Raquel Barros' new approach is rehabilitating young, low-income, chemically dependent mothers, an underserved population in Brazil. By allowing mothers to keep their children with them during treatment, Raquel is changing the model of drug rehabilitation into a more effective treatment which prepares women to be responsible parents, helps them find employment, and creates mechanisms for involving community members in the rehabilitation process, thus facilitating the women's reentry into society.
The New Idea
Existing therapeutic communities don't serve young, chemically dependent mothers, who are a key target population in Brazil where increasing numbers of minors are using drugs and having children. Treating chemically dependent women in isolation from their children addresses only their dependency issues, yet their ability to reenter society depends on their capacity to form healthy relationships and hold a job. Raquel is taking advantage of a window of opportunity: her clients' average age is eighteen, which implies that they have been using drugs for a relatively short time. Since the client's child is usually less than one year old, combining drug treatment with parenting skills prevents any incipient child abuse.A mother allowed to keep her child with her during treatment is already one step closer to full recovery. Therapy, job training, education, and co-responsibility all make up parts of Raquel's holistic model, which prevents relapses and offers a genuine exit from a life clouded by chemical dependency. Capable, chemical-free mothers are more likely to raise healthy children, thus ending the vicious cycle of psycho-social problems that are often passed from one generation to the next.
In Brazil today the fields of drug prevention and drug rehabilitation are growing due to a combination of need and awareness. Programs aimed at women, however, are not equipped to deal with the fact that many women are not only clients but also parents. At the Quixote Rehabilitation Clinic in São Paulo, for example, 30 percent of female clients are mothers.Low-income women in at-risk situations are coping with drug use, homelessness, prostitution, the absence of close relatives, sexual abuse, and unemployment. They are vulnerable to exploitation. All of these factors increase dramatically with the addition of a child. Children born to women already in danger themselves are very likely to have psycho-social problems.
Another vulnerable factor is age. Children born to minors account for 30 percent of births in Brazil. According to the Ministry of Health, seven hundred thousand young women between ten and nineteen years old gave birth in 1998. Thirty-two thousand of these mothers were under fourteen. Statistics from the Ministry of Education's Drug Use Research Project indicate that 18 percent of female students use illegal drugs on a daily basis.
Women in Brazil are also at an economic disadvantage. The average Brazilian woman earns forty-three cents to the average Brazilian man's dollar. It is common for women in drug rehabilitation programs to hand their children over to a close relative during treatment or, in some cases, to put them in foster homes or give them up for adoption. However, the guilt and trauma resulting from giving up a child, especially when it is the client's "fault," often delay rehabilitation. When they leave the program, even women who are chemically free do not necessarily have the financial stability to reclaim their children.
Children also suffer from being forcibly separated from their mother, even when her skills and income may not be adequate to care for them. Recent studies on causes of violence in Brazil have identified high instances of drug use, violence, and incarceration among abandoned and convicted youth interned for extended periods by the Federal Department for the Welfare of Minors (FEBEM). The detrimental effects of separating mother and child are further magnified by the long-term damage this can cause to the child's development.
During her apprenticeship in Italy, Raquel found that the rules of most drug treatment institutions do not work well for mothers. For example, strict schedules are impossible to follow when a child has a fever or needs to be breast-fed. At the same time, therapeutic techniques that serve single women fall short of helping mothers who need to keep their children's futures in mind as well as their own. Learning to parent well is important to decreasing a client's stress level and keeping her drug free. A woman who is deprived of her child's presence during therapy faces different challenges when reunited with her child. She needs new skills that traditional clinics do not know how to provide.
Raquel has designed a therapeutic method that works for chemically dependent mothers and has integrated this methodology into a community-based approach for promoting social reintegration based on the needs of the local community. After testing her program in Italy, she adapted her methodology to a younger, poorer, target population in Brazil.
Located on a small farm in Sorocaba in the middle of São Paulo State, Lua Nova (New Moon) houses from twenty to thirty mothers and their children for stays of six months to a year. Clients are referred by agencies in São Paulo and other states in Brazil. As a strategy for creating acceptance and sustainability for the program, Raquel has introduced a second element of community development focused on volunteer mobilization and community involvement in the Lua Nova Center.
Once a woman has passed through detoxification, her ongoing rehabilitation takes place alongside her child. Raquel takes advantage of the fact that her clients are between fifteen and twenty years old, meaning that they are not hardened addicts. Most of her clients are recovering from crack addiction and usually have only one child who is from three to twelve-months-old. Raquel teaches parenting skills to break any incipient cycles of violence.Adapting to the reality of her Brazilian clients means starting from scratch: teaching basic hygiene, housekeeping, breastfeeding, and nutrition. While these basic skills are being learned, Raquel facilitates the bonding between mother and child which will help to keep the mother off drugs. Raquel's center provides psychological treatment, child care, medical treatment (donated by a community health center), and job training. A team of appropriately trained psychologists and educators leads individual and group therapy sessions and counsels the mothers to prepare them for reentering society and finding work.
