Who cares? Mothers forced to choose treatment or their kids

CrossCurrents

By Avril Roberts

Heads – go for substance use treatment. Tails – take care of my kids. It sounds like a cruel coin toss. But it is a dilemma that many mothers with substance use issues face because most treatment programs do not provide child care, and many residential programs do not admit women with their children. “If you are a parent responsible for small children and you have nowhere safe to leave them, you are not going to go for treatment. That’s the bottom line,” says Gloria Chaim, deputy clinical director of the Child, Youth and Family Program at the Centre for Addiction and Mental Health in Toronto.

The lack of accommodation for children is one of the most significant obstacles for mothers to accessing substance use treatment. Some women never enter treatment because they do not have adequate child care. Others may be distracted by or have to leave residential treatment early because of child care problems and worries about the welfare of their children while they are away in treatment. Some women never enter treatment because they fear losing custody of their children.

Much of why women’s unique treatment needs haven’t been acknowledged has emerged from the context in which addiction services have evolved. “Historically, we approached addiction treatment through an individual lens,” says Chaim. “We didn’t do a good job of asking people if they had kids. And sometimes we didn’t want to get involved in child welfare issues.” The thinking was: “Our responsibility is to help people deal with their addiction; dealing with family issues can come later,” says Chaim. “The system was adult treatment-focused and didn’t take a holistic perspective as more service providers do now.”

Indeed, innovative services – though far too few – are emerging across the country that provide comprehensive services to women and their children together, decreasing maternal substance use while promoting healthy family outcomes.

Peardonville House is a residential substance use treatment centre in Abbotsford, British Columbia. It is the only substance use treatment program in the province, and one of the few in the country, that allows women and their children to live together. While the women receive treatment, their children attend day care. This 10-week Moms and Kids program, which accepts women age 19 and older, gets many referrals from the B.C. Ministry of Children and Family Development.

“What makes us unique,” says executive director Milt Walker, “is not just that moms and kids can reside together, but that the children are cared for during the day and for part of the evening in a fully-licensed onsite day-care centre where staff have credentials in child and youth care and early childhood education (ECE) and some hold infant toddler licences [ECE that specializes in children under age three].”

Having day care onsite is absolutely necessary because an integral part of treatment at Peardonville is Nobody’s Perfect, a parenting skills program where mothers are observed in their interactions with children and receive demonstrations of appropriate interactions on the spot.

The program can accommodate 20 mothers and eight children under age six. There was a deliberate decision to limit the program to preschoolers to eliminate school disruption. Up to two children are accepted per family; the average age is two.

In compliance with provincial health ministry regulations and community care licensing, each child is under a temporary placement order allowing the child to reside in an adult residential treatment facility. Children remain in their mother’s custody, not the centre’s.

The Mom and Kids program has had a three- to four-month waiting list since its inception in 1992. Currently, 50 mothers and their children are waiting to get in. “We’ve filled a definite need in the province, but our waiting list indicates clearly that we’re only scratching the surface,” says Walker.

Across the country, at the Jean Tweed Centre in Toronto, mothers attending the centre’s daytime programs can bring their children to a fully-equipped child development centre staffed by ece consultants cross-trained in substance use counselling. The centre is on the verge of accreditation as a fully licensed day care. Jean Tweed doesn’t yet have the capability for children to stay overnight in its residential treatment program, but it offers enriched child development and parenting skills programming.

Lucy Hume, director of clinical services, remembers one young mother who travelled an hour each way with her seven-week-old baby to get to Jean Tweed: “We realized how ridiculous it was to expect this sleep-deprived new mother to attend all her medical appointments, breastfeed her infant on demand, be here all day for five days a week and still be alert and present in programming,” says Hume. “A few more instances like that and we knew we had to offer something else. Programming should accommodate the needs of women, not the other way around.”

