MORA, Minn. — Two playgrounds border the Recovering Hope Treatment Center for addiction that sits at the end of a gravel road in eastern Minnesota’s rural Kanabec County. A meeting room inside is furnished with rocking chairs and baby walkers. And there are strollers in the halls.

Recovering Hope is one of only five providers in the state that offer family-based residential treatment, allowing women to enter the program while pregnant or to bring one of their children younger than 5 with them for the duration of their stay. Men can receive outpatient treatment but aren’t permitted in the residential program.

It’s the only such residential program located in a rural Minnesota county and is licensed for 108 beds. It has a waitlist that can span from two to six weeks, depending on whether a woman plans to enter treatment alone or with her child.

“If you don’t provide family services, the parents run the risk of losing their kids,” said Ashley Snyder, a licensed drug and alcohol counselor at Recovering Hope.

Family-based residential treatment has been recognized by behavioral health professionals as having better outcomes for women and their children. But such programs often struggle to stay afloat because of staffing shortages and volatile funding. And because of that complexity, families in rural areas are less likely to find such a residential treatment program in their communities.

Meanwhile, maternal opioid-related diagnoses have increased nationwide. From 2010 to 2017, the rates of women with those diagnoses at delivery increased by 131% and babies born with withdrawal symptoms increased by 82%, according to the Centers for Disease Control and Prevention. The increases disproportionately affected rural areas. At Recovering Hope, opioids are among the top substances, along with alcohol and meth, that lead women to seek treatment.

“There are too few programs,” said Margaret Ratcliff, an executive vice president at Volunteers of America, which co-published a national directory of family-based residential treatment programs with Wilder Research in 2019. At that time, the directory listed 362 family-based residential treatment programs nationwide, a number that experts, including Ratcliff, say is continually in flux.

Many of the programs offer some variation of the model in place at Recovering Hope, though the maximum age of children varies.

From its own affiliations with such programs, Ratcliff said, Volunteers of America has seen that “the problem is that Medicaid does not cover the cost of a comprehensive program, and grants come and go.”

Even at Recovering Hope, which has operated since 2016 and is expanding its outpatient treatment to include teenagers and building sober houses, smaller insurance reimbursements have affected care. Women in the center’s residential program previously spent up to an average of 40 days in high-intensity care at the beginning of their treatment, but that timespan is now closer to 30 days to contain costs due to those low reimbursement rates. Most of the women in the residential treatment program are covered by Medicaid.

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