Team for Infants Exposed to Substance Abuse: Supporting Families at Risk for Over 30 Years

February 10, 2022

In 1990, the United States was experiencing dual and often inter-connected epidemics: Crack cocaine and HIV/Aids. Across the nation, women with substance use disorders gave birth to infants who’d been exposed in-utero to myriad drugs, including crack, the free base form of cocaine. Babies exposed to substances like crack cocaine, alcohol, or other drugs are at risk for premature birth and learning, behavioral, and attention difficulties as they grow. As a result of HIV risk behavior, including needle sharing with drug use, some of the same women who were pregnant and had substance use disorders also had HIV, which meant their babies were also at risk for HIV. 

“We had women who were addicted to cocaine, many were polydrug users, and sometimes they had HIV in addition to a substance use disorder. And it impacted their abilities to parent,” said Oneta Templeton, Community Programs Manager at Children’s Mercy Hospital. “We also had many infants born drug-exposed in utero, and those children often had special needs which added to the struggle.”

In addition, many of the women lacked access to employment, health services, and housing, which also affected their ability to provide adequate care for children.

“We needed a system to identify, support, and follow-up identified children to promote safety and child development,” Templeton said.

In response, a consortium of community agencies, including hospitals, child welfare organizations, and early childhood and childcare groups, applied for a grant to the U.S. Department of Health and Human Services to fund the Team for Infants Exposed to Substance Use (TIES) program. At the start of this 32 year partnership, Children’s Mercy became the grantee, and UMKC’s Institute for Human Development (IHD) served as the program evaluator – and continues to serve in this role.

Today, the TIES program provides intensive home-based services for pregnant and postpartum women affected by maternal alcohol and other substance use and their families in Kansas City. Social workers and parent-educator specialists work with families to help them achieve long-term goals. Designed to create good health outcomes, the goals for the women in the TIES program are:

  • To maintain a drug-free lifestyle
  • To build parenting skills
  • To learn how to address physical and mental health needs
  • To secure a stable income
  • To secure stable, safe housing 

It’s a team effort to reach the goals, as drug-involved mothers often require support learning to bond and attach with their babies. They may have had limited positive role models for parenting and personal social support and often continue to cope with trauma and resultant addiction and recovery.

“My TIES workers have become an integral part of my life. They help me find resources for food, bill paying, and shelter,” Johanna T., a TIES participant, said. “Honestly, without my workers, I would not be sober or working.” 

Another TIES participant, Kim D., said the program had been beneficial to her peace of mind.

“The TIES program helped me find my voice,” Kim D said. “If I get worried about the baby, I know I can reach out at any time to get information and reassurance.”

Dr. Danielle Chiang, TIES program evaluator and researcher at UMKC’s Institute for Human Development, said women in the TIES program build resilience and the skills they need to navigate the community, and to build parenting skills.

“We recently conducted a study of program effectiveness for women participating in the TIES program vs. individuals who receive care as usual, and we found that individuals receiving the TIES Program intervention were able to improve their nurturing and empathy skills for their children,” Chiang said. “Most importantly, we found improvement in child health outcomes, like getting immunizations, helping children hit their developmental milestones, and taking them to doctor’s appointments.”

The Covid-19 pandemic posed challenges for the program moving forward, Chiang said. The home visits moved to an online format, and researchers found the program wasn’t retaining participants as well. Pandemic disruption also created barriers to recruiting new participants, data collection, and conducting timely assessments. 

“Once home visiting and data collection resume, we hope to have more complete data in the coming year," Chiang said. "Complete data and assessments are important to the future work of the TIES program because we are working on moving the TIES program from a promising approach to an evidence-based model other programs can emulate.”