Demeter House is an innovative, nationally-accredited, residential substance abuse center located in Arlington, Virginia that serves women in a gender-specific setting that is comfortable and feels like home. The program is designed not only to break the cycle of addiction, but also to empower women to re-enter the community as responsible citizens. Demeter House is a program of Phoenix House, an independent nonprofit organization that is the nation’s leading not for profit provider of alcohol and drug abuse treatment and prevention services, operating more than 123 programs in ten states.
Demeter House offers comprehensive and professional services for women, women with children, and women who are pregnant in residential settings. Mothers entering treatment may bring one child with them. The program offers a flexible length of stay and a phased treatment regimen of individual, group, and family counseling sessions that are woman-centered and sensitive to the special needs of women who have experienced past traumas. The addiction counselors at Demeter House, as well as their medical and psychiatric staff, use a cognitive-behavioral, 12-step approach, including medication management and medication-assisted treatment, to address a wide range of substance abuse and mental health problems.
Demeter House provides evaluations, medical and psychiatric care for the women in treatment and ensures that linkages to prenatal and postnatal care, well-baby check-ups, and immunizations are obtained for the children in the community. While their mothers are in treatment, children are cared for on-site in a nurturing environment. In addition to residential programming, Phoenix House may also provide outpatient services.
All programs at Demeter House are Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited and use evidence-based cognitive behavioral, psycho-educational, and motivational enhancement practices to promote and support recovery and an enhanced quality of life. Residents follow individualized treatment plans that are designed to meet their specific needs, and treatment length is determined by continuous case review. Additional services may include medical and mental health care; case management; supervised recreational activities. Women (and her family members where appropriate) participate in an individual assessment and evaluation to determine treatment needs and appropriate levels of care.
Interview with Deborah Taylor, Senior Vice President and Regional Director, Phoenix Houses of the Mid-Atlantic
Q What inspired you to begin Demeter House?
A Our program opened in 1989 and was one of the first in the country to provide a gender specific program for pregnant and post-partum women. We allowed moms to bring their kids into the program with them. When we started, women could either be pregnant or bring thier child up to twelve years old with them. We knew – based on our relationship with county criminal justice agencies, that this was a tremendous area of need. Many of the women who were involved in the justice system locally were arrested for crimes like solicitation, drug offenses, and larceny. The clients were not typically violent felons.
Q How are clients referred to you and how is your work funded?
A Women tend to enter Demeter House directly from jail or after experiencing trouble while under parole and probation supervision. Demeter House was originally funded by local Virginia county government, and as more people came to know about our work, other local, state, and federal agencies contributed their support. We typically serve up to twenty women at any given time in our residential program.
Q What are some of the most compelling lessons you have learned that you can offer to others in the field?
A When we started the program, women typically came to us when they were pregnant and heavily using drugs – this was during the height of the crack cocaine epidemic. As we were providing services to these children, Georgetown University came to Demeter House and conducted a research study on the kids who had been born addicted to crack and were participating in our program. Essentially, they observed the baby’s development and found that when the children were nurtured and stimulated correctly, they did not demonstrate residual negative effects. In other words, we could help them simply by taking care of them and their mothers.
In addition to the crack epidemic, we were initially dealing with the welfare system before welfare reform. We wanted to empower these women to not be dependent on men and to learn how to end their reliance on welfare. We wanted to encourage women to become self-sufficient – by going to work and taking responsibility. We began with a very needy population of women – many of them did not understand their own anatomy, did not know how to take care of their kids’ basic needs. We focused on how to help women become more self-reliant and independent, and be better able to mother.
We also learned that while the demographics of women may be the same on paper, the women are actually very different. For example, we opened a program in neighboring Washington, DC in the late 1990s. In that program (as compared to our program in Arlington, VA), the women did not present with the same number of mental health issues – it seemed as though survivors had dissociated from that. In other words, for women in Arlington it seemed to be more acceptable to experience mental health issues. Women in Washington DC were in “survivor mode.”
Today, we are focusing much more on looking at the trauma in women’s lives that cause them to abuse substances and to relapse in terms of criminal behavior.
Q How has your work at Demeter House evolved in recent years?
A We focus more on criminogenic risk and needs and much more on trauma. We see fewer issues around teaching women independence, and women do not typically have as many children as they used to. At Demeter House, we don’t see nearly as many women coming with children – it used to be closer to two thirds of our participants, but now only 10% of women come into treatment with their child.
