Women and Children: Treatment Improves Health
By Rebecca A. Clay
Just by looking, Ginny Vicini could tell that the family focus
of the substance abuse treatment project she ran was working. When
women and their children first arrived, she would look out her office
window and see them walking across the parking lot with 5 feet of
space between them. After 3 or 4 months of treatment, she'd see
them walking across the parking lot holding hands.
"It sounds so corny," said Ms. Vicini, now executive
director of Chrysalis House in Lexington, KY. "But it was the
most moving thing."
Now Ms. Vicini has the data to back up her anecdotal evidence.
Last fall, SAMHSA's Center for Substance Abuse Treatment (CSAT)
issued findings from a study in a white paper, Benefits of Residential
Substance Abuse Treatment for Pregnant and Parenting Women: Highlights
from a Study of 50 Centers for Substance Abuse Treatment Demonstration
The study evaluated Chrysalis House and 49 other CSAT-funded residential
treatment programs designed specifically for substance-abusing women
who were pregnant or the mothers of infants or young children. Just
as Ms. Vicini suspected, the study found that such programs significantly
improve the health of the women, their offspring, and the family
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An Innovative Model
Launched in 1993, the CSAT grant programs had a dual purpose:
expanding women's access to long-term residential treatment and
developing model programs that could provide a basis for evaluating
such programs' effectiveness. The Pregnant and Postpartum Women's
program offered 5 to 6 years of funding to projects serving substance-abusing
women who were pregnant or mothers of children less than
1 year old; the Residential Women's and Children's program focused
on treatment for women with older children.
Serving cities, rural areas, and Indian reservations around the
country, the 50 CSAT-funded projects differed in their admission
criteria, philosophies, and treatment approaches. All of them, however,
shared several key features, including:
Treatment services designed especially for women
Culturally appropriate treatment
Comprehensive services for the women, including substance
abuse treatment, medical and mental health care, vocational training,
parenting advice, legal assistance, transportation, and other support
Onsite residential care for the women's children
Supervised parenting, and
Comprehensive services for children, including prenatal
and pediatric care, nurseries, and preschools.
Several aspects were considered major innovations when the programs
were first launched, according to James M. Herrell, Ph.D., a co-author
of the white paper and acting branch chief of CSAT's Treatment and
Systems Improvement Branch.
"At the time this project was initiated back in the early
1990s," he said, "the idea of designing treatment programs
just for women and letting women bring their children into treatment
with them was relatively novel and daring."
In addition to the 50 projects, CSAT also funded a cross-site
evaluation that assessed the projects' effectiveness. Between 1996
and 2001, the researchers collected data about providers' treatment
approaches and clients' characteristics and outcomes.
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That cross-site evaluation proved that this innovative approach
worked. In some cases, the approach not only worked but succeeded
far beyond what anyone at CSAT anticipated.
For example, there was an 84-percent reduction in the risk of
low birth weight among infants born to women in the programs compared
to babies born to alcohol or drug abusers who hadn't received treatment.
Similarly, there was a 70-percent risk reduction for premature delivery
and a 67-percent risk reduction for infant mortality.
These rates are not only lower than those of untreated substance
abusers, they are also lower than the rates reported for all American
women. Premature delivery rates were 7 percent for the former substance
abusers compared to 11 percent for all American women; low birth
weight rates were 6 percent compared to 8 percent; and infant mortality
rates were 0.4 percent compared to 0.7 percent nationwide.
The women's relationships with their older children also improved.
The percentage of participants with physical custody of their children
increased from 54 percent shortly before entering treatment to 75
percent 6 months after discharge. The number of participants with
one or more children living in foster care dropped from 28 percent
to 19 percent.
At the root of those family-related outcomes were significant
reductions in alcohol and drug use. More than 60 percent of participants
reported being completely alcohol- and drug-free during the 6 months
following discharge. An additional 13 percent suffered relapses
at some point after being discharged but claimed to be completely
alcohol- and drug-free in the past month.
Paralleling that reduction in alcohol and drug use was a reduction
in criminal activity. Only 7 percent of the participants were arrested
for alcohol- or drug-related offenses, such as selling drugs, driving
while intoxicated, or being publicly intoxicated, during the 6 months
following discharge, compared to 28 percent in the year before entering
treatment. The percentage of participants arrested for other crimes,
such as shoplifting, burglary, prostitution, or assault, dropped
from 32 percent to 11 percent.
The longer the women stayed in treatment, the more they improved.
For example, 68 percent of the women who stayed in treatment longer
than 3 months remained alcohol- and drug-free, compared to 48 percent
of those who left within the first 3 months of treatment. Only 9
percent of women who stayed in treatment past the 3-month point
were arrested, compared to 20 percent of those who left before then.
More important, staying in treatment for a reasonable amount of
time helped almost everyone who participated in the programs.
"We went to a lot of trouble statistically to try to tease
out things either at the client level or program level that would
have had a differential effect. That means we looked to see if a
particular type of treatment worked better for younger women versus
older women or for African American women versus Caucasian women,"
explained Dr. Herrell. "What we found was that there weren't
any major predictors of who would benefit."
"That's good news for program managers as well as participants,"
added Dr. Herrell. "It means program designers don't have to
fine-tune programs to match every possible situation."
Although cost analyses are still ongoing, Dr. Herrell and others
at CSAT are already convinced the programs can save states money.
"These programs indicate that substance abuse treatment can
save taxpayers money that otherwise would be spent on other medical
costs," said CSAT Director H. Westley Clark, M.D., J.D., M.P.H.
Many of the states that hosted the CSAT-funded projects are also
convinced that investing in treatment services will pay off. Take
Kentucky, for example. Armed with evaluation data, staff from the
Chrysalis House project persuaded the state legislature to provide
funding that will allow the project to create a new 40-apartment
complex for women in recovery.
"If I had told our legislators in Frankfurt the story about
watching the women walking across the parking lot hand-in-hand with
their children, those people couldn't care less," said Ms.
Vicini. "If it hadn't been for the research data, we would
not have been able to sustain the program."
The white paper on findings from the residential treatment programs
study is available at csat.samhsa.gov/publications.html.
See also companion article, Women and Children:
The Faces Behind the Numbers.
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