SHIELDS

Narrative Description of Program

SHIELDS was formed in 1987 in response to the high incidence of infants born at Martin Luther King Hospital in South Central Los Angeles who were prenatally exposed to drugs. Utilizing a fiscal intermediary, SHIELDS implemented three programs to target the special needs of these infants. In 1991, SHIELDS incorporated as a State of California private, non-profit organization with a focus on family based services addressing issues inherent to this community. Since that time, SHIELDS has rapidly grown into a nationally recognized and respected human service agency.

SHIELDS for Families is a comprehensive, community based, non-profit organization serving families residing in South Central Los Angeles who are affected by substance abuse, child abuse/neglect, and homelessness, and as well as physical and/or emotional abuse issues within the family unit. SHIELDS' primary goals are to: (1) increase the number of drug/alcohol abusing women seeking prenatal care and treatment; (2) promote family reunification and support families remaining intact in the community; (3) strengthen families through the provision of comprehensive, collaborative services; (4) improve the general well being of families through comprehensive health programs and preventive social services; (5) promote self-sufficiency and economic independence.

Current Programs and Activities

SHIELDS has fourteen programs that serve the South Central community with a static capacity of 500 families enrolled in services which include drug treatment, family preservation, case management, and high risk youth programs. All 14 programs provide a continuum of comprehensive services that address the needs of the entire family. SHIELDS for Families drug treatment programs view substance abuse as a chronic, relapsing disorder that is biopsychosocial in nature. Treatment services provided include: individual, group, and family counseling; sexual abuse counseling; parenting and parent/child interaction classes; women's issues - topic groups; life skills training class; drug and alcohol education; relapse prevention; anger management; nutrition, HIV/AlDS, health education; basic education class which prepares clients for the G.E.D test; case management services to teach clients skills to access community services; transportation; and child care.

Population Served

SHIELDS for Families provides services to women, children, and families who reside in South Central Los Angeles inclusive of the Watts/Willowbrook and Compton communities. According to available population estimates, this area has the largest percentage of minorities in the county with an ethnic breakdown of approximately 16.5% Caucasian, 65% Latino, 33% African American, 1.8% Asian American/Pacific Islander and 2.1% other. This area also has the highest rates of unemployment and overcrowded housing units and a median income of $14,944.

Accomplishments

Since inception in 1987, SHIELDS for Families has grown rapidly into a nationally recognized and respected human service agency. It's programs have been used as models for other substance abuse treatment programs including HUD and the Center for Substance Abuse Treatment. Programmatically, SHIELDS continues to have high retention rates in all fourteen programs and 80% of the graduating clients who are actively involved in our Aftercare/Alumni component remain drug-free. Approximately 10% of the staff are graduates of SHIELDS. Since inception the number of infants born drug exposed at Martin Luther King Hospital has been drastically reduced from 1200 annually in 1989 to 250 annually in 1995.

The increased dilemma faced by chemically dependent women and their prenatally exposed children was the catalyst for the development and growth of SHIELDS for Families Project, Inc. Seven of the SHIELDS 14 programs effectively address the needs of this special population. Since its inception in 1987, SHIELDS has made a dramatic impact in the reduction of drug exposed infants, including high risk youth, has been instrumental in strengthening and stabilizing family units through case management and home-based services, has provided education and intervention to assist families in the prevention of child abuse and neglect, and has serviced over 3,000 families affected by substance abuse in the South Central Los Angeles area with an 80% success rate.

Program Description

SHIELDS for Families Project, Inc. primary goals are to:

1. Decrease the incidence of substance abuse, child abuse and neglect in South Central/Compton;
2. Promote family reunification and support families remaining intact in the community;
3. Strengthen families through the provision of comprehensive, collaborative services;
4. Improve the general well being of families through comprehensive health programs and preventive social services.

SHIELDS has demonstrated effectiveness in addressing these issues holistically by providing culturally sensitive, community based and client specific drug treatment programs which address substance abuse as a chronic, relapsing disorder; biopsychosocial in nature. In 1991, SHIELDS incorporated as a State of California private, non-profit organization focusing on family based services and addressing inherent issues. SHIELDS has grown into a nationally recognized and respected human services agency. Program staff is comprised of multidisciplinary personnel who are culturally sensitive to multiproblem families in need of rehabilitation. SHIELDS was formed in 1987 in response to the high incidence of drug exposed infants born at Martin Luther King Hospital in South Central Los Angeles. SHIELD'S funding sources come from a variety of Federal, State, and County grants which minimizes and/or waivers costs to the client.

