Rico Rivera MA b Peer Recovery Coaches for Child WelfareInvolved Families with Substance Exposed Newborns and Methamphetamine Using Parents Stephen James MS Rico Rivera MA and Julie Sauvageot MSW ID: 702542
Download Presentation The PPT/PDF document "The Effectiveness of: (a) Program A.N.E...." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
The Effectiveness of:
(a) Program A.N.E.W. in Improving Life Quality, and HIV and Hepatitis Knowledge in Hispanics
Rico Rivera, M.A.
(b) Peer Recovery Coaches for Child Welfare-Involved Families with Substance Exposed Newborns and Methamphetamine Using Parents
Stephen James, M.S., Rico Rivera, M.A., and Julie Sauvageot, MSWSlide2
Overview
Findings from two programs in Maricopa County associated with TERROS
A.N.E.W.
Say-it-Straight program (for quality of life and communication empowerment)
HIV and hepatitis workshops (for knowledge)
Parent to Parent (P2P) Recovery Program
Use of peer recovery coaches for CPS-involved families with substance exposed newborns and methamphetamine using parents (for client engagement and retention)Slide3
The Effectiveness of Program A.N.E.W. in Improving Life Quality, and HIV and Hepatitis Knowledge in Hispanics
Richard “Rico” Rivera, M.A.
Center for Applied Behavioral Health Policy
Arizona State UniversitySlide4
A.N.E.W.
Assessing Nurturing Effective Wisdom (A.N.E.W.)
Developed by TERROS and community partners
Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Prevention (CSAP).
Primary purpose: prevention
Substance abuse
HIV & hepatitis
Target population:
Minority population
Phoenix-Mesa Metropolitan Statistics AreaSlide5
Three Interrelated Interventions
Substance Abuse Prevention Intervention
Say It Straight (SIS) designated by CSAP as an Evidence-Based Prevention Program in 2003
SIS promotes wellness, personal and social responsibility, positive self esteem and positive relationships
SIS
is an action-oriented program that integrates cognitive, affective and psychomotor modalities to maximize learning.
HIV and Hepatitis Prevention Intervention
Workshop: information and risk reduction methods
HIV testing/counseling
Hepatitis screening services and immunizationSlide6
Research Questions
Were there improvements in:
Quality of life?
For a participant’s family
For a participant’s training group
Disempowering and empowering communication/behaviors?
Knowledge in HIV and Hepatitis?Slide7
Evaluation Data
Cumulative data from June, 2007 to October, 2010
Instruments
135-item Adult GPRA Survey
contained HIV/AIDS and hepatitis knowledge tests
SIS Questionnaire
GPRA data administered at three time points
Enrollment
Program exit (~1 month)
3 month follow-upSlide8
Evaluation Data: SIS
SIS Questionnaires
Quality of Life-Family
Quality of Life-Group
SIS communication skills
SIS administered twice (pre and post)
Number of days between time:
Mean = 40.1 days (
SD
= 18.9)
Median = 35 daysSlide9
Participant Characteristics
Target population: minorities
Participant characteristics
Female (84%)
Straight/heterosexual (94%)
Hispanic (95%)
Primary language: Spanish (91%)
Adults
mean age of 36 years (
SD
=8.6)
median age of 35 yearsSlide10
Participant Characteristics (continued)
Living Environment
Lived in US
< 4 years (9%)
> 5 years (79%)
Whole life (12%)
Live w/ spouse (72%)
Reside w/ children < 6 years (99%)
Reside w/ own children (55%)
Housing
Own home/apartment (75.3%)
In relative’s home (9.6%)
Group/foster/homeless or shelter (8.8%)
Other (6.3%)Slide11
Participant Characteristics (continued)
Socioeconomic Status (SES) indicators
Full/part-time employment (39.4%)
Full-time homemaker (35.5%)
At least 12 grade education (47.8%)
Household Income < 20 k (50.4%)
Alcohol and substance use
Low rates of alcohol and drug use at enrollment and throughout the programSlide12
Participant Characteristics (continued)
Sexual behavior (intake)
Protected vaginal sex (25%)
Protected anal sex (25%)
Protected oral sex (15%)
HIV and hepatitis C virus
Tested for HIV (57%)
80.6% (blood test at clinic/doctors office)
Vast majority went back for their resultsSlide13
Say-it-Straight Findings
SIS Questionnaires
Quality of Life-Family
“The people in my family like and trust me”
“If I make a mistake my family will still care about me.
