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Gateway Community Services is seeking to expand its residential and continuing care program to serve an additional 40 pregnant and postpartum women, their minor children, the fathers and extended family. Creating systems of support during and after treatment becomes critical in sustaining the work done during treatment. Women and their children will be provided with outreach, screening, and assessment; detoxification; substance abuse education and treatment; linkage to medical, dental, other physical health care services; training in parenting; education, screening, counseling, and treatment of Hepatitis, HIV I AIDS, other STDs, and related issues; mental health assessment and treatment; trauma-informed services, including assessment and interventions for emotional, sexual, and physical abuse; employment readiness, training, and placement; education and tutoring assistance for obtaining a GED and higher education; childcare; transportation, wraparound services, intensive case management and continuing care - children's services will include: screenings and developmental diagnostic assessments regarding the social, emotional, cognitive, and physical status of the infants and children; therapeutic interventions, including counseling, linkages for occupational and physical therapies; linkages for pediatric health care, including immunizations, and treatment for asthma, diabetes, hypertension, and any perinatal effects of maternal substance abuse; linkages for additional social services and financial supports; education and recreational services. Outcomes include decreased use and/or abuse of alcohol/drugs; increase of healthy pregnancies; improved birth outcomes; improved mental and physical health; prevention of behavioral disorders among children; improved parenting skills, family functioning, economic stability, and quality of life; decreased involvement/exposure to crime/violence/neglect; and decreased physical, emotional, and sexual abuse for all family members.

The Iowa Department of Public Health proposes to expand and enhance the states' continuum of care for pregnant and postpartum women in residential treatment with substance use disorders. The Iowa Pregnant and Postpartum Women's Residential Treatment Program (Iowa PPW) will be implemented at three established residential treatment programs in Cedar Rapids, Des Moines and Sioux City. Iowa's proposal builds on the successes of current programs that offer comprehensive, clinical treatment and recovery services to support a personal recovery plan. Iowa PPW will serve a minimum of 360 women and an estimated 593 minor children during three years. Iowa PPW services will use a care coordination approach to implement clinically appropriate, evidence based practices to promote improvement of services provided to pregnant and postpartum women in residential treatment. Iowa PPW will assist women in their ability to maximize the use of proven self-care management techniques to improve their health status, improve the lives of their minor children and improve self-sufficiency. Iowa PPW activities will emphasize the following goals and measureable outcomes: implement an evidence-based program and increase the number of pregnant and postpartum women served with evidence-based programming at three Women and Children's Centers in Iowa; assure client choice while focusing on gender specific issues by using a Voucher Management System to provide crucial recovery support services to this population of focus not covered by Medicare. Iowa will increase the number of successful completions in treatment; increase the number of children services; improve the health of the women and their children; improve engagement of family members; improve programming during weekends for extended family activities as evidence through client satisfaction surveys; and reduce Behavioral Health Disparities by focusing on populations with documented higher incidence of substance abuse and related problems.

Odyssey House (OH) of Utah proposes to increase access to residential substance use disorder (SUD) treatment to pregnant and postpartum women and their children in a family and client centered, trauma-informed treatment setting with access to a full spectrum of behavioral health services, including psychiatric services, robust therapeutic services for the children, integrated primary care in our on-site medical clinic, and coordination with obstetrics providers. The target populations are pregnant and postpartum women who are drug dependent and unable to achieve long-term recovery and therefore require residential care. Many of these women have long histories of substance use, including IV use; unaddressed mental health issues; failed prior treatment attempts; poor impulse control; violent relationships; history of prostitution and other high risk behavior; poor access to medical care with significant medical issues; and poor parenting skills. Additionally, many of the children who would be served with this proposed project have mental health and behavioral problems stemming from attachment disruption and trauma who are in need of significant therapy and treatment themselves. Acknowledging that many of the target behaviors are learned through family modeling, services addressing SUD and relationship dynamics are important for the family/support system to create a recovery supportive environment. The purpose of this project is to expand service access, create healthier families, and drug free communities. OH will use the Modified Therapeutic Community approach, along with Cognitive Behavioral Therapy, Dialectic Behavioral Therapy, Attachment Therapy, Trauma Focused-Cognitive Behavioral Therapy, skills development, and other EBPs. OH will also provide medical services and care coordination with specialists to create integrated treatment for the mothers and their children. Upon completion of the residential stay, OH will provide a transition to lower levels of care.