Program begun in 1987, Incorporated in 1991

87% identify cocaine as their primary drug of choice
11% identify alcohol

94% of the clientele is African American
4% Latinas
2% Caucasian

17 Programs in the South Central Los Angeles area

Service include:

• Intake and Assessment
• Drug/alcohol Treatment
• Case Management services
• High Risk Youth Programs
• Child Development Services
• Family Counseling
• Individual Counseling
• Group Counseling
• Parenting
• Domestic Violence Groups
• Life Skills Education
• HIV/AIDS Education
• Relapse Prevention
• Anger Management
• Health and Nutrition Education
• Basic Education Class/G.E.D. Preparation
• Vocational Training

3505 Families served since inception

500 Families currently enrolled in services

80% Retention Rate in all services

193 Graduates from Treatment services

10% of the graduates are employed with SHIELDS

Current Grants Received:

SHIELDS was recently awarded the C. Everett Koop Award for the most cost effective community based program nationwide. In addition to being recognized for outstanding treatment services, SHIELDS also is the recent recipient of numerous grants from every government level. The following are the most recent grants awarded:

• Office of Child Abuse Prevention - Juvenile Prevention
• Center for Disease Control - Project Begin - Child Care
• Los Angeles Homeless Service Authority - Substance Abuse, Case Management
• Housing and Urban Development and Los Angeles Homeless Service Authority - Transitional Housing
• City of Los Angeles Housing Authority - Drug Elimination
• Substance Abuse and Mental Health Services Administration Child Development Assessment Project - Exodus

Narrative Description of Evaluation Results

SHIELDS for Families is a private, non-profit organization comprised of fifteen therapeutic, nonresidential programs, providing comprehensive, collaborative and community based services to families in South Central Los Angeles. Targeted are women with alcohol and drug abuse problems, drug affected newborns, high risk siblings, and affected family members.

The SHIELDS catchment area is defined as South Central Los Angeles, which includes Compton. Martin Luther King Hospital, the primary provider of medical services in the area, reports a significant decrease in the number of drug exposed infants born. In 1989, 1,200 infants were born drug exposed, while in 1994 that number dropped to 300. Infants born to drug abusing mothers are at an increased risk of prenatal morbidity and mortality; reporting numerous long-term medical, developmental and behavioral problems beyond the newborn period. SHIELDS has an Intake and Assessment Specialist on site to complete assessments and give referrals to all women who give birth to drug exposed infants. 55% of these women are referred to one of fifteen SHIELDS programs. To date SHIELDS' Intake and Assessment component has admitted 3505 women for services. Approximately 4 out of 10 have successfully completed the program. 90% of the present client population's age range is 25-35 years. 87% of the clients identify cocaine as their primary drug of choice, 11% identify alcohol, with the remaining 2% reflecting all other substances. The incidence of HIV/AIDS is less than 2%, STD'S are approximately 30%, and there is a 36% incidence of mental illness. 94% of the clientele is African American, with Latinas representing 4%, and Caucasian 2%.

Cost Analysis

Non-Participant Costs

The economic costs of perinatal substance abuse are overwhelming: "Unchecked, its exponential growth threatens costs that will drain health care and social service budgets. . . "(Senator Pete Wilson, introducing the Child Abuse During Pregnancy Prevention Act, Congressional Record, 8-l-89) . In California, hospital expenses are estimated at $178 million annually for the additional costs related to drug exposed infants. The majority of this funding is coming from the Medi-cal and California Children's Services programs (Legislative Analyst,1989).

The costs continue to rise throughout the child's life as services are required from other social service providers. Developmental programs estimate an increase of $70,000 annually for a drug exposed infant. Child protective services estimates an annual costs of $24,000. The educational system estimates an additional $6,900 annually for special programs and services for each drug exposed child. If the costs for severe developmental impairment due to drug exposure are not counted, the annual cost for each child like the ones served by the SHIELDS for Families Project is $30,900. Over 15 years this will amount to nearly half a million dollars ($463,500). If addicts are treated and future children of participants are not born drug exposed as a result of treatment the savings to the State start at $463,500 per child and could range as high as $1 million depending on the medical and developmental complications.

Participant Costs

The average cost per participant in the SHIELDS for Families Project is approximately $1,500. Combined with the cots for drug treatment ranging from $5,000 per treatment slot for specialized perinatal outpatient treatment to $12,000 per slot for residential or intensive day treatment for hard core addicts. This constitutes one time only annual costs ranging from $6,500 to $13,500.

• Shields for Families Project, Inc

The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.

Evaluation

The "Shields for Families Project, Inc.", Los Angeles, targets women with alcohol, drug and child abuse problems, drug-affected newborns, high risk siblings and affected family members. Martin Luther King Hospital delivered 1,200 drug exposed infants, and reduced the number to 300 by 1994. Interventions with 40 substance abusing women showed post-natal care costs of $400,000 v. $1,954,000 for non-intervention. Applied to 1,000 similar women surveyed, the cost would have been $10 million v $48 million.

This project addresses a very difficult health problem, targets its audience well, is recognized for quality, and has outcome and cost data. There is strong community integration, the program is comprehensive, and it integrates a physiologic approach with psycho-social interventions. The program goals relating to promoting family reunification are innovative and commendable. The program addresses a critical need of the community. The program has resulted in a significant decrease in the number of drug-exposed infants in South Central LA from 1,200 in 1989 to 300 in 1994 for an estimated savings of over one million dollars. It is a clearly set program with clear objectives. The program is culturally competent. There are excellent cost-benefit analyses published and presented.

This is an expensive intervention and long-term results are lacking. The focus is narrow. There are no controls and some missing data. There are many opportunities for good future studies. Methodology design is unclear. There is no discussion of participants versus non-participants. Dropout rate is relatively high with 47 noncompliant out of 85 and a participation rate of only 40 percent.