In Search of Solutions

A new program is available to pregnant women and mothers in Richmond battling substance abuse

July 30, 2018

10:44 AM

Photo by Thinkstock

Ashely Ritchie receives one or two phone calls each month from women in a particularly tough spot: They’re battling addiction, often to prescription painkillers or other opioids — and they’re pregnant. They want to know where to go to get help.

Unfortunately, there are few options.

“It’s like, ‘Well, where do you send them?’ ” says Ritchie, director of The Mercy House, a residential drug treatment program for women.

The need for such programs is great. According to the Substance Abuse and Mental Health Services Administration, 21,000 pregnant women abuse opioids every month in the United States. But only 13 percent of outpatient treatment programs and residential treatment facilities offer services designed for pregnant women.

In Virginia, 1,334 infants were reported as born substance exposed in 2016. Richmond has just one residential treatment facility serving pregnant women, Richmond Behavioral Health Authority’s North Campus facility (formerly Rubicon Inc.). Services for pregnant women are also offered at a handful of the city’s outpatient medication-assisted treatment clinics, which provide medications like methadone in coordination with behavioral therapies and counseling to support recovery.

Infants with substance exposure can experience withdrawal symptoms and may be at a higher risk for physical and developmental impairment. Substance-use disorder in parents is a contributing factor in many unsafe sleeping situations resulting in infant death.

But pregnancy is also one of the most opportune times for someone struggling with addiction to get treatment, according to many service providers. “It’s kind of an ideal window of opportunity for making a life-changing impact on the mom,” says Robin Foster, director of the Child Protection Team at the Children’s Hospital of Richmond at VCU.

The opioid crisis has brought more attention — and more funding — to the issue of addiction. In 2016, VCU Health began its HOAP clinic (Health Obstetrical Addiction Program) to serve pregnant and postpartum women with substance use disorder. HOAP is open to women with any substance addiction, but its director, Sebastian Tong, says most are in treatment for opioid misuse. The program offers a multidisciplinary approach, including drug treatment, drug counseling and social support, and has served about 100 women.

There’s also a new project underway, one for which Ritchie is serving on the strategy team. Called the Family Resiliency Project, the program is a coordinated effort by the children’s hospital, Family Lifeline, Greater Richmond Stop Child Abuse Now and community partners like Ritchie to provide integrated health care and social support for pregnant and postpartum women with substance use disorder and their infants on a scale not yet offered in the Richmond area. The project brings together drug treatment and counseling, pediatric care, home-visiting, peer support, and a 14-week parenting education program with baby bonding sessions, among other services. Enrollment, which will cap at 30 women for now, began in June, with referrals coming mostly from treatment programs like the HOAP clinic and VCU’s MOTIVATE drug treatment clinic.

“The complexity of this problem requires an enormous support system,” says Foster, who is helping coordinate the children’s hospital’s role in the project.

An Underserved Community

One challenge of serving pregnant women is that historically drug treatment for women has lagged behind treatment for men. “Traditionally, treatment programs were set up around men,” says HOAP’s Tong. “The focus was around men, the studies were designed and evolved around men.”

Men continue to make up the majority of drug overdose deaths in the United States, but the gender gap is closing with opioid-related deaths. Between 1999 and 2015, rates of fatal overdoses from prescription painkillers for women increased by 471 percent, while overdose rates in men increased by 218 percent.

Research suggests that metabolic and genetic differences between men and women may impact addiction. The U.S. Centers for Disease Control and Prevention says that women may be more susceptible to cravings and may become dependent on certain substances quickly. Differences are also sociological. Trauma — especially sexual violence — is a significant contributing factor for addiction and relapse in women.

Then there is the simple fact that women are often the primary caretakers for children, complicating their access to treatment programs.

“Once you’re so far in addiction, you’re not choosing it — you’re just trapped.” —Ashely Ritchie

“The traditional methadone clinic model, for example, is one where you go first thing in the morning to get medicated, and then you go in after work,” Tong says. “So the idea that you could wake up your 5-year-old and your 3-year-old and take them out to the clinic doesn’t seem realistic.”

He adds that pregnancy can be a major life stressor for some women. Many struggle to get clean and stay that way when substance use is their coping mechanism of choice.

And while shame and stigma are factors that can discourage people from all backgrounds from getting help for substance abuse, they exert themselves particularly forcefully on pregnant women.

“You think about moms and the images we have of moms, and then if a mom is continuing to use while she’s pregnant, there’s a lot of stigma,” says Jeanine Harper, executive director of SCAN. “It’s a very, very tough place to be.”

It’s a place that Ritchie knows well. In 2009, she was pregnant and struggling with an addiction to heroin. She wanted to be a good mother, but it was difficult. “The desire was there. I just didn’t know how to put all the pieces together.”

“There wasn’t anybody I felt like I could go to,” she adds. “Once you’re so far in addiction, you’re not choosing it — you’re just trapped.”

Ritchie’s son was born healthy, but she continued to struggle to stay clean. Her mother ended up taking temporary custody of her son after the first few months of his life. “She was the mom when I couldn’t be,” Ritchie says.

A turning point happened for Ritchie when she became a part of The Mercy House’s 12-month residential program in 2011. She also took a parent education program run through SCAN while there. Ritchie now has custody of her son and works full time for The Mercy House.

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Mercy House Director Ashley Ritchie and her son, Gage (Photo by Julianne Tripp)

Coordinated Care

The Family Resiliency Project is the first treatment program for pregnant and postpartum women in Central Virginia to bring so many elements of care under one umbrella. “A key piece of this whole project and why we’re doing it together, it’s sort of ‘the parts matter,’ but it’s really that we’re bringing the parts all together,” Harper explains.

Monthly case-management meetings will allow providers working on different elements of the program to coordinate their care. And ensuring that every woman enrolled in the program has access to a spectrum of services to address her health, the infant’s health and the mother-child relationship will, the partners hope, give participants the best chance for long-term success.

Amy Strite, president and CEO of Family Lifeline, which will be providing the home-visit component of the project, says that service providers can sometimes operate in their own worlds, even when their missions overlap. “This [project] allows us to break down these silos,” she says.

Both Harper and Strite emphasize the need to coordinate training and messaging, in addition to the actual services. They note that factors such as trauma and systemic racism impact substance use disorder and access to services, and they say there is a need for all partners to have an understanding of those issues.

“[The goal] is to get everybody that’s providing that continuity of service on the same page,” explains Foster.

A Reason to Hope

Ritchie’s son is 9, and he has now lived with her full time for five years. She credits SCAN’s parenting program for helping her have the skills and confidence to become the kind of mom she always wanted to be.

In Ritchie’s story, as she tells it, there are echoes of Foster’s sentiment about the ways pregnancy can be a turning point when the right support is there.

“It took me being in the program and getting to that point where I was willing to do whatever it took to be a mom to my son,” Ritchie explains.

For the partners in the project, it’s not just the magnitude of the problem, but the capacity of people to heal and change that energizes their work. “We talk a lot about trauma,” Strite says. “But we can’t forget about the resiliency piece, and the belief that the people we’re serving have tremendous resilience.”

It’s a message Ritchie lives every day. “Because I’ve been there,” she says, “and because I’ve come out on the other side, I know that there’s hope.”