Behavioral Connections will serve as the lead applicant for a collaborative solution to address a noted gap in our current system: residential substance use disorder treatment for pregnant and postpartum women. These women and infants are at particularly high risk for morbidity and mortality, and there are no coordinated local approaches to address this need, especially in underserved communities. SAMHSA's Residential Treatment for Pregnant and Postpartum Women opportunity will support our Maternal and Child Residential Integrated Treatment (MCRIT) project. Funding will support low income women, predominantly African- American, age 18 and over, who are pregnant, postpartum, and their minor children, age 17 and under, who have limited access to quality health services. These women will receive care for their co-occurring disorders through an integrated services treatment approach for clinical care, mental health illness, substance use disorders, trauma and support with parenting. We will collaborate with others leading health and mental health providers, including Harbor and ProMedica Health Systems to provide primary, OB/GYN, and mental health care in combination with substance use disorder treatment, using Stages of Change and Modified Therapeutic Community as conceptual frameworks for the approach. The project will serve a primarily Medicaid population through a 15-bed residential facility for pregnant and parenting mothers and their children. We intend to serve approximately 20 women, 35 children, and 60 other family members each year for a total 315 individuals over the course of the three-year grant period. Our objectives are to use integrated treatment service offerings to help ensure successful community reintegration and avoidance of relapse through a coordinated team-based and case management approach, and implementation of a comprehensive family service treatment plan.

McDermott Center (dba Haymarket Center) proposes a Family Centered Treatment Program for pregnant and postpartum women to provide evidence-based family strengthening and recovery support models that address trauma, parenting, child education and prevention. Over three years the program will serve 144 women and their children, family members and fathers of the children. The proposed project will build on their strong framework, which includes residential treatment where women receive on-site medical attention and child care. The project will build on successes and lessons learned from a previous PPW project. The new project will have goals of improving substance use and mental health outcomes among women; increasing drug-free births and improving health of moms and children; improving mental, physical, and developmental health in children; and improving parenting skills and quality of life in families. Project-funded staff includes a family therapist, pediatric social worker, and pediatric nurse who will implement Creating Lasting Family Connections to improve family functioning. The project will also implement the evidence based Manual for Recovery Coaching. Project-funded family recovery coaches will engage families, help develop recovery plans, and link participants to self-help, housing, vocational services, medical care, and other services. Children's fathers may be linked to the Responsible Fatherhood program. Recovery coaches will provide support for a full year. The project will develop a family recovery center and a youth leadership program to keep families and children engaged in recovery. These new components will join evidence-based practices sustained from the previous project including parenting, trauma services, and practices for prevention and child development. Essential supportive services for all participants will be available on site or through referral to a network of partners who have signed Memoranda of Agreement for this project.

United Community Center will provide trauma- informed, gender-responsive, culturally competent, services within a family-centered treatment model for 126 Milwaukee County, WI pregnant and postpartum (PPW) (primarily Hispanic) women (Latinas) with substance use disorders (SUDs) and co-occurring mental health disorders. The project will also serve an estimated 334 infants, other minor children, and non-residential family members of both the women and children during the 3-year project. This project, titled Madres Sanas, Ninos Sanos (MSNS) will be delivered by UCC and its project partner, Sixteenth Street Community Health Centers (SSCHC), a Federally Qualified Health Center (FQH C). Within the context of a patient centered medical home, SSCHC will integrate perinatal, labor and delivery, postnatal, pediatric and other health care with comprehensive family-based SUD treatment offered by UCC. Services will be delivered within the context of UCC's "one-stop-shop" multi-program (including an on-site SSCHC health clinic) community center serving Milwaukee's Hispanic community. Care will be coordinated using an Individual Recovery Plan (IRP) process that incorporates the requirements, goals and resources of all systems with which the family is involved, including (e.g., health care and maternal health program provided by SSCHC; SUD, TANF, child welfare, probation/parole, etc.) to assure that everyone is communicating (i.e., a single plan), and to avoid contradiction and duplication among multiple plans.

