Wisdom of Women: Peer Support for Women with Co-Occurring Disorders and Histories of Trauma Women, Co-Occurring Disorders & Violence Study December 2001 Innovations From the Sites WISDOM OF WOMEN is a gathering of women who share their experience, strength, and hope with each other and find support and understanding as we face life on life’s terms. Wisdom of Women meets to help heal the wounded areas of our lives whether those wounds are the result of abuse, neglect, drug use, or physical or mental challenges on the part of ourselves or from others. Our primary purpose is to help ourselves and others in our journey of recovery and empowerment. The only requirement for membership is the desire to live a healthy life with right human relationships. We grow through being open, honest, and willing as we share our life’s experiences. —Preamble, Wisdom of Women Wisdom of Women (W.O.W.) is a peer support group for women affected by substance abuse, mental illness, and trauma. The program provides an empowering combination of educational information, mutual support, and opportunities for shared leadership. Women who participate in W.O.W. believe it plays a critical role in their recovery by giving them the help and hope they need to grow and heal. W.O.W. is part of the Triad Women’s Project, one of nine SAMHSA-funded Women, Co-Occurring Disorders and Violence Study sites. The Triad Women’s Project is a multi-dimensional integrated services program serving women with co-occurring disorders and histories of violence in a three county area in rural, central Florida. The project is being operated by Tri-County Human Services, a substance abuse prevention, intervention, and treatment agency and the Louis de la Parte Florida Mental Health Institute. CREATING WISDOM OF WOMEN The idea for W.O.W. grew out of the concerns of consumer/survivor/ recovering (C/S/R) women who completed trauma-specific psychoeducational group therapy, then felt “dropped” from the program because there were no other group opportunities to continue their recovery. C/S/Rs felt strongly this service gap needed to be filled in a way that fostered empowerment and mutual support. With this charge, the Triad Consumer Coordinator, along with other project staff and a consultant with expertise in creating peer support groups, met with women who were currently in treatment to develop the focus, structure, and operating procedures for a new group. Planning was consumerdriven, allowing the women to create the type of group they wanted. W.O.W. draws on traditional peer support group models, including Alcoholics Anonymous (A.A.), Narcotics Anonymous (N.A.), AlAnon, Adult Children of Alcoholics, Emotions Anonymous, and Trauma Survivors Anonymous. However, W.O.W.’s unique focus on creating a safe, supportive, empowering atmosphere for women with mental health, substance abuse and trauma experiences caused the planning group to break with tradition in important ways. For example, instead of employing a deficit-based approach centered on limitations and labels (“I am an addict”; “I am a major depressive”), W.O.W. partici- pants present themselves as women with specific challenges (“My name is ___ and I have these challenges”). W.O.W. allows women to talk about addiction along with other challenges they face and other experiences that impact their lives (e.g., trauma and abuse). Because many women do not feel safe sharing experiences of victimization in groups with men, W.O.W. is for women only. Once the general framework for the group was established, women in the Triad project and other women in the community were invited to participate. Invitations and brochures were broadly distributed to several residential treatment programs and other local support groups. The Victims’ Advocate of the County Sheriff’s Department, the agency that administers Temporary Assistance to Needy Families (TANF) and other local service agencies were asked to tell women about the group. Advertisements also were placed in the newspaper and brochures were posted on community bulletin boards. The first W.O.W. group was established within a half-way house for women in recovery from substance abuse and mental health issues and their children. The group began in April 2000 and included many of the women who helped to create the program. There are now five W.O.W. groups meeting in various service and community settings, and plans are underway to start a sixth group at a local jail. The groups range in size and organizers believe that any size can work, but that five to six women per group is ideal. Triad’s Consumer Advisory Board and its Consumer Coordinator provide on-going oversight and management of the W.O.W. groups. ~ Women who participate in W.O.W. believe it plays a critical role in their recovery by giving them the help and hope they need to grow and heal. ~ HOW WISDOM OF WOMEN WORKS W.O.W. groups meet weekly for two hours. There are no fees or dues. Members receive a “starter kit” when they begin that includes: preamble and guidelines, 12 Steps (adapted from A.A.), Bill of Rights (Adult Children of Alcoholics), Just for Today (AlAnon), the Twelve Promises (A.A.), inspirational writings, and various exercises. Groups are on-going and women may join at any time. Women do not have to be affiliated with the Triad project to participate. Each meeting is divided into two sections. The first section (approximately 50 minutes) includes an opening and an educational program. The Chairperson (a group member) opens the meeting by reading the W.O.W. preamble, guidelines, and 12 Steps. The group is provided with topics they may wish to address during the educational portion of the meeting; members are free to select other topics. A brief presentation is usually made, and readings and exercises may be provided followed by a group discussion. Topics may include: safety; serenity; sense of self; support system; and solving life’s problems. After a short break, the second section (approximately 60 minutes) begins with a meditation followed by group sharing and a closing. A member leads the group in a brief meditation— a poetry reading, listening or dancing to music, or reading one of the daily devotionals from A.A., N.A., AlAnon, or another source. During the “sharing your week” portion of the meeting, members spend a few minutes talking about their week and the issues they have been working on. Members are allowed to “pass” if they wish. The meeting closes with the Chairperson reading the 12 Steps, “Just for Today” or other reading, and a statement of affirmation and support for the group and its members. The “We” version of the Serenity Prayer is recited by all. Because the group is self-directed, the nature and content of W.O.W. groups varies. For example, groups with women in early stages of recovery focus on sobriety, basic issues of trust, and how to interact with each other in meaningful ways. Groups whose members are further along in their recovery are more likely to discuss more painful issues and experiences. Each group is facilitated by a C/S/R woman who manages the group’s operation (e.g., opening and closing the meeting space, providing written materials, etc.). Facilitators often lead the educational component of the meeting until other members feel comfortable doing so. Although she is compensated for her time, the facilitator is a member of the group and participates accordingly. A “SPIRITUAL GLUE” AMONG WOMEN W.O.W. has been very well received among C/S/R women and providers alike. The on-going success of five separate groups suggests W.O.W. is providing something women like, want, and need. Several local service agencies have requested that groups be started within their programs. W.O.W. seems to be successfully filling a gap in the traditional service delivery system. Sharon Slavin, Triad’s Consumer Coordinator, believes the special healing ingredient of W.O.W. is a “spiritual glue” formed among women in the group. She believes the group’s sense of belonging and fellowship can not be gained through traditional, professionally-run services, or through peer-run services not designed to meet the unique needs of women who have substance abuse, mental health, and trauma histories. Slavin observes, “Sometimes it is easier to hear things from a peer.” ~ “By allowing women to come together, talk, and support each other, the groups create situations where women can really feel and believe there is a reason to recover.” – Arthur Cox, Sr., Principal Team Leader ~ Anita Cape, the consultant who helped to create W.O.W. and actively participated during its first year-anda- half, sees the group as a way for women to “begin to heal by regaining a voice for ourselves. As women share their experience, strength, and hope with others they gain a sense of self...as I listen to your experiences, strengths, and hopes, I gain added insights for my own personal growth and healing. This kind of sharing is empowering to women and helps a person to feel as if life has meaning and purpose beyond just trying to survive every day.” W.O.W. is now viewed as an essential component of the Triad intervention. Margo Fleisher-Bond, the Triad Project Director, believes that the groups have “filled a critical gap in service delivery and expanded the continuum of care in meaningful ways for women.” She believes the groups’ flexibility and openness have been extremely helpful and appealing to women and notes that, “the groups are able to support women wherever they are in the recovery process.” Arthur J. Cox, Sr., Principal Team Leader for Triad, believes that W.O.W. plays a critical role in women’s recovery. “By allowing women to come together, talk, and support each other, the groups create situations where women can really feel and believe there is a reason to recover.” Karen, a longtime member of one of the W.O.W. groups, finds it a place to “share and work on stuff that I couldn’t talk about in A.A.” For her, the group was not like going to a counselor. She found it very helpful to be with other women “who know what it’s like to be where I am.” Equally important is the opportunity to develop healthy friendships with others and to “experience feelings of being cared for by others.” She concludes, “when you know others care, that helps you heal.” LESSONS LEARNED The Triad Women’s Project has learned much through the process of creating and sponsoring W.O.W. groups that is applicable to others interested in such efforts. Primary lessons include: Making C/S/R involvement a reality is critical and sometimes challenging. The idea, creation, and on-going operation of W.O.W. comes directly from C/S/R women. This is the essence of self-help. Professionals need to respect the wishes and opinions of C/S/Rs, and allow them to create and manage their own efforts. A facilitator is key to the group’s success. The facilitator must be able to handle a range of organizational tasks, and should be well-versed in trauma and how it relates to mental health and substance abuse. This person must be a C/S/R with significant time in recovery. Experience in leadership development is also helpful to support members’ progress toward leading group activities. Facilitators require on-going support and training. W.O.W. facilitators have a complex role to play. They are responsible for managing the group, but they are full participants as well. They serve as role models to other members, but have their own vulnerabilities and challenges. Providing on-going support and training helps facilitators navigate these multiple roles. Instead of formal supervision, this support can be provided by other facilitators. The community must be educated about the project. Triad found that service providers, agencies, and the general public needed to be educated to help build support for W.O.W. For example, some traditional peer support group sponsors did not understand W.O.W. and as a result discouraged women from