Quality of Life-Group
“I like and trust the people in my group”
“I can accept members of my group, even when I don’t like their behavior”
SIS communication skills (seven subscales)
Administered at two time pointsSlide14
Were there improvements in quality of life for a participant’s family?
There was a significant difference between pre-test and post-test scores for family quality of life (
p
< .001)
Using non-parametric tests within language version:
For English speakers, the family quality of life scores were not significantly different (
ns
)
For Spanish speakers, family quality of life was significantly different (
p
< .001)Slide15
Were there improvements in quality of life for a participant’s training group?
Overall, there were significant differences between pre-test and post-test scores for group quality of life,
p
< .001
For English speakers, there were pre and post-test differences on group quality of life (English version),
p
< .05
For the Spanish version, participants had improvements in group quality of life,
p
< .001Slide16
SIS disempowering and empowering communication/behaviors.
32 items of SIS questionnaire measured disempowering and empowering communication behaviors
For this sample, 24 of these items were scored to indicate seven domains:
Placating
(
4
items)
“I feel that I have to please everybody and put their needs before my own”
Passive aggressive
(
4
items)
“I appear to go along, but I make plans to get even.”
Bullying (4 items)
“I bully or threaten others.”Slide17
SIS disempowering and empowering communication/behaviors.
Seven domains (Continued):
Distraction (3 items)
“I will do anything to distract other people, like change the subject or crack a joke.”
Hiding feelings
(
2
items)
“I hide my feelings.”
Respectfully honest (3 items)
“ I express my feelings honestly”
Talking with a trustworthy person
(
4
items)
“When I worry about the behavior of someone I don’t know so well, I talk it over with someone I trust”Slide18
Were there improvements in disempowering and empowering communication/behaviors?
Overall, there were significant differences between pre- and post-test scores for three subscales: placating, passive aggressive and hiding feelings
Spanish version (differences on four subscales):
Lower ‘placating’ levels (
p
< .005)
Lower ‘passive aggressive’ levels (
p
< .005)
Lower levels of ‘hiding feelings’ (
p
< .01)
Higher levels of ‘talking with a trustworthy person’ (
p
< .05)
English version (difference on only one subscale):
Lower levels of ‘hiding feelings’ (
p
< .05)Slide19
Were there improvements in HIV knowledge?
Improvement from Baseline to Exit (
p
< .01)
Enrollment to Exit
Decline: 14%
Same: 42%
Improved: 44%, Slide20
Were there improvements in Hepatitis knowledge?
Improvement from Enrollment to Exit (
p
< .01)
Enrollment to Exit
Decline: 11%
Same: 13%
Improved: 75%,Slide21
Review
Overall, the majority of participants reported significantly higher quality of life for both family and group at program exit than at program enrollment
Overall, the majority of participants reported significantly less placating, passive aggressiveness, or hidden-feeling communication styles at exit than at program enrollment
There were improvements in knowledge of HIV or hepatitisSlide22
The Effectiveness of Peer Recovery Coaches for Child Welfare-Involved Families with Substance Exposed Newborns and Methamphetamine Using Parents
Stephen James, M.S.,
Richard “Rico” Rivera, M.A.,
& Julie Sauvageot, MSW
Center for Applied Behavioral Health Policy
Arizona State UniversitySlide23
Overview of Peer Recovery Coach Presentation
Literature Review
Purpose
MethodsResults
DiscussionSlide24
Methamphetamine Use in US
Adapted from SAMHSA (2010)Slide25
Methamphetamine Use by US Region
Adapted from SAMHSA (2007)Slide26
Substance Exposed Newborns (SEN)
5% of pregnant women in US use illicit drugs
(SAMHSA, 2009)
More than 4,500 SENs in AZ every year
*
Prenatal exposure to substances associated with physical, emotional, and developmental problems
(Young et al., 2009)
