1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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