Career Renewal: Helping Mothers in Recovery Secure and Sustain Employment
Career Renewal is a service of Renewal House, Middle Tennessee’s only long-term, comprehensive family residential treatment program that keeps women who are seeking treatment for substance use disorder and their children together. The purpose of this document is to describe how Renewal House launched Career Renewal and to detail the impact of this program. The intended audiences are community organizations, funding agencies and individuals interested in developing similar programs to help women achieve recovery and financial self-sufficiency.
Authors: Pamela Sessions, MSSW, Renewal House and Thomas Alfieri, PhD, Purdue Pharma L.P.
The authors thank Nicole Wesley, MD, founder and president of Nikki’s House Recovery in Warren, Ohio, and Anne King-Hudson, MA, CADC, CSS, CPS, founding executive director of Allies in Recovery in Brighton, Michigan, for their insightful comments and suggestions. In addition, the authors acknowledge editorial support from A.M. Samuels, MPH and Padilla, a communications firm specializing in public relations, advertising and multi-media engagement.
Purdue also provided funding to support the development of this case study.
Thomas Alfieri, PhD, is an employee of Purdue.
After reviewing this case study, readers will understand how Renewal House in Nashville, Tennessee, is helping clients gain meaningful employment through its Career Renewal program.
The case study summarizes the model and approach, and reviews the outcomes and key learnings after the program’s first 15 months.
Below is an overview of the program discussed in this report.
- Renewal House has provided inpatient and outpatient recovery services to women in Tennessee for more than 20 years. It is the only comprehensive residential program where mothers and expectant mothers can live with their children while in treatment.
- Renewal House provides services and support to the women it serves, which include caring for their infants, assistance in obtaining high school equivalency diplomas or other educational certificates, help with expunging criminal records, and overcoming other barriers to recovery and reintegration into society.
- The organization recognizes the importance of integrating workforce preparedness to its recovery program to help its clients gain employment, one of the best predictors of successful recovery.1
- In the first 15 months (April 2019 to June 30, 2020), Career Renewal served 51 pregnant and/or parenting women, 13 of whom secured employment while still in the residential program.
- ○ Career Renewal services were also provided to 37 additional women in Renewal House’s intensive outpatient program.
- ○ Success rates may have been negatively impacted by the pandemic, which is believed to have stalled the local job market and created new challenges for all job seekers.
- Client completion of Career Renewal classes and goals was high, including:
- ○ Career assessments (85%)
- ○ Resumé creation (73%)
- ○ Computer classes (71%)
- ○ Financial literacy training (100%)
The Career Renewal program has helped women in recovery gain the skills and confidence to seek and often find meaningful employment, which is an essential component of maintaining recovery.
Career Renewal Program
Every woman in the Renewal House residential program is enrolled in Career Renewal upon admission. Career Renewal follows a systematic approach that integrates recovery and employment services for the women it serves.2
Goals & Approach
- The Career Renewal program, launched in April 2019, prepares clients to enter or re-enter the workforce through vocational training, individual career coaching and financial literacy classes.
- The goal is to help clients secure and sustain employment in living wage jobs that can support a successful transition to independent living in the community.
Career Renewal Curriculum
- Vocational curriculum is designed to help clients assess their career possibilities, create resumés and gain interview skills.
- Financial literacy curriculum provides the skills needed to manage a paycheck and budget household expenses.
- One-on-one coaching gives each client individualized support at every stage of entering or re-entering the workforce.
Client Interventions, 8-Week Program
- 1.5-hour weekly group session, divided between vocational and financial literacy curricula
- 1.5-hour weekly group computer training session
- Individual career coaching of at least 1 hour per client per week, with more time available
- Career Renewal staff possess specific skills and training as well as a desire to discuss the types of barriers clients face, such as interaction with the criminal justice system.
- Renewal House Director of Programs oversees Career Renewal program and staff
- A career coach leads vocational and financial literacy classes and provides one-on-one coaching for all clients
- A community engagement coordinator identifies recovery-friendly employers in the community willing to hire Career Renewal clients through local networking and outreach
- Career Renewal also contracts with local educators from the Nashville State Community College’s Workforce and Community Development program to teach computer skills workshops
A Mother’s Story: Tiffany*
The first time Tiffany was pregnant, she didn’t realize it until she was 7 months along—and she was actively using substances.
