Promoting Economic Self-Sufficiency Among Women with 
Co-Occurring Disorders and Histories of Violence: 
PROTOTYPES Systems Change Center
May 2003 
Innovations From the Sites

Women with substance abuse 
and mental health problems who 
have histories of violence face a 
variety of challenges when trying to 
establish and maintain economic 
self-sufficiency. 

To address these challenges, 
PROTOTYPES Womens Center has 
created a comprehensive program 
to support women in achieving 
this goal. One of nine SAMHSAfunded 
Women, Co-Occurring 
Disorders and Violence Study sites, 
PROTOTYPES, Centers for Innovation 
in Health, Mental Health, 
and Social Services, the parent 
organization for the Womens 
Center, incorporated welfare reform 
issues within its proposed project 
for the study. PROTOTYPES saw the 
crisis of welfare reform as a core 
concept in readiness to change 
systems. Therefore, preparing the 
women for the challenges of TANF 
(Temporary Assistance to Needy 
Families) was an integral part of 
PROTOTYPES work from the 
beginning of the project. 


PROTOTYPES, a large multi-services 
agency in Los Angeles County, 
provides residential, outpatient, and 
day treatment services for substance 
abuse, mental health, HIV/AIDS, and 
domestic violence and other trauma 
services to women and children. 
Promoting financial self-sufficiency is 
central to its treatment philosophy. 


By incorporating a comprehensive 
treatment approach that includes 
income and job support, the 
program helps women work towards 
economic independence. Support 
mechanisms assist them throughout 
the different stages of the process. 
The program addresses womens 
changing needs around income and 
employment as they progress through 
treatment. 


IMPACTS OF SUBSTANCE 
ABUSE, MENTAL ILLNESS, 
AND TRAUMA 
There are generally four stages to 
establishing economic self-sufficiency 
for women with co-occurring 
disorders and histories of violence: 
 Accessing welfare and other 
benefits while women are in 
treatment 
 Preparing for workforce 
entry through job training and 
on-site vocational tracks 
 Active job seeking and entry 
into the workforce 
 Ongoing support to maintain 
employment 


Passage of the Personal Responsibility 
and Work Opportunity 
Reconciliation Act of 1996 
transformed a 60-year federal 
commitment to income support for 
needy families into a temporary 
assistance program granting states 
the authority to determine eligibility 
and benefits. This law emphasizes 
workforce entry and establishes 
time limits that mandate work after 
two years (or as short as two months 
in some states), and creates a lifetime 
cap on benefits after five years. Strict 
time requirements on welfare benefits 
can be problematic for women with 
co-occurring disorders and histories 
of violence. 

Recent research has found that 
women who have experienced severe 
violence over their lifetimes are more 
likely to remain on welfare for longer 
periods (Tolman & Rosen, 2001; 
Honeycutt & Marshall, in press; 
Barusch, Taylor & Derr, 1999). 
Research has also examined the 
impact of violence on womens 
capacity to gain and maintain 
employment. Raphael (1995, 1996) 
has documented how interference 
from an abuser (such as keeping a 
woman up all night with arguments 
before a job interview, inflicting 
visible facial injuries, threatening 
to kidnap children, and in-person 
harassment on the job) can impinge 
upon a womans ability to work. 
A report by the Urban Institute (1996) 
on a multi-site study of welfare-to-work 
programs revealed that many 
women were struggling with 
depression, learning disabilities, low 
self-esteem, and fear of failure. 

Substance abuse and mental health 
issues may also impact womens 
abilities to obtain and maintain 
employment (Danzinger, et al., 2000; 
Browne, Salomon & Bassuk, 1999; 
Allard, et al., 1997). The Urban 
Institute (1996) found substance 
abuse and mental health issues to 
be significant barriers to employment. 
One study showed that mental 
health disorders reduced a womans 
chance of maintaining work by 
approximately one-half (Browne, 
Salomon & Bassuk, 1999). Without 
adequate support, women with 
experiences of substance abuse, 
mental health problems, and histories 
of trauma struggle to achieve 
economic independence (Browne, 
Salomon & Bassuk, 1999; Lloyd, 
1997). 

