Summary Report Treatment And Rehabilitation For Women With Substance Use Problems Workshop On Best Practices June 6 And 7, 2002

2.0 Best Practices - Outreach, Contact and Engagement

2.1 Presentation by Nancy Poole

Increasingly service providers realize the importance of addressing substance use problems in the context of other issues, including mental health concerns, the experience of violence, and HIV. Further, the broader determinants of health as experienced by women need to be addressed in conjunction with substance use problems. The implications for outreach are numerous.

Substance abuse treatment and rehabilitation agencies need to continually broaden their outreach programs to include other agencies and professionals that work with women and are in a position to refer women with substance use problems to treatment and rehabilitation programs. The misinformation about the substance abuse field itself and the process of recovery needs to be addressed to raise awareness and educate all collateral service providers. Strategies to achieve this can include: distributing program specific promotional materials which profile services; building and fostering trans-disciplinary networking opportunities; presenting related topics at conferences; and using established networks, such as the Canadian Centre on Substance Abuse (CCSA).

Substance abuse programs and services need to be profiled so that other agencies and professionals are encouraged to cooperate and collaborate with those working in the substance abuse treatment and rehabilitation field.

Further outreach strategies to encourage other agencies and professionals to refer women to treatment and rehabilitation programs could include:

• Supporting their practice. By providing handouts and posters, and sample questions to use in screening for substance use; by teaching basic intervention strategies at local community colleges and universities.
• Building on commonalities of approach. For example the progressive, strength-based theories in the fields of psychology and trauma recovery.
• Profiling and providing integrated programming. Make a profile of how your program emphasises safety, offers trauma-related programming, and is culturally competent.

It is important to address barriers to improve access for women. This can be achieved by:

• Making treatment compatible with mothering. Women need to know that they have options in programs that include care of their children or support for finding safe places for them.
• Offering a menu of services. Access can be greatly enhanced by offering a menu of services addressing key health issues (for example, trauma, smoking, culturally specific needs) as well as treatment and rehabilitation for the substance abuse. Women respond positively when they can understand that all their concerns will be addressed.
• Make treatment affordable. Intensive day treatment is an alternative for women who cannot pay for a residential program. Day treatment is more affordable if women do not have to travel long distances. Covering the costs of child care and bus fare is also helpful. Group work in outpatient settings is a good alternative and/or adjunct to residential treatment.
• Provide harm reduction programming as an alternative to other services. Access to treatment for some women (especially pregnant and parenting women) can be increased by harm reduction approaches that do not require women to be abstinent and that support any changes women can make; the focus is on the health and social issues impacting women as a way of reducing the pressure to use.

Nancy concluded her presentation by emphasizing the need to define values in addiction work at the service level and on a system-wide basis. Clearly defined values form the foundation for all women's services.

2.2 Strategies for Applying Best Practices - Outreach, Contact and Engagement Identified by the Participants

Outreach
Reaffirm the importance of outreach. Outreach activities should be done despite the risks of burdening the system with new clients. The goal should include treatment, rehabilitation and education. Outreach must involve finding people where they are in many different settings and following up with referrals.

Communicating with potential clients and the public
Oral communication is considered to be more effective than printed materials. Radio call-in shows, presentations to community groups and other opportunities to talk in person about substance abuse are favoured over the printed word. The messages delivered should be woman-centred, should emphasize that treatment is a first step, and should highlight the range of services available, and where applicable indicate that they are free of charge.

Printed materials can be used, but need to be plainly written and designed for easy faxing or copying. To reach new clients, written material highlighting difficult issues in women's lives rather than focussing on substance abuse (for example a pamphlet with a title "You can't come to my house" - for children living with addiction, developed by the Addictions Foundation of Manitoba) are considered to be more effective.

Educating those in a position to refer
There is a need for training of medical, nursing and social work students either in the university/college setting or via community placements. In some cases university degree programs have invited addiction services to participate in developing course curriculums. Exposing students to clients in the agency setting can be an effective educational approach. Education workshops could be offered to physicians.

Empowering Clients
Clients can be empowered with information and support via Websites, chat lines, help lines and 1-800 numbers.