. WOMEN, ADDICTION AND RESIDENTIAL TREATMENT... Education on Alcoholism and Drug Addiction...

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1 GENERAL TREATMENT NEEDS OPENING DOORS: A GUIDE TO RESmENTIAL TREATMENT FOR PREGNANT AND PARENTING WOMEN AND THEIR CHILDREN TABLE OF CONTENTS PREFACE i INTRODUCTION BRIEF HISTORY OF WOMEN'S TREATMENT SERVICES RESIDENTIAL TREATMENT FOR PREGNANT AND PARENTING WOMEN 3 PARTA.TREATMENT. 5. WOMEN, ADDICTION AND RESIDENTIAL TREATMENT Education on Alcoholism and Drug Addiction Peer Support Relapse Prevention Visiting Family'Issues Pregnancy-Related with Children. Issues Educational and Vocational Training TREATMENT Life Skills PHASES II. EMOTIONAL WELL-BEING WITHIN A RESIDENTIAL COMMUNITY THERAPEUTIC APPROACH: BUILDING ON STRENGTHS Women The Position as Survivors: of Women Identifying Strengths STAFF Self-In-Relation COMMUNITY. Theory SPECIFIC RESIDENTCOMMUNITY ISSUES THAT AFFECT THE WELL-BEING OF THE COMMUNITY Race and Ethnicity Age Sexuality Drugs of Choice and Drug Life Styles

2 PLANNINGTHEEVALUATION The Integrating Need for Children Policies Physical Disabilities. Mothering Victims/Victimizers. Medical Issues.... Dual Diagnosis... Postpartum Depression CONCLUSION , , 6 PART B. OPERATIONS 27 III. POLICY AND PROCEDURAL ISSUES INTAKE PROCEDURE AdmissionCriteria ReferralSources Intake ReferralsandWaitingLists Interviews '. INTEGRATION AND DIVERSITY. VISITATION OF CHILDREN The Involvement of Child Welfare Agencies and Foster Families. GUIDELINES Preparing MonitoringVisits FOR Mothers CHILD for WELFARE Visits AGENCY INVOLVEMENT.. Level of Staff and Program Involvement Child Neglect, Abuse and Abandonment ADMINISTRATIVE DISCHARGE POLICIES Reasons for Administrative Discharge CLIENT DischargeProcedures RIGHTS AND RESPONSIBILITIES SAFETY VI PROGRAM TYPES OF EVALUATION EVALUATION GOALS AND OBJECTIVES DATA COLLECTION SUGGESTED TNEMSESA DATA INSTRUMENTS COLLECTION: SUGGESTED DATA COLLECTION: PROCESS EVALUATION. OUTCOME EVALUATION FEEDBACK v PHYSICAL SET-UP SITING Gaining Community Support 47

3 HEALTH CARE ISSUES FOR WOMEN InfectiousDisease Prenatal Care Access to Other Services Other Siting Issues TYPE AND SIZE OF BUILDING..... Security. Use Accessibility of Space SAFETY PROCEDURES Childproofing FireSafety VI. STAFF/STAFFING ISSUES STAFF CREDENTIALS/EXPERIENCE JOB DESCRIPTIONS/PERSONNEL POLICIES TRAINING. STAFFING PATTERNS.. SUPERVISION ' : SPECIAL CONCERNS : PART C. SPECIAL ISSUES 57 VII. HEALTH CARE ISSUES What are the health care concerns of residents in treatment programs? How are residents educated regarding good health care for How is themselves provision and of their medical children? services organized for the benefit of the residents? What protocols or procedures would assure good communication among a resident, her treatment provider and the health care provider regarding the resident's health care needs?.. What specific health care issues arise within a residential setting with women and children? Nicotine Addiction and Environmental Tobacco Smoke (ETS) PREGNANCY, LABOR, DELIVERY, AND POSTPARTUM CARE Medical Care Provider Awareness Labor and Delivery POSTPARTUM Nutrition CARE HEALTH Breastfeeding ISSUES FOR CHILDREN IN RESIDENTIAL PROGRAMS Pediatric Care Immunizations Childhood Immunization Schedule Children With Soecial Needs ()R

4 SERVICES FOROLDERCHILDREN GNIMIT NOITISNART ESAC MANAGEMENT OF AFTERCARE TO COMUNITY SYSTEMS PLANING SECIVRES INTHEAFTERCAREPLAN VIII. CHILD CARE AND CHILDREN'S SERVICES GENERAL ISSUES SERVICES FOR INFANTS, TODDLERS and PRESCHOOLERS.... EARL Y INTERVENTION PROGRAMS EARLY & PERIODIC SCREENING, DIAGNOSIS AND TREATMENT OTHER RESOURCES CHILD CARE Headstart MENTAL AND EMOTIONAL HEALTH CHILD EDUCATION. CARE AND... RECREATION IX. SERVICES FOR OPIATE-ADDICTED PREGNANT AND PARENTING WOMEN Steppingstone Neil J. Houston House X. ISSUES OF LINKAGE 'POSSIBILITIES: TOWARDS A COMPREHENSIVE MODEL OF CARE Affiliation Agreements RECOMMENDATIONS Cross Other Training Linkages FOR CREATING LINKAGES KEY AGENCY LINKAGES PART D CONTINUING CARE 90 XI. ONGOING RECOVERY GRADUATION ChoosingaLocation Housing AFTERCARE PLANNING WITH FAMILIES AND SIGNIFICANT OTHERS Individual therapy Alcoholics Relapse AftercareGroups Prevention Anonymous/Narcotics Groups Anonymous/Women for Sobriety.. Issue-Oriented Support Groups Parenting Support Educational and Vocational Planning Urine screens

