Best Practices Model Treatment Programs
ARC CENTER FOR WOMEN AND CHILDREN, ARC HEALTHY BEGINNINGS
ARC Center for Women and Children and ARC Healthy Beginnings in Madison are community-based, women specific AODA day treatment programs for adult women and their children. Awarded to ARC Community Services in 1989, ARC Center for Women and Children was a state demonstration pilot for the development of a comprehensive, innovative AODA treatment program specifically for women and their children, known as ACT 339, "Model Women's AODA Treatment Program." ARC Healthy Beginnings was funded as a Center for Substance Abuse Treatment (CSAT) Federal Demonstration Project and opened in 1994. ARC Healthy Beginnings provides AODA services to pregnant and postpartum women and their infants. At the close of Federal funding, the State of Wisconsin and Dane County Human Services picked up the funding and management.
Both projects received legislatively mandated independent three-year evaluations, which concluded:
"ARC has been successful in providing AODA treatment to women who are typically underserved."
"The goals are being met."
"The treatment model that the Center for Women and Children has developed should be replicated in order that women's treatment needs are adequately addressed."
"Given that our society places a high value on assisting families to stay together, funding for this type of program providing treatment within the family context must be a priority."
Both projects target Dane County addicted women and their children who are low income or unemployed, enrolled in W-2 or TANF eligible, and/or those at risk for abuse and neglect of their children and/or unable to access AODA services due to pregnancy or child care barrier.
ARC Center for Women & Children and ARC Health Beginnings have been developed around the "Self-in-Relation" model. Based on research from the Stone Center for Developmental Studies at Wellesley College, there is growing acknowledgment that the "self" of women is organized around making relationships and maintaining relationships. It is recognized that women (girls) are damaged in relationships and therefore heal within relationships. This places a heavy responsibility on the caregiver to pay attention to the relationship developed with clients as well as the curriculum and therapy. The way that the message is conveyed is just as important as the message itself. It also means that women are most successfully treated within the context of their significant relationships.
ARC Center for Women and Children provides licensed, comprehensive, wraparound, family-focused day treatment, intensive outpatient, and outpatient AODA services for adult women. A cognitive trauma response management component is offered throughout the programming to reduce relapse. Incorporated into the trauma response curriculum are anger management and grief services. Child and family therapy is offered to all women in order to begin to solve family issues that have come from the addiction of the mother. ARC has found that women's recovery must include their children because the role as a mother is critical to relapse prevention. To expect a woman substance abuser to be able to manage sobriety without receiving additional services and support for her parenting is both unrealistic and unfair. Wraparound services include case management, child care, parenting, transportation, and meals.
ARC Healthy Beginnings includes all of the above services with additional services to assist with pregnancy issues. ARC Community Services, Inc. is licensed as a Prenatal Care Coordination site by the State of Wisconsin. This provides for the coordination of transportation and medical appointments for eligible women. The services for pregnant women are flexible and span the pregnancy as well as four months postpartum. Pregnancy groups are facilitated by the Health Educator and include preparing for delivery, infant care, nutrition, and health assistance. The infants remain with their mothers in the treatment setting, thus enabling the parents to learn how to enhance the mother/child attachment.
These programs seek to address the barriers to service of AODA involved women including:
- Provision of on-site, licensed child care and/or community coordination;
- Interruption of the cycle of intergenerational addiction by providing direct AODA prevention/intervention services to the children of addicted women; and
- Provision of case management services to assist with the development or maintenance of a stable lifestyle, including food, clothing, shelter, and medical attention.
- Intake/Outreach Coordinator
- Masters Level AODA Therapists
- Wraparound Service Case Manager
- Child/Family Therapist
- Health Educator
- Therapeutic Daycare Staff
- Cultural Specialist Consultant
- Screening and Assessment
- Group Counseling
- Individual Counseling/Treatment Planning
- Family Counseling
- AODA Education and Relapse Prevention
- Trauma Response Education and Empowerment
- Anger Management
- Grief Services
- Exploration of Spirituality
- Vocational/Educational Work Readiness
- Health Education and Referral
- Wraparound Case Management
- Community Advocacy and Referral
- Prenatal/Postpartum/Infant Care and Health Education
- Housing Assistance
- HIV/AIDS and TB Testing
The majority of women entering treatment have significant deficits in their parenting skills, are at high risk for HIV/AIDS/TB, possess extensive histories of sexual, emotional, and physical abuse, and tend to live in high drug traffic and crime areas. The racial breakdown and success rates of the average woman are both 50% African American and 48% Caucasian with very small enrollment of other races. The average age is 34 with the span from 18 to over 40 years of age, 56% of the children are African American. The average number of children per mother is three with age range of the children from 0 to 8 years old. Approximately 50% of the children are in some form of care other than with their mothers.
