The themes captured women's motivations for attending New Choices, the ways in which participation in New Choices had changed their lives and their children's lives, and their perceptions about the quality of the program.
Motivation to participate in New Choices
Almost all of the women interviewed acknowledged that their children were the primary motivation to participate in New Choices. Many women with addiction issues lose custody of their children or do not have their children living with them. When asked about her reasons for attending New Choices, one woman said, "It was the point of staying clean from cocaine, getting my children back." Another participant remarked, "The biggest motivation is that I'm going to keep my kids and I'm going to keep my sanity. Those two good things and then I can just pretty much conquer the world."
Impact on women
All of the women interviewed noted the positive impact New Choices had had on their lives. These effects were consistently described as decreased substance use; enhanced mental, social and physical health; improved parenting skills and knowledge; increased opportunity for employment; and increased awareness of and access to other services in the community.
Substance use
Almost all women commented that coming to New Choices helped them to stop or decrease use of drugs and/or alcohol and to resist the urge to relapse. One woman remarked:
I'm a bit smarter now because when I see people who are walking around high on crack, I won't bullshit, I do itch for it especially when I get upset. It makes me smarter because I can see it now. Before I couldn't. I couldn't identify. Now I can. It's just a matter of staying at that point when I'm strong enough not to do it anymore.
Change in substance use was attributed, in part, to "self-discovery" and learning strategies to reduce use:
... substance abuse has been around my whole life. We have to try and have an understanding and to know why you're doing things that you're doing and maybe it gives you a chance to rethink it and maybe something else that would help to deal with the situation. Like you can cover it up but it's not going to solve your underlying problem. So like there's a lot of self-discovery, things that I really like.
Another individual commented:
Well, I don't think it's a problem that you can just solve, it's an ongoing thing, but it [New Choices] gives you much ... you're much better prepared to deal with it and you can understand yourself a lot better. So I think once you have those tools you have a much better chance of not falling into the same trap.
Hearing other women's stories in the addictions group sometimes served as a reminder of the impact of addiction:
Yeah, just go in and see what happens to people when they don't [stop] is reason enough to. You see the problems that it causes in people's lives ... So you can just see how damaging it can be if you let it get out of hand, that it can really be devastating to the family.
Listening to others also gave women encouragement and a sense of hope because "you see the other girls step-by-step improving their lives." One participant stated, "The one that's talking, going through the exact same thing. Seeing her put her life back together and achieve so much, yeah, it just gives you the willpower knowing that it can be done." Women valued the peer support they received in the addiction group:
Most of the girls like it when they're going to the group and they're going for the addiction group and they're sitting with a bunch of other women. They need the support of the other women, not just the counsellors. They want the support of other people. They want to see someone that's going through it, they want to see how they're advancing, they want to get that motivation to advance themselves as well.
And coming here on that Tuesday, it just made me realize hearing other people say to me that that wasn't healthy, that I had to change something. And when I told them I knew that I had to change something, they came out and said, "If you're sure you need to change something this is how you can get help." Other than that I would've gone home and just taken it, dealt with my day.
Mental, social and physical health
During the interviews, participants explained how New Choices had impacted positively on their health. One of the goals of the program is to empower individuals to make healthy choices, and many of the women commented on their increased sense of control: "And that's the main thing of becoming clean is getting control of your life, and I have control and that's all that matters to me. I control my future and my destiny." Another participant vividly described her sense of control as follows:
I used to have anxiety attacks, but I've worked through those by just convincing myself that nothing is going to overpower me, no drugs, no man, no nothing is going to overpower me but me. So only I can control me and my thoughts and my feelings. Me doesn't want to do those drugs anymore.
The validation and positive reinforcement women received through New Choices raised self-esteem: "It's almost embarrassing, I feel too important sometimes. They make you feel really good about yourself. That's good." Another woman remarked, "I don't feel like a low-life when I come in here and that's what I meant before is that they treat me like a real person in here. They don't treat me like, oh, you're a drug addict." The following comment illustrates the process of self-esteem enhancement experienced by some women:
They slowly build up your self-esteem. You could have a bad day, yeah. It's alright to have a bad day though, you know, as long as you're going on to the next day and you're not making the same mistake as you made the day before, and just follow through and reach that goal because you can reach it. And they reinforce the positive attitudes a lot and that's what you've got to keep. You've got to keep that positive attitude. It may slide to negative ... oh why bother, I'll just give up ... but no, they're there to bring it back up and make sure you keep that positive attitude. Because once you have that positive attitude you're going to go ahead and go through it.
