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Wellness in the Woods—Woodsong, Residential Treatment for Mothers And Their Children

Patricia Avè-Lallemant
Project Director
Woodsong
Georgia Pines Community Mental Health,
Mental Retardation and Substance Abuse Services
Thomasville, Georgia

Abstract Woodsong is a demonstration grant funded by the Center for Substance Abuse Treatment (CSAT) that provides residential treatment to women and children. It is an addition to the Georgia Pines Community Mental Health, Mental Retardation and Substance Abuse Services (MHMRSA) service delivery system. This program is located in a rural southern environment characterized by low income, high unemployment, and illiteracy. The target population is women primarily addicted to crack cocaine and alcohol. Approximately 70 percent of families served are African American; 30 percent are Anglo American. A special concern is for women who are in imminent danger of losing custody of their children. The women are between 17 and 45 years of age, and the children are between 1 and 10 years of age. Woodsong has two major goals. The first is to implement an array of culturally relevant services that lay the groundwork for women to adopt a sober, secure, and creative lifestyle and empower children to become self-directed, self-confident, and knowledgeable about addiction. Woodsong's second goal is to empower women and their children to create and embrace healthy, fulfilling relationships. To accomplish these goals, Woodsong provides comprehensive residential services, conducts thorough assessments and evaluations, develops family service plans for each family in residence, conducts an intensive children's program, increases the quality of relationships, and prevents relapse in the target population.

Georgia Pines Community Mental Health, Mental Retardation and Substance Abuse Services is located in a rural southern community encompassing approximately 3,000 square miles, including 6 counties with 31 towns and a population of approximately 150,000 residents. About 34 percent of the population are African-American, 64 percent are Caucasian and the remainder are Hispanic, Asian American, and Native American. This low-income area has high unemployment, particularly in the African-American population, and a per-household income of only $12,200. Illiteracy is rampant, with only 43 percent of the population in possession of high school diplomas. Alcohol and cocaine addiction has skyrocketed in this area. A recent study conducted by the State Division of Mental Health, Mental Retardation and Substance Abuse focused on regional cocaine admissions from fiscal year 1984 to fiscal year 1988. The southwest Georgia region had an increase of 4,835 percent, by far the highest increase in the State of Georgia (see figure 1).

Services for individuals with addictive disorders are sparse and, until the advent of Woodsong, resources designed specifically for women and their children were unknown in Georgia.

Purpose

In response to the increasing demand for services for substance using women with children, in 1993 Georgia Pines Community Services applied for and was awarded Federal funds. Woodsong, a CSAT demonstration grant program for residential treatment for women and their children, is an addition to the Georgia Pines continuum of care. The Woodsong target population is women, primarily addicted to cocaine and alcohol, and their children. The majority of the women have intergenerational problems as well as other coexisting conditions that have thwarted their recovery in more traditional treatment settings. Women and their children generally stay in the program from 9 to 12 months. Woodsong has two primary goals: first, to implement an array of culturally relevant services that lay the groundwork for women to adopt a sober, secure, and creative lifestyle and empower children to become self-directed, self-confident, and knowledgeable about addiction; and second, to empower women and their children to create and embrace healthy, fulfilling relationships.

Program/Research Description

The historic national substance abuse treatment trend has been based on a male model. Few programs have been designed specifically for women, fewer have offered child care, and rural programs for women with children have been virtually unknown. In this southwest Georgia community, where crack and alcohol use among women is mushrooming, we at Georgia Pines Mental Health, Mental Retardation and Substance Abuse (MHMRSA) Services became alarmed by our inability to offer viable treatment to women with children. Although short-term residential services were available, there was no provision for children whose mothers were in treatment. Our day treatment and outpatient programs were not meeting the needs of many women who were diagnosed with a substance use disorder and who had a multitude of coexisting issues.

As national research indicates, women with substance use disorders frequently have problems with housing, child care, and parenting skills deficits. In 1993, counselors in the Georgia Pines six county outpatient clinics identified 140 addicted women with children who were underserved, due to the paucity of our resources. Furthermore, staff in our detoxification and short-term residential programs had identified 39 women with children who were in urgent need of extensive services that we could not offer.