BARRIERS TO ACCESSING 
TANF BENEFITS 
Upon admission to PROTOTYPES, 
many women are already receiving 
some form of welfare benefit. Those 
who are not enrolled are encouraged 
to apply for Californias Temporary 
Assistance to Needy Families (TANF) 
program, otherwise known as 
California Work Opportunity and 
Responsibility to Kids (CalWORKs). 
One of the largest barriers in seeking 
TANF benefits is womens fear of 
losing their children. If they admit to 
having substance abuse, mental 
health, and trauma issues, women 
worry that the state will remove the 
children from their care. In addition 
to their fears, the complex application 
procedures for TANF benefits 
can also be intimidating for women 
who are just beginning treatment. 
Already dealing with many issues 
related to their recovery, the addition 
of a complicated enrollment process 
may feel overwhelming. According to 
Marta Munoz, Assistant Director of 
the Vocational and Employment 
Services Program at PROTOTYPES, 
women often do not get the 
information they need and do not 
know how to apply for the funds. 
They may not understand what 
signing their welfare-to-work contract 
means. 

Further complicating matters, TANF 
workers may be unaware of the issues 
women are facing. For example, they 
may not know that trauma and abuse 
experiences are often the primary 
reasons for substance abuse and 
mental health problems in women. 
Furthermore, the TANF program is 
frequently seen as a work first 
program, which can lead to on-going 
tension between the womens needs 
for treatment versus their need to find 
gainful employment. Finally, without 
an understanding of their clients 
experiences, TANF workers may be 
less sensitive to the challenges women 
face, particularly those with children. 
Criminal records may also be a 

barrier, since many women with 
substance abuse histories have also 
been involved in the criminal justice 
system. California residents with 
felony convictions, depending on 
the nature of the crime, are not 
eligible for certain welfare benefits. 
Finding employment also can be 
difficult with a criminal record. 
Thus, a vicious cycle is created: 
without the options of welfare assistance 
or employment, a person may 
be more likely to engage in illegal 
activity to gain income to survive. 

Perhaps the most significant barrier is 
the time limits on benefits imposed by 
welfare reform. Californias mandate 
to enter the workforce within two 
years may be unrealistic for many 
women in recovery. Laurie Pendroff, 
Deputy Director of the Womens 
Center at PROTOTYPES, notes that 
many of [our clients] are struggling 
with addiction and have very poor 
work histories. When they come 
through our doors, they need much 
more than what the timelines require. 
Were finding we have to adjust our 
treatment accordingly. 

Former PROTOTYPES client Terry 
Wright, now the Food Services 
Coordinator for the program, speaks 
from her experience as a recovering 
addict, I was a woman with a 21-year 
addiction. When I got here, I had to 
learn to do everything all over again, 
and thats basically learning how to 
live all over again. After 21 years of 
usage, there were a lot of things I 
wasnt necessarily ready to address at 
that time. We deal with women with 
multiple disabilities and recovery is a 
long-term process. 

THE PROTOTYPES 
APPROACH TO ACCESSING 
TANF BENEFITS 
PROTOTYPES has responded to many 
of the challenges women face when 
trying to access TANF funds by 
implementing unique strategies to 
address both systems issues and the 
individualized concerns of their 
clients. 

 Welfare Department Buy-In 
PROTOTYPES has established good 
relationships with local welfare 
department staff. The head of the local 
Los Angeles County office serves 
as a member of PROTOTYPES 
Coordinating Body, otherwise known 
as the Local Experts Group. In this 
role, she gained a detailed understanding 
of the needs and challenges for 
these women, and the goals of the 
treatment program. The local TANF 
office has become more responsive to 
PROTOTYPES clients as a result of 
this collaboration. In addition, 
PROTOTYPES has access to both 
administrative and caseworker staff at 
the TANF office, allowing them to 
address systems and client-level 
issues more effectively. 

 Cross-Training 
Training of welfare department 
and PROTOTYPES employees has 
alleviated many barriers. Training for 
welfare department employees 
focuses on sensitivity and awareness, 
and the impact of trauma on 
the lives of women with substance 
abuse and mental health issues. 
Dr. Vivian Brown, President and 
Chief Executive Officer at PROTOTYPES 
explains, It is important to let 
them know that most women who 
are substance abusers also have 
some sort of mental illness and are 
almost always traumatized. Since 
substance abusing moms tend to be 
looked at negatively, knowing that 
trauma is a driver of substance 
abuse has really improved sensitivity 
towards the moms. 

