1. Promoting Recovery: Substance Use Treatment Services Presented By: Margo Spence, MS, LSW, LICDC

2. “ 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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