Housing Families with Substance Use Challenges

1. National Alliance to End Homelessness: 2006 Annual Conference Ending Homelessness: Plan, Act, Succeed * July 17-19, 2006 * Washington, DC * Housing Families with Substance Use Challenges July 18, 2006 Deborah Werner Children and Family Futures 4940 Irvine Blvd., Ste 202 * Irvine, CA 92620 714.505.3525 * dwerner@cffutures.org

2. Public Health Model Problem exists when an Agent interacts with a Host in an Environment. • Agent– alcohol or other drugs • Host - Individual who is susceptible to an AOD problem. Often surrounded by families. • Environment – family, social and community environment including media and peers. Strategies to prevent, reduce and treat alcohol and other drug problems address all three areas.

3. Public Health Interventions • Individuals • treatment • building protective factors • reducing risk factors • Agent • Alcohol policy (formal and informal) • Interdiction • Environments • building environments which discourage problem use • supportive social networks • healthy community messages • safe communities

4. Continuum of Substance Use • Abstinence • Experimental Use • Responsible Use • Episodical or Situational Abuse • Chronic Abuse • Dependency • Abstinence

5. Addiction & Dependency Addiction: A state in which an organism engages in a compulsive behavior even when faced with negative consequences • Behavior is self-rewarding (relieving or pleasurable) • Loss of control in limiting intake Dependence: Dependence develops when neurons adapt to repeated drug exposure and only function normally in the presence of the drug. • Manifested as a physical disturbance when the drug is removed. Source: NIDA: Neurobiology of Addiction www.nida.nih.gov

6. The Basics • Substance abuse leads to negative consequences and often puts the user and others in danger. • Substance use disorders are a chronic health problem, a bio-psycho-social disease. Specialized interventions are available. • Substance abuse is characterized by obsession, compulsion, denial, guilt and shame. • Relapse is common. Prognosis/relapse the same as for hypertension or diabetes. • Substance use affects whole families. • Most people have a family member or friend with a substance use disorder, and yet, substance abusers, especially pregnant and parenting users are highly stigmatized and stereotyped. • Substance abuse makes us angry!

7. Stages of Change • Pre-Contemplation • Contemplation • Preparation • Action • Maintenance Source: Prochaska and DiClemente, 1984 • Regardless of approach or philosophy there are service and intervention opportunities appropriate for each stage. • Change is HARD.

8. Continuum of Substance Use Services • Prevention (primary, secondary, indicated) • Intervention (outreach, engagement) • Assessment (7 life areas, severity, placement) • Treatment (detoxification, outpatient, residential, medically assisted) • Recovery support (housing, community services, family services, case management, aftercare)

9. Factors that can accompany substance use disorders • No Self Efficacy Or Self Esteem • Trauma, Violence and Grief • Co-Occurring Mental Health Problems • Felony Convictions, Parole Requirements • Poor Parenting Skills, High Need Children and Open Child Welfare Cases • Grief • Health Concerns, HIV status, Hepatitis C • Low Literacy, Education, Job Experience • Intergenerational Cycle, Partners who Encourage Use

10. Other Factors of Many Substance Users • Delayed Maturation and Reactive Thinking • Poor Planning/Follow-Through, Little Discipline Accompanied by an Expectation of Failure • Manipulative Behavior • High Levels Of Creativity • Willingness To Help Others And Be Of Service • High Levels Of Intelligence And Ability To Think “Out Of The Box” • Extended Family Network • Resilience • Gratitude

11. Children’s Issues • Substance use increases risk of child neglect and child abuse • Mandatory reporting • 4 Clocks • Therapeutic needs of children of substance users • Most substance using women entering treatment have histories of trauma, including child abuse. These issues can effect parenting. • Children’s Substance Use

12. Clocks Challenging Us To Act Quick • TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) 24 Months Work Participation; 60 Month Lifetime • ADOPTION AND SAFE FAMILIES ACT (ASFA) • 12 Months Permanent Plan • 15 Months out of 22 in Out of Home Care Must Petition for TPR • RECOVERY • One Day at a Time for the Rest of Your Life • CHILD DEVELOPMENT • Clock doesn’t stop • Moves at Fastest Rate from Prenatal to Age 5

13. Gender Responsive Treatment • 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

14. Culturally Relevant Treatment • Honors traditions and values • Acknowledges cultural pain and racism • Addresses acculturation tensions and issues among individuals and families • Builds appropriate efficacy and support • Staff, management and Board reflective • Respects individuals • Differentiates drug culture from culture itself • Helps people learn cultural traditions • Relational

15. CSAT Model of Comprehensive Services for Women & Children CSAT Women, Youth and Families Task Force (2004). Unpublished draft.

16. Comprehensive Model includes: • 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

17. 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 Treatment Services

18. FOR 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 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 Clinical Support Services

19. 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 Community Support Services

20. Family Treatment – the Next Evolution • Services for all family members • Addresses the relational needs of women • Dynamic, different members come at different times • Continuum of family involvement to family treatment • Breaks the Inter-Generational Cycle

21. Treatment Options Questions to Consider • Types of Services Available • Is the treatment provider culturally appropriate? Gender responsive? • Are children’s services provided? • Does the treatment provider use evidence-based practices? (motivation, contingency management, cognitive behavioral therapy, integrated co-occurring services, gender responsive) • Can we collaborate with the treatment provider?

22. Required Ingredients for Collaboration • Cross-Training and Understanding • Common Goal • Communication Mechanisms • Common Language • Identification of Common Principles • Respect and Trust • Daily Practices • Evaluation • Accountability Sid Gardner & Nancy Young, Children & Family Futures

23. What Works in Housing • Individualized Services Tailored to Meet Needs of Each Client/Family • Protecting the Safety and Integrity of the Environment • Property Management/Services Partnership in Supportive Housing • Strengths Based Approaches and Respect • Clarity on level of structure • Community events in housing sites. • Close collaborations with substance use treatment agencies with compatible philosophies • Recovery is a process not an event. On-going nature.

24. Voluntary/Mandatory Continuum Least restrictive Most restrictive The Werner Hartman Group, 2006 Must participate in a service but client decides what service or objective Mandatory Participation In All Services Relapse addressed Most Services fall in here. Case Plan Contracts, agree to attend certain services, contingency management, drug testing, relapse does not necessarily result in loss of participation No services Housing only Mandatory Participation Removal if use alcohol /drugs