What Works for Women in Recovery

Transcription

1 What Works for Women in Recovery Minnesota Department of Human Services: Alcohol & Drug Abuse Division Wilder Research Objectives Understand major findings and successful outcomes Share information about challenges and pitfalls of providing case management Identify real-life experiences Workshop Format Part One Initiative Overview Evaluation Findings Provider Panel, part 1 Table Discussion and report back Part Two Participant Panel Summary of Outcomes Provider Panel, part 2 Table Discussion and report back Sustainability and Moving Forward 1

2 Perspectives and Voices Treatment providers Residential providers Metro area Greater Minnesota County-level Tribal-level Consumer voice The DHS ADAD Women s Recovery Services initiative 5-year grant: July 2011 June 2016 Goal is to improve treatment support and recovery Grantees provide comprehensive, genderspecific services to pregnant or parenting women with substance use disorders Currently 10 grantees statewide (5 metro, 5 greater MN) Background We know that women... Have higher levels of pain, loss, and trauma, especially early childhood and intimate trauma -Higher levels of anxiety and depressive disorders -More social restrictions on behavior and choices, and a strong sense of lack of power 2

3 Women experience... Domestic violence and danger from family members if they seek help Higher levels of involvement in the sex industry The tendency to turn to drugs or alcohol after a serious loss Greater negative impact of drugs and alcohol on their bodies Women s Recovery Services Initiative: Overview Complex physical health care issues can raise women s vulnerability to drug and alcohol use Enormous impact of drug and alcohol use on women s health care needs Caregiving responsibilities make it difficult for women to seek or stay in treatment or recovery Challenges for children whose mothers are addicted Women s Recovery Services Initiative: Overview High value on relationships, a value not always respected in traditional service models Sexual harassment and exploitation in treatment and recovery support settings Re-traumatization through harsh, confrontational, treatment practices Most recovery groups created around the needs of men 3

4 Barriers to Treatment Lack of childcare/transportation/health insurance/finances; drug-abusing partner; lack of support; we also know that Mid-life / older women are the largest consumers of prescription benzos, pain meds, antidepressants Shame and stigma are still more prevalent for female addicts/alcoholics Suicide rates are higher for female substance abusers than the general population (4x) The DHS ADAD Women s Recovery Services Initiative WRS grantees provide gender-specific, integrated and collaborative, family-centered treatment support and recovery services for pregnant and parenting women with substance use disorders WRS grantees serve a very high-risk population and include services and supports related to treatment and recovery, basic needs and daily living, mental and physical health, and parenting. The goal is to improve women s treatment access, treatment completion and increased involvement in post-treatment recovery and recovery maintenance activities. Evaluation Findings Wilder Research Michelle Gerrard, Monica Idzelis Rothe, Jackie Aman, Darcie Thomsen 4

5 Wilder Research Women s Recovery Services initiative: What works? What makes a difference? Wilder Research October 28, 2015 The Grantees American Indian Family Center Fond du Lac Reservation St. Cloud Hospital Recovery Plus Wayside House Meeker-McLeod-Sibley Community Health Services Ramsey County Community Human Services RESOURCE, Inc. St. Stephen s Human Services Hope House of Itasca County Description of clients 954 clients and 1,932 children served in year 3 At intake: 50% White, 26% American Indian, 14% Black 5% Hispanic ethnicity Most (78%) between the ages of Two-thirds (68%) had at least a high school diploma or GED 1 in 8 employed full-time or part-time Just under one-third (29%) pregnant 5

6 Client chemical use 30-days prior to intake 44% Alcohol (45%) Marijuana (42%) Meth (37%) 56% Used alcohol or drugs NOT used alcohol or drugs General health and well-being at intake One-third (33%) had chronic physical or cognitive health issues Three-quarters (75%) had at least one mental health diagnosis Most (93%) at or below federal poverty line Four in ten (41%) involved in Child Protection Nearly half (46%) involved in criminal justice system Length and amount of participation Program participation: Range: <1 to 30 months Average among all clients: 5 months Contact with program staff: 64 contacts (77 hours) on average 89% had at least one in-person contact per month 6

7 Services offered At least three quarters (74%) of clients had needs related to: Substance use support Mental health/counseling services Parenting education Transportation Treatment Physical health/medical care Healthy relationship support Services used and found to be most helpful Yes, program No, but client No, and client Percentage who felt helped with needed this did not need this was most this type of help this type of helpful to them or Did the program help the client help children (N= ) Get or stay sober 82% 12% 6% 36% Find a support network of people who could help them stay sober 68% 19% 14% 5% With parenting 74% 11% 15% 11% With things like housing, transportation, or paying bills 50% 31% 19% 9% With getting benefits like MFIP or WIC 46% 12% 42% 4% By just being there to provide emotional support or encouragement 83% 12% 4% 35% Wilder Research Key findings to date 7

