Assignment II (HUMAN BEHAVIOR)

Come Home Houston  is a new program recently awarded through funding from SAMSHA to Baylor College of Medicine, with Santa Maria (SMH) serving as a sub-grantee. The award is for a 5 year period for nearly $2 million. The grant will be specifically targeted to serve underserved homeless individuals who are living with both substance use and co-occurring mental health disorders. These services will be targeted in areas where there are high concentrations of women who need support; identified by data and designated by zip code. It appears that these identified areas share a common lack of access to available support services, creating conditions where women face steep barriers to self-sufficiency. These barriers include low levels of employment, poverty, poor educational backgrounds, prior criminal justice involvement and incarceration, trauma histories and lack of family support. In short, almost every barrier standing on its own restricts successful reentry after treatment. Combined, these barriers require intensive intervention to provide a better probability of lasting recovery.

Santa Maria has been selected as the site to provide services for these identified individuals. Primary treatment will include integrated substance use disorder and mental health treatment. The program expects to assist 60 participants a year to successfully gain housing. This will be achieved by support and individualized services related to recovery housing, health, life skills, vocational training and employment coaching. It will also include a strong enhancement of tobacco and vaping cessation services. The approach used will emphasize survivor empowerment and peer support. The program will also be tailored to be culturally responsive to the needs of black and Latina female substance users who experience homelessness at a disproportionate rate. All participants will have access to a level of recovery support that will assist them in reconstructing their lives Women are already being selected by our case managers and coaching staff who have deep roots in the communities targeted by these objectives. As they are admitted, they are assigned a recovery coach and a counselor. They also are welcomed to their new residence.

This grant ensures that the door will be kept open for disenfranchised women in our community to receive life- changing services.  We are grateful for our partnership at Baylor, the relationships with the team there and for the opportunity to empower women to lead healthy, successful, productive and self-fulfilling lives.

Need to align policy and practices with recommended best practices. It was clear through our interviews that sectors were not routinely reviewing and updating policy and practice guidelines to follow current research and recommended best practices. For example, the Bexar County and Harris County jails are taking postpartum women off MAT (medically assisted program), which does not follow current best practices and actually increases the risk that these new mothers will overdose after release from jail. Interviewees provided multiple accounts of needing to intervene in court proceedings in which a pregnant woman was ordered to stop MAT without the consent or 7 recommendation of her medical provider. Language and interpretation were also found to be causing a lack of compliance with best practices. In healthcare, there are multiple definitions and interpretations of the term “screening” particularly as it refers to drug screening. When obstetrician/gynecologists (Ob/Gyns) were asked if they were screening for drug use during pregnancy, they often thought the question referred to urine drug screening (testing) and not verbal, self-report questions using validated screening tools. This misunderstanding may be contributing to hesitation by providers to screen all patients as a part of standard prenatal care, as recommended by the World Health Organization (WHO), American College of Obstetrics and Gynecologists (ACOG), and Substance Abuse and Mental Health Services Administration (SAMHSA).