A Comprehensive Model to Serving Latino Families Affected By
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• • 7 C-! J I 7 • • • • • • • PROJECT • • MILAGRO • A Comprehensive Model to Serving • Latino Families Affected by • Substance Abuse and HIVIAIDS • Replication Manual • • Submitted to • u.s. Department ofHealth • and Human Services • Administration for • Children and Families, • Children's Bureau • • • • Contents • Introduction Appendices Purpose ofthis Replication Manual • Appendix A: Job descriptions for positions • Philosophical Framework 1. Family Support Worker Culturally Responsive Services 2. In-home Counselor • Family Centered Services 3. Therapist • Adopting Project Milago's Model: Checklist Appendix B: Evaluation instruments • Companents ofProject Milagro 1. Bienvenidos Intake Form Targeting Families Through Community Outreach 2. Parent/Caregiver Risk Factor Survey: I + Ii • Population Served 3. Child Risk Factor Survey: i +Ii • Point ofEntry and Assessments 4. CES-D Initial Visit 5. Short Acculturation Scale for Hispanics ISASH) • Home-based Services 6. Social Support • Field Safety 7. Medical Access Form [English and Spanish] Service Planning and Coordination 8. Family Assessment Form IFAF Safety scale) • Project Milagro's Expected Outcomes 9. Health Related Quality ofUfe Survey • 7O. Coping Survey [English andSpanish] Team Approach 17. Health Interview Survey for HIV/AIDS • StaffPatterns and Role Definitions 12. Substance Abuse Health Interview • Case Reviews andStaffSupervision 13. Changes in Home/Environment / Family Log Case Closing 14. Client Satisfaction Survey for AlA Family Programs • Five Stage Model ofPermanency Planning 15. Copyright Instruments • Stage 1: Assessing the Readiness ofthe Family 16. Informed Consent Farm for Treatment and Evaluation • Stage 2: Education on Permanency Planning Appendix C: Program Documents Stage 3: Identifying a Future Guardian • 1. In-home Visit Progress Report Stage 4: Securing the Plan 2. Case Plan • Stage 5: Aftercare Services Appendix D: Program Brochure • Building Bridges Through Community Partnerships Appendix E: Planning for the Future Care • Project Evoluation ofMy Children Workbook • Qualitative and Quantitative Data Collection Evaluation Methods and Procedures • Evaluation Design • Sample o 00•0•00000000000000•00•••0•000000 000 0 0 000 0000000000000000 000 • To obtain copies Authors We dedicate this replication manual of this publication Lourdes Carranza, M.s. to allpersons affected by substance • by mailplease contact: Martha Cristo, Ph.D. abuse and HIVIA/DS. Ofcourse, our • deepest gratitude and respect to the Bienvenidos • Funder families for sharing their stories and 316 West 2nd Street • This replication manual was made possible participating in the pragram. Further, 8th Floor by a grant from the U.S. Department of we thank the leadership ofBienvenidos, Los Angeles CA 90012 • Health and Human Services' Administration who consistently supported the 213 78S S906 • on Children, Youth, and Families. We development and implementation www.bienvenidos.org • appreciate the investment and interest of ofculturally sensitive and innovative Pat Campiglia and the Children's Bureau. made/so In addition, we thank all the • staffwho extended valuable support, • Contributors wisdom, and expertise to oureffort of • We thank the National Abandoned Infants promoting safety, permanence and well-being children affected by • Assistance Resource Center, School of Social of Work, University of California, at Berkeley for substance abuse and HIVIAIOS. • supporting the work of Project Milagro for • over 12 years. • • • • Introduction with Latinas and children. The project's comprehensive model 1 • developed effective strategies to address co-factors relevant Bienvenidos Children's Center implemented the Abandoned to HIV/AIDS within a cultural context. Additionally, service • Infants Assistance (AlA) Program, Project Milagro, from 1992 to mechanisms that successfully resulted in positive outcomes • 2008. Project Milagro chronicled relevant factors that improve were supported by the project's evaluation findings. • the safety, permanency and well being ofchildren living with The project's Substance Abuse women were primarily second • Latina mothers, primarily of Mexican origin, who are coping and third generation Mexican Americans with chronic with HIV/AIDS or Substance Abuse. Equally important, historical • alcohol and drug addictions. Most ofthe project's Latinas pathways to understanding the social and familial dynamics • were identified as "neglectful" parents, actively engaged in that impede positive outcomes among Latinas have been child welfare systems and had limited parenting knowledge. • clearly delineated by this longstanding AlA program. The Project Milagro developed a model that targeted substance • gaps