In turn, PROTOTYPES staff are trained 
on TANF procedures and regulations. 
CalWORKS organizes a bi-monthly 
forum for all local service agencies to 
provide the opportunity to work through 
some of the challenges associated with 
accessing TANF. Other training for 
PROTOTYPES staff focuses on a variety 
of topics, including application procedures, 

time limits, receiving treatment 
under welfare-to-work contracts, and 
work requirements. 

 Client Orientation Sessions 
PROTOTYPES staff conduct orientation 
sessions to familiarize their 
clients with the welfare system. These 
are intended to simplify the TANF 
application process, and alleviate 
anxiety about procedures and 
regulations. These sessions are often 
conducted at the local welfare office 
in the presence of TANF employees. 
PROTOTYPES staff feel the orientation 
is helpful, noting that women 
appreciate hearing from people who 
are familiar and more sensitive to 
their issues, particularly at this early 
point in the recovery process. 

 On-Site Welfare 
Department Staff 
A welfare department staff member is 
available on-site at PROTOTYPES to 
work individually with PROTOTYPES 
clients to ensure they have a solid 
understanding of TANF application 
procedures and regulations. Terry 
Wright explains that the welfare 
department worker takes one person 
at a time, and shes very specific in 
terms of what shes explaining. Thats 
a big plus. 

 The Buddy System 
PROTOTYPES has established a 
buddy system for women traveling 
to the TANF office. Women who feel 
nervous about going to the TANF 
office alone can pair up with a 
PROTOTYPES staff member who will 
accompany them to ease their anxiety 
and serve as a bridge between the 
two worlds. 

JOB TRAINING AND SKILLS 
DEVELOPMENT 

Many women with co-occurring 
disorders and histories of violence 
have limited work histories and are 
unfamiliar with meeting the 
responsibilities associated with maintaining 
employment. Clients entering 
treatment have frequently either been 
supported by a partner or have supported 
themselves by engaging in sex 
work. With gaps in their work experience, 
they must learn or relearn the 
skills necessary for the workplace. 
This may be difficult for women just 
entering recovery. The amount of time 
needed to acquire new work skills can 
also be frustrating, particularly as 
women attempt to learn quickly to 
meet the constraints of welfare 
benefits limits. Furthermore, when 
working with trauma survivors, the 
need for trauma-informed vocational 
training is critical. Staff must always 
be cognizant of situations that 
might trigger traumatic reactions. 
As women prepare for the workplace 
through job training, gaining mastery 
of work behaviors can be challenging. 
Laurie Pendroff explains, The issues 
for our clients are responsibility and 
obligation. These concepts dont 
come easily for several reasons. Some 
women have been out on the streets 
for many years. Frequently, our job 
is really re-training people, working 
with them to wake-up on time, 
figuring out what you are going to 
do with your children, working with 
co-workers you may or may not get 
along with, and dealing with a supervisor 
who may or may not be the best 
match. Learning new work behaviors 
while focusing on treatment and 
recovery is hard. 

VOCATIONAL AND 
EMPLOYMENT SERVICES: 
A CORE COMPONENT 
OF THE PROTOTYPES 
TREATMENT PLAN 

The Vocational and Employment 
Services Program is a core component 
of the PROTOTYPES treatment plan. 
By integrating vocational training and 
skills development into treatment, 
clients are helped to understand 
the value and demands of work, learn 
or reestablish skills and work 
behaviors, and develop the independence 
necessary to obtain and 
maintain employment. The program is 
divided into four components: the 
first two focus heavily on training 
and skills development; the later 
stages are geared towards active 
job-seeking strategies and integration 
into the community. 

