When Dawn* entered the San Antonio Mommies Program, she’d been struggling with a serious substance use disorder for several years. The program helped connect her with substance use treatment, counseling, and education services to prepare her to care for her child and to stay in recovery.
“It’s still working for me today,” she said in a Texas Department of State Health Services video about the program. Several years out of the program, Dawn has custody of her child, an apartment, and a car. She is working on getting a promotion to a leadership position at her job.
“It’s been life-changing for a lot of the women,” said Briseida Courtois, the Director of Addiction Treatment Services at The Center for Health Care Services, which runs the Mommies Program.
The program, then called Project Cariño, was launched with a grant from SAMHSA in 2007. It paired comprehensive substance use and mental health services offered by the Center for Heath Care Services, a state-funded local treatment provider, with the prenatal and neonatal care expertise of the nearby University Hospital System. The county where the program is located sees about one-third of the state’s cases of neonatal abstinence syndrome (NAS), a condition in which a child is born dependent on opioids and undergoes withdrawal symptoms after birth, said Lisa Ramirez, Texas Department of State Health Services Women’s Substance Use Disorders Services Coordinator. The University Health System wanted to improve its birth outcomes, Ramirez explained.
“You really want a strong attachment between mom and baby,” explained Ramirez. But the hospital system and its staff identified barriers to forming such a bond.
Mothers of Children Born with NAS Overcome Barriers to Health Care
Among the barriers the hospital system and its staff identified was a strong social exclusion associated with substance use during pregnancy that was having a negative effect on the way clinical staff interacted with the mothers of children born with NAS.
“It took time and training to help [clinicians] understand the impact of stigma and bias,” Ramirez said.
The Mommies Program helped change the clinicians’ views and behavior. Clinicians now refer to the women as “mommies.” Women in the program are required to enter outpatient medication-assisted treatment (MAT) during their pregnancies, which is considered a best practice for caring for pregnant women with opioid use disorders, Courtois said. Many of the women experienced trauma in childhood or adulthood, so the program provides counseling to address that trauma. Additionally, the women take courses in parenting, relapse prevention, and life skills. Clinicians from the hospital teach the women about prenatal care, NAS, and how to soothe a baby experiencing withdrawal symptoms.
“After seeing the patients on a regular basis, the [clinicians] became committed to helping them work on recovery,” said Courtois. “That was key.”
Building supportive relationships with the clinicians also helped reduce stress among the mothers, Ramirez said. The soothing techniques the mothers learn not only help them to more effectively care for their children, Ramirez noted, but decreases the need to treat the infants with medication and reduces the length of time babies need to stay in the neonatal intensive care unit.
Successful Recovery Approach Serves as a Program Model
Nearly 600 women have now been through the Mommies Program, and many have been able to maintain custody of their children, according to Courtois and Ramirez. The hospital and the state continue to fund the program.
In fact, the program has been so successful that the state is working with hospitals and treatment programs in five other Texas counties with high rates of NAS to expand use of this model, Ramirez said. Ramirez and her colleagues also created a video to educate both mothers and providers about the program. One of the strengths of the program is the long-term bond that forms between the mothers and those who care for them and their babies. Many of the mothers return to the hospital each year for a reunion.
“They continue to maintain those relationships long after they’ve delivered,” Ramirez said. “They have the tools and the support to maintain recovery and maintain their strengths as parents.”
*The name has been changed to protect the anonymity of the client portrayed.