Prenatal drug use associated with child maltreatment and CPS involvement
(Young et al., 2007)
*
Retrieved from: http://www.governor.state.az.us/cps/documents/SenGuidelines.pdfSlide27
Peer Recovery Coaches
Recent increases in facilities that offer peer recovery coaches
*
Increase access to services for SA abusing caregivers in child welfare system
(Ryan et al., 2006)
May improve treatment engagement and retention
Both predict successful treatment outcomes
(McKay & Weiss, 2001)
Substance-abusing child welfare parents have low treatment completion rates
(
Gregoire
& Schultz, 2001)
*
Retrieved from: http://oas.samhsa.gov/spotlight/Spotlight009Mentoring.pdfSlide28
Parent to Parent (P2P) Recovery Program
Three year grant (2008 to 2010)
From SAMHSA
Awarded to ADES – DCYF
Enhancement to Arizona Families F.I.R.S.T. (AFF)
Target Population
CPS-involved families in Maricopa County with:
SENs
Methamphetamine using parents
Critical Element
Assignment of a Recovery Coach for 60 days
To increase treatment engagement and retentionSlide29
Evaluation/Research Questions: Effectiveness of Peer Recovery Coaches
Do Peer Recovery Coaches (PRCs) improve rates of:
Outreach
Assessment and services initiation
Service engagement (including length of treatment and program completion)
Outcomes (including maltreatment recurrence and permanency)
Qualitative perspectives
What are the beliefs of program staff, P2P alumni, and peer recovery coaches on the roles/responsibilities, effectiveness, and areas of potential improvement for peer recovery coaches?Slide30
Method - Sampling
Maricopa County (TERROS)
AFF & P2P Referrals between October 1, 2007– September 30, 2010
686 P2P families
6,820 AFF families
For each CPS maltreatment report, DES identified an index child (i.e., youngest).Slide31
Design - Sampling
No random assignment
May result in bias
Quasi-e
xperimental comparison group design
Propensity score matching was used
Identify a subgroup of the 6,820 AFF referrals similar to P2P referrals
Selection of comparison sample matched on 31 variables
Target characteristics
Literature on predictors of maltreatment recurrence and engagement in SA treatment
Time of referral & missing data
681 matched comparison groupSlide32
Sampling - Variables Used for Matching
Target characteristics
SEN
Methamphetamine use
Other variables:
Demographics (e.g., gender, ethnicity, single status)
SES indicators (e.g., education, employment, income)
No. and age of children in CPS reportSlide33
Sampling - Variables Used for Matching Cont.
Other variables (continued)
Risk factors
Domestic violence
Criminal charges
Substance use (e.g., alcohol, cocaine, marijuana use)
Method variables
Time of referral (in years and semi-annual periods)
Missing indicators (e.g., missing on income, marital status, substance abuse, CPS report)Slide34
Methods – Data Sources
TERROS data
Descriptive info (e.g. gender and employment status)
Substance use patterns
Treatment status/outcomes
DES data
Maltreatment allegations
Out-of-home placements and reunification status
Qualitative dataSlide35
Participant Characteristics – Matched Cont.
Other Characteristics
Matched AFF
Comparison
P2P
Index Child Age at Time of Referral
Mdn
= 1 day
M
=
12 months
(
SD
= 32)
Mdn
= 1 day
M
=
6.8 months
(
SD
= 22)
Client Age (years)
Mdn
= 28
M
=
29
(
SD
= 7)
Mdn
= 27
M
=
29
(
SD
= 7)
Female
79%
80%
Caucasian/White
82%
81%
At least a HS Degree
45%
44%
Employed (FT/PT)
15%
16%
Single
/Never Married
72%
75%
Alcohol Use
56%
54%
Marijuana
Use
49%
48%
Pending Criminal Charges
75%
75%Slide36
Findings on the effectiveness of peer recovery coaches on the following domains:
Outreach
Assessment and services initiation
Service engagement (including length of treatment and program completion)
Outcomes (including permanency and maltreatment recurrence )Slide37
Outreach
Outreach Patterns
AFF Matched
Comparison
P2P
Percent of Referrals with Outreach Attempt
84%
83%
No. of Outreach Attempts
per Referral
**
Mdn
= 2
M
=
2.2
(
SD
= 1.4)
Mdn
= 1
M
=
1.9
(
SD
= 1.3)
No.
