonymity that the telephone