It’s not unusual for a pregnant woman to feel nervous as her due date approaches, but in the months leading up to the birth of her twin daughters, Dionna Johnson’s anxiety reached new heights.
Johnson, whose struggles with addiction led to the termination of parental rights for her three oldest children, was determined that this time she’d be able to stay sober, take her twins, Harmony and Melody, home with her from the hospital and raise them herself — rather than surrendering them to the foster-care system.
“I was scared,” she said, explaining that her history of substance use disorder made it feel like losing her children to foster care was inevitable, that once she entered a hospital to give birth, child protection workers would be waiting in the wings to whisk them away.
But the realization that she was expecting twins somehow made her want to restart her life.
“At first I didn’t plan on keeping them, but it’s harder to try to make a decision to get rid of two,” Johnson said. “I couldn’t figure out what I was going to do with two in the situation I was in at the time. After I found out I was pregnant, that’s when I got sober.” She realized, she said, that, “I was wanting to parent my twins.”
To raise the odds of taking her babies home this time, Johnson voluntarily signed up for Project CHILD, a more than 30-year-old Hennepin County-run program that, with the support of a team social workers, health care providers and case managers, works to increase the likelihood that pregnant women with a history of substance use disorder will be able to maintain sobriety, take their infants home from the hospital and parent them themselves.
Johnson first heard about Project CHILD from a case worker at the transitional recovery housing program for mothers with children at Avivo, a Twin Cities-based addiction treatment nonprofit. When she moved into her apartment at Avivo, Johnson was given the option of completing the organization’s 60-day inpatient program after her twins were born, but she said she decided to jump right in.
“I was kind of scared and upset,” Johnson recalled, “but I wanted to get [inpatient treatment] out of the way. So I told them that I wanted it to happen before I had my kids.”
She was willing to do anything she could to finally raise her own children. Her due date fast approaching, Johnson signed up for Project CHILD and met with Cindy Fleming, her case manager. From there, the wheels of support were set in motion.
A history of keeping families together
Liz Booker has been a case manager at project CHILD for decades, so she understands better than almost anybody about the program’s founding. She explained that, back in 1990, when the program was launched, the focus was on women who used “specific drugs: cocaine, meth, heroin: the opiates. Eventually, in 1999, it expanded to include women who use alcohol and marijuana.”
While the criteria for being included in Project CHILD has shifted over the years, the focus has remained the same, Booker said: “The goal of the program is a drug-free, healthy baby.”
All program participants are pregnant when they join Project CHILD, Booker said, but they can be at any stage of gestation. What’s important is getting the women wrapped up in the web of support that the program provides. “We had one woman that came in at just six weeks. One time, we had one join at 38 weeks.” As soon as that woman signed up, Project CHILD staff jumped into action, Booker explained: “We got her into treatment at 39 weeks.”
Beyond helping clients get into addiction treatment programs, Project CHILD staff try to help individual clients get the different elements of their lives in order so they can up the odds that they’ll be able to avoid child protection involvement and take their children home from the hospital.
This is achieved through intensive case management, Booker said.
“I like to set up a case plan with my clients. If they do have a termination of parental rights or transfer of legal custody on their record, I set up a specific case plan for them which would include treatment.” If a client says she doesn’t want to go to treatment, Booker said she has another option up her sleeve: “I am able to take urinalysis here and keep track of their (urine tests) to make sure that they are clean.”
Case managers also help participants gather supporting evidence of their efforts to stay clean and focus on their parenting skills, Booker said. “I tell clients, ‘I don’t want you to just go to treatment. I want you to do treatment. I want that counselor to know you. I want that counselor to write you the best supporting letter ever that you’re changing your life.’”
Having parental rights terminated is a traumatic event, and many of the women enrolled in Project CHILD bear the lasting scars of that experience, said Alexandra Kraak, Hennepin County behavioral health manager. She explained that the program serves mostly Indigenous and Black clients, so this trauma only piles on to other historic traumas.
Making recovery stick and keeping biological families intact requires a deep understanding and a commitment to addressing existing inequities, she added. “When you add layers of race and substance use disorder, there is a high degree of medical advocacy that needs to occur to ensure that people get the kind of quality care and service that they are owed to be able to stabilize and stay healthy and work on recovery goals.”
One way that Project CHILD workers try to address this issue is by offering options for participants to work with people who have similar life experiences. Makela Roberts-Virden, Project CHILD staff nurse, adds medical insight to participants’ addiction care.
