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.