Women and children first

Generally speaking, most women’s identity and sense of self tend to revolve around relationships. For mothers struggling with addiction, the relationship that most often affects their battle toward recovery is their children. But due to a variety of circumstances, those women often have to face a difficult choice.

“If women do the right thing and get help, they have to do the wrong thing and give their kids to someone else,” explains Francine Feinberg, CEO of Meta House, a women’s treatment facility in Milwaukee that more than 25 years ago introduced a program whereby children could live with their mothers during treatment.

According to Feinberg, many of the women she saw back then needed an approach to recovery that “revolved around the role that was most important to them, defined them, and absorbed their daily life.”

When a woman first seeks treatment at Meta House, she is asked a series of questions. The most important, according to Feinberg, is “What do you want to be?” Invariably, the answer is always the same.

“They say they want to be a good mother,” she says. “Fortunately, sobriety is a necessary part of reaching that goal.”

Barriers to bonding

In one respect, women can see their obligations to their children as a barrier to seeking treatment. There may be issues with finding or paying for daycare or not trusting family members, or fears of losing the child to the welfare system.

“There are certainly women who need treatment but can’t access it because their children have no place to go,” explains Doug Paulson, program director at Wellcome Manor Family Services in Garden City, Minn. “But it also may be more of a perceived barrier.”

Offering a service that removed that barrier was one of the goals when Wellcome Manor opened its doors in 2007.
Initially focused on providing a simple daycare option, Paulson says the goal soon shifted to working directly on parenting during treatment because “it’s just more effective to have moms and kids here, working together.”

For women struggling with substance abuse, that relationship doesn’t always come naturally. According to Feinberg, almost every woman who walks in the door has a history of “severe, unremitting trauma” that has a significant impact on their abilities as a parent.

When these women become mothers, they are often emotionally distant with their children and develop a negative sense of self as a result. Of course, those feelings of inadequacy help fuel their chemical dependency. But if they can bond with their kids, these programs show that lasting sobriety can follow.

“If you’re doing well at the thing that’s most important to you in your life, you feel confident. That’s a good thing when you’re trying to stay sober,” explains Feinberg.

Integrating treatment programs

Not surprisingly, children of mothers with chemical dependency are struggling, too. Many children exhibit obvious behavioral issues; some even refuse to eat. When Meta House first started its program, Feinberg says it took “all of 10 minutes” to realize the need for an entirely new child-focused program.

“When a 2-year-old child you’ve never seen before runs right into your arms, you know that’s trouble,” Feinberg says of one experience she had. “It feels nice, but that child should be looking to their mother to find out if this person is safe.”

When children are not part of the treatment process, those behaviors can persist even after treatment. Since children typically spend that time in foster care, nothing has changed for them. So when mothers attempt to “reintegrate” with their children, Paulson says “a whole new set of stressors” can be introduced.

“A woman might go through treatment, implement these changes and develop these new skill sets, but she hasn’t addressed any of it with her kids,” he explains. “That’s why it makes such a big difference when they’re able to go through it together.”

Feinberg notes that Meta House’s programs are based on a “relational model,” which means that whatever activities are being done with the children, the mothers are involved as well. A significant part of the process involves observing each woman’s parenting skills.

“Many of these women have never been a parent while they were sober, so they have no idea what to do,” notes Feinberg. “We realized that we needed people who knew how to teach them.”

Both Meta House and Wellcome Manor now offer programs that teach mothers how to be a “therapeutic agent” for their children. To “encourage and promote interaction,” Wellcome Manor prohibits the use of common distractions such as portable DVD players or electronic gaming systems. In addition, they conduct parent/child interaction therapy, in which mothers are “coached” in real-time.

“They have a little wireless earpiece, and a parenting counselor coaches them on how to interact and redirect their kids,” explains Paulson. “They are given specific tasks and evaluated on a monitor. That way only the mom is the focus, and not an instructor.”

In addition to parenting lessons, child and family specialists help clients learn basic skills such as cooking, cleaning, self care, nutrition, money management, and how to make the home safe. And while these tasks can be difficult at first, Paulson says the children’s presence often provides the necessary motivation. Sometimes, given all of the other ways the woman has torn her life asunder from substance abuse, parenthood might be the only remaining factor motivating her into treatment.  

“We take a very tactful, soft approach, but we bring about awareness of how these behaviors impact their children,” Paulson explains. “And that can be very motivating.”

Administrative aspects

As with any new program, an idea isn’t enough. The right people need to be there to make it work. For Meta House, Feinberg says it was recognized early on that building a new team, one that included child treatment professionals, would be critical if the program was going to succeed.

The team now includes alcohol and drug abuse counselors, mental health specialists, child and family therapists, parenting specialists, specialists who teach living skills and vocations, infant mental health specialists, maternal health nurses, psychiatrists, psychologists, and several child and family “facilitators,” who help make sure the mothers are implementing what they’ve learned. There are also several consumer peers on staff.

Of course, there were some growing pains in the process. With so many different disciplines involved, people naturally would see things differently, or “speak different languages.” Feinberg says the initial challenge involved getting everyone to work together.

“There was the natural tension that is going to occur, when sometimes what’s good for the child isn’t good for the mother—or vice versa,” she explains. “That’s just a question of consistency and time, having a philosophy, constantly communicating, and developing systems.”

While Wellcome Manor has had children residing with their mothers all along, the initial vision of offering daycare to enable mothers to seek treatment quickly expanded to fostering “parent/child interaction.” Now a variety of specialists are on staff, including a parenting coordinator, parent aides, mental health therapists, chemical dependency counselors, and daycare staff members.

“They are all privy to what is being worked on in treatment plans,” notes Paulson. “We make sure that everyone is on the same page and knows what every client is working on.”

And because women in substance abuse treatment are often involved in the child welfare and/or criminal justice systems, case management is an important factor, too. At Wellcome Manor, for example, 60% of female clients have open child protection cases. Plus, there are numerous issues related to children’s activities, doctor’s visits or court appointments. In many cases, simply organizing that process can take a month or two.

“Everyone has plans for them, schedules, requirements, probation obligations. These things often conflict and no one can manage it all,” Feinberg says. “So case managers have to get it organized and get all these people together to come up with a single plan.”

In the end, training is only one part of the process. There also needs to be an administrative presence involved, according to Feinberg. That’s because this type of treatment requires a “very specific way of being with clients,” and there can’t be more than one approach.

“It’s a culture in terms of how staff treats one another, and you want it to trickle down to how they act with the mothers and children,” Feinberg explains. “It’s never allowing things to go on that are inappropriate, but also never being demeaning, regardless of what you see.”