The Wayside Whole Family Treatment project will provide evidence-based residential family treatment services to assist women, their children, and their families to recover from addiction, reunify, and build stable lives. Located in Minneapolis, Minnesota, the project will serve a total of 100 women and their children and family members annually, prioritizing women who are pregnant, intravenous drug users with minor children, and women involved with child protection. Over three years, the project will serve 300 low-income women, 600 children, and 300 family members, including high numbers of African-American participants. Women who combine chemical dependency with pregnancy, parenting, and child protection issues typically have very complex needs that also impact their children and families. Through the Wayside Whole Family Treatment project, women with these intensive needs will be able to access on-site chemical dependency treatment, individual and family therapy, psychiatric consults, STEP parenting groups, individual Triple P (RAP) parent coaching sessions, and 24-hour parenting support and supervision. Children up to age 11 may also live at Wayside Family Treatment, preserving the family. They participate in developmentally appropriate childcare, therapeutic preschool, and/or afterschool activities. The woman's entire family, including fathers, partners, and children living off-site, may participate together in therapeutic family programming, the evidence-based Celebrating Families! curriculum, and family therapy. Wayside will also provide comprehensive screening, assessment, referral and case management as appropriate to each family member. As women and children transition into the outpatient phase of treatment, Wayside staff ensures they exit to safe, sober and affordable housing with supports.

The Tennessee Residential Treatment Program for Pregnant and Postpartum Women tackles the problem of substance use and abuse among young adults ages 18 and over. The program is intended to expand the availability of comprehensive, residential substance abuse treatment, prevention, and recovery support services for pregnant and postpartum women and their minor children, including services for non-residential family members of both the women and children. The populations of focus are low-income (according to federal poverty guidelines) women, ages 18 and over, who are pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who have limited access to quality health services. Through the expansion and enhancement of service capacity, addiction peer recovery support services will be provided in a collaborative effort between the University Of Tennessee College Of Social Work and the Helen Ross McNabb Center, Incorporated, a Regional Mental Health System. These organizations will provide comprehensive services to clients who are ineligible for, or unable to afford or to obtain, adequate services through public or commercial means. Two hundred and twenty-five (225) clients will be served over three years (75 per year) with the goal of providing a better foundation for a successful transition into recovery and improving the overall quality of life. Services will be extended when deemed appropriate to fathers of the children, partners of the women, and other family members of the women and children who do not reside in the residential treatment facility.

The Village Families in Transition (FIT) Program in Miami-Dade Florida will expand its current residential substance abuse treatment, prevention, and recovery services to 120 pregnant and postpartum women and 240 children (40 pregnant and postpartum women and 80 children annually). The program will also provide trauma-informed services to stabilize, strengthen, preserve, and reunite families for the women, minor children, fathers of the children, partners of the women, and extended family members. Through the use of evidenced-based strategies the FIT Program will accomplish its goals of (a) decrease the use and/or abuse of prescription, alcohol, tobacco illicit and other harmful drugs among pregnant and postpartum women; (b) increase safe and healthy pregnancies, improve birth outcomes, and reduce related effects of maternal and /or paternal drug use on infants and children; (c) improve the mental and physical health of the women and children; and prevent mental, emotional, and behavioral disorders among the children; (d) improve parenting skills, family functioning, economic stability, and quality of life for families; and (e) decrease involvement and exposure to crime; violence; neglect; and physical, emotional, and sexual abuse for all family members. The FIT Program will provide residential treatment services to pregnant and postpartum women and their minor children, as well as an array of services for non-residential family members of both the women and children delivered on-site at the Village or in-home. Other components will include follow-up care after families leave the residential setting by continuing the individual and family wellness and recovery plans in the home, and adding parenting and workshops to enhance family functioning and mitigate re-lapse. FIT will include culturally competent, trauma-informed services designed to meet the specific needs of PPW and their children.