ARC Services are designed to provide comprehensive, wraparound, family-focused, women-specific AODA treatment services.
ARC Center for Women & Children's Phase System provides flexible support for the different stages of recovery. Stabilization services are:
Phase 1 -- five days per week, 9:00 a.m. to 3:00 p.m. for six weeks
Phase 2 -- two days per week, 9:00 a.m. to 3:00 p.m. for four weeks
Phase 3 -- individually scheduled to coordinate with W-2 or work, minimum three weeks or until the client feels ready for less support with up to two years of aftercare.
ARC Healthy Beginnings develop flexible options for women to meet a wide range of needs and length of support required by a variety of individual health needs and prenatal and postpartum cycle at the time of admission. A woman may enter Healthy Beginnings at any time during pregnancy or even up to six months after the birth of her baby. Primary services are available five days a week, 9:00 a.m. to 3:00 p.m. for a minimum of four months.
ARC Healthy Beginnings coordinates and provides for health education with the staff nurse including prenatal and child well being coordination, childbirth education, infant care classes, nutrition, and child development.
Staff sensitive to issues related to domestic violence and other abuse.
Licensed on-site child care and/or coordination with community child care to provide safe care for children.
Child care with developmental testing, play therapy, and parent interaction.
AODA prevention/intervention programming for their children to help them understand their own feelings and learn about choices.
Parenting support and education that focuses on the importance of the parenting role to the recovery of the mother and child.
Cognitive trauma symptom management education to help women to develop choices in coping with abuse.
"Topic weeks" provide reinforcement of AODA and life skills education. These topics are delivered in varying methods and throughout all group opportunities to help women to absorb the information in a natural manner.
A therapeutic model that addresses a woman's unique needs and the importance of the role of relationships in healing.
Case management services to improve independent living skills to assist her in accessing the system of supports available within the community.
W-2 coordination to support her through changes involved in taking responsibility in the workforce.
Aftercare follow through to assist with the transition from using drugs to consistently making other choices and further addresses the social isolations of recovering women by keeping each woman connected with a support system during this stage of recovery.
Utilization of day treatment modality while allowing a woman to stay in the community with her children as well as enable her to bring her children into treatment with her. This modality also addresses the social isolation of addicted women as a key contributing factor to her dependency. Her isolation can also make it unsafe for her to identify any currently occurring domestic violence issues.
The provision of culturally sensitive programs is a priority of ARC Community Service, Inc. projects given that the target population includes those who experience oppression, because of gender, race, ethnicity, sexual orientation, and poverty or class. Services are developed as much as possible to respond in design, content, and staffing patterns to the values, belief systems, and behavioral patterns of the affected cultural groups. Cultural support groups are offered weekly to provide an environment for exploration of self. An African American consultant who specializes in cultural learning facilitates the African American support group. This group has the opportunity to experience recovery with women from an African American community without presence of the dominant culture. Also available is another group for enrolled women of other cultural backgrounds. This group explores the culture of being female, family, heritage, and holidays. Both groups provide the opportunity for exploration of relationships in the broader social context.
TRAUMA RESPONSE EDUCATION AND EMPOWERMENT (TREE)
TREE is a cognitive therapeutic curriculum addressing the array of trauma issues of addicted women. The clients served by ARC Community Services, Inc. usually have complicated life histories with multiple traumas that interfere significantly with the recovery process. The trauma effects are often dulled by the use of drugs with continued use or relapse becoming a woman's primary, although destructive, trauma response. In order to interfere with the continued use of drugs, women must learn healthier ways to responding to trauma symptoms. Another way problems with recovery and trauma present themselves is the belief that the trauma must be dealt with in order to recover. This can result in relapse for women who are without the coping skills to manage handling the traumatic memories directly. In both cases, containment and development of healthy coping skills is required as part of recovery. The cognitive approach to trauma has been successfully used to develop a trauma management base for recovery development.
WORKING WITH W-2
A relationship has been developed and built by ARC and the W-2 Program to assist women with the transition from welfare to work. In the supportive and friendly relationship that exists, our clients are able to adjust to the concept of taking responsibility through changing lifestyles. The relationship with W-2 is characterized by the following:
- Service agreement to provide AODA treatment for Dane County W-2 participants.
- FEPs make AODA referral for assessment.
- Assessments are also available on-site at the Dane County Job Center.
- Cross training between ARC Community Services, Inc. and the W-2 Program.
- ARC Community Services, Inc. provides education on self-esteem at W-2 orientation.
- ARC Community Services, Inc. coordinates hours for clients in W-2 Transition.
- ARC Community Services, Inc. provides coordinated case management services.
- ARC clients participate in "How To Get a State Job" workshop.
- New FEPs are given a tour of ARC Community Services, Inc. AODA facilities.
- Follow-up case management to assist in stability of AODA affected women for two years as they adjust to the work place (new in 2000).
