Best Practices - Early Intervention, Outreach and Community Linkages for Women with Substance Use Problems

3.3 Key Client Considerations

For related results from Literature Review, see sections 2.3 and 2.4
For related results from Focus Groups, see sections 4.3 and 4.4

3.3.1 Circumstances and Needs of Women with Substance Use Problems

Participants were asked to describe the main circumstances that women with problem substance use often face. Respondents outlined a range of key challenges related to the current life situations of many women. These included:

• History of trauma, violence, and victimization:
  Women with problem substance use often have histories of trauma and abuse. In many instances, they are currently victims of domestic violence or sexual assault and have experienced significant stress related to personal and family safety.
  
  
• Stigma and risks associated with seeking treatment: Many women avoid seeking treatment as a result of potential repercussions resulting from their disclosure of problem substance use. Perceived consequences linked with accessing treatment support can include loss of custody of children, estrangement from family members and social relationships, and risk of increased domestic violence.
  
  
• Multiple family and caregiver responsibilities:
  Women often have additional responsibilities including care for children, aging parents or other family members. In many instances, they may be the primary or sole caregivers within the current family system.
  
  
• Poverty and inadequate housing: In addition to problem substance use issues, women may have concerns related to financial stressors and provision of basic needs for themselves or family members. As a result, they may be reluctant to engage treatment services if other need areas cannot be addressed.
  
  
• Fewer social supports, isolation: Many key informants indicated that women with substance use problems often have limited social support networks or positive links within their communities. Lack of child care services and transportation further impedes efforts to access support or engage in treatment activities.
  
  
• Emotional and personal distress: Women often experience feelings of guilt and shame related to their continued problem substance use. Such personal distress contributes to lower levels of self-esteem, feelings of sadness and decreased hope.

3.3.2 Service Delivery Considerations for Specific Groups of Women

Key informants were asked to identify the main issues that should be taken into account for specific groups of women when providing early intervention and outreach services in the community setting and enhancing community linkages.

Pregnant Women

• Early intervention and outreach initiatives need to make concerted efforts to establish positive helping relationships with women who are pregnant. This is particularly important for preserving the health of both the child and mother and reducing the risks associated with FASD.
  
  
• Support activities should include disseminating relevant health information on prenatal care and ensuring basic medical services.
  
  
• Several respondents also indicated the need to provide advocacy for this client group to connect them with key services and using non-judgmental approaches in developing a strong therapeutic alliance.

Women with Children

• Women's fears regarding the potential for losing custody of their children are a significant barrier to pursuing treatment. Efforts should be undertaken to address this when providing early intervention and outreach.
  
  
• Basic needs, including adequate resources for food, clothing or housing, need to be addressed in conjunction with outreach and treatment efforts.
  
  
• Provision of child care and transportation services are important considerations to facilitate women's initial involvement in programs.
  
  
• Outreach to clients can be undertaken in collaboration with community-based education programs that address life skills instruction on such topics as self-care, parenting or budgeting.

Women with Concurrent Mental Health Problems

• It is important for mental health and addiction specialists to work collaboratively when providing comprehensive service plans for this client group. Such efforts should address treatment issues while also developing positive community linkages that will provide ongoing post-treatment supports.
  
  
• Various respondents indicated the need for health care providers and addiction workers to receive specialized training on specific strategies for working with concurrent clients.

Homeless and Transient Women

• Addressing basic needs such as food, shelter and clothing are critical considerations for reaching out to homeless women experiencing problem substance use.
  
  
• Outreach services should provide flexible meeting times for clients in accessible locations.

Rural Residents

• There are often limited accessible services available for women with problem substance use in rural communities. Lack of transportation can be a significant barrier for women to attend services or programs in other locations.
  
  
• In smaller communities, the importance of maintaining confidentiality was viewed as critical for facilitating clients' willingness to seek assistance for problem substance use.
  
  
• Local support groups or help lines can provide a means for connecting with women in rural areas and linking them with early intervention services.

Injection Drug-using Women

• Women who use injection drugs should be provided with safe environments in which they can disclose their problems and openly discuss their concerns without fear of judgment or repercussions from others.
  
  
• Increasing awareness and understanding among employers, community members and service providers may reduce the stigma associated with injection drug use and reduce the barriers associated with accessing treatment.

Aboriginal Women

• Addiction and health service providers need to be sensitive to the traditions and beliefs associated with Aboriginal communities. Cultural awareness should be taken into account in the development and adaptation of approaches for working with Aboriginal women.
  
  
• Aboriginal community members, leaders and professionals may be important sources of support and play valuable roles in the delivery of outreach and early intervention services.

Senior Women

• Outreach services are crucial for providing treatment services for seniors with problem substance use.
  
  
• Misuse of prescription medication among seniors is an area of concern that should be targeted for early intervention efforts.

Sex Trade Workers

• Sex trade workers often have long-standing histories of both physical and sexual abuse and have an increased likelihood of experiencing ongoing problem substance use.
  
  
• Outreach programs are critical for connecting with sex trade workers. Such services should be provided in accessible locations, and target times when individual contacts can be made with the client.

Women in Conflict with the Law

• Several respondents underscored the importance of problem substance use screening when women first come into conflict with the law. Such efforts may provide a critical opportunity for providing early intervention services.
  
  
• Police and other justice professionals should receive training on problem substance use and strategies for linking women with community resources and services.