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Over the five year grant project, through the Promoting Opportunities for Women Entering Recovery (POWER) Program, Hope House will increase access to evidence-based mental health and substance use residential treatment services, intensive case management, and linkages to other supportive services for 225 low-income pregnant and/or postpartum women having substance use disorder (SUD) and/or co-occurring mental and substance use disorder from across rural Georgia. The health of Georgia women and children has precipitously declined in recent years. The state currently ranks 40th in the nation for overall health of women and children. Georgia has the third highest rate of uninsured in the country and the highest maternal mortality rate with low-income African American women being the most vulnerable. At the same time, drug overdose rates among childbearing age women in Georgia and the incidents of Neonatal Abstinence Syndrome have doubled and tripled year over year with rural areas being the most impacted. The barriers to treatment are most significant for women who are pregnant and/or have minor children residing in rural Georgia counties designated as Healthcare Professional Shortage Areas. The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) Addictive Diseases' Women's Treatment and Recovery Services has a well-established network of substance use treatment providers, of which Hope House is an approved program. However, the current demand for services well exceeds the state's capacity. DBHDD placed 325 pregnant women across the state in SUD treatment in 2019 (a 30.5% increase over 2018) and maintains an average waiting list of 127 pregnant women. DBHDD has segmented the state into six regions to oversee programs. Hope House is one of 22 DBHDD approved providers in the state, and the only program in its region that serves women (single, pregnant and/or with children). The POWER Program will offer residential mental health and substance use disorder treatment within a comprehensive system of integrated services that support recovery. The program targets women 18 years and older pregnant and/or with children with gender specific evidence-based programming and a family centered approach that supports sobriety. Measurable objectives and expected outcomes for the POWER Program are: 1) annually, provide SUD and mental health treatment and comprehensive wraparound services to support recovery to 45 women; 2) annually, 100% of women who participate for at least 3 months and their children will have improved mental and physical health; 3) by August 2025, 225 children and 168 family members will participate in therapeutic child care and wrap around recovery support and educational services; 4) 70% of participants will secure or increase monthly income through employment or permanent benefit programs; 5) 85% reduction in positive drug screens after 30 days of initial treatment; 6) 95% births to participants will be healthy births; 7) 75% of participants with minor children will retain and/or regain custody; and 8) 80% of participants will improve parenting skills and family functioning.

Southcentral Foundation (SCF) through its residential treatment program, Dena A Coy (DAC), will work with other SCF health programs and local organizations to reduce unmet treatment needs of pregnant and postpartum women in rural Alaska through the provision of prevention, treatment and recovery services for substance use disorders and increase access to culturally appropriate and evidence-based treatment at the DAC Residential Treatment facility in Anchorage, Alaska. DAC is a primary service provider for the residential treatment of pregnant and postpartum women in Alaska. As such, the program is responsible for intake, orientation that includes state-mandated classes, inpatient treatment, and classes on life-skills, health relationships, parenting, substance abuse, wellness, emotional and peer-to-peer processing. The Dena A Coy residential treatment program supports family reconciliation and reunification through family therapy and education sessions and visitation. Additionally, the program includes childcare, postpartum health care, health and wellness, coordination of care during discharge and transition, including outpatient and aftercare services. This project proposes to serve at least 100 pregnant and postpartum women along with their children and families over a five year period with a target group of over 2,000 women of childbearing age from twelve rural, remote villages plus the Matanuska Valley. Although SCF as a tribal organization serves primarily Alaska Native and American Indian, DAC serves all women and children because the needs is very high throughout the state for residential treatment for women with children and DAC is the only program that focuses on needs specific to prenatal and pregnant women and their children living in the same facility. Using current evidence-based practices and tools, the twenty individuals selected each year will be based on priority: 1. Pregnant IV users, 2. Non-pregnant IV users, 3. Pregnant women with SUD, 4. Women involved with the Office of Children Services, and 5. Women with non-IV SUD. The endeavor for the next five years is to help pregnant and postpartum women to achieve an optimum quality of life through developing treatment plans, enhancing life skills, addressing health and mental health needs, engaging in meaningful activities and building social connectedness and community relations. The program's 4-point approach will be to: (1) Promote services to pregnant and postpartum women and their families in thirteen Alaska rural locations and identify women with substance use disorders to encourage treatment to protect the unborn; (2) Provide residential treatment and a continuum of services to pregnant and postpartum women in need of treatment for substance use disorders; (3) Provide relevant services to the children of women who are in residential treatment for substance use disorders at DAC during the project period; and (4) Provide quarterly and annual evaluations based on data collected during the project period.

