Housing Families with Substance Use Challenges

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Housing Families with Substance Use Challenges
National Alliance to End Homelessness 2006
Annual Conference Ending Homelessness Plan,
Act, Succeed July 17-19, 2006 Washington,
DC

• July 18, 2006
• Deborah Werner
• Children and Family Futures
• 4940 Irvine Blvd., Ste 202 Irvine, CA 92620
• 714.505.3525 dwerner_at_cffutures.org

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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.

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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

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Continuum of Substance Use

• Abstinence
• Experimental Use
• Responsible Use
• Episodical or Situational Abuse
• Chronic Abuse
• Dependency
• Abstinence

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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

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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!

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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.

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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)

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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

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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

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Childrens 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.
• Childrens Substance Use

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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 doesnt stop
• Moves at Fastest Rate from Prenatal to Age 5

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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

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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

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Unpublished draft.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

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Clinical Treatment Services

• 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

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Clinical Support Services

• 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

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Community Support Services

• 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

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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

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Treatment Options Questions to Consider

• Types of Services Available
• Is the treatment provider culturally appropriate?
  Gender responsive?
• Are childrens 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?

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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
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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.

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Voluntary/Mandatory Continuum
Least restrictive
Most restrictive
The Werner Hartman Group, 2006