The Family Achievement in Recovery (FAIR) at PAR Village project will provide gender-specific, culturally competent and linguistically appropriate residential treatment services for 60 substance abusing pregnant, postpartum women, 60 children and 120 family members over the project's three-year period, focused on achieving sustained recovery characterized by: abstinence from drugs of abuse; family stability; stable mental and physical health, positive child development and healthy behaviors. The project will emphasize enrolling multi-racial and/or minority women of color, women who are involved with the child welfare system and those at risk for or living with HIV/AIDS. The goals and measurable objectives of the FAIR project are to increase PAR Village's residential capacity for an additional 60 women and their children as appropriate over a three-year period based on a six-month length of stay on average; develop natural pathways to substance abuse, mental health, primary health care, education, parenting, life skill, employment and housing services as warranted to ensure the health and well-being of each woman and her family; and enhance existing aftercare systems to support each mother and her family's successful sustained recovery.

The Women's Treatment Center, Inc. (Chicago, Illinois) mission "is to provide women with a continuum of care, recovery tools, and parenting skills to maintain a sober lifestyle as they rebuild their lives and their futures, and mend the bonds with their families". TWTC is the only Illinois non-profit 501c3 community-based organization that is licensed to provide substance use disorder treatment services devoted solely to women, women and their children and families, by the Illinois Department of Human Services, Division of Alcoholism and Substance Abuse (IDHS/DASA). The purpose of the PPW program is to expand the availability of treatment to pregnant and postpartum women who are assessed to be appropriate for residential substance abuse rehabilitation services (Level 111.5) based on ASAM patient placement criteria (ASAM, 2013). The proposed TWTC PPW unit will serve 130 pregnant and post-partum women (i.e., Year: 30 patients and up to 23 children; Years 2 & 3: 100 women and up to 75 children). The PPW project will have the capability of allowing for the children of admitted women, 6 years of age and younger, to reside on site with their mothers. TWTC has selected six SAMHSA NRREP the 9 SAMHSA grant priorities, including: Living in Balance, Seeking Safety, Dialectical Behavioral Training, Parents as Teachers, Training for Effective Parenting and 24/7 Dad which have been found to be effective in working with women in treatment, in particular, with our population which constitute 56% African Americans and 17% Hispanics.

United Bronx Parents (UBP) is proposing to expand and enhance its "La Casita Residential Program" (La Casita) to serve 50 additional pregnant or postpartum women with substance use disorders and their minor children and family supports each year (150 women over the life of the grant), providing them with a full continuum of care that includes evidence-based substance abuse and mental health interventions, medical care, health and wellness education, HIV/STD education, smoking cessation, peer support, life skills training, parenting training, educational and vocational services, recreational activities, resource referral, housing location services, and on-site licensed child care. The women, drawn from the five boroughs of New York City, will all be low income (living below the Federal Poverty Line) and have active substance use disorders at the time of admission. Approximately 33% of the women served will be African American, 33% will be Hispanic/Latina, and 33% will be White. The average age of the women served will be 23-25 years old. Licensed by NYSOASAS and as an affiliate of the Acacia Network, La Casita will draw upon its rich history of serving pregnant and postpartum women suffering from substance use disorders, as well as that of the entire Network, for this proposed project. La Casita is a family-centered, bilingual, culturally competent and trauma-informed residential program designed to provide a safe and nurturing therapeutic environment for New York City's pregnant and postpartum women suffering from substance use issues and their minor children, in order to assist them in overcoming the debilitating effects of addiction and restoring dignity and self-reliance to each woman and family served. As a program under the umbrella of the Acacia Network, women served by La Casita benefit from access to the largest community based Latino-led health and human services agency in New York.

