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Beth Glover Reed, PhD Kathleen Branson Hillegas, RN, PhD candidate Suzie Antonow, MSW, CSW, CACI

Increasing Collaboration to Address Substance Abuse, Women & Their Children: Strategies and Approaches. Beth Glover Reed, PhD Kathleen Branson Hillegas, RN, PhD candidate Suzie Antonow, MSW, CSW, CACI Julie D. Cushman, MSW, CAC-1 Ruth Gordon Shabazz, MSW, ACSW, CSW.

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Beth Glover Reed, PhD Kathleen Branson Hillegas, RN, PhD candidate Suzie Antonow, MSW, CSW, CACI

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  1. Increasing Collaboration to Address Substance Abuse, Women & Their Children: Strategies and Approaches Beth Glover Reed, PhD Kathleen Branson Hillegas, RN, PhD candidate Suzie Antonow, MSW, CSW, CACI Julie D. Cushman, MSW, CAC-1 Ruth Gordon Shabazz, MSW, ACSW, CSW

  2. Outline/organization of Workshop • Overview • Desired outcomes & principles • Strategies • Conferences & Trainings • Educational case conferences, Problem-solving & Priority setting • Generating/using knowledge • Institutionalizing change • Services coordination • Components to increase collaboration & create change p 2 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  3. Overall Goal - present ways to collaborate to increase and coordinate resources for substance abusing women and their children Specific Goals • Strategies to increase & coordinate resources for substance abusing women and their children • Ways to Link strategies targeting policy makers • Horizontally across systems • Vertically throughout systems • Use of Task Forces & Coalitions to catalyze change by • Raising awareness • Creating new culturally competent knowledge & tools • Planning change to address issues Reed, Antonow, Cushman, Hillegas & Shabazz

  4. Specific Goals - continued • Link a variety of initiatives to identify gaps and barriers • Training/education • Coordinated case conferences and forums • Conferences to catalyze common views of needs and generate ideas across boundaries to address gaps • Strategies to link services & programs Reed, Antonow, Cushman, Hillegas & Shabazz

  5. Context Washtenaw County, MI • Population 300,000 • 2 cities, • Ann Arbor & • Ypsilanti • Towns, Villages, townships & rural areas • 2 Universities, • U of Michigan & • Eastern Michigan U • Median age 31.3 • Median income $51,990 • Affluent areas • Pockets of very low income • Problems with homelessness • 3 major health care systems p 3 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  6. Gender Breakdown of Those Receiving AOD & MH Services in 2002 Total Revenue and Expenditures for Substance Abuse and Mental Health in 2002 $4,275, 736 Reed, Antonow, Cushman, Hillegas & Shabazz

  7. Washtenaw Reed, Antonow, Cushman, Hillegas & Shabazz

  8. Background Washtenaw County MI 1980’s • Few sources of women-centered substance abuse treatment • High levels of infant mortality • Crisis intervention & violence against women services had little knowledge of AOD • Segmented service systems • Trouble communicating across boundaries between agencies/systems • Concern about crack cocaine • AOD services beginning to consider family members p 4 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  9. p 5 handout 7/15/04 Reed, Antonow, Cushman, Hillegas & Shabazz 10

  10. Desired Outcomes • Make existing resources more women-friendly • Add elements to address gaps • Transformation - change existing practices p 6 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  11. General Principles • Long term vision AND short-term activities/successes • Theoretical/conceptual ANDPractical/applied • Work simultaneously at Multiple LevelsANDin multiple systems • Continuous assessment • Small committed leadership team • Widespread communication & involvement Reed, Antonow, Cushman, Hillegas & Shabazz

  12. Triangle of Collaboration Consumers Health & Human Services Academic Resources Reed, Antonow, Cushman, Hillegas & Shabazz

  13. Strategies • Conferences & Trainings • Educational Case Conferences • Action Research • Institutionalizing Change • Services Coordination Reed, Antonow, Cushman, Hillegas & Shabazz

  14. General Strategy - Conferences & Trainings • Objectives • Build knowledge & skills • Create neutral space • Mobilize people across systems • Generate common vision & language • Build relationships at different levels p 7 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  15. Conferences & Trainings, cont. • Key Elements/Principles • Identify topics of interest • Plan with representatives of different systems • Incorporate consumers • Include teams from each organization • Make language and assumptions explicit • Include variety of approaches • Create linkages across systems • Recruit new people • Identify & develop advocates/leaders among participants • Participants plan next steps & prioritize Reed, Antonow, Cushman, Hillegas & Shabazz

  16. Conferences & Trainings, cont. Examples • Coordinating Project on Women • Conferences/training on AOD, DV, HIV/AIDS, drugs and women, pregnancy & AOD • Assault Crisis Center & Council for Children • Child sexual abuse/trauma & AOD • SAFE ANCHOR • Cross agency simulation • CTTI • FAS/FAE conferences Reed, Antonow, Cushman, Hillegas & Shabazz

