Keeping Them Together

My husband heard this story on NPR and knowing it would be of interest to me, told me about it. I grew up in a different kind of Texas than we usually think about the state in these modern times. I am grateful to have something good to say exists in that state today.

LINK>Casa Mia is a refuge for mothers with opioid use disorders and their infants in San Antonio Texas. Through a partnership between the School of Nursing at the University of Texas and Crosspoint Inc (a local nonprofit organization), mothers and their young children are offered housing while the mothers are enrolled in a recovery program and receive support services.

Casa Mia is located on a quiet street in a predominantly historic neighborhood near downtown San Antonio. It is a two-story house filled with laughter, baby bottles, diapers and toys. It includes a garden in the back. Gardening is proven to be therapeutic and helps with recovery, and nutrition is important to recovery as well. “A lot of our ladies have grown up with food insecurity,” says Dr. Cleveland. “People who are in recovery from a substance use disorder often have cravings, and it is important to discuss nutrition for mom and for baby.” There are clean beds for the women to sleep on at night. It is a far cry from the streets where these women formerly resided. Back in 2019, they were able to help 32 women and 26 children.

Dr Lisa Cleveland co-founded Casa Mia after witnessing the traumatic separations of mothers, who were diagnosed with opioid disorders, and their newborns shortly after birth. She partnered with Crosspoint Inc who had previously used the building as a women’s recovery support home. Crosspoint is a local nonprofit organization that provides transitional and behavioral health services to San Antonio’s most marginalized and vulnerable citizens.

“Casa Mia follows a social recovery-housing model. The focus is on teaching moms to live their lives without substances. We show them that they can have a great life without them,” Dr. Cleveland says. They provide a comprehensive wellness program for the mothers and also teach them life skills, while offering them a safe place to live with their children, while they recover.

While nationally there are numerous transitional or recovery homes for women, only 3 percent of that housing offers beds for their young children. As a neonatal nurse for 28 years and a mother, Dr Cleveland understands the mental and physical need for a child and mother to be together from birth. The maternal bond is important for each of them. “We need to help women become moms in a supportive environment before we put them out into the world,” she says.

Local and county statistics further solidified her resolve to take action. One-third of all Texas infants diagnosed with opioid withdrawal are born in Bexar County, the highest rate in the state. This equates to 300 to 400 babies each year; more than Dallas-Fort Worth and Houston combined. Casa Mia is a one-of-a-kind program designed to turn the tide.

“The statistics just really floored me,” says Dr Cleveland, “and I thought why is no one talking about this, especially since it has a really large impact on our community. With those numbers, it stands to reason that Bexar County really needs to set the standard for the state, and we are now. Bexar County truly is the leader in best practices and best care for these families.”

Traditionally, pregnant mothers who are diagnosed with substance use disorder have only two options after they give birth: either have a family member take care of their infant while they go to a treatment center or Child Protective Services places the infant in foster care. “Even if the infant is placed with a family member, the mother and baby are still separated. This separation is very traumatic for the mother and very traumatic for the baby. It is traumatic for the staff at the hospital as well. It just doesn’t make sense to me,” Dr Cleveland says. “Why are we taking these babies away from mothers who need help? Why are we not helping the mothers instead?”

Funded by the Texas Department of State Health Services, the Baptist Health Foundation and the Sisters of the Holy Spirit, Casa Mia is staffed 24 hours a day and can house up to 20 mothers and their young children at a time. Each woman must continue her recovery or treatment plan and follow the rules of the house. The first phase is fairly restrictive. Residents are not allowed to stay overnight elsewhere and must be in the house by a set curfew. They must let the staff know where they are going when they leave, even for treatment; they have to call when they get where they are going from the landline phone at their location, not a cell phone; and they have to call when they are on their way back to the house. As they progress through their recovery, the restrictions are relaxed until they eventually get ready to exit the program. There is no set timeframe for a resident to stay or exit the program.

“I think recovery is very individual,” Dr Cleveland says. “One of the things that makes our program unique is that if someone relapses, they do not get thrown out of the house. We know that recovery is a process and sometimes people relapse and that is part of the learning process. I have heard of women who have relapsed after leaving the program and then get right back on track. To me, that is a huge success.”

At Casa Mia, women may arrive expecting a child, having just given birth, or hoping to be reunited with their child. One case study is Becky who arrived at Casa Mia one January, six-months pregnant with her seventh child. After using drugs for six years, now at the age of 33, is thankful the judge sent her to Casa Mia. As a result of her drug use, she had lost custody of three of her children to their father and has joint custody of three others with a different father. She has been in recovery for more than a year and is finally excited about her future. While living at Casa Mia, Becky continues her recovery program, works a steady job (which she has had for almost two years) and takes classes to complete her GED. She plans to become a real estate agent.

“Now that my baby is born, I haven’t left her side, not even once. I am very happy because I think the Lord gave me another chance. He showed me these young women and how they take care of their children and that planted seeds in my head. Now that I have my little girl, he has given me another chance to be a mom again, and I’m very thankful for that.” She adds, “I love the staff at Casa Mia. They want what’s best for us, and they really try to help you. Having your children with you is the best thing, and I just see how everything works together.”

Crosspoint brings its expertise in recovery housing and support, the School of Nursing provides its expertise in women and children’s health as well as nutrition and childhood development. Classes for the mothers range from child nutrition and parenting to yoga and infant care.