5 ELPMAS CONSENT FORMS Relapse and Re-admission Alumni Involvement XII. REFERENCES. 98 XIII. RESOURCE BIBLIOGRAPHY 99 APPENDIX SAMPLE INTAKE/ADMISSION FORMS SAMPLE RESIDENT ORIENTATION PACKETS... XIV SAMPLE PROGRAM FORMS/PROCEDURES..... SAMPLE PROGRAM SCHEDULES

6 INTRODUCTION OPENING DOORS PAGE 1

7 Although long term residential treatment for women has existed since the 1970's, there is little written information to offer support and guidance for persons or organizations interested in developing a residential program for pregnant and parenting women with their children. The intention of this manual is to provide such guidance and support based in experience. Residential treatment offers the opportunity for women and their children to enter recovery together in a safe, supervised, structured and supportive living environment. The residential treatment program serves as a transitional alcohol and drug-free community for residents and their children where new skills can be learned and applied in early recovery. This manual will describe many facets of residential treatment including clinical issues, policy and. procedural matters, program evaluation, physical set-up, staffing patterns, health care issues, child care and children's services, necessary linkages and post-residential treatment issues. A bibliography will offer a list of resources and the appendix will provide examples of policies and forms. We begin Quening Doors with a brief history of women's treatment services to provide a context for the future development of services. BRIEF mstory OF WOMEN'S TREATMENT SERVICES Historically, alcohol and drug addiction have been viewed primarily as a "man's disease". Attention given to women's alcohol and drug use was often negative, focussing anger and blame on addicted women. For example, in Ancient Rome drunkenness in women was punishable by death. The stigma and victimization faced by addicted women are formidable barriers to treatment. Resistance to treating addicted women, especially pregnant women, has been encountered in every sector of the health care, substance abuse and social service systems. The initial impetus for funding specific women's services came from the federal government, in response to concerns raised by field groups such as the National Council on Alcoholism (NCA) and feminist organizations. Since the 1970's, federal initiatives have increased services to women. In 1976 more than 50 programs were funded nationwide through the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the National Institute of Drug Abuse (NIDA). For some programs, serving women meant adding beds for women into existing programs serving men. Only recently has there been a growing awareness that program policies and therapeutic approaches need to be examined in light of the special needs of women. The federally funded programs did stimulate the development of a national network of women's treatment providers and began a cross-fertilization of ideas and model programming across the country. Funding cuts and the shift from categorical funding to block grant funding in the 1980's placed women's programs in competition with other interests. Many programs did not survive intact. The sharing of ideas was halted before truly comprehensive models were developed. Particularly lacking were programs for women with children and pregnant women. In the late 1980's, Congress enacted Public Law requiring each state to set aside five percent of its total Alcohol, Drug Abuse and Mental Health Services block grant funding OPENING DOORS PAGE 2

8 for the expansion of existing and the creation of new prevention and treatment services for pregnant and parenting women. In 1988, this "set aside" was increased to ten percent. This federal initiative re-ignited interest in women's services. As women's services became a focus of attention, other barriers to women's treatment were identified. The small number of reliable studies on the etiology, development and treatment of alcohol and drug addiction in women became more apparent. Attitudinal barriers that existed within the service delivery system needed to be addressed. Comprehensive women's treatment needed to include services to family members, especially children. Many women have responsibilities for children.. Women's residential treatment programs have historically been reluctant or unable to accept newborns and other children into treatment with the mother. Concerns range from lead paint in older residential settings, space required for babies' or children's care, additional staffing requirements and funding issues. Most often women have needed to choose between treatment and the placing of their children in substitute care. Often the substitute care is provided by child welfare services frequently viewed by the mother as not supporting her relationship with her children or her recovery. Despite these obstacles, treatment programs around the country have begun to open their doors to gender-specific services for pregnant and parenting women, choosing a family rather than an individualistic approach to treatment. RESffiENTIAL TREATMENT FOR PREGNANT AND PARENTING WOMEN Residential treatment provides a safe, supportive and structured living environment for women who have demonstrated an inability to remain substance-free in the community, have a history of unsuccessfully attempting outpatient treatment and require a structured milieu program. Women assessed to have a high relapse potential and a need for daily structure and peer support within a recovery-based environment are best served within residential treatment programs. As women entering treatment bring with them not only needs and issues but strengths, talents and capabilities, the residential community supports residents learning skills and strengths from their peers. Residential treatment for women and their children allows women the following opportunities:. to enter a recovery community without fearing loss of their children to the care of others. to deliver drug-free, healthy babies. to enter recovery as a family. to gradually reunite with other children. to learn to balance parenting with early recovery. Programs that successfully mix pregnant women, mothers with their children and women OPENING DOORS PAGE 3

9 without children understand that participation in their programs raises additional issues for women in the program who are not pregnant, do not have children or are not living with their children. Many women in residential treatment have lost custody of their children, terminated pregnancies or freed infants for adoption before services were available to pregnant women or to women with their children. The mixing of these populations raises many issues and feelings for the entire community of residents. OPENING DOORS PAGE 4

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