  17. General Strategy - Problem Identification, Solving & Priority-setting • Objectives • Improve coordination of services between agencies • Explore how clients move through each system • Consider how to enhance working relationships • Key elements/Principles • Ground rules for interactions • Client confidentiality • Focus on clarification, identification of issues • Preparation of presenters • Use of nominal group process • Priority setting p 8 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  18. Problem Identification, Solving & Priority-setting, cont. • Examples • Educational case conference, case autopsy(Infant Survival Initiative) • Nominal group process & priority setting • Interagency simulation (SAFE ANCHOR) • Forums (SAFE ANCHOR) pp 8 - 11 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  19. General Strategy - Action Research • Goals • Generate knowledge to guide planning • Generate knowledge from actions • Involve participants in the process • Principles • Action Research Model p 12 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  20. ACTION RESEARCH CYCLE p 13 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  21. Action Research, cont. Examples: • Formal Needs Assessments • 25 focus groups of women various stages of change • SWOT (Strengths, Weaknesses, Opportunities & Threats) analyses • Organizational Assessments • Components • Perceptions Reed, Antonow, Cushman, Hillegas & Shabazz

  22. Action Research, cont. • STEPS Forum • Assessment of expectations • Data about attendees, organizations & clientele • Data about concerns, priorities • Evaluate event • Share information with leadership & participants Reed, Antonow, Cushman, Hillegas & Shabazz

  23. General Strategy - Institutionalizing Change • Goals • Critical assessment of existing practices • Creation of alternatives • Identify changes in policy, budget and administrative procedures to institutionalize change p 14 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  24. Institutionalizing Change, cont. • Principles • Work across and within systems • Generate new or redeploy resources to fill gaps • Provide on-going support, education & supervision past initial change Reed, Antonow, Cushman, Hillegas & Shabazz

  25. Institutionalizing Change Examples • Critical Pathways, St. Joseph Mercy Health System • Community Team Training Institute • SAFE ANCHOR Executive leadership sessions • Resources for ongoing work Reed, Antonow, Cushman, Hillegas & Shabazz

  26. Examples of Service Coordination Ruth Gordon Shabazz, MSW, ACSW, CSW Director Programs & Services Shelter Association of Washtenaw County Ann Arbor, MI p 15 handout Reed, Antonow, Cushman, Hillegas & Shabazz

  27. General Strategy - Increasing Services Coordination • Objectives • Coordinating & advocating for services/resources • Address multiple and overlapping areas • Principles • State of readiness and stages of change as framework • Comprehensive assessment • Must be client centered • Care coordination • Within the larger community Reed, Antonow, Cushman, Hillegas & Shabazz

  28. Increasing Services Coordination, cont. • Steps/Tasks • Network with those of like-mind • Work with individuals from different perspectives • Boundary crossing • Don’t burn any bridges • Consider alternate ways to deliver services • Provided informal education and consultation Reed, Antonow, Cushman, Hillegas & Shabazz

  29. Shelter Association of Washtenaw County • Community Kitchen • Food Gatherers • 50 bed shelter for adults • 20 bed rotating shelter (winter) • 50 chair warming center (winter) • Medical clinic • Case management • Focus on income/savings/housing Reed, Antonow, Cushman, Hillegas & Shabazz

  30. Services • Sheltering • Assessment • Physical • Psychological • Mental health • Family • Trauma • Chemical Dependency • Other Barriers • Literacy • Lack of income • Legal issues Reed, Antonow, Cushman, Hillegas & Shabazz

  31. On-site Services • Groups • Gender specific trauma groups • Women’s group on “toxic relationships” • Dual recovery education series • Life skills - practical • Eight 12-step groups • Literacy • Fiber arts • Alumni group Reed, Antonow, Cushman, Hillegas & Shabazz

  32. On-site Services, cont. • Case management • Medical case workers • Obtaining entitlements(SSI, VA, FIA, insurance) • Employment • Soft skills • Resumes • Job search • Housing search • Community Kitchen Reed, Antonow, Cushman, Hillegas & Shabazz

  33. Networking with agencies (on-site representatives) • Dawn Farm (substance abuse) • VA • Food Gatherers • Community Supports & Treatment Services (mental health) • PORT - outreach mental health • Michigan Rehabilitation Services • Health Services Access - county • Michigan Works - county • Family Independence Agency - DSS • Washtenaw Literacy • Area hospitals • Student volunteer groups • Michigan Ability Partners/Homeless Response Team • HIV/AIDS Resource Center • Volunteer lawyer Reed, Antonow, Cushman, Hillegas & Shabazz

  34. Examples of Service Coordination Suzie Antonow, MSW, CSW, CACI Mental Health & Chemical Dependency Therapist St. Joseph Mercy Health Systems, Ann Arbor, MI Reed, Antonow, Cushman, Hillegas & Shabazz

