1. Programs Should Be Comprehensive

As many services as possible should be offered at one site or effectively linked to existing services in the community. To meet the complex and extensive treatment needs of this population, programs must provide:

• Legal advocacy
• Child protective services
• Prenatal medical care for women
• Pediatric care for the infant
• HIV testing and counseling
• Preconception education and family planning services
• Womens' chemical dependency treatment
• Education and job training
• Coordination of social services
• Developmental assessment of children
• Child care
• Case management
• Parenting education
• Mental health services
• Support groups
• Transportation
• Housing
• Domestic violence counseling.

2. Programs Should Be Confidential and Accessible

Substance-using women are often distrustful of social service systems and "helping" agencies because they fear criminal reprisals, moral judgements, and loss of their children to protective services. Programs must therefore ensure confidentiality and accessibility in order to be effective and inviting to women. Barriers to participation such as lack of child care or transportation must be eliminated.

3. Programs Must Be Collaborative and Coordinated

Collaboration among professionals from different disciplines is recommended. To meet the large number and variety of treatment needs of these patients and to assure integration and avoid fragmentation of services, professionals must clearly define and coordinate their roles. Collaboration is recommended among the many agencies often concurrently serving these women and their families. To provide a unified and coordinated approach among agencies, case management must take place.

4. Interventions Must Be Intensive

The problems of these women - lack of healthy social support systems, the disease of chemical dependency, and parenting infants with behavioral difficulties - require an intensive program response. Programs must make a long-term commitment to clients, and staff should be readily accessible and have frequent contacts with clients. Practical recommendations for creating intensive interventions include home visits, the use of drop-in centers, and crisis telephone lines operating on a 24-hour basis.

5. Programs Must Have a Supportive Orientation

Women in these programs are often emotionally fragile and vulnerable. Interventionists who forge supportive therapeutic bonds foster the woman's motivation to recover and desire to be a good parent. Programs should offer women the opportunity to build a relationship with a few key interventionists.

Many current drug treatment programs based on the therapeutic community model use a confrontational group process approach that is quite successful with men. Most treatment experts believe that chemically dependent pregnant women require specialized treatment models that include groups made up solely of these women in order to encourage contact and interaction, peer support, and focus on common problems.

6. Programs Should Be Culturally Competent

Program staff need to be responsive to the specific racial, ethnic, and cultural backgrounds of women using the service.

7. Residential Treatment and / or Drug-Free Housing Must Be Available

Treatment experts strongly recommend that patients be encouraged to leave their living environments where drugs may be readily available and commonly used. Options include residential treatment programs for those most severely chemically dependent, as well as drug-free housing for all others. Children must always be included in all residential options.

8. Programs Should Include Parent Education and Quality Child Care

Women want to be good parents. Often their natural inclinations are unsuccessful because their drug-exposed infants are difficult to parent. Sensitive parent education can help them understand their babies and care for them effectively. "Hands on" experiences in parenting should be part of any residential treatment program. The integration of infants and young children into residential treatment programs should be done in a manner that supports the mother-infant bond as well as allows mothers time and energy for recovery.

Quality infant care is especially important for drug-exposed infants. Special attention should be paid to the development of a bond between infants and their principal caregivers. When addicted mothers are in treatment or meetings or otherwise engaged, it is important for infants to be cared for in a manner that promotes trust and security.

SOLID FOUNDATION

P.O. Box 19183
Oakland, CA 94619
415-482-3217

The Solid Foundation operates two residential programs for women: Mandela House and Keeler House, serving five or six women. The program provides comprehensive treatment, including prenatal and perinatal care and education in child development (with an emphasis on the special needs of drug-exposed children), transportation, job training, GED preparation, nutrition information, religious counseling, personal grooming, group and individual counseling, and a therapeutic nursery. Women live in the house with their infants for 12 to 18 months. Mothers are involved in the design, policies, and implementation of the program and often volunteer for service after graduation. The program has received many awards.

CHEMICAL ADDICTIONS RECOVERY EFFORTS (CARE) CLINIC

Children's Hospital
5208 Claremont Avenue
Oakland, CA 94609
415-652-3783

CARE is an outpatient treatment program for up to 65 chemically dependent mothers and their drug-exposed infants, age 0 to 3 years, offering services both in the home and onsite. The focus is to help mothers maintain custody of their children, help mothers remain drug free, and help the children developmentally. Services include: comprehensive medical and psychosocial services, weekly group sessions, recovery support groups, weekly staff home visits, parent education, therapeutic developmental nursery for children with developmental delays, support in obtaining transportation, housing, child care, and material items.