An Orientation and Assessment Phase 
provides an introduction to work. 
Following this, women move on to the 
Work Adjustment and Training 
Phase. Here, they are exposed to 
real-life work experiences via onsite 
simulated work environments 
called vocational tracks. These 
tracks combine classroom instruction 
with didactic 10 to 12-week work 
placements to promote job training 
and skills development. Areas covered 
include: communication skills, 
problem solving, values and feelings, 
interpersonal relations, managing 
stress, resume building, job applications, 
and interviewing techniques. 
The program offers a variety of 
on-site options or vocational 
tracks in several different fields: 
computers, office skills, horticulture 
and landscape, parenting 
and childcare, food services, and 
reception. The women can also 
learn retail skills at the off-site 
PROTOTYPES thrift stores. 
Integrating work experience as a core 
component of treatment has been 
very beneficial, according to PROTOTYPES 
staff. Certain aspects of the 
program have been particularly 
helpful in addressing the needs of 
women with co-occurring disorders 
and trauma histories as they prepare 
for work. 
 A Structured Environment 
The programs structure and 
consistency is intended to keep 
women committed to treatment and 
recovery. Though initially difficult, 
women eventually become 
accustomed to the structure and, 
in some cases, appreciate it. As the 
Food Services Coordinator within the 
Food Services vocational track, Terry 
Wright notes, After ten weeks, my 
girls are committed to me and to 
working. Thats what makes it so 
special for me. They love the structure 
after a time, but you have to get them 
to like where theyre at and what 
theyre doing. You look at one person 
coming in telling you I dont want to 
be here, and by the end, you cant get 
them out of the kitchen. Thats the 
miracle of it all. Thats the blessing. 

 Ongoing Staff Support 
Support and encouragement from 
program staff is essential as women 
prepare themselves for work. 
Vocational and Employment Services 
staff work intimately with clients to 
teach them skills, address their 
concerns about work, and support 
them throughout the job training 
process. As Food Services 
Coordinator, Terry Wright spends 
much of her time during the early 
stages of the program emphasizing 
the positive aspects of work. She 
teaches problem-solving skills and 
empowers women to make decisions 
for themselves. If a client happens 
to make a choice she regrets, Terry 
encourages her not to be hard on 
herself, but rather think about how 
things could be done differently the 
next time. She teaches a full range of 
food services skills from the basics of 
food preparation and safety and 
sanitation, to more universal job skills 
such as communication, self esteem, 
self-advocacy, and time management. 
At the end of the training, Terry notes, 
Its not about whos the greatest cook, 
its about the commitment, and after 
ten weeks my girls are committed. 

 Incorporating a Focus on Trauma 
The Vocational and Employment 
Services Program was modified to 

meet the needs of women with 
histories of trauma. Certain tracks that 
were once mandated components 
of treatment are now optional for 
women with histories of violence and 
abuse. This provides women with 
choices about participation in 
activities that might make them 
uncomfortable. For example, the 
childcare track was found to be 
anxiety-provoking for some women, 
particularly those who had been 
victims of childhood abuse. Food 
service was also found to trigger 
traumatic memories for some clients. 
Therefore, women choose which 
vocational tracks they wish to 
participate in. 

 Choice of Work Roles 
Women are encouraged to explore a 
variety of roles to determine the 
best fit. Since many women have 
limited work experience or skills, 
PROTOTYPES staff encourage them 
to consider jobs that might be seen as 
non-traditional for women. Dr. Elke 
Rechberger, Director of the Systems 
Change Center, states, These vocational 
paths provide a different 
conceptualization for women about 
what types of work they can do, and 
what their strengths are. Non-traditional 
jobs such as plumbing, welding, 
and mechanical repair also provide 
women a living wage that may be 
more difficult to obtain in other 
work environments. 

PROTOTYPES seeks to provide 
training for women wishing to pursue 
these skill areas. For example, when a 
building at the PROTOTYPES facility 
was being remodeled to create extra 
bathrooms, a group of women learned 
how to tile and install plumbing during 
the process. There are additional 
therapeutic benefits associated with 
this type of work: Dr. Vivian Brown, 
CEO, who participated in the 
remodeling project, states, Women 
feel a sense of accomplishment 
when they can manually create 
something that takes creativity, 
dexterity, and skill. 

THE CHALLENGES OF 
COMMUNITY INTEGRATION 
AS WOMEN ENTER OR 
RE-ENTER THE WORKFORCE 

At the completion of the 10 to 12- 
week vocational track, both the 
supervisors and the women themselves 
conjointly determine who is 
work-ready. These women then 
move onto the next phase of the 
program, Community Integration, 
where they learn job-seeking 
strategies, develop individualized job 
search plans, and participate in 
peer-support activities. They also 
prepare for the Community Re-Entry 
Phase, during which they take on 
temporary placements or internships 
that may be either volunteer or paid 
positions. 

