Access to residential substance use treatment for mothers and their children is foundering across Montana, a new report from a group of maternal health advocates found.
Mothers could wait up to six months for a residential bed or be unreachable by the time a spot opens up due to homelessness and other barriers.
Data shows pregnant women in the state use substances during the last three months of pregnancy at rates above the national average. One estimate suggests it could be as high as 22% of pregnant women.
Babies born to mothers who use substances while pregnant are more likely to experience neonatal abstinence syndrome, birth defects or stillbirth. Women who use while pregnant are at greatest risk of miscarriage and dangerous health conditions such as preeclampsia.
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As of 2016, just 6% of the state’s approved treatment facilities reported having programs for pregnant and postpartum women who can bring their children with them, according to the Montana Health Care Foundation, leaving moms who struggle with substance use without many pathways to recovery.
Despite the clear need, “a severe shortage of treatment” for pregnant and postpartum women persists.
Healthy Mothers, Healthy Babies and the Missoula County Perinatal Substance Use Network conducted a survey of treatment and sober living facilities in Montana between Aug. 1 and Aug. 31, 2023, to identify resources available to parents needing services while still watching over young children or infants.
Where are the facilities?
The report identified 14 known facilities statewide, including mental health centers, sober living homes and treatment facilities. Sober living residences, defined by the report as offering housing but no treatment programs, are the most common.
Of the 14 identified, it reached and interviewed 13 locations that account for a total of 103 adult beds. They offer care ranging from outpatient services paired with housing to clinically managed treatment. Authors noted it’s possible additional facilities exist but were not discovered during the research process.
Most facilities that admit mothers with children are located in Billings, Helena and Missoula. There are no such facilities in Gallatin, Cascade, Butte-Silver Bow or Beaverhead counties, despite containing population areas, according to the report.
Authors surveyed five licensed treatment programs and one unlicensed treatment program. Licensed treatment programs can provide different levels of care. For example, Mountain Homes Montana in Missoula provides the most basic level of care, offering outpatient treatment at an office attached to a residential home for mothers and children. The YWCA in Helena bumps up a level, as it also pairs outpatient treatment with residential living, but provides more intensive treatment. Florence Crittenton Recovery Home in Helena is a residence home that integrates treatment into its work.
Five of the facilities self-identified as faith-based.
Two licensed treatment facilities serving mothers with children recently converted to facilities for single men, one in Missoula and another in Billings. That leads to fewer adult beds statewide for mothers. There are also two facilities, both faith-based and located in Billings, for fathers with children.
Barriers
Existing facilities that accept parents with children encounter many roadblocks in day-to-day operations and in trying to grow their capacity.
According to the report’s findings, one of the most commonly cited challenges is connecting with clients sitting on a wait list. People are generally referred to these residential facilities from elsewhere. It could be Family or Drug Court, community partners, Child and Family Services or any number of other places where an individual’s need is identified.
But there’s typically a waitlist that lasts weeks, if not months.
“Maintaining a cell phone or other method of contact can be impossible when someone is struggling with substance use, mental health disorders, homelessness and parenting or any combination of those,” the report states. “Over such a broad timetable, the information to reach clients can change multiple times, they may not even be enrolled in the program that referred them.”
Funding also proves difficult.
Licensed treatment providers that also provide housing can put multiple adults in one room, which means they can bill Medicaid multiple times even if only using one residential unit. By comparison, those that house parents and children must provide, for example a private room, to the mother and child. Therefore their total reimbursement for one residential unit is lower.
Eleven of the 13 programs surveyed said they must use grant funds to pay their bills. Nearly half also rely on private donors.
Finally, there are limits on the use of medication to treat opioid use disorders, considered the best way to help people overcome opioid addiction.
Of the facilities included in the report, six allow any kind of medication-based treatment.
Three sober living facilities allow Suboxone but prohibit Methadone. Both medications are used to treat opioid addiction, but the latter can lead to more intense side effects and can be addictive. Other facilities employ a smattering of restrictions, including a number of faith-based programs that don’t prohibit medication to treat opiate addiction altogether.