Cynthia C. Crone, APN University of Arkansas for Medical Sciences

1. National Alliance to End HomelessnessConference CallJanuary 10, 2008Families with Substance Use Disorders – Housing Options Cynthia C. Crone, APN University of Arkansas for Medical Sciences Partners for Inclusive Communities cronecynthiac@uams.edu

2. Arkansas CARES and Family Homelessness Prevention • Arkansas CARES Services • Addiction Treatment • Collaborative Efforts to Prevent Family Homelessness

3. Arkansas CARES • Comprehensive family treatment program established in 1992 to decrease maternal substance abuse and promote healthy family outcomes through prevention, treatment, education, research and advocacy

4. Recognized for Innovations and Outcomes • 2002 – American Psychiatric Association’s Gold Achievement Award • 2004 – National Association of Public Hospital’s Jim Wright Safety Net Award for Vulnerable Populations • Numerous local and state awards

5. Kathleen at Admission

7. Kathleen

8. Kathleen 1 year later…

9. Kathleen and Family – 4 years later

10. Kathleen Four Years Later • Drug-free • Reunified with Children • Re-Married • Buying Home • Happy, Healthy Member of Society

11. Mothers and Substance Abuse • A serious problem associated with: • Unemployment and Poverty • Homelessness • Child Welfare Issues • Trauma Issues • Mental and Physical Illness • Arrests and Incarceration • Repeating the Cycles of Poverty, Abuse and Dependency

12. In Arkansas, estimates are that 29% of mothers with children under 18 need substance abuse treatment • Underserved population • Most treatment based on male alcohol model • Most treatment dollars go to men • Lack of comprehensive family-treatment • Children need services as well as mothers

13. Top Needs Expressed by Mothers at Arkansas CARES • Good job • Safe, affordable housing

14. Top Needs of Mothers Receiving Substance Abuse and Child Welfare Svs.(Grella, 2003) Service% Needed% Received Jobs 62 16 Housing Assistance 56 6 Family Counseling 54 25 Childcare 46 18 Help with Benefits 45 16

15. The Disease of Addiction

16. Addiction is a Chronic Disease • American Medical Association, 1954 • Chronic, Progressive Familial Disease Characterized by Compulsive Use in Spite of Negative Consequences, and Relapse • Treatment is Effective

17. Treatment Works(McLellan, et al., 2000) • Addiction Relapse Rates - Less than for Asthma and Hypertension • Adherence to Treatment Plan - Greater with Addiction than for Asthma, Diabetes, or Hypertension • Behavior Change(to decrease risk and increase functional status) in Addicted Persons -Doubles that for Asthma, Diabetes, or Hypertension

18. Are we treating addiction as a chronic disease for which treatment works?

19. Family Treatment • Recognizes addiction as a chronic disease • Addresses multiple health and social issues through integrated services that are gender and culturally specific • Values families and keeping them together • Is cost beneficial in human and economic terms

20. Family Treatment Components(Rebecca Project, 2006) • Alcohol and Drug Treatment • Mental Health Counseling • Vocational Preparation and Job Training • Parenting Classes • Relapse Prevention • Supportive Housing • Therapeutic Childcare • Child-focused Academic Tutoring and Assistance • Family Therapy

21. Arkansas CARESFunding Partners

22. Client Families at Admission • White 73% • Pregnant 35% • Independent Living 57% • Married 16% • Ed. Completed 11.7 yr • Employed 5% • Arrested p. 6 mo. 81% • Incarcerated 14% • Probation/Parole 47% • Number Children Living with mother 2.2 • Open Child Protect. 36% • Abuse Histories 82% • At-risk Depression 80% • At-risk PTSD 44% • Methamphetamine 45% • Cocaine 27%

23. Graduate Outcomes One Year or More After Residential Treatment • Drug-free 80% • Employed 65% • Permanent Housing 84% • Receiving Housing Assistance 57% • Arrested 19%

24. Lack of Safe, Affordable Housing Presents Major Barrier to Family Treatment • One –third to one-half of families entering treatment are homeless or near-homeless. • Many fear entering treatment due to fear of losing their children to child protection actions. • There are too few resources for residential support of mothers with their children during treatment. • At time to transition from intensive, residential treatment to community living many families cannot obtain housing supports due to past history.

25. Arkansas CARES Collaborative Efforts to Prevent Family Homelessness

26. Intensive Residential Treatment Key Partners • Private • Black Community Developers • UMCH • Public • SAMHSA • Alcohol and Drug Abuse Treatment • City of Little Rock • TANF • Emergency Shelter Grant • Division of Childcare and Early Childhood Education • McKinney funded school program

27. Expansion of Residential Care • 1999 – SAMHSA Community Action Grant • Little Rock Housing Authority • North Little Rock Housing Authority • Pulaski County Housing Authority • 2000 – SAMHSA Targeted Expansion Grant • Partnered with North Little Rock Housing Authority • City of North Little Rock grantee • Eastgate Terrace Residents’ Association support • NIMBY • Bank of America Playground

28. Eastgate Program

29. Building Bridges Continuing Care Program • Local Partners and the Robert Wood Johnson Foundation - $1 Million over 4 years • Prevent Relapse and Sustain Gains Made During Intensive Treatment through Intensive Case Management Targeting: • Employment/Education • Safe, Affordable Housing • Child Care • Primary and Behavioral Health Care • Transportation

30. Continuing Care • Building Bridges Housing Partners • Little Rock Housing Authority – Vouchers / waivers • North Little Rock Housing Authority – waivers • Leased 4 units at Eastgate as “emergency transitional housing” - TANF assists with rent • Arkansas Supportive Housing Network – Shelter Plus vouchers for formerly incarcerated clients / gifts • Arkansas CARES Advisory Board assisted with landlord recruitment • Altrusa International of Little Rock - Incentives • Little Rock School District – local non-profit; low income tax credit housing proposal

31. CAREfully Catered created as Building Bridges 1st Social Enterprise • Multiple partners • Local funders and RWJF • Arkansas Culinary School • Arkansas CARES • Christ Episcopal Church • Non-Profit Organization with Double bottom line: Mission and Margin • Revenue will go back into continuing care

32. CAREfully Catered

33. Sacred Authority Chapter • Leadership from Rebecca Project – Washington DC • Leadership program for women to use their voices in advocacy for other families • Meeting January 3, 2008: Housing was a strong message

34. Organizational Transition • University of Arkansas for Medical Sciences 1992 - 2006 • Department of Obstetrics and Gynecology • Department of Psychiatry • Methodist Family Health 2007 - current • >100 year old non-profit organization • Location, mission, services remain the same

35. What’s in the Works to Expand Housing Options? • MFH looking at Low Income Tax Credit projects – expand populations served • Working to continue partnerships with Public Housing – expand to Domestic Violence Projects • Residential Support during Intensive Outpatient Treatment – variety of funding options include HUD, DCFS, DYS, OADAP, Workforce Services, others

36. Collaboration • Takes Time • Takes Learning • Requires Trust • Requires Accountability • Requires Being the Leader Sometimes and the Follower Sometimes • Is Fun! • Improves Results

37. Levels of Collaboration Changingthe System Changingthe Rules JointProjects Information Exchange Sid Gardner

38. Working together, we can break the intergenerational cycles of poverty, abuse, and dependency.

39. It’s about Collaboration and a Shared Vision!

40. ..and a thought From the great scientist, Thomas Edison: “Vision without execution is hallucination”.