A closer look at this group revealed an inordinately high proportion of women plagued with multiple afflictions. We discerned that approximately 90 percent of the women had a history of childhood sexual and/or physical abuse. We further determined that 87 percent of the women were currently involved in abusive relationships with men. Women who have been victims of sexual abuse have difficulties in treatment programs that include men. Often women remain in abusive relationships with a spouse or partner because of economic problems. These women have learned to give away their power and are unable to defend themselves. It is essential that women receive services in an nurturing environment that champions women's issues, including honing assertiveness skills.

The target group is 70 percent African American and 30 percent Anglo American. In this area, where it was not until 1970 that the "black" school closed and the educational system became racially integrated, there are a series of cultural, economic, and educational barriers that must be torn down so that African-American women can become self-supporting within this community. Issues of black identity and feelings of isolation and awkwardness in the social camaraderie of a self-help community are special concerns for recovering African Americans. An issue particular to African-American women is the myth of the black superwoman, which espouses that black women can withstand any amount of pain and continue to perform, and the shame associated with being chemically dependent and not living up to this expectation.

Addiction is a family disease and affects not only the addict, but family members as well. When these members are children, they often become the victims not only of the disease but of concomitant dangers. At least 28 percent to 35 percent of child abuse cases occur where drinking is ever-present. Children of alcoholics and other drug addicted parents are far more likely to be truant or delinquent, abuse alcohol or other drugs, drop out of school, and attempt suicide. Children of alcoholics are two to four times more likely to develop alcoholism than others. In our six-county service area, there are exceedingly high rates of child abuse, teen suicides, and juvenile court commitments and institutionalization. In fact, in the 159-county State of Georgia, two of our six counties rank in the top three (158,157) for juvenile court commitments and institutionalization. These indicators of family dysfunctions are most frequently associated with substance use disorders. The most beneficial time for intervention is in childhood, before behavior patterns become overly rigid. Children of addicted parents are prime candidates for education, prevention, intervention, and treatment. Research indicates that building self-esteem and developing decisionmaking skills are especially important for girls and women influenced by the drug use of significant others.

To meet the critical demands in our rural area, a program was designed and key community agencies were solicited for collaboration. Locating a facility that could accommodate 20 families was the first major hurtle, as real estate here offers much land but few large buildings. After an exhaustive search, an abandoned school was located. Due to persuasive entreaties, the county school board agreed to transfer the deed to the county Commissioners, who in turn agreed to finance the reconstruction and remodeling of a four-building facility located in the woods. The flip side of the dearth of resources in this rural area is the community's enthusiastic reception of additional services. The success of Woodsong as an integral part of a larger community is contingent on supports from key organizations. Agreements with the Department of Family and Children Services, the judicial system, Public Health, the rural medical clinic, the Housing Authority, Rehabilitation Services, the school system, Thomas Technical School, and Valdosta State University have been vital in the provision of quality comprehensive care.

Woodsong has two primary goals. First, in concert with key community resources, Woodsong is to implement an array of culturally relevant services for addicted women and their children. These services guide women through their first stages of recovery and lay the groundwork for a sober, secure, and creative lifestyle and empower the Woodsong children to become self-confident, self-directive, and knowledgeable about addiction. Second, because the target population includes a majority of families who have suffered seriously impaired relations with significant persons in their lives, Woodsong aspires to empower women and their children to create and embrace healthy, fulfilling relationships. The following objectives are being achieved:

1. Provide comprehensive residential services for parenting women and their children, for a duration that allows the mother to participate fully in recovery, family treatment, and vocational services that will enable her to return to the larger community and sustain herself and her children.

2. Conduct comprehensive physical, bio/psycho/social, financial, educational, and vocational assessments with women and children participating in Woodsong.

3. Develop a Family Service Plan for each family participating in Woodsong.

4. Conduct a comprehensive children's program for all children residing at Woodsong.

5. Increase the quality of relationships in the target population.

6. Prevent relapse by providing intensive continuing care, including coordinating with community services, counseling, and followup evaluations.

Case Narrative

A 32-year-old African-American mother was referred to Woodsong for alcohol addiction and crack cocaine dependency. She had experienced multiple negative consequences for her 7 years of extensive drug use, including legal problems, financial problems, and the loss of custody of her youngest child to the Department of Family and Children Services (DFACS). She reported initially using because of her chaotic home life with an abusive husband who sold drugs to support the family. She has been in numerous treatment programs and outpatient therapy since 1989 and entered Woodsong in 1994.

