To implement a practice change and system transformation in Wisconsin by having a strength-based coordinated system of care, driven by a shared set of core values, that is reflected and measured in the way we interact with and deliver supports and services for families who require substance abuse, mental health, and child welfare services.
- Family-Centered: A family-centered approach means that families are a family of choice defined by the consumers themselves. Families are responsible for their children and are respected and listened to as we support them in meeting their needs, reducing system barriers, and promoting changes that can be sustained overtime. The goal of a family-centered team and system is to move away from the focus of a single client represented in systems, to a focus on the functioning, safety, and well being of the family as a whole.
- Consumer Involvement: The family's involvement in the process is empowering and increases the likelihood of cooperation, ownership, and success. Families are viewed as full and meaningful partners in all aspects of the decision making process affecting their lives including decisions made about their service plans.
- Builds on Natural and Community Supports: Recognizes and utilizes all resources in our communities creatively and flexibly, including formal and informal supports and service systems. Every attempt should be made to include the families' relatives, neighbors, friends, faith community, co-workers or anyone the family would like to include in the team process. Ultimately families will be empowered and have developed a network of informal, natural, and community supports so that formal system involvement is reduced or not needed at all.
- Strength-Based: Strength-based planning builds on the family's unique qualities and identified strengths that can then be used to support strategies to meet the families needs. Strengths should also be found in the family's environment through their informal support networks as well as in attitudes, values, skills, abilities, preferences and aspirations. Strengths are expected to emerge, be clarified and change over time as the family's initial needs are met and new needs emerge with strategies discussed and implemented.
- Unconditional Care: Means that we care for the family, not that we will care "if." It means that it is the responsibility of the service team to adapt to the needs of the family - not of the family to adapt to the needs of a program. We will coordinate services and supports for the family that we would hope are done for us. If difficulties arise, the individualized services and supports change to meet the family's needs.
- Collaboration Across Systems: An interactive process in which people with diverse expertise, along with families, generate solutions to mutually defined needs and goals building on identified strengths. All systems working with the family have an understanding of each other's programs and a commitment and willingness to work together to assist the family in obtaining their goals. The substance abuse, mental health, child welfare, and other identified systems collaborate and coordinate a single system of care for families involved within their services.
- Team Approach Across Agencies: Planning, decision-making, and strategies rely on the strengths, skills, mutual respect, creative, and flexible resources of a diversified, committed team. Team member strengths, skills, experience, and resources are utilized to select strategies that will support the family in meeting their needs. All family, formal, and informal team members share responsibility, accountability, authority, and understand and respect each other's strengths, roles, and limitations.
- Ensuring Safety: When child protective services are involved, the team will maintain a focus on child safety. Consideration will be given to whether the identified threats to safety are still in effect, whether the child is being kept safe by the least intrusive means possible, and whether the safety services in place are effectively controlling those threats. When safety concerns are present, a primary goal of the family team is the protection of citizens from crime and the fear of crime. The presence of individuals who are potentially dangerous requires that protection and supervision be sufficiently effective to dispel the fears of the public.
- Gender/Age/Culturally Responsive Treatment: Services reflect an understanding of the issues specific to gender, age, disability, race, ethnicity, and sexual orientation and reflect support, acceptance, and understanding of cultural and lifestyle diversity.
- Self-sufficiency: Families will be supported, resources shared, and team members held responsible in achieving self-sufficiency in essential life domains. (Domains include but are not limited to, safety, housing, employment, financial, educational, psychological, emotional, and spiritual.)
- Education and Work Focus: Dedication to positive, immediate, and consistent education, employment, and/or employment-related activities which results in resiliency and self-sufficiency, improved quality of life for self, family, and the community.
- Belief in Growth, Learning and Recovery: Family improvement begins by integrating formal and informal supports that instill hope and are dedicated to interacting with individuals with compassion, dignity, and respect. Team members operate from a belief that every family desires change and can take steps toward attaining a productive and self-sufficient life.
- Outcome-Oriented: From the onset of the family team meetings, levels of personal responsibility and accountability for all team members, both formal and informal supports are discussed, agreed-upon, and maintained. Identified outcomes are understood and shared by all team members. Legal, education, employment, child-safety, and other applicable mandates are considered in developing outcomes, progress is monitored and each team member participates in defining success. Selected outcomes are standardized, measurable, based on the life of the family and its individual members.
The Department of Health Services has established the following six core fundamental principles as the foundation of integrating women-specific substance abuse treatment services and wraparound/integrated services, while focusing on effective and comprehensive treatment of women and their families.
The Self-in-Relation (Relational/Cultural) Model or a similar model that is based on the psychological growth of women should be the foundation for recovery.
