Children, Families & Substance Abuse Impact and Treatment

1. Children, Families & Substance Abuse Impact and Treatment

2. Specialized Female Treatment Services • DSHS must spend 13.9 million on specialized female services to include: • Gender specific counseling for relationship issues. • Reproductive health education & care. • Perinatal service support. • Childcare. • Transport.

3. Pregnant, Post-Partum Intervention (PPI) Programs • Based in perinatal clinics, WIC sites, CPS offices: • Provide intervention services for women at risk for substance abuse. • Risk factors: teen pregnant, resident with substance abuser, past or present use of the client, domestic violence, mental health problems or other significant indicator of need.

4. PPI Services • Education on the effects of alcohol, tobacco & other drugs on the fetus. • Problem identification and referral. • Parenting education. • Alternative activities to promote child well being and family bonds • Referral for substance abuse, domestic violence and mental health services.

5. Specialized Female Services • Pregnant adult & adolescent women and women, adult & adolescent, who have dependent children including those whose children are in foster care. • Women meeting these criteria are a priority population for access to treatment.

6. HIV Related Required Services • Priority population adult & adolescent women must be provided: • Education & service referral for infectious diseases including: • HIV • Other STD’s • TB

7. But… • DSHS substance abuse programs cannot require women to reveal test results or current HIV status • HIV information & education is often male oriented in content, lacking in adequate detail and does not include information about HIV and pregnancy

8. Yet in FY05 • DSHS funded substance abuse specialized female programs served: • 459 pregnant women entered residential substance abuse treatment. • 424 pregnant women entered outpatient treatment.

9. And? • We have no information to show that these pregnant clients received: • HIV counseling & referral • Education on HIV and pregnancy • Pregnancy related HIV treatment

10. Nor can we show that • Children born to pregnant women in substance abuse treatment are HIV –.

11. CLINICAL PROFILE OF ADULT & ADOLESCENT FEMALE CLIENTS • 50-75% history of sexual, emotional & physical abuse from early childhood • 50-85% have abuse related PTSD & associated depression • Pattern of multiple drug use • Lack of basic medical and prenatal care • Family history of ATOD abuse • Impoverished & unstable living environment • Partners who are addicted • Poor or few educational/vocational skills • Poor self-esteem, guilt, shame • Children vulnerable to developmental, behavioral & emotional problems

12. Please note: Research shows: • Women WILL NOT engage in treatment unless & until they feel that they AND their children are safe • Safety, childcare and transportation are the three major access, engagement & retention barriers cited by women

13. Other key points • Treatment must be trauma informed. • Needs of all family members must be addressed. • Close coordination key to outcomes. • Services must address: • domestic violence • mental health • housing • employment

14. Where do we go from here? • To maximize resources and service impact: • We need a state-wide structure to provide adequate and accurate information on HIV, women and pregnancy. • We need outreach workers and efforts to outreach WHERE women can be found: STD, reproductive health & perinatal clinics and WIC sites.

15. Basic Clinical Reading • Treatment Improvement Protocols: • TIP 02: Pregnant, Substance-Using Women • TIP 05: Improving Treatment for Drug Exposed Infants • TIP 09: Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse • TIP 19: Detoxification from Alcohol and Other Drugs • TIP 23: Treatment Drug Courts: Integrating Substance Abuse Treatment with Legal Case Processing • TIP 25: Substance Abuse Treatment and Domestic Violence • TIP 27: Comprehensive Case Management for Substance Abuse Treatment • TIP 36C: Substance Abuse Treatment for Persons With Child Abuse and Neglect Issues (Clinician's Version) • TIP 38: Integrating Substance Abuse Treatment and Vocational Services

16. Some Websites • SAMSHA Treatment Improvement Exchange:http://www.treatment.org/Topics/archive/women.html • Children and Families Futures:www.cff.org • National Center on Substance Abuse & Child Welfare:www.ncsacw.samhsa.gov • The National Center on Addiction and Substance Abuse(CASA): www.casacolumbia.org. Recommended publications: • Food for Thought: Substance Abuse and Eating Disorders • The Formative Years: Pathways to Substance Abuse Among Girls and Young Women Ages 8-22 • No Safe Haven: Children of Substance-Abusing Parents • Substance Abuse and The American Woman

17. Treatment Assistance Protocols: • http://www.treatment.org/Taps/index.html • TAP 23: Substance Abuse Treatment for Women Offenders, Guide to Promising Practices • TAP 26: Identifying Substance Abuse Among TANF-Eligible Families • TAP 27: Navigating the Pathways: Lessons and Promising Practices in Linking Alcohol and Drug Services with Child Welfare

18. CSAP Resource Guides • http://store.health.org/catalog/ • Violence Against Women • Children Witnessing Violence and Substance Abuse • Children of Alcoholics • Pregnant/Postpartum Women and Their Infants • Women

19. CONTACT Judy Brow Specialized Female Services Coordinator Community Mental Health & Substance Abuse Services Texas Department of State Health Services 512-206-5884 judy.brow@dshs.state.tx.us