Case study: Maria 33 year old female pregnant with 3rd child 17 year old daughter pregnant at the same time Toddler living with husband and his mother HIV viral load controlled during pregnancy Reported smoking crack/cocaine during pregnancy Had pending family court case for custody of her second daughter and criminal court case for robbery

What happened? Patient attended inpatient 28 day program Patient mandated to substance use treatment program three times a week Multiple team conferences involving MCM, FFHCP, PCP and ob-gyn team Patient had ACS case conference following delivery and was granted custody of her daughter

Case study: tonya 36 year old female pregnant with 4th child Patient treated for STD during pregnancy but otherwise had no other medical issues Patient was almost undetectable at time of delivery Previous self-reported not using any substances Cocaine in urine toxicology when she was about to do emergency C-section Said she used in order to cope with stress of 3 children and partner

What happened? ACS was contacted and Patient was discharged without her child After ACS case conference, Patient was able to take her baby home Patient was required to attend outpatient substance use treatment program three times a week Patient continues to attend the program after having a positive tox screen for marijuana several months ago

Case study: Lisa 27 year old female pregnant with 4th child HIV was not suppressed during pregnancy Patient had indeterminate Quantiferon and consistent cough Patient reported drinking alcohol and smoking marijuana Patient was undecided on terminating her pregnancy and started and stopped her medications for months Did not complete prenatal appointments until she was 6 months pregnant

What happened? FFHCP Case manager called ACS due to reported substance use during pregnancy and was primary care giver for her other children. The call was not accepted since details were missing Patient delivered baby without an undetectable viral load and was able to take the baby home Patient missed several pediatric appointments for the newborn and her 1 year old son. When son was brought in, he had only gained 5 pounds in 5 months and was severely underweight and eventually hospitalized Patient missed appointments once he was discharged and ACS was contacted All four children were removed from her custody and placed in foster care Patient refused to continue receiving services at STAR

Case study: Jessica 25 years old female pregnant with 5th child Patient required to attend weekly progesterone shots 1 year old son was in Foster care, three older children in custody of her parents Smoked marijuana during course of pregnancy Had symptoms of depression but refused psych treatment

What happened? Patient had C-section and was undetectable at time of delivery ACS was contacted after Patient gave birth Patient’s baby was immediately put in foster care in same family as her other son Patient’s boyfriend is trying to get custody but he cannot live with Patient due to previous ACS allegations Patient has been inconsistent with her care since