The United Community Center's (UCC) Madres Sanas, Ninos Sanos (MSNS, Healthy Mothers, Healthy Children) will serve 226 pregnant and postpartum women (PPW) with substance use disorders (SUD) or co-occurring SUD and mental health disorders (COD), along with their infants and children, who reside in Milwaukee County, WI. The project will address the shortage of family-based SUD treatment options for PPW and their children in Milwaukee Services will be delivered within the context of UCC's multi-program community center serving MC's Hispanic community. While the UCC SUD treatment program serves individuals of all races/ethnicities, in 2017, 30.3% of those served were Hispanic, more than twice the proportion of Hispanics (14.5%) who live in the County as a whole. According to the Milwaukee County Medical Examiner's office, 404 people died from opioid overdose in 2019, the highest annual total ever recorded. The zip codes with the most deaths were 52204 (38 deaths) and 53215 (46), the two zip codes representing the heart of UCC's service area. The Milwaukee County Behavioral Health Division (BHD) reports that 26.2% of individuals reported opioids as their primary substance at intake. In contrast, fully 65.5% (205 of 313) of women seeking treatment at UCC in 2019 reported their primary substance as opioids. A consistent finding across research studies is the markedly elevated risk of adverse birth outcomes for women who abuse alcohol/drugs during their pregnancies. In 2017 Milwaukee's infant mortality rate (IMR), at 12.6 deaths per 1,000 births, ranked 3rd highest among the 50 largest cities in the U.S. UCC will admit PPW to MSNS who meet criteria for residential level of care. UCC operates two residential facilities with 32 beds including family suites so children can reside with their mothers. However, the entire continuum of care (day treatment and outpatient) will be available when women are ready to step down to a lower level of care. Each PPW will be assigned a recovery support coordinator (RSC) who will assist her to develop a Recovery Plan of Care (RPOC) based on a comprehensive assessment of her clinical and psychosocial needs as well as those of her family. The major MSNS treatment framework will be The Matrix Model with other evidence-based practices to be implemented including, Seeking Safety to address the trauma histories and symptoms that commonly co-occur with SUD, onsite medication-assisted treatment to address the significant proportion of participants with opioid used disorders, and the trauma-focused Nurturing Program which addresses the mother child bond. UCC has put together a robust network of community partners that will offer supportive services from housing to pre/postnatal care, to child/family services, to education/employment services. Measurable objectives include: treatment retention, decrease substance use, decreased mental/health/trauma symptoms, improved child health/wellbeing, improved parenting attitudes, progress on economic self-sufficiency, access to stable housing, and connection to social supports.

Based in Manchester in Clay County, KY, VOA Mid-States' proposed project will expand services for pregnant and postpartum (up to 12 months) women aged 18+ annually seeking treatment for substance use disorder (SUD) with an emphasis on opiate use disorder and their infant and minor children age 17 and under. The widely-lauded, comprehensive evidence-based approach will promote long-term recovery and safe, healthy, stable families. Project Name: Freedom House Southeastern Kentucky. Population to be Served: VOA Mid-States will serve pregnant and postpartum (up to 12 months) women (PPW) aged 18+ seeking treatment for substance use disorder (SUD) with an emphasis on opiate use disorder and their infant and minor children age 17 and under. The target area covers 16 rural counties in Southeastern Kentucky: Bell, Breathitt, Clay, Harlan, Jackson, Knott, Knox, Laurel, Lee, Leslie, Letcher, Owsley, Perry, Rockcastle, Whitley, and Wolfe. Strategies and Interventions: VOA Mid-States will use a suite of Evidence-Based Practices to provide an effective, holistic, trauma-informed treatment program to promote recovery through its widely lauded Freedom House model. PPW funds will support residential and intensive outpatient services, which is the second phase of a comprehensive three-phase treatment plan. Goal 1: Enhance capacity to provide comprehensive, trauma-informed, evidence-based SUD treatment for PPW. Objectives: create evaluation plan, hire and train staff, notify partners about project launch, and launch grant project expansions within 60 days of award. Goal 2: Ongoing delivery of evidence-based, trauma-informed, family-focused SUD clinical treatment services to PPW. Objectives: accept referrals & provide screening, complete evidence-based mental health and trauma screening and clinical assessments, provide residential treatment and intensive outpatient services to PPW and their children, provide immediate access to prenatal and medical care, provide evidence-based, trauma-informed clinical group, individual, and family therapy, and provide aftercare planning to provide ongoing outpatient, aftercare services, and case management. Goal 3: Deliver supportive services to promote recovery and family stability. Objectives: provide case management, coordinate clinical treatment plans with non-clinical care and requirements of child welfare case plans to avoid unnecessary removals and create an integrated hand off into treatment; refer clients to educational and workforce training and placement services via partners; provide vocational, educational, and life skills services; refer/provide care coordination to harm reduction resources and HIV, Hepatitis C and other infectious disease testing and care for participants via health care provider partners; provide referrals and service coordination for childcare services. Goal 4: Provide parenting and child well-being resources and education to promote safe and healthy families. Objectives: provide family-based preventive interventions to reduce the likelihood of interpersonal violence, criminal involvement, behavioral or emotional disorders in children, and child abuse and neglect; provide parent education and training to decrease child trauma symptoms and/or address behavior problems using healthy, non-violent parenting techniques; provide child trauma and mental health screenings, assessment, and treatment; provide access to medical and developmental screenings and treatment. VOA Mid-States proposes to serve 50 unduplicated PPW/year (250 during the five-year grant period) and their children (132/year and up to 660 during the grant period).