2 La Crosse/Russia Alcohol Treatment Project Page #I La CrosselRussia Alcohol Treatment Project Background Proiect Information The La Crosse/Russia Alcohol Treatment Project was a cooperative venture between a non-profit organization in the United States and an non-governmental organization in the Former Soviet Union. Gundersen Lutheran and Franciscan Skemp Healthcare in La Crosse, Wisconsin served as the nonprofit organizations. The designated non-governmental organization in the former Soviet Union was the Dubna Center for Education. Funding for the Alcohol Project was made possible with funds from the US Agency on International Development and awarded through World Learning's PVO/NIS Project. The grant award was for a two-year period ending in September, A six-month extension was granted, thus the project's ending date was March, The overall goal of the project was to create social and educational structures to reduce the incidence and negative effects of alcoholism in four selected communities in Russia. Four communities in Russia were identified to participate in the Alcohol Project. The communities were Dmitrov, Sergiev Posad, Taldom and Dubna. Several months after the start of the project, two additional cities were included in the project. Those cities were Klin and Zaprudnia. The project was designed to encourage the six communities to work together to address the health and social concerns of alcoholism in their communities.
3 La Crosse/Russia Alcohol Treatment Project Page #2 Proiect Backwound The La CrosselDubna Health Partnership Project, through its Alcohol Work Group, realized the scope of the problem of alcoholism in the community of Dubna as well as in communities surrounding our Sister City. Alcoholics Anonymous and Al-Anon meetings were initiated through the Partnership Project. It was realized that much more work could be accomplished with additional time and funds in this needy area in Russia. Thus, an additional grant was written to specifically address alcoholism in the former Soviet Union. It was the beginning of the La CrosseiRussia Alcohol Treatment Project. Project Desiq n Russia La Crosse Central Office in Dubna Administrative Coordinator 4 b Clinical Coordinator Clinical Coordinator Project Coordinator Taldom Counselor Community Specialist I Klin Counselor Sergiev Posad Counselor Community Specialist Dubna Counselor Community Specialist La Crosse Alcohol Work Group Chemical Dependency Counselors Detox Nurse Educators Prevention Specialists Administrators Pharmacist Family Therapist Training Specialists 1 1 I Zaprudnia Counselor Dmitrov Counselor t--c Community Specialist e-
4 La CrosselRussia Alcohol Treatment Project Page #3 Project Design, cont. Six alcohol counselors, four community specialists and two project administrators were hired in Russia. The Administrative and Clinical Coordinators were hired to coordinate overall project activities for the Russian side. The Clinical Coordinator provided clinical knowledge and support. She provided inservices to staff on at least a monthly basis. The Administrative Coordinator was responsible for financial reporting in Russia as well as travel and scheduling coordination. The coordinators were based in the Central Office in Dubna, but traveled to each project city often to oversee each respective city's activities. Alcohol counselors were hired and trained to provide alcohol counseling services in each of their respective cities. While visiting the United States, counselors were trained in a 12-step psychological support model. They applied this approach to their Alcohol Centers in Russia. In addition to individual counseling, counselors were trained to provide group therapy for clients. Community Specialists were trained to develop and implement community-based education activities within their respective communities. Specialists assisted other project staff in the promoting of AA and Al-Anon groups, publicizing services of their Alcohol Centers and the general promotion of alcoholism awareness. Specifically, specialists created newspaper and TV spots to promote Center's services as well as to educate the community about alcoholism. Proiect Goal, Outcomes, Outputs, & Indicators A project framework format was developed to provide direction. It included an overall goal, a project outcome as well as outputs
5 La CrosseJRussia Alcohol Treatment Project Page #4 expected and end of project indicators predicted for the end of the project. Following is a summary of the expected outcomes developed for the two and one-half year project. La Crosse, Wisconsin, USA and Dubna, Dmitrov, Klin, Sergiev Posad, Zaprudnia and Taldom, Russia Project Goal: To create social and educational structures that will reduce the incidence and negative effects of alcoholism in six communities within the Moscow Region. Project Outcomes: To develop a model that will strengthen the administrative, management, human resources and service delivery capabilities addressing the health and social problem of alcoholism in six communities within the Moscow Region. Project Outputs: 1 Direct support of community and healthcare institutions for alcoholism treatment; 2) Establishment of AA, Al-Anon and Alateen support groups in each of six participating communities; 3) Teachers trained in prevention education and integrated into curriculum; and 4) women's support services available within communities. ~ n of d Project Indicators: I) i Personnel in place to coordinate community education efforts; 2) Communication channels established among the six participating communities; 3) Prevention education curriculum in place within schools; 4) AA, Al-Anon and Alateen support groups established in each of the participating communities; 5) Detoxification centers in each of the participating communities; and 6) Support available for women affected by alcoholism.
