Academic journal article Social Work

Experiences Associated with Intervening with Homeless, Substance-Abusing Mothers: The Importance of Success

Academic journal article Social Work

Experiences Associated with Intervening with Homeless, Substance-Abusing Mothers: The Importance of Success

Article excerpt

Shelters in 88 percent of 24 major cities have to turn away homeless families because of lack of resources (U.S. Conference of Mayors, 2005). The majority of homeless families are headed by single mothers, with rates ranging from 85 percent to 94 percent (Bassuk, Rubin, & Lauriat, 1986; National Center on Family Homelessness, 2006;E. M. Smith, North, & Fox, 1995). Most research on homelessness focuses on mothers instead of fathers because mothers are more likely than fathers to have their children with them when experiencing homelessness. Homeless mothers are also substantially more likely to experience drug and alcohol problems than are housed mothers (Bassuk, Buckner, Perloff, & Bassuk, 1998), and many studies have noted that homeless substance abusers are underserved by the substance abuse treatment system (Koegel, Sullivan, Burnam, Morton, & Wenzel, 1999; North & Smith, 1993; Robertson, Zlotnick, & Westerfelt, 1997). Even though the Institute of Medicine concluded that substance abuse represents the predominant public health problem of people who are homeless, little research has assessed what types of treatment are effective with homeless mothers (Stahler, 1996). Substance abuse treatment is imperative because substance abuse disorders can exacerbate the severity of homelessness, which has many personal, social, and economic costs (Robertson, 1991).

In addition to substance abuse problems, homeless mothers often have histories of victimization, including childhood and partner abuse; lack of social support from family and friends; and multiple financial, legal, physical, and mental health problems (Conners et al., 2004). For example, studies indicate that 28 percent of homeless mothers report having had a suicide attempt; 57 percent report having had multiple attempts; and 50 percent meet Axis I diagnostic criteria for at least one clinical or major mental disorder, such as a mood, anxiety, or psychotic disorder (LaVesser, Smith, & Bradford, 1997; Rog, Holupka, & McCombs-Thornton, 1995). Homeless parents and children become sick and go hungry twice as often as do members of nonhomeless families and typically lack a regular source of medical care (National Center on Family Homelessness, 2006). Homeless mothers report fewer people they can count on in times of need and fewer people who would be able to care for their children than do housed mothers (Letiecq, Anderson, & Koblinksy, 1996).

The experiences described in this article arose from a pilot intervention study whose primary goal was to develop and evaluate a treatment intervention to stabilize homeless mothers and their children. Therefore, treatment occurred within the context of a stage 1 treatment development grant award from the National Institutes of Health and is part of an ongoing project. This article is based on experiences during a nonrandomized pilot conducted between September 2009 and July 2010. Fifteen homeless families participated; all of them were engaged through a local shelter for homeless families. All mothers met diagnostic criteria for an alcohol or other psychoactive substance abuse disorder and had at least one biological child from two to six years of age in their custody. The intervention was provided by three master's level PhD students in a couple and family therapy program. All therapists were female and white (non-Hispanic). Therapist experience ranged from two to four years. The intervention, ecologically based treatment (EBT), included three months of rental assistance for independent housing and six months of intensive case management and substance use/mental health treatment (the community reinforcement approach [CRA]) (Meyers & Smith, 1995). The intervention began at the shelter, in private offices, but once women obtained housing, services were provided in their homes. Each case management session ranged from 15 minutes to two hours, and CRA sessions lasted, on average, one hour. …

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