Hendrée Jones, Ph.D., Executive Director of UNC Horizons, a residential and outpatient treatment program for pregnant women and mothers experiencing substance use disorder in North Carolina, was recently given the American Society of Addiction Medicine’s R. Brinkley Smithers and Distinguished Scientist Award for her accomplishments in advancing the scientific understanding of addiction and its prevention and treatment. With support from the Foundation for Opioid Response Efforts (FORE), Jones is now preparing to launch Jenna’s Project, named after a patient who died from an opioid overdose shortly after being released from prison. We spoke to Jones about her work and how FORE’s grant funding will help fill an important gap in the continuum of treatment and support services for women.
What motivated you to specialize in this area?
Jones: I can trace it back to childhood. My mother taught children who had severe developmental disabilities and cognitive challenges. Three in particular changed my view of the world and set me on my path. One was a boy who had been affected by exposure to lead paint, another was a girl whose mother had been the victim of violent abuse while she was pregnant, and the third—a girl with my exact same birthday—had full-blown fetal alcohol syndrome. I remember looking at her and thinking, that could be me if my mother drank. My Ph.D. research focused on prenatal inhalant use. As part of that I got to meet women who had substance use disorders while they were pregnant or during the time they were new moms. I fell in love with the patients and their stories of survival. These women were so stigmatized and demonized, but talking to them it was clear they had amazing stories of resilience and survival. It just cemented that I wanted to be part of the solution.
Over the last few decades, addiction medicine and treatment have evolved with our understanding of how substances, as well as adverse childhood experiences and trauma, change brain chemistry. What are some of the most important takeaways for you—particularly as they relate to women?
Jones: I think the big takeaway is that two licit substances—alcohol and tobacco—pose the greatest risk of having long-term negative outcomes on children, far more than illicit drugs. Despite this, there continues to be a misunderstanding that because a substance is illegal, it must mean it’s worse or the outcome should be worse. I don’t think we have effective enough interventions for alcohol and tobacco before, during, and after pregnancy. There is also an over-attribution of problems to prenatal exposure to substances; they are often presented as the only explanation for a poor birth outcome or poor longitudinal outcomes. But we know from the literature that the postnatal environment is equally if not more important. That’s why I am excited that many states are expanding Medicaid for at least one year postpartum. It really should be three years because those are the most critical for child development.
The program you run, UNC Horizons, provides residential and outpatient treatment for pregnant women and new moms with substance use disorder. In what ways is Horizons different from other substance use disorder treatment programs for women?
Jones: Many programs are focused on moms while others focus more on the child or the fetus. We treat the mom, the child, and the relationship. It’s that dyadic work that really sets us apart. We’re helping children understand what moms are trying to say, helping moms understand what the child is trying to say, and helping them communicate with one another. We also focus on praising women for all the positive things they do because we want to model verbal reinforcement that they can use as parents. Many of the women we serve grew up in the foster care system and have been bounced around, often in the care of someone with an active addiction. We want to build on their strengths and help them understand the importance of celebrating milestones in their children’s lives.
How do you assess whether women have experienced trauma?
Jones: We know that 85 percent of women coming into our program have experienced physical, sexual, or emotional abuse if not as children then certainly in adulthood, so we act as though everyone has been exposed. We also know that people who have been traumatized often see the world as unpredictable and unsafe, so women aren’t going to walk in and trust us. So saying very openly and explicitly, here’s what we do, and here’s what we don’t do is important. We are, supervising with some guardrails, but they control their treatment experience. We say here’s a menu of 25 things. Tell us what resonates for you.
How have your operations changed as a result of COVID-19?
Jones: Fortunately, we have had no positive cases across any of our programs, but I am worried about it because we work with a marginalized population—many are women of color who fit the risk factors for contracting COVID-19. To protect patients and staff we moved all of our residential and outpatient groups to the HIPAA-compliant version of Zoom, which means people are still isolated. I’m worried about that because in my view addiction is isolation and the opposite is connection. I’m also worried because across the country we are seeing increased rates of child abuse and neglect. To lessen the risk, our day care workers have pivoted to having Zoom calls with kids, sending them notes, and developing little activity packets for them as well as increasing the support women and children are receiving from a maternal-child therapist team.
What other changes have you made to the residential program to protect women from exposure?
Jones: While we continue to stay open and admit new women and their children, we do this slowly with a move-in protocol that includes a two-week quarantine where we bring the family, their medicine, food, and other needed home items using social distancing. The biggest change is not having visitors and no outings other than to the grocery store, which means more trips so there is social distancing in the vehicles.
What can you tell us about your outcomes? How do you measure them?
Jones: Only about 5 percent of children have low birth weight or are born prematurely, which is better than the state average and certainly better than the national average. More than three-quarters of the women are employed when they complete our program and for women involved with child protective services, 95 percent have their cases closed. It’s fantastic to be listening to our women share when they get their children back.
What are you hoping to accomplish through Jenna’s project?
Jones: We know that people leaving jails and prisons are 40 times more likely to die of a drug overdose in the first two weeks after release. To help them through this dangerous period, we plan to engage women before they are released and meet them at the door to make sure they get treatment for their opioid use disorder. We will also help them get housing, or a job, or reunify them with their children. That’s the whole objective: to help women not just avoid death but thrive.
What challenges do women face with parenting after time spent in prison?
Jones: A lot of times women have an idealistic view that they’re going to walk back into their child’s life and just be welcomed with open arms. Sometimes that happens and sometimes it doesn’t. The child may not know how to respond or doesn’t want to be with them and that just brings up more guilt and shame and can create an opportunity for abuse and neglect. It’s a matter of carefully navigating those relationship dynamics to make sure that everyone feels safe and they are getting the support that is going to be most helpful for everyone.
How will the grant from FORE help?
Jones: It will allow us to have the staff we need for case management and to hire peers to help with recovery. We hope the results of the pilot will demonstrate to our state and others that is a model that works. I’m really thankful that FORE is so innovative and forward-thinking to be willing to invest in Jenna’s Project.
(Picture: Hendrée Jones, Ph.D., center)