Fluent Essays

About 15 years ago, before evidence-based practice became a standard to which to aspire, a professor found an article describing a treatment program for substance-abusing African-American women that incorporated their children and aimed to preserve their families. The program was built around principles of African-centered theory. The professor thought the program appeared well designed and heartily urged students to study the article and possibly find ways to imitate the program ideas, if not the program itself. A few years later, the professor, having continued her education, especially in the area of research, searched for a follow-up on the program, perhaps reporting outcomes and evidence of effectiveness. No research evidence on the program appears in the scholarly journals. In fact, no evidence that the program continues to exist at this time has been found. The fact that what appeared to be a promising practice approach did not endure or have the opportunity to benefit from evaluation is unfortunate. Note: This week you will work as a class to create a plan for evaluating the rite of passage program described in the assigned article. Each member of the class will be assigned one step of the research process: Long Data collection instruments To prepare for this Discussion, read the Poitier et al. study and then revisit what you have learned about your assigned step of the research process. Consider what would be the most important information to share with your colleagues about that step. Together the class will create a research plan for evaluating the rite of passage program described in the assigned article. By Day 3 Post an explanation of your assigned step of the research process and how you would complete that step. A Rite of Passage Approach Designed to Preserve the Families of Substance-Abusing African American Women Vanesta L. Poitier, Makini Niliwaambieni, and Cyprian Lamar Rowe This article approaches the treatment of addicted African American women in ways drawn from traditional African culture. While the modern African American woman is clearly not the same as her continental African foremother, the reality of her life is still predicated on the basis of her culture and her material wealth or lack of it. The approach recommended here, a rite of passage, derives from the belief that the value orientations drawn from the African wisdom of the ages offers the best way to work with families to recover both sobriety and a powerful understanding and repossession of culture that will help to ensure not only sobriety but also ways of holding together and rebuilding the families of today and the future. Vanesta L. Poitier, M.S.W., LICSW, is Director, and Makini Niliwaambieni, A.A.S., is Rites of Passage Coordinator, Partnership for Family Preservation Program, Washington, DC. Cyprian Lamar Roive, Ph.D., is Assistant Dean for Student Services and Multicultural Affairs, School of Social Work, University of Maryland at Baltimore, Baltimore, MD. 0009-4021/97/010173-23 $3.00 © 1997 Child Welfare League of America 173 174 CHILD WELFARE • Vol. LXXVI, #1 • January-February Historically, drug treatment programs have been lessthan sensitive to women and to the cultural consider-ations that affect them, and women, as a whole, have seldom received adequate treatment. Although opportunities for women to receive treatment have recently begun to expand, in many cases, treatment for drug addiction alone is insufficient. For women to receive adequate care with sustainable results, it is critical that they and their children be involved in the recov- ery process. With the establishment in 1992 of the Women and Childrens Branch of the Center for Substance Abuse Treatment (CSAT), a federal agency, it became apparent that the family is the most powerful resource for the survival of its own mem- bers [Amen 1992]. To be effective, the treatment approach must explore un- charted waters: family preservation as a primary factor in the treatment of substance-abusing women. The inclusion of fam- ily members and the understanding of the familys cultural con- text, when taken together, can be major deterrents to the pro- tracted use of drugs. The withdrawal of destructive substances can reduce the negative forces that have the overall effect of disassembling the lives of women and their families. The rite of passage is an innovative approach to treatment for African American women and their children whose exist- ence has been marked by family dysfunction and substance abuse. It is designed to assist families recovering from addic- tion and addictive ways of living. It offers a balanced approach, rich in African culture and tradition, that empowers families to achieve the level of functioning necessary for sustenance of in- dividuals and the families that individuals make together. The aim is to make families self-sustaining. The rite of passage approach integrates four basic principles for a full human life, beyond mere existence: (1) Restraint, (2) Respect, (3) Responsibility, and (4) Reciprocity. If incorporated into an overall recovery program, these principles can inspire