The purpose of this model is to foster the development of
state-of-the-art recovery for women with alcohol and other drug dependence and
to foster the healthy development of the children of substance-abusing women.
The model is a guide that can be adapted by communities and used to build
comprehensive programs over time. The goal of alcohol and other drug treatment
is to support a woman's journey to a healthy lifestyle for herself, and for her
family whenever possible. Because alcohol and drug dependent women tend to have
few economic and social resources, comprehensive treatment is extremely
important. The purpose of comprehensive treatment is to address a woman's
substance abuse in the context of her health and her relationships with her
family, community, and society. These relationships are influenced by gender,
culture, race and ethnicity, social class, sexual orientation, and age.
Treatment that addresses the full range of a woman's needs is associated with
increasing abstinence and improvement in other measures of recovery, including
parenting skills and overall emotional health. Treatment that addresses alcohol
and other drug abuse only may well fail and contribute to a higher potential
for relapse.
Confidentiality and informed consent, as well as the establishment of universal
precautions against the spread of STDs, are essential throughout all aspects of
treatment.
Although this treatment model has been designed specifically for women and
their families, many components apply to men as well.
1. Program Structure and Administration
Develop joint cooperation among substance abuse agencies, schools,
courts, probation officers, health and mental health providers, job training
programs, and human service agencies. Create inventory of local, state, and
federal resources available to the treatment program.
Establish an advisory board to assist the treatment program in
collaborating with other resources and organizations, and to advocate on behalf
of the program. This board should reflect the cultural and socioeconomic
diversity of the women and include recovering persons as well as community
leaders. Training and support are necessary.
Cross train staff in collaborating organizations to develop an
integrated continuum of care for each woman in treatment and to address
differences in philosophy, experience, and style of various disciplines.
Staffing should include individuals who are culturally competent
and sensitive to and knowledgeable about treating substance-abusing women.
Substance abuse treatment in correctional facilities should be
delivered by trained and certified personnel.
Staff training should encompass the guidelines generated in CSAT's
TIPS that relate specifically to perinatal substance abuse.
Clinicians and program managers should participate in staff training.
Such training should help lead to an understanding of the impact of
psychological and psychiatric disorders, incest, physical and sexual abuse and
their impact on recovery, and readiness for treatment, family dysfunction,
multi-addiction, and the importance of flexible treatment approaches.
II. Clinical Interventions and
Other Services
Intake Screening and
Comprehensive Health Assessment
Admission priority must be given to women who are known to be
pregnant, HIV-positive, or who have AIDS, and/or TB. Pregnant/postpartum women
should be referred immediately for obstetrical care. (See TIPs.) Immediate
referrals must be made if the program cannot provide appropriate care for these
women. It is essential to document all referrals and admissions.
Assessments for possible pregnancy, HIV status, and exposure to
and/or existence of TB should begin immediately.
Same-day intake services should be offered whenever possible.
Assessment may occur over a period of time. A complete health
assessment must be conducted, and must include a physical examination,
psychosocial evaluation (including psychiatric assessment where indicated), as
well as an assessment of a woman's reproductive, oral, and nutritional health
status.
Other assessments must include a substance abuse history;
physical, emotional, and sexual abuse history (past and present); educational
level and intellectual functioning; work history; family assessment; current
living situation and childcare responsibilities; and racial/cultural/ethnic
factors that are relevant to treatment. There should be an assessment of
patient eligibility (and subsequent registration) for Medicaid, Medicare, SSI,
public assistance, and other health and human service benefits.
An individualized treatment plan, including a plan for relapse
prevention and continuing care, must be developed in collaboration with each
woman entering treatment.
Medical
Interventions
Medical assessments and subsequent care should be provided through arrangements with
healthcare facilities accessible to individuals in the community or on-site,
and should include the provision of preventive and primary medical care
(including prenatal care, if appropriate); medical or medically supervised
detoxification services, where clinically indicated; linkage to psychiatric
care; provision of or established referral linkages as needed for acute medical
care; testing and treatment for hepatitis, tuberculosis, HIV and HIV disease,
sexually transmitted diseases, anemia and malnutrition, hypertension, diabetes,
cancer, liver disorders, eating disorders, gynecological problems, dental and
vision problems, and poor hygiene. It is preferable to have a healthcare
professional available to consult directly with the program.
Women's Health Services. Preconceptional care should be provided either on-site or through
referral, for nutrition, family planning, and general gynecological services.
Pharmacotherapy intervention should be provided on an as-needed basis and should
include provision of, or established referral linkages, for concomitant
assessment and monitoring by qualified medical or psychiatric staff.
Interventions should promote equal access to treatment for all women based on
assessment of their ability to participate in treatment.
Urine testing should be used where clinically appropriate, and should be
conducted on an initial and random basis. (See TIPs.) The program should follow
informed consent
Infant and child health services should be provided either on-site
or through referral and should include the following: primary and acute
healthcare for infants and children, including immunizations, nutrition services (including assessment
for WIC eligibility), and a developmental assessment by qualified personnel.
For treatment programs without medical personnel on-site, a back-up medical
plan that identifies a protocol for pediatric emergencies must be in place.