participating since they did not see it as central for recovery from addiction. The location of the group is important. The location must feel safe for women who are trauma survivors. The outside of the building should be well-lighted and secure; the indoor space should be private (e.g., not in a room with large windows or one to which others have access during the meeting). It is helpful if the location is convenient and accessible since many women do not have their own transportation. Careful consideration should be given to whether the group should be housed within a service program/ agency or not, and if so, what type of program/agency. Location of the first W.O.W. group within a half-way house made involvement difficult because most of the women in the program were already very busy working and participating in a full array of required treatment activities. This location also discouraged involvement of women who were not residents in the program. Getting women to participate can be difficult. Triad’s efforts to encourage service agencies to refer women to W.O.W. proved challenging and time-consuming. They found written material about the program to be extremely helpful. Triad also learned that once relationships are established with agencies, they need to be actively maintained. ~ “When you know others care, that helps you heal.” Karen, W.O.W. group member Learn from others, but stay true to your focus. Using the work of established peer support models as a spring-board was extremely helpful in launching W.O.W., but the program’s success is anchored in the critical adaptations that were made to ensure sensitivity to the needs of women with mental health, substance abuse, and trauma histories, and to facilitate W.O.W.’s central goal of empowerment. For more information on W.O.W., please contact: Sharon L. Slavin, Consumer Coordinator, Triad Women’s Project 100 W. College Drive Avon Park, Florida 33825 863-452-3858 (phone) 863-452-3862 (fax) triad@strato.net ~ When women first learn about W.O.W., many express an understandable hesitation to participate. Personal contact with current W.O.W. members and word-ofmouth helps to overcome this initial barrier. RESOURCES: W.O.W. Starter Kit Available from: Sharon L. Slavin, Consumer Coordinator, Triad Women’s Project, 100 W. College Drive, Avon Park, Florida 33825 863-452-3858 (phone) 863-452-3862 (fax) triad@strato.net Consumer/Survivor-Operated Self-Help Programs: A Technical Report Center for Mental Health Services, SAMHSA Available from the Knowledge Exchange Network: P.O. Box 42490 Washington, D.C. 20015 800-789-2647 (phone) ken@mentalhealth.samhsa.gov mentalhealth.samhsa.gov/ Starting a Self-Help/Advocacy Group: Technical Assistance Guide National Mental Health Consumers’ Self-Help Clearinghouse 1211 Chestnut Street, Suite 1207 Philadelphia, PA 19107 800-553-4539 (phone) 215-636-6312 (fax) info@mhselfhelp.org www.mhselfhelp.org The Self-Help Movement: Review of the Past Decade of Research Linda Farris Kurtz In Social Work with Groups, Vol. 13(3), 1990, The Haworth Press, Inc. Helping Characteristics of Self-Help and Support Groups: Their Contribution to Participants’ Subjective Well-Being Miriam Schiff and David Bargal In Small Group Research, Vol. 31, No. 3, June 2000, 275-304, Sage Publications. Alcoholics Anonymous Grand Central Station, P.O. Box 459 New York, NY 10163 www.alcholic-anonymous.org Check web-site for local telephone numbers Al-Anon Family Group Headquarters, Inc. 1600 Corporate Landing Parkway Virginia Beach, VA 23454 757-563-1600 (phone) 757-563-1655 (fax) wso@al-anon.org www.al-anon.org Co-Dependents Anonymous Fellowship Service Office, P.O. Box 33577, Phoenix, AZ 85067 602-277-7991 (phone) Info@codependents.org www.codependents.org Emotions Anonymous P.O. Box 4245 St. Paul, MN 55104-0245 651-647-9712 (phone) 651-647-1593 (fax) Info@emotionsanonymous.org www.emotionsanonymous.org Family Trauma Survivor’s Network Anita Cape FamilyPTSDnet@aol.com http://familyptsdnet.tripod.com Narcotics Anonymous P.O. Box 9999, Van Nuys, CA 91409 818-773-9999 (phone) 818-700-0700 (fax) www.na.org On-Line Recovery – 12-Step Groups www.onlinerecovery.org Survivors of Incest Anonymous World Service Office, P.O. Box 190 Benson, MD 21018 410-893-3322 (phone) www.siawso.org Women for Sobriety P.O. Box 618 Quakerstown, PA 19851 215-536-8026 (phone) 215-538-9026 (fax) www.womenforsobriety.org This publication was made possible by grant number 5 UD1 TI11404 from the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment, Center for Mental Health Services, and Center for Substance Abuse Prevention. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, Center for Mental Health Services, and Center for Substance Abuse Prevention. The Women, Co-Occurring Disorders and Violence Study is generating knowledge on the development of integrated services approaches for women with co-occurring substance abuse and mental health disorders who also have histories of physical and/or sexual abuse. This Innovation From The Site was written by Dawn Jahn Moses of The Better Homes Fund, and is a product of the Women, Co-Occurring Disorders and Violence Coordinating Center which is operated by Policy Research Associates, in partnership with The Better Homes Fund and the Cecil G. Sheps Center for Health Services Research. The Coordinating Center provides technical assistance to program sites, conducts cross-site process and outcome evaluations, and develops a range of application products from the study sites. The Women, Co-Occurring Disorders and Violence Study is funded by the Substance Abuse and Mental Health Services Administration’s three centers – The Center for Substance Abuse Treatment, The Center for Mental Health Services, and The Center for Substance Abuse Prevention. For more information on this Initiative, please contact Policy Research Associates, 345 Delaware Avenue Delmar, NY, 12054, 518-439-7415, e-mail: wvcc.prainc.com, web: www.prainc.com/wcdvs