participants and their family members to make personal life changes and to grow mentally, spiritually, and physically healthy. Vanesta L. Poitier / Makini Niiiwaambieni / Cyprian Lamar Rowe 175 Since the family is the most powerful interpersonal resource for the survival of its members, effective treatment depends upon family preservation as a primary factor in the treatment process [Amen 1992]. This article expounds upon the thesis that an adequate prototype/model for the treatment of African Ameri- can drug-abusing women and their families must proceed from a knowledge base of both cultural and gender-specific treatment modalities, and offers such a model. Family and Culture Drug use/abuse attacks, at its core, the families of African Americans. Not only does drug abuse lead to a suspension of attention to the life-preserving mandates implicit in every cul- ture (those learned from history and the life-in-context of a liv- ing culture) but it also undercuts drastically a familys atten- tion to the rudiments of communal life that can preserve it as a unit. A number of studies [Mondanaro 1989; Chasnoff 1988; Nobels 1985] report that the quality of family life and familial relationships are the victims of the plague of drug addiction. According to Mondanaro [1989], the substance-abusing fam- ily is characterized by chaos, unpredictability, and inconsis- tency. She also states that children from drug-dependent fami- lies tend to learn to accept and expect the unexpected. Thus, one can deduce that children exposed to drug abuse and other self-abusing behaviors will themselves mimic what they see, thereby continuing the cycle of destruction. The obverse is also true: Positive role-modeling, mirroring [Comer & Poussaint 1976; Miller & Dollard 1941], empathic nurturing, parental interactions, and appropriate expectations [Bavoiek & Comstock 1985] are essential elements in the nur- turing and rearing of children and can lead to healthy, self- sufficient, and responsible adults. Supporting this belief is one of the core tenets of African philosophy: the individual does not exist alone but rather co- operatively and collectively [Mbiti 1969]. Thus, whatever 176 CHILD WELFARE • VoL LXXVI, #1 • January-February happens to the individual happens to the whole group, and whatever happens to the group has an impact on the individual [Mbiti 1969]. This core belief is stated in the adage: I am be- cause we are, therefore, I am. To treat addiction in the African American community, and especially among African American women with children, we must understand the spiritual context of African Ufe. Addiction is a pattern of behaviors that undermine the physical and psy- chosocial well-being of the primary addict. It also creates a cor- relative and respondent secondary addiction that seizes and cor- rupts the entire family unit, as well as a tertiary addiction that multiplies itself in all the interactions that the addict and her family members have with the world in which they live. We must, therefore, look at family in a much larger context. Family in the African American context does not necessar- ily carry a solely nuclear meaning; it may refer to whoever re- sides in the household as well as those who share an extended relationship within a given community. Family may include a number of fictive relatives—persons who are or become very close to a person or blood family and, to all intents and pur- poses, are viewed as family and treated as such even in essen- tial features of family life. Relationships within the nuclear and extended families are guided by ethical principles recognized by Sudarkasa [1980] and others in their research into African kinship groups, discussed below. Here it is important, however, to make the point that in the African context, the meaning of family follows a design that, when overlooked, undermines the attempt to treat addicted women who come from this community. Aphorisms such as It takes a village to raise a child and If relatives help each other, what evil can hurt them are not taken casually in the African context. They are indeed a con- stant reaffirmation of all belonging to all [Leslau & Leslau 1962]. Kuhn [1970] describes a natural family as an observed cluster of similar objects, sufficiently important and sufficiently dis- crete to command a generic name, that is, family. Comparatively, Vanesta L. Poitier / Makini Niliwaambieni / Cyprian Lamar Rowe 177 Akbar [1976] likens the African family to a spider web in that one cannot touch the least element of the web without causing a vibration of the whole. The separation and the mutual exclusion between the drug addict and the significant others in close proximity is indica- tive of the lack of understanding of the true meaning of key concepts like kinship and collectivity in African philosophy. Many drug treatment programs are based upon intervention strategies that continuously treat the addicted mother as a monad, a single, singular being whose disease and cure are lo- cated solely in the ability of the program to clean her up and refocus her energies on the elements of life that bring her least obtrusively to