  35. ST.JOSEPH MERCY HEALTH SYSTEM • ACADEMIC OB/GYN CLINIC • OUR PROGRAM PROVIDES MEDICAL CARE FOR PREGNANT WOMEN AND WOMEN WITH GYNECOLOGIC CONCERNS. • ST. JOSEPH MERCY HEALTH SYSTEM IS A TEACHING HOSPITAL. Reed, Antonow, Cushman, Hillegas & Shabazz

  36. SERVICES PROVIDED IN THE ACADEMIC OB/GYN CLINIC • HIGH RISK OBSTETRICS • TEEN PREGNANCY • CD COUNSELING SERVICES • SOCIAL WORK • FINANCIAL COUNSELING • MATERNAL SUPPORT SERVICES Reed, Antonow, Cushman, Hillegas & Shabazz

  37. C.D. THERAPIST ROLE • EDUCATION, TRAINING • LINKAGES WITH OTHER PARTS OF THE HOSPITAL • LINKAGES IN THE COMMUNITY Reed, Antonow, Cushman, Hillegas & Shabazz

  38. HOW PATIENTS ARE SCREENED, REFERRED • ALL PATIENTS SEEN AT THEIR NURSE VISIT ARE INFORMED OF DRUG URINE SCREENS. • IF A PATIENT TEST POSITIVE AND/OR REPORT A HISTORY OF DRUG USE • NO PRENATAL CARE Reed, Antonow, Cushman, Hillegas & Shabazz

  39. INITIAL CONTACT/TRIAGE • RESULTS OF THE URINE TOX SCREEN • BRIEF COMPREHENSIVE ASSESSMENT • REVIEW RISK OF ATOD ON THE FETUS • RECOMMENDATION/ABSTINENCE Reed, Antonow, Cushman, Hillegas & Shabazz

  40. WHAT IS NEEDED SYSTEMICALLY FOR THE INTERVENTION TO WORK • ANYONE WHO WORKS WITH THIS POPULATION NEEDS TRAINING • COLLABORATIONS WITHIN THE HOSPITAL(NURSES, SW,PHYSICANS) • MUST BE INDIVIDUALIZED Reed, Antonow, Cushman, Hillegas & Shabazz

  41. REFERRALS/LINKS LINKS WITH OTHER GATEKEEPERS (HEALTH CARE ACCESS,ANN ARBOR SHELTER ASSOCIATION,HOME OF NEW VISION, ETC…) LINKS WITH FETAL ALCOHOL INITIATIVE. COMMUNITY GRANTS PROCESS TREATMENT PROGRAMS Reed, Antonow, Cushman, Hillegas & Shabazz

  42. DATA ON THE EFFECTIVENESS OF THE PROGRAM • NUMBER OF WOMEN REFERRED TO TREATMENT • NUMBER OF BABIES BORN WITH NEGATIVE SCREENS AT THE TIME OF DELIVERY • WHAT PRECENTAGE OF TOTAL POPULATION BEING SERVED TESTED OR REPORTED A HISTORY Reed, Antonow, Cushman, Hillegas & Shabazz

  43. SUMMARY • REMEMBER TO EDUCATE • HELP COORDINATE SERVICES /SUPPORT FOR HIGH WOMEN • KEEP WOMEN AND CHILDREN ON THE AGENDA Reed, Antonow, Cushman, Hillegas & Shabazz

  44. Examples of Service Coordination Julie Cushman, MSW, CAC-1 Clinical Director, Home of New Vision, Ann Arbor, MI Reed, Antonow, Cushman, Hillegas & Shabazz

  45. Women-Specific Services - Home of New Visions, 12/96 Structured safe environment for women recovering from chemical dependency - Includes: • transitional housing (4 homes, up to 30 women, up to 10 children) • outpatient services, individualized and gender-specific, through individual and group activities (about 120/year) • outreach activities of various kinds • dual program (for women with mental health issues) • transportation and childcare Reed, Antonow, Cushman, Hillegas & Shabazz

  46. New Horizons,1995 component of the Family Support Network (a coalition of agencies with the mission of ending homelessness for families) • Address an identified gap (the absence of women-specific treatment sensitive to homelessness and violence issues • advisory group from the multi-agency network of programs concerned with homelessness, violence, and housing. Reed, Antonow, Cushman, Hillegas & Shabazz

  47. New Horizons, cont. Provides • education, • consultation, • outreach, • screening, • assessment, • brief interventions and intensive outpatient • therapeutic daycare for children from 0 – 6, with • after school services as well for older children • transportation Reed, Antonow, Cushman, Hillegas & Shabazz

  48. Key Organizational Principles • Team approach, non-hierarchical • Former consumers co-facilitators of groups, and as liaisons with New Horizons consumers • Treatment addresses more than drugs—also understanding selves, and changing lives • Self-esteem, • gender roles, and • shame must be addressed • Skill development focus Reed, Antonow, Cushman, Hillegas & Shabazz

  49. Women-specific treatment issues Reed, Antonow, Cushman, Hillegas & Shabazz

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