Curriculum for Addiction Professionals (CAP): Level 1

Competency 4: Prevention

Outreach Services

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 addiction treatment 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 prevention strategies, etc.