- ARC Center for Women & Children and ARC Healthy Beginnings create safe places for women who are addicted and their children to receive AODA services. ARC also provides:
- Places that encourage recovery in a supportive manner while addressing the mother/child bond.
- Increased access to prenatal care and well child care in order to decrease birth complications.
- Enhance the mother's attachment and parenting support to assist in stopping the cycle of child abuse and neglect.
- Healthy family functioning and family intactness.
META HOUSE FAMILYWORKS PROGRAM
Integrated Services for Women with Substance Use Disorders Who are Being Assisted by: Wisconsin Works (W-2) & Child Welfare
Located in Milwaukee, Meta House has provided substance abuse treatment and related services to women in Milwaukee County for the past 36 years. In the 36 years that Meta House has been providing family focused, gender-specific treatment to women, the staff have learned that welfare assistance, child protection, and substance abuse treatment are disciplines that are intimately related and dependent upon each other for success. Employment and the ability to appropriately care for children have long been integral parts of substance abuse treatment at Meta House and have contributed heavily to the phenomenal success of this program.
Over the years, Meta House has developed a program that recognizes that the development of addictions is significantly defined by gender-role socialization. Women with substance use disorders differ from men in etiology, patterns, co-existing problems, consequences, and treatment experience. Utilizing a relational model of female ego development, programs have been developed that placed a strong emphasis on assisting women who are in recovery to consistently apply their treatment experience to every aspect of their lives. Since two important roles women play in society are that of caretaker and single or co-breadwinner, for themselves and their children, parenting and employment have become main focuses for the Meta House program.
With the introduction of welfare reform and a new child welfare system implemented by the State in Milwaukee County, Meta House has taken the next critical step in the development of treatment for women. A new program called FamilyWorks was implemented in May 1999. This expansion is an ambitious effort to achieve the effective transfer of the Meta House philosophy, approach, and competence that has been honed in the residential setting to provide a solid foundation for a new model of non-residential treatment. This model incorporates the best practices encouraged in the latest national research and the outcomes of a Meta House, five year evaluation that attends to the special needs of women, including: unique barriers to treatment, high prevalence of physical and sexual abuse and their impact on relapse, and critical treatment needs relating to poor health and nutrition, domestic violence, intervention for children, parenting, vocational training, and employment assistance. The Meta House evaluation tied the strength of a relational model of ego development, integration of services, cultural competence and family focus with extraordinary outcomes for sobriety, employment, family reunification, mental health and illegal activity.
FamilyWorks has two distinctive primary purposes. One is to develop a model for new, effective connections among substance abuse providers, welfare reform agencies and child welfare agencies. The second purpose is to fill the treatment gap for extremely high-risk women and children through the expansion of the existing, nationally recognized, Meta House program for substance-abusing women and their children. This unique expansion is a response to the recognition of the gap in access to substance abuse treatment as a barrier to success for W-2 participants and families served in the child welfare system. Meta House can now serve as a treatment bridge between W-2 and child welfare and expand its proven treatment program to provide a more flexible non-residential and residential program for substance abusing women engaged in these initiatives. Throughout the program women are provided with services that integrate the goals of child welfare and welfare reform with the goals of substance abuse treatment. The following are the objectives of the FamilyWorks program:
- Improvement in physical and mental health
- Improvement in the ability to stay alcohol and drug free
- Family Reunification or Intactness
- Improvement in social and/or spiritual support
- Resolution of family issues leading to child welfare involvement
- Improvement in family functioning
The FamilyWorks program is targeted to assist mothers who are in either W-2, the child welfare system, or both, and have a substance use disorder. The programming is designed to meet the needs of women who have many of the following characteristics:
- Lower socio-economic background
- Multiple rapes
- Live in metropolitan area that evidences poverty & fragmented families
- Poor nutrition
- Pregnant or some or all children in out-of home care
- Little to no medical or prenatal care
- Moderate to severe psychological problems
- Illiteracy or poor education
- Incest and molestation
- Few to no job skills
- Poor interpersonal relationships
- Poor physical health of self and children
FamilyWorks was specifically designed for mothers that are in either the W-2 system the child welfare system or both. Therefore, the majority of referrals come from these two systems. Referrals are made from other sources and if the potential client is involved in W-2 or child welfare she may be accepted into the FamilyWorks program.
The W-2 Connection
All Meta House programs have the philosophy that employment is crucial to health and long term recovery and that the incorporation of vocational services directly into the treatment program is, in and of itself, therapeutic.
The Meta House FamilyWorks program combines intensive day treatment with comprehensive case management, on-site child care, practical skills development, and multi-faceted and open-ended continuing care. Over the course of 12 months, the intensive portion of the program (four to six months), called the Intensive Family Care Phase, transitions to outpatient visits, called the Supportive Family Care Phase and finally to sustained participation in the Continuing Family Care Phase. When needed, a limited number of short-term residential beds are available. Consistent, one-on-one case management administered by the FamilyWorks staff is the thread that allows the principles of recovery to be woven into the entire fabric of the woman's life.
