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.

The Damage Done By Addiction

It is a personal issue for me but people do sometimes recover. Just this morning I was reading an article by a woman who admitted the difficulty of recovering from the trauma of her past and four addictions. Today’s story –

I am a foster parent and have a one year old child in my home who I have had since she left the hospital. I have a good relationship with her parents, I think about as good as can be expected in this situation. We text frequently, exchange pictures, arrange visits outside of the court-mandated ones. They love her endlessly but are deep into struggles with addiction. Both have had a few stints where they go to treatment for a day or two (so, there does not appear to be a barrier with access to treatment) but do not stick with it. Addiction has been a long-time struggle for both parents.

Her case is very much still open and I am still trying to help them into treatment. But, it’s to the point where the department is asking about permanent placement options. The child has a relative (I think mom’s second cousin, not positive on the exact relationship) who lives about three hours away and is not in contact with the rest of the first family. Relative has said she would adopt if needed, but didn’t want to be the first choice. Parents were asked who they would want to adopt and they said me. I had not talked to them about this and didn’t know it was being asked, so I don’t think they felt pressured. If we get to that point, I would try to facilitate a relationship that’s beyond “open” – i.e., I would invite them to her activities and holidays and would support them seeing her with gas cards and paying for activities and the like. I know many open adoptions end up closed, but to the extent that you can believe an internet stranger, please try to believe that I would not do that.

She also has four half siblings and cousins, aunts, uncles, grandparents (none placement options, unfortunately) in the area where I/her parents live. Under these circumstances, what’s the “best” placement option? (Understanding that the actual best option is with her parents). I’m a foster parent who yells at other foster parents about interfering with kin placements, but it seems like parents should get a say here. How does one weigh the benefits of living with a member of your first family vs living outside of your family but having the option to see them regularly? (I know guardianship would be preferable, but the department won’t do that – so, the options are adoption or not adoption for this case).

First of all, straight up, I would NOT want to go to a relative that didn’t want me.

One response seems realistic to me as well – I would adopt if left no other legal choice. If you do allow her parents to see her when they are able, then I think ultimately it’s what best for the girl, if her parents can’t find their way out of addiction and the state is pushing the issue. A similar response from an adoptee was – If I was the little one in question, and guardianship was not an option, I would want you to adopt me over the distant relative and keep me in contact with my close family. The deciding factor, for me, is that the distant cousin doesn’t want to be the first option, and that is bound to come across to the adoptee, especially if times get tough when they are older. It’s hard enough to know that your biological parents didn’t want to/couldn’t raise you, but when you start getting the same message from multiple sources, it can really compound the trauma.

Someone else writes – Considering the addiction issues, this child needs a home. If there was NO other option but you vs the cousin, I’d prefer you because you live near her family/parents. But, closing this child off from her family at anytime and getting all “she’s MINE” – no, nope, nada. Being a supportive and caring adoptive mom with the child’s mental and psychological health front and center – providing therapy as needed throughout this child life for issues that will pop up – remembering always that you are not this child’s mother….period. I can be on board for you to provide a stable home for this child.

Finally this from a voice of experience – I was adopted at the age of 9. Both of my parents are addicts. My adoptive parents said they would never keep me from my family. True to their word, they didn’t. When my mom was clean and I asked to go back and live with her, they let me. Even paid my mom child support that wasn’t mandated, just to help out. She relapsed and my adoptive dad actually gave me the choice to stay in foster care and finish high school or for him to come and pick me up, since legally he was my parent. I chose to stay in high school in order to stay near my siblings, instead of moving across the country. If you are really going to keep it open, with access to the child’s family, I would say you are the better option than a long distance blood relative who doesn’t speak to the family. I just hope that you always give her parents grace and don’t cut off communication when you are mad. Especially if the child wants to keep that communication open.

Defunding Foster Parents

If a biological parent can’t financially support their children, they are taken away. Yet the state funds foster parents to keep other people’s children. If you want to raise these children, you should be able to afford to do that first.

Case in point – a woman has NINE foster children and says that without funding from the state, she would only be able to care for THREE. Needless to say that having 9 foster kids in one home would constitute that home as being a “group” home. Different standards should apply plus a lot more monitoring.