As women begin the process of 
accessing employment opportunities, 
several new challenges emerge. Many 
clients have been out of the workforce 
for several years and are intimidated 
by the thought of work. They fear 
failure and worry about appropriate 
work roles. Additionally, they may 
not have a wardrobe suitable for 
the workplace. Physical appearance 
can also inhibit their ability to 
access employment. Terry Wright 
explains, Say, for instance, you have 
a person with several tattoos, a lot of 
piercings, tear drops down the 
eyes indicating gang affiliation, or 
disfigurements in her face because 
of domestic abuse. You know in 
your heart that the client can do the 
work, but the employer doesnt want 
to take the risk. She might say all the 
correct things but if she doesnt look 
the part, that becomes one of the 
biggest barriers. 

In Los Angeles County, one of the most 
significant barriers for women is 
transportation. The area is large and 
spread out geographically with 
substandard public transportation. 
Women typically do not own cars, 
and view the bus system as inadequate 
and unsafe. Pomona, the location 
of PROTOTYPES, is situated at the 
county line, requiring public transportation 
passengers to transfer to 
a different transportation system. 
Travel to a job that might take 20 
minutes by car can take two hours 
by public transportation. 

After women enter the workforce, 
job retention becomes a major 
challenge. Clients who have been 
unemployed for several years may 
be overwhelmed by the responsibilities 
imposed by work. PROTOTYPES 
staff are cognizant about the potential 
surfacing of trauma dynamics 
while on the job. Systems Change 
Center Director Dr. Elke Rechberger 
states, Educating personnel across 
all points of the benefits and 
employment process to realize that 
concomitant job training in a 
supportive environment leads to 
better outcomes has been helpful. 
Other logistical barriers can challenge 
a womans ability to maintain work. 
Since most clients are still undergoing 
treatment when they enter 
the workforce, coordinating their 
treatment schedules with work hours 
can be difficult. Laurie Pendroff 
explains, Since our clients are 
returning to work more quickly 
because of welfare reform, the 
whole timeline is more difficult. A 
person may still have some core 
treatment to continue and also have 
to go to work. Maybe the group that a 
client needs is offered at 1:30 in the 
afternoon, but shes at work from 10 
to 5. Being able to get the treatment 
she needs while being productive at 
work is difficult. Lack of childcare 
further complicates the situation. 
TANF has helped alleviate some of 
the cost, but there are too few 
providers to serve all the women 
who require help. 

PROTOTYPES SUPPORT 
FOR ACTIVE JOB SEEKERS 
AND NEW EMPLOYEES 
PROTOTYPES has developed useful 
strategies to overcome some of the 
barriers associated with job placement 
and retention. 

 On-Site Employment 
Counselors 
Women are assigned employment 
counselors to assist them with every 
aspect of job preparation and 
employment. If necessary, these staff 
members work with women individually 
throughout their time in the 
Vocational and Employment Services 
Program. When women are 
employed, staff follow-up extensively 
to monitor their progress, and address 
individual needs and concerns. 

 Job Club 
The Job Club is a peer support group 
for clients who are actively seeking 
employment or working that is 
facilitated by Vocational and 
Employment Services staff. Here, 
women share their experiences about 
job seeking, job leads, and frustrations 
about the challenges of working. 
Staff believe the group has been 
extremely beneficial. Marta Munoz, 
Assistant Director of Vocational and 
Employment Services states, It helps 
keep women focused from week to 
week and they can encourage each 
other. Maybe somebody just secured 
a job and they can talk about that. 

 On-Site Resources 
PROTOTYPES offers a variety of 
resources and supports to assist 
women with job training and job 
seeking. An on-site computer center 
allows women to develop computer 
skills. They receive help with resume 
preparation and interviewing 
techniques. Recognizing that many 
of the women do not own appropriate 
business attire, PROTOTYPES provides 
two outfits for all newly 
employed women as part of their 
Working Womens Wardrobe. 
Additional professional attire and 
accessories can be obtained at the 
PROTOTYPES thrift stores. 

