Episode #7: What's Public Health Got to Do With It? Maternal Health, Substance Use, and the Criminal Justice System

This episode explores the unique experience of pregnant people navigating substance use disorders and the criminal justice system. Jenna’s Project, a program of UNC Horizons, works to support people in recovery at the North Carolina Correctional Institution for Women. In this episode, a mom shares her journey navigating incarceration while pregnant and recovering from a substance use disorder, and Essence Hairston, the program’s clinical instructor, offers her perspective on opportunities for the public health field to better support pregnant people who use substances.

Resources:

• Foundation for Opioid Response Efforts: Integrating Obstetrical and Substance Use Disorder Treatment for Pregnant and Postpartum People in Prison
• Prison Policy Initiative: What role does drug enforcement play in the rising incarceration of women?
• National Advocates for Pregnant Women: Punishing Pregnant Drug-Using Women: Defying Law, Medicine, and Common Sense 
• Guttmacher Institute: State Laws and Policies on Substance Use During Pregnancy
   

Transcript

[00:00:00] Jessica Simon: Welcome to MCH Bridges where we lift up innovative ideas and inspiring stories from people in the maternal and child health field. I'm Jessica Simon. I'm a program manager at AMCHP and your guest host for today. 

[00:00:16] If you've seen the news over the past six months, you've likely encountered headlines like "overdose deaths reached record high as the pandemic spread" or "new data shows the U.S. drug epidemic is deadlier than ever". What does all of this mean for the maternal and child health world? It means that more women, youth, and families are struggling with the impact of substance use disorders. It also means that women are being imprisoned at higher rates than ever largely due to substance related charges. And for one North Carolina woman, it means a wake up call.

[00:00:50] Rachel: My day-to-day life pretty much evolved around getting high or how to get it. If we had it, how to sell it so we could have more money to, to get more. It was kind of all by myself, living with my boyfriend. And my boyfriend at the time was, I guess like, was the dope man. 

[00:01:14] Jessica Simon: That's Rachel, a soft spoken, 35-year-old, single mother of three, from North Carolina.

[00:01:20] Rachel: I knew I was pregnant, but there was a part of me that was kind of in denial. I didn't wanna accept the fact that I was pregnant. Like me and my boyfriend knew that I was pregnant, but I was very reluctant to tell anybody, because I know that wouldn't look good that people would, even though they were using too, would say, "my gosh, you're pregnant and you don't need to be doing this".

[00:01:41] Jessica Simon: Rachel is talking about the stigma associated with being pregnant and struggling with a substance use disorder. And she's not wrong. 44 states will prosecute women for substance use during pregnancy while 24 states classify prenatal substance use as child abuse or neglect. Imagine if you're struggling with substance use and faced with these social and criminal penalties that come along with seeking help. Would you reach out?

[00:02:06] Rachel: I knew that when the baby came, I knew that I, there was no way I could stay where I was at. Just because there was just too many drugs around and it just was not a safe environment for a baby. So I knew I needed to get help. I just didn't know really how to go about doing it, especially being alone. So I hadn't, I hadn't actually seeked out any kind of medical treatment up until I got in prison.

[00:02:34] Jessica Simon: Rachel enters jail for charges related to her substance use four months into her pregnancy alone, fearful and unsure of what to expect. She's quickly transferred to the North Carolina Correctional Institute for Women. A transition that very well may have saved her life.

[00:02:51] Rachel: I'd been in jail before, but it was my first time actually being in prison. I was actually thankful that they had moved me to prison so that I didn't have to spend it in jail, cuz I, I don't know that I would've survived it in jail, being pregnant.

[00:03:09] Essence Hairston: Her experience in the jail and being relieved that she was transferred to the women's prison in Raleigh, I think it, it speaks volumes to the jails inability to provide medical and substance use treatment for pregnant and postpartum people, but also for the general population. 

[00:03:30] Jessica Simon: Meet Essence Hairston. 

[00:03:32] Essence Hairston: My name is Essence Hairston and I am a clinical instructor here at the Horizons program in Raleigh. 

[00:03:38] Jessica Simon: Essence is a young, passionate social work professional on the front lines, helping people like Rachel get back on their feet. 

[00:03:45] Essence Hairston: So you have pregnancy, that's vulnerable in itself, then you add on addiction, then you add on homelessness. Then you add on the lack of, you know, familial and healthy supports. And then you add on what Rachel, you know, she talked about surviving, right? She was surviving in active addiction. And so when you put all of that, including incarceration, it is very vulnerable and a very traumatic experience. 