“People were dying all around me. People were dropping like flies. I didn’t want to die. I wanted to live.”
Later, Tiffany was pregnant and incarcerated. Her attorney referred her to Renewal House’s structured, family-centered recovery program just two weeks before her son was born. She felt everything: nervous, scared … and excited. She could keep her son with her during treatment, and she was ready for a new life. Ready to change. Ready to be better.
“A mother needs her children and children need their mothers.”
At Renewal House, Tiffany participated in intensive counseling for her substance use disorder. She met with a childcare counselor to help build her parenting skills. And she participated in the Career Renewal program to help her prepare to re-enter the workforce. The ability to keep and sustain a living wage job would help Tiffany make a successful transition back into the community and living independently.
Tiffany completed the program successfully—and she did it with her children by her side.
“I wouldn’t be where I am today without Renewal House. I learned how to be responsible. I learned how to dress right for an interview. All sorts of little things that you wouldn’t think matter. Things that come naturally to a normal person. But to me, they didn’t. Today, people trust me. It’s amazing to have that. My kids trust me. My mama trusts me. And I’m trusted at work. I’m training to be a manager now.”
*Client names have been changed to protect their privacy.
The Need for Treatment and Recovery: On the Ground in Tennessee
Children also experience the consequences of the high rates of substance use disorder among adults in Tennessee—some starting at birth. Tennessee’s rate of neonatal abstinence syndrome (NAS) is more than twice the national average, at 16.4 cases per 1,000 hospital births compared to 7.3 cases per 1,000 nationally.5
NAS is a group of withdrawal symptoms infants may experience because of exposure to opioids or other drugs during pregnancy, and can include severe irritability, difficulty feeding, breathing problems and seizures.6 Parents’ substance use has also been identified as a driving factor in the state’s steady rise in the number of children entering its foster care system and the amount of time the children remain in state care.7-10
There is political support for treatment of substance use disorders in Tennessee. The “TN Together” reform, passed by the state’s general assembly in 2018, combines legislation and funding to decrease the supply of prescription opioids, increase funding for opioid use disorder treatment, and strengthen law enforcement efforts to attack illicit sale and trafficking of opioids.11
However, one practical challenge for women on public health insurance seeking substance use disorder treatment is that they must have physical custody of their child to qualify for Tennessee’s Medicaid program. This can create a damaging cycle: without custody of a child, a mother cannot get coverage or treatment, and treatment is required before a mother can regain custody.
The beginning of Tiffany’s story may be common, but thanks to Renewal House, Tiffany’s story—and the stories of hundreds of other women—have taken a positive turn.
Seeking Treatment and Recovery:
Barriers Women Face
The OWH report, part of an initiative from the U.S. Department of Health and Human Services that examined prevention, treatment and recovery issues for women who misuse opioids, points to a big issue for mothers: traditional inpatient treatment programs seldom allow children to be present.12 A 2019 government survey on U.S. substance abuse treatment programs reports that only 12% of residential programs like Renewal House accommodate clients’ children.14 This leaves women torn between taking care of their children and taking care of themselves.12
“What these models don’t take into consideration is how difficult it is for mothers to leave their children with family members, if that is even an option, or to make the extremely difficult decision to put their children in foster care,” says Savak Millis, LPC-MHSP, Renewal House’s Director of Programs. Nearly a decade earlier, the 2011 National Drug Control Strategy acknowledged the importance of not making women choose between seeking treatment and caring for their children.12
“Renewal House clients are often survivors of domestic violence or sex trafficking, deal with financial insecurity and the majority also experience depression, anxiety or other mental health disorders. ”
— Savak Millis, LPC-MHSP, Director of Programs, Renewal House
It’s a painful dilemma: being better parents to their children is a strong motivator for mothers who want to seek treatment, but mothers are more likely to bear primary responsibility for childcare, making it more difficult for them to attend regular treatment sessions. This issue seldom arises for fathers seeking recovery treatment.15
In a 2019 brief, the Association of State and Territorial Health Officials (ASTHO), which represents the public health agencies in all 50 states, reported that 44 states will prosecute a woman for substance use during pregnancy.17 ASTHO also reported that 24 states and Washington, D.C. consider substance use during pregnancy as child abuse or neglect, and that women have been arrested or lost child custody after even a single positive preliminary drug screening. Yet, healthcare providers may not prescribe medications that can help pregnant women wean off and stay off opioids because they may operate from an outdated and incorrect assumption that women cannot take these medications during pregnancy.17
Women are afraid to acknowledge substance use — an essential first step in getting needed medical treatment — because of fears of losing custody.12 This fear of social, civil and criminal penalties can be powerful enough to keep mothers and pregnant women away from the healthcare system, a result that puts both a mother and her child’s health at risk.17
An effective treatment and recovery model must take all these factors into account to give mothers the best chance to participate and succeed. Renewal House does exactly that, helping women through recovery and providing essential skills needed to enter or re-enter and succeed in the workforce through its Career Renewal program.