Intensive Family Care Phase
- 4 hours-day/5 days-week = 350 hours
- Chemical dependency education
- Group therapy/Process group
- Child care
- On-site psychologist/M.D. available
Supportive Family Care Phase
- Group therapy
- Individual sessions
- Child care
- Relapse prevention
Continuing Family Care Phase
- Recovery Group, Alumni Group
- Child care
- Relapse prevention
There is also short-term residential treatment capability.
- Life skills -- money management, health and wellness, nutrition education, community resources, legal services
- Parenting skills -- Nurturing Program, parent-child interaction, in-home parenting support
- Vocational skills -- job readiness, transitional employment (Step Industries, Inc), job placement and retention
Comprehensive Case Management
- Relocation to safe housing · Money management · Home visits
- Health care coordination · Parenting support · Crisis intervention
- Coordination with W-2, Child Welfare · Retention support · Relapse prevention support
The program model assumes that a full year of substantial treatment involvement is necessary for women to securely attach to a drug-free lifestyle. During this time, the need for intervention varies with intensive services required at the beginning and ideally tapering off through the year. Within this general framework, however, women receive the intensity of services required to effectively address their needs at the time -- regardless of whether their needs match the projected program model. Services are integrated and anchored in each woman's needs and strengths as they evolve over time.
The FamilyWorks program model has three primary components:
b) Skills Development, and
c) Comprehensive Case Management.
The three components are woven into an integrated, multidisciplinary holistic environment in which addicted women can easily accept help, help themselves, and ultimately, help each other. Tying all treatment, skills development and case management activities into a coherent package is the treatment contract (plan). This contract is developed, along with the liaisons from the W-2 and child welfare agencies.
Treatment at FamilyWorks offers a continuum of care that includes different levels of intensity or services, two time options, child care, meals and transportation, and random drug testing. Treatment is offered two times each day with one day and two evening groups. Women are able to move flexibly between tracks as their work schedules or other responsibilities change. The daily schedule includes:
Group therapy sessions
Chemical dependency education
Skills Development occurs on three levels: life skills, parenting skills, and vocational skills.
- Life Skills focuses on personal and family management issues, including money management and budgeting, health and wellness, nutrition, community resources and legal services.
- Parenting Skills utilizes "The Nurturing Program" and a parenting program designed specifically for recovering women. This skill training increases empathy so that women are more aware of their children's feelings and needs, increases self-esteem and self-concept, so mothers understand their own strengths and weaknesses and their appropriate role with their children, teaches alternatives to physical and verbal violence and increases awareness of developmental needs and characteristics of children.
- Vocational Skills development focuses on the acquisition of skills and work habits necessary to gain and retain employment. Services are provided to address specific occupational needs and capabilities based on substance abuse factors and an employability assessment, conducted as part of the treatment planning. Fundamental to this process is the agreement with the referring W-2 agency that participation in the FamilyWorks program is to be considered part of the individual's work requirement and that other work assignments (during non-treatment hours) will be coordinated by Meta House in cooperation with the W-2 agency staff.
- Basic skills remediation, focusing on basic employment-related language and math skills using computer-assisted educational instruction materials for adults; in-house MATC classroom for GED and HSG, literacy services, testing for general cognitive difficulties and learning disabilities
- Skills identification and development to encourage women to recognize their interests, talents and skills within the context of employability
- Job-seeking skills training, including preparing resumes and completing applications, interviewing skills, personal appearance, demeanor, and expectations for the process
- Work environment awareness of employer expectations, attendance, appearance, supervisors' roles, conflict resolution, and appropriate behavior on the job
- Managing stress and gaining self management skills
- Understanding the banking system and other relevant information for appropriate use of financial institutions
Job placement activities focuses on acquisition of jobs with the potential for stability and occupational growth. Meta House has established relationships with several employers and W-2 agencies that are willing to train and employ Meta House's clients. A Meta House staff person continues to function as the job coach for each woman, and liaison between the woman and her employer for as long as needed.
Comprehensive Case Management. Case management is FamilyWorks primary retention mechanism. The Meta House experience has shown that women stay in treatment when they can establish a primary relationship with a staff person. This stable and consistent relationship counters the chaotic internal and external lives of substance-abusing women and their families, providing a supportive influence as women transition to fully functional lives. Case management is extremely important in the non-residential context because women are often living in families and neighborhoods that can actively subvert treatment.
