Michael was a natural leader; he was drawn to tribal politics at a young age, and by 26 he was elected as a tribal council member. However, his life spiraled downward a few years later when he became addicted to heroin, was sent to prison, and his children were removed from his care.

Upon release, Michael entered the Native American Connections residential substance use treatment center. He felt welcomed and accepted by the staff and appreciated the program’s connection to traditional healing practices. Eager to change, Michael completed treatment and identified personal goals, along with the steps needed to achieve those goals. He participated in culturally appropriate services, including Sweat Lodge, Talking Circles, and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), moved into transitional housing, and signed up for a series of workforce development classes. He was eventually hired at Native American Connections and has since worked his way up in the organization. Most importantly, Michael regained full custody of his children and today they live together in one of Native American Connections’ affordable housing communities.

Michael’s story is not unique. In fact, parental substance abuse is a key factor associated with children entering foster care. Federal data from 2016 found that approximately 35 percent of children in foster care, or more than 92,000 children, had been removed due to parental substance abuse. What is unique about this story, however, is that Michael was able to find a residential treatment center that helped him develop his life goals, tailored its services to his needs, and provided him with housing and employment so that he could be reunified with his children. As a result, he is now helping other parents struggling with substance abuse so that they can keep their families intact.

Native American Connections has continued to expand over the decades, and 10,000 men, women, and children each year now benefit from its programs. In addition to the Patina Wellness Center, the agency offers an array of services.

The approach

The Patina Wellness Center in Phoenix offers four units (two for women and two for men) that include 70 residential substance use treatment beds. The program provides special accommodations for parents (mothers or fathers) with young children so that they have their own two-bedroom space. Building parental capacities is a critical component at Patina Wellness Center, as well as a focus on the healing of the family unit. Parents are encouraged to bring their children, ages birth to five, with them to the residential treatment program, in part because the agency has found that parents who are with their children during recovery are more likely to complete treatment than those without. Child care is available on site and there are counselors who work directly with the parents to build parental capacities through coaching and mentoring.

Patina provides treatment for four priority populations: pregnant and post-partum women; IV drug users; parents with dependent children (including those in foster care); and Native Americans. Its highest priority population is pregnant, substance abusing women, for whom there is no waitlist to ensure they can enter treatment immediately.

The six-week program is designed to help clients overcome substance use; learn to communicate their feelings; identify healthy relationships; improve their focus on mind, body, and cultural traditions; and develop the social and technical skills needed for future employment. Each client is assigned a treatment team composed of a recovery coach, case manager, and a Master’s level clinician. The recovery coach has lived experience with the recovery process and can provide clients with daily guidance. The case manager coordinates care and discharge, including housing arrangements, and the clinician offers therapeutic counseling for clients and their families.

The essential elements

The Patina Wellness Center operates from a strong set of core values and beliefs:

Honoring cultural values

The Patina Wellness Center believes that healing from substance use cannot be separated from culture and spirituality. Native traditional healing practices and cultural enhancement activities are both core and complementary interventions in promoting wellness and long-term recovery. The program draws from a Native American cultural approach of mind, body, and spirit, and cultural components are woven into all program activities. The program invites participants to reclaim the values that may have been lost by earlier generations and validates existing knowledge and traditions. According to Dede Devine, President/CEO of Native American Connections, “The program is designed to connect clients with the values that help them identify who they are as a person.”

Two of the most powerful traditional healing practices offered to Patina clients are the Sweat Lodge and Talking Circles. Sweats are offered three times a week (twice for women, once for men) and are open to all residents of the Patina Wellness Center, as well as outside community members who would like to provide support. The Sweat Lodge is a sacred space where clients can ask for healing, forgiveness, and hope, and give thanks during their journey toward wellness and recovery. The Talking Circle provides self-empowerment and healing by giving participants an opportunity to speak their truth without interruption, criticism, or judgment.

Other Native American traditional healing practices central to the recovery process at Patina include drumming, art, singing, and storytelling. In addition to traditional healing practices, Patina provides nutritious meals and tai chi, yoga, and other fitness classes that enable clients to focus holistically on mind-body wellness. As Devine explains, Patina embodies a wellness model because “we know that relapse comes with recovery, so we concentrate on helping people find a healthy mind, body, and spirit so they can get through it.”

