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Week of 8 January 1999 Vol. II, No. 18 Feature Article $800,000 committed Dual grants will help drug-treatment services By J. Nicole Long Hortensia Amaro, vice-chair of the Boston Public Health Coalition and SPH professor, recently received two national grants totaling $2,300,000 from the Substance Abuse and Mental Health Services Administration, aimed at addiction prevention and treatment. A Faculty Development Program grant from the U.S. Department of Health and Human Services is contributing $100,000 per year for three years to train SPH professors. "We are training four professors on addictions treatment and prevention," Amaro says, "who will be able to offer new courses and perhaps a minor in the field." SPH Assistant Professors Lisa Sullivan and Elaine Alpert, Associate Professor Lee Strunin, and Professor Wendy Mariner are attending three-hour biweekly seminars at BU to discuss effective methods of addiction prevention and treatment, develop course packets, and determine field placements. "It's an exciting opportunity to collaborate with other faculty who are where the rubber meets the road, working directly with clients," says Alpert. "Most of my work is with domestic violence. We once thought women remained in physically abusive relationships as a consequence of their substance abuse. We are now finding that victims turn to substances as a coping mechanism. The seminars will give me a chance to explore this in-depth." Amaro says the expertise of the faculty will trickle down to students, and hopes that the number of thoroughly trained personnel will increase in the workforce. The second grant, the Boston Consortium of Services for Families in Recovery (BCSFR), was awarded to Amaro and John Auerbach, executive director of the Boston Public Health Commission, in collaboration with the School of Public Health to develop a new model of a health department. Announced by Mayor Thomas Menino, it is one of 14 given throughout the country that will provide support for five years: $500,000 over the first two years and then $500,000 each following year to test the effectiveness of the new program. With 20 years of experience in the public health field, Amaro says that a coalition of organizations needs to be established so that clients can receive more evidence-based and effective treatment. Amaro also says that organizations can cut costs and spend taxpayers' money more wisely. If the project implements a successful city-based system of integrated services, she says, Boston will be a model for cities around the country. The BCSFR grant specifically targets women who are substance abusers, physically or sexually abused, and mentally ill. "They're dealing with numerous agencies at one time, such as the courts and criminal justice system, homeless shelters, welfare offices, addiction treatment centers, and mental health providers," says Amaro, "and that can be overwhelming. Just managing the paperwork and requirements that these agencies place on families can be a full-time job." An integrated plan will unify the kind of treatment a client receives as well. "Philosophies and approaches to addictions vary," she says. "Women and their families often receive conflicting advice and become confused about what they are supposed to do." Professor Hortensia Amaro is the recipient of two public health grants that benefit the prevention and treatment of drug addictions. Photo by David Herwaldt. To establish a collaborative effort, Amaro has identified more than 50 city and state agencies that determine policies and provide services to mothers and children. Her plan proposes the development of shared assessment tools, case-management protocols, practice guidelines, and cross-training programs for all providers. Members of the consortium include mental-health providers and substance abuse treatment providers, children's services providers, law enforcement and criminal justice personnel, community health centers, religious leaders, policy makers, and the women, or consumers, who have personally experienced the problems in the existing system. Amaro says that if the consortium focuses on women, it will have a more significant impact on communities. Because many of the women are single mothers, they often avoid seeking help out of fear they might lose custody of their children, or they refuse inpatient care because treatment facilities do not provide accommodations for children. "To break the cycle," Amaro says, "the women must get help. They need to be treated, they need to know that while they are receiving treatment their children will have a place to go, and the children need treatment, too. If the children are growing up in an environment of abuse or addiction, they are being primed to continue the cycle." A public health system with agencies that communicate with one another would more effectively reach women and include children, she says. To document the progress made in improving the health-care system, an evaluation of the consortium's activities and its eventual impact will be conducted by the New England Research Institutes. Sarah McGraw, a senior research scientist at the Institutes and one of the evaluators, says that there will be focus groups from four sectors of public health: medical care, substance abuse treatment, shelters, and consumers. During the focus group sessions, policies will be examined and amended. "Perhaps the most critical group are the consumers," says McGraw. "The women will voice their experiences and also be trained through a leadership program. Their involvement in the decision processes will be crucial."