Women's Substance Use and Disorders Issues


Evaluation of Female Offender Treatment and Employment Program (FOTEP)
Christine E. Grella, Ph.D., Principal Investigator (grella@ucla.edu)

The goal of the FOTEP project is to enable the successful reintegration of women parolees into the community, particularly in regard to reducing criminal behavior, substance use, and welfare dependence, and to strengthen family relationships and employment skills. The FOTEP evaluation study consisted of a quasi-experimental study with a sample of FOTEP participants (n = 343) and a Comparison group of eligible, but non-participating, female parolees (n = 157). All participants initially participated in in-prison substance abuse treatment; about two thirds of the sample then transferred to community-based treatment in FOTEP, while the others were paroled to the community and referred to treatment as usual. A 12-month follow-up interview was conducted with about 90% of the study sample from 2001-2003 and outcomes were assessed regarding their drug use, criminal behavior, employment, parental status, and psychosocial functioning. Recidivism (i.e., return-to-prison) has also been analyzed for up to 48 months following parole using administrative data. Analyses showed that longer time in FOTEP treatment (at least 150 days) reduced the odds of a return to prison by about half, and that individuals who completed FOTEP treatment were significantly less likely to return to prison as compared with individuals in the Comparison group.  In addition, surveys conducted with in-prison treatment participants and program staff and focus groups with FOTEP participants have provided information for ongoing project evaluation. 

Evaluation of Female Offender Treatment and Employment Program (FOTEP) was funded by the State of California, Department of Corrections and Rehabilitation, Division of Addiction and Recovery Services, Contracts C03.052 and C06.229  (July 2003 through June 2009).

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Evaluation of Trauma Informed Substance Abuse Treatment (TI-SAT)
Christine E. Grella, Ph.D., Principal Investigator (cgrella@mednet.ucla.edu)
Nena Messina, Ph.D., Co-Investigator
Luz Rodriguez, B.A., Project Director

The Trauma-Informed Substance Abuse Treatment (TI-SAT) program was established at the Leo Chesney Community Correctional Facility in 2008 to provide gender-responsive and trauma-informed substance abuse treatment for women offenders.  Trauma-informed treatment is based on the recognition that childhood and adult trauma exposure is pervasive among women offenders and intricately related with their substance abuse problems.  ISAP is conducting an evaluation of the TI-SAT to determine whether the trauma-informed treatment components are implemented as planned; if obstacles are encountered in the implementation process, and if so, the strategies used to address these obstacles; and the characteristics of participants, their treatment retention and aftercare participation, and their outcomes on parole.  A total of 106 participants were recruited to participate in the outcome study; interviews are conducted at study intake and at 6-month follow-up.  Study findings will compare risk of recidivism of TI-SAT participants with comparable women offenders who were enrolled at the facility prior to implementing the TI-SAT program. Outcome analyses will examine the effects of program participation on status and functioning of participants, including their relapse to substance use, criminal behavior involvement, employment, parenting and family relationships, and overall mental health and psychosocial functioning.  In addition, surveys with program staff and observational site visits are conducted to determine whether the gender-responsive and trauma-informed program components are successfully implemented.

Evaluation of Trauma Informed Substance Abuse Treatment (TI-SAT) was funded by the State of California Department of Corrections and Rehabilitation, contract C08.106, from October 2008 to March 2011.

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Evaluation of the Liberating our Families from Drugs and Incarceration Program
Christine E. Grella, Principal Investigator (grella@ucla.edu)
Luz Rodriguez, Project Director

