Parents and Substance Use: New programs help strengthen families and break cycles - MetroFamily Magazine
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Parents and Substance Use: New programs help strengthen families and break cycles

By Oklahoma Department of Mental Health and Substance Abuse Services

by Erin Page

Reading Time: 5 minutes 

Oklahoma has historically experienced high rates of parents with Substance Use Disorders (SUDs), which has contributed to increased incarceration of women, maternal deaths and children being removed from their homes, and the statistics have only worsened in recent years:

  • In 2019, Oklahoma had the eighth highest proportion in the nation of children in foster care whose removal was due to substance abuse, according to the Adoption and Foster Care Analysis and Reporting System (AFCARS).
  • The number of pregnant women in Oklahoma diagnosed with Substance Use Disorder (SUD) has increased by more than four times since 1999, according to ODMHSAS.
  • An infant is born with symptoms of opioid withdrawal every 25 minutes in Oklahoma, according to ODMHSAS.
  • Drug-related maternal deaths in our state rose by 190 percent between 2010 and 2019, according to the journal Obstetrics & Gynecology.
  • Oklahoma has the second highest rate of state imprisonment of females in the United States, according to The Sentencing Project.
  • More than 68 percent of Oklahoma’s incarcerated women are mothers of minor children and nearly 62 percent of incarcerated women reported using substances once a week or more prior to their incarceration, according to the Oklahoma Department of Corrections.

In response, in 2018, ODMHSAS and other local and statewide agencies studied how to improve outcomes of individuals with SUD, moms in particular, to benefit not just the parent but their children and families.

ODMHSAS identified three sites in which to design and implement a pilot program, including Tulsa’s Center for Therapeutic Intervention (CTI), the STAR Prenatal Clinic at OU Health Sciences Center and Okmulgee’s CREOKS Behavioral Health Services center.

When the pilot program began, if a mother was using substances while pregnant, there wasn’t a clear path to connect her with recovery services until her baby was born substance exposed or substance affected. Even that didn’t always result in treatment. In 2018, 1,040 women gave birth to infants affected by opioid withdrawal symptoms in Oklahoma licensed medical facilities, according to ODMHSAS; 70 percent of those mothers were not connected with treatment after delivery.

“Child Protective Services (CPS) doesn’t have the ability to intervene until after a child is born,  so, unfortunately, it can be a challenge to identify folks who may benefit from treatment or intervention during the prenatal period,” said Katie Harrison, senior program manager for Adult and Family-Centered Substance Use Treatment and Recovery Services within ODMHSAS. “The same thing could happen at the hospital level. If a baby is born substance exposed or affected, they are referred to CPS to be assessed for safety. If it is determined during the investigation that the family can provide a safe environment, a referral to treatment may not necessarily be made. And we know that there are often times, even though safety may not be a risk, the family could still benefit from treatment and support.”

The agencies considered what positive outcomes could occur if there was a method to intervene and offer recovery solutions while a mother was pregnant, or even before, and prior to a child welfare report ever needing to be made.

“We really wanted to enhance supports by moving upstream to increase recovery during pregnancy,” explained Harrison. “This is not an Oklahoma Department of Mental Health initiative only — it’s many aligned partnerships across systems and communities — because we know addressing this in one system alone is not going to have the kind of impact we need.”

What is a Family Care Plan?

One key component of these pilot programs has been the development of Family Care Plans (FCP), which were officially launched as part of the larger 2020 SAFER (Safely Advocating for Families Engaged in Recovery) statewide effort addressing the continuum of care for persons who have a substance use issue, mental health or co-occurring disorder and are pregnant, parenting or are wanting to become pregnant.

Kept either digitally or in a binder, FCPs are client-owned compilations of documents that help moms and their providers keep track of all key paperwork, check lists, appointments and resources needed in their journeys toward recovery. FCPs also highlight their accomplishments, identify goals and address needs.

An FCP could include things like the log from a mom’s participation in a 12-step recovery program, information about carseat access and safety, behavioral health and substance abuse treatment updates, notes from prenatal appointments, information on local domestic violence support services and much more. The client is encouraged to take the plan to all prenatal, treatment, court and agency appointments to be updated or added to by each provider they encounter.

“These families can have a lot of intensive social needs and are trying to coordinate care across systems and providers,” explained Harrison. “This tool can bridge some of the gaps between systems and aid not only the person keeping track but also demonstrate the steps they are taking toward recovery to CPS and the court. This is also about helping people get connected, equipping them with the supports they need and teaching them what to track and how to advocate for themselves.”

If an infant is born substance exposed or affected and CPS is notified, the FCP details the steps the mom has taken and will continue to take in her recovery. While having an FCP doesn’t mean an infant won’t be removed from the home if the environment is deemed unsafe, it does help families reduce or eliminate safety issues and gives them a better chance of keeping custody of their children.

“Our primary goal is to prevent family separation whenever safely possible and provide enough robust community supports to that family that they can discharge home with their infant,” said Harrison. “This provides the family greater odds for long-term recovery, reduces the ACE [Adverse Childhood Experience] score on day one of a baby’s life and breaks cycles.”

The data shows FCPs are working. At CTI in Tulsa, between October 2019 and November 2022, 81 Family Care Plans were developed. Of those families who had babies in that time period, 100 percent of infants were released from the hospital with their parents. Similarly, at the STAR Center in Oklahoma City, 85 percent of infants whose parents had FCPs were released home.

The next step is to increase education and reduce stigma so that parents, or parents-to-be, with  SUD will feel empowered to access services.

“Research shows that a punitive approach has counteractive results,” said Harrison. “It can push people not to engage in prenatal care or treatment. They become afraid. But a public health approach has greater success because it allows the continued relationship between the child and parent, reduces recidivism, improves child welfare outcomes and is a great motivator toward someone staying in recovery.”

Any person with an SUD who wishes to become pregnant, is pregnant, is in the postnatal period or who has child welfare involvement is a candidate for an FCP. Any provider can start an FCP for a parent or parent-to-be with an SUD, using online training from ODMHSAS, including an OBGYN, treatment agency employee, a representative from the hospital where a mom gives birth, a child welfare worker, a WIC officer, a family member or a friend.

Harrison hopes the success of FCPs will keep more families together, improve how local and state systems work together to support parents with SUD and empower long-term recovery.

“We need to address the stigma surrounding those with an SUD, especially individuals who are pregnant or parenting,” said Harrison. “We have this view that if you don’t stop using it means you don’t love your child. But SUDs are a medical disease that need treatment. It’s important to address so we can improve the quality of treatment, engagement and access to treatment.”

Editor’s note: This article is part of a 10-month series of articles and podcasts with ODMHSAS. Find the full series at metrofamilymagazine.com/mental-health.

The 988 Mental Health Lifeline is designated as a three-digit number for the National Suicide Prevention Lifeline. The 988 Mental Health Lifeline operates 24/7 and offers services for mental health crisis calls. Operators are licensed and certified health crisis specialists who answer calls and connect to and dispatch local services and mobile crisis teams. For more information, visit 988Oklahoma.com.

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