the attention of society, its mores, and its norms. This orientation to treatment is inadequate to the needs of any person dealt with outside of her or his culture. Its inadequacy and misplacement are dramatic when applied to persons whose cultural orientation and instrumentalities derive from the col- lective. Unfortunately, the intervention strategies of many drug treatment programs continue to compartmentalize interventions into separate boxes marked addict, family, society, and underlying spiritual values. These atomized notions are clearly not empowering for women coming from a cultural con- text in which strength, loyalty, oneness, and union are basic values. These women are apt to resist the sorts of notions that come out of the perspectives in which the African family is char- acterized as weak, disorganized, and vulnerable [Moynihan 1965; Frazier 1932]. Family is that entity in which the individual personality is nurtured and developed. It is the place where responsibility to the group is learned through observation and practice; where self-esteem/self-worth is developed; and where respect, re- straint and reciprocity are observed and learned. These quali- ties, in addition to reverence and humility before elders, are internalized through observation and practice. Family is the place where obedience is learned and group expectations of the 178 CHILD WELFARE • Vol. LXXVI, #1 • January-February individual are continually clarified as the individuals mission within the family and response to the family are made evident. Family is also that place where children learn important life skills, such as compromise, negotiation, styles of showing be- longing, and building intimacy. Family is that living organism in which are enshrined the vital teachings of the elders, whose wisdom and experience are the living endowment of the ages. Familial relationships within the extended family must, therefore, be understood and made a part of the healing pro- cess called recovery. It cannot be emphasized enough that it is not the individual alone who must recover. It is that total world, in which the individual addicted mother has lived out the pa- thologies of addiction, that must be brought into the recovery process. Culture is the way people are in the world. It brings together all things into what becomes for them reality. Amen [1992] defined culture as a set of ideas used to influence and change behaviors in people into refined social qualities necessary to bring about a harmonious, stable, and prosperous society. Hence, it is only with a firm grasp on the living, moving, and motivating power of African culture that the addicted mother and her family can be moved to choose sobriety and ultimately familial, communal health. It is to culture then that we should look for those healing elements that can be applied in the process of recovery for Afri- can American women and their families. These processes must be carried out in tandem and they must be animated and guided by a set of principles that are an age-old value articulation of African soul. Relationships within the extended family are guided by ethi- cal principles recognized by Sudarkasa [1980] and others in their research into African kin groups in indigenous African societ- ies. These principles are consistently identified from group to group and found among the seven principles of Maat^ [TShaka 1995]. They are principles of wholeness from ancient Kemet Vanesta L. Poitier / Makini Niliwaambieni / Cyprian Lamar Rowe 179 (Egypt) to which many African historians trace the roots of more contemporary African indigenous groups. These principles are, as noted earlier, restraint, respect, responsibility, and reciprocity. The traditional structure of African American families is obviously not what it was 40 years ago. Each decade within the past 40 years introduced some new challenge to the traditional family structure that persisted in some form through and since the Maafa^ period [Richards 1989]. The 1980s and the 1990s have witnessed such a change in African American families that what were traditionally consid- ered the familys wealth, that is, the children, are now too fre- quently given over to the force of public assistance, which val- ues neither the notion of family nor its need to endure as a self- sufficient, self-perpetuating articulation of African American humanity. We are witnessing the intergenerational transmission of antifamily values. We are witnessing two or more genera- tions of families addicted to illegal substances. And we are wit- nessing two or more generations of families who, as a result of these addictions, are unable to pass down cultural wisdom. We are witnessing families that are so dysfunctional that disrespect between parents and children, between children and children, between both and the many articulations of an invasive social structure, are the norm rather than the minuscule variant. The depth of dysfunction challenges, at its most profound level, the ability of significant numbers of African American people to pass on core culture or even to experience family in the manner ideally described above. It