The Residential & Community Treatment Program for Pregnant and Postpartum Women of the Lund Family Center, Burlington, VT, will provide support and enhanced residential substance abuse treatment services to low-income, substance-abusing women who are pregnant/ postpartum, their minor children, and their family members. The geographic area is the State of Vermont, with a focus on Chittenden County, the state's most populous county and a primary center of its opiate epidemic. The purpose of the proposed program is to 1) increase outreach to and positive treatment outcomes for pregnant and postpartum women living with substance abuse; 2) improve short- and long-term outcomes for minor children up to age 17; and 3) provide support services to other family members, including partners and fathers. With this proposal, Lund seeks to expand its range of services to minor children living in the community; meet the needs of a growing number of older children among its program families; expand services to racial, ethnic, and sexual minority women; and continue its successful co-located partnership with the state Department for Children and Families. With this grant, the Residential & Community Treatment Program for Pregnant and Postpartum Women will serve 40 minor children, 20 children aged 5-17, 150-215 low-income pregnant or postpartum women, and 20 other family members annually. Over three years, services will be extended to 120 minor children, 60 children aged 5-17, 450-645 low-income pregnant or postpartum women, and 60 other family members.

Susan B. Anthony Recovery Center (SBARC) is uniquely positioned to provide substance abuse treatment to this underserved population. Since 1995 SBARC has been addressing the treatment needs and unique barriers to entry experienced by PPW as the only program in Broward County and one of a handful in Florida to provide organized substance abuse treatment services for women and their minor children, allowing women seeking recovery while residing with their children in a safe and secure setting. SBARC is proposing to join with community partners in an effort to expand and enhance their proven core services to further engage and embrace this underserved population and help fill the desperate need facing these Broward families in crisis. The proposed SUPPORT program intends to positively and significantly affect PPW and their families by Strengthening and Unifying Pregnant and Parenting Opportunities for Recovery and Transformation. The SUPPORT program will provide structured assistance at weak points within the continuum of care, particularly at the initial point of entry. This will be accomplished through strategic service enhancements that include intensified outreach efforts targeting new marginalized disparate populations, significantly broadened pre-treatment services with community linkages and expanded family engagement during residential treatment.

The purpose of the Freedom House II: Comprehensive Residential Family Treatment for Substance Abuse Recovery (CRFTSAR) project is to provide comprehensive, residential substance abuse treatment for pregnant and postpartum women to decrease substance use, promote mental and physical health and financial stability, and improve family relationships, for themselves and their children. The CRFTSAR is a partnership between Volunteers of American Kentucky, Inc. (VOA) and University of Louisville (U of L) to build on an existing residential substance abuse treatment program in Louisville, Kentucky to provide holistic, evidence-based services to approximately 75 women and 60 children living in a residential facility, Freedom House II. The CRFTSAR will accomplish the following: 1) Provide evidence-based behavioral health treatments for mothers, children, and families; 2) Provide strengths-based casework to promote financial and housing stability for mothers and families as well as employment readiness for mothers; and 3) Create a more trauma-informed agency complete with measurable outcomes. The CRFTSAR project will implement a coordinated set of screening, assessment, and interventions following individual and family treatment plans. On-site, credentialed clinicians will screen and assess for substance use, trauma, mental health, family functioning, as well as assess the trauma-informed nature of the agency. They will then create customized and comprehensive individual and family treatment plans. Evidence-based clinical models to be provided to women include Motivational Interviewing/Motivational Enhancement Therapy, the Boston Consortium Model, and Relapse Prevention Therapy.

Southern California Alcohol & Drug Program's (SCADP) La Casita project proposes to serve low-income (per federal poverty guidelines) women, age 18 and over, who are pregnant or postpartum (within 12 months of childbirth), who have a substance use disorder or co-occurring substance use and mental health disorder (COD), and have limited access to quality health services. We will also serve their minor children (17 and younger) and other family members. We will serve primarily racial and ethnic minority women, who have been traditionally underserved, and their children, partners, fathers of the children, and other family members as appropriate. Over half of the women we will serve will be Hispanic; approximately 20% each will be Black and non-Hispanic White; and less than 10% will be other races. Because homelessness is such a serious issue in our service area, and the consequences of homelessness so profound for pregnant women and children, women who are currently homeless or immediately at-risk of homelessness will be our priority. We propose to serve 50 pregnant or postpartum women per year (150 total for the project), 35 infants/residential children per year (105 total), and 50 nonresidential family members per year (fathers, partners, nonresidential children, and other family members that may be part of the family support system - 150 total).