In summer 2006, Jean Tweed launched a pilot program called Moms and Kids Too that is slated to continue until December 2007. The 21-day treatment program runs three days a week, stretched over seven weeks. Starting with breakfast every day, the program adds parenting skills, child development and moms and kids playtime to the core components of substance use treatment. “In addition to offering integrated services, we wanted the program to be sufficiently flexible so that a mother could attend to other needs in her life and still succeed in the program,” says Hume.

No one appreciates this more than Petra, a 34-year-old single mother with four children under age three. Last year, Petra made the 45-minute trip across the city, three days a week, for seven weeks, with her three-year-old son to attend Moms and Kids Too while family members cared for her triplets. The availability of child care at Jean Tweed allowed Petra to concentrate on her treatment, while spending time during breaks with her son in the child care centre in an environment that was less stressful than at home.

Petra appreciates the integration of children into treatment, particularly the parenting skills component: “Staff see you and your children – how you socialize with them, play with them and show that you love them,” she says. “Too bad there aren’t more places like that.”

Pathways to Healthy Families is another innovative program, in which Jean Tweed has partnered with four community agencies to better identify and work with substance-using pregnant women and mothers of children up to age six. Pathways team members work in diverse communities across the city: a community health centre in a neighbourhood with a sizeable immigrant population; a young parents’ resource centre; a shelter for pregnant teens and young, single mothers with babies; and a child and family service/child welfare agency serving First Nations, Inuit and Métis populations.

The agencies provide outreach services – meeting women in their homes, in shelters and on the streets if necessary to do assessments and referrals. “When a woman decides to make a change, it’s important to reach her as quickly as possible,” says Alita Sauvé, a Pathways outreach counsellor for pregnant and parenting women at Native Child and Family Services of Toronto. “Pathways is unique in creating an opportunity for women of different cultures to connect to what that they need to do to reach their goals for substance use and to enhance their ability to connect with their children,” she says.

Funded by the Ontario Ministry of Health and Long-Term Care, Pathways has served more than 500 women since its creation as a pilot project under the Ontario Early Years Addiction Initiative in 2002.

The Children’s Aid Society of Toronto (CAS) and Catholic Children’s Aid Society of Toronto (CCAS) are major referral sources to Pathways. “We have clients in common,” says Debbie Schatia, assistant branch director of cas Toronto. “For us, the child is the primary client, but if the mom benefits from substance use treatment, that’s also going to benefit her child,” she says. “Pathways has made a lot of effort to understand our work and mandate, as we have theirs.”

Given the high level of trust that Pathways counsellors develop with their clients and their intimate knowledge of their clients’ lives, they help to smooth the relationship between the women and child welfare agencies and participate in decisions about whether a child should remain with a parent or be placed in temporary or permanent care. “It’s important for us to use resources like Pathways to try to get support in place so parents have the best chance to deal with their substance use issues and their children’s needs at the same time,” says Schatia.

Contrary to public perception that cas automatically removes children from the home if a mother has substance use issues, Schatia says, “It’s a last resort. Before we remove the child from the mom’s care, we look at alternatives. Can the mother move in with someone and get treatment and still be involved in the care of her child? If a mother is using heroin on the street, that wouldn’t be safe for her child, but are there other people who may be able to take care of that child?”

Kinship care is a new legal custody option in Ontario, thanks to amendments passed in 2006 to the Ontario Child and Family Services Act. Wherever safe and appropriate, children may be placed in the care of grandparents, extended family members or a community member with whom the child has a relationship.

If a child is taken into care, Pathways workers help clients understand cas requirements, for example, explaining that within 12 months, a permanent custody plan has to be in place for a child under age six, and within 24 months, for children six years and older. Helping women understand this reality is often the first step in initiating the lifestyle changes needed to resume parenting, says Hume.

Understanding the reality of women’s lives by accommodating children in substance use treatment programs means better outcomes for mothers like Petra and her children. “I have to be strong,” she says. “I may have to get help again, but whatever it takes, I don’t want to lose my kids. I love them to death.”

 

For more information about Pathways to Healthy Families and other Jean Tweed programs, visit www.jeantweed.com. For more information about Peardonville House, visit www.peardonvillehouse.ca.

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