We recognize how important it is to focus on the needs of women. We formerly ran a program that included both men and women and stopped doing that. We ultimately made both of our programs separate and gender-specific – women could not deal with their issues in that setting and would revert to their dependence on men. We wanted to teach them to depend on themselves and to get strength from other women. We want women to learn to share responsibilities- and learning to get along with other women was key.
How do you handle situations where women cannot adhere to the rules of the program?
Because the majority of women in our program are criminal justice referrals, we work with the woman’s case manager or probation or parole officer to discuss what the behavior was and what the sanction should be. For violent infractions, we recommend that women be returned to custody. If the problem behavior is a relapse, and the woman tells us, we usually advocate that they stay and work through the relapse. We work collaboratively and do joint staffings with parole/probation on a regular basis.
Q How do you think services for women involved in the criminal justice system changed over the past 5-10 years?
A On the whole, the criminal justice system is getting better at assessing risks and needs early on. With this information, we can deliver the right curriculum targeted at the right issues. We are getting a better idea of why women are breaking the law from a behavioral perspective and are better able to determine: are we dealing with criminals? Or are we working with people who are committing crimes because of other issues? With this information in hand, we can be better at preventing reoffense.
Q What do you see happening in the field of criminal justice as it relates to women or gender-informed practices in the next few years? What progress still needs to be made?
A The use of trauma-based curriculum is critical. One of the things we try to help people to understand is that when you look at prisoners of war and what they experience – a sense of being unstable, of feeling like life is unpredictable, that they never know if they will be tortured, killed, or abused – if you are a two year old, and have an unpredictable mom and dad and are being hit or spanked, neglected, and/or not having your basic needs met, that has the same effect on a two year old as being tortured as an adult man. Severe dysfunction feels like trauma to a little one, they do not understand it. Focusing on the trauma of women and the potential impact of trauma on children is critically important.
Q What, if any, outcome data do you collect about the women who participate in Demeter House?
A We collect follow up data on all of the women who participate in Demeter House, whether they successfully complete our program or not. We collect information about whether the women are drug free and whether they have reoffended criminally. Our data indicates that 73% of women are crime/drug free after leaving our program (after three months), according to their own self report (we do also make collateral contact with probation and parole officers to try to verify this information as much as possible). We follow up with all program participants at a three month interval for research purposes, but would also like to do longitudinal studies in the future if the opportunity presents itself.
According to our most recent data, our completion rate in 2012 was 65%, which is over 10% higher than the national average of 54%. It is interesting to note that the number of admissions to Demeter House has increased by 22%, but women are staying for shorter periods of time – this is attributable to a lack of funding. We have women in our program typically for 30-60 days when we used to be able to keep them for 6 months to a year. We would really like to keep them long enough to make changes, and believe that it takes closer to two years to have an “evolution.” We recognize that it is important, at a minimum, to keep the women linked to treatment for two years. When a woman leaves our program we try to place them in a step down/Oxford house, or halfway house, and have them attached to an aftercare program, in order to provide them with the continued support they need.
Q What advice do you have for professionals working in the field who want to achieve better outcomes with the justice-involved women with whom they work?
A In addition to what we have discussed about looking at the individual needs of these women, I would take care to recognize the power that those working in the criminal justice system and the effect that can have on women with trauma.
Q Are you aware of current, or up and coming resources that are being developed, for which the field should be on the lookout?
A Seeking Safety (see http://cjinvolvedwomen.org/seeking-safety-an-intervention-for-trauma-exposed-incarcerated-women for more information); the Milkman cognitive behavioral curriculum for substance abuse (see http://static.nicic.gov/Library/021657.pdf); the work Ed Latessa has done out of the University of Cincinnati, and the assessment tools from Texas Christian University are all very valuable in our work.
Q What has inspired you the most in your work?
A This is a very special program. When we see a child thrive, that is extraordinarily rewarding. When women come back to recovery celebrations, they have reclaimed their lives and established new values, and seeing that is tremendously uplifting. We have women (who have two years or more of sobriety) who come back to work for us. Working in addiction is inspiring, particularly when you can see people get back on the right footing and find their way.
For more information about Demeter House, visit their web site at http://www.phoenixhouse.org/locations/virginia/demeter-house/ or contact Deborah S. Taylor, R.N., C.D., Senior VP/ Regional Director, Phoenix Houses of the Mid-Atlantic at firstname.lastname@example.org.