The target population for this project is addicted pregnant and postpartum women (PPW) and their children living in Mississippi being treated at Region One Mental Health in a comprehensive residential treatment program for addicted PPW and their children. The four county catchment area served by Region One includes Coahoma, Tunica, Tallahatchie, and Quitman counties. These counties are located in the Mississippi Delta, a rural, socioeconomically deprived, underserved area of Mississippi. Investigators from the University Mississippi Medical Center will partner with Region One to implement trauma-informed, evidence-based treatment for addicted PPW women, their children, and non-consumer parents/partners. Services that will be installed include an evidence-based mental health assessment, evidence-based treatments of PTSD for PPW and the children (i.e., Prolonged Exposure and Trauma-Focused Cognitive Behavioral Therapy), evidenced-based treatments for depression for PPW and their children (Behavioral Activation), emotion regulation training for PPW (Dialectical Behavior Therapy Skills Group), and state-of-the-art parent training for PPW and non-consumer parents/partners (Incredible Years). National experts at the University Mississippi Medical Center will treat PPW and their children at Region One, will train Region One providers in evidence-based assessments and interventions, and will supervise Region One provider's provision of these services. Outcomes, including involvement of African American/Black PPW, children of PPW, non-consumer parents/partners, healthy parenting, and symptom severity of PTSD and depression will be assessed at baseline, end of treatment, and six month post-baseline.

With support from the Services Grant Program for Residential Treatment for Pregnant and Postpartum Women (PPW), Project ARCC, (Achieving Recovery through Coordinated Care) will enhance and expand Prototypes' capacity, address the priorities set forth in the PPW program and fulfill the Substance Abuse and Mental Health Services Administration's (SAMHSA) focus on expanding the availability of comprehensive, family centered residential substance abuse treatment services. The ARCC program will serve low-income, pregnant or postpartum women and their minor children, along with fathers, partners or other family members as appropriate. Prototypes is licensed for 160 adult (female) beds including 8 beds designated for sub-acute detoxification services and 90 children's beds, and provides gender responsive, trauma informed residential treatment services for females, and reunification services, parenting and family support to their children. Other (county or private) system of care services may be available for women and children, but through ARCC, Prototypes will enhance and expand a program that specifically addresses a woman's individual circumstances to include non- resident family members. ARCC will serve a total of 120 women, their children (estimated at 204) and other family members (estimated at 120) over the three-year grant period.

The Mommy & Me Program, Miami-Dade County, Florida, provides residential treatment for mental and behavioral health, substance abuse, and co-occurring disorders for pregnant and postpartum women (PPW), and residential services for their young children. The program offers long-term wrap-around services and community support for mothers with children, and provides comprehensive, continuous, and integrated systems of care. The program provides a medical home model that integrates primary care and behavioral health care services that move clients toward quicker restoration and self-sufficiency in a continuum of care. Currently there are 8 designated residential rooms housing 2 women each and their children, serving approximately 100 women and children annually. Funding for this program will allow an additional 4 double-rooms and added staff and staff time, for an additional 50 women each year to receive treatment while having their children in the same facility. By expanding capacity from 100 to 150 per year, an estimated 450 women will be served throughout the lifetime of the project at a cost of approximately $3,777 per person. The objectives of this project include enlarging capacity to serve 50% more women; decreasing barriers to treatment accessibility by 50%; decreasing the barriers to accessing project-related services by 61%; improving birth outcomes, mental and physical health, and family functioning of participants and minor children by 60%, and decreasing involvement in crime and abuse by 75%. The outcomes include increased early entrance into treatment in the first trimester; increase number of clients receiving evidence-based services; improved quality of life as measured by improvements in housing and employment; increased child health promotion, prevention, and treatment interventions; improved child functioning; improved mother-child bond; improved family functioning; and reduction/elimination in use and/or abuse of drugs, alcohol, and tobacco.

