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
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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:
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“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
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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
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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
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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
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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
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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