Renewal House: Supporting Family-Centered Treatment, Recovery and Independence
Renewal House was established in 1996 by Nashville community leaders who were troubled by the number of mothers entering the legal system due to substance use and the children who were left to the state’s child welfare system. Millis calls the Renewal House founders “true visionaries because they recognized the impossible situation these women were in and decided to do something about it.”
“The Renewal House model allows mothers to heal while also restoring relationships with their children. The program’s top priority is the children, and we know that whenever possible, children are better off with their mothers. Addiction happens within the family system— so we work to heal the whole family, not just the mother,” said Millis.
This whole-family approach encompasses the need to address a range of situations. For example, when medical services are needed to address an infant’s exposure to substances in utero, Renewal House supports mothers by helping them understand what to expect from their baby’s hospital stay. Renewal House will also teach clients ways to regulate their own stress so they are better able to meet their babies’ needs. Renewal House collaborates with a home visiting infant nursing program to provide mothers with additional support as needed.
The average stay in the residential program is six months, but Renewal House imposes no limit. Clients are given the time needed to rebuild their lives. “Many clients come to Renewal House from unhealthy and unsafe environments,” says Millis. “Living on the positive, healthy, substance-free Renewal House campus removes many stressors and environmental triggers that can challenge a woman’s recovery.”
Many clients rely on Renewal House staff to help prioritize self-care. For example, staff help clients with setting up medical and mental health appointments and help with reminders to take medications as prescribed, which is very important for those on medication-assisted treatment for opioid use disorder.
The overwhelming majority of women entering the program have had interactions with the criminal justice system. Renewal House provides each woman with individualized support to help reduce the anxiety of dealing with the criminal justice system while also working toward recovery. This can range from helping eligible women get their records expunged, to simpler tasks such as assisting in obtaining documents (e.g., social security cards, birth certificates) needed to prove identity and getting proof that women have met their obligations to the system, such as paying past fines.
The year after Renewal House opened, services expanded to include Recovery Housing – 16 below-market rate, permanent rental apartments on its campus to support families’ long-term recovery. In 2017, Renewal House launched Recover Together, an outpatient therapy satellite program in partnership with Vanderbilt University Medical Center.
In 2019, Renewal House added the Career Renewal program to its services. The program recognizes the positive correlation between meaningful employment and better outcomes for women in recovery.18 The benefits of treatment and employment are bi-directional. Maintaining recovery predicts success in securing and succeeding at a job; while succeeding at work reinforces lasting sobriety.18
In essence, the Renewal House goal is to replace the cycle of addiction with a positive cycle of recovery, employment, self-sufficiency and return to society.
At Renewal House, mothers can focus first on recovery, building confidence and developing the skills needed to maintain sobriety. Mothers can then focus on employment skills through the Career Renewal program, learning how to balance work while parenting and managing the challenges of life without the use of substances.