New Choices also had a positive effect on women's confidence: "Yeah, like I know if I put my mind to it so I can pretty much do I want to do. If I can visualize the goal and stay focused." Another participant said:
When I first started going to, for the first couple of months when I went to New Choices my confidence was iffy at certain times, certain situations. But now I have no problem in my confidence, my self-esteem is just fine. I really don't care what anybody else thinks now. It's all about what I think. And yeah they've really helped and built that up. They really did. Because I was ... it wasn't so much my self-esteem when I went there but my confidence. But now I know I have the confidence. I know I can do it.
Other remarks conveyed the importance of increased confidence. For example, one woman noted:
I'm very confident now that when I go out, I go out with my friends if I go anywhere or do anything and these people are drinking around me, that it's ok, that I don't have to drink. I don't care what they say. I don't feel I have to drink, and shouldn't have to convince anybody else as long as I'm convinced myself.
In addition to improving emotional well being, New Choices provided opportunities for enhanced social health. Women commented favourably on the support they received through the program. For example, a participant stated:
Actually, most of the girls get along really, really good. I was actually surprised. I thought they were all going to be some evil women but no, they were really nice, they were really helpful, they listened great. They were always there to hand out their advice. They're always sharing their stories. All giving you the confidence ... oh yes, you can do it. Giving you positive reinforcement, "Oh don't worry about that, you can do it, you can do it." And keeping you on track as well, yeah. Their friendships were pretty good there.
Other women reported, "It's given me a place to come if I needed just to talk to somebody," "Well, I think it's been a positive influence in my life because you can meet with other people who have similar goals as yourself. They keep checking in with you," and "They're all there to support you. You can just speak your mind and they don't judge you for it because they've all been there and done it." The enhanced support decreased women's sense of isolation and loneliness:
It's good to know that I've got people that are willing to say, listen you're going through something right now and we're here to help you, you're not alone. And that's a big part of making any changes or even trying to get clean off of anything is you have that feeling of being alone, because whether it's a drug or a man or whatever, there's an attachment. I have a place now that I know if I fear that I'm going to break, I can call. I don't have to feel that anymore.
New Choices also contributed to enhanced physical health in that participants concurred that the program provided useful information on nutrition and highlighted its importance. Women commented, "They teach you how to do cooking or meal ideas, things like that" and "I liked the nutrition and I liked the budgeting. I found that to be probably the most practical information that I was getting." Another woman noted, "Nutrition is the key for me, it's definitely key for getting healthy myself so that I could overcome my addictions."
Parenting
Women who were interviewed agreed that they gained knowledge about parenting and learned new parenting skills. Some women were more resistant to the parenting program than others: "About the fact of the parenting thing, that's the one thing I had a problem with is people telling me how to be a parent ... and I don't believe in textbook parenting." However, most of the comments about the program were positive. One woman said:
Stuff that I'm getting now and I never knew about it. It's more so information on stuff like how to help counsel my kids during the divorce, how to help my son stay mentally healthy, but still disciplining him when he needs to know when he's done wrong but not crush him for what was done. Just, there's little things everywhere that I'm picking up on.
Participants talked about particular parenting strategies they had learned. For instance, one woman remarked:
Almost at the end of each day or even during the program we'll touch base and come up with new ideas on things that [child's name] needs help ... the sticker program for one. That's really helped him... Because he'll think about sticker and then he'll stop himself ... That's definitely something I want to try to carry on at home with all four kids, the sticker and different tactics.
New Choices also helped women understand their children better, as reflected in the following comment:
Well, in regards to me as well, it helps me understand [child's name] a little more because I realize that because at one point in time, just to give an example, at one point in time he was hitting everybody. He just hit them for no reason, especially little babies that weren't doing anything. So I was like horrified that he was doing such a thing. I didn't know if I spawned Satan's child or what was going on. And they taught me that, oh no, a lot of other kids I see now, a lot of other kids do that. Because now he's at it, at it, at it. I see other children doing the same thing. It helped me not compare is the wrong word, it helped me relate to other children really better than [child's name] because I saw the behaviours of other children.
Employment opportunities
Women in New Choices commented favourably on the employment component of the program. Employment was important to the women "because ... [it] gives back to a person because you're out there doing it for yourself. Like there's nothing more rewarding than your own pay cheque every week." Another participant reflected on the importance of pre-employment counselling as follows:
She was doing the employment group. She made us feel so good about ourselves. She gave us workbooks on self-esteem and employment, and reintegrating into society and everything. She took us to, it was like a second hand store, for clothes and she got us business suits. Oh, it was beautiful. We felt so good. ... And it was, it was a huge chunk of our recovery because isn't that like a huge thing is self-esteem. Yeah, I went back to work. It was great. Yeah, I felt ten feet off the ground.