PROTOTYPES WOMEN'S CENTER

845 East Arrow Highway
Pomona, CA. 91767
714-624-1233

PROTOTYPES provides a wide range of services to substance-using women and their children and has both a long-term residential treatment program and an outpatient program. The residential program serves 55 women and up to 30 children for a period of 9 to 18 months. The program has four treatment phases: orientation, stabilization, reparenting, and community re-entry, with the women assuming increasing responsibility in each phase. Core activities of the program include: chSUPical dependency education, individual and group counseling, women's health issues group, family treatment, household responsibilities, vocational training, aftercare planning (including a "buddy" who assists in seeking Employment and gaining independence), recreational activities, and participation in 12-step groups. Specialized groups include: pregnancy, grief and loss, communication skills, relapse prevention, women's survivors, and parenting training. Children's activities include a therapeutic nursery, play groups, parent-child outings, and after-school tutoring for school-age children.

The outpatient treatment program includes women who are preparing to go into the residential treatment program and who graduate from the program as well as those who prefer to remain in outpatient care. Services include family therapy, individual and group counseling, parenting groups, referrals, and structured social events.

PROTOTYPES also has an enhanced outpatient treatment program quite similar to residential treatment except the families do not live at the facility.

OPTIONS FOR RECOVERY

San Diego County
Alcohol and Drug Services
3851 Rosecrans Street
San Diego, CA 92110
(619) 692-5757

This is a federally-funded, comprehensive, interagency collaborative pilot project that incorporates case management, alcohol and drug treatment, recovery services, and, if appropriate, foster care placements for pregnant and parenting women and their children aged 0-3. Comprehensive case management services are provided to a static count of 200 pregnant and parenting adolescent and adult women. Case managers follow clients for 2 years. Treatment services include two intensive day treatment programs with a static count of 30 each, one residential treatment program with 24 beds, one 18-bed satellite housing facility for women in day treatment, transitional housing, and P.I.P., a prenatal and drug education program operating within the women's correctional facility. All treatment programs provide onsite child care for children 0-3 and incorporate the children into the treatment community. In addition to alcohol and other drug treatment and recovery services, the treatment program provides parenting, relapse prevention and life skills classes, and nutrition education with meals prepared and served on site. Women are encouraged to participate in the treatment and recovery programs for a minimum of 6 months.

The recent addition of Perinatal Treatment Expansion funds from the State of California and the use of Federal Medicaid dollars expanded perinatal services in San Diego County to include two additional intensive adult day treatment programs, an intensive day treatment program for adolescents, outpatient services for alcohol-primary and Hispanic women, a 6-bed perinatal residential detoxification program, and a 12-bed expansion for the residential treatment program.

RIEL HOUSE

1408 West Yakima Avenue
Yakima, Washington 98902
509-575-4810

Riel House is a project of Triumph Treatment Services and has been in operation for 30 years. Riel House serves pregnant women and new mothers, along with their other children up to age 6. The aim is to provide a healthy lifestyle and chemical-free environment for women and their children while they learn new coping and parenting skills. Some of the beds are reserved for adolescent mothers. Services include therapy, parenting education and training, job skill training, and health and social service referrals. Special programs include a "How to Cope" series and other family programs.

HAYMARKET HOUSE

120 North Sangamon
Chicago, Illinois 60607
312-226-7984

Haymarket House is a detoxification, residential, and outpatient substance abuse treatment agency, operating a number of special programs for women, including a program for pregnant women and another program for postpartum women. The Maternal Addiction Center (MAC) at Haymarket House is a program for substance-using pregnant women with a 60- to 90-day length of stay. Services include: group and individual counseling, classes (on homemaking skills, parenting, nutrition, etc.), recreational therapy, medical referral and prenatal care linkage, and family involvement. A new Haymarket-Maryville Program for postpartum women includes women whose substance use continued through pregnancy. Part of the program is a 60- to 90-day length of stay, while another component (where a woman's older children up to preschool age can join her) is 6 months in duration. Support is provided to help the mother find appropriate housing, education, and work opportunities.

WOMEN'S RESIDENTIAL SERVICES

1125 North Milwaukee Avenue
Libertyville, Illinois 60048
708-362-7494

This is a residential treatment program for family recovery. The child and the parent each receive active treatment. The child's treatment plan includes: orientation to the Twelve Steps, drug and alcohol education, recovery from abuse (including sexual abuse) and neglect, self-esteem boosting, and social skills development. Children who have been in foster care are included in the program. Children who have been doing the parenting while the mother was using drugs are taught to understand that they are no longer in the parenting role and that the relationship between mother and child must change. The woman's treatment plans address chemical dependency, education, domestic violence recovery, self-esteem, and parenting.

DEMAND PROGRAM

Turning Point
1015 Olsen Highway
Minneapolis, Minnesota 55411
612-374-2272

This program is designed for women and children up to 5 years of age; they are together while the mother undergoes treatment. Women have an apartment for 6 months; aftercare is mandatory for an additional 6 months. Services include: parenting groups, child development, and self-esteem workshops. Transportation is provided, along with job and GED training.

