Transcript National Alliance to End Homelessness: 2006 Annual Conference Ending Homelessness: Plan, Act, Succeed * July 17-19, 2006 * Washington, DC * Housing Families.

National Alliance to End Homelessness: 2006 Annual Conference
Ending Homelessness: Plan, Act, Succeed
* July 17-19, 2006 * Washington, DC *
Housing Families with Substance
Use Challenges
July 18, 2006
Deborah Werner
Children and Family Futures
4940 Irvine Blvd., Ste 202 * Irvine, CA 92620
714.505.3525 * [email protected]
Public Health Model
Problem exists when an Agent interacts with a Host
in an Environment.
 Agent– alcohol or other drugs
 Host - Individual who is susceptible to an AOD
problem. Often surrounded by families.
 Environment – family, social and community
environment including media and peers.
Strategies to prevent, reduce and treat alcohol and
other drug problems address all three areas.
Public Health Interventions

Individuals
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Agent

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
treatment
building protective factors
reducing risk factors
Alcohol policy (formal and informal)
Interdiction
Environments
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building environments which discourage problem use
supportive social networks
healthy community messages
safe communities
Continuum of Substance Use
 Abstinence
 Experimental
Use
 Responsible Use
 Episodical or Situational Abuse
 Chronic Abuse
 Dependency
 Abstinence
Addiction & Dependency
Addiction: A state in which an organism engages in a
compulsive behavior even when faced with negative
consequences
 Behavior is self-rewarding (relieving or
pleasurable)
 Loss of control in limiting intake
Dependence: Dependence develops when neurons
adapt to repeated drug exposure and only function
normally in the presence of the drug.
 Manifested as a physical disturbance when the
drug is removed.
Source: NIDA: Neurobiology of Addiction www.nida.nih.gov
The Basics

Substance abuse leads to negative consequences and often puts
the user and others in danger.
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Substance use disorders are a chronic health problem, a biopsycho-social disease. Specialized interventions are available.
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Substance abuse is characterized by obsession, compulsion,
denial, guilt and shame.
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Relapse is common. Prognosis/relapse the same as for
hypertension or diabetes.
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Substance use affects whole families.
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Most people have a family member or friend with a substance use
disorder, and yet, substance abusers, especially pregnant and
parenting users are highly stigmatized and stereotyped.

Substance abuse makes us angry!
Stages of Change

Pre-Contemplation

Contemplation

Preparation

Action

Maintenance
Source: Prochaska and DiClemente, 1984
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Regardless of approach or philosophy there are
service and intervention opportunities appropriate for
each stage.
Change is HARD.
Continuum of Substance Use Services
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Prevention (primary, secondary, indicated)
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Intervention (outreach, engagement)
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Assessment (7 life areas, severity,
placement)
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Treatment (detoxification, outpatient,
residential, medically assisted)

Recovery support (housing, community
services, family services, case management,
aftercare)
Factors that can accompany
substance use disorders

No Self Efficacy Or Self Esteem
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Trauma, Violence and Grief

Co-Occurring Mental Health Problems
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Felony Convictions, Parole Requirements

