Casa Mia Provides Hope to Mothers, Their Babies
By Salwa Choucair
On a quiet street in a predominantly historic neighborhood near downtown San Antonio sits a two-story house filled with laughter, baby bottles, diapers and toys. Called Casa Mia, this house is a refuge for mothers with opioid use disorders and their infants and toddlers. With its fresh garden in the back and clean beds to sleep on at night, it is a far cry from the streets where these women formerly resided.
“We helped 32 women and 26 children in 2019,” says Lisa Cleveland, Ph.D., RN, CPNC, IBCLC, FAAN, associate professor at UT Health San Antonio’s School of Nursing. Dr. Cleveland co-founded Casa Mia in partnership with Crosspoint, Inc., which previously had used the facility as a women’s recovery support home.
Crosspoint is a local nonprofit organization that provides transitional and behavioral health services to San Antonio’s most marginalized and vulnerable citizens.
“Casa Mia follows a social recovery-housing model. The focus is on teaching moms to live their lives without substances. We show them that they can have a great life without them,” Dr. Cleveland says.
While nationally there are numerous transitional or recovery homes for women, only 3 percent of that housing offers beds for their young children. Casa Mia is changing that. As a neonatal nurse for 28 years and a mother, Dr. Cleveland understands the mental and physical need for a child and mother to be together from birth. The maternal bond is important for each of them.
“We need to help women become moms in a supportive environment before we put them out into the world,” she says.
Local and county statistics further solidified her resolve to take action. One-third of all Texas infants diagnosed with opioid withdrawal are born in Bexar County, the highest rate in the state. This equates to 300 to 400 babies each year; more than Dallas-Fort Worth and Houston combined. Casa Mia is a one-of-a-kind program designed to turn the tide.
“The statistics just really floored me,” says Dr. Cleveland, “and I thought why is no one talking about this, especially since it has a really large impact on our community. With those numbers, it stands to reason that Bexar County really needs to set the standard for the state, and we are now. Bexar County truly is the leader in best practices and best care for these families.”
In December 2018, Casa Mia opened as a partnership between the School of Nursing and Crosspoint. Together at Casa Mia, the nursing school and nonprofit organization offer mothers and their young children housing while they are enrolled in a recovery program and receive support services.
Funded by the Texas Department of State Health Services, the Baptist Health Foundation and the Sisters of the Holy Spirit, Casa Mia is staffed 24 hours a day and can house up to 20 mothers and their young children at a time. Each must continue her recovery or treatment plan and follow the rules of the house.
Structure is important for recovery, and Casa Mia uses a tiered system. The first phase is fairly restrictive. Residents are not allowed to stay overnight elsewhere and must be in the house by a set curfew. They must let the staff know where they are going when they leave, even for treatment; they have to call when they get where they are going from the landline phone at their location, not a cell phone; and they have to call when they are on their way back to the house. As they progress through their recovery, the restrictions are relaxed until they eventually get ready to exit the program. There is no set timeframe for a resident to stay or exit the program, says Dr. Cleveland.
“I think recovery is very individual,” she says. “One of the things that makes our program unique is that if someone relapses, they do not get thrown out of the house. We know that recovery is a process and sometimes people relapse and that is part of the learning process. I have heard of women who have relapsed after leaving the program and then get right back on track. To me, that is a huge success.”
Traditionally, pregnant mothers who are diagnosed with substance use disorder have only two options after they give birth: either have a family member take care of their infant while they go to a treatment center or Child Protective Services places the infant in foster care.
“Even if the infant is placed with a family member, the mother and baby are still separated. This separation is very traumatic for the mother and very traumatic for the baby. It is traumatic for the staff at the hospital as well. It just doesn’t make sense to me,” says Dr. Cleveland. “Why are we taking these babies away from mothers who need help? Why are we not helping the mothers instead?”
At Casa Mia, women may arrive expecting a child, having just given birth, or hoping to be reunited with their child. One of Dr. Cleveland’s favorite stories is when a mother was reunited with her child on Christmas Eve. The mothers, whose ages range from mid-20s to mid-30s, are in various stages of their recovery, she says, and that offers wonderful opportunities for them to mentor each other.
Current resident Becky C. has been on both ends of this mentoring. When she arrived at Casa Mia in January, she was six-months pregnant with her seventh child, and she watched the other mothers take care of their children with complete attentiveness. That was something she had never done with her other children. She gave birth to a healthy girl in March.
“Now that my baby is born, I haven’t left her side, not even once. I am very happy because I think the Lord gave me another chance. He showed me these young women and how they take care of their children and that planted seeds in my head. Now that I have my little girl, he has given me another chance to be a mom again, and I’m very thankful for that.”
After using drugs for six years, Becky, now 33, is thankful for the judge who sent her to Casa Mia. As a result of her drug use, she lost custody of three of her children to their father and has joint custody of three others with a different father. She has been in recovery for more than a year and is excited about her future.
While living at Casa Mia, Becky continues her recovery program, works a steady job which she has had for almost two years and takes classes to complete her GED. She plans to become a real estate agent.
“I love the staff at Casa Mia,” Becky says. “They surprised me with a baby shower and gave the baby lots of gifts and made me feel really special and valued. That was my first baby shower ever.
“I will never forget everything that has been done for me, and I am thankful. They want what’s best for us, and they really try to help you. Having your children with you is the best thing, and I just see how everything works together.”
Becky is proud to have been recently named “Resident of the Month,” which is just one of the many activities planned by the combined staff from Crosspoint and the School of Nursing.
As Crosspoint brings its expertise in recovery housing and support, the School of Nursing provides its expertise in women and children’s health as well as nutrition and childhood development. Currently, a registered nurse as well as a registered and licensed dietitian—who both serve on the faculty for the School of Nursing—work closely with the mothers at Casa Mia.
Martha Martinez, M.S.N., RNC, associate professor/clinical who teaches population health, spends one day a week at the house and requires her nursing students to develop classes for the mothers on topics that range from child nutrition and parenting to yoga and infant care.
“The nursing students leave the house with a different perception of what substance use disorder is,” says Martinez. “They see how wonderful these moms want to be and how hard they are working at it. It is about giving someone a second chance.”
Martinez works closely with Christiane Meireles, Ph.D., RDN, LD, clinical assistant professor. A registered and licensed dietitian, Dr. Meireles also spends time at Casa Mia. She started a garden and teaches the mothers about nutrition. Gardening is proven to be therapeutic and helps with recovery, and nutrition is important to recovery as well.
“A lot of our ladies have grown up with food insecurity,” says Dr. Cleveland. “People who are in recovery from a substance use disorder often have cravings, and it is important to discuss nutrition for mom and for baby.”
Together Dr. Meireles and Martinez along with the full-time staff from Crosspoint provide a comprehensive wellness program to the mothers at Casa Mia. They teach them life skills while offering them a safe place to live with their children while they recover.
“I believe that by working together with compassion and empathy, we are making a difference in the lives of these mothers and their kids,” says Dr. Meireles. “We have parties, celebrate birthdays and holidays, and do fun things, just like a family does. For many of them, this is something they have never experienced. It is really wonderful for the children as well.”
While the research data is being collected one resident at a time, the results are pretty clear: Casa Mia is making a positive difference and changing lives.
“We are not just doing community service here. We are also doing something that is scientific in the realm of human work,” Martinez says. “We are training the next generation of health care providers as well as teaching them to realize their biases and ask themselves how their biases may affect the way they treat patients.”
In the end, Casa Mia is offering hope to women and families not only in San Antonio but in communities across the nation.