6 La CrosselRussia Alcohol Treatment Project Page #5 Project Accomplishments Following are selected accomplishments listed in chronological order achieved by the Alcohol Project from September, 1994 through March, Date October, 1994 November, 1994 November, 1994 January, 1995 January, 1995 February, 1995 March, 1995 March, 1995 Description of Accomplishment Cities of Dubna, Sergiev Posad, Taldom and Dmitrov identified to participate in the project Agreements are developed and signed by Lutheran Hospital (non-profit organization in the US) and the Dubna Center for Education (non-governmental organization Russia) to establish the administrative structure for the Alcohol Project. Community interest groups were established in Dubna, Taldom, Sergiev Posad and Dmitrov to serve as support groups for the Alcohol Project activities. Interest group representatives included city officials, narcologists, teachers, psychologists, militia and healthcare workers. A four-day pre-training and hiring process was developed to specifically meet the personnel needs of the Alcohol Project. The process resulted in the successful hiring of project staff in each project city. The La CrosselRussia Alcohol Questionnaire was developed, tested for reliability and validity and then administered in Russia. The administration resulted in the collection of baseline data describing each community's knowledge and attitudes toward alcohol and alcoholism treatment. Cities of Zaprudnia and Klin selected to participate in the project. City officials from Russian project cities visit La Crosse and sign the Memorandum of Understanding to "officially" begin the La Crosse/Russia Alcohol Treatment Project. A signing ceremony took place at Gundersen Lutheran and documented by local television and radio stations. City officials and key project supporters from Dubna, Dmitrov, Taldom and Sergiev Posad visit La Crosse alcoholism treatment centers and community AA and Al-Anon meetings to learn about
7 La Crosse/Russia Alcohol Treatment Project Page #6 alcoholism treatment in the US. July, 1995 July, 1995 July, 1995 July, 1995 July, 1995 January, 1996 May, I996 June, 1996 July, 1996 AA groups established in two project cities: Dubna and Dmitrov. Groups meet weekly. Al-Anon also begins this month is Dmitrov. Discussions begin in Moscow with Social Work professionals to begin a Social Work professional preparation and continued training for project counselors and specialists. Educational sessions showcasing peer education models provided in each project city for teachers and students. Assessments made in each project city for the potential of medical andlor social detoxification services for each Alcohol Center. Taldom begins first AA group. Interim evaluation conducted by external evaluation team. Significant findings include: * Major support for staff members with addition of other staff! * Appropriate space for the project established in 5 of the 6 project cities. * Computers and FAX machines available in each project city. * Prevention efforts have been incorporated into the school curriculum in Sergiev Posad, Dubna and Dmitrov. * Teachers in Klin, Dubna, Taldom, Dmitrov, and Sergiev Posad have participated in extensive teacher training in the area of healthy lifestyles and prevention. * Strong support given for the model used to train staff. Project cities have established offices, additional staff hired and are increasing services to their respective communities. The centers: Dubna - "The Rebirth Center" Zaprudnia - "Hope Center" Dmitrov - "Center of Medical Psychological Help" Taldom - "Choice" Klin - "Center for Social Psychological Help" Eight AA representatives from Russia earn money themselves to visit La Crosse to learn more of AA and treatment in the US. A project highlight! Seven individuals representing three project communities
