Safely Advocating Families Engaged in Recovery (SAFER)
Safely Advocating for Families Engaged in Recovery (SAFER) is a statewide effort involving multiple state and local agencies and initiatives addressing the continuum of care for persons who have a substance use, mental health, or co-occurring disorder and are pregnant or parenting, or are wanting to become pregnant. SAFER aims to expand timely access to family centered treatment through policies, practices, and processes intended to improve parent-child interactions, child and parent well-being, and reduce potential adverse childhood experiences (ACEs) along with the likelihood of, or ongoing involvement with, child welfare and/or legal systems. SAFER nurtures hope while providing the tools for families to lead their recovery journey and offers a holistic approach to family centered care.
SAFER Framework
- Identifying the Points of Intervention
- Establishing Goals
The SAFER framework focuses on 5 points of intervention:
Pre-Pregnancy - Promote Awareness of effects of prenatal substance abuse.
Prenatal - Screen pregnant women for substance use and the need for further assessment. Initiate enhanced prenatal services, including treatment services.
Birth - Screen neborns for substance exposure; screen or test mother when indicated.
Postnatal/Neonatal - Ensure infant and mother's medical needs are met; ensure Plan of Safe Care is developed for both infant, mother, and caregiver/family.
Childhood - Identify and respond to the needs of the infant/preschooler/child/adolescent and their family.
Oklahoma's SAFER framework uses the established points of intervention to establish goals at each stage.
Pre-Pregnancy - Create an intentional parenting framework by:
- Creating referral pathways between SUD providers, the Take Control Initiative and LARC.
- Creating communications materials on STAR clinic preconception counseling.
- Creating process to educate women and men prior to becoming pregnant of the potential risks of SUD and pregnancy and identify nontraditional places to distrivute materials.
Prenatal - Expand opportunities for women and access treatment during pregnancy by:
- Developing policies and procedures for automatic referral to Early Head Start.
- Training workforce including DHS and Court Systems.
- Implementing universal SUD screening in each trimester of pregnancy and in non-traditional settings (via tablet or CHESS app).
- Creating public education campaign and non-traditional pathways for SUD information and referrals (ex. TANF, WIC, other DHS programs).
- Expanding prenatal POSC by replicating programs such as the SAFER Program, STAR clinic, Beyond Families.
Birth - Develop hospital-based system for identification of IPSE and cross-system linkage to care coordination by:
- Creating a bifurcated pathway (notification vs. CPS report) for moms on MOUD and in recovery (partial).
- Developing statewide protocol for identification, assessment and reporting of IPSE.
- Expanding OMNO (Oklahoma Mothers Affected by Opioids) AIM bundle implementation statewide.
- Developing policies and process for SUD providers, hospitals and DHS to review prenatal POSC or devlop a POSC at the hospital.
- Expanding programs that enhance parent/child attachment and bonding.
- Expand Eat, Sleep, Console protocols to hospitals statewide.
Postnatal/Neonatal - Develop and augment family-centered supports for the fourth trimestyer by:
- Reviewing and revising current statute on infant affected by substance use to expand POSC beyond NAS and FASD.
- Creating a pathway for community-held POSC for families with no abuse/neglect concerns.
- Establishing cross-systems database.
- Creating a state-wide communication and training plan.
- Creating a framework for monitoring POSC.
- Aligning efforts with the State Maternal Health Innovation Program (SMHIP).
Childhood - Ensure families have access to the right supports at the right time by:
- Creating a clear protocol and referral process for home visiting for IPSE calibrated to risk.
- Reviewing and expanding early intervention/home visiting in rural areas.
- Developing policies and procedures for referring to Head Start.
Substance Use Disorder Treatment
Women with Children Residential Services - Oklahoma Women with Children Residential Services is a targeted gender-responsive treatment service designed to empower pregnant and parenting individuals on their recovery journey to receive treatment for substance use disorder (SUD) and mental health treatment. In these facilities, located throughout the state, children under the age of 12 can accompany their parent during their recovery journey.
Women with Children Outpatient Services - Oklahoma Women with Children Outpatient Services is a targeted gender-responsive treatment service designed to empower pregnant and parenting individuals seeking substance use disorder (SUD) and mental health treatment. Pregnant and parenting individuals will be welcomed into a nurturing environment to heal, recover, and establish strong parenting and family bonds. Research indicates that long-term recovery is best achieved when relationships are at the forefront of treatment. Through a family-centered approach to care, individuals and families will receive specialized care to ensure safety, increase permanency, and build pathways to long-term resilience. Evidence-based practices are used to engage, motivate, and create relationships with all family members in mind, including infants, children, fathers, and other identified supports.
Pregnant and parenting individuals will be welcomed into a nurturing environment to heal, recover, and establish strong parenting and family bonds. Through a family-centered approach to treatment, pregnant and parenting individuals can receive any necessary support and treatment while their children can thrive in a safe environment to increase overall safety, permanency, and well-being. Evidence-based practices are utilized to engage, motivate, and foster relationships with all family members in mind, including infants, children, fathers, and other identified supports.
