Promoting Recovery:Substance Use Treatment Services

Presented By:

Margo Spence, MS, LSW, LICDC

“AT THE END OF LIFE WE WILL NOT BE JUDGED BY HOW MANY DIPLOMAS WE HAVE RECEIVED. HOW MUCH MONEY WE HAVE MADE. HOW MANY GREAT THINGS WE HAVE DONE. WE WILL BE JUDGED BY – I WAS HUNGRY AND YOU GAVE ME FOOD TO EAT. I WAS NAKED AND YOU CLOTHED ME. I WAS HOMELESS AND YOU TOOK ME IN.”

MOTHER TERESA

First Step Home’s Mission

To help women break the cycle of addictions and abuse so that they can become self-sufficient and provide a safe, nurturing environment for their children

Defining Homelessness

Homelessness can be defined as the state of “disaffiliation” or the complete alienation from meaningful human relationships and their social support systems. *

Homeless people are either addicts themselves or the product of dysfunctional families that were significantly impacted by addiction. *

* Baum and Burnes, A Nation in Denial

The Homeless Interface

Baum and Burnes in their book “ A Nation In Denial” state that 65-85% of all homeless adults suffer from chronic alcoholism, drug addiction, mental illness or a combination of the three.

33% suffer from severe and persistent psychiatric disorders with 50% dually diagnosed with addiction to alcohol and /or drugs

Treating the Homeless Woman…The Clinical Plan Recognize that we need to treat the “whole”

person to break the cycle Substance Abuse Mental Health Physical Health Vocational Training Family Development

Common Threads….Addictions and Homelessness 80% of the women in addictions treatment

have co-occurring disorders 75% have physical or sexual abuse issues A majority have significant histories of family

addictions and are single heads of households

Educational levels are well below national averages

Inadequate levels of income

Homelessness and Addictions:Tragic Facts Over 65% of the addicted women treated at First

Step Home enter with histories of homelessness: “Flopping” from site to site Living on the streets/ drug seeking Reside in emergency shelters Have no permanent address Justice System referral

Over 40% are chronically homeless 50% enter treatment without a predictable housing

situation in place

A Comparison of Data

46% of cities surveyed by the National Conference of Mayors cited domestic violence as a main cause of homelessness for women 75% of the women we treat have experienced

domestic violence The Federal Task Force on Homelessness

reports that 20-25% of the homeless have some form of psychiatric disorder 80% of the women we treat have a mental

health disorder

Comparison of Data…Continued

The US Conference of Mayors city survey indicated that families comprise 38% of the homeless 47% of the women we treat enter with children

The Department of Agriculture indicates that 95% of the homeless live at less than 75% of the Federal Poverty Guideline 73% of our clients live at 50% and below the

guideline

Continuum of Homeless Housing Approaches “Wet” Housing

Clients can drink on-site but are eligible to receive treatment for addictions

Controversial but effective in treating hard core addicts on change

“Damp” Housing No alcohol or drugs in housing site but can use off site Usually a second level approach to relapse issues

“Abstinence Based” Housing No substance use allowed on site or in community Client commits to sobriety

The “Campus” Approach to Service

Gather all service sites into a common area or neighborhood

Promotes coordinated services Increases operational controls Creates a “sober” community Increases opportunities to engage in sober

leisure activities for all levels of clients

The Role of Case Management

Case management is a critical tool for successful retention strategies

Clients have numerous social welfare needs that need to be accessed

Case management services basic needs acquisition including housing, childcare, financial assistance and healthcare.

90 minutes per client per week is a safe standard

The Role of Childcare in successful Addictions Treatment Allows for assessment of the children for

psycho-social issues Children get to interact with other children in a

safe environment Clients are instructed in methods of reducing

generational stress based abuse Parenting classes teach the skills necessary

for everyday mother/ child interaction

Educational Assistance is a Key

Referral of clients to Community based programs for GED assistance

Strong emphasis on educational growth is integrated into individual treatment plans

Success stories are highlighted Cognitive assessment of client at entry is our

goal Specialized studies, i.e. culinary arts

programs, are very useful.

Staffing and Training

Establishing credentialing levels by position Recruiting through information dissemination Hire by qualification not need Put a vision to your agency and recruit to the

vision Develop a staff training plan and stick to it Provide remedial assistance where it is

required Set high expectations of your staff

The Four Steps to Successful Residential Treatment of the Homeless Provide integrated services designed to

eliminate barriers to successful treatment Link outside specialties to your system of

care….FQHC’s, Mental Health agencies Use Motivational Interviewing extensively Offer a connection to community

reintegration through transitional services

Step One… Integrated Services

Assess the client’s physical, mental, family and addictions status at the onset of treatment

Develop a fully integrated service network that treats all of these issues in a timely and comprehensive manner.

Provide the support tools ( medications, counseling, etc.) required for active healing

Step Two…Link Specialties

Develop partnerships with community resources that may be non-traditional, i.e. FQHC’s for medical care.

Build relationships with community businesses that lead to operational supports, i.e. Blooming Roses, LLC

Step Three…Motivational Interviewing Techniques Miller’s Theory of Motivational Therapy has a

proven record of success It breaks down old barriers and replaces them

with new reinforced thoughts Allows clients to discard “bad thinking” and

start fresh Can be adapted to all clients regardless of

pre-conditioned thoughts

Step Four…Transitional Treatment

Provide a process for building a sober support network

Refine counseling approaches to concentrate on reintegration into the community

Address housing issues Provide vocational assistance Aftercare and Alumni Groups Teach Life Skills Strengthen the family Relapse Prevention