Established in 1996
Programs and Capacity
- Family Residential Program: 17 women with one to two children each, children up to age 10 years at entry
- Recovery Housing: 16 one-bedroom below-market rental apartments that prioritize women in recovery who have children living with them
- Career Renewal: workforce preparedness program, which served 88 women in its first 15 months
- Intensive Outpatient Program: a licensed program providing group therapy and educational sessions focused on the root causes of a woman’s substance use disorder
- Recover Together: a partnership with Vanderbilt University Medical Center to enhance patient care through open communication with OBGYN and medication-assisted treatment (MAT) providers and the Renewal House treatment team
Renewal House defines recovery as a process through which its clients improve their health and wellness to live self-sufficient lives. Recovery begins the day a client decides to make a change. While Renewal House avoids the term relapse, the chronic nature of addiction and the way it affects the brain means that many clients will use substances at least once during the recovery process. Renewal House recognizes that substance use does not mean a client is no longer in recovery. It simply means she needs additional support to get back on track and move forward. The only way a woman is no longer considered in recovery is when she makes the choice to continue to use.
Keeping mother and child together improves outcomes for both
According to one of the most popular and empirically supported parenting theories, “Attachment Theory,” early child-parent attachment is essential to a child’s social, emotional and school functioning.19 This attachment usually develops over the first year of life.20 Attachment is a very specific parenting role, where the child uses the parent as a secure base from which to explore, a safe haven to return to, and a source of comfort.19 Attachment is distinct from other parental roles, such as caregiver, teacher, playmate and disciplinarian, and one of the most important.19
SAMHSA looks at the other side of the parent-child equation, pointing out that strong relationships with children help mothers maintain recovery.13 SAMHSA also says that therapeutic services that help improve a mother’s parenting skills will lead to better outcomes for the children, which is particularly important because children of parents with substance use disorders are at high risk of child abuse and neglect, developmental problems and their own substance use later in life.13
Career Renewal Snapshot
Career Renewal: From Defining the Need to Measuring Impact
In 2018, Renewal House began developing a new service to help its clients prepare for and seek employment. The organization recognized that without income and meaningful employment, recovery while living independently could be challenging, and for many women it was impossible. Renewal House applied for and received funding from Purdue to support development and management of the new service.
Defining the Need
Renewal House initiated the Career Renewal program to help women address these barriers. Career Renewal helps mothers prepare for, secure and maintain meaningful employment.
“My daughter watches me work. She says she wants to be like me. I never in a million years thought my children would want to be like me. Before Renewal House and the Career Renewal program, I didn’t even want to be me.”
— Lisa*, Career Renewal Program Graduate
*Client names have been changed to protect their privacy.
Career Renewal Goals
Enhance employability of Renewal House clients through early occupational assessment, resumé completion, computer classes and vocational classes.
Staffing Mix and Considerations
The program’s career coach notes how many of the women in the Career Renewal program have faced incredible adversity and know their path forward will not be easy. Yet, they persevere and improve their lives and their children’s lives.
Figure. Career Renewal Is Staffed by a Collaborative Team of Professionals
- Leads job readiness group sessions; provides one-on-one client interest, skills and personality type assessments; works with clients to develop individual employment plans
- Also leads financial literacy training
Community Engagement Coordinator
- Cultivates relationships with businesses in the community to develop employment opportunities for Renewal House clients
- Provides on-site training in common workplace computer programs and applications, including Microsoft (Word, Excel, PowerPoint, Outlook) and Gmail.
Figure. Benefits of Hiring People in Recovery28,29
Systematic Job Development
The community engagement coordinator identifies potential employment partners through community and business networking opportunities. For example, by regularly attending meetings of the local Chamber of Commerce and Connect Nashville, a network of local business professionals that focuses on strengthening relationships and helping one another grow their businesses through the power of connections. The Chamber of Commerce itself actively engages with employers across the state to encourage recovery-friendly workplaces (see Tennessee Chamber of Commerce Helps Employers Navigate the Opioid Crisis).
The community engagement coordinator’s primary responsibility is to develop job possibilities for Renewal House clients, but also to help employers understand how hard these women are working to rebuild their lives. The goal is for employers to see the value—from both a business and a personal perspective—to help these families thrive (Figure).
