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Ages 0-50

Rating: Level 3


The goal of the SISTERS program is to provide much-needed peer-oriented outreach/support and case management to ensure the coordination of drug treatment, prenatal, postpartum, pediatric, and family support services for pregnant and postpartum women—particularly African-American or Hispanic women who are on public assistance, are mandated to treatment, report having experienced more than four violent traumas (e.g., sexual assault, death of a loved one), and have smoked crack cocaine during their last pregnancy. Program strategies include coordinated services such as relapse prevention counseling, acupuncture detoxification, prenatal care, housing, transportation, child care, nutrition, assistance with child welfare, Medicaid, and sponsorship for attendance at Narcotics Anonymous meetings.

Program counselors, or “SISTERS,” are women in recovery who have experienced many years of addiction, abusive relationships, life on the streets, birth of infants with positive toxicology, and removal of their child by protective services. These women have turned their lives around by getting help through available social service agencies. The SISTERS cultivate a trusting relationship with clients while serving as peer counselors. Those SISTERS who have received licensure as New York State Certified Acupuncturists administer acupuncture detoxification treatments to their clients. Additional tasks for the SISTERS include providing assistance to their clients concerning infant health services, housing, food, transportation, helping read and understand medical forms, promoting positive attitudes about the use of health and social services, and abstaining from alcohol and substance abuse.

SISTERS must rate appropriately in five criteria: 1) professional experience or education, 2) race, ethnicity, and culture, 3) experience, age, and maturity, 4) gender, and 5) interpersonal and helping skills. Additional requirements include 1) a desire for the position, 2) having given birth to a baby with positive drug toxicology, 3) successful completion of treatment, 4) maintenance of sobriety for at least 1 year, and 5) the unqualified endorsement of supervisory staff in the clinic.


The evaluation was designed to demonstrate the effectiveness of peer counseling through 1) availability and use of services, 2) substance abuse abstinence and psychosocial functioning, and 3) birth outcomes and parenting attitudes. A repeated-measures (intake, 2 months, 6 months) evaluation design with a comparison group of non-SISTERS clients from the clinic was used. Data collection involved focus groups, individual client satisfaction surveys, and in-person interviews conducted by a social worker for which clients received stipends. Urine toxicology data from the clinic’s information system was used as to assess sobriety outcomes.


Major program outcomes include the following:

  • Urine samples of SISTERS clients became significantly cleaner over a 1-year period compared with the control group.
  • Change scores for SISTERS clients significantly improved for measures of depression and self-efficacy in contrast to the non-SISTERS group.
  • SISTERS’ clients, when compared with non-SISTERS clients, experienced a significant decrease in parental stress and rigidity of parenting style.
  • SISTERS’ clients used more services than non-SISTERS clients.
  • SISTERS’ clients were more likely to use warm expressions of empathy to describe their counselors.
  • Seventy-eight percent of SISTERS clients gave birth to babies weighing at least 2,500 grams. More active clients had significantly heavier babies than less active clients.
  • Eighty percent of infants born to SISTERS clients were toxicologically clean at birth.
  • SISTERS’ clients continually regained custody of children; at intake 60 percent had no children living at home, but at the end of the project this portion decreased to 18 percent. All SISTERS clients who obtained custody of their babies kept them for the duration of the program.

Risk Factors


  • Early sexual involvement
  • Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use
  • Life stressors
  • Poor refusal skills
  • Teen parenthood


  • Family history of the problem behavior/Parent criminality
  • Family management problems/Poor parental supervision and/or monitoring
  • Poor family attachment/Bonding


  • Availability of alcohol and other drugs
  • Economic deprivation/Poverty/Residence in a disadvantaged neighborhood


  • Peer alcohol, tobacco, and/or other drug use

Protective Factors


  • Perception of social support from adults and peers
  • Self-efficacy
  • Social competencies and problem-solving skills


  • Effective parenting
  • Good relationships with parents / Bonding or attachment to family
  • Having a stable family
  • High expectations
  • Opportunities for prosocial family involvement
  • Rewards for prosocial family involvement


  • Presence and involvement of caring, supportive adults


  • Presence and involvement of caring, supportive adults
  • Prosocial opportunities for participation / Availability of neighborhood resources


  • SAMHSA: Model Programs


Sanders, Laura M., Chau Trinh, Barry R. Sherman, and S.M. Banks. 1998. “Assessment of Client Satisfaction in a Peer Counseling Substance Abuse Treatment Program for Pregnant and Postpartum Women.” Evaluation and Programming Planning 21(3):287–96.

Sherman, Barry R., Laura M. Sanders, and Chau Trinh. 1998. Addiction and Pregnancy: Empowering Recovery Through Peer Counseling. Westport, Conn.: Greenwood Publishing Group.

Sherman, Barry R., Laura M. Sanders, and J. Yearde. 1998. “Role-Modeling Healthy Behavior: Peer Counseling for Pregnant and Postpartum Women in Recovery.” Women’s Health Issues 8(4):230–38.


Barry R. Sherman, Ph.D.
New York State Department of Health
780 Corning Tower, ESP Room 890
Albany, NY 12237
Phone: (518) 474-6968
Fax: (518) 473-2015