Culturally integrated maternal and infant mental health residential treatment in hawaii: pregnant and postpartum women (PPW) of native hawaiian descent with substance use disorders (SUD) continue to…

Culturally integrated maternal and infant mental health residential treatment in hawaii: pregnant and postpartum women (PPW) of native hawaiian descent with substance use disorders (SUD) continue to be over-represented in hawaii's gender responsive residential treatment and recovery support programs. The salvation army family treatment services (safts on oahu) and malama family recovery center (mfrc on maui) are part of a network of providers that will use a culturally integrated approach to address maternal and infant mental health issues leading to the goal of multi-generational change and long-term recovery. PPW specific SUD programs represent only 14 percent of the total number of SUD providers in hawaii. Along with the challenge of limited treatment options for women that allows children to reside and receive treatment with their mothers, PPW experience factors that make accessing help difficult such as CO-occurring mental health disorders, lack of safe housing, violence and trauma, and involvement with the legal system. Based on a 2016 hawaii legislative task force report, 75% of the state's incarcerated women were mothers and many had substance use disorders. These PPW obstacles heighten their risks for pregnancy complications, separation or loss of custody of children and for the child, they have an increase vulnerability to be born premature and experience subsequent infant mental health challenges, placing them at risk for developing suds later in life. The mutigenerational cycle continues. Population to be served: based on gpra data collected from 2017 to 2022, safts and mfrc have found that 51% of admissions are native hawaiian with caucasian and asian following next at 15% and 11% respectively. Sixty-five percent of PPW reported a CO-occurring mental health diagnosis, 36% were on probation or parole and 50% had child welfare services involvement upon admission to treatment. The majority of women were between the ages of 25-34 (62%). All women entering treatment meet the federal poverty guidelines. They reported extensive trauma, multigenerational alcohol and substance use and mental health disorders in the family. They are often heavily involved with multiple legal and behavioral health systems which make navigation of such systems overwhelming. Women entering treatment identify as heterosexual, homosexual and bisexual, but they are all biological mothers. Methods: PPW and their families / partners will receive a full continuum of recovery care including but not limited to outreach / case management, screening and assessment, family centered treatment planning, maternal and infant mental health interventions, gender responsive residential / IOP / OP treatment and supportive housing for women and their children. Evidence-based services will be provided in a culturally responsive manner with adaptations to best meet the native hawaiian population and island culture. Interventions that focus on managing ptsd symptoms while also creating a space for mother / infant bonding reduces substance use cravings and risk of continuing perinatal substance use (sanjuan, P.M., EG.AL., 2020). Expected results: by the end of the grant, safts and mfrc intend to serve 205 PPW, 240 children, 56 partners / fathers and 125 additional family members. Further goals include PPW reducing alcohol, illegal substances and tobacco use; increasing the number of safe and healthy pregnancies and deliveries; improving the mental health of mothers; improving the mental health and resilience of infants and children; increasing baseline parenting skills and self-efficacy; and increasing the health of supportive relationships and engagement in family and culturally based intervention services. A final goal based on what safts and mfrc are continuing to learn through the current samhsa PPW grant is to increase the ability to use data evaluat