Housing Families with Substance Housing Families with Substance Use ChallengesUse Challenges

July 18, 2006July 18, 2006

Deborah WernerDeborah WernerChildren and Family FuturesChildren and Family Futures

4940 Irvine Blvd., Ste 202 * Irvine, CA 926204940 Irvine Blvd., Ste 202 * Irvine, CA 92620

714.505.3525 * dwerner@cffutures.org714.505.3525 * dwerner@cffutures.org

National Alliance to End Homelessness: 2006 Annual Conference National Alliance to End Homelessness: 2006 Annual Conference Ending Homelessness: Plan, Act, SucceedEnding Homelessness: Plan, Act, Succeed

* July 17-19, 2006 * Washington, DC * * July 17-19, 2006 * Washington, DC *

Public Health ModelPublic Health Model

Problem exists when an Agent interacts with a Host Problem exists when an Agent interacts with a Host in an Environment.in an Environment.

Agent– alcohol or other drugsAgent– alcohol or other drugs Host - Individual who is susceptible to an AOD Host - Individual who is susceptible to an AOD

problem. Often surrounded by families. problem. Often surrounded by families. Environment – family, social and community Environment – family, social and community

environment including media and peers. environment including media and peers.

Strategies to prevent, reduce and treat alcohol and Strategies to prevent, reduce and treat alcohol and other drug problems address all three areas. other drug problems address all three areas.

Public Health InterventionsPublic Health Interventions

IndividualsIndividuals treatment treatment building protective factors building protective factors reducing risk factorsreducing risk factors

AgentAgent Alcohol policy (formal and informal) Alcohol policy (formal and informal) InterdictionInterdiction

Environments Environments building environments which discourage problem usebuilding environments which discourage problem use supportive social networks supportive social networks healthy community messageshealthy community messages safe communitiessafe communities

Continuum of Substance UseContinuum of Substance Use

AbstinenceAbstinence Experimental UseExperimental Use Responsible UseResponsible Use Episodical or Situational AbuseEpisodical or Situational Abuse Chronic AbuseChronic Abuse DependencyDependency AbstinenceAbstinence

Addiction & DependencyAddiction & Dependency

Addiction: A state in which an organism engages in a Addiction: A state in which an organism engages in a compulsive behavior even when faced with negative compulsive behavior even when faced with negative consequencesconsequences Behavior is self-rewarding (relieving or Behavior is self-rewarding (relieving or

pleasurable)pleasurable) Loss of control in limiting intakeLoss of control in limiting intake

Dependence: 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 Manifested as a physical disturbance when the drug is removed.drug is removed.

Source: NIDA: Neurobiology of Addiction www.nida.nih.govwww.nida.nih.gov

The BasicsThe Basics Substance abuse leads to negative consequences and often puts Substance abuse leads to negative consequences and often puts

the user and others in danger. the user and others in danger. Substance use disorders are a chronic health problem, a bio-Substance use disorders are a chronic health problem, a bio-

psycho-social disease. Specialized interventions are available.psycho-social disease. Specialized interventions are available. Substance abuse is characterized by obsession, compulsion, Substance abuse is characterized by obsession, compulsion,

denial, guilt and shame. denial, guilt and shame. Relapse is common. Prognosis/relapse the same as for Relapse is common. Prognosis/relapse the same as for

hypertension or diabetes. hypertension or diabetes. Substance use affects whole families.Substance use affects whole families. Most people have a family member or friend with a substance use Most people have a family member or friend with a substance use

disorder, and yet, substance abusers, especially pregnant and disorder, and yet, substance abusers, especially pregnant and parenting users are highly stigmatized and stereotyped.parenting users are highly stigmatized and stereotyped.

Substance abuse makes us angry! Substance abuse makes us angry!

Stages of ChangeStages of Change

Pre-ContemplationPre-Contemplation ContemplationContemplation PreparationPreparation ActionAction MaintenanceMaintenance

Source: Prochaska and DiClemente, 1984Source: Prochaska and DiClemente, 1984

Regardless of approach or philosophy there are Regardless of approach or philosophy there are service and intervention opportunities appropriate for service and intervention opportunities appropriate for each stage.each stage.

Change is HARD.Change is HARD.