Each woman in the FamilyWorks program has a Case Manager. The Case Manager is the key person on the treatment team throughout her involvement with the program. This is the point person for all service coordination, problem solving, crisis intervention, and retention and relapse prevention. Case management services are provided at the program site and through regular home visits. Initially, the Case Manager assists with basic needs and establishing safe, affordable housing as the first priority for women who are living in a dangerous environment. Meta House uses either its own transitional housing program or longstanding relationships with other transitional living programs and private landlords to insure safe housing.
The Case Managers establish working relationships with the two primary referral systems: W-2 and child welfare. They become the liaison to the W-2 and Child Welfare systems and the myriad of other systems involved with the woman and her family. In addition to these specific services, the Case Managers, along with the AODA Counselors, provide ongoing in-home support, encouragement, and mentoring to reinforce parenting skills, life skills, and retention in treatment. Bi-weekly home visits occur for four to six months and monthly visits thereafter, as needed. The home visits are the primary mechanism for the early determination of environmental problems, following up on absences from the program, and coaching women as they develop new coping skills. Home visits are critical to the replication of the close, caring, home-based relationships between clients and staff that have contributed to Meta House's residential program success.
The FamilyWorks program also includes on-site child care while mothers are in treatment or participating in other program activities. A welcoming, nurturing environment includes opportunities for the development of motor skills, language, creative expression, and cognitive and social growth. All children are screened for developmental growth and referred if professional intervention is needed.
Transportation and Meals are provided as needed to assist her with her participation in FamilyWorks and employment. Meals are provided to women and children in the program.
Random Drug Testing is used to inform and support the therapeutic process. Drug tests are conducted at the discretion of the treatment team and results are used to improve treatment efforts.
ST. CLARE CENTER
HISTORY AND PHILOSOPHY
Located in Baraboo, St. Clare Center Bio-Behavioral Health Services began at St. Clare Hospital and Health Services in 1986. The major components of our model for the treatment of substance addiction have developed incrementally over the intervening 13 years into a comprehensive system of modalities, techniques, and literally, location of service. St. Clare Center's primary service area in southwestern Wisconsin encompasses approximately 7,500 square miles, with a population density average of less than fifty people per square mile.
St. Clare Center addresses substance addiction as a biological phenomenon -- a disease -- that is strongly influenced by psychological, social, and more often than not, hereditary factors. Our role is to utilize the best-established research on addiction and recovery to assist patients in developing the motivation, knowledge, and skills, to accept and address these "bio-psycho-social" factors in their lives and in developing an individualized plan for their ongoing self care and support.
EFFECTIVE TECHNIQUES FOR RECOVERY
AODA treatment has been, until recently, a paraprofessional field primarily due to a lack of research and outcome data. Services largely consisted of 12-step programming and a variety of personal techniques that individuals and programs "hoped would work." While the enormous body of anecdotal and now empirical information suggests that 12-step facilitation is highly effective, outcome research has not supported many "sacred cows" of the past. For example, self-esteem building has been shown to have little effect in prevention or treatment and a few studies suggest that students completing programs that focus solely on building self-esteem are slightly more likely to use drugs.
It has been the goal of St. Clare Center to provide professional healthcare services for addictions -- "care pathways" that are based on well-replicated outcome data and best practices, like any other area of healthcare. St. Clare Center's system programming is designed around four key elements demonstrated to be effective in addictions treatment:
- Motivational Enhancement which blends two primary techniques:
- Motivational interviewing strategies seek to "meet the patient where they are" and progressively build on existing and emergent strengths -- we view motivating the patient to recovery as our responsibility.
- St. Clare Center marries a variety of cognitive-behavioral strategies, including Rational-Emotive Behavioral Therapy, "corrective thinking" protocols, and 12-step philosophy. This education and experiential model facilitates patients making changes in their belief, thought, and coping systems. The goal is positive change in behavior and, yes, self-esteem.
MENU OF SERVICES
The St. Clare Center Model provides all four Wisconsin Uniform Placement Criteria (WI-UPC) levels for substance abuse services, and facilitates an individual patient's entering of treatment at the level appropriate to their needs and moving to a less-restrictive level of care as quickly at the patient's recovery goals are met. These levels of care include:
- Level 4 Detoxification Services are medically managed and available on the medical/surgical floors at St. Clare Hospital.
- Level 3 Residential Treatment is provided on the St. Clare Center unit of the hospital. This is a medically supervised inpatient-type setting allowing for limited medial evaluation and 24-hour a day care in a controlled environment. Services are provided seven days a week with special focus on intensive diagnostic and therapeutic work and family issues on Sunday and Wednesday. Staffing includes:
- Supervision by a physician who is a certified addictionologist.
- A daytime registered nurse providing nursing services; "off-hour" medication, nursing, and emergency services are provided by other hospital units.
- Three certified alcohol/drug counselors and at least on intern providing case management, and counseling in staggered shifts so that at least two are on duty at any given time.
- Family services and further diagnostic work facilitated by a masters-level psychotherapist.
