Summary Report Treatment And Rehabilitation For Women With Substance Use Problems Workshop On Best Practices June 6 And 7, 2002

4.0 Best Practices - Client Retention

4.1 Presentation by Nanci Harris

Nanci presented a summary of factors that support client retention at Jean Tweed Centre (a residential program in Ontario):

• Flexibility. This a quality that needs to be present in both the staff and structure of the program. It is also important to look at individualized lengths of stay in treatment programs to better meet individual client’s needs.
• Client centred model. Jean Tweed Centre incorporate a variety of treatment approaches within the context of being “client centred”. They situate the woman’s use of drugs and alcohol within the broader context of her life experience which includes the physical, emotional, economic, social and spiritual aspects.
• Individual client time given. When needed women receive individual counselling.
• Engaging the client. The staff very consciously use language and works hard to create and environment that conveys respect and a belief that women who come to Jean Tweed Centre are capable of making lasting positive changes in their lives. Clients are considered active equal participants in doing the work required.
• Non-judgmental hope. As reported by former clients, the Centre provides a sense of hope that clients can change and reclaim their lives. It is very important for women not to feel judged, especially women involved in the sex trade who are already carrying loads of guilt and shame. In recognition of the fact that women who have participated in illegal activities often feel different, some of the programming is done separately for those women to create a higher level of safety and comfort.
• Multi-functional services. The ability to provide a full range of services that women need means they don’t have to initiate and maintain relationships with multiple service providers. This reduces the likelihood that clients will drop out of treatment. In Toronto, “Breaking the Cycle” is an addiction and parenting program for pregnant women or women parenting children under the age of six. They brought together welfare, public health, children’s health and the Motherrisk program under the same roof as a way of offering the clients one trusted space working with their program counsellor to address their life issues.
• Regular participation in Phase I. Women do much better when they are able to come to pre-treatment support groups if they are within commuting distance, or if they have regular support and contact with their referral agency when from out of town.
• Families engaged at earliest stage. Women are supported in establishing a support group for themselves (not necessarily traditional family members) and the program examines how families may contribute to the addiction, and how they can help during treatment and rehabilitation.
• Childcare. Providing childcare services can greatly improve client retention.

There are also many staff factors that influence client retention:

• Work as a team. Staff inform their clients from the beginning that they work as a team and that decisions are not made by individual counsellor.
• Staff convey acceptance and hope. Women are shown that they are valued by the courtesy and respect they receive from staff.
• Flexible meeting times for clients.
• Continuity of support between program and residential staff. At the Jean Tweed Centre regular meetings for residential and treatment staff are held twice a day to debrief and pass on relevant information.
• Regular clinical supervision. Staff need regular supervision to do the work effectively and not burn out. An external clinical supervisor is also present twice a month to conduct professional supervision to the clinical team as a whole.
• Provision of ongoing training and development. The program allows educational days (for example, three days per year) for staff to obtain training in areas of interest to them. Training staff on the many issues that clients may be dealing with such as personality disorders, eating disorders, traumatic experiences, etc., will help staff addressing these issues in their programming and be better equipped to respond.
• Client Matching. The quality of the relationship between the client and the counsellor is key. Gender specific treatment will be required, but the quality of the treatment is dependent on the development of good rapport and working relationships.

4.2 Client Retention – Challenges and Strategies Identified by the Participants

Waiting Lists
It can be difficult for clients to remain engaged while waiting for services. Short workshops on health promotion could be offered to clients, or assistance in accessing other programs in the community.

Flexibility of Services
Services need to be flexible. For example, some clients are not suited to group work, therefore one-on-one sessions would be required for them to succeed. Clients respond best when services meet their needs and are adapted to their circumstances.

Inadequate Detoxification
Inadequate detoxification can limit clients’ ability to complete a program. Options for home detoxification with appropriate standards and protocols should be developed. During the detoxification phase, women experience a high level of physical and emotional vulnerability which can impact retention. Agencies need to ‘normalize’ the detoxification experience for women by explaining exactly what will happen to them and include them in decision-making regarding their care.

Inappropriate Referrals
In some cases clients are not properly referred and/or are not ready for treatment and rehabilitation. Agencies need to build good relationships with referring agencies and provide education so that these situations are avoided.

Closed Intake System
Clients who have to wait to be admitted are less likely to follow through when intake dates are limited to certain days or times of the month. Open admissions with continuous intake would ensure clients are linked with the system when they are ready.

Cultural Sensitivity
Clients’ comfort level and the likelihood that they will remain in treatment and rehabilitation increases when services are sensitive to their culture and language needs. Formalized standards and the process for assessment, and program design need to be reviewed for cultural sensitivity. Programs should reflect the diversity of the clients they serve.

Language Barriers
Agencies can alleviate language barriers by hiring language-specific staff, having more and easier access to interpreters, providing written information in specific languages, and consulting women to find what works best in helping them overcome language barriers.

Client Lifestyle
Clients without stable housing or who are transient need a non-judgmental open-door setting. Incentives, such as lunch, coffee, money for telephone, etc., can also help.

Physical Environment
Many women seeking treatment and rehabilitation are intimidated by unfamiliar, institutional settings. This can be alleviated by having program staff meet and greet clients in a welcoming manner.