Medications for Opioid Use Disorder - Medications for Opioid Use Disorder (MOUD) services which includes Office Based Opioid Treatment (OBOT) and Opioid Treatment Providers (OTP)/methadone clinics are provided statewide to all individuals and their families across the lifespan affected by opioid and/or stimulant use disorder. Research shows that MOUD, combined with counseling and behavioral therapy, has remarkable impacts on treating substance use disorders and supporting long-term recovery. These programs also have specific outreach for vulnerable populations such as adolescents, pre and post-natal individuals, Veterans and individuals who have served in the military and their families, Native Americans, and individuals soon to discharge from jail or prisons with opioid use disorders (OUDs) at risk for relapse.
Substance Use Treatment and Recovery (STAR) Prenatal Clinic
The STAR (Substance use Treatment and Recovery) Prenatal Clinic provides pregnancy care that is tailored to the needs of pregnant individuals with a history of substance use and the unique challenges they face in receiving prenatal care. As a patient of the STAR clinic, one will receive specialized medical care, as well as access to a case manager, social worker, peer counselors, and group education sessions in order to support a healthy pregnancy.
Family Care Plans (FCP)
Providing Family Care Plans (FCPs) to pregnant, postpartum, and parenting people is a vital component of Oklahoma’s SAFER Project, which seeks to increase support to pre-pregnancy, pregnant, and parenting individuals with a substance use disorder (SUD) by strengthening the continuum of care, improving access to services, building community support, and destigmatizing treatment through multi-systemic partnerships and collaboration at the state and local levels.
Family Care Plans help facilitate several of the state’s goals related to the pre-pregnancy, prenatal, birth, and postnatal points of intervention. It is part of a conscious, multi-system collaborative effort to move services and supports for individuals and families affected by parental substance use upstream in hopes of decreasing or preventing family separation and the ongoing trauma it creates, thereby lessening the burden on Oklahoma’s family-serving systems and our future generations.
Family Treatment Court (FTC)
Family Treatment Court (FTC) was created to address the poor outcomes of traditional reunification with caregivers who struggle with substance use issues and have had their child(ren) placed in custody of Oklahoma’s Department of Human Services (DHS).
Strengthening Families & Celebrating Families
Celebrating Families! (CF!) is an evidence-based program that is an intergenerational, family skills building curriculum designed to support and maintain recovery from substance use and addiction; improve the health and well-being of children and family members; and increase family reunification. The program strengthens family life and is comprehensive, developmentally appropriate, and relevant for diverse cultures and includes all family members.
Celebrating Families! helps participants break the rules of a chemically dependent family: "Don't Talk, Don't Feel, Don't Trust." CF! teaches about the disease of chemical dependency, that it is a brain disease, its impact on families, and facts about alcohol, tobacco, and prescription & illegal drug use. The session structures include a family meal, breaking into age-appropriate groups to learn the curriculum, then re-joining as a family to practice the skills just learned, in a segment called, “Connecting with my Family.”
Celebrating Families! empowers participants by teaching healthy living skills such as:
- Anger Management
- Communication
- Expression of Feelings, Understanding defenses
- Boundaries
- Refusal skills
- Choosing safe and trustworthy friends
- Problem Solving: Steps in making decisions, dreams, and goal setting
- Identification of a safe person
- Meditation/Centering/Relaxation
Each session of Celebrating Families! is fully scripted, including role-plays, handouts, children's stories, and activity sheets. CF! integrates addiction recovery concepts in every session, so every family member is learning the same skills/concepts. CF! helps all family members learn:
- I did not CAUSE the disease
- I cannot CURE the disease
- I cannot CONTROL the disease
- I can help take CARE of myself one day at a time
CF! is a 16-week program that can be offered in a variety of settings. CF! is meant to run ONE age group at a time, instead of multiple age groups simultaneously. For more information on training opportunities for providers or implementing CF! at your organization, please contact sfpcfp@odmhsas.org. For more information on the CF! program for consumers, please visit https://nacoa.org/celebrating-families.
Strengthening Families (SF) is an evidence-based family skills training program found to significantly reduce problem behaviors, delinquency, and alcohol and drug use in children, and to improve social competencies and school performance. SF is effective because it was specifically crafted to increase Protective Factors and reduce the Risk Factors that lead to both substance abuse and youth depression.
Over nearly thirty years, SF 6-11 has been implemented in schools, drug treatment centers, family and youth service agencies, child protection and foster care agencies, community mental health centers, housing projects, homeless shelters, churches, and drug courts, family courts, juvenile courts, and prisons.
SF is a 14-week, evidence-based parenting skills, children’s social skills, and family life skills training program specifically designed for high-risk families. Parents and children participate in SFP, both separately and together. Group Leader Manuals contain a complete lesson for every session. Parents’ and children’s Handouts are also provided for every session. Each session structure includes a family meal.
SF empowers participants by teaching healthy living skills such as:
- Child’s Game or, for teens, Our Time, similar to therapeutic child play where the parent/caregiver allows the child to determine the play activity
- Complimenting the good
- Effective communication
- Family meetings
- Making family rules
- Positive discipline
- Group practice in problem solving and anger management skills
SF can be offered in a variety of settings. SF is meant to run MULTIPLE age groups simultaneously, instead of one parent’s group and one children’s group for each cycle. For more information on training opportunities for providers or implementing SF at your organization, please contact sfpcfp@odmhsas.org. For more information on the SF program for consumers, please visit https://strengtheningfamiliesprogram.org/.