Tennessee Chamber of Commerce
Helps Employers Navigate the Opioid Crisis
The Tennessee Chamber of Commerce & Industry (the Chamber) recognized an urgent need to help employers navigate the challenges associated with opioid use disorder and other forms of substance use disorder. The organization’s reach in business communities across the state uniquely positioned it to address the need through relevant education, conversation and resources. With grant funding from Purdue, the Chamber launched the Tennessee Workforce Recovery Initiative in 2020, convening a series of summit meetings across the state and developing an employer toolkit.
“Helping employees get the treatment they need, rather than severing ties, is a winning strategy for everyone — employees, business and our community.”
— Kelly Boutwell, Vice President, the Chamber
The Chamber’s four regional summits, held in January and February of 2020, focused on helping employers better understand and support their current workforce and build recovery-friendly workplaces. Attendees included nearly 500 business leaders serving in a range of roles, from CEOs and human resource directors to chaplains, professors and kitchen managers, representing a broad spectrum of blue- and white-collar industries.
The summits provided information on brain function, mental illness and substance use disorders, and connected attendees with practical guidance from addiction specialists. Presentations and panel discussions included insights from professionals like Renewal House CEO Pamela Sessions and others with relevant expertise, such as business leaders, lawyers and people who have lived experience of substance use disorders. The group discussed key topics such as preventing substance misuse in the workplace, reducing stigma, how to support employees seeking recovery services, and ways to get buy-in for recovery-related workplace initiatives from company leaders.
Boutwell says that opioid use disorder and other forms of substance use disorder—and recovery—represent a business issue. She urges companies to acknowledge the problem and get involved. The first steps for an employer, outlined in the toolkit, are to develop an internal advisory team and to update the company’s mental health and substance abuse coverage.
Another key step included in the toolkit is knowing what services are available locally so companies can help their employees make the right connections quickly. “Helping employees get the treatment they need, rather than severing ties, is a winning strategy for everyone – employees, businesses and our community,” said Boutwell.
The Tennessee Chamber of Commerce & Industry’s Workforce Recovery Initiative event series and associated toolkit for employers are part of a grant that Purdue’s Office of Corporate Social Responsibility provided to the Chamber in 2019.
Group Training and Individual Career Coaching
Just 18 months after inception, Career Renewal expanded its financial literacy curriculum because staff recognized that clients needed more support in this area than anticipated (see Financial Literacy Curriculum). Many Renewal House clients enter with little or no experience earning and managing a paycheck. However, many do have experience managing limited income sources, such as food stamps and a welfare benefit.
Millis says children, of course, are welcomed in the classroom with their mothers. “The most unique thing about our program is how amazing and patient our staff members are. Our groups look incredibly different than in your typical intensive treatment center, but this is what mothers need to succeed.”
- Week 1: Career assessment
- Week 2: Resumé writing
- Week 3: Communication styles
- Week 4: Job searching/interview skills
- Week 5: Getting to and from work as a mother
- Week 6: You got the job! Now what?
- Week 7: Healthy boundaries in the workplace
- Week 8: SMART goal setting
Individual Career Coaching
Following analysis of the assessment results, the career coach assists each client in developing a written employment plan. The plan may include interim steps to help women achieve their goals and gain their independence. For example, Renewal House has partnerships in the community to connect interested clients to trade programs and can also connect clients to partners in the community that provide GED classes at no cost.
Financial Literacy Curriculum:
- Week 1: The art of budgeting
- Week 2: Making money
- Week 3: Banking services
- Week 4: Credit cards
- Week 5: Cars and loans
- Week 6: Saving and investing
- Week 7: Living on your own
- Week 8: In trouble
For example, a client who had recent legal charges was anxious about applying for jobs because she was sure she would not get hired. Through the community engagement coordinator’s work developing a partnership with an employer in the community and the career coach’s counsel, the client was hired at a local fulfillment warehouse. Through her hard work, she is now thriving at this job, where she has received two raises and is now making more than $14 per hour.
One-on-one coaching also digs more deeply into each woman’s financial education and needs. For example, helping clients to open their first checking account or navigate the process of repaying past bank fees so they can reopen existing ones. Depending on each client’s level of need, coaching may include deeper discussion of debt and debt reduction, student loans, credit scores and wage garnishments that may occur once the client is employed.