- An intake specialist providing alcohol/drug evaluations and admissions services, often in concert with nursing, referring patients to the appropriate level of care.
- A Ph.D. psychologist who attends regular patient staffings and provides psychometric testing and further diagnostic services.
- 24 hour coverage by specially trained patient care assistants.
- Supervision of admissions, treatment planning, and program facilitation by the clinical supervisor for addiction services.
This staffing pattern and the location within a well-equipped community general hospital allows Level 3 service to provide a high level of care and availability of medical and other services including those for handicapped patients, the elderly, and individuals with medical problems needing ongoing monitoring.
- Level 2 Day Treatment Services and the "hotel stay" option. Day treatment service is "piggy-backed" on the residential program and offered seven days per week. Features include:
- Case management by a certified alcohol/drug counselor and case staffing by the multi-disciplinary team as described earlier.
- Morning and afternoon "blocks" of educational, group, and individual primary treatment services. Patients are scheduled for between four and fourteen "blocks" according to the individual treatment, family, work, child care, and other needs. For example, one patient may be treated all day Saturday and Sunday, then come in only in the morning on certain weekdays.
- Some patients may require only Level 2 Day Treatment Services, but live a prohibitive distance from the primary treatment site in Baraboo. The "hotel stay" option allows these patients to purchase room and board at St. Clare Hospital for a nominal fee, receive services of the appropriate intensity at the hospital, and attend sessions on intervening days at their local clinic.
- Level 1 Outpatient Clinics are located in New Lisbon, Lancaster, Richland Center, and Baraboo (a separate site from the hospital.) Aftercare, psychotherapy, and primary substance abuse/addiction services are available for patients less impaired by bio-psycho-social issues at these clinics. Each clinic provides:
- Abuse/addiction services by a certified alcohol/drug counselor, supervised by the clinical supervisor.
- Mental health evaluation and psychotherapy by a master-level therapist, under the supervision of a psychiatrist (the Richland Center Clinic has an on-site psychiatrist.)
- Outreach, primary prevention, and other services. Each clinic provides slightly different programming based on the needs of the communities they serve.
- Immediate access to and coordination of services with the primary treatment services in Baraboo. Each clinic acts as a local "feeder" to higher levels of care, while providing convenient, local transitional services in the patient's home area.
Intrinsic to the St. Clare Center Model is its flexibility in matching patients with the level of care appropriate to their individual needs. Patients have the ability to move to a less or more intensive level of care or regimen of services within a particular level of care as they progress in treatment or issues emerge. This is facilitated by ongoing patient assessment throughout the system, and results in patients receiving only the level of services that they require -- and the maximization of their health care benefits.
For purposes of illustration, the following is more or less "typical" experience of an addictions patient through the menu of services at St. Clare Center.
Evaluated by alcohol/drug counselor at New Lisbon clinic. Evaluation suggests need for Level 4 detoxification. Patient referred to St. Clare Hospital, Baraboo, the same day. Evaluated by nursing staff and intake specialist who concur. Admitted to Level 4 detoxification on 3 West Med/Surg unit.
Patient assessed as medically stable, but in need of 24 hour monitoring due to relapse risk and unstable home situation. Transferred to Level 3 Residential Treatment.
Relapse risk assessed as reduced, home situation stabilized somewhat following Family Day activities (family referred to psychotherapy at New Lisbon clinic). 24 hour monitoring no longer necessary but patient continues to need primary care. Transferred to Level 2 Day Treatment to attend morning sessions on weekdays and all day Saturday and Sunday. Review regimen as goals are met.
Significant progress noted in meeting goals and developing a sober support system; has secured a 12 step sponsor in New Lisbon. Patient will continue in Day Treatment, attending Saturday and Sunday all day on August 7-8 and 14-15, and also individual sessions on intervening Wednesdays.
Patient assessed as having met Day Treatment goals, relapse potential significantly reduced. Possible symptoms of adult Attention Deficit Disorder have been noted by the family therapist; and, recommendation for evaluation is noted on the continuing care plan. Patient is discharged from Day Treatment, and referred to aftercare services at the New Lisbon clinic.
Patient begins weekly aftercare group, individual counseling sessions are held monthly and as necessary. Continues with 12-step groups. Family continues with psychotherapy; conjoint sessions as necessary.
Patient is evaluated for Attention Deficit Disorder by New Lisbon psychotherapist, begins treatment for the same.
Discharged from addictions services.
MILWAUKEE WOMEN'S CENTER, INC.
Where hope begins and abuse ends.
The mission of the Milwaukee Women's Center (MWC) is to research, develop and administer programs to end abuse. For nearly twenty years, MWC has provided high-quality research, prevention, intervention and support services in the areas of family violence, homelessness, alcohol and drug abuse, mental health, poverty, and maternal child health problems. MWC celebrates diversity, fosters creativity and helps strengthen families to end abuse.