ISAP is conducting the evaluation of the SAMHSA-funded project “Liberating our Families from Drugs and Incarceration (LOFFDI),” which is part of the Pregnant and Parenting Women’s Treatment Initiative at the Center for Substance Abuse Treatment.  The LOFFDI program is provided at the Walden House program in El Monte, CA, and the target population is women parolees who have a history of substance use problems and who are currently pregnant or have young children.  The program’s objectives are to improve the mental and physical health status, employment status, and parenting skills of participants so that they can successfully reintegrate into the community following their release from prison.  Intensive case management services are provided within the context of residential substance abuse treatment, which includes children’s services, family counseling, parenting skills training, vocational services, mental health services, trauma-related services, and referral for medical services for the women and their children. The evaluation study showed that approximately 60% of participants (N=110) completed the LOFFDI treatment, compared with an average of 39% for participants in other aftercare programs for female offenders in California.  Moreover, LOFFDI participants demonstrated significant improvements in their alcohol and drug use, psychological status, family functioning, employment, and quality of life at the 6-month post-discharge follow-up.  Participants had a high level of satisfaction with the services received and staff improved their competency in delivering parenting and other services over the course of project implementation. Overall, the evaluation demonstrated that LOFFDI participants improved in targeted domains that address the multiple and complex problems faced by female offenders and their families as they re-integrate into the community following parole.

Evaluation of the Liberating our Families from Drugs and Incarceration Program was funded by Walden House, Inc., Contract20064370 (October 2006 to September 2010).

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A Long-term Follow-up Study of Drug-Dependent Mothers and their Children
Yih-Ing Hser, Ph.D., Principal Investigator (yhser@ucla.edu)
Nena Messina, Ph.D., Co-Investigator
Elizabeth Evans, M.A., Project Director

Risky health behavior causes serious health problems for mothers and their children.  In recent years, increased numbers of women-only programs have offered special services to address the unique problems and service needs among mothers, including child care and parenting services. However, few studies have examined short-term and long-term outcomes of mothers and children served in women-only programs. We are conducting a long-term follow-up study of 4,500 mothers treated for risky health behaviors via their administrative records, and by interviewing a subsample of mothers (n = 1,000) to provide complementary data on their status. Additionally, we are collecting assessment data from the mothers interviewed on their target children (mostly aged 8 to 10). The specific aims of the study are: (1) to investigate mothers’ long-term outcomes measured by administrative records (e.g., treatment, mental health, arrest) in relation to their index treatment in women-only versus mixed-gender programs; and (2) to locate and interview a subset of mothers to determine, in relation to mothers’ index treatment in women-only versus mixed-gender programs, (2a) mothers’ current status (social support, parenting behaviors, health behaviors, mental health) and (2b) children’s current status (custody, school achievement, behavioral problems). The study should provide empirical data with treatment and policy implications for improving services and outcomes for mothers and their children.

A Long-term Follow-up Study of Drug-Dependent Mothers and their Children was funded by the National Institute on Drug Abuse, grant 1 R01 DA021183, from June 2009 to May 2011.

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Evaluation of Horizon's Integrated AODA Treatment/HIV Services for Justice Involved Women
Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
Project Director and degree: Kira Jeter, M.P.H.

The purpose of this SAMHSA funded project is to expand Community Advocates - Horizons Campus’ program to increase access to integrated outpatient AODA treatment and HIV services for a minimum of 600 justice-involved women who are less likely to enter treatment through formal systems. Objectives are to: (1) increase the number of women who participate in integrated outpatient AODA/HIV services from 25 to 125 women per year; (2) enhance Community Advocates-Horizons Campus’ program with research-based AODA/HIV curricula that will engage hard-to-reach women, their children and their partners; and (3) increase the number of women and partners who receive rapid HIV testing from 90 to 200 per year.

  • ISAP is conducting the evaluation, which (1) includes process and outcome components to monitor the implementation of the planned intervention and (2) measures observed changes in participants from before to after their participation in the project in the following domains of functioning: (a) alcohol and drug use; (b) parenting behaviors and family functioning; (c) quality of life and social functioning; (d) criminal behavior and legal status; (e) mental health and physical health status; (f) HIV/AIDS risk reduction behaviors; and (g) treatment and services received.

ISAP will determine the degree the project was able to increase access for justice-involved women to gender-specific, integrated outpatient AODA treatment and HIV prevention services.

