C. Pregnant Women and Relapse Prevention and Safety Plans

1. Pregnant Women and Substance Use

Since 1994, pregnant women have been a priority population in state-funded substance use disorder treatment services. Pregnant women using opioids should not discontinue opioid use due to the risk of maternal relapse, overdose, withdrawals, and fetal demise. In 1998, a National Institutes of Health consensus panel recommended methadone for Medically Assisted Treatment (MAT) in pregnant women dependent on opioids. It is still considered the standard of care today. Tapering of MAT dosing during pregnancy is associated with more frequent relapse into addiction. Every health region in Texas has an Outreach, Screening, Assessment and Referral (OSAR) Center which can assist any Texas resident with finding appropriate treatment and community resources. To find your local resource and for more assistance please visit https://hhs.texas.gov/services/mental-health-substance-use/mental-health-substance-use-resources/outreach-screening-assessment-referral-centers.

2. Relapse Prevention

Parents in CPS cases who have difficulty with substance use can relapse. However, with the right support, it is possible to achieve successful reunification with a parent who addresses their substance use issues. At this time there are no standardized resources and most providers pursue an individualized plan for the recovering parent. DFPS policy states the following regarding relapse prevention planning:

Developing a Safety Plan in Case a Client Relapses

•   Relapse is the return to the pattern of substance abuse or addiction, as well as the process during which indicators appear before the client's resumption of substance use.

•   In the relapse safety plan the client spells out the steps he or she plans to take to ensure the safety of the children when relapse becomes an issue; for example, the client might state in the relapse safety plan that:

◦   he or she will place the children with CPS-approved family members or friends when experiencing a relapse; and

◦   the children will remain with the family members or friends until the client returns to abstinence and is once again engaged in treatment or aftercare services.

•   Any court orders supersede any actions stipulated by the client involving a voluntary caregiver in the relapse safety plan.

•   Please also see https://www.recovery.org/relapse-prevention/