Project Precious will provide residential substance abuse treatment and other services to 100 adult, primarily Hispanic, low-income, pregnant and postpartum (PPW) women, and an estimated 75 of their children, in San Antonio, Texas. Precious will provide a trauma-informed, family-centered, culturally-competent continuum of services to aid women in attaining long-term recovery while reuniting and strengthening their families. In partnership with Volunteers of America, Precious will efficiently expand the substance abuse, parenting, and recovery services available to substance-using PPW. The project will integrate a number of evidence-based models: Trauma Recovery and Empowerment Model, a trauma-informed recovery program; Motivational Enhancement Therapy, a person-centered counseling approach; Nurturing Parenting, a family skills training program for families in substance abuse treatment and recovery; Pathways to Family Reunification and Recovery, a skills building module addressing child custody issues; and, finally, process groups, a time when participants integrate and process what they have learned. Services will also be provided to children and other family members of the participating women, such as screenings and referrals for physical and mental health needs, including substance abuse treatment. Comprehensive, strength-based case management will guide women through their services and link them to outside resources. These interventions support SAMHSA's goals of reducing substance use; increasing safe, healthy pregnancies; improving mental and physical of women and children; improving family functioning; and decreasing crime, violence, abuse, and neglect. A total of 285 women, men, and children will be served over the life of the project. As required by SAMHSA, Participants will complete a 6-month follow-up assessment.

The project will provide residential substance abuse treatment and comprehensive services to 183 women, 264 infants and children, and 639 extended family members, for a total of 1,086 persons served over a 3-year project period. The purpose of the proposed project is to provide comprehensive, high-quality residential substance abuse treatment for low-income women age 18 and over, who are pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who have limited access to quality health services. The target population also includes fathers of the children, partners of the women, and other extended family members of the women and children in treatment when their inclusion in non-residential treatment services is deemed to be appropriate and beneficial. The project will enhance the existing comprehensive continuum of care offered by VOAD to pregnant and postpartum women with addiction issues and their families. Located in Sioux Falls, South Dakota, it will serve families throughout the state, as well as in Southwest Minnesota and Northwest Iowa using effective evidence-based, trauma-informed substance abuse.

Casa Esperanza, Inc. is a community-based human service agency that provides integrated addiction and mental health treatment to Latinos in Massachusetts. Casa's proposed Salud y Sustento will expand and enhance bilingual/bicultural services for pregnant and post-partum Latinas living with addiction and co-occurring serious mental illness and their families through the creation of a culturally competent, trauma-informed person-centered health home that provides integrated substance abuse; mental health; medical; family stabilization, reunification and recovery; case management; and peer support services. The project will serve 50 individuals during the first year, including Latina women, their children, and other family members, with a total of 150 individuals being served over the three-year grant period. Based on our previous experience, we expect 100% of the women to have extensive trauma histories, 100% will be homeless, 18.5% will be disabled; 40% have injected drugs in the past six months, and of those, 40% shared needles or works; 34% had sex in exchange for drugs; and 17% have been in jail for prostitution. Regarding specific mental health markers, we anticipate 58.6% will report recent depression, 63.5% will report recent anxiety, 48.7% will have had serious thoughts of suicide, and 42.7% will have attempted suicide. Participants will be 100% female ages 18- 44. All will identify as Latina, more than 80% will identify as Puerto Rican; 40% will be monolingual Spanish speakers, 40% will have limited English skills; 71.5% will not have their own place to live; 61.2% will not have a high school diploma; 100% will be unemployed; 18.5% will be disabled; 91% will identify as heterosexual, 3% as Lesbian, 5% Bisexual and less than 1% as Transgender.

