SISTERS

The SISTERS program provides much-needed peer-oriented outreach/support and case management to ensure the coordination of drug treatment, prenatal, postpartum, pediatric, and family support services for pregnant and postpartum women--particularly African-American or Hispanic women who are on public assistance, are mandated to treatment, report having experienced more than four violent traumas (e.g., sexual assault, death of a loved one), and have smoked crack cocaine during their last pregnancy. "SISTERS," are women in recovery who have experienced many years of addiction, abusive relationships, life on the streets, birth of infants with positive toxicology, and removal of their child by protective services. These women have turned their lives around by getting help through available social service agencies, and now function as program counselors for the SISTERS Program. The SISTERS cultivate a trusting relationship with clients while serving as peer counselors. Program strategies include coordinated services such as relapse prevention counseling, acupuncture detoxification, prenatal care, housing, transportation, child care, nutrition, assistance with child welfare, Medicaid, and sponsorship for attendance at Narcotics Anonymous meetings.

The goal of the SISTERS program is to provide outreach/support and case management to pregnant and postpartum women who are on public assistance, are mandated to treatment, report having experienced more than four violent traumas and have smoked crack cocaine during their last pregnancy.

The evaluation was designed to demonstrate the effectiveness of peer counseling through 1) availability and use of services, 2) substance abuse abstinence and psychosocial functioning, and 3) birth outcomes and parenting attitudes. Major program outcomes include the following:

-Urine samples of SISTERS clients became significantly cleaner over a 1-year period compared with the control group.
-Change scores for SISTERS clients significantly improved for measures of depression and self-efficacy in contrast to the non-SISTERS group.
-SISTERS' clients, when compared with non-SISTERS clients, experienced a significant decrease in parental stress and rigidity of parenting style.
-SISTERS' clients used more services than non-SISTERS clients.
-SISTERS' clients were more likely to use warm expressions of empathy to describe their counselors.
-78% of SISTERS clients gave birth to babies weighing at least 2,500 grams. More active clients had significantly heavier babies than less active clients.
-Eighty percent of infants born to SISTERS clients were toxicologically clean at birth.
-SISTERS' clients continually regained custody of children; at intake 60% had no children living at home, but at the end of the project this portion decreased to 18%. All SISTERS clients who obtained custody of their babies kept them for the duration of the program.