Fetal Alcohol and Drug Unit
Partnership to Enhance Services for Residential Treatment for Pregnant and Postpartum Women (“Partnership for Families (PFF)”)
Principal Investigator: Therese Grant, Ph.D.
Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (2012 – 2016)
Partnership for Families was designed to enhance the availability of trauma-informed, evidence-based intervention services for pregnant and parenting women and their children living at Perinatal Treatment Services (PTS) and later Evergreen Recovery Centers (ERC), long-term residential substance abuse treatment facilities in King County, Washington. The project provided: (1) Seeking Safety therapy to the mothers; (2) sensory-based and trauma-informed parenting education and training for the mothers with their children; and (3) case management and services linkage to nonresidential family members, modeled on the Parent-Child Assistance Program (PCAP) and included a male case manager who worked with fathers of the children. Over three years, project served 150 women and 75 children in residence at PTS/ERC, and provided case management services for 210 adult non-residential family members. The projects’ goals were to improve the health and well-being of family members by delivering high quality trauma-informed maternal therapy, parenting education that responds to the children’s trauma-based behavioral and self-regulation difficulties, and comprehensive case management that meets the needs of the family unit as a whole.
The PFF project made significant achievements at three levels:
- The individual woman and her child/ren
- The residential treatment facility (ERC)
- The King County community and surrounding area
At the individual level:
- 150 women in residence at Evergreen, along with their child/ren, were enrolled in PFF and received the Seeking Safety and Trauma-Informed Parenting services offered.
- Seeking Safety (SS). A total of 902 sessions were delivered to 131 women (mean 7 sessions). At 6-month follow-up, compared to their status at PFF intake women reported significantly fewer total number of trauma symptoms; decreased days (in the past 30) experiencing depression and anxiety; and reduced PTSD consequences in the following domains: family relationships, general life satisfaction, and overall functioning. In addition we observed a significant increase in participation in outpatient mental health treatment and recovery support groups. The mothers’ responses to the World Health Organization Quality of Life assessment also showed significant improvements in the psychological and environmental domains.
- Trauma-Informed Parenting (TIP). A total of 356 TIP sessions were delivered, either with the PFF client alone, or in parent-child sessions. The individualized TIP sessions provided mothers with developmental and sensory profile information on their child, along with practical strategies to help them successfully manage daily routines (e.g., eating, sleeping, dressing, and transitions) and child behaviors in light of the child’s sensory and regulatory needs. At 6-month follow-up we observed significant reductions in the percent of children who: screened positive for a developmental risk; were categorized as at-risk or high-risk in the areas of Problem Solving, Communication, Fine Motor; and Personal/Social; and who scored above the cut-off for social emotional and/or behavioral concerns. In terms of parenting stress, we observed decreases in the percent of mothers reporting moderate stress on the Difficult Child and Parent-Child Dysfunctional Interaction domains, and decreases in clinically elevated stress on the P-CDI domain. At exit there was a significant decrease in any of the mothers’ children living with someone other than her, due to a CPS order.
- Family Case Management (FCM). The family case managers (FCMs) worked with a total of 83 adult family members, not including fathers of the children whose data is below. They had an average of 5.4 face to face visits over an average span of 4 months with the purpose of connecting family members with community services in order to reduce family stresses and support the mother’s recovery process when she left treatment. The most common service connections made were for a healthcare provider, positive recreation/enrichment, food stamps, other health services, and medical coupons. In addition, the FCMs provided service connections on behalf of 94 children who were living with these family members. The most common service connections made for the children were for healthcare, positive recreation/enrichment, other health services, child welfare, and child care.
- The male FCM worked closely with the four female FCMs in serving the fathers of the children (including father figures, i.e. husbands and male partners). This strategy not only enhanced the skills of female team members in supporting fathers’ stability and recovery, but it also increased the willingness of men to enroll in family case management. The FCMs worked with a total of 33 fathers of children, doing an average of 4.9 face to face visits over an average span of 4 months. The most common service connections made were for food stamps, positive recreation/enrichment, healthcare provider, CPS services, and medical coupons.