8 .- La Crosse/Russia Alcohol Treatment Project Page #7 (Taldom, Dmitrov, and Dubna) visit La Crosse to study detoxification services. Clinical manifestations of various stages of alcoholism and patient management during recovery were cited as highlights by Russian colleagues. September, 1996 October, 1996 November, I 996 December, 1996 December, 1996 January, 1997 January, 1997 January, 1997 March, 1997 March, 1997 An international conference, "Our Journey Together" was held at the Rotmino Conference Center in Dubna for over 150 participants from at least 15 cities throughout Russia and the Ukraine. Project staff from Russia, La Crosse Alcohol Work Group representatives and World Learning and USAlD representatives participated in the conference. Response from the September conference prompt inquiries for training, information and assistance from project staff in beginning AA and Al-Anon groups in various communities throughout Russia; requests for written information continue through the end of the year. An additional AA group is added in Dmitrov, bringing the total of AA groups to 4. AA groups now meet daily in that city. The number attending community programs about alcoholism top 2,000 in Dubna during this quarter (October - December, 1996). Many project staff participate in the video "My Family" developed as an alcoholism education tool in Moscow. Anon created in Zaprudnia and Dmitrov; entire families involved in recovery in Zaprudnia. Prevention efforts in schools continue in Dubna; more than 3,000 students reached this quarter (January - March, 1997). Project counselor staff visit La Crosse for two weeks of intensive individual counselor training as well as group therapy technique training. Training includes one week of clinical training in four chemical dependency inpatient andlor outpatient centersin La Crosse. Franciscan Skemp and Gundersen Lutheran medical facilities willingly participate. More than 1,600 individuals reached this quarter through AA and Al-Anon meetings among project cities. The number of group and individual client sessions reach more
9 La CrosselRussia Alcohol Treatment Project Page #8 than 1,500 among project cities this quarter. The number of client sessions have increased each quarter during the project. March, 1997 March, 1997 March, 1997 MarchlApril, 1997 April, 1997 After detox personnel were added to the staff, Dubna Rebirth Center shows a significant reduction in hospitalizations for chronic alcoholism patients. Dmitrov staff hosts interested professionals from Reutov and Zheleznodorozhny and shares knowledge gained from the Project. Leads to a lasting support and collaboration. Three centers increase the number of staff employed full time in their respective centers. The increase is based on workloads and increase in activity within their Centers. Series of two videoconferences between La Crosse and Dubna held to evaluate the overall project. The first involved staff in La Crosse and staff from project cities. The second involved staff in La Crosse and project staff along with city administrators from project cities. The hope is to continue some training and support through videoconferences between La Crosse and Dubna. All project cities will be invited to particpate. An open AA meeting via videoconference is planned between AA members from the La Crosse community and those AA members from all project cities. Additionally, an open Al-Anon meeting is also planned for the near future. Significant Project Activities One of the significant activities of the project was the establishment of Alcoholics Anonymous groups in each of the project cities. Professional staff facilitated the process of group establishment, training of AA members, and assisted in the process of finding adequate, confidential space for meetings. The Russian and La Crosse work groups assisted in the training of meeting facilitation for AA members.
