At A Glance Long-term residential treatment center with gender-specific services for female substance abusers, ages 13 to 17 years; capacity, 16 girls; funded by Rhode Island Department of Health, supplemented by fundraising and sliding-scale fees

Caritas House, founded in 1971 by Susan D. Wallace to serve adolescent female substance abusers, is the oldest gender-specific residential drug treatment facility in the country. It is housed in a residential neighborhood. Wallace opened Corkery House, to serve young male substance abusers, in Richmond, Rhode Island, in 1994.

Although Caritas House targets girls who are seriously abusing alcohol and other drugs, the program views the whole person in the dynamic context of total life circumstances. The underlying psychosocial model looks at the girl in terms of self and her relationship to family and the larger community. The program philosophy rewards hard work, commitment, and attainment of manageable goals, and fosters the development of social-competence skills.

Onsite staff are females (except for one male administrator), and are predominantly Caucasian. New staff are provided with a program overview, then receive six weeks of individualized on-the-job training, with special attention to gender-specific issues. Ongoing training is provided in weekly meetings. Staff positions include an executive director, assistant director, therapists, counselors, and a quality-assurance manager.

Most of the girls at Caritas House are Caucasian; about 20 percent are African American. Girls are typically referred by the Department of Children and Youth Services or juvenile court, although there is an open referral process. Substance abuse is the risk factor that is specifically targeted at Caritas House, but most girls face additional and related risks. Sexual abuse is the most prominent factor. Girls may also be the children of substance abusers, have a history of emotional and psychological abuse, lack adult supervision, or have a lesbian orientation.

Treatment begins with assessment and orientation. At this stage, many girls express resistance and denial of problems. Once a girl has acknowledged her problem and becomes accustomed to the structured environment of Caritas House, she begins to progress through the three stages of treatment (awareness, transition, and community living). She can advance by setting manageable, incremental goals for herself and reaching them. Girls earn rewards only through their own hard work, commitment, dedication, and goal setting. They are also taught to recognize and appreciate their own resilience and strengths.

Girls who have been substance abusers may need to fill gaps in their development. The program targets skills that are significant in substance-abuse recovery, especially social skills. Girls are taught to communicate their needs, to settle differences, to form healthy relationships, and to appreciate "helping" skills that will enable them to connect in a positive way with others in their family and the larger world. Staff members model these skills, and girls who have progressed in therapy are also encouraged to act as positive peer mentors.

Caritas House has found group therapy to be especially useful in working with adolescent girls, who are more likely than boys to share their feelings and relate with one another in group settings. Daily therapy sessions focus on such gender-specific issues as sexual abuse, eating disorders, sexuality, family issues, and self-esteem, as well as substance abuse.

Families are encouraged to participate in treatment. In the early stages of treatment, when a girl may not yet be internally motivated to stop abusing drugs and alcohol, the family can provide external motivation to put her on the path to recovery. As treatment progresses, family counseling may focus on issues underlying the girl's drug and alcohol use. With her family, she discusses how to keep her commitment to recovery, how to deal with relationships and responsibilities, and how to avoid or rebound from relapse as she prepares to leave the program. Siblings become involved in treatment to provide them with substance abuse education and primary prevention.

Caritas House provides structured aftercare and follow-up support as a girl makes the transition to community living.