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Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems

Table 14: Model Program Elements
Underlying Principles of Treatment (All Components)	- Menu of options (Finkelstein et al. 1997) - Menu of approaches (Office of Reed, 1987; Zandowski, 1987; Drabble, 1996; Nelson- Zlupko et al. 1996; the U. S. National Drug Control Policy, 1996; Swift and Copeland, 1996; Finkelstein et al., 1997) - Harm reduction model (Creamer and McMurtrie, 1998; Lightfoot et al., 1996b) - Holistic (Covington, 1998; Creamer and McMurtrie, 1998) - Addresses practical needs (Booth et al., 1992; Schleibner, 1994; Nelson- Zlupko et al., 1996; Swift and Copeland, 1996) - Gender specific (Dahlgren and Willander, 1989; Copeland and Hall, 1992; Jarvis, 1992; Schleibner, 1994; Nelson- Zlupko et al., 1996; Swift and Copeland, 1996; Finkelstein et al., 1997) - Supports connections between women (Covington, 1998) - Supportive, collaborative, non- hierarchical (Finkelstein et al., 1997; Covington, 1998) - Based on empowerment model (Schliebner, 1994; Strantz and Welch, 1995; Drabble, 1996; Finkelstein et al., 1997; Creamer and McMurtrie, 1998) - Respectful (Kasl, 1995) - Client driven (Mattson and Allen in Waltman, 1995; Finkelstein et al., 1997; Creamer and McMurtrie, 1998) - Supports client education and awareness - Based on strengths, not deficits (Finkelstein, 1993) - Uses feminist approach (see gender specific above and empowerment)

General Component of Treatment	Program Accessibility	Principles of Treatment	Approach and Methods	Outreach
Client Contact and Engagement	- Multidimensional publicity strategy - Broad outreach for publicity (multiple venues) - Focus on confidentiality - Publicize range of treatment options - Range of ormats - Toll- free line - Mother's needs emphasized (Finkelstein et al., 1997) - Solution focussed - Flexible and open treatment entry (Waltman, 1995; Grella, 1996) - Timely and structurally accessible treatment (Waltman, 1995; Swift and Copeland, 1996; Grella, 1996)	- Women centred (Schliebner, 1994; Swift and Copeland, 1996; Finkelstein et al., 1997; Covington, 1998a and b) - Culturally appropriate (Ja and Aoki, 1993) - Realistic objectives - Women's empowerment approach (Finkelstein et al., 1997; Creamer and McMurtrie, 1998)	- Menu of options (Schliebner, 1994; Swift and Copeland, 1996; Finkelstein et al., 1997; Covington, 1998a and b) - Offer practical (life) supports (Booth et al., 1992; Nelson- Zlupko et al., 1996; Swift and Copeland, 1996)	-Collaborative approach with physicians (Thom, 1986; Smith, 1992; Allen, 1994) - Linkages with other community agencies (Smith, 1992; Allen, 1994) - Direct (street) outreach to clients (Booth et al., 1992; Finkelstein et al., 1997)

General Component of Treatment	Program Accessibility	Principles of Treatment	Approach and Methods	Outreach	Family
Treatment Approaches and Methods			- Educational approaches (health, healthy relationships and nutrition) (Drabble, 1996) - Nutritional education - Individualized multi- dimensional approach to eating disorders - Exposure to alternative therapies (see Menu of Approaches) - Psycho- bio- social approach - Relational model (Zankowski, 1987; Covington, 1999) - Practical skill- building approach (Zankowski, 1987; Adam et al., 1999) - Focus on experiential learning - Provisions of services for children (see Menu of Approaches) and understanding - Acceptance of relapse - Cognitive- behavioural approach (Eliany and Rush, 1992) - Post- treatment support (Office of the U. S. National Drug Control Policy, 1996)	- Referral to specialists (see Menu of Approaches) - Specialists on staff - Build post- treatment community support (Office of the U. S. National Drug Control Policy, 1996)	- Couples work and family therapy (Zankowski, 1987; Smith, 1992; Schliebner, 1994; Nelson- Zlupko, 1996) - Exploration of parenting styles

General Component of Treatment	Program Accessibility	Principles of Treatment	Approach and Methods	Outreach	Staff/ Client Relations	Family
Retention in Treatment (many themes repeated above)		- Client- centred and individualized (see above) - Relapse not defining point in treatment (see above) - Menu of options (see above)	- Flexibility at entry (see above) - Women's empowerment model (see above) - Practical issues (see above) - Gender specific (see above) - Client treatment matching - Discharge planned in advance		- Staff respectful and egalitarian - Staff encourages continual feedback	- Needs of children considered priority (Swift and Copeland, 1996) - Treatment provided in the context of relationships (see above)
Treatment Organization and Duration		- Continuum of services to meet client need (Waltman, 1995; Office of the U. S. National Drug Control Policy, 1996; Finkelstein et al., 1997; Creamer and McMurtrie, 1998)	- Out- patient preferable structure - In- patient best for high- need groups (Kissin in Finney, 1996) - Gender specific treatment see above under gender specific) - Well- planned co- ed involvement - 5- week duration (residential) Miller and Kessler in Eliany and Rush, 1992 - Out- patient 3 -6 months (Gerstein and Harwood in Simpson et al., 1997)

General Component of Treatment	Program Accessibility	Principles of Treatment	Approach and Methods	Outreach	Staff/ Client Relations	Family
Adjunctive Services Required			Services required: (See Menu of Options above) - Vocational/ education - Mental health services - Health services (physical health) - Counselling/ training/ education related to parenting; - Connections to social services and family support - Child care services - Housing; - Financial support (see Menu of Services above)
Organization of Adjunctive Services			- Collaborative approach (information sharing, common purpose, established referral networks (Booth et al., 1992; Waltman, 1995; Laken, 1996; Finkelstein et al., 1997) - Agency provides some services in- house - All services co- located - Empower clients to use services (Booth et al., 1992)