By Savannah Koplon
Kate (name redacted for patient privacy) was five months’ along when she found out she was pregnant. During a doctor’s visit, she failed a drug test. Kate had struggled for years with addiction to heroin and prescription drugs but had no idea she was using while with-child.
Kate was referred to the University of Alabama at Birmingham’s Comprehensive Addiction in Pregnancy Program (CAPP) within the Division of Maternal Fetal Medicine. In Alabama, it is a felony offense to use drugs during pregnancy, as a result of the state’s Chemical Endangerment Law. CAPP’s multidisciplinary, outpatient approach aims to help vulnerable mothers who voluntarily enter the program with prenatal and postnatal care, navigating government systems and resources, social work support, opioid replacement therapy, and ultimately, recovery.
In April of 2019, CAPP celebrated its first year of care, enrolling 48 women in the program. Since July 2018, 22 women have successfully completed a treatment program.
The CAPP program, funded by the University of Alabama Health Services Foundation General Endowment Fund and the Children’s Bureau, has helped mothers like Kate who face challenges and confusion about how to access available resources to reach sobriety in both pregnancy and motherhood.
“The women we treat face tremendous barriers to care during pregnancy, including social stigma, legal consequences, transportation, poor communications between providers and limited facilities for addiction treatment programs,” said Lorie Harper, M.D., maternal-fetal medicine specialist and director of CAPP. “In this first year, we have exceeded our own expectations and have created a sustainable model of care for vulnerable patients who not only need our direction and resources, but truly are buying into our program of sobriety and success.”
CAPP is one-of-a-kind in the state of Alabama, and provides a full complement of obstetric addiction therapy, including opioid replacement therapy, subspecialty pediatric follow-up, care coordination, social services, peer recovery support and in-home parenting education. Many of the mothers CAPP supports would not seek recovery-based services during pregnancy out of fear of criminal consequences and the shame often associated with substance use. However, for mothers like Kate, enrolling in CAPP’s intensive outpatient program was absolutely key in detoxing and reaching sobriety — something she has maintained in the nine months since her son’s birth.
“Getting sober took a lot of work; but my son motivated me more than anything, and CAPP gave me the tools to accomplish everything I did,” Kate recounted. “This program saved my life; the CAPP team held my hand until I could walk on my own. They helped create the path that I can walk on today.”
For Kate, the unwavering support from the CAPP nurses, social workers, physicians like Harper and her program peers gave her a sense of belonging and encouragement in a judgment-free zone. She sings the praises of the intensive outpatient care provided by the CAPP team, noting how exceptional and individualized the care she received was.
Kate experienced what she remembers as intense judgment from another physician in the community, something she feels further stigmatizes expectant mothers who are trying to get sober.
“CAPP provided such a safe space where I could grow and learn. I wasn’t just learning how to be a mother, but I was also learning how to be the best version of myself,” Kate said. “Knowing the CAPP team was investing in all aspects of my sobriety and journey made all the difference. Dr. Harper even stayed by my side during all 30 hours of my labor — that’s just one testament to what this program provides.”
Harper notes that the mothers like Kate who voluntarily enter CAPP — most usually referred from partner agencies and UAB prenatal clinics — are going through such adversity during what should be an amazing journey to motherhood. CAPP’s goal is that, through their one-stop-shop approach to sobriety and prenatal care and education, the women they help will ultimately continue along their journey of success once they graduate from the program.
“The women we serve are getting prenatal care and resources, but they are also working on themselves with everything else that’s going on in their lives that led them to this point. They are really resourceful, strong and self-sacrificing, and want to overcome their addiction for themselves and their baby,” Harper said. “We’ve tried to cultivate a community where there’s no shame and stigma, but rather where these mothers can get the critical medical care that both they and their baby need and have guidance and access to resources to help them live a sober life.”
In reflecting on the care that CAPP has been able to provide so many mothers, Suzanne Muir, UAB Substance Abuse Programs associate director and principal investigator for the Children’s Bureau funding, sees ways for the program to expand even more in the years to come.
“We serve such a vulnerable population, and while I think we are meeting a lot of gaps in care for our patients, we find new ways to add to our care portfolio with each patient we see,” Muir said. “Our goal is for mothers to leave the hospital with their child. If we can get them the treatment they need, they can become healthy and stable for themselves and their child.”
While success is celebrated, CAPP’s directors see countless ways to continue to grow the program in time, including reaching more patients outside of UAB’s direct Birmingham footprint with telemedicine, supporting fathers in the pre- and postnatal journey, continued postpartum care, and connecting to early intervention services, as well as in identifying further community support.
One example of such support that can impact the program’s offerings is the creation of the “CAPP Cash Program” with a grant from the Jefferson County Public Health Advised Fund of the Community Foundation of Greater Birmingham. With the generous gift, CAPP plans to open a store within the clinic where mothers can shop for items including car seats and other necessities. This teaches patients accountability and positive rewards association while helping them secure items they need in order to care for their baby.
In looking forward, Muir explains that there is such a need for CAPP’s services and system, that expansion is inevitable as more expectant mothers seek support.
“We’re working hard to remove barriers to care, and while we need to continue to focus on what we can do locally, I look forward to being able to take this a few circles out and see if we can have an impact on a bigger footprint and population,” Muir said. “There’s such a shortage of treatment in Alabama, and as much as we scramble here in Jefferson County, we are still considered resource-rich. To be able to bring the model to other Alabama women in need of care would be amazing.”