Seeking A Different Outcome

A woman lost her firstborn child to Child Protective Services when she was 17, after having been abandoned by her abusive father. Part of the reason for losing the child then was poverty – no crib or medical insurance. She also had untreated mental issues. She has been in therapy since she was 18 and her therapist will support her now – 6 years later. She is now 3 1/2 months pregnant with her second child and understandably afraid of losing this child as well or that they’ll bring up her mental health issues from the past. This child’s father is not the same one as her first child’s father and is supportive of her. She gets SSI income and her boyfriend is a line cook. Because they are on a tight budget, she is buying what she can in preparation for her baby, as she can. How can she avoid a repeat experience ?

A response came from a woman who works in primary care settings. She has seen cases where if the parent previously lost a child to the Div of Health Services, that parent comes under heightened scrutiny. Suggestions – If you are going a regular OB clinic or community clinic, show up for every single prenatal appointment, stay on top of scheduling. Make them aware of the regularity/consistency of your therapy appointments. I personally would not meet with or trust their social or behavioral health person – keep them at arm’s length until you get a good read as to whether they seem genuinely interested in helping with you. It seems you have good support already, so don’t even go there. If you feel you have to appease them and must meet with one, just be prepared to say all the areas you have covered already. Don’t express vulnerability or what you don’t have. Better to go through trusted community organizations if you need physical items, housing resources, etc. Expect to have to do a Urine Analysis at some point. Avoid using any substances including marijuana that might get you flagged.

I am a big fan of midwives and so I liked this suggestion – seek out a birth center or better yet a home birth midwife. You can meet them for a consultation (no pressure to pick that one). Wait until you find one you think you could have a trusting relationship with. They won’t have access to all your medical records. They are more focused on supporting you as an individual. The less contact with nosy/intervention happy medical people, the better in your case. If you end up needing to birth in a hospital, a good midwife ought to be a good advocate for you in that setting, even though it is also a high risk setting for Div of Health Services involvement/hospital staff scrutiny.

If she is in a conventional medical care setting, the woman suggests be one step ahead with all the baby item planning. Having the car seat well in advance, like by 30 weeks, and schedule a car seat installation safety check (you can find them by searching “car seat safety clinic” they are often done at fire departments). If she signs up for WIC (which pays for formula), she needs to be aware that they are another scrutinizing entity that could represent a threat.

The biggest poverty factor to control for is housing stability. If you rent, is your lease month to month or year long? Being on good terms with your landlord can smooth inspections. Best have a Plan B. Make certain savings could cover a move, if needed. Or have a support network, one that would allow you stay with a stable family that is considered “safe”.

Additional suggestions from another with behavioral health work within a primary healthcare setting – No one can report a thing until the child is born. Be careful about what releases you sign. No one can talk to anyone about you without your release – unless it becomes a mandated report. If you sign releases, you are at risk. Therefore, any releases need to be very specific. Don’t sign blanket things like “service coordination.” Instead say what services you want coordinated.

This woman disagreed with some of the previous advice – I don’t agree with universally declining behavioral health services, because those services can be helpful for connecting with community based programs for things like car seats, help with food insecurity, clothing, etc. If your ongoing therapist is well connected, and knows what programs are available within your community, they may be able to serve in that role. In that case, it is appropriate to explain that you are in regular behavioral health care already.

There will likely be complete screenings as a routine part of your care to look at maternal stress/perinatal mental health concerns. They may also be helpful in holding the balance of psychotropic medication/medication choices, while you are pregnant, if that is part of your typical mental health treatment plan. You can consider signing a very specific and narrow release with your therapist, but generally, I would limit it only to things like medication, pregnancy health, dates of service. I would not allow your therapist to release your progress notes, progress summaries, treatment plans unless there is a compelling reason to do so.

Is Foster Care Professional Employment ?

These days it seems anything goes. Even a stay at home mom of 25 years managed to get a job running a movie theater with a staff of 15 people. She made her case by outlining her experience in scheduling and budgeting experiences related to running a household.

With foster care, the “payment or stipend” goes to the child’s expenses and so is not actual compensation for doing specific work. It has been mentioned that if this a job that you would have to be bonded for, then yes you would list that experience of being a foster care parent on a resume.

If you are applying for a job where foster care experience is relevant, such as working with a youth program or something like that, it should definitely be listed but not as employment experience. It may need to be disclosed as a potential conflict with some positions, for example – work in behavioral health for an agency that also does child welfare work.

And it is interesting that advertisements seeking foster parents are always listed in the “jobs” section of the classifieds. Listing time spent fostering would make logical sense to explain a gap in work history. If you didn’t work for x number of years because you needed to be at home with foster children.

One foster parent shared – I might list foster parenting under community service/volunteer experience, depending upon the job I was applying for. I never have listed it in our 25+ years as a foster family. I feel that people are prone to look at me as a “savior” then, and I don’t feel comfortable with all that goes with that.

Another mom said – I did list foster parent and stay at home mom. I was applying for a teaching job after 10+ years of no employment, and I listed it as experience rather than employment. I definitely wouldn’t put it on a resume, if I was applying for a job that didn’t involve work with children.

A Human Resources Director noted – I would find it odd to see foster parenting on a job resume. Unless the job that they are applying for is in the foster field – like a volunteer, a house mom for a group home. Resumes are to get you the interview, not the job. Any gap of employment should be explained in a cover letter and not the resume. She also noted that HR professionals are not looking at gaps in employment as a big negative at this time. After the financial crisis, a lot of people lost jobs and it was hard to find other jobs and/or a good fit.

In fact, this professional admits there are employers out there that will not consider a person for a position because of familial obligations. She suggests the applicant remove any mention of foster care, stay-at-home, etc. Instead say something like “I was away from the workforce for x amount of time because of a personal obligation/matter. That obligation/matter has been addressed and is no longer a factor nor will it impact me in this position.