10 ,. La CrosselRussia Alcohol Treatment Project Page #9 The results of these efforts ma iund in Chart 1. AA Meeting Average Attendance (# attending meetings per week) July, March, 1997 Dmitrov Dubna Zaprudnia July-Sept, '95 Jan-March, '96 July-Sept, '96 Jan-March,'97 Chart I Klin Taldom & Sergiev Posad The chart demonstrates growth in average AA meeting attendance among project cities for the time period between July, 1995 and March, Average AA group attendance grew steadily among project cities. In July, 1995 the average attendance for all project cities was below 20. By March, 1997 two cities had doubled that attendance. AA groups have increased their activity and visibility throughout the duration of the project. The first established AA groups in Dubna and Dmitrov traveled to Klin, Zaprudnia and Sergiev Posad on several occasions to assist in the establishing of groups there. There has been a "regional AA" group established and groups from the region meet occasionally to hold a joint meeting. Regional groups have been known to gather for an AA group anniversary. In fact, on the two-year anniversary of Dmitrov AA, more than 100 AA members from the area and Moscow were in attendance.
11 La CrosselRussia Alcohol Treatment Project Page #I 0 An additional significant activity that took place in the project was the establishment of Al-Anon groups in each of the project cities. Staff were educated that alcoholism is a family disease, and therefore, the entire family would benefit from support. Al-Anon seeks to educate the entire family about the disease of alcoholism and provide support for the family members' healing and dealing with the disease. Chart 2 shows the growth in average weekly Al-Anon attendance for each city since the beginning of the project in July, Al-Anon Meeting Average Attendance (# attending meetings per week) July, March, e Dubna -8- Dmitrov -.- Zaprudnia -- Klin +Taldom +Sergiev Posad July-Sept, '95 Jan-March, '96 July-Sept,'96 Jan-March.'97 Chart 2 By March, 1996 five of the six project cities had established at least one Al- Anon group. By the end of the following quarter (June, 1996) all project cities had formed Al-Anon groups with attendance of at least five individuals: By project's end (March, 1997) there were ten Al-Anon groups established among project cities. Average attendance per group grew to at least eight, while Dubna's average per meeting grew to 25. As part of the end-of-project evaluation, each staff member was asked to rate a number of groups on their support of the project. The groups selected to consider included: medical professionals, school teachers, employers within the community, ambulance, city officials, school
12 La CrosselRussia Alcohol Treatment Project Page #I 1 administrators, police, Al-Anon groups, AA groups, church, and other agencies. Staff members were asked to rate each on a scale of 1 to 5, from 1 indicating NOT very supportive to 5 indicating VERY supportive. Chart 3 shows the average ratings for each of the groups evaluated. Project Cities' Average Rating of Support "How supportive do you feel each of the following groups are to your efforts?" other church AA group Al-Anon Group police administrators city officials ambulance employers teachers medical pportive supportive Chart 3
13 La Crosse/Russia Alcohol Treatment Project Page #I 2 End-of-Project Evaluation Evaluation questions for project staff and for project city administrators were prepared and presented to appropriate individuals to respond. Following are selected responses to several questions. -I What impacts do you think the Alcohol Project has had on your community? "Change in public opinion, new programs, new approach to treatment and set up of a new type of help for people suffering from alcohol and drug addiction." Zaprudnia "Change in people's attitude towards the alcohol problem." Klin "A new place for people with needs for alcoholism treatment and counseling to turn to." Taldom "We expected and hoped for change in the alcohol situation in the city and the region. In rality, our efforts didn't result in global change of the situation, even though some success is undisputable." But the people get addicted to alcohol faster than we treat them." Dmitrov "Before the project was started, chemical dependency services in the community were practically nonexistent. The Alcohol Project has allowed us to revive the service and introduce new services. Due to the project, the community turned its face to the problem. People with this problem became able to receive counseling and support." Dubna