is balanced, perhaps, only by the powerful embodiments of African American values in culturally functional institutions in the community. The call of Sankofa, an Adinkra symbol and proverb from the Ashanti people of Ghana, West Africa, has been sounded loud and clear, and responded to by many among Africans from every walk of life in the diaspora. Sankofa is represented visu- ally as a bird who wisely uses its beak, back turned, and picks for the present what is best [seen] from ancient eyes, then steps 180 CHILD WELFARE • Vol. LXXVI, #1 • January-February forward, on ahead, to meet the future, undeterred. [Kayper- Mensah 1978]. Sankofa tells one that it is not taboo to go back and fetch what one forgot. It tells Africans in the diaspora to look to their traditions to correct challenges that face them today. This concept is applicable to the development of programs for women (and their families) who are recovering from substance-abuse. Prototype for Family Preservation Walker et al. [1991] state that parental drug abuse has led to a dramatic increase in the national foster care caseload in recent years. They also note that an unprecedented number of Afri- can American children are entering care. The essential intercon- nection between these conditions is inescapable. Experts in the fields of child welfare and substance abuse are clear that ser- vices in each of the areas are either unavailable, insufficiently brokered or uncoordinated [Walker et al. 1991]. The literature suggests that if relevant services and programs are not implemented comprehensively, family preservation and reunification goals will not be achieved as intended. It has also been suggested that family preservation programs are basically ineffective intervention strategies for treating families charac- terized by extreme poverty, single parenthood, low educational attainment, and mental health problems [Dore 1993]. Further- more, many of the reunification programs have been criticized for their inability to ensure the safety of children, leaving them vulnerable to abuse and neglect, and exposed to drugs and vio- lence. A number of authors have attempted to measure, in its to- tality, the influence of drug abuse on the quality of parent-child relationships. Some have offered prescriptions for change [Tay- lor 1991; Chasnoff 1988; Boykin et al. 1985; Edelman 1985]. Most often, they characterize these relationships as chaotic and lack- ing emotional warmth. The prescriptions applied, however, lack the characteristics of a reciprocal, interdependent, and evolv- Vanesta L. Poitier / Makini Niliwaambieni / Cyprian Lamar Rowe 181 ing relationship between parent, child, and other family mem- bers, among whom are included all those relatives (blood or fictive) who constitute the extended family support network. The prescriptions also fail, on the whole, to discern what could have been missing culturally so that, despite the best intentions of workers, destructive familial behaviors remain. The passage from destruction to self- and family reconstruc- tion, regeneration, and resurrection, can be summed up in the phrase familial recovery. Familial recovery can best occur for Af- rican Americans when the recovery process is firmly and fully grounded in an African perspective, integrating fully and mean- ingfully the traditions from the African past, and also taking into full account the challenges that African people in America have experienced and continue to experience. Program Design A rite is a formal, cultural, often religious, procedure/ceremony. It is placed at critical cultural junctures to mark passage, on the one hand, from one symbolic state to another, and, on the other hand, to grant power and permission for the new journey and responsibilities required of the person/s undergoing the rite. Five major rites of passage have been identified and ritualized in the traditional African setting: rites of birth, puberty, mar- riage/parenthood, eldership, and passage [Warfield-Coppock 1994]. In the Akan tradition, for example, the Outdooring cer- emony marks the first time a newborn is formally introduced to the village and given a name. From this point on he or she is formally part of the people. For our program, the rite of passage is preparation of the individual, within a collective framework, for the coming phases of life. In this context, collective means that children and other family members are included. This rite of passage approach re- sponds to the profound African belief that humans are fully themselves only as part of the people (that is to say, the vil- lage, the tribe, the nation) and to the profound realization that 182 CHILD WELFARE • Vol. LXXVI, #1 • January-February the essence of our existence as human beings is grounded in our connection to the Creator, the ancestors, the cosmos, one another within the construct of the family, and the community [Akoto 1994]. Some [1985] discusses the importance of the pu- berty rite among his people in Burkina Faso. Some had left his village at the age of four. Returning at the age of 20, he discov- ered that many of his family and friends would have little