Welcoming pregnant women, where others turn away

At a time when some addiction treatment programs maintain a refusal to admit pregnant women, and as some government policy-makers move toward criminalizing substance-using behavior during pregnancy, two organizations in South Florida are moving aggressively to create a strengths-based approach that seeks to help women overcome fears about pursuing treatment.

The Pregnant Addiction Solutions initiative involves a collaboration between two facilities in Broward County: Reawakenings Wellness Center, which provides detox services, and LakeHaven Recovery Center, which offers partial hospitalization services with community housing as part of its outpatient continuum of care. LakeHaven's vice president of clinical services explains that it is important for such programs to confront directly the severe social stigma facing pregnant women with substance use problems.

“These women will seek prenatal care for their baby, however.” says Barbara Brockmeier, LCSW. “If we're able to identify the problem then, and make it safe for her to seek treatment, that's a great opportunity.”

Expectations differ

The trajectory of treatment for the pregnant woman will not look the same as treatment of the broader population. Brockmeier says program leaders expect a somewhat lengthier detox stay for the pregnant patient, usually at least 10 days.

She says her Pompano Beach-based outpatient facility generally treats individuals accessing care through an out-of-network insurance benefit. LakeHaven takes a medication-free approach in treating these women, so none of these patients are on maintenance doses of buprenorphine or methadone while in treatment.

From a clinical perspective, professionals must remain aware that confrontational approaches won't work particularly well with this population. “These women have a fear of being judged by others,” says Brockmeier. “A supportive environment is the best way to help the woman feel safe.”

Shame and guilt are prevalent in all addictions, but may be an even more significant factor for the pregnant patient, she adds.

Therefore, the LakeHaven approach is heavy on Motivational Interviewing and cognitive-behavioral techniques. Professionals in the program must remain aware of the physical issues that can have an impact on treatment, from the increased fatigue that a pregnant woman might experience to her need possibly to put her feet up on the table during group, even if that's usually against the facility's rules, Brockmeier says.

She says that programming for pregnant women must include components of maternal health intervention, maternal behavioral health, parent-child attachment, and aftercare planning. All pregnant patients must be under the care of an OB-GYN while in treatment at LakeHaven Because many of the patients in this program arrive from outside the region, sound discharge planning that includes care management and life skills is essential. Pregnant Addiction Solutions is undertaking a national outreach effort for this often stigmatized population.

Brockmeier says she was attracted to work at LakeHaven because of the opportunity she was given to build an individualized treatment program. She is hoping to move in the direction of being able to conduct groups consisting of pregnant women only.