HOPE, UNITY, AND GROWTH (HUG) OF THE ELEANOR HUTZEL RECOVERY CENTER

4A75 Coplin
Detroit, Michigan 48125
313-822-8830

HUG is the residential treatment program for the Eleanor Hutzel Recovery Center offering services for substance-using women and their young children. Services include: individual, family, and group therapy, support groups, and child care. Residents of more than 30 days become buddies and mentors to newcomers. Program graduates volunteer for an outreach program in which they go into the community and speak about chemical dependency.

DREAMWEAVER

11031 Mack Avenue
Detroit, Michigan 48214
313-331-8990

Dreamweaver has recently opened Grateful Home, a 90-day residential treatment program for eight women and their children (up to 18 years of age). Services include group counseling, lectures, and daycare. "Babes World," a prevention program, works with children while the mother is in treatment, using clinicians and other specialists.

META SUBSTANCE ABUSE TREATMENT PROGRAM FOR WOMEN AND CHILDREN

Our Home Foundation, Inc.
2591 North Farwell Avenue
Milwaukee, Wisconsin 63211
414-962-2024

META for Women and Children is a 30-bed comprehensive residential treatment program for substance-using women and their children (from birth to 10 years); it has won many awards throughout the State. Length of stay ranges from 6 to 18 months. Services include: individual and group counseling, parenting classes, nutrition classes, exercise groups, educational classes, support groups, and relaxation and art therapy. Children up to age 3 are given treatment to enhance cognitive, affective, behavioral, and social functioning. Older children participate in a program for understanding substance use and abuse, and age-appropriate family responsibilities. The program emphasizes enhancing the mother / child relationship.

ODYSSEY HOUSE OF NEW YORK

MABON Family Center
Building #13, Ward's Island
New York, New York 10035
212-860-2460 or 477-9493

Odyssey House established one of the first programs in the country for substance-using women and their children some 25 years ago. Today, the program serves 25 mothers and 25 infants and toddlers (children older than 18 months are not accepted). Services include treatment and counseling, licensed day care, and referrals to diagnostic therapeutic nurseries. There is an emphasis on parenting, with parent education to enhance the relationship between mother and child.

UNITED BRONX PARENTS

LA CASITA
773 Prospect Avenue
Bronx, New York 10455
212-292-9808

LA CASITA serves 40 mothers and 50 children, taking children up to 9 years of age. Program services are similar to those of Oddyssey House, although there are after-school activities for the children.

CENTER FOR COMPREHENSIVE HEALTH, INC.

PAAM (Pregnant Addicts, Addicted Mothers)
163 East 97th Street
New York, New York
212-360-7805

Although this outpatient program has no residential component, it offers a comprehensive array of services. Unlike many residential treatment programs, PAAM is part of a hospital complex, and offers many onsite medical services (including pediatric and obstetrics / gynecology). There is a wide variety of services aimed at the children, including a therapeutic nursery.

PROJECT RETURN

315 East 15th Street
New York, New York 10029
212-348-4480

This residential treatment program serves a large number of substance-using women and children (no older than 3 years, no younger than 1 month), including mentally ill women, and women with other disabilities.

CENTER FOR CHILDREN AND FAMILIES

AMI (Addicted Mother and Infant Program)
8912 162nd Street
Jamaica, New York 11432
718-523-3396

This is a residential treatment program for adolescent teens who are pregnant or who have children. This program, with strong linkages to the city's child welfare agency, has a wide array of services for the children and mothers.

HALE HOUSE

Homeward Bound
300 Manhattan Avenue
New York, New York 10026
212-678-5801

Homeward Bound operates under the auspices of Hale House, located in central Harlem, founded in 1969 by Mother Hale. Homeward Bound is a transitional residential program for homeless women (who have already "graduated" from a rehabilitation program), and their children, many of whom have been in foster care. Families can reside in Homeward Bound for up to 18 months and receive parenting services, life skills training, and counseling.

OTHER NEW YORK INFORMATION

A small residential treatment facility also operates in Rochester: Project Re-Start, run by the Catholic Family Center. APPLE Mother and Child Program, A residential treatment facility for mothers and children, operates in Lake Ronkonkomo, New York (516-981-3977). For additional information about programs, contact Maria Vandor, Director of New York State's Substance Abuse Services for Women and Children at 212-870-8320.

EPIPHANY HOUSE, Inc.

P.O. Box 3308
Long Branch, New Jersey 07740

The program provides transitional living for four families. Supportive services include therapy and vocational training.

CHOICES, Inc.

169 Roseville Avenue
Newark, New Jersey 07104
201-481-1889

Choices provides up to 18 months of room and board, with supportive services for 38 women and 22 children.

NEWARK RENAISSANCE HOUSE, INC.