Evaluation of Community Advocates - Horizons Campus Integrated AODA Treatment/HIV Services for Justice- Involved Women was funded by the Substance Abuse and Mental Health Services Administration, Grant TI18592 to Community Advocates-Horizons Campus (October 2007 to September 2012).

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Enhancing Substance Abuse Treatment Services for Women Offenders
Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
Maria Zarza, Ph.D., Project Director (September 2005 to Sepember 2007)
Stacy Calhoun, M.A., Project Director (September 2007 – Present)

This 3-year study will examine Mental Health Systems, Inc.’s (MHS), readiness and capacity for practice improvement as it incorporates women-focused treatment into four MHS program sites currently serving female drug court participants. The proposed study will also include an experimental component to determine the relative effectiveness of a women-focused (WF) treatment program based on relational theory compared to the standard mixed-gender (MG) outpatient treatment program delivered to women offenders deferred from incarceration through drug court to promote positive behaviors (e.g., HIV risk reduction and substance abuse, and increased psychological functioning). The WF curriculum has been fully developed (Helping Women Recover, Covington, 1999; 2003); however, the activities outlined in this application will be the first empirical test of the curriculum that includes assessments of staff readiness and barriers to enhancing service. Specifically, 150 women participating in four MHS drug court programs in San Diego, California, will be randomly assigned to the WF or MG treatment program groups. The proposed study has the following specific aims:

  1. To identify and address barriers to coordinating and integrating new and appropriate WF services, including HIV prevention, for substance-dependent women offenders;
  2. To coordinate and integrate a theoretically based women-focused protocol into the existing MHS program curriculum;
  3. To develop effective fidelity measures to assess staff performance, adherence, and retention of the newly integrated curriculum;
  4. To pilot test the efficacy of the theoretically based, multi-faceted, WF curriculum to promote positive behaviors among women offenders compared to the impact of the standard MG program;
  5. To qualitatively assess women’s perceptions of their treatment experience, comparing those of  women in the newly integrated WF program and those of women in the standard MG program.

Preliminary Findings

Findings from the staff focus groups revealed that the facilitators were very supportive of implementing the WF focus curriculum in their drug court and showed a strong willingness to be trained in the new curriculum.  However, they were concerned that they were not trained enough to deal with traumatic events that might come up in group.  In particular, they were worried about “opening a can of worms” and being unable to resolve the situation before a session is finished and thereby placing the client at risk for using again.  Findings indicate the need to provide the counselors with an on-site experienced clinician to help them deal personally and professionally with their daily work.

The findings from the client satisfaction survey showed that there were no differences between the two groups in their overall satisfaction with their treatment program.  Both groups were very satisfied with the treatment they received.  However, the women in the WF group were significantly more likely to find their groups to be helpful in their recovery process then the women in the MG group (95% vs. 84%, p < .05).  The women in the WF group were also more likely to rate their program as being the best kind of program for women (81% vs. 67%, p=.08). 

Enhancing Substance Abuse Treatment Services for Women Offenders was funded by Mental Health Systems, Inc., Grant 720 (R01 DA022149) (September 2005 to July 2010).

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Integrated Outpatient AODA/HIV Treatment for Justice-Involved Women
Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
Kira Jeter, M.P.H., Project Director

The Horizon House Community Connections Program (CCP) is funded by a grant from the Substance Abuse and Mental Health Services Administration to expand outpatient access to alcohol and other drug abuse (AODA) treatment and HIV services to justice-involved women who are less likely to access treatment through formal systems. The project’s goal is to increase participant access to gender-specific, integrated outpatient AODA treatment and HIV prevention services. Objectives include: (1) increase the number of women who participate in integrated outpatient AODA/HIV services; (2) enhance the CCP program with research-based HIV/AODA curricula focused on engaging hard-to-reach women, their children, and their partners; and (3) increase the number of women and their partners who receive rapid HIV testing. The UCLA Integrated Substance Abuse Programs will determine the degree to which the project was able to increase access for justice-involved women to gender-specific, integrated outpatient AODA treatment and HIV prevention services.