Intake

At intake, the client reported she has three sons ages 10, 9, and 1. She stated she has a good relationship with her two older sons who live with their father; she visits them every week. She stated at intake that she did not have a relationship with her youngest son, because she has not seen him since he was placed in foster care in October 1993. Her legal problems began in 1992 when she was arrested for theft and sentenced to 10 years probation. During her probation she had a positive drug screen and went to jail for a short time. She was arrested for the second time for reckless conduct (children left unattended) and sentenced to 12 months probation. She stated that her alcohol and drug use tended to interfere with her parenting responsibilities. Her drug use had also interfered with her spiritual growth, in that she had not been attending church. This client reported that she had not worked since 1992 because of her drug use. At admission, this client was on probation for her two prior arrests and an alleged homicide threat to her DFACS caseworker.

Treatment

Entering treatment, this client lacked basic parenting skills, had no social support, had low self-esteem especially in relation to her family, lacked social skills, and had no relationship with her youngest son. During her treatment at Woodsong, a relationship was formed between mother and child. A gradual increase in her parenting skills was observed by everyone working with the family. The mother grew in her ability to interact appropriately, and she slowly learned to control her outbursts of anger. Her son in turn became a bright, active child. The client's test results showed an increase in social support and self-esteem. During her exit interview, the mother reported that her drug and alcohol abuse problems and how she deals with the loss of her children were much better because she is now able to cope with life.

Other issues that were identified in treatment (grief, relationship with her son's father, and her family problems/sexual abuse) were considerably better because of her work with the counselors at Woodsong. Her finances have improved because she has learned to save her money. Her housing situation has also improved because she is now able to live at home with her father. She feels her ability to train her child has improved because she has learned to use time out instead of corporal punishment. She is now relating to her child better—she is more patient and is able to talk to him and in turn he listens. Her relationship with her extended family has improved. She has become more active in the community and is attending Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings. She has been involved in school since coming to Woodsong. Her physical health has also improved. She is better able to provide for herself and her family since coming to Woodsong because she is now employed.

After Treatment

One month after completing the program, the client moved into her father's home with her youngest son. Her two oldest sons still live with their father in another State. She reported the living arrangements to be good; there are no serious family problems. She has been involved in church, aftercare activities with Woodsong, and AA/NA meetings. She has been working full time, and reported that she was in good health. Three months after competing the program, the client was still doing well. Her relationship with her child continues to grow. She was still working and has moved into her own apartment. There have been no reports of any drug use or problems with the law. She is currently working on obtaining full custody of her youngest child. DFACS reports that if things continue as they are, she should receive custody in 6 months.

Methods

The following four elements ensure the actualization of Woodsong goals and are tailored to compensate for the scarcity of local resources and to maximize the community's investment in the project.

Establishing a Service Network Through Community Relationships

Although the original plan was designed specifically for this locale, the network has expanded to include agencies throughout Georgia and neighboring States. The rural setting has provided an appropriate and comfortable alternative to urban options available in other areas. Additionally, local health services, schools, and agencies have participated in Woodsong training events that feature national and regional experts. Recently, Woodsong enacted its first official interstate agreement. The Florida Department of Health and Rehabilitation Services (HRS) referred a family to Woodsong. Because the mother had lost custody of both children, it was necessary for HRS to enter into an inter-State compact with Georgia's Department of Family and Children's Services (DFACS) for monitoring purposes.

Another recent development has been engaging targeted community resources to become involved in and to share in our commitment to the residents of the program. Many agencies and individuals have invested in the success of Woodsong.

Conducting Ongoing Assessments

An evaluation contract with Valdosta State University ensures the integrity of the program and illuminates its accomplishments and flaws. The clinical staff at Woodsong also conduct a variety of assessments throughout the treatment process. Additionally, the Woodsong residents participate in a weekly group consultation for peer- and self-assessment.

Proven Strategies and Approaches to Treatment

Original models have been modified and refined to accommodate the population served. Creative use of the training budget has optimized learning opportunities for staff, the umbrella agency, and other community organizations by bringing nationally recognized specialists in sexual abuse, children exposed to alcohol and other drugs, etc. to Woodsong.

To accomplish the goals and objectives of the project, state-of-the-art strategies and approaches have been enacted and continue to be refined. A variety of educational sessions focusing on women's issues and cultural diversity are offered. Much of the material presented comes from the following sources: Alcohol and Drugs Are Women's Issues, edited by Paula Roth; From Love That Hurts to Love That's Real, by Sylvia Ogden Peterson; Awakening Your Sexuality, by Stephanie Covington; Do I Have to Give Up Me to Be Loved By You? by Paul Jordan and Margaret Paul; and an excerpt from Getting Sober, Getting Well, "Women of Color: Outreach and Treatment Issues." Instructional sessions on addiction, educational activities, life skills training opportunities, daily meditation, bibliotherapy, scriptotherapy, AA and NA meetings, therapy and educational sessions for the dually diagnosed, and an intensive addiction treatment phase are provided through the agency's day treatment component.