Youth and Family Treatment Center
508 Central Avenue
Newark, New Jersey 07107

This comprehensive outpatient program is designed to provide substance abuse treatment services to the addicted parent and prevention / intervention services for their children on a daily basis. Intensive outpatient services for the parent include: counseling (group, family, individual), 12-step programs, parenting skills, health promotion (with linkages to clinics), work adjustment, and an "ecological assessment" of the families' social support networks, parenting skills and attitudes, etc. to help in restructuring and empowering the family unit to become self-sufficient. Services to children include: developmental child care (provided to 100 children), developmental testing, drug education, health promotion, and group therapy. There are special services for school-age "latch-key" children, including some meals, educational evaluations, evaluation of school performance, and tutoring.

Family Center

Thomas Jefferson University
1201 Chestnut Street, 11th Floor
Philadelphia, Pennsylvania 19107
215-955-8577

The Family Center, part of the Department of Pediatrics at Thomas Jefferson University, provides comprehensive medical and psychosocial services to pregnant substance-using women and their children. Components include an outpatient program, a residential facility (My Sister's Place), a parent / child center, and a research department. The outpatient facility includes medical services and education, including AIDS prevention counseling and prenatal, parenting, and nutrition courses. Treatment programs are aimed at improving family and interpersonal relationships and access to resources. My Sister's Place is a 2-year residential treatment program for cocaine-addicted pregnant women and their children from birth to age 4. The Parent / Child Center serves the outpatient facility and the residential program, providing an early education intervention program for both mothers and children, as well as nurturing groups and parent support groups. The research component's immediate objectives are to provide effective treatment for maternal cocaine addiction.

Women and Infant Program

Boston City Hospital
818 Harrison Avenue
Boston, Massachusetts 02118
617-534-4235

The Women and Infants Program emphasizes outpatient prevention for substance-using women, combining substance abuse treatment, pediatric care, child development services, and family planning, all located in the pediatric clinic. Comprehensive medical care is provided to the drug-exposed infant.

WOMEN, Inc.

244 Townsend Street
Dorchester, Massachusetts 02121
617-442-6166

This program provides residential substance abuse treatment services for women and their children, with a strong emphasis on parenting and a feminist orientation.

HOUSTON HOUSE

Social Justice for Women
9 Notre Dame Road
Roxbury, Massachusetts 02119
617-445-3066

This residential program serves as an alternative to incarceration for 15 pregnant women recovering from substance use. Houston House provides perinatal medical care, substance abuse treatment, family services, aftercare services, and assistance with finding employment and housing. New mothers and their infants live at the House for 8 weeks after delivery and receive counseling for 6 to 9 months after reentering the community.

Center for Addiction and Pregnancy

Francis Scott Key Medical Center
Mason F. Lord Building, D3 East
4940 Eastern Avenue
Baltimore, Maryland 21224
410-550-3033

The Center for Addiction and Pregnancy is an affiliate of the Francis Scott Key Medical Center, which is owned and operated by John Hopkins University. The Center was designed by a Hopkins psychologist and obstetrician. The residential treatment center has 16 beds, and there is no fixed length of stay. The Center provides a wide array of medical and support services. Women are accepted into the program during pregnancy and up to 4 months postpartum. Infants sometimes remain with their mothers, but there are no accommodations for the mother's other children.

Economic Opportunities Family Health Center

5361 2nd Avenue, N.W.
Miami, Florida 33142
305-637-6419

The Family Health Center provides comprehensive health services to substance-using people in the community, including a long-term residential program for pregnant women and children under the age of 5. The women and children remain at the Center for 6 to 9 months, and participate in a support group for up to 1 year after discharge. There is a range of services available for mothers and for the children, including: individual and group counseling, a therapeutic nursery, referrals to and coordination with other necessary services, and a relapse prevention group. To graduate, each of the mothers must obtain a GED, be employed for 90 days, secure housing, be drug and alcohol free, and have at least $500 in a savings account.

CHANGED LIVING RECOVERY RESIDENCE (CLRR)

2512 Melleville Avenue
Decatur, Georgia 30032
404-289-8968

CLRR was founded in 1991 by Alfreda Capers, who has had personal experience with addiction recovery. It houses nine pregnant or postpartum substance-using women and their children. The minimum stay is 3 months, the maximum is 1 year. Recovering mothers participate in family counseling, working closely with the child welfare agency. School-age children participate in drug prevention programs. Mothers receive group therapy, 12-step meetings, a course in "recovery dynamics," and spiritual guidance. Job training and parenting skills are developed in a supportive, empowering environment.

ATLANTA

There are several other recently opened programs in the Atlanta area serving substance using women and children. Additional information can be obtained by contacting Nancy White with the Alliance for Healthy Mothers and Children, at 404-872-7516.