However, women's readiness for employment varied and often was related to family circumstances, as suggested by this comment:
Like I'm not ready for employment, I have four kids. They're all babies. There's only one in school. So the employment thing would have helped in a couple of years, and she gave me a lot of stuff to help me for when I am ready so that was good, but otherwise it's not. I'm not ready to go look for a job. I mean my kids aren't even in day care.
Access to other services
Many participants reflected on their increased access to other services through involvement in New Choices. One woman reported that this enhanced access was one of the things that attracted her to New Choices:
I think that's what attracted me to New Choices was that you were not really, as a group you seemed to be able to reach out to a lot of other agencies as well. And I need that. I don't want to feel as though I'm just left alone on my own. Although I do these things independently, I can at least access them easier.
Another participant said:
They helped me with a lot of other services as well, like I was given an opportunity to speak to many different professionals from all different agencies and stuff like that, and psychiatrists. That was a good experience to be able to talk to him. And just provided me with a lot of different services here like CPR, you know.
Women identified a number of other services made accessible to them:
Before I went there I didn't know about the Women's Centre at the YWCA, now I do. I think that would have been helpful for me to find out about their program a lot earlier than I did. They did make me aware of it. And the car seat programs.
Counselling groups outside of here. Counselling groups for children who have witnessed abuse outside of here. Bedding services through the Social Assistance.
They helped with the women's shelter. When I left my husband they gave me all the one numbers that I needed to have and contacts at that point. ... They are extremely helpful and knowledgeable to get you what you need.
Impact on children
The women observed that New Choices had had a positive effect on their children's behaviour and development, including improvements in motor skills, social skills, and language skills. In discussing changes she had noted in her child's behaviour, one woman said, "Like before, well, yeah, it was a discipline because before he was having problems hitting everyone, and now he's totally out of that where he ... I don't have to get mad at him. He's just been so good." Another participant commented, "It's given [child's name] an opportunity to express his feelings in different ways to cope when he's angry. And to be around with other children who have been through similar things like he has."
When asked about how her child benefited from participation in the children's program, one woman reported, "His fine motor skills, definitely." Another participant remarked, "Oh I love it. I think it's great. I think it teaches a lot of kids motor skills which [child's name] was really lacking of." Comments on children's social skills development included the following: "Oh she's very social. Like before she would shy from people" and:
My kids enjoy it. They like the playtime. They like the people that are involved around them. They've learned how to share more being here because there's a lot of kids here. I think it's a growing experience for them as well.
Some women noticed improvements in their children's language and speech: "I think he can express himself more which is good" and "Like I said she uses her words a lot more now ... She's more expressive." Enhanced language and speech development was sometimes attributed to linkages with appropriate services:
If you need any help with your children such as my child had a speech problem and they had Early Words to come into the group and work with him and now Early Words works with him at the day care ... And it's something I wouldn't have considered doing ... And yeah it did help because without the information New Choices had given me he wouldn't be at the stage he's at right now with his speaking, into day care. All that was because of New Choices.
Quality of the program
Every woman who was interviewed commented that participating in New Choices had been a positive and meaningful experience. One participant remarked, "Well, it was a positive, like you said, it was a positive experience for me while I was here and I'm ready to move on now." Another woman said,
Yeah I really enjoyed the program and I would recommend it highly to anyone who happens to have some type of issues. And it doesn't even necessarily have to be Children's Aid, just if you want to take a step back and have a look at your life and reassess yourself and maybe take a step in a new direction, I would really recommend it.
Staff
Most respondents agreed that staff members in New Choices were very supportive. One woman described how she was assisted through a difficult period in her life:
I was so confused I didn't know what to do at the time. I came here and I talked with a counsellor and I talked with a couple of them, and they helped me. They helped me figure ... what I needed to do with myself, what I needed to do with my health. And I took it from there. I went home and packed my bags.
Women felt that staff respected them and their choices:
They acknowledge that. They don't try and change your mind. They respect where you are, that's what you want to do, and they work on that with you. They give you a different choice than AA. Just AA and one-on-one counselling. They give you a third choice.
Another comment was, "They've been very supportive of all of the choices and the decisions that I've made."
Although women generally felt supported, some participants were concerned about confidentiality in relation to reporting harm or the potential for harm to a child to child protection services. One women said, "I don't tell them [staff] too much about that. They'll call the Children's Aid and stuff like that." Another participant stated:
The one thing that I would probably say could be improved was the confidentiality between what people disclose and what the counsellors need to report to the Children's Aid. I feel if they report everything no one is going to be able to say what's really going on and then really they're not going to benefit from the program if they're afraid to open up and say what they're really thinking. So I think that could be kind of harmful.