An array of prevention, education, and therapy services are offered for children who range in age from 1 to 10 years. Fundamental sources include I Can Problem Solve, edited by Myrna B. Shure; "Just For Me"—a video series by the best Foundation for a Drug Free Tomorrow; Working With Children of Alcoholics, edited by Bryan E. Robinson; About Me, by Randall G. Holland; Child Support, by Lois Landy; Good Touch, Bad Touch, by Pam Church; and Twelve Steps to Healthy Touching, by Kee MacFarlane and Carolyn Cunningham. The Woodsong staff utilize a developmental approach in planning and implementing activities through art, dance, music, games, and social interactions. All children and women are afforded opportunities to participate in a variety of educational, cultural, social, and recreational activities, including local parades, museums, and celebrations, as well as visits to out-of-town exhibits, cultural events, and field trips.

An array of culturally relevant educational and therapeutic relationship centered activities are offered at Woodsong. All activities are designed to enhance positive parent/child interactions. Treatment opportunities for Woodsong families include three times weekly parenting groups and weekly family experiential sessions, family sleepovers for children who exceed the Woodsong age limit, the intensive day treatment's weekly Family Night, and the monthly Family Day at Woodsong. The focus of Woodsong is personal responsibility, including a responsibility to create and embrace healthy relationships. Emphasis is placed on recognizing quality in relationships as integral to sobriety, serenity, and growth.

Employing Competent Staff Who Celebrate Cultural Diversity

The challenge of hiring sensitive and knowledgeable professionals has been met through conscious compromises. That is, although seasoned, well-trained staff are not in abundance in this rural environment, imaginative, dedicated, and open-minded individuals have been selected after careful scrutiny. Woodsong has made significant investments in professional training and opportunities for self-actualization.

Barriers/Problems Encountered and Solutions

During the first year there were two barriers to successful implementation that became increasingly evident. The first centered around sexualized behaviors of the 3- to 6-year-olds. The majority of the women we serve have been victims of sexual abuse, and their children have also been injured by sexual activity. Many of the children have histories of sexual molestation, and most have witnessed sexual activity of their mothers, who often prostituted themselves to obtain the drugs to which they were addicted. Recognizing the victimization of the children and the chronic and severe consequences that children living in these families suffer was a primary reason for embarking on this project. In Georgia, the Department of Family and Children Services (DFACS) is the entity responsible for handling child abuse matters. To help mend difficulties in the working relationships of Woodsong and DFACS that developed during attempts to address the sexuality issue, the project director requested technical assistance on identifying, monitoring, and treating sexualized children in the CSAT-funded program. A conference was arranged utilizing nationally recognized experts. Other CSAT grantees from the southeastern United States were in attendance, and local agencies, particularly the DFACS staff, were well represented. We have had ongoing training on this issue, and Woodsong staff have become skilled in this field. Interagency relations have stabilized, and a better understanding of the needs of Woodsong families has been accomplished.

The second barrier to success was premature termination by Woodsong women. Exploration of this brought to light two major issues impacting retention. The first was the frustration women were feeling during the first 2 months due to the extensive expectations of their various roles as responsible parents, members of the Woodsong treatment family, day treatment participants, and fellows in the self-help community. After admission to Woodsong, women were initially given a week for on-site assessments, after which they were immersed in the rigors of day treatment, homework, residential responsibilities, and active parenting. In response to the difficulties the women were having assimilating into the program, a stabilization phase was affixed to the front end of the Woodsong treatment continuum. There are now four phases: stabilization, intensive addiction treatment, community reintegration, and continuing care. The stabilization segment facilitates a more thorough transition and orientation to Woodsong, a better structure for completion of the initial battery of assessments and treatment plans, and increased opportunities for staff to identify and address clinical needs. Additionally, the stabilization phase provides a chance for residents to focus on women's issues and relationship education, reflect on and process their level of commitment to recovery, and tend to parent/child bonding.

