Evaluating Treatment Experiences Among Peer Mentors

By Shirl Richardson DSW

Substance abuse among women has greatly increased over the last decade. Women involved with child welfare services appear to be the most affected. Chronic shortages of appropriate substance-abuse treatment hinder women needing help .The demands of court-ordered treatment state women must enter and complete six to eighteen months of treatment before child custody is reinstated.

• Language: English
• Publisher: Christian Faith Publishing, Inc.
• Release date: Dec 3, 2019
• ISBN: 9781098002558

Book preview

Chapter 1

Introduction

The misuse of substances among women in the United States has dramatically increased in the last decade. Women involved in Child Welfare Services (CWS) and the Criminal Justice System (CJS) are the most affected and continue to encounter barriers to treatment for substance use disorders (SUD). Treatment availability designed specifically for women with SUD revealed long waiting lists, lack of gender-specific treatment, and ineffective treatment programs. An evaluation of a Northeastern United States gender-specific halfway house for treatment of women with substance use disorders (GSHTSUD) that provides peer mentoring services for women in treatment is described. These clients are also involved with CWS, CJS, or both. The perspectives of the peer mentors who are themselves in recovery from SUD and employed at this GSHTSUD program were included. During this qualitative appreciative action research (AAR) study, peer mentors provided their perceptions through a researcher-designed online questionnaire comprised of nine demographic questions and twelve open-ended qualitative questions designed to collect and analyze data (Appendix appendix A).

The completed responses from the five peer mentors who participated were reviewed for recurring themes and epiphanies. These results were triangulated with the reflective journal and agency artifacts to present the findings, which included positive program attributes as well as suggested areas for improvement. Positive themes of personal experience and understanding of the recovery process, hope, and motivation, as well as inspiration for and from the clients, were highlighted. The peer mentors as well as the agency artifacts demonstrated the strength of this program in addressing the specific needs of women in treatment for SUD. The themes for potential improvement included the ongoing need for development of coping strategies to avoid personal relapse and burnout among the peer-mentors, and concerns for their physical safety in high high-crime neighborhoods. Additional results showed a need for streamlining paperwork, decreased wait-time for clients to gain access to this treatment program, as well as improvement of the overall communication and problem solving pathways between the treatment facility, CWS, and CJS.

Background of the Problem

The prevalence of substance use disorders (SUD) in women continues to increase in the United States (Astramovich and Hoskins 2013). Women encounter multiple barriers to successful treatment for SUD, including the need to promote reunification of their families (Covington 2008; Marsh, Smith, and Bruni 2011). For example, the family reunification timeline mandated by the Adoption and Safe Family Act (ASFA) outlines how women may face barriers to treatment of SUD based on the limited number of gender-specific treatment programs available as well as the prolonged waiting time for entry into a program of any type (Phillips and Mann 2013). This action research and appreciative inquiry (AAR) study used action research to evaluate one of the ten Northeastern gender-specific halfway house treatment programs for substance use disorders (GSHTSUD) located in the United States. Women in this program are offered peer mentoring services facilitated by women who are themselves in recovery from SUD. These peer mentors serve as a support system to women involved with child welfare services (CWS) and the criminal justice system (CJS).

All peer mentors employed at this center were invited to participate in this qualitative study. Five peer mentors accepted the invitation to participate in the study. A researcher-designed questionnaire consisting of nine demographic and twelve open-ended questions was administered via SurveyMonkey (appendix A). The overarching research question and three sub-questions guided the data collection for this study. A conceptual framework using the women’s integrative treatment model was used. The misuse of substances occurs when individuals use drugs for a reason other than their intended purpose (Holland, Forrester, Williams, and Copello 2014). In contrast, the abuse of prescribed or illegal substances occurs when an individual uses medication or substance for the explicit purpose of getting high. According to the Office of Applied Studies (OAS), approximately six million children resided with caregivers who abused alcohol or other drugs; 80 percent of the children in foster care were removed due to parental SUD (Taylor 2011).

A recent study conducted by child welfare researchers indicated that 77 percent of the women involved with CWS were victims of abuse, 59 percent had mental health problems, 50 percent were involved with CJS, and 50 percent to 80 percent were diagnosed with SUD (Marsh et al. 2011). Researchers in the child welfare field suggested the number of women with SUD is expected to increase, creating more demand for gender-specific treatment programs (Lee, Esaki, and Greene 2009; Oliveros and Kaufman 2011). These authors also stated women who are also involved with CWS are anticipated to be the most affected by the limited availability of gender-specific treatment programs.