Integrated Outpatient AODA/HIV Treatment for Justice-Involved Women was funded by Community Advocates, Substance Abuse and Mental Health Services Administration, Grant # TI018592-04 to Community Advocates, October 2007 to September 2012.

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TOWAR: A Comprehensive Training on Women’s Addiction and Recovery
Nena Messina, Ph.D., Principal Investigator (nmessina@ucla.edu)
Stacy Calhoun, M.A.

The purpose of this Phase I Small Business Technology Transfer (STTR) project is to develop TOWAR: a comprehensive Training on Women's Addiction and Recovery specifically for use in drug courts. Social Solutions International, Inc. (Social Solutions), in collaboration with UCLA Integrated Substance Abuse Programs (ISAP), proposes to develop the training and a woman-focused, innovative model of a drug court program. Instructions for how to implement the woman-focused drug court program will be incorporated into the comprehensive training and toolkit. The project will have strong commercial potential, as it will incorporate training, research, and education on appropriate treatment protocols, criminal justice supervision, and services for women eligible for participation in drug court settings nationwide. The project also involves the cooperation of the Los Angeles County Drug Court, Los Angeles Alcohol and Drug Program Administration, and the Center for Gender and Justice. 

TOWAR: A Comprehensive Training on Women’s Addiction and Recovery was funded by the National Institute on Drug Abuse, number 1 R41 DA022101-01A2, from January 2009 to June 2010.

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A Parenting Intervention for HIV+ Moms: The IMAGE Program
Debra A. Murphy, Ph.D., Principal Investigator (dmurphy@mednet.ucla.edu)
Diana Payne, Ph.D., Project Director

The purpose of this R01 pilot study is to develop and then test the feasibility of implementing a parenting intervention for HIV-infected mothers with well children age 6 – 14 years old. The intervention is designed to improve parenting skills and maternal self-care skills in order to improve child and maternal outcomes.  The basis for development of this intervention is work from two previous R01s (MH # 5R01MH057207) designed to longitudinally assess HIV-positive mothers and their children. MLH (n = 60) and their children (total N = 120) will be recruited, randomized to a theory- based, skills training intervention or a control condition, and assessed at baseline and 3, 6, and 12-month follow-ups.  The intervention (“Improving Mothers’ parenting Abilities, Growth, & Effectiveness”—the IMAGE program) will consist of 5 sessions, and will be based on the Information – Motivation – Behavioral Skills (IMB) model of health behavior change, with specific skills selected based on our 10-year observational study of MLH and their children, which is on-going at UCLA. A random subset of 40% of the intervention mothers (n = 12) will be asked to participate in an in-depth qualitative interview after their last follow-up, to obtain detailed process information on their experiences in the intervention.

A Parenting Intervention for HIV+ Moms: The IMAGE Program was funded by the National Institute of Mental Health, grant 1 R01 MH086329, from April 2010 to December 2013.

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Maternal HIV: Intervention to Assist Disclosure to Children
Debra A. Murphy, Ph.D., Principal Investigator (dmurphy@mednet.ucla.edu)
Mary-Lynn Brecht, Ph.D., Co-Investigator
Diana Payne, Ph.D., Project Director

