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Women and Children: Treatment Improves Health

By Rebecca A. Clay

Just by looking, Ginny Vicini could tell that the family focus of the substance abuse treatment project she ran was working. When women and their children first arrived, she would look out her office window and see them walking across the parking lot with 5 feet of space between them. After 3 or 4 months of treatment, she'd see them walking across the parking lot holding hands.

"It sounds so corny," said Ms. Vicini, now executive director of Chrysalis House in Lexington, KY. "But it was the most moving thing."

Now Ms. Vicini has the data to back up her anecdotal evidence. Last fall, SAMHSA's Center for Substance Abuse Treatment (CSAT) issued findings from a study in a white paper, Benefits of Residential Substance Abuse Treatment for Pregnant and Parenting Women: Highlights from a Study of 50 Centers for Substance Abuse Treatment Demonstration Programs.

The study evaluated Chrysalis House and 49 other CSAT-funded residential treatment programs designed specifically for substance-abusing women who were pregnant or the mothers of infants or young children. Just as Ms. Vicini suspected, the study found that such programs significantly improve the health of the women, their offspring, and the family unit itself.

An Innovative Model

Launched in 1993, the CSAT grant programs had a dual purpose: expanding women's access to long-term residential treatment and developing model programs that could provide a basis for evaluating such programs' effectiveness. The Pregnant and Postpartum Women's program offered 5 to 6 years of funding to projects serving substance-abusing women who were pregnant or mothers of children less than 1 year old; the Residential Women's and Children's program focused on treatment for women with older children.

Serving cities, rural areas, and Indian reservations around the country, the 50 CSAT-funded projects differed in their admission criteria, philosophies, and treatment approaches. All of them, however, shared several key features, including:

Treatment services designed especially for women
Culturally appropriate treatment
Comprehensive services for the women, including substance abuse treatment, medical and mental health care, vocational training, parenting advice, legal assistance, transportation, and other support services
Onsite residential care for the women's children
Supervised parenting, and
Comprehensive services for children, including prenatal and pediatric care, nurseries, and preschools.

Several aspects were considered major innovations when the programs were first launched, according to James M. Herrell, Ph.D., a co-author of the white paper and acting branch chief of CSAT's Treatment and Systems Improvement Branch.

"At the time this project was initiated back in the early 1990s," he said, "the idea of designing treatment programs just for women and letting women bring their children into treatment with them was relatively novel and daring."

In addition to the 50 projects, CSAT also funded a cross-site evaluation that assessed the projects' effectiveness. Between 1996 and 2001, the researchers collected data about providers' treatment approaches and clients' characteristics and outcomes.

Impressive Results

That cross-site evaluation proved that this innovative approach worked. In some cases, the approach not only worked but succeeded far beyond what anyone at CSAT anticipated.

For example, there was an 84-percent reduction in the risk of low birth weight among infants born to women in the programs compared to babies born to alcohol or drug abusers who hadn't received treatment. Similarly, there was a 70-percent risk reduction for premature delivery and a 67-percent risk reduction for infant mortality.

These rates are not only lower than those of untreated substance abusers, they are also lower than the rates reported for all American women. Premature delivery rates were 7 percent for the former substance abusers compared to 11 percent for all American women; low birth weight rates were 6 percent compared to 8 percent; and infant mortality rates were 0.4 percent compared to 0.7 percent nationwide.

The women's relationships with their older children also improved. The percentage of participants with physical custody of their children increased from 54 percent shortly before entering treatment to 75 percent 6 months after discharge. The number of participants with one or more children living in foster care dropped from 28 percent to 19 percent.

At the root of those family-related outcomes were significant reductions in alcohol and drug use. More than 60 percent of participants reported being completely alcohol- and drug-free during the 6 months following discharge. An additional 13 percent suffered relapses at some point after being discharged but claimed to be completely alcohol- and drug-free in the past month.

Paralleling that reduction in alcohol and drug use was a reduction in criminal activity. Only 7 percent of the participants were arrested for alcohol- or drug-related offenses, such as selling drugs, driving while intoxicated, or being publicly intoxicated, during the 6 months following discharge, compared to 28 percent in the year before entering treatment. The percentage of participants arrested for other crimes, such as shoplifting, burglary, prostitution, or assault, dropped from 32 percent to 11 percent.

The longer the women stayed in treatment, the more they improved. For example, 68 percent of the women who stayed in treatment longer than 3 months remained alcohol- and drug-free, compared to 48 percent of those who left within the first 3 months of treatment. Only 9 percent of women who stayed in treatment past the 3-month point were arrested, compared to 20 percent of those who left before then.

More important, staying in treatment for a reasonable amount of time helped almost everyone who participated in the programs.

"We went to a lot of trouble statistically to try to tease out things either at the client level or program level that would have had a differential effect. That means we looked to see if a particular type of treatment worked better for younger women versus older women or for African American women versus Caucasian women," explained Dr. Herrell. "What we found was that there weren't any major predictors of who would benefit."

"That's good news for program managers as well as participants," added Dr. Herrell. "It means program designers don't have to fine-tune programs to match every possible situation."

Although cost analyses are still ongoing, Dr. Herrell and others at CSAT are already convinced the programs can save states money.

"These programs indicate that substance abuse treatment can save taxpayers money that otherwise would be spent on other medical costs," said CSAT Director H. Westley Clark, M.D., J.D., M.P.H.

Many of the states that hosted the CSAT-funded projects are also convinced that investing in treatment services will pay off. Take Kentucky, for example. Armed with evaluation data, staff from the Chrysalis House project persuaded the state legislature to provide funding that will allow the project to create a new 40-apartment complex for women in recovery.

"If I had told our legislators in Frankfurt the story about watching the women walking across the parking lot hand-in-hand with their children, those people couldn't care less," said Ms. Vicini. "If it hadn't been for the research data, we would not have been able to sustain the program."

The white paper on findings from the residential treatment programs study is available at csat.samhsa.gov/
publications.html. See also companion article, Women and Children: The Faces Behind the Numbers.

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