Continuum of Substance Use ServicesContinuum of Substance Use Services

Prevention (primary, secondary, indicated)Prevention (primary, secondary, indicated) Intervention (outreach, engagement)Intervention (outreach, engagement) Assessment (7 life areas, severity, Assessment (7 life areas, severity,

placement)placement) Treatment (detoxification, outpatient, Treatment (detoxification, outpatient,

residential, medically assisted)residential, medically assisted) Recovery support (housing, community Recovery support (housing, community

services, family services, case management, services, family services, case management, aftercare)aftercare)

Factors that can accompany Factors that can accompany substance use disorderssubstance use disorders

No Self Efficacy Or Self EsteemNo Self Efficacy Or Self Esteem Trauma, Violence and GriefTrauma, Violence and Grief Co-Occurring Mental Health ProblemsCo-Occurring Mental Health Problems Felony Convictions, Parole RequirementsFelony Convictions, Parole Requirements Poor Parenting Skills, High Need Children and Open Poor Parenting Skills, High Need Children and Open

Child Welfare Cases Child Welfare Cases GriefGrief Health Concerns, HIV status, Hepatitis CHealth Concerns, HIV status, Hepatitis C Low Literacy, Education, Job ExperienceLow Literacy, Education, Job Experience Intergenerational Cycle, Partners who Encourage UseIntergenerational Cycle, Partners who Encourage Use

Other Factors of Many Substance Other Factors of Many Substance UsersUsers

Delayed Maturation and Reactive Thinking Delayed Maturation and Reactive Thinking Poor Planning/Follow-Through, Little Discipline Poor Planning/Follow-Through, Little Discipline

Accompanied by an Expectation of FailureAccompanied by an Expectation of Failure Manipulative BehaviorManipulative Behavior High Levels Of CreativityHigh Levels Of Creativity Willingness To Help Others And Be Of ServiceWillingness To Help Others And Be Of Service High Levels Of Intelligence And Ability To Think High Levels Of Intelligence And Ability To Think

“Out Of The Box”“Out Of The Box” Extended Family NetworkExtended Family Network ResilienceResilience GratitudeGratitude

Children’s IssuesChildren’s Issues

Substance use increases risk of child neglect and Substance use increases risk of child neglect and child abuse child abuse

Mandatory reportingMandatory reporting 4 Clocks4 Clocks Therapeutic needs of children of substance usersTherapeutic needs of children of substance users Most substance using women entering treatment Most substance using women entering treatment

have histories of trauma, including child abuse. have histories of trauma, including child abuse. These issues can effect parenting. These issues can effect parenting.

Children’s Substance UseChildren’s Substance Use

Clocks Challenging Us To Act QuickClocks Challenging Us To Act Quick

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)(TANF)24 Months Work Participation; 60 Month Lifetime24 Months Work Participation; 60 Month Lifetime

ADOPTION AND SAFE FAMILIES ACT (ASFA)12 Months Permanent Plan15 Months out of 22 in Out of Home Care Must Petition for TPR

RECOVERYOne Day at a Time for the Rest of Your Life

CHILD DEVELOPMENTClock doesn’t stopMoves at Fastest Rate from Prenatal to Age 5

Gender Responsive TreatmentGender Responsive Treatment

RelationalRelational

Strength-based, motivationalStrength-based, motivational

ComprehensiveComprehensive

Trauma informedTrauma informed

Addresses the different pathways to use, Addresses the different pathways to use, consequences of use, motivation for consequences of use, motivation for treatment, treatment issues and relapse treatment, treatment issues and relapse prevention needsprevention needs

Culturally Relevant TreatmentCulturally Relevant Treatment

Honors traditions and valuesHonors traditions and values Acknowledges cultural pain and racismAcknowledges cultural pain and racism Addresses acculturation tensions and issues among Addresses acculturation tensions and issues among

individuals and familiesindividuals and families Builds appropriate efficacy and supportBuilds appropriate efficacy and support Staff, management and Board reflectiveStaff, management and Board reflective Respects individualsRespects individuals Differentiates drug culture from culture itselfDifferentiates drug culture from culture itself Helps people learn cultural traditionsHelps people learn cultural traditions RelationalRelational

CSAT Model of Comprehensive Services for Women & Children

CSAT Women, Youth and Families Task Force (2004). Unpublished draft.

ComprehensiveComprehensive Model includes: Model includes:

ComponentsComponents

• Clinical treatment services for womenClinical treatment services for women• Clinical support services for womenClinical support services for women• Community support services for womenCommunity support services for women• Clinical treatment services for childrenClinical treatment services for children• Clinical support services for childrenClinical support services for children• Community support services for childrenCommunity support services for children

Cultural Competence, Gender Competence Cultural Competence, Gender Competence and Developmentally Appropriate and Developmentally Appropriate

Clinical Treatment ServicesClinical Treatment Services

FOR WOMENFOR WOMEN Outreach and engagementOutreach and engagement Continuing careContinuing care ScreeningScreening PharmocotherapiesPharmocotherapies Drug monitoringDrug monitoring Treatment planning mental Treatment planning mental

health serviceshealth services DetoxificationDetoxification Medical Care and ServicesMedical Care and Services AssessmentAssessment Trauma Informed and Trauma-Trauma Informed and Trauma-