[00:04:14] Jessica Simon: It's clear that the criminal justice system as a whole is not well equipped to support pregnant people with substance use disorders. But let's get back to Rachel's story. Why was the transition from jail to prison Rachel's saving grace? Because that's where she was connected to the Jenna's Project. The UNC Horizons program is a residential and outpatient treatment center for pregnant people that is housed within UNC school of medicine. In 2020 UNC Horizons launched Jenna's Project.

[00:04:44] The project is named after a former patient who died from an opioid overdose shortly after being released from prison, an all too common occurrence. Jenna's project works to prevent overdoses by connecting with pregnant people in North Carolina's women's prison, where nearly all the pregnant people have a substance use disorder. The UNC Horizon staff work alongside the prison clinical staff to provide integrated treatment for both substance use and pregnancy care. Pregnant people are offered medication assisted treatment, which is the best practice to prevent withdrawal symptoms and reduce the risk of relapse. Clients are also offered counseling to navigate their early recovery during incarceration.

[00:05:28] So every time Essence was providing these services in the women's prison, she stopped by to see Rachel and offer to connect her to the program. But at first Rachel was skeptical. 

[00:05:37] Rachel: Well, I just assumed that, you know, it was gonna be like therapy. I didn't realize that it was gonna be so much more than what it was. So finally I, I said, yes, and I went and talked with them and they told me all about this program and it just sounded like an answer to my prayers really.

[00:05:58] Essence Hairston: We know that the research shows that treatment is effective for managing substance use disorders. And so we would like to increase access to substance use treatment so we can really treat the, you know, the root cause 

[00:06:15] Jessica Simon: Rachel's story starts looking up. Jenna's project connects her to prenatal and substance use care and her recovery journey begins.

[00:06:22] Rachel: It was kind of a big surprise. The treatment was actually pretty good treatment and it was like round the clock. Like the longest time I would go without seeing a doctor would be two weeks. I was just thankful that I was getting my medicine and I was getting medical treatment. 

[00:06:40] Jessica Simon: After Rachel spent about four months in prison and is now eight months pregnant, Essence and the Jenna's Project staff save the day once again.

[00:06:48] Rachel: I was scared to death that, that I was gonna deliver while I was in prison. And I, I knew, you know, they were working as hard as they could, like they'd even gotten a judge that worked with Horizons on my case to help them. They ended up, they got me out a little over a month before I had my son. So I'm just really grateful how hard they worked. 

[00:07:13] Jessica Simon: But the challenges that face perinatal people with substance use disorders don't stop once someone is released. 

[00:07:19] Essence Hairston: We'll get a call, whether it's from the jail or the prison, and we will go pick someone up. It doesn't matter the time or the day we've had 2:00 AM, phone calls, 3:00 AM phone calls, picked individuals up, place them in emergency housing, um, and then help get them to treatment.

[00:07:37] We did a lot of telehealth visits with our providers to ensure that they still had access to their medication for opioid use disorder, as here in the state of North Carolina individuals are not provided with their medications upon release. And so within 24 hours, we ensure that individuals can access their MAT or MOUD to maintain the recovery that they started, um, while incarcerated at the women's prison.

[00:08:05] Jessica Simon: Jenna's Project seeks to keep women connected to treatment as they leave prison by coordinating between staff at the prison, county jails and treatment providers. They also help clients find jobs, reunite with their children, rebuild their lives and secure safe housing, including the opportunity to stay at the UNC Horizons residential treatment facility, where Rachel is today.

[00:08:28] Rachel: When the baby came this time, it was, it was really a good experience because I'm, I'm here at this residential treatment program now. And it's just, it's just amazing. 

[00:08:44] Essence Hairston: We have reduced recidivism. So Rachel, you know, she's been here in our program and the courts have been pleased, but we are not surprised because this is what happens when we actually focus on addressing the root of trauma and substance use.

[00:09:05] You know, it is so evident that, you know, treatment works and treatment where women have the right to have their babies and have the right to parent and free, you know, from all other stressors and barriers so they can regroup.

[00:09:28] Rachel: Being like here in this program, like I'm scared to death, like a lot of the girls here, like can't wait to leave, you know, and be on my own. And me I'm like, I wanna stay as long as I can, I'm not trying to leave here. Cuz it's just, it's just so nice, like you just able to focus on yourself, and your recovery. But it's scary too to know that like I'll be, I might have to be leaving soon, but they try to give you all the, the most positive resources, for you to use to your advantage so that, you know, you'll be able to set up like a good start for you when you leave this program, like housing...