The second major issue negatively affecting retention was women's investments in relationships with men. The disturbing relationship issues ranged from flirtations in the community self-help meetings that were blossoming into romantic liaisons to continued commitments in pathological relationships, in which the partner was unwilling to participate in counseling. In response to this critical issue, a variety of strategies were incorporated. All women now participate in weekly therapy sessions focusing on relationships and sexuality. The number of outside self-help meetings was reduced, thus affording more mother/child time and eliminating many of the distractions the women were experiencing through their regular interactions with men in the community.

Through a 3-day diagnostic assessment at the start of the second year, a team of three treatment specialists identified staff communications and coordination of services as two areas needing cultivation. A variety of internal controls have been adopted to enhance the consistency of communication among staff. The solutions involve the implementation of weekly administrative and departmental meetings and daily morning check-in meetings. Methods of accountability have been implemented through meeting minutes and weekly follow-up. Purchasing of bulletin boards and centralizing the work area in the conference room to include needed supplies and pertinent day-to-day programmatic information has also helped to streamline communications. The second area noted in the diagnostic assessment was the coordination of services. The plans targeting this domain include modification of counselors' schedules to ensure the most efficient and appropriate staffing in the women's and children's programs, the new internal communication system, and Woodsong counselors' participation in a weekly intra-agency staffing of consumers utilizing multiple services.

Findings

The experiences of the past 20 months verify the critical need for women to explore their identities and to examine their various societal roles. Although the message in the recovery community is to wait for one year's sobriety before engaging in a new relationship, this may not be a realistic goal for the Woodsong target group. Women who are entering the program and even women who are midstream in treatment exhibit a determination to sustain pathological relationships with men, are unable to identify themselves as individuals, and continue to define themselves based on the number and types of relationships that they have. In this cultural milieu, relationships with men are requisite and define acceptance and happiness. In the words of Julia A. Boyd in In the Company of My Sisters:

We are led to believe that loving is like magic. It will cure all our ills, make our lives easier, and most of all make us more acceptable to everyone else. The truth is that we can only love someone else as deeply as we love ourselves. It's almost impossible to give someone something that we don't already have in our possession.

Based on our findings, Woodsong gives priority to assisting women to acquire the knowledge and skills required to identify and accept themselves as individuals and to achieve healthy self-esteem. Woodsong is developing and integrating this focus through an array of efforts, including activities centered around Adult Children of Alcoholics (ACOA) and Sexual Abuse Survivors to identify and process key issues and accelerate transformations.

Recommendations

If we are to assist in the empowerment and self-actualization process of others, it is imperative that we ourselves be empowered and self-actualized. Woodsong makes an investment in staff through therapeutic weekends and by supporting a variety of paths to enlightenment. We highly recommend this approach to other programs.

References

Church, P. Good Touch, Bad Touch. Valdosta, GA: Golden Publishing, 1993.

Covington, S. Awakening Your Sexuality: A Guide for Recovering Women and Their Partners. San Francisco: Harper, 1991.

Finkelstein, N.; Duncan, S.A.; Derman, L.; and Smeltz, J. Getting Sober, Getting Well: A Treatment Guide for Caregivers. The Women's Program of CASPAR, 1993.

Holland, R.G. About Me. Charlotte, NC: kidsrights, 1992.

Landy, L. Child Support. Charlotte, NC: kidsrights, 1984.

MacFarlane, K., and Cunningham, C. Twelve Steps To Healthy Touching. Charlotte, NC: kidsrights, 1990.

Paul, J., and Paul, M. Do I Have To Give Up Me To Be Loved by You? Center City, MN: Hazelden Educational Materials, 1983.

Peterson, S.O. From Love That Hurts to Love That's Real. Park Ridge, IL: Parkside Publishing, 1989.

Robinson, B, ed. Working With Children of Alcoholics. Lexington, MA: D.C. Heath, 1989.

Rossellini, G. and Worden, M. Of Course You're Angry. Center City, MN: Hazelden Foundation, 1985.

Roth, P, ed. Alcohol and Drugs Are Women's Issues. New York: Scarecrow Press, 1991.

Shure, M.B. I Can Problem Solve: An Interpersonal Cognitive Problem-Solving Program. Champaign, IL: Research Press, 1992.

Women of color: Outreach and treatment issues. In: Finkelstein N.; Duncan, S.A.; Derman, L.; and Smeltz, J. Getting Sober, Getting Well: A Treatment Guide for Caregivers. The Women's Program of CASPAR, 1993.

Last Updated 11-7-02