MIRRORS (Maternal Initiative for Reflective Recovery-Oriented Residential Services) expands and enhances specialized residential substance abuse treatment, prevention and recovery support for high-risk women who are pregnant or postpartum (the period following childbirth up to 12 months), their children and families. Pregnant/postpartum women will be age 18 and over and meet The Diagnostic and Statistical Manual of Mental Disorders, Volume 4, Text Revision (DSM-IV-TR) criteria for substance dependence diagnoses. Women to be served are from Houston and Texas Public Health Region 6, inclusive of Harris County and 12 surrounding counties, including Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Liberty, Matagorda, Montgomery, Walker, Waller and Wharton. Primary population demographics include low-income (according to federal poverty guidelines), uninsured and indigent women, as well as women with co-occurring psychiatric disorders, domestic violence and trauma histories, HIV/AIDS or disabilities, and women identified as homeless, veterans or involved in the prostitution trade or human trafficking. Based on treatment program experience/regional trends, significant prescription drug/opioid dependence is expected. Risk factors include involvement with DFPS, history of substance use, domestic violence, trauma history or abuse, mental health issues, lack of/late prenatal care, teen pregnancy and financial distress.

The Native American Connections Pregnant & Post-Partum Women's (NAC PPW) Project will enhance and expand the delivery of culturally adaptive comprehensive residential treatment services and intensive case management treatment for low-income pregnant and post-partum women and their dependent children, with an emphasis on those who are homeless and/or Native American. Support services for family members and kinship, which are fully integrated with Native American traditional healing and wellness practices, are critical to the wellness of the mother and children and will also be available. The NAC PPW will provide up to 90 days of evidence based residential treatment services, co-occurring behavioral health and substance abuse treatment services, trauma informed treatment services, recovery support services, permanent supported housing, educational and job skills training and placement, family reunification services, childcare and treatment services, and traditional healing practices. The NAC PPW will strongly emphasize the Circle of Strength program, which is designed to foster improved family cohesion and stability through integrated family counseling sessions that addresses interfamilial conflict, communication challenges and issues unique to the recovering family. Our Guiding Star Level II Residential Substance Abuse Treatment Program will be the primary service location, with other services and supports provided through our community partners within Maricopa County, Arizona. In 2016, the services that had been provided at Guiding Star will be transitioned to the new Virginia Wellness Center, a comprehensive wellness campus currently under development. Designed by researchers affiliated with ASU and approved through an Institutional Review Board, the Center will be located next to a new NAC housing community. The NAC PPW Project will provide services to 314 individuals (110 pregnant or postpartum women, 204 dependent children) as well as 175 members.

Project Precious will provide residential substance abuse treatment and other services to 100 adult, primarily Hispanic, low-income, pregnant and postpartum (PPW) women, and an estimated 75 of their children, in San Antonio, Texas. Precious will provide a trauma-informed, family-centered, culturally-competent continuum of services to aid women in attaining long-term recovery while reuniting and strengthening their families. In partnership with Volunteers of America, Precious will efficiently expand the substance abuse, parenting, and recovery services available to substance-using PPW. The project will integrate a number of evidence-based models: Trauma Recovery and Empowerment Model, a trauma-informed recovery program; Motivational Enhancement Therapy, a person-centered counseling approach; Nurturing Parenting, a family skills training program for families in substance abuse treatment and recovery; Pathways to Family Reunification and Recovery, a skills building module addressing child custody issues; and, finally, process groups, a time when participants integrate and process what they have learned. Services will also be provided to children and other family members of the participating women, such as screenings and referrals for physical and mental health needs, including substance abuse treatment. Comprehensive, strength-based case management will guide women through their services and link them to outside resources. These interventions support SAMHSA's goals of reducing substance use; increasing safe, healthy pregnancies; improving mental and physical of women and children; improving family functioning; and decreasing crime, violence, abuse, and neglect. A total of 285 women, men, and children will be served over the life of the project. As required by SAMHSA, Participants will complete a 6-month follow-up assessment.