Co-responsibility is a key element in Raquel's program. Starting with the basics, clients take turns cooking, cleaning, and maintaining the center. This prepares them to take care of their own houses after leaving the program and makes them active participants in the therapeutic process.During their stay, clients learn job skills in addition to parenting techniques. Their goal is to break away from chemical dependence without substituting a dependence on support groups. An income generating cooperative program is in the works. After a period of six to twelve months in a residential treatment center, the client and staff draw up a "life project": a plan for reentering society and finding housing and a job. Since most of her clients do not have support from close relatives, it is imperative that they map out a way to keep themselves and their child safe, fed, and chemically free. Raquel has further developed her strategy for social reinsertion by incorporating activities that serve members of the surrounding community. She aims to increase Lua Nova's visibility, gain resources (human, financial, and technical), and improve the integration and socialization of adolescent mothers and their children. Raquel purchased the Lua Nova farm with the help of the Italian clinic where she was an intern and then secured the Sorocaba municipal government's support for the project.
Raquel developed a mutually beneficial community involvement strategy for Lua Nova that began with the creation of a community day care center. This center relies on community volunteers who need day care, gives the adolescent mothers positive examples for child care, provides them and their children with an opportunity to socialize with community members, and increases the overall support and visibility of the drug treatment and social integration program.Lua Nova's first component is called "Community" and teaches the mothers parenting techniques, professional skills, and basic human rights. The second component, "Surroundings," brings in groups of low-income women from the neighborhood to offer courses on citizenship and community development. The Surroundings program promotes understanding of and solidarity for the Lua Nova program, as well as developing alternatives for participants to improve their own community. The third program, "Lua Nova Cooperative," provides training and income alternatives for mixed groups of adolescent mothers and community members. The co-op produces and markets clothing to increase personal income for its members and resources for the Lua Nova Center. The final component is the "Training Center." Volunteers from the community and professional staff are developing a network of institutions that can provide assistance to clients and the Lua Nova institution as a whole.
Raquel's next step is to create a halfway house to offer an environment of increased independence for young women who complete the rehabilitation and training program.Raquel has developed partnerships with government institutions and businesses to strengthen and expand the program. After the project gained initial acceptance from the Sorocaba municipal government, its social assistance board asked Lua Nova to teach its municipal staff how to apply Lua Nova's methodology to its upcoming social assistance projects. Raquel is also negotiating agreements for support from São Paulo State's Secretary for Social Assistance, and is presenting Lua Nova's work to judges and FEBEM employees to influence public policies on rehabilitation and reintegration of adolescent mothers with a history of drug use. Raquel has secured in-kind donations from Brazilian businesses to underwrite the pharmacy expenses and provide the center with furniture, supplies, and volunteers. Raquel has also created a resource mobilization program, Friends of Lua Nova, that links local businesses, the community, and larger companies to the program through financial contributions, volunteering, and in-kind donations. One result has been a developing partnership with a leading cellular phone company whose employees provide donations and other services to Lua Nova. Negotiating partnerships with local businesses helps win support for her program and reduces prejudice from residents concerned about having a drug treatment center in their community.Raquel has increased her team of volunteers from three to fourteen in the last year, including both community members and university students to help her core team accomplish its goals.
Raquel's expansion strategy has two aspects. First, she will train professionals in her methodology. These professionals will carry the idea to other residential and outpatient treatment programs. Second, she will launch more centers like the one in Sorocaba as soon as she has consolidated the pilot. Serving the "whole" woman and helping her break through the diverse and interrelated barriers which have kept her marginalized are the goals of Raquel's center. This start-to-finish operation examines all of the mitigating factors keeping individual clients from leading productive lives and offers effective strategies for problem solving and teaching appropriate skills.
When Raquel was ten she started a school in her home for neighborhood children. Raquel's grandmother was an enormous influence on her upbringing, taking her along on weekly trips to distribute bread and blankets in nearby low-income neighborhoods. Raquel's academic training focused on traditional and alternative methods for counseling and treating people with chemical dependencies. After graduating, Raquel launched a nonprofit clinic called SEFAP and was invited to become the coordinator of a new alternative clinic, where she designed social programs for people with chemical dependencies. At the same time, she traveled throughout São Paulo's public school system as a representative of the Ministry of Education, working with teachers to implement student drug prevention programs.Seeking further education and new techniques, Raquel attended a seminar by a leading Italian psychologist who offered her an internship in his clinic in Venice. There, she proposed a new project: a separate house for mothers and their children. Out of thirty-two clients, twenty-six exited the program healthy and working, and only six failed to complete their treatment. Based on this unusual success rate, Raquel returned to Brazil to implement her program in her native country.