Comprehensive Treatment for Pregnant and Postpartum Women Families PPW Family Works Omaha, Nebraska Carolyn Thiel

1. Comprehensive Treatment for Pregnant and Postpartum Women & Families � PPW Family Works Omaha, NebraskaCarolyn Thiele and Heather TingelhoffHeartland Family ServiceJuan Paulo Ram�rez, Ph.D. University of Nebraska Public Policy Center

2. Family Works Program Design New program initiated by SAMHSA/CSAT funding in FY06 Locally supported via revenue streams Medicaid Waiver Substance Abuse Block Grant State Probation Voucher Program Fundraising Start date September 2007 Capacity 10 women and their children

3. Family Works Program Objectives Decrease the use and/or abuse of: alcohol, tobacco, and other drugs among pregnant and postpartum women. Increase safe and healthy pregnancies. Improve mental and physical health of women and their children. Improve family functioning, economic stability and quality of life. Decrease involvement in and exposure to crime, violence, sexual and physical abuse and child abuse and neglect

4. Portrait of a Family Works Client Meet Lisa then� - 27 year old pregnant single mother of four - Homeless, living in emergency shelters - Oldest son placed in foster care - Family history of addiction - Current meth and alcohol addictions - Severe depression, suicidal thoughts - Gambling issues when using - Major trauma from past sexual abuse - Grief issues from previous state interventions (loss of child and sister�s children) - Unable to trust anyone

5. Family Works Population Total population served since September 2007: 42 mothers 70 children (55 on-site, 15 off-site) 12 drug free babies born (100%) 65 family members 24 fathers

6. Family Works Population Other population characteristics 61% reported experiencing serious depression in addition to substance dependence Alcohol, marijuana and methamphetamine are most used substances 41.5% are under age 24 Average of 1.84 children per family Oldest age of child served- 17 years old 63.4% Caucasian, 22% African-American, 2.4% Multi-racial, 12.2% Other

7. Substance Used at Admission

8. Age at Admission

9. Family Works at a Glance

10. Family Works Services Services provided: Substance Abuse Treatment Mental Health Treatment Psychiatric Care Parenting Education Job Training Nutrition Education Health Care Infant Care Children�s Services Seeking Safety Groups (Domestic Violence / Trauma) Smoking Cessation Case Management Day Care Family Therapy Savings Program Starfish Program (Incentives)

11. Family Works Services Services are integrated for co-occurring disorders and are trauma informed Women receive treatment on-site in therapeutic community environment Family Works Facility is an apartment complex with 10 units (7 for residents, 3 for staff and treatment) Van and driver available to assist with transportation needs of participants

12. Family Works Services Family Outreach Program FY07 Administrative Supplement funding allowed for increase in family programming and support Engaged extended family members struggling with an addiction Engaged fathers in parenting group/education Provided couple and family counseling, including Saturday services Increased advocacy for reunification Increased maternal involvement in the school system Structured family group to include a family-only session Provided more flexible visiting hours Utilized NiaTX support to improve services

13. Family Works Collaborations Adult and Family Drug Treatment Courts Countryside Community Church Visiting Nurses Association Junior League of Omaha Catholic Charities Childcare Facilities NE Dept. Health and Human Services Healthy Start Oxford Houses Transitional Housing programs Next Generation Omaha

14. Family Works Results 19 (60%) total families have completed Family Works 7 left program within 1-2 weeks of admission and have not been in contact 17 are in aftercare or successful follow-up 30 children reunified with families

15. Family Works Results 114 women have been turned away Reasons for non entry include the following: mother does not have a child under age one (26% of total) child not living with mom program at capacity clients not appropriate for residential treatment

16. Partnership with Child Welfare for Permanency for children 60% of families served have been involved with child welfare and juvenile court system and for them these outcomes were measured: Maintain parent-child bond 33% of mothers involved with child welfare system have successfully reunified with their children

17. Partnership with Child Welfare for Permanency for children Permanency occurs for children when parental recovery have not occurred 17% of mothers not maintaining recovery chose to relinquish custody of their children 28% of child welfare cases have moved or are moving to permanency via termination of parental rights proceedings

18. 1. Decrease AOD Use Objective: To decrease the use and/or abuse of: alcohol, tobacco, and other drugs among pregnant and postpartum women. Outcome: 78% of mothers entering treatment are located for 6 month follow-up and 87.5% of them reported no use of alcohol or drugs for past 30 days*

19. 2. Improve Birth Outcomes Objective: To increase safe and healthy pregnancies. Outcome: 100% of babies born to Family Works participants (12/12) were drug-free Outcome: 100% of births have been to term (at least 37 weeks)

20. 3. Improve Mental/Physical Health Objective: To improve mental and physical health of women and their children Outcome: 78% of mothers entering treatment are located for 6 month follow-up and 68% report significant decreases in symptoms of depression and anxiety. Outcome: 100% show increase in access to physical health and screening services

21. Physical Health of Mothers

22. 4. Improve Family Functioning Objective: To improve family functioning, economic stability and quality of life. Outcome: At 6 month follow-up, clients show significant improvement in family, psychological and spiritual, and health and functioning subscales (Ferrans & Powers)

23. Quality of Life

24. 5. Decrease Crime and Violence Objective: To decrease involvement in and exposure to crime, violence, sexual and physical abuse and child abuse and neglect Outcome: 78% of mothers entering treatment are located for 6 month follow-up and 100% report no arrests or prison stays within the past 30 days.

25. Focus Groups for Participants and Family Members Primary requests from 3 focus groups (clients and families included): Develop adult learning activities Review the current schedule to increase flexibility for participants 3. Increase support in transitioning to community

26. Portrait of a Family Works Graduate Meet Lisa now� - 14 months sober - Family intact, a caring and supportive mother - Gained trust of others and is able to trust - Understands the need for support systems and recovery plan - Leader among peers and other graduates - Improved family relationships - Worked through feelings of grief and denial - Still suffers from depression, but manages with medication

27. Conclusions Integrated, multi-system approach is needed to serve participants and families Participation of family members (particularly fathers) in the recovery process is key. Trauma-informed practices and management are vital to successful service delivery, program results and retention of staff.