- The Self-in-Relation Model emphasizes the central importance of relationships in women's lives. Since women in this culture have been the caretakers of certain aspects of the total human experience, specifically carrying responsibility for the care and maintenance of relationships, this model attempts to address the strengths as well as the problems arising for women from this relational orientation.
- The primary motivation for women throughout life is toward establishing a basic sense of connection to others.
- Women feel a sense of self and self-worth when their actions arise out of a connection with others. The experience of psychological connection is based on empathy and mutuality in relationships.
Treatment revolves around the role women have in society, therefore treatment services need to be gender specific.
- Gender-responsive programs are not simply "female only" programs that were designed for males.
- A woman's sense of self develops differently in women-specific groups as opposed to coed groups.
- Equality does not mean sameness; in other words, equality of service delivery is not simply about allowing women access to services traditionally reserved for men. Equality must be defined in terms of providing opportunities that are relevant to each gender so that treatment services may appear very different depending on to whom the service is being delivered.
- The unique needs and issues (e.g., physical/sexual/emotional victimization, trauma, pregnancy and parenting) of women should be addressed in a safe, trusting and supportive environment.
- Treatment and services should build on women's strengths/competencies and promote independence and self-reliance.
The wraparound philosophy is driven by the woman and her family (many issues overlap treatment; her W-2 involvement, trauma, mental health, child welfare, criminal justice, and domestic violence are very common.)
- Utilizing the wraparound philosophy through inter-systems collaboration and involvement of informal supports is recommended.
- Even though there are many agencies and systems involved the life of the woman, her needs determine the connections with those agencies and systems that are impacting her life or her family's life.
- Each woman will have a single coordinated care plan or plan of service that is used for service coordination.
- The care coordinator should remain the same as the woman progresses in recovery.
The model is one of empowerment.
- The participant is shown and taught how to access services, advocate for herself and her family, and request services that are of benefit to her and her family.
- This experiential learning process is initially taught by the care coordinator or recovery advocate, and is woven into recovery.
- This tapestry of recovery focuses on empowerment as a learned skill that is taught by all service providers working with the woman and her family.
- The ultimate goal for the service system is to weave the woman so well into the fabric of informal support systems that the role of formal services is very small or not needed at all.
Work is an important component in recovery and serves as a vital therapeutic tool.
- The structure of work is a benefit to recovery, and treatment providers need to be aware of the work requirement of W-2. Historically, treatment providers were hesitant to encourage patients to return to work or engage in work related activities during the early stages of recovery. Yet, waiting for a client's substance abuse problems to subside before addressing their vocational concerns is not an appropriate strategy for W-2 participants. W-2 participants must engage in work and/or work-related participation requirements, therefore, treatment providers working with W-2 participants must clearly integrate work and/or work-related activities into the overall treatment services provided to clients.
The use of a multi-system approach that is culturally cognizant.
- Gender specificity and cultural competence go hand in hand. There are a number of gender and cultural competencies that allow people to assist others more effectively. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community. Sue, Arredondo, and McDavis (1991) suggest three broad categories:
- Awareness of one's own assumptions, values, and biases;
- Understanding the worldview of the (gender) and culturally different client; and
- The ability to develop appropriate strategies and techniques.
People that are skilled in these competencies posses the following beliefs and attitudes:
- They are aware of their own (gender) and cultural history and value and respect the differences of others.
- They are aware of how their own gender and cultural background, experiences, attitudes, values and biases influence the psychological process and relationship with others.
- They are able to recognize the limits of their competencies and expertise.
- They are comfortable with gender and cultural differences.
Also, if an agency is providing services to a multi-linguistic population, there should be multi-linguistic resources, including use of skilled bilingual, bicultural translators, and interpreters whenever a significant percentage of the target community is more comfortable with a language other than English.
Treatment standards for AODA services to women
To meet the specific needs of women, successful programs begin with an understanding of the emotional growth of women. Current thinking describes women's development in terms of the range of relationships in which women can engage. This is very different from the theories of emotional growth which have been the basis of substance abuse treatment and which apply to the psychological growth of men. The relationship theories for women suggest that the best context for stimulating emotional growth comes from an immersion in empathic, mutual relationships.
The strongest impetus for women seeking treatment is problems in their relationships, especially with their children. A woman's self-esteem is often based on her ability to nurture relationships. Her motivation and willingness to continue treatment is likely to be fueled by her desire to become a better mother, partner, daughter, etc. Programs that meet the needs of women acknowledge this desire to preserve relationships as a strength to be built upon, rather than as a resistance to treatment. When a program operates from this theoretical point of view, the characteristics of the clinical treatment program and its objectives and measures of success are defined very differently from those of traditional treatment programs.