[00:10:07] Jessica Simon: Rachel's story has a happy ending because of the transformative and life changing support offered by Jenna's Project and UNC Horizons. I wanted to know how we can take these lessons learned and start thinking about how to improve the system as a whole, for pregnant people with substance use disorders. 

[00:10:22] Essence Hairston: I think racism is the root of it all. If we look back into the war on drugs, which was actually a war on people, and the increase of perinatal incarceration on black and brown women, we see where our policies continue to perpetuate that notion, you know, those punitive outcomes, which is why we see the increase of perinatal incarceration. And so it's really important that we hear from the folks that we are working with individuals in long term recovery, so we can ensure that we get it right. And so also from a, you know, grant writer and thinking about quality improvement and assurance programs, making sure that even on a smaller systemic scale, that we are not reinforcing developing policies without, you know, including individuals that it would impact in the future.

[00:11:17] Jessica Simon: Essence also told me that many of her clients are involved with child protective services, which can be a traumatic experience for families and harmful to both the mom and the baby. Jenna's project works as an advocate for their clients and coordinates with child protective services to keep families together as much as possible. An example, we should all follow across our public health programs. 

[00:11:40] Rachel: So I know, a lot of girls that I was in there with, and including me, they're worried that, you know, because they're pregnant and they're using that's automatically contribute to them losing their child. And I didn't feel like we had a safe space to, to really talk about it.

[00:11:56] Jessica Simon: Essence also talked about the challenges people face after being released in accessing Medicaid coverage and other healthcare services.

[00:12:04] Essence Hairston: It's advocating for health benefits at the time of release or, you know, do not deactivate health benefits at all because again, when you have a pregnant patient leaving a jail or prison, there's the lack of prenatal care or primary care, the stigma. So even if it exists, what Rachel is sharing is what we've heard across the board, of going into medical appointments, I've even worked with clients who delivered at home to avoid hospital and healthcare settings.

[00:12:43] Jessica Simon: Before we wrapped up, I wanted to know what drives Essence to do this work. 

[00:12:47] Essence Hairston: You know, to be quite honest, I feel like reproductive and social justice is what drives me to do this work and utilizing my power and my privilege to advance the perinatal population, and their children. We are honored when individuals want to come to us for treatment and trusting us with their care after, you know, being let down from other providers and systems. But I'm just fortunate, you know, to constantly be educated and guided by the individuals that I work with and I learn from, you know, every day.

[00:13:26] Jessica Simon: Essence isn't the only one that's learning a lot. She's made a real difference in Rachel's life and helped her get back on her feet and maintain her recovery as she parents her newborn baby.

[00:13:36] Rachel: I would've never learned about this program, which opened my eyes to so much more. And I'm, I'm still learning. It's, I guess, gonna be a learning process, but it's like, it's got me off to a really good start.

[00:13:50] Jessica Simon: I'm so grateful to Rachel and Essence for sharing their stories and experiences with us on this episode. It highlights for me the importance of programs like Jenna's project, which is an incredible example of providing equitable and comprehensive support to pregnant people who use substances. A research article authored by the National Advocates for Pregnant Women says it best: "there is an inherent unfairness of a system that expects low income and substance dependent pregnant women to provide their fetuses with the healthcare and safety that these women themselves are not provided and have not been guaranteed."

[00:14:32] It's clear to me that if we hope to truly advance maternal and child health outcomes for all, then access to non-judgmental care and family centered alternatives to jails in prison must also be a priority.

[00:14:56] Maura Leahy: Thank you all for joining us on this MCH Bridges. We kindly ask that you take a few minutes to fill out a quick feedback survey and let us know what MCH related topics you're interested in and who you want to hear from on future episodes. A link to the podcast feedback survey, as well as the transcript of this episode, can be found at www.MCHBridges.org.

[00:15:18] Be sure to follow AMCHP on social media. We're on Twitter and Instagram at DC_AMCHP. We hope this episode created some new connections for you. Stay well and I hope our paths cross on the next MCH Bridges.

[00:15:36] This project is supported by the Health Resources and Services Administration, or HRSA, of the U.S. Department of Health and Human Services, or HHS, as part of an award totaling $1,963,039 with 0% financed with non-governmental sources. This information, content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. Government.