Rounding out the work the career coach does are computer training sessions led by educators from the Nashville State Community College’s Workforce and Community Development program. The weekly one-and-a-half-hour training sessions focus on common workplace computer programs and applications including Microsoft Office (Word, Excel, PowerPoint, Outlook) and Gmail.
Program Evaluation Measures
Career Renewal Outcomes
Career Renewal served 51 pregnant and/or parenting women from the Renewal House long-term, comprehensive family residential program, a 46% increase from the estimated 35 participants. Career Renewal was able to serve more women from the residential program during this time because of more rapid client turnover than anticipated. The mean age of the women served was 30.6 years (range 20 to 42 years). Three-quarters (75%) identify as white, 18% African American, 4% Hispanic and 2% American Indian/Native American. Most women have completed high school or have an equivalency diploma (53%) or have attended college or trade school (22%), but approximately one quarter (24%) do not have a high school degree.
Once the program was up and running, capacity was also increased by providing Career Renewal services to 37 additional women in Renewal House’s intensive outpatient program. These clients attended group sessions and received one-on-one career counseling, though it was not scheduled weekly as it was for residential clients.
Renewal House clients who secured jobs found employment in a range of industries. One is a self-employed graphic design professional who was able to restart her business. Another took an interim job while pursuing one working with animals, and she was eventually hired as a veterinary technician. Others are employed as real estate agents, hospitality workers, social workers and customer service representatives.
More than four in five clients (85%) completed career assessments, meeting the 85% goal. The eight clients who did not complete the program left Renewal House because they were either not ready to be in recovery or continued recovery elsewhere. Nearly three-quarters of Career Renewal clients (73%) completed resumés, exceeding the 60% goal. Seven in 10 clients (71%) participated in every computer class and 100% completed financial literacy training.
“I’m in school now for criminal justice and social work. I have been approved to receive state certification as a peer support advocate. I want to work with people like me—women who have been in addiction or an abusive situation who feel like there’s no way out.”
— Devorah*, Career Renewal Program Graduate
*Client names have been changed to protect their privacy.
Discussion: Program Successes,
Shortfalls and Challenges
Though not included in goals outlined at the program outset, the rates of attendance at computer classes (71%) and financial literacy classes (100%) demonstrate the commitment of Renewal House clients to learning new skills to assist with employment and their ability to live self-sufficient lives.
The computer class attendance rate was reduced because local COVID-19 rules restricted the number of clients who could be in the computer lab at one time to four people. Vocational and literacy class sizes were maintained using technology, with classes live-streamed to clients spread out in socially distanced small groups across several rooms, including some attending from their apartments. Clients are provided with tablet devices for class attendance only. Devices are then collected, as the campus is largely technology free to encourage clients to remain “present” and focused on their recovery.
The biggest challenge was the low placement rate of clients in the workforce. Renewal House leaders attribute this challenge to the COVID-19 pandemic. Nashville had a thriving employment market, but starting in March 2020, the pandemic resulted in an economic shutdown, limiting employment opportunities for everyone, including Renewal House clients. Three of the six Career Renewal clients who were employed in the food service industry when COVID-19 began lost their jobs because of the pandemic, but as restrictions eased, all three regained employment.
The effect of COVID-19 has been felt not just in Career Renewal services, but throughout Renewal House. Based on guidance from its Medical Director, Renewal House stopped new program admission for nearly two months at the beginning of the pandemic (April-May 2020). This had a large effect on Renewal House’s billing and outcomes. In-person group activities, including Career Renewal classes, were initially reduced in size and eventually halted, before starting again through a combination of smaller class sizes and streaming technology for remote participation.
At the time this case study was written, the career coach was meeting with clients remotely for one-on-one counseling sessions, however they were able to return to in-person meetings at the end of June 2021. The Career Renewal outreach team is also looking forward to resuming in-person outreach within the community as they recognize that it is easier to develop strong relationships through in-person meetings with potential employers.
“Women come to Renewal House literally held down by their addiction but leave free and flourishing. Our clients leave not only as better moms, but as graphic designers, real estate agents, team leaders, hospitality workers, social workers, admissions clerks and contributing citizens to our community.”
— Pamela Sessions, CEO,
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