Some women were not in agreement with the obligation to report, as suggested by the following comment:
Well, I was told that if anybody reports any drug or alcohol, you must report it to Children's Aid immediately and I don't think that's good because it's an addictions group, so if you think you want to have some you should be able to talk through it with somebody and maybe they can give you some support instead of being worried about saying, "What's really going on?" and have to deal with it on your own.
Program components
The comprehensive nature of the program was an important feature to clients:
The thing I like about New Choices is it doesn't just focus around the person who has the addiction, but you also focus around, ok, what's going on in your life to make you do this, how is your family reacting to this, do you have children, who's taking care of your children during this time. All of these things come up. And they also help them focus on dealing with your children because they're growing up with an addictive lifestyle. So they help you to deal with them and learn how to take care of them throughout this period.
One of the features of New Choices is the provision of bus tickets, food vouchers, and clothing. Women expressed appreciation for these items as follows: "Well, yeah, they also give you bus tickets and food vouchers. I find it helpful. If you're down and out and you need to buy the milk, you've got your food voucher, you can get a bag of milk" and "Yeah, donations, I found that very helpful. I got a lot of good clothes for the kids and myself. So it is resourceful, and I mean I bring things in myself for the donations program."
In spite of the generally positive comments about the addictions group, there were differing opinions about the group size and structure. Some women expressed preference for a smaller group of "three or four, then that leaves enough room for you to discuss things and get feedback, to have your space for validity because a lot of the time you need to be validated." It also was mentioned that women's different stages of recovery sometimes made it difficult to relate to and share with others: "...on the negative side, everybody has a different stage. There are some people who are just coming off the street and then there's somebody that's been clean for a year."
The women highly valued the children's program and described how their children enjoyed participating in it:
The first couple of times she was like not very sure of it [the children's group]. She didn't know and maybe some of the kids were a bit rough or whatever. But she got a good grip of it and went with it. Yeah, she loves it. She looks forward to group. She asks me almost every day, mommy, is today group day? "Not today, Tuesday." When's Tuesday? "Tuesday is coming." When?
Women remarked favourably on the staff's interaction with their children. One woman said:
I love the day care program. [Child's name] absolutely adores [staff member name] and all of them. It's great. They make the kids very comfortable. They play with them. They amuse them...Yeah she loves it.
Although women were positive in their comments about the impact of New Choices on their children's life, a few women mentioned that they would have liked more of a focus on education in the children's program. One participant said, "You've got to have some educational force in there somewhere, especially for the children getting older and getting ready to go to school and stuff. I think that would be a benefit."
Women who did not have custody of their children appreciated the additional opportunity for supervised visitation available through New Choices. The importance of this feature to one individual was expressed as follows:
Oh, if I didn't have this place to visit I think I'd go nuts because to see, like I can see my two older babies whenever I want but [child's name], I'd have to see her like only in that visitation for that and I can't stand it.
New Choices played a role in helping some women regain custody of their children. As one participant said:
The urine samples proof helped [getting children back] plus letters from New Choices. It's just simple stuff like that they help you with. Like the planning for your future. You know what's going to help you, what's really not going to help you, and I think that was like really important because if I didn't have my daughter I'd probably just have went back out.
"One stop shopping" model
Participants in New Choices liked the one-stop service the program provided, and it reportedly was meeting their multiple needs:
That's convenient, very convenient. You've got your drugs, you've got your alcohol addiction, you've got your parenting, you've got your employment. You've got everything wrapped up all in one and saves you from going from one place for one thing and then going to another place for another thing. It's more time convenient. You go there you deal with all your problems all that one day ... You've got it all right there.
You're involved with your kids as well as taking care of your addiction problem. Like your children, it's the only place I know where you can bring your children. Like you can in the AA but you have to sit there with your child.
Some women, however, were dissatisfied with the location of New Choices. As reported by one participant:
I wish they had a more convenient location.
It's kind of far out to take one bus and then transfer onto another bus. You're looking at a half hour with kids on the bus. One girl with four kids, I felt sorry for her dragging all them kids down there. Yeah, they need a more convenient, maybe downtown location, where all the buses meet so if any of the girls are coming from anywhere they're all meeting at the same place without having to transfer and drag buggies and drag kids.
Another woman commented on the importance of location especially for women with addictions:
And when you're dealing with addiction and you're dealing with children and you're dealing with life and you're trying to cope, you throw some screwed up bus schedule that you have to take this bus to this place and this bus to this place and then get off and walk two blocks and walk up one, I mean you're literally screwed. ... I'm making myself nuts. I'm going to go use just because I'm coming here. It's stressful.