asso- ciation with him because he had not participated in the ritual that would have prepared him for manhood. The council of el- ders, however, permitted him at the age of 20 to participate in this rite. The continental African section of Haleys landmark work Roots [1976], is replete with examples of such rites in which Kunta Kinte participated among his Mandingo people in the Gambia. The family rite of passage approach encompasses and is designed for four phases: genesis, initiation, passage/transfor- mation, and Sande Society—with four ethical principles found within the extended family structure as enumerated above: re- straint, respect, responsibility, and reciprocity. The phases and principles are linked as follows: Genesis (Restraint), Initiation (Respect), Passage/Transformation (Responsibility), and Sande Society (Reciprocity). These phases and principles are interre- lated and overlapped. The overall objective of family preservation using the four principles can best be achieved in an environment that fosters and promotes communal living. The ideal environment consists of individual apartments equipped with kitchens, communal group and meeting rooms, a fully equipped child care center, recreational and exercise gym, a vocational training room, a medical/health area, and staff offices. The surroundings pro- mote positive social interactions between families and decrease the opportunity for isolation and functioning outside of the col- lective. Upon acceptance and admission to the program, each woman is required to complete a seven-day orientation process Vanesta L. Poitier / Makini Niliwaambieni / Cyprian Lamar Rowe 183 to acclimate her to her new surroundings, inform her of pro- gram expectations, and give her time to decide whether or not the program is for her. Phase One: Genesis The Genesis Phase is a four-month period during which the ethi- cal principle of restraint is the primary focus. When a substance- abusing woman is able to declare, I want to change my life. I cannot go on this way. I want to be a productive woman and mother!, she is ready to face the rigors of recovery. Each woman focuses on stabilizing herself in order to function, first, within her family; second, within the treatment center community; and, last, within the general community/society. The participant is required to begin the process of dealing with those forces that led to her substance abuse. Only then can she learn to live without abusive substances, and, only then, can she learn what restraint means to a female individual within a family and within the larger communities of which she is a part. According to Sudarkasa [1980], restraint means that a per- son cant do...her own thing. That is, the rights of any person must always be balanced against the requirements of the group. This message is different from the one expressed by a do-your- own-thing society. Because of this tension, the principle requires discussion, examples, and a willingness on the part of the par- ticipant to embrace the metamorphic process. Emphasis is placed on program requirements because group requirements and group standards must be adhered to by all members if they hope to meet their goals. This is true of all groups, be they familial, communal, or political. Parallels be- tween all these various group contexts are consistently and per- sistently underscored in this approach. In the case of family, adults must not only live up to stan- dards and meet goals, they must also establish both standards and goals. They must, by example, resocialize their children by 184 CHILD WELFARE • Vol. LXXVI, #1 • January-February living the reality that these standards and goals aim to struc- ture and preserve. These standards and goals are, at their most profound level, nonnegotiable since the perdurability of the family-and-group as family-and-group depends upon their ob- servance. If the participants former emphasis has been, Its my thing, I do what I want!, she may find that incorporating into her life principles of restraint and sacrifice for the good of the whole may be difficult. Hence, in the Genesis Phase there must be a focus on personal development within the context of group par- ticipation and group bonding. This is, after all, what happens in creatively functioning families. During Genesis, in addition to attitudinal transformation, emphasis is also placed on detoxification, regular exercise, and nutrition. Individual psychotherapy, and training in parenting skills, daily living skills, problem-solving skills, and schedule- maintenance are all part of the Genesis Phase, during which women are paired with another participant until they are ac- cepted into the Initiation Phase—the point at which they are reunited with their children. This process is approximately 120 days or four months in length. Shared living in the Genesis Phase fosters group bonding, sharing, and kinship building. Within the communal envi- ronment, each woman assumes a specific role. She also follows a strict daily schedule that eliminates idle time and increases productivity. Rising each weekday morning at 6:00 A.M. (8:00 A.M. on week- ends), the