Using evidence-informed practices

In addition to the cultural healing practices, there are a range of evidence-based interventions used at Patina Wellness Center, including Cognitive Behavioral Therapy, Motivational Interviewing, Dialectical Behavior Therapy, Relapse Prevention Therapy, and Stages of Change. Depending on client needs, different approaches may be used. For example, for the clients who are mandated to treatment at Patina, staff use Motivational Interviewing to encourage them to engage and remain in the program.

Trauma-informed care is also a core element of the program. Many clients are dealing with their own histories of abuse and neglect, as well as intergenerational and historical trauma common to Native American men and women. According to Dwight Smith, case manager at Patina, “Clients come to us broken. They come with trauma and our goal is to help them realign with themselves—their true themselves, their families, and their community. What we teach is how to make that reconnection with their community.”

Creating a community of parents

Patina encourages parents to engage in treatment within the family unit. According to Jacqueline John, Patina’s clinical director, “Women with children have better outcomes here than those who are away from their children. Having their children at the site helps them focus on themselves and are a motivating force for recovery.”

Patina also helps clients learn how to parent, even those without children. “We are all part of this community and we are all responsible for each other’s children,” Devine explains. The program utilizes the Positive Indian Parenting curriculum, which empowers Native families to reclaim their right to their heritage to be positive parents and draws on the strengths of traditional Indian child-rearing practices using storytelling, cradleboards, harmony, lessons of nature, behavior management, and the use of praise.

Advancing housing stability and employment

One of the most significant challenges that parents in treatment face is dealing with housing and employment once they re-enter society. For those that successfully complete treatment, the stress of integrating back into their communities may trigger a relapse. Patina staff are acutely aware of this dynamic and have developed a robust step-down housing program, as well as internship programs and assistance with employment. For example, once women leave the program, they can move into Pendleton Court, a 12-bed program with an in-house “grandma,” a program graduate who has been living there for more than seven years. The housing developments are structured to promote community connectedness: Native American Connections and the architects designed the housing and treatment center as one community, with a vision of designing not merely a building but instead a space for people to feel a sense of well-being. “It’s one thing to build housing,” says Devine. “It’s another to build communities that are accessible to people in need.”

In addition to housing, program graduates have access to different pathways to employment. Native American Connections is deeply committed to investing in its clients and building a sense of hope and confidence, and as a result, approximately 25 percent of the workforce at Native American Connections are program graduates. Native American Connections provides clients with opportunities for job training and ongoing skill development, including an internship program and access to a range of entry-level jobs, which provide graduates with the experience and skills they need to become economically stable and move out into the community.

Building a Circle of Strength

Patina understands the importance of having a positive network of support once clients leave treatment and re-enter the community. Devine observes, “If someone has a person who cares about them and is part of the recovery process with them, they will do better.” However, many clients have disrupted relationships with family members, due to their addiction. For those fortunate enough to still have intact and supportive relationships, family members may not be familiar with the long journey of recovery. Circle of Strength was created to build those connections and raise awareness. Offered one weekend per month, it brings families together to promote family wellness while supporting family members in recovery. Through art and music, along with spiritual and cultural activities, family members learn how to set boundaries, improve communication and problem-solving techniques, and work toward common family goals so that they can be positive supports for their loved ones.

Collaborating for reunification

Approximately 20 percent of women who seek treatment at Patina are involved with state or tribal child welfare agencies, and most of their children are placed in foster care. To date, a small number enter into the residential treatment center with their children. However, Patina Wellness Center is working to increase the number of mothers that enter into residential treatment before they become involved with child protective services, and before their children are removed from their care.

For those mothers with children in foster care, Patina case managers work with the Arizona Department of Child Safety (DCS) to host family visitation on site and, upon reunification, to place children with their parent at the Patina Wellness Center. The clinical team provides support to parents so that they are prepared for the transition and able to employ positive parenting techniques once they reunify. Patina also holds collaborative Adult Recovery Team meetings every two weeks, which typically include the family’s DCS caseworker and function as team brainstorming sessions to determine the best ways to work together to support the parent. While Patina does not make recommendations regarding reunification, case managers do share information about parenting skill development and accomplishments.

Is it working?

While Patina does not currently track child welfare outcomes, the agency has a substance use treatment completion rate of approximately 92 percent, and a recent grant found that 67 percent of approximately 100 pregnant or parenting women were still in recovery and had not used substances six months post-treatment, a figure that increased to 75 percent at 12 months post-treatment.