in knowledge for providing program polices and service abusers with histories of prenatal drug/alcohol use; domestic • designs that target the complexities of needs for Latinas and violence victims; drug exposed infants; victims of child abuse; their children have led to an array of innovative AlA programs • sexual trauma; depression; and chronic relapses. Although that are perceptible in the interiors of poor and disenfranchised • the project's Latinas were faced with these challenges, the communities. In general. AlA programs have collectively worked program model was effective in reducing risks for child abuse • towards providing services to the"least ofthese'.' communities, and child abandonment. Further, strategies aimed at improving • families and children. Thus, these programs continue to mental health, coping skills and quality of life were significantly • contribute to improving our knowledge base by developing effective for this group. • strategies to meet the unique needs of HIV/AIDS and Substance Abuse families. • Purpose ofthis Replication Manual • Project Milagro provided comprehensive services to Mexican The primary purpose ofthis manual is to provide community and Mexican American mothers and their children residing in • based programs, policy decision makers and special entities the East and Southeast Los Angeles area who were identified • that focus on developing programs for Latinas and their as high-risk for abandoning their infants and young children children a guide to implementing the Project Milagro model, • due to HIV/AIDS or chronic substance abuse. The project's its' framework and the underlying factors that contributed • target service area has a large concentration of Latinas living to its effectiveness. The unique aspect ofthis model has • with HiV or AiDS and has been identified as a priority group by been attributed to the implementation ofculturally specific • the Los Angeles County HIV Prevention Plan (2008). Multiple services that recognizes the heterogeneity of Latinas. The co-factors have been attributed to the disparities of HIVIAIDS • Project Milagro model incorporated its history ofservices to among Latinas. More importantly, such co-factors continue to • provide a framework that illuminated the understanding ofthe add to the vulnerabilities of Latinas for newly diagnosed HIV mechanisms and pathways for successfully providing services • infections, liVing with AIDS and limited prevention strategies that address contextual factors (poverty, unemployment, low • for acquiring HIV. The incidence rates in the United States for wages) cultural sensitivity (Immigrants, acculturation, sex roles, • women living with AIDS and women at risk for HIV infection language barriers), regional applications (migration patterns, or transmission has led to re-examining emerging patterns of • urban environments) and community infiuences (disparities in the epidemiological nature of HIV/AIDS. Overall, the number of • serVices, discrimination, single head of households). Latinas diagnosed with HIV or AIDS has not only increased but • has exceeded case rates among women in general. One in seven This replication manual outlines the program's serVices, staffing • Latinas are living with HIV/AIDS compared to white female patterns, recruitment strategies, referral process, community • counterparts. Although HIV/AIDS among African American collaborations and the evaluation design, including the project's • women exceed rates for both Latina and white women, the instruments and assessment forms. The intent ofthis manual is • critical factors associated with reducing HIV infections and to guide communities working with and evaluating Latinas faced prOViding preventive services have not been fully addressed with multiple challenges and living with HIVIAIDS or Substance • when working with Latinas. Project Milagro provided services Abuse. Particularly, family based in home services are described • aimed at improving the quality of life among high-risk Latinas in the context of reducing the abandonment and abuse of • and their children. The model applied to these families emerged children, and increase permanency and positive well-being. • from acquiring knowledge ofHIVIAIDS trends and working • .1 • • _2_ The Philosophical Framework values: familismo (familisml-high value and regard for the family, view offamily as the primary unit of support and heip; of Project Milagro .,• Simpatia-a social script emphasizing a pleasant demeanor focused on reducing conflict and promoting agreement; and Over the course offour years, Project Milagro implemented • Personalismo-a personal attitude valuing warmth, friendliness, a model that was highly effective in promoting safety, and respect toward others, especially toward family and those permanence, and well-being of children