Based in Milwaukee, Wisconsin, the Milwaukee Women's Center, Inc. was founded in 1980 as a private, non-profit, women and minority governed organization. The first program initiated by the agency was an emergency shelter for women and children who were victims of family violence. As more women and children entered shelter, it became apparent over time that these women and their families were in need of services that extended beyond just temporary shelter. These needs included victim support groups, substance abuse and mental health counseling/treatment, parenting classes, and children's programming.
In 1987, MWC developed and implemented integrated services for women and children affected by violent relationships, substance abuse, and mental health issues. After screening for short- and long-term treatment needs, outcomes indicated that 40% of women in MWC's shelter entered with substance abuse issues. Today, the shelter provides support groups and comprehensive programming for substance abuse and family violence issues. Additional programs for children in shelter are also provided and are designed to educate them about self-protective behavior, healthy lifestyle choices, and resources available in the community.
In 1989, the Wisconsin Act 122s.46.48(19), titled "Multi-disciplinary Prevention and Treatment Team for Cocaine Families" provided $1,050,000 for a "multi-disciplinary prevention and treatment team in Milwaukee County for cocaine abusing women and their children." MWC was awarded this grant and initiated POWER (Positive Options for Women Entering Recovery) in 1990.
POWER -- (Positive Options for Women Entering Recovery)
POWER is an integrated service delivery system designed to meet and treat the specific needs of culturally diverse women. The program was created in response to the lack of services that integrated alcohol and drug abuse, domestic violence, and mental health programming while utilizing a women-sensitive and race-sensitive treatment approach.
The primary population of consumers are single mothers and pregnant women, between the ages of 18 and 55, and their families living in poverty who have a current or recent history of family/intimate violence, cocaine abuse and/or other drug or alcohol addiction and/or mental health issues. In 1998, approximately 70% of consumers were African-American, 20% Caucasian, 5% were Hispanic/Latino and 5% the ethnic heritage was unknown. Each woman served had an average of 3 children. The non-custodial parent of the women's children is usually engaged in the treatment process and offered services in case management, treatment, parenting and/or abuser treatment.
HOME AND COMMUNITY BASED CASE MANAGEMENT AND TREATMENT MODEL
The POWER program is a multi-disciplinary, case management and integrated substance abuse and mental health treatment model. POWER is a non-institutionalized model of service delivery that operates in the homes, neighborhoods and communities of consumers. Through short- and long-term case management and treatment, the program addresses the barriers that prevent women from succeeding in traditional alcohol and other drug abuse (AODA) treatment programs.
METHODS OF POWER INCLUDE:
A multi-disciplinary focus:
- Access to expert professionals in medical, social services, childcare, and substance abuse fields.
- Establishing relationships with managed care and HMO providers.
- Case managers establish relationships with other key professionals in external systems where women are involved (e.g. welfare reform and child welfare agencies, probation and parole, and medical practitioners).
- Continuum of care for each client/family that includes comprehensive wrap-around services located at the Milwaukee Women's Center, Inc. and with MWC's preferred providers and collaborators.
Home- and community-based case management services
- Access to alliances and support networks within the community to help foster goal attainment.
- Use of home-based services to women and children in their own environment.
- Access to community resources including emergency food, clothing, housing, and energy assistance.
- Focus on prenatal care, infant care, and parenting skills.
- Developing individualized treatment plans around the participant's individual needs and circumstances.
- Using a consumer advocacy approach that encourages each client to set her own goals and build on her strengths.
- Working with the family of each client to build the client's kinship network which can be a key resource for her recovery.
GOAL OF POWER
To provide comprehensive and integrated case management and treatment services to women and families that promotes healthy individual lifestyles and builds strong, productive families.
OBJECTIVES OF POWER
- To provide home and community based case management services to promote healthy women/mothers who are better able to care for their own health and that of their born and/or unborn children.
- To maintain and increase the level of broad-based community support and collaboration to enhance client success through appropriate and accessible resources.
- To recruit, maintain, train, and support a highly qualified and diverse workforce.
- To work closely with MWC's child welfare subsidiary Innovative Family Partnerships, Inc. in integrating POWER services into child welfare treatment and permanency planning.
- To integrate government, Medicaid, and private funding on behalf of POWER families.
- To provide gender and culturally competent mental health, alcohol and drug abuse treatment.
- To promote self-sufficiency and economic growth through employment and education.
