Transcript Slide 1
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