SISTERS

Brief Program Description

SISTERS Intervention Services is a comprehensive paraprofessional case management program for substance abusing pregnant and postpartum women receiving detoxification treatment services. The mission of the program was to provide peer support and case management to ensure the coordination of drug treatment, prenatal, postpartum, pediatric, and family support services for pregnant and postpartum women. The SISTERS program was specifically designed to add much needed peer-oriented outreach and case management to the existing Maternal Substance Abuse Services Program, which already combined prenatal care delivered by a nurse midwife and drug treatment for pregnant and postpartum women with children.

The increasing prevalence of substance abuse among women, particularly the use of crack cocaine during pregnancy, exacted a toll in unprecedented high rates of maternal and infant morbidity and mortality. The failure of the existing health and human services delivery system to meet the comprehensive needs of this burgeoning population necessitated the development of innovative, flexible program models such as SISTERS. Women in this program received detoxification treatment services at the Lincoln Acupuncture Clinic in the Mott Haven section of the Bronx, New York.

Program Strategies

Four peer counselors coordinated services including relapse prevention counseling, acupuncture detoxification, prenatal care, sponsorship for attendance at Narcotics Anonymous meetings, housing, transportation, child care, nutrition, assistance with child welfare, AFDC, and Medicaid.

"SISTERS" are women in recovery themselves, all of whom had experienced many years of addiction, abusive relationships, life on the streets, birth of infants with positive toxicologies, and removal of children by child protective services. They also turned their lives around by getting help and successfully entering recovery through utilization of available social supports, completion of their own detoxification, obtaining gainful employment, and perhaps the most challenging and rewarding of all, reunification with their own children.

The primary goal of the project was to demonstrate the effectiveness of peer counseling vis-à-vis:

1. Availability and utilization of services
2. Substance abuse abstinence and psychosocial functioning
3. Birth outcomes and parenting attitudes

A repeated-measures (intake, 2 months, 6 months) evaluation design with a comparison group of non-SISTERS clients from the clinic was used. Data collection involved in-person interviews, conducted by a social worker, for which clients received stipends. Urine toxicology data from the clinic's information system were used as the measure to assess sobriety outcomes.

Population Focus

The SISTERS program served pregnant women, of which the majority were either African American or Hispanic/Latino. Target population also included women on public assistance, women mandated to treatment, women who reported experiencing more than four violent traumas (e.g., sexual assault, death of a loved one), and those who had smoked crack cocaine during their last pregnancy.

Suitable Settings

The intervention is appropriate for service provider environments, which address women's health issues, particularly pregnancy, substance abuse, and trauma.

Required Resources

Expertise and coordination of prenatal care and substance abuse treatment are mandatory prerequisites for success. Strong involvement of social workers and health professionals is required. "Connecting and Coping," a curriculum for conducting support groups for individuals affected by psychological trauma, is available from the Principal Investigator.

Implementation Timeline

A 6-month minimum is required for recruitment and training of peer counselors and initiation of case management and support services, which integrate prenatal care with substance abuse treatment.

Outcomes

Major program outcomes include the following:

• Positive significant pre- and post-test differences were observed in the percentage of negative urine toxicologies.
• Urine samples of SISTERS clients became significantly cleaner over a one-year period compared to the comparison group.
• Change scores for SISTERS clients significantly improved for measures of depression and self-efficacy in contrast to the non-SISTERS group.
• SISTERS clients compared to non-SISTERS clients experienced a significant decrease in parental stress and rigidity of parenting style.
• SISTERS clients utilized more services than non-SISTERS clients.
• Seventy-eight percent of SISTERS clients gave birth to babies weighing at least 2500 grams. More active clients had significantly heavier babies than less active clients.
• Eighty percent of infants born to SISTERS clients were toxicologically clean at birth.
• SISTERS clients continuously regained custody of children; at intake 60% had no children living at home, but by the end of the project, this was reduced to 18%.
• All SISTERS clients who obtained custody of their babies kept them for the duration of the program.

Contact Information

For indepth information on this program, please use the contact listed below.

Program Developer

In April 1999, this program was designated as a Promising Program under SAMHSA's previous National Registry of Effective Prevention Programs system.

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A program of the U.S. Department of Health and Human Services Substance Abuse & Mental Health Services Administration