POWER IN ACTION
A client example
Substance abuse creates a host of barriers and challenges to building healthy families, gaining and retaining employment, and moving towards economic self-sufficiency. A young mother of three entered the program in 1996 at age 23. She was pregnant, unemployed, homeless, very insecure and lacked support from family or friends. She struggled with issues of childhood abandonment and physical, mental, and emotional abuse. After fully engaging in the comprehensive case management program and building a strong relationship of support and trust with her case manager, she 1) located independent housing, 2) was able to meet all court requirements for reunification for her three children who had been in foster care for over a year, 3) gave birth to a drug-free baby, 4) stayed sober and free from relapse, 5) increased her self-esteem and enrolled in a GED program. She was discharged in 1998 and today lives with all her children, is employed full-time, and leads a productive and drug free life.
MWC believes, as an agency as well as throughout all levels of case management, that it is essential to develop alliances and support networks within the community that help to foster the attainment of POWER's goals. MWC has a network that extends from shelter care for homeless clients to outpatient treatment (mental health and alcohol/drug abuse) to residential family services. Case managers have established and maintained alliances with many agencies to acquire access to this range of services including child care and transportation services. The following agencies provide training, education, and collaborative services to POWER program staff and their clients:
- EFNEP (Extension Food and Nutrition Education Program) educates POWER clients on nutritional well being.
- Planned Parenthood provides education and training on sexuality/parenting and planned pregnancies.
- Wisconsin Department of Health and Family Services provides information on sexually transmitted diseases and communicable disease such as tuberculosis, and provides follow up with counselors on client participation.
- Milwaukee Police Department donates furniture, clothing, and toys for POWER families.
- Division of Probation and Parole provides follow up with counselors on client participation.
- New Concepts/Foster Care Program provides follow-up with client participation.
- La Causa offers satellite program foster care and crisis intervention day care.
- Meta House offers residential AODA treatment for clients and families.
- Crossroads offers residential treatment for single clients.
- YWCA offers transitional residence for clients leaving emergency shelter.
- Hope House offers shelter accommodations for homeless clients.
- Hospitals such as Sinai Samaritan-Women's Assessment and Northwest General for AODA Services.
- Community Advocates offer temporary transitional residence for clients.
- UW-Extension provides educational programs for clients.
- AIDS Resource Center of Wisconsin provides HIV/sex education for clients.
Internal wrap-around services
At the Milwaukee Women's Center, Inc., POWER clients have access to a comprehensive array of services to meet their individual needs. These services include:
- 24-hour emergency shelter and supportive services for women and their children who are victims of family violence,
- Mental health and AODA counseling services at the Behavioral Health Clinic, and,
- Home-based assessment and intervention services for developmentally delayed or disabled infants and toddlers through the Birth-to-Three program.
The program staff receives supervision and consultation with the agency's medical director and Behavior Health Clinic director. Team case management is conducted with appropriate staff members according to the needs of the POWER families.
Connection to external systems
The Director of POWER regularly meets with state and other local providers, W-2 sites, the Milwaukee Bureau of Child Welfare, and Probation and Parole. The meetings provide the opportunity for advocacy on behalf of POWER clients and the ability to further increase client access to services and treatment. In turn, representatives from larger systems can receive current information and feedback on the needs of these women and families.
In terms of cross-collaboration, W-2 agencies and other service providers in the community can receive the following services at MWC to assist their clients with substance abuse and family violence prevention:
- AODA and mental health screens,
- AODA counseling and mental health therapy,
- Case management services,
- Family counseling,
- Batterer's treatment, and
- Other support group services (i.e. parenting, domestic violence education, sexual education, family dynamics, etc.).
EVALUATION OF POWER
In 1992 the University of Wisconsin-Milwaukee, Center for Addiction and Behavioral Health Research was hired by the Milwaukee Women's Center, Inc. to evaluate the POWER model. Results indicated that case management services were essential with this population of women and children. Based upon the multiple diagnoses of depression, personality disorders, schizophrenia, paranoia and/or other problems among the all the women in POWER, that stemmed from abuse, neglect, sexual assault, and AODA problems, the evaluation results made a strong case that an integrated model of service delivery was necessary and successful for these women and children.
POWER continues to be evaluated in an ongoing manner through the use of client feedback surveys, managed information systems and quarterly program reports. The retention, length of sobriety, and positive outcomes of women and children in the program reflect the strength of the model. The computerized management information system provides information on services delivered, length of stay in program, and other program statistics that support program activity. The quantifiable data is then generated and monitored on a quarterly basis by program reports.
Each quarter, through staff evaluation and client feedback survey data, program strengths and weaknesses are identified in order to determine innovative solutions to address key problem areas. The Program Director is responsible for consultation with the President/CEO and implementation of program changes to alleviate problem areas.
In preparation for 2000, POWER will:
- continue to refine the outcomes based performance measures,
- receive any training and/or guidance offered by the Wisconsin Bureau of Substance Abuse Services regarding outcome measurements,
- monitor client progress and outcomes related to foster care, employment, education, discharge status, and other effective methods for measuring quality of service delivery, and
- collect additional follow-up data on client outcomes after discharge.