· Early
Intervention Services for
children should be available.
Access to an age-appropriate, comprehensive developmental
assessment by qualified personnel, including an assessment
of learning and developmental disabilities, should be
provided to all children, beginning at birth. On-site
provision of, or referral to, early intervention and remedial
programs, and linkages with State Individuals with
Disabilities Education Act (IDEA) should be encouraged.
· Home-Based Support. Public health nursing and/or social
work visits should be provided to high-risk postpartum
women and their infants, especially to new mothers and
those who are discharged within 24 hours after delivery.
Linkages and referrals should be established with home care
agencies.
Counseling for
HIV-positive/AIDS Patients. The program must provide for pre- and post-test counseling for
HIV-positive/AIDS patients as well as individual counseling and support groups.
Staff should be properly trained to intervene on behalf of those who are
HIV-seropositive, whether symptomatic or asymptomatic. Appropriate care for
HIV-positive children must also be assured.
Linkages and
Collaboration
· Appropriate linkages to-local, state, and federal programs must
be maintained for those services not provided on-site.
· Linkages with outreach, outpatient, and residential programs
should be maintained as a means to assure appropriate matching of women to substance
abuse treatment. Similarly, linkages with parental/child programs (e.g., Head
Start) should be encouraged.
Support should be offered with the criminal justice system where
appropriate, and should include intervention with juvenile or adult justice
authorities, TASC (or related case management/tracking systems), Legal Aid,
and/or Bureau of Indian Affairs. Access to needed legal services should be
provided if not available through Legal Aid, probation, immigration, child
welfare, foster care, and legal service.
Substance Abuse Counseling and Psychological Counseling
Substance abuse education and counseling, psychological counseling
(where appropriate), and other therapeutic activities should be provided by
practitioners who are licensed or certified to provide these services and
matched in competency to the populations served.
Services should be offered in the context of families and
relationships, including individual/group/family therapy. Counseling for
partners and fathers of babies should be promoted/provided at critical times
throughout treatment.
Counseling should address low self-esteem; race and ethnicity
issues; gender-specific issues; family relationships; attachment to unhealthy
interpersonal relationships; interpersonal violence, including incest, rape,
and other abuse; eating disorders; sexuality; parenting issues; grief related
to loss of alcohol and other drugs, children, family, partner, work, and appearance;
creating a support system that may or may not include family and/or partner;
developing a vision for the future and creating a life plan; and therapeutic
recreational activities for wornen alone and with their children.
Parenting Education. Counseling, including information on child
development, child safety, injury prevention, and child abuse prevention should be provided.
Parenting education should be integrated with substance abuse counseling in
order to be recovery-oriented. A woman's family issues that affect parenting
should be addressed in a way that supports rather than compromises her stage of
recovery.
· Relapse prevention should be a discrete component or phase
of each woman's recovery plan.
· Flexibility and creativity should be stressed in the use and
timing of therapeutic approaches. Accusatory, judgmental,
and humiliation techniques are inappropriate and have not
been proven to be effective.
Health Education and Prevention Activities
· Health education and prevention activities should include
HIV/AIDS education; the physiology and transmission
of sexually transmitted diseases; reproductive health;
understanding female sexuality; preconception care;
prenatal education; child birth education; childhood safety and
injury prevention; physical and sexual abuse education and
prevention; nutrition and smoking cessation classes, especially
for pregnant women; and general health education.
Life Skills Education. Life skills education should be offered and should cover
practical life skills such as parenting (where appropriate); vocational
evaluation; financial management; negotiating access to services; stress
management and coping skills; and personal image building.
Educational Training
and Remediation Services
· Educational training and remediation services should be
provided, with on-site provision of or case-managed referrals to local
education/GED programs and other rernediation issues identified at intake.
· English language competency and literacy assessment
programs should be facilitated.
· Job counseling and training should be provided, if possible,
via case managed/coordinated linkages to community
programs.
Transportation. Transportation
to programs is needed to access treatment and related community services.
Housing Access to safe, drug-free housing to
the maximum extent possible throughout treatment is all-important.
Childcare Services. Age-appropriate care of infants and
children should be provided at treatment facilities using a developmental
model. Respite care should also be available. If space or licensing
requirements prohibit on-site care, contractual arrangements with local,
licensed childcare providers should be provided.
Continuing Care. Continuing Care should be provided,
planned for, and should include sustained and frequent interaction with
recovering individuals who have graduated from the intensive or primary phase
of treatment.
· Provision should be made for graduate re-admission to
more intensive forms of therapy in cases where relapse has
occurred.
· As women complete the intensive phase of treatment
and move into the community, the effects of domestic
violence, rape, and childhood sexual abuse must continue
to be addressed.
Socioeconomic issues
(e.g., jobs/educational deficits) require long-term remedies and must be
included in relapse prevention planning.
Public assistance and housing must be addressed in the continuing care plan.
Ongoing transportation assistance must be provided for attendance at self help
groups (AA, NA, and other support meetings).
Continuing provision of primary healthcare services and medical assistance as
needed for women and children.
