Ashleigh Rider panicked when she returned to her townhouse one afternoon to find the business card of a child protection services worker stuck in the jamb of her front door.
She had feared this might happen, but she was also tired of the guilt and shame she felt for using alcohol, crystal meth and opiates. For years, she had avoided seeking treatment, terrified that opening up about her addiction would mean having her young daughter taken away from her.
"I knew I wasn't making the right choices, but I was desperate to not lose my child," says Rider, 30, of Kingston, Ont. "I thought doing drugs would be better than her not being with me."
Mothers such as Rider are often faced with what Kingston physician Adam Newman calls an "impossible choice." If they do not seek treatment for their substance use, they can lose custody of their children. But to get the treatment they need in order to keep their families, they're required to leave their children for weeks at a time since most facilities aren't set up to allow families to stay together.
"If your motivation is to be a mother who's on the ball and is looking after her kids, you have to abandon your kids," says Newman, a family doctor who specializes in obstetrics and addiction medicine.
Newman and a team including doctors, nurses, social workers, and women with lived experience are proposing a solution that would be a rarity in Canada. They're looking to build a residential facility in Kingston that would allow mothers with substance-use disorders to stay with their children as they work on their recovery. Currently, the nearest residential rehabilitation centre that accommodates women and children is Portage's Mother and Child Program in Montreal, a model on which the Kingston team's project is based. Few others do the same in other parts of the country.
Yet, the growing number of Canadian babies born each year to drug-dependent women points to an urgent demand. There were 1,846 babies in hospital with neonatal abstinence syndrome in 2016-2017, up 27 per cent from 1,448 in 2012-2013, according to Canadian Institute for Health Information data, not including Quebec.
As Newman explains, the idea for the Kingston project arose from his team's efforts to keep babies born to opioid-dependent women with their mothers at Kingston General Hospital. Instead of whisking the babies off to the neonatal intensive-care unit immediately after birth for observation, their "rooming-in" program, implemented in 2013, offered support for mothers and infants as they were given a chance to bond, uninterrupted. Keeping the mothers and infants together resulted in better health outcomes: The number of babies requiring oral morphine therapy for their withdrawal symptoms was significantly lower, and their average hospital stay was considerably shorter.
But Newman and his team recognized many of these women and babies lacked support once they were discharged.
The concept of keeping mothers and children together is not based on sentimentality, Newman says. There's evidence to suggest it can be beneficial for the women, too. Treatment for substance-use disorder is notoriously unsuccessful for women who are separated from their children, he says. "She's distracted and heartsick and guilty and missing her kid and feeling bad about the fact that she's not with them. It doesn't work."
A University of Manitoba study, published this fall in the Journal of Epidemiology and Community Health, showed women tended to have higher rates of mental illness and substance use disorder diagnoses after their children were taken into care.
Elizabeth Wall-Wieler, lead author of the study, say there's a need for more preventative measures to support women before they're deemed unable to take care of their children. And in cases where it's necessary for children to be taken into care, women need help to ensure the separation doesn't lead to further deterioration of their health and well-being, since that could make it harder for them to regain custody.
"There's a lot of trauma associated with losing custody of a child," she says.
Rider experienced this firsthand. After child protection services intervened in 2015, her daughter, then 6, was placed in the care of Rider's father and stepmother. Meanwhile, Rider went to a treatment centre in Whitby, Ont., more than 200 kilometres away.
Rider, who has her child's name tattooed on her forearm, recalls the pain of hearing her daughter sob, "I want you, Mommy," on the other end of the phone. She fought the urge to immediately run out of the treatment centre to find and comfort her. But she also knew that if she were to regain custody, she needed to remain in the month-long program.
Others told her that the separation was for the best; she needed time to be away from her daughter to focus on herself. But to Rider, that didn't ring true. "That doesn't happen. I'm a mother. I can't disconnect [from] that ever," she says.
Rider considers herself lucky that her daughter was in the care of family members. She knows of plenty of mothers struggling with addiction who have no one on whom to rely. She eventually regained custody after several months, and she says she is now making positive strides. But even their relatively short time apart has had lasting effects. Rider says her daughter still gets anxious about being separated from her. Had the option of staying with her daughter during treatment been available to her, Rider would have sought help long before child protection services became involved, she says. "I could have started to make changes a lot sooner."
The proposed Kingston House of Recovery for Women and Children, which would accommodate 24 women with up to two children each for a minimum of six months, has a long way to go before it becomes a reality. The team behind it is seeking charitable status and has been promised a site in downtown Kingston, but it still needs to raise funds, and to plan, build and staff it.
What is certain, Newman says, is the team will have no trouble filling it.
"Unless somebody decides to make it a cause and to push it forward, it doesn't matter how worthy or useful or efficient it would be, or cost-efficient even, it won't happen," he says.