women participate in a guided group meditation from 6:30 A.M. to 7:00 A.M. After meditation, they return to their apart- ments, dress, prepare their own breakfasts, and clean up their living areas. Chores scheduled for community areas must be completed by 9:00 A.M., when group psychoeducational sessions begin. These extend to noon. Afternoon sessions begin at 1:00 P.M. and last until 5:00 P.M., when individual therapy sessions and dinner preparation be- Vanesta L. Poitier / Makini Niliwaambieni / Cyprian Lamar Rowe 185 gin. Evening psychoeducational sessions begin at 7:00 P.M. and end at 8:00 P.M. Lights go out at 10:00 P.M. weekdays and at mid- night on weekends. During the first two months of Genesis, the women are not directly involved with parenting considerations. Preparation, however, is continually being made for that time when the chil- dren will arrive. Until then (the second half of the Initiation Phase), arrangements are made for biweekly, supervised visits with the children, depending upon each womans progress dur- ing the phase. Biweekly case management meetings are held between each participant and the treatment staff to assist the participant with matters of personal development. At this time, progress is un- derscored and remaining challenges recognized. Group meetings with the women in this phase are held twice weekly to enable them to discuss their development as a collec- tive. These meetings are guided by the treatment staff, and to- gether with reports from both the psychoeducational groups and individual therapy sessions, help the staff and participants to assess each womans readiness for the next phase. Evaluation of readiness for movement to each subsequent phase is conducted by designated staff members and Phase IV women. Phase IV women constitute the Sande Society Council. The process of movement from phase to phase is in the tradi- tion of the secret societies found among many groups in Africa. The secrecy is expected to be maintained by each woman. If the secrecy is violated, the penalty/consequence is determined by the Sande Council. (Eor example, a woman found to have re- vealed information to a noninitiate may have to defer to a Sande Society sister by doing her laundry or cleaning her room/house for a period of time.) Concomitant with the movement of women through the Genesis Phase is the movement of children through their Gen- esis Phase. Children of Genesis Phase women meet weekly as a group to prepare for their transition into community living. 186 CHILD WELFARE • Vol. LXXVI, #1 • January-February Transition meeting topics include discussion of the mothers recovery, approximate dates for mother-child reunification, child-centered discussions wherein children are able to articu- late their personal trauma resulting from their mothers sub- stance-abusing behavior, and sharing of coping strategies and techniques. The children also undergo comprehensive devel- opmental assessments to determine their educational, social, psychological, and medical needs. Phase Two: Initiation The Initiation Phase is guided by the ethical principle of respect: respect for self, respect for family, respect for staff members, respect for rules, and respect for community. This phase, like Genesis, also lasts four months, with the continuation of a strict daily schedule, daily-living skills building, individual psycho- therapy, communal living, and collective responsibility for clean- liness. Central to this phase are the concepts of womanhood, sisterhood, and motherhood. Sessions are designed to increase the participants aware- ness of their personal developmental needs. Hence, continuing emphasis is placed on spiritual counseling, academic testing, and the building of parental skills. In this phase, a womans primary role as mother is rigorously studied in an effort to fos- ter the understanding that a womans needs and desires must be secondary to her childrens development and nurturance needs. The program strives to bring participants along the path of understanding that a childs development depends on the guidance, nurturance, and direction provided by a mother. The mother must provide clear, concise standards that are aimed at the commonweal, the welfare of the whole: the individual, the family, the extended family, and the community. The women are helped to identify and implement new meth- ods aimed at changing the trinity of the me-myself-I attitude dictated by addiction. Emphasis is placed on building problem- solving skills such as those required to work out daily living Vanesta L. Poitier / Makini Niliwaambieni / Cyprian Lamar Rowe 187 schedules for oneself and ones children. The collective living arrangements and community meetings all require honest, open interaction. This group interaction significantly advances the effort to change habitual attitudes. Attention is called to the ef- fectiveness of communication engaged in between participants, and among participants and staff members. Special attention is directed to the womens interactions with, and responses, to their children. What might be called the diminution of frenzy (the ten- dency to respond as if …