Christine Grella: Jackson’s article challenges us to rethink our entire understanding of drug treatment, expand our definition of who is in treatment, and revise our list of desired outcomes. If the family, not the individual with the drug problem, is the unit of treatment, then what counts as success must include whatever contributes to family members’ well-being and the way the entire family system functions. Carol Shapiro: I agree. I was struck by Families in Transition’s ecological approach, the way it takes into account the entire context of its clients’ lives. Too often, researchers and clinicians tend to isolate people, thinking about them as separate entities and ignoring their personal relationships and connections with their community. On the other hand, I’m wondering whether the program may actually be limiting in its focus. Its emphasis on case management—on obtaining the right professional services for each child—might lead to a de-emphasis on the children’s natural connections with adults other than their parents—the aunts, uncles, and godparents—who may function as their guardians. It’s possible that the children’s stay in a residential center will weaken or even fracture some of those connections, so that they will need to be repaired when the mother and children leave the program. Also, residential programs like this are so expensive and the need for treatment is so staggering, that I wonder whether there are more cost-effective ways to support people where they are living. The added benefit of outpatient programs is that the transition out of treatment would be less drastic. Grella: Actually, I felt that one of the nice features of this program was that its creators have really expanded the concept of family and make it very elastic, to include the aunts and grandmothers. Dace Svikis: The program is definitely a significant achievement. I operated a residential and intensive outpatient program for pregnant and postpartum drug-dependent women and their children, and I remember what we went through to get our hospital to approve it, and the liability and cost issues we faced. Grella: I like Jackson’s straightforward attitude. She makes it perfectly clear that what she is attempting is fraught with logistical and other practical problems. For one thing, the presence of so many children in the program demands a major commitment of staff resources. Jackson is frank about the fact that the children exhibit serious behavior problems and that safety is a major concern. I think she should be applauded for taking on a real challenge.
C. Grella, C. Shapiro, D. Svikis
Science & Practice Perspectives