 Connections with Local 
Employers 
PROTOTYPES has established 
relationships with many local employers 
and has tried to raise awareness 
about the challenges facing 
women with co-occurring disorders 
and trauma histories. Their connections 
within the community have 
helped in securing job placements for 
women. They have also collaborated 
with a local university to sensitize 
employers about the issues women 
with co-occurring disorders and 
histories of violence face. Funding 
is being sought to continue this 
work. As clients enter the workforce, 
and prove their capabilities 
and commitment, employers take 
notice and show greater interest and 
willingness to hire women in recovery. 
One example is the relationship 
PROTOTYPES has established with a 
local Holiday Inn. As Marta Munoz 
states, If employers have any 
problems or issues with our clients, 
they can contact us. If there is anything 
they need to support clients, we can 
provide it. This way, the employers 
also have support. 

 Staff and Employer Flexibility 
PROTOTYPES has worked to alleviate 
some of transportation and logistical 
issues. If a group of women is 
working in the same area, a staff 
member might provide them with 
transportation to and from the bus line. 
This helps with safety concerns, 
as women do not have to ride public 
transportation alone. The PROTOTYPES 
thrift stores have been able to 
obtain donated cars that are safe 
and sell them to women at the lowest 
possible price. Coordination of 
treatment with work schedules and 
childcare has been best addressed 
by helping women find jobs that 
offer some degree of flexibility. The 
relationships PROTOTYPES has 
developed with local employers 
has helped with this. 

 Job Coaching 
To alleviate the anxiety sometimes 
experienced during the first few weeks 
in the workplace, a staff member 
accompanies women to the job site to 
offer support as they adjust to the new 
work environment. On-site job 
coaching has been very helpful with 
many clients. 

Among all the supports PROTOTYPES 
has implemented to help women in 
recovery succeed at making the 
transition from welfare to work, 
their dedicated staff has been most 
critical. Women have access to teams 
of caring individuals who support 
them throughout the duration of 
treatment. As Dr. Vivian Brown, 
President and Chief Executive Officer, 
explains, with every challenge, 
there is a committed group of 
people to support and encourage 
the women. This multidisciplinary 
team effort seems to make the 

process a little easier. 

For more information please contact: 
Elke Rechberger, Ph.D. 
PROTOTYPES 
Director, Systems Change Center 
5601 W. Slauson Avenue, Suite 235 
Culver City, CA 90230 
(310) 641-7795, ext. 152 
erechberger@prototypes.org 
www.prototypes.org 
~ 
With every challenge, 
there is a committed 
group of people to 
support and 
encourage 
the women. 
Dr.Vivian Brown, 
President and Chief Executive Officer, 
~

The Women, Co-Occurring Disorders and Violence Study is generating knowledge on the development of integrated services approaches for women with 
co-occurring substance abuse and mental health disorders who also have histories of physical and/or sexual abuse. 

This Innovation From The Site was written by Brandy DAmbrosio of the National Center on Family Homelessness, and is a product of the Women, 
Co-Occurring Disorders and Violence Coordinating Center which is operated by Policy Research Associates, in partnership with the National Center on 
Family Homelessness and the Cecil G. Sheps Center for Health Services Research. The Coordinating Center provides technical assistance to program sites, 
conducts cross-site process and outcome evaluations, and develops a range of application products from the study sites. 

The Women, Co-Occurring Disorders and Violence Study is funded by the Substance Abuse and Mental Health Services Administrations three centers  
The Center for Substance Abuse Treatment, The Center for Mental Health Services, and The Center for Substance Abuse Prevention. 
For more information on this Initiative, please contact Policy Research Associates, 345 Delaware Avenue Delmar, NY, 12054, 518-439-7415, e-mail: 
wvcc@prainc.com, web: www.prainc.com. 

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Center for Law and Social Policy 
1015 15th Street, NW 
Suite 400 
Washington, DC 20005 
(202) 906-8000 
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1129 20th Street, NW 
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This publication was made possible by grant number 5 UD1 TI11404 from the Substance Abuse and Mental Health Services Administrations 
Center for Substance Abuse Treatment, Center for Mental Health Services, and Center for Substance Abuse Prevention. The contents are solely 
the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services 
Administration, Center for Substance Abuse Treatment, Center for Mental Health Services, and Center for Substance Abuse Prevention.