Specific ServicesSpecific Services Case ManagementCase Management Substance Abuse Counseling Substance Abuse Counseling

and Educationand Education Crisis InterventionCrisis Intervention

FOR CHILDRENFOR CHILDREN IntakeIntake ScreeningScreening Medical Care and ServicesMedical Care and Services Therapeutic Child CareTherapeutic Child Care Development ServicesDevelopment Services Mental Health and Trauma Mental Health and Trauma

ServicesServices AssessmentAssessment Residential Care in Residential Residential Care in Residential

SettingsSettings Case ManagementCase Management Substance Abuse Education & Substance Abuse Education &

PreventionPrevention Care PlanningCare Planning

Clinical Support ServicesClinical Support Services

FOR WOMENFOR WOMEN

Life skillsLife skills AdvocacyAdvocacy Primary health care servicesPrimary health care services Family programsFamily programs Parenting and child development Parenting and child development

educationeducation Housing supportHousing support Education remediation and Education remediation and

supportsupport Employment readiness servicesEmployment readiness services Linkages with legal system and Linkages with legal system and

child welfare systemschild welfare systems Recovery community support Recovery community support

servicesservices

FOR CHILDRENFOR CHILDREN

Primary health care servicesPrimary health care services Onsite or healthy child careOnsite or healthy child care Recovery community Recovery community

support servicessupport services AdvocacyAdvocacy Educational servicesEducational services Recreational servicesRecreational services Prevention servicesPrevention services Mental health and Mental health and

remediation servicesremediation services

Community Support ServicesCommunity Support Services

TransportationTransportation Child careChild care Housing servicesHousing services Family strengtheningFamily strengthening Recovery community support servicesRecovery community support services Employer support servicesEmployer support services TANF linkagesTANF linkages Vocational and academic education servicesVocational and academic education services Faith based organization supportFaith based organization support Recovery managementRecovery management

Family Treatment – the Next Family Treatment – the Next EvolutionEvolution

Services for all family membersServices for all family members Addresses the relational needs of womenAddresses the relational needs of women Dynamic, different members come at Dynamic, different members come at

different timesdifferent times Continuum of family involvement to family Continuum of family involvement to family

treatmenttreatment Breaks the Inter-Generational CycleBreaks the Inter-Generational Cycle

Treatment Options Treatment Options Questions to ConsiderQuestions to Consider

Types of Services AvailableTypes of Services Available Is the treatment provider culturally Is the treatment provider culturally

appropriate? Gender responsive?appropriate? Gender responsive? Are children’s services provided?Are children’s services provided? Does the treatment provider use evidence-Does the treatment provider use evidence-

based practices? (motivation, contingency based practices? (motivation, contingency management, cognitive behavioral therapy, management, cognitive behavioral therapy, integrated co-occurring services, gender integrated co-occurring services, gender responsive)responsive)

Can we collaborate with the treatment Can we collaborate with the treatment provider?provider?

Required Ingredients for Required Ingredients for CollaborationCollaboration

Cross-Training and UnderstandingCross-Training and Understanding Common GoalCommon Goal Communication MechanismsCommunication Mechanisms Common LanguageCommon Language Identification of Common PrinciplesIdentification of Common Principles Respect and TrustRespect and Trust Daily PracticesDaily Practices EvaluationEvaluation AccountabilityAccountability

Sid Gardner & Nancy Young, Children & Family Futures

What Works in HousingWhat Works in Housing Individualized Services Tailored to Meet Needs of Each Individualized Services Tailored to Meet Needs of Each

Client/FamilyClient/Family Protecting the Safety and Integrity of the EnvironmentProtecting the Safety and Integrity of the Environment Property Management/Services Partnership in Supportive Property Management/Services Partnership in Supportive

HousingHousing Strengths Based Approaches and RespectStrengths Based Approaches and Respect Clarity on level of structureClarity on level of structure Community events in housing sites.Community events in housing sites. Close collaborations with substance use treatment Close collaborations with substance use treatment

agencies with compatible philosophiesagencies with compatible philosophies Recovery is a process not an event. On-going nature.Recovery is a process not an event. On-going nature.

Mandatory ParticipationRemoval if use alcohol

/drugs

No servicesHousing

only

Must participate in a service but

client decides what

service or objective

Mandatory Participation

In All Services Relapse

addressed

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

Voluntary/Mandatory Continuum

Least restrictive Most restrictive

The Werner Hartman Group, 2006