Poor Parenting Skills, High Need Children and Open
Child Welfare Cases

Grief

Health Concerns, HIV status, Hepatitis C

Low Literacy, Education, Job Experience

Intergenerational Cycle, Partners who Encourage
Use
Other Factors of Many Substance
Users
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Delayed Maturation and Reactive Thinking
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Poor Planning/Follow-Through, Little Discipline
Accompanied by an Expectation of Failure
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Manipulative Behavior
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High Levels Of Creativity
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Willingness To Help Others And Be Of Service
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High Levels Of Intelligence And Ability To Think “Out
Of The Box”
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Extended Family Network
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Resilience
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Gratitude
Children’s Issues
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Substance use increases risk of child neglect and
child abuse
Mandatory reporting
4 Clocks
Therapeutic needs of children of substance users
 Most substance using women entering treatment
have histories of trauma, including child abuse.
These issues can effect parenting.
 Children’s Substance Use
Clocks Challenging Us To Act Quick
 TEMPORARY ASSISTANCE FOR NEEDY FAMILIES
(TANF)
24 Months Work Participation; 60 Month Lifetime
 ADOPTION AND SAFE FAMILIES ACT (ASFA)
12 Months Permanent Plan
15 Months out of 22 in Out of Home Care Must Petition for
TPR
 RECOVERY
One Day at a Time for the Rest of Your Life
 CHILD DEVELOPMENT
Clock doesn’t stop
Moves at Fastest Rate from Prenatal to Age 5
Gender Responsive Treatment
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Relational
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Strength-based, motivational
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Comprehensive
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Trauma informed
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Addresses the different pathways to use,
consequences of use, motivation for
treatment, treatment issues and relapse
prevention needs
Culturally Relevant Treatment
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Honors traditions and values
 Acknowledges cultural pain and racism
 Addresses acculturation tensions and issues among
individuals and families
 Builds appropriate efficacy and support
 Staff, management and Board reflective
 Respects individuals
 Differentiates drug culture from culture itself
 Helps people learn cultural traditions
 Relational
CSAT Model of Comprehensive Services for
Women & Children
CSAT Women, Youth and Families Task Force (2004). Unpublished draft.
Comprehensive Model includes:
 Components
•
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Clinical treatment services for women
Clinical support services for women
Community support services for women
Clinical treatment services for children
Clinical support services for children
Community support services for children
 Cultural Competence, Gender Competence
and Developmentally Appropriate
Clinical Treatment Services
FOR WOMEN
 Outreach and engagement
 Continuing care
 Screening
 Pharmocotherapies
 Drug monitoring
 Treatment planning mental
health services
 Detoxification
 Medical Care and Services
 Assessment
 Trauma Informed and TraumaSpecific Services
 Case Management
 Substance Abuse Counseling
and Education
 Crisis Intervention
FOR CHILDREN
 Intake
 Screening
 Medical Care and Services
 Therapeutic Child Care
 Development Services
 Mental Health and Trauma
Services
 Assessment
 Residential Care in Residential
Settings
 Case Management
 Substance Abuse Education &
Prevention
 Care Planning
Clinical Support Services
FOR WOMEN
FOR CHILDREN


Life skills
 Advocacy
 Primary health care services
 Family programs
 Parenting and child development
education
 Housing support
 Education remediation and
support
 Employment readiness services
 Linkages with legal system and
child welfare systems
 Recovery community support
services
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Primary health care services
Onsite or healthy child care
Recovery community
support services
Advocacy
Educational services
Recreational services
Prevention services
Mental health and
remediation services
Community Support Services

Transportation
 Child care
 Housing services
 Family strengthening
 Recovery community support services
 Employer support services
 TANF linkages
 Vocational and academic education services
 Faith based organization support
 Recovery management
Family Treatment – the Next
Evolution
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Services for all family members
Addresses the relational needs of women
Dynamic, different members come at
different times
Continuum of family involvement to family
treatment
Breaks the Inter-Generational Cycle
Treatment Options
Questions to Consider

Types of Services Available
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Is the treatment provider culturally
appropriate? Gender responsive?
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Are children’s services provided?
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Does the treatment provider use evidencebased practices? (motivation, contingency
management, cognitive behavioral therapy,
integrated co-occurring services, gender
responsive)

Can we collaborate with the treatment
provider?
Required Ingredients for
Collaboration

Cross-Training and Understanding

Common Goal
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Communication Mechanisms
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Common Language

Identification of Common Principles
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Respect and Trust
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Daily Practices
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Evaluation
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Accountability
Sid Gardner & Nancy Young,
Children & Family Futures
What Works in Housing
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Individualized Services Tailored to Meet Needs of Each
Client/Family
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Protecting the Safety and Integrity of the Environment
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Property Management/Services Partnership in
Supportive Housing
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Strengths Based Approaches and Respect
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Clarity on level of structure
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Community events in housing sites.
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Close collaborations with substance use treatment
agencies with compatible philosophies
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Recovery is a process not an event. On-going nature.
Voluntary/Mandatory Continuum
Least restrictive
No services
Housing
only
Must
participate in
a service but
client
decides what
service or
objective
Most restrictive
Most Services fall in here.
Case Plan
Contracts, agree to attend
certain services, contingency
management, drug testing,
relapse does not necessarily
result in loss of participation
The Werner Hartman Group, 2006
Mandatory
Participation
In All
Services
Relapse
addressed
Mandatory
Participation
Removal if
use alcohol
/drugs