Amanda Wilde (Host): Welcome to Recovery Unscripted, the Haymarket Center podcast, where we have meaningful conversations focused on the integration of substance use disorder, mental health, and primary care treatment. Today, we'll get an inside look at Haymarket Center's integrated programs in women's health services, including its OB-GYN program.

I'm your host, Amanda Wilde, with Dr. Dan Lustig, President and CEO of Haymarket Center. Welcome back, Dr. Lustig. It's good to see you.

Dr. Dan Lustig: It's good to see you too, Amanda.

Host: And we have the pleasure of hosting Haymarket Center OB-GYN, Dr. Judith Cothran. Welcome to you, Dr. Cothran.

Judith Cothran, MD: Thank you. It's a pleasure to be here.

Host: And Kristyn Smith offers her personal story as a patient. She is our guest as well. Welcome to you, Kristyn.

Kristyn Smith: Thank you so much for having me..

Host: Dr. Lustig, Haymarket offers critical programs that provide trauma-informed, culturally appropriate, and evidence-based care for women experiencing substance use disorder. Now, that is a lot of mission. First, can you talk about why it was important to create programs specifically designed for women and mothers?

Dr. Dan Lustig: Absolutely. And thank you, Amanda. So, you know, at Haymarket Center, we really believe that recovery begins by treating the whole person, not just the addiction. So when women enter treatment for substance use disorder, she's often carrying far more than a substance use disorder. She may be managing the effects of trauma, chronic medical conditions, unplanned pregnancies, the responsibilities of motherhood, or years of really unmet healthcare needs. They may have experienced discrimination, stigma, or healthcare systems that really fail to understand their lived experiences.

And so, it was really important for Haymarket as we became a truly integrated health facility to try to address that missing piece of gynecological care for women seeking services here. We have women from different cultural and racial, ethnic, and socioeconomic backgrounds that come to Haymarket Center, and they face unique barriers to healthcare. Language differences, historical mistrust of the medical system, transportation challenges, financial hardship, fear of judgment have often prevented women who come to Haymarket from seeking routine reproductive healthcare.

And so for women living with substance use disorders, these barriers are often greater than what they can manage alone. And so, part of Haymarket's hope and restoring hope is really helping to give comprehensive medical cares to individuals by providing culturally responsive OB-GYN care, we create an environment where women feel respected, heard, and understood. Dr. Cothran recognizes every woman's story is different and that effective care must honor her culture, values, beliefs, family structure and, most importantly, their individual experiences. Because it's that trust that, you know, foundation of recovery is built on.

Host: Well, going to you, Dr. Cothran, you oversee the OB-GYN program that falls under Haymarket's Women's Services. Can you talk about what services specifically this program provides women, and how do you help women navigate pregnancy, delivery, and postpartum recovery while also focusing on addiction treatment?

Judith Cothran, MD: Pregnancy is a big motivator for women to get connected with recovery and stay in recovery. That's pretty much where we start. When they first come in and we know that they're pregnant coming in, we first make sure they have an assessment prior to being admitted. So, an ultrasound to make sure that the pregnancy is viable, that it's dated properly, and that they're being, treated with the appropriate medications for any underlying medical conditions. So, we usually have a high-risk obstetrician evaluate them as a prerequisite to entry into Haymarket.

Once they get here, we make sure they're connected with high-risk obstetrical care, because these pregnancies are considered a high-risk pregnancy. So, we make sure that the maternal fetal medicine providers are plugged in. So, we make sure within a week or two of them arriving here, that they are connected with a provider at one of our major medical centers that we partner with.

And then, I see them also to do kind of a cursory initial evaluation. We would treat any kind of vaginitis or sexually transmitted infections that we would pick up. We would begin that treatment if that exists. And then, we make sure, if the pregnancy is far enough along, that we can listen to the heart tones, reassure patients that everything is okay from what we can see so far. And then, going along, we reassure them that we are here to be on their team so that their baby, once born, can come back to Haymarket with them, and she can continue her recovery program here.

Host: Dr. Cothran, do you have some specific programs I'm curious about? The Maternal Addiction Treatment Program, the MATR, I think it's called program, or is and may-ter, and the MOMS program?

Judith Cothran, MD: Correct. And, you know, that's part of the recovery part. I really deal with the obstetrical care, but probably Dr. Lustig could speak more to the specifics of those two programs.

Dr. Dan Lustig: One of the exciting things about Haymarket Center and how we built this integrated model is that when women access treatment, they're getting an integrative approach. So, we're addressing their substance use disorder, we are addressing their mental health disorder, and we are addressing the primary care conditions that a patient presents with.

