Jamie Twombly works as a housekeeper at Seabrook and lives with her two young daughters and adolescent son in a duplex in Aberdeen. The space is often tight for the four of them. But for Twombly, a cramped life with her three kids is far preferable to the space she would have if they lived elsewhere.

That was her situation a few years ago, before she began treatment for an addiction to fentanyl and methamphetamine. Growing up in Marysville, Twombly developed a drug addiction late in her teenage years. She was in and out of treatment programs, and later, after a few years living clean in Arizona, she fell back into addiction, and moved back to Washington and Grays Harbor.

“And then it just stuck,” she said.

It wasn’t until she faced the threat of losing her unborn daughter to child welfare that she searched again for treatment.

Now aged 30 and a near 10-year resident of the Harbor, Twombly has been sober for more than a year and a half since completing a five-month stay at a residential treatment facility near Everett.

That facility was tailored specifically for pregnant and parenting individuals, called PPI for short, a model that provides an option for parents to remain united with their children during substance use treatment.

Currently, pregnant women and new mothers, as well as fathers, must leave Grays Harbor County to find that model. But last month, the state’s Health Care Authority announced that $1.7 million is available for a provider to staff and operate a PPI in Grays Harbor County. Providers have until April 5 to submit applications for the grant money.

A spokesperson for the HCA said the agency could not provide information about which groups, if any, have applied until after an application is chosen for the award.

The opportunity comes as behavioral health and substance use treatment options are beginning to upswing on the Harbor, and could fill a public health gap in a county where both substance use and child welfare cases are among the highest in the state.

In 2022, 35 children less than one year old in Grays Harbor County were removed by the state from their homes and put into other care. About half of those children were American Indian or Alaska Native.

Washington state is among tops in the nation for the highest percentage of infants entering out-of-home care, which happens more frequently than any other age group.

“In our state that’s been driven primarily by substance-exposed infants — infants who are born to moms who have been using,” said Vickie Ybarra, secretary for partnership, prevention and services at the Department of Youth, Children and Families (DCYF). “So we wanted to do something about that.”

Ybarra said that for many years the agency, which has a goal of safely reducing the number of children in out-of-home care by half, has been talking about the need for more substance use treatments that allow families to stay together. The largest need exists in three counties: King, Pierce and Grays Harbor.

“People who have substance use disorder or opioid use disorder deserve to have treatment close to home, where they can be in touch with supportive family and community members,” Ybarra said. “They don’t need to be traveling from Grays Harbor to Eastern Washington to get their treatments.”

Leaving the Harbor for treatment

Healthcare providers are required by law to report potential child safety concerns to Child Protective Services. The criteria for reporting, developed in 2019 through a government workgroup, include if a newborn tests positive for substances and if a parent has an ongoing substance use disorder that causes safety concerns.

Sometime that leads to referral to services instead of separation, but depending on the circumstances, could result in a newborn removed from a mother’s care.

“When I was in active addiction, there was a lot of girls that were pregnant,” Twombly said. “They just go to the hospital, lose them and that’s it.”

Danielle Russell is the director of funding and development for Connections, a family health center in Montesano that provides services for pregnant women and mothers in addiction, including the Parent-Child Assistance Program, a home-visitation program.

Russell said there are 47 women currently enrolled across Connections’ programs that could be eligible for treatment at a facility like the one pending for Grays Harbor.

Pregnant women can seek substance use treatment through a specialized clinic in the behavioral health unit at Harbor Regional Health Community Hospital, where they can stay during treatment for up to 26 days.

“If mom comes into treatment and she is pregnant and delivers baby, she doesn’t have the opportunity to take the baby back to treatment with her,” Russell said.

Twombly, who was already separated from an eleven-year-old son because of past addiction, sought treatment late in her pregnancy with her first daughter, hoping to prevent the same from happening.

It wasn’t until after her daughter was born and removed from her care that she learned about the facilities that could’ve prevented the separation in the first place.

Twombly left the Harbor for a brief stay at a pregnant and parenting treatment center in Yakima, then transferred to a facility near Everett in March of 2022. She likened her stay to being back in middle school, following a schedule of classes — not only on addiction recovery, but on mending and maintaining relationships with her children.

Three months later, her daughter, who had been staying with a family member nearby, and was now a one-year-old, joined her in treatment, where she received childcare.

“As a parent you feel like you missed out on so much,” Twombly said. “She wasn’t even a year (old) yet and there was still a bunch I missed out on. Doing little visits two hours at a time wasn’t building a bond with her.”

That changed during her stay in treatment.

“Me and my daughter are very close,” she said.

One month after she was reunited with her first daughter in treatment, Twombly gave birth to a second daughter, who never left the care of her mother.

Legislative response to a tragedy

The $1.7 million available for a residential treatment facility for pregnant women and parents is the result of a legislative response to the case of Oakley Carlson, the five-year-old Oakville girl who went missing in 2021 and was never found after she was returned to biological parents with a history of substance use.

That response initially had a different goal: to reform DCYF. In the 2023 legislative session, Rep. Jim Walsh (R-Aberdeen) introduced House Bill 1397, the “Oakley Carlson Act,” which would have expanded the supervision period of the state when returning children to situations where substance use disorder was the primary reason for separation and created stricter sobriety requirements prior to reunification.

After the bill died in committee last year, money for the Grays Harbor treatment facility was included in the budget as a partial compromise.

In an interview, Walsh said the treatment facility is a “worthy use of resources,” but not exactly the accountability aspect he wanted to address with legislation, an effort he said he will continue.

“It’s related but not precisely the same issue,” he said. “I believe it will do good. But I haven’t given up on the Oakley Carlson Act. We are still pursuing that reform.”

Ybarra said increasing residential substance use treatment is an important tool to safely reduce the number of children who leave their parents’ care in the first place. Access to these types of treatments are decreasing, not increasing, she said, citing the closure of a program last year at the Cowlitz Family Health Center in Longview. Officials there said the high-cost program struggled to pay for itself, especially with a few empty beds on average each night.

Other models have been successful. A new treatment center in Everett opened in October 2023.

“There’s some wonderful providers, and there’s a lot of good happening in that space,” Ybarra said. “There’s just not enough.”

Contact reporter Clayton Franke at 406-552-3917 or clayton.franke@thedailyworld.com.