14 La Crosse/Russia Alcohol Treatment Project Page #I 3 "The city acquired the only place where alcoholics and their families can turn for rehabilitation. Rehab programs were started." Sergiev Posad "The project promoted a more serious attitude toward addictions; a change in attitude towards patients and their families." Dubna "An Alcohol Problems Center opened in the city, where people can obtain free and qualified counseling and medical services. AL-Anon and AA groups gre considerably." Dmitrov How have you changed personally andlor professionally as a result of traininglparticipation in the project? "This program stimulated my personal growth, systematized my knowledge and provided new ideas for work. While working in the project, I acquired new colleagues, friends." Natasha Semenova, Dubna I -- - " I believe that I grew spiritually, professionally and I think that I know how to shape public opinion and make it more favorable towards the 12-step program." Lioudmila Suchkova, Zaprudnia I "The project has played an important role in the life of the city and the life of separate individuals. The people got hope to change their lives for the better. This hope is not only in people with chemical dependency, but in people around them as well." Oksana Strelets, Klin
15 La CrosselRussia Alcohol Treatment Project Page #14 "we learned a lot of new and useful things. The acquired knowledge helps I in work as well as in personal life. In some areas I started feeling myself more confident, but the more knowledge and experience I get, the more there emerge questions and desire to find the answers." Marina Piskareva and Natasha Kablioukova, Taldom "I became more knowledgeable about the alcoholism problem, its roots. I learned to conduct preventive talks with various groups of the population, do radio talks, n/ presentations, write articles for mass media. I learned to pursuade people that alcoholism is a disease which is easier to prevent than to treat." Evgueni Alexandrov, Dubna I "I became more sociable, more tolerant to weaknesses and strengths of the people around me, more open to change, I learned not to be afraid to be a leader, assume responsibility." Olaa Vasiutina. MD Dubna What has surprised you about working with the Alcohol Project? "At the very beginning (1994), the philosophy of the rehabilitation process spiritually oriented programs delighted me. During the whole process we met with kindness and patience to us on the part of our American colleagues and teachers. Lately I was fascinated with the idea of developing a treatment and rehabilitation center for drug addicts operating as a "Therapeutic Community". Olga Vasiutina, MD, Dubna "I realized that I am a personality, by freeing myself from co-dependence I live and let others live." Lioudmila Suchkova, Zaprudnia
16 La Crosse/Russia Alcohol Treatment Project Page #I 5 "New opportunity in alcohol treatment, a chance for people to understand themselves and normalize their relationship with the others." Oksana Strelets, Klin "First, I started looking differently at the alcoholism problem. Secondly, by seeing the example of the La Crosse work group I realized how important the team approach is." Natasha Semenova, Dubna "New concept of alcoholism as a disease, interesting approach to preventive work, new circle of like-minded people who then became my friends." Evgueni Alexandrov, Dubna "We met many new and interesting people, learned about the system approach to community help set-up." Marina Piskareva and Natasha Kablioukova. Taldom "That the most important thing in life is spiritual growth, and health, material and other values are just derivatives from this main one." Nadezhda Smirnova & Natalja Zakharova, Dmitrov Summary and Conclusions The La CrosseJRussia Alcohol Treatment Project met its goal in creating social and educational structures that reduced the incidence and negative effects of alcoholism in project communities. This was evidenced by a dramtatic change in attitude in every project city as well as school prevention curricula in place in many of the schools within project cities. The school curricula were also implemented in the communities of the project, thus reaching thousands among project cities. The project outcome of developing a sustainable model was also achieved in 5 of the 6 communities. The administrative, management, human resources and service delivery capabilities were strengthened in most project cities. The project activities and services will continue in 5 of the 6 participating cities. One community lacked city administration support, which was determined to be a key to sustainability for alcoholism treatment
17 ..) La CrosselRussia Alcohol Treatment Project Page #I 6 services. The staff of this city worked to establish AA and At-Anon groups with some success. It is our hope that this city's administration will learn from other project cities' administrative leaders about the importance of alcoholism treatment initiatives, and, soon raise its priority in the city. The La Crosse Alcohol Work Group and the project staff in each of the Russian communities collectively deserve acolades for successfully addressing the health and social problem of alcoholism. Great strides have been made in establishing comprehensive alcohol prevention, treatment and rehabilitation efforts in Dubna, Taldom, Dmitrov, Klin, Sergiev Posad, and Zaprudnia, Russia.
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