Substance use during pregnancy and motherhood is an ongoing public health concern in Los Angeles County. Substance-using PPW here, especially poor women and those of color, are subject to increased surveillance – often facing arrest, prosecution, conviction and/or child removal for what is a health concern. These policies work to create stigma and fear which are significant barriers to treatment. Moreover, there are grave geographic and health disparities for PPW in L.A. County. Black women here had three times the risk of infant mortality than White or Asian women. From 2006-2016, the greatest number of maternal deaths occurred in L.A. County Service Planning Area (SPA) 6 (54 deaths) and neighboring SPA 7 (30 deaths) – the highest rates in L.A. County. Only 62% of L.A. County women living below the Federal Poverty Level had a medical home, as compared with 85% of women living above it. Additionally, the SPA 6 teen fertility rate for females 15-19 was 23.9 for Black teens, 31.7 for Latina teens, but only 4.5 for White teens. Of SPA 6 residents, 28% are Black and 68% are Latino (our clients' preferred term).
To address these geographic and health disparities, Los Angeles Centers for Alcohol and Drug Abuse (L.A. CADA) will create a PPW continuum of care: 32 residential treatment beds and a 20-slot PPW outpatient program. The former L.A. CADA PPW facility (which could not accommodate children) will be converted to 16 beds for PPW Recovery Bridge Housing, completing L.A. CADA's PPW continuum of care. Our program will serve L.A. County SPA 6 and 7, and surrounding cities. L.A. CADA proposes to create this program at 8919 California Avenue in South Gate, CA 90280 to:
1) double our current PPW program capacity, creating 16 beds for children ages 0-16;
2) provide access to evidence-based treatment for SPA 6 – the area of greatest need in L.A. County; and
3) accommodate the addition of outpatient services to provide a comprehensive continuous care model (funded by other sources);
4) provide PPW Recovery Bridge Housing (funded by other sources).
L.A. CADA owns the client-ready South Gate facility which is already licensed by the State of California for treatment of women and children. The move and all start-up activities can be completed in four months, with service delivery beginning on January 30, 2022 or earlier. Outpatient facility certification and services are expected to be completed within six months of funding.
The Alice's House program will deliver a bilingual (English/Spanish) ASAM Level 3.1 PPW treatment program that is 60-120 days in duration, based upon individual need. An outpatient services component will be certified and integrated into the PPW program to create a continuous care model providing ongoing support for PPW. Recovery Bridge Housing will be provided in L.A. CADA's former PPW facility. Services will be gender- and gender-identity specific, as well as culturally-focused to facilitate healing through kinship and community. The emotional and physical safety of women will take precedence over all other considerations in service delivery. Alice's House services will incorporate a range of evidence-based practices endorsed by SAMHSA, including services based on the Strengthening Families Approach and Protective Factors Framework. PPW will receive:
-- screening, assessment, and treatment planning;
-- comprehensive SUD/COD treatment across a residential, outpatient, and recovery bridge housing continuum;
-- Harm Reduction services;
-- case management for PPW, minor children, and family members as appropriate;
-- supplemental services for women; family services;
-- services for the minor children, fathers of the children, partners of the women, and the extended family members of the women and children, as requested by the woman and as appropriate; and
-- peer recovery support services.
L.A. CADA expects to serve at 480 PPW from 2022-2027, plus their children and family members.