It was February, snowing, and Sheena Von Cannon was seven-months pregnant. She needed medicine, but the weather trapped her inside. She realized that day how unmanageable her life had become.
She called on someone who had helped her before: Dr. John Thorp, a longtime OB-GYN and professor at UNC-Chapel Hill who 22 years ago founded UNC Horizons, a prenatal substance abuse program to help women like her. She’d tried the program before, but wasn’t ready, and she left.
“I was pregnant, and I was on drugs, and I couldn’t stop. I was in a really dark place in my life,” said Von Cannon. “I told Dr. Thorp my whole life was just in shambles.”
Von Cannon returned to UNC Horizons and got well on February 20, 2014. When her son Rohan was born that April, Horizons staff was by her side, guiding her through long and painful labor without medication. With the help of speech and physical therapists, Rohan is a vibrant 18-month-old who just learned to say “mama,” and Von Cannon has the skills she needs to lead a productive life.
“When I first came to Horizons, I couldn’t even look people in the eye,” she said. “I didn’t have a voice then.”
Andrea McSwain’s son Cassidy was two months old when they arrived together at UNC Horizons. She lived in constant fear, and at night, her only prayer was that it soon end.
“If I was still using, I would not be living, going to school, going to work, parenting, being honest with myself and others, caring about people, being someone I am actually proud of being,” said McSwain.
Cassidy walks, runs and plays like a normal toddler. McSwain still attends therapy, meets with a case manager and no longer worries her children will repeat her mistakes.
“He’s doing all those things that babies do, and I’m present. Horizons has given me another life,” she said. “Giving up my old life was not much to give up. It was not worth having in the first place.”
Gender-specific, trauma-informed care
When Thorp founded UNC Horizons, the program had two employees and a simple idea: combine prenatal care with substance abuse treatment in the same location. Now, the program has 80 employees, robust residential treatment, two intensive outpatient programs, an Early Head Start child care center and 25 apartments where women and children can live up to a year.
Thorp’s idea was unique from other programs: treat mothers and their children together with gender-specific, trauma-informed care. Separating a mother from her children doesn’t work, he said. It only compounds shame.
“Eight or nine out of 10 of our women have had significant childhood and adult trauma with both physical and sexual trauma histories. These are not things that are going to be addressed in mixed groups. The childcare piece is also really important: it’s hard to take a four-year-old to a 12-step meeting and have him or her play in the corner. You won’t do that for very long.”
Hendree Jones, Ph.D., an internationally recognized expert in the behavioral and pharmacologic treatments for pregnant women and their children, joined UNC Horizons as executive director in 2013. Mothers don’t arrive with just one or two issues to be addressed, she said.
“They have physical issues in terms of having unmet medical needs, they face spiritual issues, they face economic issues, they lack employment skills, they lack educational skills, they often lack parenting skills and they also come to us with a whole history of childhood as well as physical, emotional and sexual abuse.”
Substance-abuse counselors work hand-in-hand with case managers, peer-support specialists, psychiatrists, job specialists, child counselors and obstetricians. Not only does the care work to break the cycle of violence and addiction, it helps the women create parenting models for the future, creates better birth outcomes and reduces incarceration, Jones said.
The model more than works: this year 53 percent of Horizons graduates were employed, and for the last three years 100 percent of families have been reunified post-graduation. For the women who graduate from the outpatient program, 75 percent have positive child protective service outcomes.
“We’re reuniting and unifying families, which has tremendous society cost savings and has tremendous generational benefits for not just this family, but perhaps for future families to come,” said Jones.
Thorp’s vision was one of amplification: a partnership between UNC Horizons, the UNC Health Care System and Carolina’s campus would bring the resources of one of the world’s greatest research universities to bear on one of the state’s most difficult problems.
“We’ve leveraged and relied upon all the great things that the University and health system have to offer and brought them together under this gender-specific, trauma-informed rubric,” said Thorp. “And there are so many people across campus who are interested in varied parts of that, and we’ve been able to bring those parts together like stone soup to make something really special.”
While UNC Horizons has grown from around 20 women in treatment to hundreds, the program needs more to grow more. Currently under construction is a new home at Shelton Station in Carrboro, slated to open in late 2017. Transitional housing is still a need, as living in Chapel Hill is expensive, and keeping mothers within their established communities is important to their care.
Thorp said the savings UNC Horizons brings to the state speak for themselves. To house a family at Horizons for one year is roughly $30,000, whereas foster care can run $40-45,000 per child, and a year in prison is $60,000.
Horizons more than saves money – it helps women realize their own human capital, which is harder to quantify.
“I believe that addiction is a family disease,” said Thorp. “Whether it’s genetics or environment – and it’s probably a complex mixture of both – we can break that intergenerational cycle of addiction and violence.”