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Special Population Challenge:

Preserving Positive Outcomes for Women Clients

— Mary H. Bair, Division Director, Gaudenzia, Inc. Women and Children's Programs, Harrisburg, Pennsylvania. Gaudenzia, a leader in the field of women and children's services, is the parent organization for four Pennsylvania programs offering treatment, intervention, prevention, and education services for pregnant and parenting women and their children: Vantage House in Lancaster, New Image in Philadelphia, Kindred House in West Chester, and Gaudenzia Fountain Springs in rural Schuylkill County.

For the past 25 years, we have been struggling to provide and fund quality addictions treatment and programming for pregnant and parenting women and their children. How can we preserve the broad-based, continuing care we have fought so hard to provide for this special population?

The Struggle for Long-term

AOD Care

Providers of long-term, residential therapeutic community (TC)-based treatment for pregnant and parenting women with children have been involved in several dramatic turning points in the AOD field. Pennsylvania's experience illustrates how far we have come in our efforts to assist poor and uninsured women with addiction problems — and how much we could lose as funding streams change. Our beginnings in the late 1970s were meager. At that time, the State provided virtually no specialized treatment services for poor, substance-abusing women who were pregnant or parenting.


Pregnant and parenting women with children were being referred for admission to treatment only to become lost in a maze of service delivery systems that could not meet their particular needs. Limited services were available to these women in facilities that were geared to men. Sometimes these services were counterproductive, with drop-out rates for women that far exceeded those for men.

Obstacles to treatment

Many mothers refused to enter treatment without their children. Most feared placing their children in foster care or with friends or family members who had an active addiction. Further more, placing their children with various childcare agencies was not an option for these mothers. Many had themselves grown up in those very systems, where they had often experienced mental, physical, or sexual abuse.

Providers refused to accept pregnant and parenting women with children for fear of insurance liabilities and possible lawsuits, or because the providers lacked on-site medical services and were not equipped to provide intervention, education, and alternative activities for the children. The issue of funding compounded these obstacles. Who would pay to provide treatment services not only for these mothers, but also for their children?

The struggle for program funds

Gaudenzia, Inc. joined forces in 1978 with the Lancaster County Mental Health/Mental Retardation Drug and Alcohol Program and the Single County Authority Planning Council to design a program specifically for pregnant and parenting women who were abusing or addicted to alcohol and drugs. This collaboration resulted in Gaudenzia/Vantage House, which pioneered the first long-term, residential therapeutic community in the United States targeted for this special population.

Funding services for this population continued to be a challenge over the next 10 years. The struggle for funds eased in 1992, when the Federal government mandated that States set aside a portion of their substance abuse block grants for specialized women's services. The Pennsylvania Department of Health's Office of Drug and Alcohol Programs (ODAP) established a State and county 90/10 funding pool for long-term residential treatment services for pregnant and parenting women and their children, which was eliminated in 1997. Those funds have been distributed to counties to address women's and children's services to include all levels of care. The impact of this decision on women and children in need of residential treatment remains to be seen.

Pennsylvania has gained national recognition for developing a statewide network, now totaling 52 programs, to serve the special needs of pregnant and parenting women and their children. Currently, Pennsylvania has 17 licensed long-term residential treatment programs for this population and provides 35 other licensed programs that specialize in treating pregnant and parenting women and their children. In addition, there are four perinatal and two correctional programs.

Issues with Managed Behavioral Health Care

Managed behavioral health care has jeopardized the ability of many specialized programs to serve pregnant and parenting women with children. Behavioral health care companies are simply not prepared to understand or treat this population. Our concern is that many of these companies will opt for income over outcomes. We cannot afford to let this happen.

A number of factors impede the ability of behavioral health care companies to serve low-income pregnant and parenting women and their children:

  • Most managed behavioral health care companies have a limited view of addiction and little or no actual experience in treating pregnant or parenting women.

  • Most companies have no track record of positive outcomes with low-income or Medicaid-eligible addicted women who have children.

  • Many companies use commercial models of addiction treatment that have limited or no impact on these women.

    Many managed behavioral health care companies lack the perspective of those who serve publicly funded AOD clients — that these are clients with multiple problems requiring a comprehensive continuum of care. Often these companies do not have a holistic or long-term view of addiction services.

    Positive Steps by HMOs

    The obstacles to adequate and comprehensive services under managed care can be overcome. In Pennsylvania, some of the health maintenance organizations (HMOs) that subcontract with managed behavioral health care entities have recognized their inexperience. These HMOs have set up special pools and financing that by-pass the behavioral health care companies.

    These HMOs realize that adequate AOD treatment for a woman creates reduced costs in medical care for the woman's entire family. For this reason, HMOs are concerned with ensuring healthy births and immunizations for children, as well as preventing child abuse, domestic violence, and illness related to addictions — not only for the women but also for their families.

    Another positive note is the increased awareness by Medicaid agencies of the need to provide comprehensive services as an adjunct to addictions treatment. State Medicaid Bureaus are now starting to recognize and actually provide these needed services in their managed care plans.

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