of Days from Referral to First Successful Outreach
**
Mdn
= 1
M
=
4.9
(
SD
= 23)
Mdn
= 0
M
=
1.7
(
SD
= 4.7)
**
p
< .01Slide38
Assessment and Service Initiation
Assessment
and Service Initiation Patterns
AFF Matched
Comparison
P2P
Percent of
Referrals that Were Assessed
81%
84%
No. of Days from Referral to Assessment**
Mdn
= 21
M
=
27.7
(
SD
= 25.2)
Mdn
= 17
M
=
23.6
(
SD
= 25)
Percent of Referrals that Engaged in at Least One Unit of Service
~**
90%
97%
No. of Days
from Referral to First Service~**
Mdn
= 20
M
=
26.4
(
SD
= 25.8)
Mdn
= 16
M
=
22.6
(
SD
= 28.5)
~Excluding assessment and drug testing services
**
p
< .01Slide39
Program Completion for Clients Engaged in Services
**
P
<.01Slide40
Service Engagement
Patterns of Length
of Treatment (days)
AFF Matched
Comparison
P2P
All Closed Referrals
**
Mdn
= 106
M =
126.4
(
SD
= 92.8)
Mdn
= 120
M =
153.5
(
SD
= 125)
Completed
Treatment Plan **
Mdn
= 118
M =
140.7
(
SD
= 104.6)
Mdn
= 151
M =
182.9
(
SD
= 141.6)
Discontinued Participation
**
Mdn
= 104
M =
120.4
(
SD
= 84)
Mdn
= 123
M =
157.6
(
SD
= 120)
**
p
< .01Slide41
Outcomes – Permanency
Permanency Achieved by Index Children
AFF Matched
Comparison
P2P
Children Placed Out-of-Home
*
32.6%
38.1%
Achieved Permanency
52.1%
53.4%
Reunification
*
81.8%
93.2%
*
p
< .05Slide42
Outcomes – Maltreatment Recurrence
Patterns
of Maltreatment Recurrence Among Perpetrators
AFF Matched
Comparison
P2P
Pre-Referral Neglect Allegation
97.9%
98.5%
Maltreatment Recurrence Rate
23.4%
25.5%
Recurrence: Neglect Allegation
83%
92%Slide43
Qualitative Perspectives
Methods
Two Participant Groups
One Provider Group
Individual Structured Interviews with Recovery Coaches
Six program Participants
Average age of 37 years
50% male
Average number of children was 4
Six providers
Average time in field was 17 years
Four Peer recovery coaches
3 females
Average time in position was 15 months
Average length of sobriety was 3 yearsSlide44
Role of Peer Recovery Coaches
Connecting Modeling
Informing Teaching
Navigating Advocating
Supporting Encouraging
Slide45
Engaging Parents
“No service is as powerful as being separated from your child.” – Parent
“The recovery coach was a boost to get in there, but it had to do with me and my child and getting sober. So, I would have been there no matter what.” – Parent Slide46
Recovery Coach Characteristics and Attributes Related to Effectiveness
Parents:
“A softer introduction…”
“They explain a little more…”
“You’re a little more prepared…”
Providers:
“Some one on their side…”
“Making that first connection…”
“An unbiased listener…”Slide47
Making a Connection with Parents through Shared Experiences
“I ask them to tell me their story. Usually, they open right up because they have that kind of relationship with me already – somebody who’s been through it.”
– Recovery Coach
“You don’t have to hide what you are. It’s like having a weight lifted off your shoulders.” – Parent
“I’ve had clients tell me, ‘If you hadn’t of been there [at the assessment], I would have got up and walked out.” –Recovery Coach
“There’s this cloud hanging over your head until you’re done. And it is a huge fear; it rules your life. For me, [the Recovery Coach] can tell me it is ok, it’s going to be ok.” – ParentSlide48
Discussion Regarding Openness
“I encourage them to be honest with the Team
before
the UA results return...”
– Recovery Coach
“We wouldn’t be Recovery Coaches if we had not been those parents at one time.”
– Recovery CoachSlide49
Distinctions between Peer Recovery Coaches and Providers
“They ask the hard questions, but in a little more friendly manner.” – Parent
Distinct role in the larger intervention
More friendly Less formal More open
Build rapport with parents through self-disclosureSlide50
“
Hands –On” Approach
“My Recovery Coach helped to keep me on track.”