Programs that are designed to meet women's needs tend to be more successful in retaining women clients. For an agency to be able to offer women-specific treatment, its programs must include the following criteria:
There are many barriers that may critically inhibit attendance and follow-through for women and children. They may include child care, transportation, hours of operation, depression, and other signs of mental health issues.
Standard: Agencies/programs shall demonstrate a process to reduce barriers to treatment by providing those ancillary services or ensuring that appropriate referrals to other community agencies are made.
Women with children need to be assessed and treated as a unit. Women often both enter and leave treatment because of their children's needs.
Standard: Assessment shall be a continuous process that assesses the client's psychosocial needs and strengths within the family context and through which progress is measured in terms of increased stabilization/function of the individual/family. In addition, all assessments shall be strength-based and conducted through motivational interviewing.
III. Psychological Development
Many of the traditional therapeutic techniques reinforce women's guilt, powerlessness, and "learned helplessness," particularly as they operate in relationships with their children and men.
Standard: Agencies/programs shall demonstrate acknowledgement of the specific stages of psychological development and modify therapeutic techniques according to client needs, especially to promote independence/autonomy.
A history of abuse, violence, and trauma often contributes to the behavior of substance abusing and dependent women.
Standard: Agencies/programs must develop a process to identify and address abuse/violence/trauma issues. Services will be delivered in a trauma-informed, trauma-sensitive setting and provide safety from abuse, stalking by partners, family, other participants, visitors, and staff.
V. Family Orientation
Many women present in a family context with major family ties and responsibilities that will continue to define their sense of self. Drug and alcohol use in a family puts children at risk for physical and emotional growth and development problems. Early identification and intervention for the children's problems is essential.
Standard: Agencies/programs must identify and address the needs of family members through direct service, referral, and/or other processes. Families are a family of choice defined by the clients themselves and agencies will include informal supports in the treatment process when it is in the best interest of the client.
VI. Mental Health Issues
Women with substance abuse problems often present with concurrent mood disorders and other mental health problems.
Standard: Agencies/programs must demonstrate the ability to identify concurrent mental health disorders and develop a process to have the treatment for these disorders take place in an integrated fashion with substance abuse treatment and other health care.
VII. Physical Health Issues
Substance abusing women and their children are at high risk for significant health problems. They are at greater risk for communicable diseases such as HIV, TB, Hepatitis, and sexually transmitted diseases. Prenatal care for substance abusing women is especially important as their babies are at risk for serious physical, neurological, and behavioral problems. Equally as important is to provide screening and information for Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). Early identification and intervention for children's physical and emotional growth and development and for other health issues in a family is essential.
Standard: Agencies/programs shall:
- Inquire about health care needs of the client and her children;
- Make appropriate referrals;
- Document client and family health needs, referrals, and outcomes.
VIII. Legal Issues
Women entering treatment may be experiencing legal problems, including custody issues, civil actions, criminal charges, and probation and parole.
Standard: Agencies/programs shall document an individual's compliance and facilitate required communication to appropriate authorities within the guidelines of federal confidentiality laws. Additionally, programs will avoid setting up barriers to individual compliance with legal authorities.
A high rate of treatment non-compliance among female substance abusers with a history of sexual abuse has been documented. The frequent incidence of sexual abuse among women substance abusers necessitates the inclusion of problem specific questions during the initial evaluation (assessment) process. Lack of recognition of a sexual abuse history or improper management of disclosure can contribute to a high rate of non-compliance in this population.
Standard: Agencies/programs shall:
- Conduct an assessment that is sensitive to sexual abuse issues;
- Demonstrate competence to address these issues;
- Make appropriate referrals;
- Acknowledge and incorporate these issues in the discharge treatment plan;
- Assure that the client will not be exposed to exploitive situations that continue abuse patterns within the treatment process (coed groups are not recommended early in treatment, physical separation of sexes is recommended in inpatient/residential treatment setting.)
X. Survival Skills
Women's treatment is often complicated by a variety of problems that must be addressed and integrated into the therapeutic process.
Standard: Agencies/programs must identify and address the client's needs in the following areas, including but not limited to:
- Education and Literacy
- Job Readiness and Job Search
- Parenting Skills
- Language and Cultural Issues
- Basic Living Skills
The agency/program shall refer to appropriate services and document both the referrals and outcomes.
XI. Continuing Care
In order for a woman to remain sober after treatment, she needs to be able to retain a connection to the treatment staff and to receive support from appropriate services in the community.
Standard: Agencies/programs shall:
- Conduct an assessment prior to discharge to address and plan for the client's continuing care needs;
- Design a written plan with the client to meet those needs;
- Make and document appropriate referrals as part of the continuing care plan;
- Remain available to the client as a resource for support and encouragement for at least one year following discharge.