A major portion of Northeastern states suffered the devastating effects of the crack cocaine epidemic in the mid-1980s and 1990s. Child welfare services was prompted to search for alternative methods to reduce the number of children entering the foster care system due to the increasing number of women becoming addicted (Phillips and Mann 2013). The ASFA, signed into law in 1997 under President Clinton’s administration, stated children placed for a period of fifteen months or beyond twenty-two months must be made available for adoption (Marsh et al. 2011; Phillips and Mann 2013). In the United States, ASFA is recognized as standard practice among child welfare organizations. Given the designated timeline to make children available for adoption within fifteen months and not to exceed twenty-two months in foster placement, parents must meet the demands outlined in the court order that specifies completing treatment for their SUD (Oliveros and Kaufman 2011).

For women with SUD, this presents a problem; there are long wait lists to enter treatment and the chronic shortages of gender-specific treatment programs for SUD prevents women with children from meeting specific deadlines (Hughes 2014; Marsh et al. 2011; Oliveros and Kaufman 2011). It matters little if women are mandated to treatment or voluntarily enter a program; the same principles and state regulations are applicable (Hughes 2014; Lee et al. 2009). Parent-child reunification is a lengthy process that includes the decisions made by the dependency courts in determining whether children are still at risk. If parents do not successfully complete a treatment program for substance abuse within the time period allotted, there is an increased risk of permanently losing custody of their children (Hughes 2014; Taylor 2011).

There must be a focus on treatment of the SUD as well as the reunification of the family; many of the gender-specific underlying issues and initial causes of the chemical dependency, including trauma, sexual abuse, and intimate partner violence among others, also bear exploration (Hughes 2014; Marsh et al. 2011; Westad and McConnell 2012). Some of the women with children and pregnant women released from CJS diagnosed with SUD are referred to CWS. During the intake and screening process, the women may present with a current SUD as well as various co-occurring disorders and histories of trauma. Covington (2008) and Marsh et al. (2011) argued that in some programs, counselors only focus on one aspect of recovery and assume that other problems, including those dealing with gender-specific issues and the contributing and underlying factors to SUD, will be handled by other programs. Additionally, one of the chronic problems in the treatment of women afflicted with SUD is the lack of gender-specific treatment programs.

This research study was an evaluation of the program offered by a GSHTSUD located in one of ten Northeastern states. This gender-specific program provides treatment services for women over the age of eighteen who have been diagnosed with SUD. Preference is given to pregnant women who use heroin. This program also provides partial hospitalization for detoxification as well as residential and outpatient options for treatment. Women with SUD and co-occurring disorders, as well as those with children, are also afforded housing options as needed. In 2001, GSHTSUD began providing peer mentoring, which increased the range of services for women with SUD who are involved with CWS as well as for women recently released from jail. The clients are offered peer mentoring services as a support to help their recovery from their SUD.

The peer mentors who work in this program are themselves in recovery from SUD and have been drug free for five or more years. They experienced similar situations to their female clients and are able to share valuable insights (Berrick, Young, Cohen, and Anthony 2011). The peer mentors share their journey to sobriety as well the pressure of participating in court-ordered activities and the negative consequences of their SUD. The peer mentoring services are voluntary; if a client chooses to accept these services, the peer mentor will make in-home visits, accompany clients to court hearings, and encourage and empower GSHTSUD clients by sharing their story of recovery. The addition of peer mentor services at GSHTSUD has enhanced and strengthened the overall program.

As previously mentioned, during the crack cocaine epidemic, GSHTSUD and various hospitals in conjunction with CWS organizations received an influx of reports that disclosed the increasing number of pregnant mothers with crack cocaine addiction (Covington 2008; Marsh et al. 2011; Phillips and Mann 2013; Taylor 2011). As a result, perinatal drug intervention research foundations and treatment models for women with SUD were established in several large cities across America. The GSHTSUD program added services to accommodate this newly identified program and increased its services to pregnant women with SUD.

The staff at GSHTSUD continues to be instrumental in providing specialized treatment for women with SUD, leading to positively affected court-ordered parent-child reunification efforts. The court requires that permanency hearings must be held within twelve months of the child’s placement and termination of parental rights proceedings initiated within the fifteen- to twenty-two-month window (Phillips and Mann 2013; Taylor 2011). Women with SUD mandated by the court need to complete a drug treatment program within a twelve-month period or risk losing custodial rights (Drabble and Poole 2011; Westad and McConnell 2012).

When women