Real world, practical suggestions and information, backed by personal experience
Shifting focus from engagement to self-directed commitment to succeed
Illustrating tangible results Slide51
Benefits of Working with a Recovery Coach
“I think parents who have a Recovery Coach seem more hopeful and confident.” – Provider
“The Recovery Coach reminds us that recovery should not be a barrier to success.” – ProviderSlide52
Setting Boundaries and Limitations
“We are friendly, but we’re not friends.” – Parent
“Boundaries can be an issue. The Recovery Coach’s role is to encourage parents, show them how to get started. They are not there to be their friend.” – Provider
“They are my clients, not my friends.”
– Recovery Coach
“My job is to guide them, not carry them.”
– Recovery Coach
Slide53
Closing Comments and Suggestions for Making the Recovery Coach Program More Effective
“The recovery coaches are the best thing they [TERROS] have.”
– Parent
“Sometimes people get a little jaded because of the level of denial by the people who use. It’s easy to sever a child from these parents; it’s harder to go the full nine yards with them. The Recovery Coach represents success and reminds us all of the fact that people can change.” – Provider
“CPS involvement in my life was the beginning of the end of my drug career and the beginning of a new life for me. Sharing that with other parents helps me to remember where I came from. It is very inspiring to me, too, just to see someone else finally get it.”
– Recovery CoachSlide54
Discussion
The use of peer recovery coaches has been proposed as an effective approach to improve access to treatment for this population (Ryan et al, 2006) .
However there is currently limited research that evaluates these claims with regard to treatment engagement and retention.
This research study fills this gapSlide55
Discussion: Qualitative Findings
According to P2P alumni, peer recovery coaches, and service providers, service engagement was enhanced by recovery coaches providing background information that assisted clients in navigating through the CPS and treatment systems.
Moreover, service providers believed that peer recovery coaches were instrumental in the initial stages of treatment, and that clients were more likely to participate and share information when their peer recovery coach was present.Slide56
Discussion: Quantitative Findings
PRCs increase engagement and retention
Increased rates of successful outreaches and reduced the duration of time from referral to successful outreach and clinical assessment.
Although lower completion rates, higher length of treatment
Although no effect on permanency rates, higher rates of reunification.
Finding converge with the work of Ryan and colleagues (2006), who found that substance abusing caregivers in the child welfare system are more likely to achieve family reunification when assigned a peer recovery coachSlide57
Discussion : Qualitative
According to the interviewed P2P alumni, support and encouragement provided by the peer recovery coach were important factors that helped clients stay on track.
Peer recovery coaches believed that developing rapport and maintaining frequent communication with clients contributed to client engagement.Slide58
Suggestions from Qualitative Findings
P2P alumni raised concerns that the case load of peer recovery coaches was too large.
Similarly, peer recovery coaches believed they could have a greater impact if they spend more face-to-face time with the clients.
P2P alumni suggested that peer recovery coaches would be more beneficial if assigned for more than 60 days. Slide59
References
Gregoire
, K.A., & Schultz, D.J. (2001). Substance-abusing child welfare parents: Treatment and child placement outcomes.
Child Welfare,
80, 433-452.
McKay, J.R., & Weiss, R.V. (2001). A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow ups: Preliminary results and methodological issues.
Evaluation Review,
25, 113-161.
Ryan, J.P., Marsh, J.C.,
Testa
, M.F., &
Louderman
, R. (2006). Integrating substance abuse treatment and child welfare services: Findings from the Illinois Alcohol and Other Drug Abuse waiver demonstration.
Social Work Research
, 30(2), 95-107.
Substance Abuse and Mental Health Services Administration. (2007). Methamphetamine use. In
The NSDUH Report
. Rockville, MD.
Substance Abuse and Mental Health Services Administration. (2009).
Results from the 2008 National Survey on Drug Use and Health: National Findings
(Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockwell, MD.
Substance Abuse and Mental Health Services Administration. (2010).
Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings
(Office Studies of Applied, NSDUH Series H-38A, HHS Publication No. SMA 10-4586Findings). Rockville, MD.
Young, N.K., Boles, S.M., & Otero, C. (2007). Parental substance use disorders and child maltreatment: overlap, gaps, and opportunities.
Child Maltreatment
, 12, 137-149.
Young, N.K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., &
Amatetti
, S. (2009).
Substance-Exposed Infants: State Responses to the Problem
. HHS Pub. No. (SMA) 09-4369. Rockville, MD: Substance Abuse and Mental Health Services Administration.