C. Pregnant Women and Relapse Prevention and Safety Plans

1. Pregnant Women and Substance Use

Since 1994, SAMHSA has designated pregnant women as a federal priority population in substance use disorder treatment services. Additionally, SAMHSA requires states to spend five percent of the states' overall budget on specialized female program for pregnant and parenting women. Pregnant women using opioids should not discontinue opioid use due to the risk of maternal relapse, overdose, withdrawals, and fetal demise. The American College of Obstetricians and Gynecologists (ACOG) and Substance Abuse and Mental Health Services Administration (SAMHSA) recommend Medication Assisted Treatment (MAT) for best practice in managing an Opioid Use Disorder in pregnancy. 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 the DFPS OSAR webpage.[197]

2. Relapse Prevention

Parents in DFPS cases who have difficulty with substance use can relapse. However, with the right support and appropriate level of intervention, it is possible to achieve successful reunification with a parent who has addressed their substance use. At this time, there are no standardized resources statewide. DFPS uses state funded and community resources that use individualized treatment approaches to meet the needs of parents and families. 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 use, as well as the process during which indicators appear before the client's resumption of substance use.

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

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

◦   the children will remain with the family members or friends until the parent returns to abstinence and/or 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 the Guide to Addiction Recovery & Relapse.[198]