This small 3-year R01 was designed to develop and pilot test an intervention to assist mothers living with HIV (MLWH) to disclose their serostatus to their young (age 6 – 12 years old) children. Information gathered in previous two R01s was used to develop a brief disclosure intervention to assist HIV-infected mothers of young children to appropriately disclose their serostatus to their child. Feasibility, acceptability, and preliminary efficacy of the intervention were tested in a pilot trial. MLWHs (N = 80) were randomly assigned to the intervention or control condition. MLWHs and children were assessed at baseline, 3-, 6-, and 9-month follow-ups. A random subset of intervention mothers (n = 12) were asked to participate in an in-depth qualitative interview after their last follow-up to obtain detailed information on their experiences in the study. The aims of the intervention were to: facilitate disclosure of the MLWHs’ HIV status to their children; increase their self-efficacy to responding to children’s questions regarding HIV; reduce fears regarding disclosure and stigma; improve maternal knowledge of child development and how to provide age-appropriate levels of information; improve MLWHs’ mental health indicators over time; improve children’s mental health indicators over time; and improve family functioning indicators.  The study has just recently completed final data analyses, with a clinically and statistically significant intervention effect.  The outcome paper has been submitted, and a full scale trial of the intervention is now being planned.

Maternal HIV: Intervention to Assist Disclosure to Children was funded by the National Institute of Mental Health, Grant 1 R01 MH077493 (January 2007 to December 2010).

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Longitudinal Study of Maternal HIV on their Late Adolescent/Early Adult Children
Debra A. Murphy, Ph.D., Principal Investigator
(dmurphy@mednet.ucla.edu)
Diane Herbeck, M.A., Project Coordinator

This study was designed to extend and expand a longitudinal study (R01-MH057207-10).  “Parents And children Coping Together (PACT) was the original study, and was designed to longitudinally assess mothers living with HIV (MLHs) and their young, well children 6 to 11 years old.  Five follow-ups were conducted at 6-month intervals in the PACT study.  A subsequent longitudinal study, “Parents and Adolescents Coping Together” (PACT II), followed up the majority of these families when the children were transitioning to early and middle adolescence; there were 6 follow-ups.  This study  (“PACT III”) continues to follow the MLHs and adolescents one last time, to continue to investigate outcomes as the adolescents transition to late adolescence/young adulthood.  Both quantitative and qualitative interviews are being conducted.  This is the first cohort of children in the U.S. to be followed almost continuously as they grow up to adulthood while living with a mother with HIV/AIDS.

The Longitudinal Study of Maternal HIV on their Late Adolescent/Early Adult Children was funded by the National Institute of Mental Health, Grant R01 MH57207-11 (2008 - 2013).

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Gender-Responsive Treatment for Women Offenders
Michael Prendergast, Ph.D., Principal Investigator (mlp@ucla.edu)
Nena Messina, Ph.D., & Elizabeth Hall, Ph.D., Co-Investigators

This 5-year study was designed to determine whether drug abuse treatment programs designed specifically for women offenders result in better outcomes than do mixed-gender programs. Consistent findings regarding the greater severity of women’s drug abuse, past trauma, and psychological disorders have led many researchers to advocate the use of gender-responsive treatment for women as a more appropriate and effective way to facilitate their recovery. As policymakers and treatment providers consider expanding treatment options for women offenders, it is critically important to determine whether women-only (WO) treatment programs do produce better outcomes than standard mixed-gender (MG) programs. The study involved the cooperation of community-based drug abuse treatment agencies providing Drug Court, Substance Abuse Crime and Prevention Act (SACPA), perinatal, and other outpatient treatment within Los Angeles County. The study used a quasi-experimental design with study intake into two treatment conditions (MG vs. WO) and had the following specific aims:

  • To evaluate the impact of WO programs on drug use, criminal activity, and social functioning (e.g., employment, education, parenting behavior) for women offenders, compared to the impact of MG programs.
  • To qualitatively assess women’s perceptions of their treatment experiences in the WO and MG treatment programs.

Using a propensity-score approach to balance the two groups on baseline characteristics, analysis indicated that, at 12-months following treatment entrance, women who participated in WO programs were significantly less likely to use drugs and to commit crimes than were women in MG programs, but the groups did not differ significantly on arrest and employment.

Gender-Responsive Treatment for Women Offenders was funded by the National Institute on Drug Abuse, Grant 1 R01 DA016277 (September 2004 through August 2009).

Last Updated:  12/05/2012

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2016 ISAP Publications
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