Gender matters. The social, emotional, physical and psychological differences between men and women create different risk factors for the development of substance use disorders, and lead each to treatment for different reasons and with different goals in mind. Women are more likely to enter treatment if they do not need to leave their children behind, for example, and if they are able to remain in treatment with their children, they are more likely to stay. The social value placed by women on relationships (which appears to have a physiological basis as well as a social one) renders attention to relationships a critical component of treatment.
Programs that have tailored their assessments, treatment plans and services to the gender-specific needs of women have the opportunity to be designated as women’s gender specific treatment programs. Requirements to provide women’s gender-specific treatment include groups and education aimed at dealing with relationships, parenting, women’s health, treatment services delivered at times that are convenient for women with child-rearing responsibility or for women who work and take care of children. Case management is a critical component of service delivery, and outreach is necessary to assist women in attending treatment. Specific services such as child care, transportation, primary health care for women and their children, issue-specific treatment such as counseling for domestic violence or mental health treatment for trauma or childhood sexual abuse are also made available.
The most recent addition to the field of women’s gender specific treatment is the Family Centered Treatment for Women model, described in Family-Centered Treatment for Women with Substance Use Disorders: History, Key Elements and Challenges. As described in this document, treatment centers on the family as a whole, rather than singling out individual family members for intervention and then including family members wherever possible. Here, children are treated together with their parents when they can be and when the program model allows, and the family’s treatment plan includes services for each individual family member in addition to the services provided to the family as a whole.
Women’s treatment is prioritized by the Center for Substance Abuse Treatment because of the impact that treatment and recovery have not only on the woman herself, but also her family, her children and future generations. This is the reason for the public dollars known as the “women’s set-aside” or here in Colorado as Specialized Women’s Services (SWS). Each Managed Service Organization (MSO) is allotted by DBH a certain amount of SWS money to be spent on women’s treatment, as required by the terms of the federal Substance Abuse Prevention and Treatment Block Grant.
Services for Medicaid-eligible pregnant women are delivered through the Special Connections program, which is managed by DBH in cooperation with the Department of Health Care Policy and Financing. There are currently thirteen different Special Connections programs contracted with DBH to deliver this service. Services include individual and group therapy, health education classes pertaining to pregnancy, initial risk assessment, and case management to assist in coordinating the delivery of these services as well as others paid for by other funding sources. Special Connections providers have established long-standing relationships with other community service providers, and draw on these resources when other needs become apparent. Special Connections also funds residential treatment at four Colorado locations for pregnant women whose treatment needs are complex enough that they cannot be safely treated in outpatient treatment. The length of the Special Connections program is different for each woman, depending upon her treatment needs and progress. Assuming continued Medicaid eligibility, Special Connections services can be delivered for up to a year post-partum.
Women’s treatment services are also funded, for those women whose families are involved with the Child Welfare system, by Core Services dollars. This pot of money is administered exclusively through the child welfare system, and is spent upon the authority of the local county department of social/human services, for the county in which the woman resides.
DBH’s funding stream set aside to treat clients who are seen through the MSO system and who have open child welfare cases is known as Additional Family Services (AFS) dollars. AFS moneys are administered by DBH and are available on a contractual basis to treat clients of any county that contracts with the local MSO for Core funds to treat Child Welfare clients. This system is designed to afford counties and providers as much local control and flexibility as possible while remaining responsible for their respective funding streams.
The following are web links to sources of information regarding treatment for women, children and families: