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. In Texas, a pregnant woman who is financially eligible and clinically appropriate must be admitted in to HHSC-funded treatment services within 48 hours of the woman's request for service. 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 return to use, 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) as a best practice in managing an opioid use disorder in pregnancy.[226] Tapering of MAT dosing during pregnancy is also associated with more frequent return to use. 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 local resources and additional assistance, please visit the DFPS OSAR webpage.[227]

Special Issue: “Return to use” is the recommended term to avoid shame and stigma associated with the term “relapse,” however relapse and relapse prevention are still commonly used terms.

2. Relapse Prevention

Parents in DFPS cases who have difficulty with substance use may relapse or return to use. However, with the right support and appropriate level of intervention, it is possible to achieve successful reunification with a parent who has addressed or is addressing 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 in relevant part regarding relapse prevention planning:

Developing a Safety Plan in Case a Client Relapses (CPS Handbook § 1982.2)

•   Relapse is a return to a pattern of substance use after a period of non-use.

•   In the relapse safety plan, the client, along with a trusted support system, plans to ensure the safety of the child or children, in case relapse becomes an issue.

•   Court orders supersede any actions that the client requests in the relapse safety plan.

•   A relapse safety plan can be developed at any stage of service.