Addressing the Substance Abuse Challenges of Homeless

Families

Deborah WernerAdvocates for Human Potential, Inc,

This presentation is made possible with support from the Substance Abuse and Mental Health Services Administration

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Substance Use

Abstinence Experimental Use Responsible Use Episodic or Situational Abuse Chronic Abuse Dependence

Responsible use = moderate, legal consumption in low-risk settings

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Not all Use is Addiction

Use of Illicit Substances Heavy consumption

Binge drinking Poor coping strategy

High-Risk Settings Driving under influence While caring for child

Episodical/Situational Abuse Common co-occurrence with intimate partner

violence

Interventions include: education, brief interventions, harm reduction, alternative activities, coping skills

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Addiction and Dependency

Brain disorder Brain impacted Cravings Tolerance

The individual becomes controlled by the substance at a cellular level. Use continues

despite catastrophic consequences.

– Nora Volkow, MD, paraphrased

The Substance Use and Mental Disorders Landscape is Changing

Reforms

Ensures consumer protections in the insurance market.

Creates immediate options for people who can’t get insurance today.

Expands health insurance coverage to 32 million Americans.

Adds 16 mil with incomes below 133% of the federal poverty level to Medicaid.

Allows states the option of continuing Medicaid coverage to former foster care children up to the age of 25 years old.

Ensures free preventive services.

Small business owners and employees will be insured

Reduces uncompensated care.

Impact of Reform & Parity

Creates guaranteed access to mental health and substance use disorder services at parity in most major public programs including Medicaid and Qualified Health Plans (QHPs) to cover the uninsured and small businesses.

Provides changes to the Medicaid program to continue and expand home and community-based services for individuals with mental health and substance use disorders.

Allows state Medicaid programs to establish health homes for those with chronic illnesses. States that seek this option mustconsult and coordinate with SAMHSA regarding the prevention and treatment of mental illness and substance use disorders among those with chronic illnesses.

Impact of Reform & Parity

Includes mental health and substance use disorder services as essential health benefit services for qualified health plans (QHPs) offered in the state-based exchanges.

Provides for grants to community mental health programs for co-locating primary and specialty care.

Creates a grant program for school-based health clinics to provide mental health and substance abuse assessments, crisis intervention, counseling, treatment and referrals.

Anticipate reductions in residential services over time. Increased need for mental health and substance use

treatment agencies to collaborate with housing programs

While substance use/abuse

in and of itself is not child abuse –

behaviors associated with substance use/ abuse can put

children at significant risk

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Inter-Generational Cycle of Substance Abuse

Substance use disorders affect the entire family unit and all the individual members.

Parental substance abuse increases the likelihood that a family will experience financial problems shifting of adult roles onto children child abuse and neglect, inconsistent parenting violence and disrupted environments

Children of parents with substance use disorders have a significantly higher likelihood of developing substance use problems themselves.

Families do recover!

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Lessons from the Treatment Field

Each family is different and their solutions are unique. Children often have service needs of their own. Developing motivation for recovery is a service not a

pre-requisite. Many women with SUDs experienced childhood trauma

and/or poor parenting which can significantly effect their relationships with their own children but effective supports and parenting programs are available.

Relapse is common. Prognosis/relapse the same as for hypertension or diabetes. Early intervention can end a relapse.

Recovery communities have powerful synergy.

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Ending the Cycle

Accessible Gender-Responsive, Trauma-Informed Behavioral Health Services

Children’s Assessments, Developmental Services, Education Comprehensive Services for Families and Family Members An array of safe, affordable housing options

Recovery residences Supportive housing Service-enriched housing “mainstream” safe, affordable housing Clean/sober communities

Accessible recovery support Opportunities for growth, economic and social well-being

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We all want to:

Help families access supports and resources

Strengthen/support families and family members

Preserve individual rights and self-determination

Support recovery and reduce risks associated with use

See children thrive

Create wellness focused communities

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Mandatory Participation

in all services.

Removal if use alcohol

/drugs

No servicesHousing

onlyStandard

lease provisions no special

rules related to alcohol or

drugs

Service Coordinator

checks in regularly.

client decides on service or objective

No abstinence

requirements

Mandatory ParticipationIn Services

Relapse addressed,

may result in discharge

Most Services fall in here.Case Plan

Contracts, agree to attend certain services, contingency

management, drug testing, relapse does not necessarily result in loss of participation

Voluntary/Mandatory Continuum

Least restrictive Most restrictive

The Werner Hartman Group, 2006

Where are you?

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Approach Varies Depending on

Agency mission, values philosophical framework Availability of collaborative partners and quality

community services Funding agency requirements/constraints Individual Family Needs Sense of urgency

What works for one family won’t necessarily work for another. Our

villages benefit from having an array of options.

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Program Variations – depending on population, philosophy and options

Acknowledging alcohol or drug use may vary depending on policies, legality of use, drug testing policies, client service plan

Response to alcohol or drug use may vary by type of use, risk to children, mental health status, resources available, “rules,” perceived risk to other residents,

Policies on if or when to evict family when householder is using.

Respect parental authority and roles when you see marginal care of children you care about.

Focusing on strengths when needs are so visible

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Resources

The Treatment Improvement Exchange http://www.tie.samhsa.gov/ http://womenandchildren.treatment.org/

Homeless Resource Center http://www.homeless.samhsa.gov

National Institute on Drug Abuse http://www.drugabuse.gov/

Join Together http://www.jointogether.org/

Werner, D., Young, N.K., Dennis, K, & Amatetti, S.. Family-Centered Treatment for Women with Substance Use Disorders – History, Key Elements and Challenges. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2008.