8 Improvements while in the program Compared to program entry, when clients left the program, they were: Less likely to be using substances (28% vs. 57%) More likely to be in AA/NA (81% vs. 50%) More likely to be employed (22% vs. 14%) More likely to be housed (90% vs. 81%) More likely to have housing that was supportive to their recovery (74% vs. 63%) Improvements while in the program More likely to have medical insurance (99% vs. 89%) and a primary care physician or clinic (94% vs. 77%) More stable overall 1 (scores moved from being a stressor to a mild strength) There were no changes in: Use of tobacco (86% vs. 83%) Involvement with child protection (39% vs. 41%) Involvement in criminal justice system (51% vs. 49%) 1 Stability was assessed using the Strengths and Stressors assessment, in which staff rate the extent to which various factors are a strength or stressor for clients. Changes in outcomes over time 100% 80% 60% 85% 62% 96% 73% 47% 97% 69% Used substances in past 30 days (N=117) In AA/NA (N=131) 40% 20% 0% 36% 43% 22% 15% 10% Intake Closing 6-mo follow-up In housing (N=124) Employed (N=106) 8

9 Changes over time (cont.) 100% Proportion who identified each factor as a strength 80% 60% 40% 20% 0% 54% 49% 49% 49% 31% 36% 26% 26% 21% 17% 10% 5% Intake Closing 6-mo follow-up Housing stability (N=39) Income/employment (N=42) Physical health (N=39) Mental health (N=39) Impact of service intensity or dosage Do outcomes differ based on the amount or intensity of service clients received? Clients were defined as receiving a high or low dosage of service based on the following criteria: Criteria High dosage Low dosage Length of program participation 90 days or more Less than 90 days Total contact hours with staff 40 hours or more Less than 40 hours Total in-person hours with staff 12 hours or more Less than 12 hours Outcomes impacted by dosage Outcome N High dosage Low dosage No substance use in past 30 days at closing % 65%* Reduced or no substance us in past 30 days at closing % 84%*** Not involved with Child Protection at closing % 48%*** Employed at closing % 8%*** Negative toxicology for infant at birth 71 81% 50%* In housing at closing % 83%* Family stability improved at closing % 46%* Differences are statistically significant at: *p<.05, **p<.01, and ***p<

10 Perceived well-being at follow-up (Compared to before you started the program), would you say your Better now 6-month follow-up (N=59) About the same now Worse now Better now 12-month follow-up (N= ) About the same now Relationships with friends/family 67% 25% 7% 54% 39% 7% Financial situation 57% 23% 19% 60% 22% 19% Employment situation 46% 45% 9% 38% 52% 10% Living situation 71% 20% 9% 77% 15% 8% Physical health 60% 27% 13% 51% 20% 29% Mental/emotional health 69% 17% 14% 61% 22% 17% Worse now Motivation for sobriety What would you say is the one thing that most motivates you to stay sober? My children the most common response Taking care of my kids providing them with a stable home. Not being like my mom. I want to be there for them when they need me. My mother left me in foster care and that really sucked, so I want them to feel that they are loved and wanted by me. They are the most important thing for me in this world. My children just being able to interact with them. Seeing how happy they are when I am sober. My children, my health because [my children] look up to mommy to be there. Everything don t work if you are using. I feel much better and look much better when I am clean. Overall program satisfaction: 6 month follow-up (N=145) 8% 6% 44% 41% Very satisfied Satisfied Dissatisfied Very dissatisfied 10

11 The cost-benefit of the Women s Recovery Services initiative Return on Investment to taxpayers Millions Total benefits for society $5.9 Program costs $4.8 Benefits minus costs $1.1 ROI for society 1.22 ***The Women s Recovery grant makes economic sense. Provider Panel: About Our Program Wayside House: Karina Forrest-Perkins, Executive Director Ramsey County-Mothers First: Laura Phillips, Program Supervisor Fond Du Lac Tagwii Plus: Kari Stroik, Program Coordinator Fond du Lac Tagwii Plus Comprehensive genderspecific services for pregnant or parenting American Indian women with substance use disorders. Service area: Carlton and southern St. Louis counties (including Duluth, Cloquet, Brookston, and Sawyer). Recovery Coach Model Help overcome personal and environmental obstacles to recovery Link the newly recovering person to the recovery community Serve as a personal guide and mentor in the management of personal and family recovery 11

