Addictions Treatment for Mothers: What's Effective?
The Indiana Department of Child Services (DCS) has seven principles for child welfare. Their fifth principle states: “Services are organized as a continuum and are linked to a wide variety of supports and services which can be crucial to meeting families' and children's needs such as: housing, substance abuse treatment, mental health, health, education, job training, child care and informal support networks."
However, DCS identified a gap in their services that should be covered by this principle; it realized that women often have to choose between receiving a higher level of treatment for substance abuse and staying with their children. For example, usually women who need a higher level of treatment at a residential facility have to leave their children in foster care, quit their jobs, and drop everything because all of the programs in Indiana do not allow their clients' children to live there as well.
Once DCS identified and decided to solve this problem, it turned to Volunteers of America of Indiana with their expertise in family services to bridge this gap and provide mothers with an option to receive residential substance abuse treatment with their children. The staff accepted the proposal, met together to establish a program curriculum, wrote an outline, sent it to DCS, and the program was approved. Then all required staff was recruited and trained and the Fresh Start Recovery Center started on August 31, 2015 with three women and one baby. Today it is currently serving ten women and four children, and can serve up to fifteen women and fifteen children.
Eligible program participants are mothers who are involved with DCS, have a substance abuse problem, and are referred to the program through their DCS case manager. Most of these women have either struggled to successfully complete other lower level program requirements or had newborn infants that were born positive for drugs. Up to two of their children are able to stay with them, but must be between the ages of zero and five, a truly unique feature of a residential treatment program.
The program is comprised of two phases. The first lasts twenty-one days and is called the acute stabilization phase and focuses on getting the mother clean. It also teaches them basic skills that will help them maintain their sobriety once they leave the facility. A plus of this program being a residential program is that the women are always here in the facility other than court or medical appointments, and this really helps them stay focused on their treatment.
After that phase, she can choose to enter an optional phase called “Step Down" for an additional two months. During this time she can still have a safe and free place for her and her child to live while she can search for a job and housing to make a smooth and stable transition into an independent life. They are also encouraged to try to find an outside substance abuse support system and get connected with child care.
There are required classes and workshops in each phase that the clients participate in such as group counseling, parenting classes, job development workshops, and a twelve step program. The mothers also meet with their case manager and their therapist several times a week to identify needs that they have to work on - individual needs that are not appropriate to discuss in a group setting. In addition to mental care, staff also provides them with connection to job resources and housing around the city.[V1] After these two phases, the women are required by DCS to participate in an aftercare program; Volunteers of America of Indiana has a counseling clinic that is an option.
While the mothers go to their classes and treatment, their children work with a child engagement specialist – a trained staff member with background in childcare experience. Together they work on developmentally appropriate activities such as muscle development, learning about colors, how to regulate emotions and how to communicate effectively. Staff also helps to address bonding issues by getting mother and child together to teach appropriate discipline techniques and good activities for the child's development to help them excel so they'll be prepared for school as they get older.
I interviewed Rachel Halleck, Director of Behavioral Services, for more information about the clients served through this program and the benefits she has seen and hopes to see.
AN: Are there any other programs similar to this one in Indiana?
RH: This is the only one like this in state. There's a similar program that obtains some of their funding from the Department of Child Services and then they have some other contracts as well in Fort Wayne. But, this is the only one primarily dedicated to the Department of Child Services involved families that allows kids with them while mom is in treatment.
AN: What's the staff's main goal for this program, for the clients?
RH: To help the mothers develop sobriety skills that will help them maintain long term sobriety and to graduate them to a lower level of treatment. We also want the women to maintain the skills that they've learned - skills for maintaining sobriety is a huge goal. Improved parenting skills is another big goal for all the women; we utilize parenting training and parenting curriculum and parenting classes on a daily basis with all the women here. And ultimately our goal is to see that the moms are able to reunite with their children and break the cycle of abuse and neglect that brought them into the system in the first place.
AN: Is there any potential for clients to be reunited with their children while they're here, in the facility?
RH: Yeah! We've actually had several instances where children that were born positive would be in foster care for six, twelve, eighteen months (variating by case), until mom was able to successfully close out of the program. And so, there are several situations in which we're reducing that separation between newborn and mom for potentially a year and a half or more to a few weeks. Which is really really crucial for the mom and the child and their ability to attach and develop healthy coping skills; a healthy sense of stability is very very important.
AN: Are there any unexpected challenges that you've run into?
RH: I would say it's really important to make sure that the toddlers and older children are really establishing a bond with mom. That is a challenge that some of the three year olds that had been in foster care or another family placement for several months, now are with mom and they're also with mom in an environment that they're not familiar with. And as the staff, we've been doing a lot of training on how to help the child best adjust to having a new primary caregiver, living in a new environment, and being in a space with other kids and a lot of adults and helping them make sure that they feel safe and secure and are adjusting as well as they possibly can.
Also, locally and state-wide, we have a really bad heroin epidemic. And the clients who are part of this epidemic prove to be the most challenging. They're going through really serious withdrawals and discomfort and it's really hard for them to stay focused on their treatment and motivation when they're physiologically fixated on their substance of choice.
AN: Have you seen any huge changes in the clients yet?
RH: Yeah definitely. What's really remarkable is that every person that so far has come to the acute stabilization phase has opted on their own to continue into the step down phase. Which I think speaks very highly of the services that we are offering. Because the court order is really just for the first 21 days, and so far, for 100% of the clients to opt into staying longer, is actually not very common in residential facilities. And we've had several people that came here, were actively using, had just come out of abusive relationships and now have daycare set up, full time job, and have found housing. Really we've just been open for one month and to have that level of change at this point is amazing. At this point all of our clients have been successful in remaining sober as well, which is pretty significant.
AN: Have you seen positive change in the bonds between mother and child?
RH: Oh yeah. We've seen kids, you know these kids are young enough that when they first get reunited with mom, if the mom hasn't seen the child since it was five days old or three and half months old, they're essentially strangers. And for this program, it was that the moms hadn't even seen the child. It wasn't that they had just visited, they hadn't even seen the child. We've had the opportunity to see mom who barely even knew how to change the kid's diaper bond with the kid. The kid is able to respond to mom's gestures and smiles at mom and you can tell that they have bonded together. The mom is able to better care for its nutritional needs and bathe them, and help them with health issues and stuff like that. So yeah it's really remarkable that a mom and a child that were essentially strangers can start feeling like a family. I think that's really neat.
AN: What overall is the main benefit of the program?
RH: I would say the opportunity to break the cycle of addiction in the lives of these kids. The program really, we serve moms, but the program is here for the generation that we have coming up in our society and our community. What we do know, is that if children are exposed to addiction and trauma growing up, then they're more likely to develop addiction and maladaptive behaviors when they become adults as well. So if we get the moms healthy, we can get the kids healthy, and as a result the community as a whole becomes healthier.