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AIA Change Agents: Families First

This post is part of an on-going series called AIA Change Agents where we get to know each of the direct service programs funded by the Children’s Bureau under the AIA Act. In this segment, we chatted with Jennifer Lewis, Project Director of Families First in San Diego, CA.

Lewis1. Tell us a little about Families First.

University of California, San Diego (UCSD) Mother-Child-Adolescent HIV Program is home to our new Families First Program. Our program seeks to reduce the risk of child abandonment and neglect through early identification and implementation of a countywide integrated intervention designed to treat substance abuse and mental illness in HIV positive parents and develop and support their role as active, engaged parents. The project coordinates integrated medical and mental health, family-based early substance abuse prevention, early intervention, child and family mental health counseling, and home-based parenting skills training. The services are provided to HIV positive, substance using women who are of childbearing age and/or pregnant; perinatally exposed (HIV and dangerous drug) infants and young children; and their biological families, including older siblings throughout San Diego County. Services are client-centered, flexible, responsive, and focus on the women and her family, not just her illness.

2. Can you tell us a bit about your staffing model?  

Our clinicians have the training, expertise and support to help reduce stigma and discrimination and to provide high-quality, safe and compassionate care to HIV women. The staff understands the cultural/social context of issues affecting sexuality, sexual health, confidentiality, HIV disclosure and partner notification. Our program hires friendly, warm, dependable, long-term staff that share similar life experiences and cultures and are able to relate well with positive women.

A multi-disciplinary team provides the interventions. Primary HIV medical care providers, psychiatrists, substance abuse counselors, mental health clinicians, case managers and parenting educators collaborate to address the family system.  Board certified psychiatrists specialize in maternal mental health.  The mental health/substance abuse specialists hold master’s degrees in social work and a CA license. As members of the multidisciplinary team, they have the primary responsibility of providing mental health assessments and services to families and provide leadership, coaching and consultation to other team members regarding mental health issues. Individual, family and group counseling services all utilize evidence-based treatment approaches. The parent-child specialists hold master’s degrees in social work and are responsible for building relationships with, and providing support to, families. They identify service needs and provide evidence-based, home-based parent training/support. Masters level social work case managers assist clients in coordinating services with community agencies and serve as role models for appropriate parent-child interactions.

3. Tell us about your clientele.  Is there a particular family that sticks out in your mind?

The one particular client that sticks out in our minds is one who has had great success because she has optimized the resources available to her through Families First.

This client is a single mother of 2 adult children and a 3-year-old child on the autistic spectrum. The mother was diagnosed with HIV a few years ago and has lived a life of perpetuated abuse and trauma. The abuse from her father, to this day, torments her immensely. She reports that due to her abuse and need to escape the effects of trauma, she began using drugs. Her goal upon entering the program was to “become a better mother and stop the cycle of abuse for her young 3-year-old son” by addressing the physical and verbal abuse from her 22-year-old son who was living in the home.

This client first accepted parenting support. Through home visitation, our family therapist provided evidence-based parent-child interactive therapy (PCIT) to both children living with the client. Due to the client’s illiteracy and cognitive limitations, PCIT was tailored to meet the client’s needs. The therapist first engaged the mother though much rapport building, modeling relationship interactions, psycho-education, constant discussion of safety and trauma-informed service. This client has chosen to break the cycle of abuse and has committed to change through change agents and pillars of strength.  Her enhanced sense of empowerment also resulted in her engaging in HIV care and achieving a reduction in viral load.

4. What would you say is the most challenging aspect of the work you do? What about the most rewarding?

One of the most challenging aspects of the work is the complex lives and circumstances of the patients we serve.  The work is challenging, to be sure, and overwhelming at times.  The families we serve are faced not only with chronic illness, mental illness, trauma, poverty, substance abuse, challenged parenting, but with the additional isolating, and often shaming, layer of HIV stigma.  The families often live in the midst of chaos and crisis, with so many needs to be addressed, and so little sense of community and connectedness.  It’s challenging for clients to accomplish the goals they have set for themselves when they subsist in survival mode.  But, precisely because the challenges are so steep, the rewards are powerful.  Watching a mom develop a bond with her child, become physically healthy, achieve sobriety, connect with a mental health provider, and build a stable foundation for her family is profound.  In particular, the biggest reward is seeing a woman become empowered to change the future for herself and her family.

5. If Families First were to have a mascot, what would it be? 

We would say, possibly, an eagle.

Eagles fly to high places and Families First is a program that has reached new levels. An eagle is not afraid to fly high to get a better view of the field. With keen sight, it assesses the needs of all, and with determination, makes decisions that will increase potential and success. Just like eagles, the Families First program can also sustain its vision and is aware of new opportunities.

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