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 STDs 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 http://www.treatment.org/Topics/archive/women.html Children and Families Futures: www.cff.orgwww.cff.org National Center on Substance Abuse & Child Welfare: www.ncsacw.samhsa.govwww.ncsacw.samhsa.gov The National Center on Addiction and Substance Abuse (CASA): www.casacolumbia.org. Recommended publications:www.casacolumbia.org –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