At the residential treatment facility level
Evergreen Recovery Centers (ERC) is the largest residential treatment facility for pregnant and parenting women, and their children, in Washington State. This has given PFF the opportunity to make a positive impact on the type and quality of trauma-informed services delivered by a treatment staff to a large number of clients. PFF’s intensive training and consultation throughout the project helped assure that the interventions introduced will be sustained as part of the standard Evergreen treatment curriculum after the end of the grant.
- Seeking Safety (SS). The SS intervention has been successfully integrated into the Evergreen clinical program. Staff found that SS skills are highly relevant to the clients and can be delivered in a flexible way, and clients reported that they liked the skills and could readily apply them. High-quality training, training materials, and periodic phone consultation by Brenda Underhill, the national SS trainer, helped staff develop confidence in their SS skills and supported them in ongoing implementation of SS.
- Trauma-Informed Parenting (TIP). TIP training was provided to ERC staff at both their Seattle and Everett residential treatment sites. Staff trained included day care providers, administrators, residential counselors and chemical dependency counselors. A sustainable training module, using a train-the-trainer model, was developed by Tracy Jirikowic, Ph.D. and implemented by Evergreen staff that have early childhood education backgrounds (Karen Kinman and Amy Black).
- Family Case Management. The sustainability of the PFF family case management component, which was based on the Parent-Child Assistance Program (PCAP) evidence-based model, is now assured. In May 2015 Washington State DSHS Division of Behavioral Health and Recovery issued a RFQ to manage the PCAP contracts in King (Seattle) and Pierce (Tacoma) Counties. Evergreen was selected to operate these two PCAP sites, ensuring that Evergreen and PCAP will sustain their close collaboration via State funding. PCAP staff members housed at the Seattle ERC facility include a clinical supervisor and seven case managers (three who were formerly PFF case managers). The lessons learned from PFF family case management will continue to be incorporated into both PCAP and ERC procedures to ensure that women, their children, the fathers of the children, and family members receive coordinated and trauma-informed services.
At the community level
- Seeking Safety (SS). Over 200 King County area providers who serve high-risk, trauma-affected mothers and children have been trained in Seeking Safety. Some received follow-up consultation from national SS trainer Brenda Underhill, and they now comprise a network of providers who are able to offer Seeking Safety and/or reinforce the trauma-coping skills of ERC clients transitioning from residential care into outpatient community services (substance abuse, mental health, transitional housing). These providers are also able to confer with each other on the effective delivery of SS.
- Trauma-Informed Parenting (TIP). Numerous community trainings were held to share TIP information with staff from the Parent Child Assistance Programs in King, Pierce, Thurston and Cowlitz counties and with front line service providers from agencies serving the women during and post-treatment at ERC (e.g., Community Psychiatric Clinic; Willows transitional housing; early intervention programs).
- Family Case Management. As described above, during this grant cycle ERC assumed state-funded contracts to implement the PCAP model in King and Pierce Counties, allowing them to provide case management services to 206 women with substance-abuse disorders, and their families in the two most populous counties in Washington State. Under the direction of two highly qualified clinical supervisors, a total of 13 case managers have been trained in the PCAP model in these counties, are working with capacity caseloads, and are incorporating lessons learned from PFF into PCAP strategies.
Over the course of this grant, Shayne Rochester, the PFF male case manager/fatherhood coordinator, has been responsible for advocacy, training and consultation with local, regional, and statewide partners. His work emphasizes the value of including fathers in the dependency process and family intervention plans, outlines the services fathers need, and offers practical strategies for helping men connect to their families and communities. He has provided consultation and/or training to numerous agencies/groups, including: Washington State Parent Advocacy Network, Snohomish County Drug Court, WorkFirst, Basic Food, Employment and Training, and Opportunity Grants Programs at Edmonds Community College. For example, the King County ‘Table of Ten’, an initiative of the University of Washington Court Improvement Training Academy, includes judges, court professionals and others interested in improving the child welfare legal process. Mr. Rochester was invited to join the Table of Ten and his participation has raised awareness regarding the needs of fathers and ways courts and judges can effectively engage them. In July, 2015 Mr. Rochester participated in an invited presentation at the American Bar Association’s National Conference on Children in the Law/National Parent Attorney Conference (Washington D.C). He spoke to the audience of legal professionals about services needed by fathers involved in the child welfare system, complex issues facing incarcerated parents, and the value of specialized community supports such as father engagement groups.