An investigative report released by Reuters and NBC News in December claims that child welfare policymakers have largely neglected infant and toddler deaths due to substance abuse. Pennsylvania was one of multiple states the report claims have failed to comply with federal law requiring hospitals to refer substance-exposed newborns, including those opioid-dependent, to child protective agencies for services.
Philadelphia has long relied on the child welfare system and the medical system to accurately identify, track, report and refer these cases to treatment when necessary. Opioids are a class of drugs that affect the nervous system. Dependence on opioids is typically by prescription of the drug methadone, under the care of a licensed physician. Federal law mandates when physicians must alert child protective service agencies if a child is born opioid-dependent. Two programs in particular, through Thomas Jefferson University’s Maternal Addiction Treatment Education and Research (MATER) project in Center City, have found positive results when treating and supporting mothers and their infants who are opioid dependent, according to Dr. Dennis Hand, an associate director of one program.
As the Reuters/NBCNews report revealed, a baby is born dependent on opioids every 19 minutes in America, and a national bill is now in the works to address this growing issue. Opioids include heroin, painkillers such as morphine or codeine, and methadone or buprenorphine.
Methadone and buprenorphine are commonly used for substitution therapies in opioid dependence treatment. The World Health Organization, the National Institutes of Health, and the American College of Obstetricians and Gynecologists currently recommend methadone maintenance as the standard course of treatment for pregnant women who are physiologically dependent on opioids.
Methadone maintenance during preganancy has been widely studied.
A 1976 study published in the Journal of Pediatrics found that use of methadone during pregnancy lowered the risk of low birth weight for infants.
More recently, two studies explored the effects of methadone maintenance on the pregnancy experience itself. These studies, conducted in 2007 in the Journal of Addiction and in 2011 in the Journal of Drug and Alcohol Dependence, found methadone maintenance to reduce stress on the fetus during development, reduce the mother’s potential for risky behaviors associated with procuring illegal substances and increase the rate of consistent prenatal care.
Advocates for methadone maintenance say that the treatment is not just about curbing illicit drug use, but also about stopping the risky behaviors associated with acquiring illegal substances.
In Philadelphia, for mothers who do not seek treatment such as methadone maintenance prior to the birth of their child, the health care system is responsible for notifying the Department of Human Services (DHS) of substance-exposed newborns.
In 2003, the Keeping Children and Families Safe Act amended the Child Abuse and Protection Treatment Act (CAPTA) by requiring each state to implement a system for notifying child protective agencies of substance-exposed newborns. The federal law calls on hospitals to alert child protective services of newborns “identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.”
The law does not specify whether infants born to a mother receiving prescription treatment for opioid dependence should be reported, but does specifically state that the birth of a child dependent on opioids is not enough to constitute child abuse. As a whole, the law urges states to refer these cases to child protection agencies for assessment and service referrals.
About five years ago, Philadelphia’s Department of Human Services (DHS) created a unit specifically focused on CAPTA compliance, which received referrals for substance-dependent infants. More recently, the CAPTA unit merged with the regular intake unit. Now all reports, whether for abuse or services, go through the same office.
June Cairns, a former training director at Philadelphia’s DHS for twelve years, has worked in child protection since 1978. She described the process of intake at DHS as beginning with a safety assessment, which includes visiting the mother’s home to assess safety for a newborn and visiting with the mother at the hospital to discuss treatment and other services available to her.
Since these assessments are not court-ordered, mothers are not required to take advantage of services referred to them, and further, may face a long waiting line for the services they do desire.
“On the East Coast, there is a rich history and tradition of nonprofits who step up to the plate [to provide services],” Cairns said. “I think we really need a partnership of the public and private sector saying, ‘We’re committed to helping these women get clean and sober.’”
While there are fourteen methadone maintenance clinics within the city, only two programs exist for mothers who desire more holistic services.
Thomas Jefferson University’s MATER project, a division of the Department of Pediatrics, oversees the Family Center and My Sister’s Place. These programs are evidence-based, meaning they are supported by findings collected through the best available research. Services include individual and group counseling, support groups focusing on life skills, parenting skills and the recovery process, obstetric and prenatal care coordination, and intensive case management services.
Case management helps connect women with outside services such as transportation to treatment or to prenatal appointments, finding stable housing, and help applying to assistance programs like Women, Infants & Children (WIC), a federal supplemental nutrition program for low-income mothers, or the Supplemental Nutrition Assistance Program (SNAP), which is not limited to mothers and their children. The Family Center provides these services in an outpatient model while My Sister’s Place provides in-patient residential care.
Currently, the Family Center is at its capacity of 230 women, and maintains a waiting list. There is no maximum amount of time a woman can receive treatment from the Family Center. The Family Center outpatient services are “very individualized,” said Dr. Dennis Hand, associate director of the program, during a conversation about their services. This focus contributes to the success the center has seen.
In 2014, the center treated approximately 340 women, approximately 110 of whom were pregnant. Of infants born in that year, three-fourths were of normal size and gestational age at birth, with only 18 of 88 babies exhibiting low birth weight (the remaining 22 babies were delivered in 2015). These numbers are not only lower than rates for women who receive methadone maintenance treatment only, but are even lower than the general population.
Uniquely, these programs have benefited from a federal grant to provide mindfulness-based parenting training.
“One of the most promising areas for child health and development in the treatment world is mindfulness,” said Dr. Dianne Abatemarco, current Director of the MATER project. “Mindfulness training allows moms to be compassionate and more attached to her child, and attachment is the greatest asset we can give mother and baby. Programs that support moms three-hundred-and-sixty degrees are the ones that are going to really affect children’s health and mortality.”
Ashleigh Martell Brunsink, Master in Social Work candidate – Ashleigh Martell Brunsink is a second year MSW candidate at the School of Social Policy and Practice. A macro student and a member of the Child Well-Being and Child Welfare (CW2) specialization, she is interested in using research to shape child welfare policy. Her specific research interests include the adult functioning of former foster youth and evidence-based interventions for youth aging out of care. This fall, she assisted Professor Johanna Greeson and doctoral candidate Allison Thompson with a systematic review of natural mentoring among older youth in foster care, which was recently accepted by the Children and Youth Services Review. At Penn, her field placements have included the Interdisciplinary Child Advocacy Clinic at Penn Law and the Children’s Home of York, a child- centered social service agency serving York, PA. She currently serves on student government as the Vice Chair for Finance and as a volunteer “PennPal” for prospective students. Ashleigh came to Penn following three years at Pepperdine University School of Law, first as an Advancement Assistant and then coordinating the Tour Program for the Office of Admissions. Ashleigh graduated, cum laude, from Johnson University’s School of Business and Public Leadership with a B.S. in Nonprofit Management and Bible in May of 2011. While at Johnson, she worked full- time as a houseparent at a local group home for adolescents and spent a gap year volunteering with a faith-based organization called Mission Year, where she interned with an after-school program and a housing agency for emancipated foster youth. A former foster youth herself, Ashleigh has experience in public speaking at recruiting and fundraising events and has been interviewed for two publications.
This story has been published in partnership with the University of Pennsylvania’s School of Social Policy & Practice (SP2). In the run up to the 2016 Presidential Election, the school launched “SP2 Penn Top 10, a comprehensive multimedia initiative in which renowned SP2 faculty members analyze and address the most pressing social justice and policy issues.”
Part of the project is the creation of stories produced by “SP2 Penn Top 10 Fellows,” graduate students from the School who are trained in solution-based journalism using the Journalism for Social Change curriculum.