In her meetings with clients, Roberts-Virden, who is Black, said she tries to take a softer approach in her interactions. “I really start lightly with them to build rapport and make it understood that I am a mandated reporter, but I am also here to build a relationship with them and learn what recovery looks like for them,” she said. While the goal of taking a healthy baby home after birth remains at the forefront of her work, she’s also focused on “recognizing that some of our women are struggling with coping and mental health and social and economic issues and that might be why they are using substances.”
Leading up to the birth of her twins, Johnson continued to struggle with a fear that somehow these children could also be taken away from her. She was afraid that increasing stress could cause her to relapse in her recovery, so Roberts-Virden offered to help her with medication-assisted treatment to ensure that she didn’t fall back into drug use during the postpartum period.
Roberts-Virden visited Johnson a few days after the twins’ birth. “I went to Dionna’s house to do a postpartum care visit and check on her and the state of her mental health during that transition,” she recalled. “We discussed the change, we discussed the environment, we discussed any sort of temptations.” Though Johnson had met her goal of bringing Harmony and Melody home from the hospital, she still had many stressful days ahead.
Roberts-Viden said she focused on continuing to support Johnson through the postpartum period, with “just a lot of reassurance and work with medication management and different coping skills. I wanted her to continue to meet her goals.”
Pilot program extends support
To further ease the fears of participants, Project CHILD instituted a new pilot program that helps bridge gaps and make proactive connections between mothers and child protection investigations social workers.
Allyssa Mashak, Hennepin County child protection supervisor, explained that the pilot program was created after Project CHILD staff and a Hennepin County Medical Center social worker “identified a gap in services to parents who were expecting who had a prior loss of rights but were actually currently sober.”
Traditionally, Mashak said, child protection was not allowed to interne with parents until after their children were born. Too often, she explained, that arrangement led to anxiety and miscommunication between both parties: “Moms feel that this person is coming to investigate their parenting, but they don’t really know what’s happening.”
In the pilot program, Project CHILD participants meet with their child protection social worker while they are still pregnant, so they can let them know about the focused work they are doing to get and stay sober and develop clear plans for caring for their children after they are born. This is where Booker’s support letters come in handy.
Johnson explained that she met with her child protection investigations social worker a week before she gave birth to her twins. “He reassured me that everything was going to be OK,” she said. “He let me know what to expect, which was nice.”
At the meeting, the social worker told Johnson that he’d reviewed her records and her urine test results from the treatment center. “He said that everything was looking good on his end as far as me being able to keep the twins as long as I kept it up,” Johnson said. “He told me to stay in all of my groups.”
After that meeting, Johnson said, “I wasn’t as worried, but I still kind of was worried about what would happen after they were born.”
After Johnson gave birth to her twins, the child protection social worker visited her in the hospital. “Once again he reassured me when he was there that everything was going to be OK and I was going to get to take them home,” she said. “Then he met with me once I made it home, too.”
The pilot program was created to reassure parents like Johnson that child protection workers can be trusted to act as part of the team that’s working to help them safely parent their children, Booker said. Regaining trust in the system is key to keeping participants connected and their children receiving essential services.
“Before the pilot program, we would lose our clients at the end of their pregnancy,” Booker said. “There was so much anxiety. They were thinking that when they had their baby at the hospital, child protection was going to take that baby and put a hold on it.” She explained that the pilot program “helped ease that anxiety because they get to meet their child protection worker.”
Easing a mother’s anxiety leads to better outcomes for everyone, Mashak said. When participants get an opportunity to connect with child protection workers in advance, she explained, “We can make a plan together to get rid of some of that anxiety. A lot of times that would get rid of a lot of the need to do a removal at birth, because child protection workers see that the patient is currently sober and there is a plan in place.”
Johnson’s twins are now seven months old. The girls, dressed in matching Halloween-themed outfits for a mothers’ support group at the Hennepin County Behavioral Health Center, look healthy and happy. Johnson is proud of their growth — as well as the hard work she’s done to keep them at home with her.
Johnson’s Project CHILD support workers say that she has every reason to be proud of her accomplishments. “Dionna’s done an amazing job with twins,” Fleming said.
Roberts-Virden agreed. She turned to Johnson, and said, warmly, “You finally met your goal. You were able to take your beautiful twins home.”
At that, Johnson smiled and nodded her head proudly. But she didn’t have time to chat. She was focused on getting to her support group on time. She knows that focusing on her recovery is key to keeping her family together and intact.
“My peers and the support I get being around other women that have been through the same thing is reassuring,” Johnson said. “It’s comfortable talking to everyone — and it helps me feel like I can keep us together.”
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