12 Ramsey County Community Human Services Mothers First Program A community-based program housed within the Family and Children s Services Division of Ramsey County, located in the inner-city. Service model: home-based that utilizes a case management model in providing prenatal and postpartum intervention and treatment to substance abusing mothers and their children. Serves women who are pregnant and/or parenting, in treatment, recently out of treatment, or want to go to treatment who live in Ramsey County and outlying areas. The program receives all mandated reports and other referrals for prenatal exposure to drugs and/or alcohol within Ramsey County Wayside House Inc. Rise Up In Recovery Treatment center Provides residential and nonresidential treatment services devoted to the genderspecific needs of women and recovery maintenance 18 year or older, support under 4 programs: pregnant or parenting Wayside House Women s and who are either Treatment Center, Wayside currently receiving House Family Treatment Center, chemical dependency Wayside House Supportive treatment services, or are Housing Program, Wayside in early recovery. House Main Street Collaborative, and Wayside House Outpatient Treatment Program. Provider Panel Discussion: About Our Program 1. How do you engage women to participate in this type of intensive case management? How do you retain them and help them stick with it? 2. What does case management and recovery support look like at your agency? What is the role of the recovery coach? How do you partner with providers in mental health, physical health, and CD treatment? 3. What services and support do you think make the most difference for your clients? What are you most proud of about your program model? 12

13 For discussion at your table What services and supports have made the most difference for the clients in YOUR program? What are the reasons behind their success? Participant Panel: Our Experiences Wayside House, Ramsey County-Mothers First, and Fond Du Lac Program Participant Panel Discussion 1. What services and supports have made the most difference for you? 2. What motivated you to get sober? What helps you stay sober? What helps you work toward other goals in your life? 3. What barriers did you face in getting sober? What services did you need that you could not access? 13

14 Summary of Outcomes: Challenges to the work Wilder Research Wilder Research What makes this work hard Client challenges 6-months after closing Increase in substance use in past 30 days from closing (15%) to 6-month follow-up (43%) Decrease in physical health as a strength from closing (54%) to 6-month follow-up (26%) No change in system involvement (between 24-42% involved in child protection, criminal justice system at any time point) 14

15 Select outcomes at follow-up Outcome 6-month follow-up (N=145) 12-month follow-up (N=59) Used substances since leaving program 46% 56% Entered treatment 22% 29% In own apartment/house 43% 64% Employed (FT/PT) 38% 29% Involved in criminal justice system 36% 32% Has mental health concerns 57% 66% A child has been removed from care (of those involved in child protection) A child has been reunited with client (of those involved in child protection) 38% 54% 50% 17% Implications for case management Relationships are important The intensity of services (dosage) makes a difference There is a need for continued focus on sobriety after case closing (e.g., aftercare services) Provider Panel Discussion: Challenges and Lessons Learned 1. How do you serve the most difficult clients? When is it time to close clients who are not ready? 2. What program level service do you feel you do not have enough of, or wish you could offer? 3. What is the one system level challenge that if addressed would make the most difference for clients? 15

16 For discussion at your table What has made this work hard in YOUR program? What are the key challenges? Sustaining this work and Moving Forward We ve learned that programs benefit from... Trauma-informed approaches that protect safety and avoid causing more trauma Approaches that mix trauma treatment and addiction services Assessment and treatment of depression, anxiety, and other conditions Strength-based approaches that focus on choice, empowerment, and recovery capital Sustaining this work and Moving Forward Comprehensive evaluation DHS Framework for the Future Dashboard Measures Continuum of Care/Recovery Oriented Systems of Care (ROSC) Recovery Community Organizations in Minnesota Minnesota Recovery Connection (Metro area) recovery is happening (Rochester, southern Minnesota) re-group (Moorhead, northern Minnesota) 16

17 Sustaining this work and Moving Forward: Policy Directions Evidence-based and person-centered care that is high quality. The goal: comprehensive models that are genderresponsive, trauma-informed, that treat the whole family, not just the woman. Overall outcome: Healthy women, children, and families. Next Steps... Next Women s Recovery Services grant cycle: July 2016 June Priorities and Partnerships: Prenatal Substance Abuse Summit For more information about the evaluation findings, go to: 17

18 Questions? Comments Thanks very much for all your great work! 18