The requirements for providing foster care do vary by state. I read that in Texas, you’re classified a group home if you house more than six kids. You are also required to have someone awake overnight on staff.

Defunding foster parents would cut down on abuse and neglect perpetrated by foster parents. However, given the current reality foster parents should not be allowed to have so many children in one home – unless they’re a sibling group. Three or four should be the maximum.

The state really should be funding parents instead of removing children in some cases. There are definitely cases where the children may need to be removed to allow the parent to get treatment/therapy/better parenting skills, etc but sometimes a parent just needs some utilities paid or other financial assistance, until they get back on their feet.

For more perspective, here is one former foster youth’s experience – group homes do have a bad reputation. I do strongly believe that with on site treatment, reputable staff and good funding it is possible to create group homes with less risk of abuse. I’ve been in 36 foster homes, in which 33 were abusive or neglectful. I’ve been in 3 group homes that were amazing. All that said, I do believe the state should be funding parents before any stranger, if it will keep a family together.

Better To Have Been Aborted

It may surprise a reader to know this, but many adoptees actually wish they would have been aborted. That is how painful it is to be given up for adoption and doubly painful if the adopting parents prove to further damage an already damaged soul.

I am pro-Choice and pro-life. Not pro-Life like most of those are. They are only pro-Birth, truth be told. They are not willing to fund adequate financial support to struggling mothers so that they can keep and raise their children.

The world has enough people already. We do NOT need to be fruitful and multiply any more. In fact, we have not needed to do that for a very long time. The population explosion first occurred on a small scale and with a relatively moderate intensity in Europe and America, more or less between 1750 and 1950. Enough is enough. If a couple wants to have children and is willing to fully support raising them, I’m all for it. Otherwise, trust women to make the best decision and stop stressing over the babies you imagine they have killed.

I fully understand what it feels like for a child to be born into this world unwanted and unprepared for. My maternal grandmother never had any other children because of the shame and guilt she felt at having surrendered a child for adoption. She died too young and I fear what happened to separate her from my mom haunted her for her entire life.

I am a woman who chose to have an abortion. The timing was wrong, the father was wrong to make any kind of commitment and the pregnancy was not developing normally. I am grateful I could go to a clean clinic, where I received counseling and good treatment. It still haunted me. I had a child before the abortion who I am forever glad I kept (even though some circumstances at the time of her conception suggested I should not have – I knew she would be just fine and she was/is). I am a woman who went on to have two very wanted sons when I entered into a marriage to a good man who wanted to be a good father and he is.

Opioid Orphans

It is so sad that medications meant to relieve serious pain have become such a travesty that people who might benefit from them find it hard to receive a prescription. I understand the complication. I have been prescribed such medications and though I never became addicted, I could see the temptation and how the drug fixes itself upon the person.

I have experienced the awareness that my ex-husband overdosed and gratefully survived the experience. When he came home he told me his friend dumped him out at the emergency room. Not long after, that friend actually died of an overdose himself. His family lived next door to my in-laws and they quite obviously, and reasonably, distanced themselves from my ex at the time – though he was not at all responsible for his friend’s death. Parents have a hard time accepting such a hard truth at the time they lose their child.

Today, many grandparents will be forced to rescue their grandchildren after such an event. Fortunately, the death I described above was a person without children. Though perhaps a few years away from retirement, they find themselves full-time parents again. This is the collateral damage caused by the opioid crisis.

As the opioid epidemic has spread across the country, through all age, gender, race and economic categories, the number of children who have lost their parents to drugs—either to death by overdose, to jail, prison, homelessness or disability—has skyrocketed. Those children wind up in one of two places: either with relatives, or in an already overburdened foster care system. In 2015, the child welfare system saw a three-year national increase of more than 30,000 children entering foster care. That number is likely much higher now as the nation finally begins to face the truth and pharmaceutical companies are being held to account.

In West Virginia, the hardest hit state in the opioid crisis, the number of foster care children grew 24 percent from 2012-2016. The numbers escalate as the number of overdoses increase; they mirror the number of addicts in treatment programs, incarceration or living day-to-day on the streets. Babies are born addicted to opioids or other drugs. More often than not, addict parents, living or deceased, have made little or no provisions for the ongoing care of their children.