School of Nursing expanding recovery program for mothers with SUD and children


The School of Nursing at UT Health San Antonio has received $16 million from the Texas Department of Health and Human Services (DHHS) to expand its successful Casa Mia recovery program for pregnant and parenting mothers with opioid use disorder (OUD) and their children, and expand these services to women with any type of substance use disorder (SUD).

The program provides the structure and support needed to help mothers turn their lives around and bond with their babies and children, breaking the cycle of trauma, homelessness and family instability,” said Lisa Cleveland, PhD, APRN, FAAN, professor in the School of Nursing, who leads the program.

About $9 million of the funding will be used to replicate this successful recovery program in two additional Texas communities through partnerships with national nonprofit agencies — Dimas Charities in Corpus Christi and WestCare Foundation in Fort Worth and to maintain the current San Antonio location. The remaining $7 million awarded will be used to pilot a new supportive housing program that will offer safe, affordable housing with wrap-around social services for new graduates of the program in San Antonio as they learn to live independently. WestCare Texas will partner with the School of Nursing on this supportive housing pilot project. WestCare Texas is the Texas chapter of a family of tax-exempt nonprofit organizations that provide a wide spectrum of health and human services in residential and outpatient environments,

Dr. Cleveland initiated Casa Mia in November 2018 with Crosspoint Inc., a longtime local provider of behavioral health, community justice and residential transitional services. The program is currently operated in Pryor House, a two-story, historic home located in downtown San Antonio and owned by Crosspoint.

“Since opening Casa Mia in 2018, we’ve provided housing for 61 adult women and 48 children for a total of 109,” Dr. Cleveland said. “Approximately 10 of our residents have given birth while living at Casa Mia and at least 20 moms have regained custody of their children. Residents who ‘graduate’ from Casa Mia are eligible to return if they encounter challenges in their recovery or housing status, and five women have done this so far,” she added.  

The Casa Mia model is novel since currently, very few programs in the U.S. offer recovery housing and programming for both women and their children.

More often than not, if a pregnant or parenting woman has an SUD, Child Protective Services becomes involved. If there are no safe living arrangements for the baby with family or friends, the baby will likely enter the foster care system.

“Many of these mothers have experienced significant loss and personal trauma throughout their lives. While placing their children in foster care may initially seem to be in the best interest of the children, this approach prevents mothers and babies from bonding and then continues the ongoing, intergenerational cycle of trauma that has long-lasting, negative consequences for entire communities,” Dr. Cleveland said.

Crosspoint’s staff supervises life at the home and provides recovery-focused case management while the women attend treatment programs offered by community partners and work toward reunification with their children.

Following birth, the mothers are assisted in regularly visiting their babies in the hospital, where the newborns may stay for weeks if they experience withdrawal symptoms called neonatal abstinence (NAS) syndrome. The symptoms of NAS may include inconsolable crying, seizures, weight loss, difficulty eating, vomiting and diarrhea.

For mothers with children not in their custody, they have an opportunity for reunification that begins with visitations, which can progress to overnight stays at Casa Mia and the child eventually moving in with their mothers full time.

Casa Mia partners closely with local programs that offer a community approach to helping mothers recover from substance use disorder by attending a 13-week series of parenting and life skills classes. One of those programs, which Dr. Cleveland helped disseminate statewide, is the Center for Healthcare Services’ Mommies Program that promotes the use of medication for opioid use disorder, such as buprenorphine and methadone.

Mothers progress by establishing and maintaining recovery, completing their education, finding a job, obtaining stable housing and regaining or maintaining custody of their children. “Statistics show that 70% of women with SUDs are the primary caregivers of young dependent children and when children are allowed to remain with their mothers, women are far more likely to achieve successful, long-lasting recovery,” Dr. Cleveland said. Casa Mia statistics show that 63% of mothers maintained their recovery during their stay and 93% remained arrest-free while in the program. Sixty one percent were substance-free and had a stable place to live upon discharge.

School of Nursing students have the opportunity for class projects, clinical rotations and community-based research at Casa Mia. With capacity holding at more than 80%, the School of Nursing and Crosspoint are partnering on a new Women’s Wellness Campus on San Antonio’s East Side to double the program’s capacity.

Dr. Cleveland said, “Our goal is for this program to become a national model of best practices in the care of women and children impacted by substance use. We have already seen many of our clients become more capable mothers and productive members of society.”

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