> Competency 4: Prevention > 9. Outreach Services
Competency 4: Prevention
Outreach services extend beyond usual agency activities to engage individuals who
have, or are at risk of developing, a substance use or related health problem. Outreach
often focuses on reaching those who are “hard to reach or hidden” and
not in contact with other services. Outreach activities may also be designed to
reach people already in contact with services but who need accessible substance
abuse treatment services.
The development of outreach services should be based on a careful assessment of
the characteristics, life circumstances, and needs of the specific group who will
receive the services. In some cultures, men and women live more segregated lives
and this must be taken into account in planning outreach services. In some cases,
such as homeless women, safety may be the primary concern.
Outreach activities may occur in community centers, cafes, drop-in or storefront
agencies, police stations, shelters, places of worship, hospitals, prisons, social
and health care settings, or any natural setting where women gather. Outreach may
be done by telephone or delivered by mobile vans or cars. Some programs establish
satellite offices in accessible locations. To establish trust, continuity is important
for recipients of outreach services, particularly for clients who are at high risk,
such as women living in violent situations.
Peer outreach can be an effective way to reach women who are not in contact with
professional services or who live in places with strong cultural taboos against
substance use by women. Among some groups, peers may be viewed as more credible,
and women who use substances may find it easier to establish trust and discuss personal
issues with peers.
Peer outreach workers can provide users with information on how to reduce risk behaviors,
can teach by example, and can link those who use substances with treatment and other
health and social services. Women who have successfully completed treatment can
be role models and provide support to women during the treatment process. AA is
a well-established form of peer outreach. In addition, the National Organization on Fetal Alcohol Syndrome (NOFAS) runs
a support network for mothers who have given birth to children with an FASD.
These women are particularly high risk of having future children with an FASD.
It is also important to identify and address life needs, such as food, housing,
a safe place to spend time away from the street, child care, and mental and physical
health care. Responding to these immediate needs can begin the process of engagement.
Below are some key themes in providing appropriate services to pregnant and parenting
women, based on results of studies from the Pregnant and Postpartum Women with Their
Infants program of the Center for Substance Abuse Treatment.18
Key Themes for Substance Abuse Treatment Services That Are Responsive to Gender
- Respectful service philosophy, which addresses women's shame and guilt, loss of
control over their lives, and their mistrust of the systems scrutinizing them, by
providing an environment that is nonjudgmental, promotes mutual respect and empowerment,
and builds on women's strengths.
- Comprehensive and practical care by combining substance use treatment with an array
of services such as
prenatal care, medical
care, parenting education, family planning, attention to nutrition and housing needs,
and counseling on violence and relationship issues, as well as practical supports
such as babysitting costs and transportation to appointments. A philosophy that
supports women’s choice in the life areas they want to work on and provides
“one-stop shopping” or a well-integrated network of services contributes
to program effectiveness.
- Interagency collaboration and coordination to engage and retain women in treatment
and provide the range of services required. Interagency collaboration and coordination
can address issues such as differing service philosophies and approaches, promoting
joint training, sharing of resources and joint planning and, in particular, promoting
collaboration between the
system, the child welfare system, and the foster care system.
- Broad and flexible continuum of care, which can support women in entering, re-entering,
and completing treatment.
- Outreach to reduce internal barriers, such as shame and fear, and to make pregnant
women aware of available services either directly through interventions, such as
street outreach, or through education of other service providers. Home outreach
and transportation are important factors in treatment compliance and outcome.
- Case management and flexible scheduling, which may include home visits, telephone
contact, professional or peer advocacy, help with transportation, and processes
that allow women to enter and re-enter treatment and accommodate their need to attend
to other issues such as medical appointments or responding to child welfare authorities.
- Attention to family issues, by integrating children and partners into women’s
care and supporting women in their decisions regarding reunification or disconnection.
- Continued support or aftercare is critical for women because of the many changes
that they experience following the intensive phase of treatment. This includes developing
new social networks, relationship issues, family-role changes, working on relapse