One evening during the blizzard of 1993, my biological mother surrendered me to the life-long care of my maternal grandmother. I was five-years old. She packed a bag, bundled me in layers, and walked me out the front door — instructing me to wait until someone came to pick me up. As an adult, I vividly recall the event and now grasp its reality: My mother was engaged in an insidious crack cocaine addiction. Left to her own devices, this was the best she was capable of doing for me.
Stories such as these were common during the crack epidemic between 1980 and 1996. Repeated news footage showed SWAT teams charging homes, incarcerated parents, soaring drug-related fatalities, children placed in kinship or foster care, and undeniable stigma flooded communities nationwide.
Today, amid a fearsome opioid epidemic, history repeats itself as we witness carousels of familiar images; families torn apart, children in crisis.
As a person in long-term recovery who was raised by a grandparent, I deeply empathize with anyone impacted by the disease of addiction.
In my role as director of prevention programs for the state leader in child abuse prevention, I appreciate the ethical dilemma Pennsylvania Supreme Court justices face in how to intervene with pregnant, substance-abusing women.
Last month, they heard oral arguments in a case involving a woman who gave birth in January 2017 in Williamsport Hospital, about 175 miles northwest of Philadelphia. The mother tested positive for marijuana, opioids, and antianxiety drugs that can heighten the effects of opioids, and her infant spent 19 days at the hospital being treated for drug-withdrawal symptoms. Clinton County Children and Youth Services (CYS) took the baby into custody, accusing the mother of child abuse under Pennsylvania’s Child Protective Services Law.
Criminalizing this behavior is not the answer. The threat of arrest and separation will only result in generations of substance-dependent individuals, promotion of stigma, and increased barriers to pre- and post-natal care.
CYS attorney Amanda Browning declared the current case before the court to be about “human rights, equal protection, and child welfare.” In my view, we can only uphold human rights and foster equal protection if we also include the welfare of the mother in the child-welfare equation.
After decades of sustained declines in foster care placements, there has been a trending incline since 2012 in the number of children placed in the system. Driving that train is the opioid epidemic. Children separated from parents face a myriad of holistic traumas due to interruption of nurture and attachment. These children are more likely to become substance-dependent. If this is the trending outcome and research proves it’s true, can we claim validity in a punitive approach under the guise rhetoric of “equal protection?”
Research conducted by licensed, trauma-focused therapists indicates that children who can remain with their parents during the treatment and early recovery process have healthier, stronger, positive attachment, and significantly lower ACE scores (adverse childhood experiences.) Children are significantly less likely to manifest conduct disorder, anxiety and depression — three conditions which often manifest in substance abuse.
Clinicians at Ohio State University found that when mothers and children were treated together, both were less likely to use substances in the future. In the United States, there are few licensed, evidence-based, inpatient programs allowing parents to enter treatment accompanied by children. Women seeking interventions are limited and threatened by the system and the possibility of losing their child upon admitting they need help. Attached to these barriers is the issue of funding and how they will afford a treatment stay or if treatment will be interrupted because of insurance terms.
We need a well-informed, cross-systems approach combined with services and interventions delivered through a scope of empathy, compassion, and empowerment. Professional systems must hold each other accountable to develop proactive policies for how to respond to this priority population and take initiative to achieve the most efficient collaboration between the criminal justice system, child welfare, treatment and social services agencies, and medical care providers.
We need public health nurses and master’s-level licensed clinicians to serve as advocates in these cases. We know that home visiting nursing programs play an integral role and create strong outcomes for at-risk populations. I urge the justices to consider why these professionals have not been asked to assist in guiding the courts to develop best practice standards for pregnant women with substance use disorder.
When I ponder that snowy night in my childhood and recall the times my grandmother struggled to make ends meet, I also consider my biological mother’s fraught decision. My heart aches for her. It’s clear to me now that many women in her position do not give up on their children. They give up on themselves. They are filled with fear and they lose hope.
For the voiceless children born into addiction, and for their mothers, it is my hope that prior to exacting punishment, those in power contribute to a mother- AND child-focused solution.
This case presents a highly emotional and divisive issue. I challenge my colleagues, my fellow Pennsylvanians, and these justices to be contemplative and compassionate. Always protect the child. Always. In doing so, please remember it is the sum of all actions and all decisions that writes the early pages of a child’s story.