So, this is truly that integrated system that, really, the goal is to overall improve health. And so, those two programs that you spoke about really speak and address women's issues. The substance use disorder programming addresses women's issues. We have evidence-based interventions that we use as a part of that treatment program. But what's really exciting part of our medical center is that as Dr. Cothran, expressed, once an individual goes through that assessment process, if an individual reports a need for mental health services, they can see somebody right after their medical appointment. So, this just isn't an integrated system. This is a seamless system of medical services that you really can't find in today's medical systems.

Host: Medical services and support, which I think is what these additional programs are about. And I see now what you mean by the integration of the medical side, and the recovery side and, and going through the OB-GYN experiences of pregnancy. And of course, the measure of success is experience, and Kristyn, that's where I want to bring you in because you have first-hand experience with Haymarket's Women's Services and Treatments. Can you tell us what brought you to Haymarket and how the services there have helped you navigate your recovery journey?

Kristyn Smith: I was seven months pregnant and I had just gotten out of jail after being in there for about two months. They had got me sober in jail, and they got me started on Suboxone right away. But as soon as I got out, of course, my addiction, you know, I got high again. My husband was waiting for me when I got out, and we were homeless, so we were just wandering around trying to figure out where we could go. I remembered the counselors that would come and see me, though, at the jail. They were telling me, you know, "If you ever want to go to—" They wouldn't tell me where, the specifics, but they told me, "If you guys both wanted to go to rehab, just call me and let me know, and we will come pick you up and take you to Chicago."

I called them that night when we were wandering around, and I set up a ride. And they told me that they'd come pick us up at 5:00 AM. So, they did. They came and picked us up at 5:00 AM the next morning. We slept in someone's backyard that night because we had nowhere to go. But the next morning, we were ready at 5:00 AM. And they picked us up, they brought us to Haymarket, two hours from where we were living. So, we didn't have anything. We literally just showed up with the clothes on our back. That was July 24th at, like, 8:00 AM. And that's when everything changed, you know? that's what brought us to Haymarket.

I was assigned to MATR Hall. You were saying Mater... It's spelled out—it's supposed to be Maternity Hall, but they call it MATR Hall. It's for mothers and babies. When I got there, I met all the staff. they were very welcoming. They treated me like a friend, you know, but they also knew when to do their job. They were very welcoming. They were nice. They made me feel welcome. my caseworker, she was amazing. She was so amazing. She helped me through a lot, especially because I was pregnant. You know, I had a lotta ups and downs and, you know, just coming off, trying to get regulated again. She helped me out a lot.

One of the biggest things about Haymarket for me was being able to have my children there with me. So as long as your DCFS worker says it's okay, you can get it cleared through them, you can bring your children with you. And I just wish that I had known that years ago when I had lost my first two kids. You know, it would've been a game-changer for me if I had known that. But, you know, I'm grateful that I knew now so that I can have my baby there with me once he was born.

Host: So for you, Kristyn, your family was a driving force behind you seeking support and keeping on with the program. Dr. Cothran and then Dr. Lustig, can you talk about the importance of keeping families together during recovery and how Haymarket makes that happen?

Judith Cothran, MD: I can speak to that just a little bit because the studies have also borne this out that when women are kept with their children, particularly newborn babies, they are far more motivated to stay in recovery, and to learn how to care for their newborn. they're more motivated to breastfeed their child because we all know that breastfeeding is the healthiest choice that moms can make for their And they know that if they're using substances, they cannot breastfeed. So, it is a big motivator for women for their mental health, and their physical health, to stay in recovery and bond with their baby.

Dr. Dan Lustig: And I would also mention that, you know, when women present for treatment, they are often faced with a lot of barriers to treatment. And one of the biggest barriers to treatment is childcare, which is why at Haymarket, mom is able to bring up to two children under the age of five into residence with them, because we know that mom tends to be the caregiver. She tends to be the caregiver for not just her kids, but the family. And so, really treating that condition helps to remove those barriers.

Host: That moms program you just mentioned is a unique program that Haymarket has added to their services to fully support mothers in need. Dr. Lustig, how has the Women's Services and OB-GYN program evolved over the years and added services to meet changing needs of mothers and women in general?

Dr. Dan Lustig: You know, it's changed a lot. For example, for pregnant women, you know, we've developed this coordinated approach that really is life-saving. Early prenatal care, as we know, improves maternal health, reduces pregnancy complications, supports fetal development. We had so many women coming to Haymarket Center that used the emergency rooms as their doctor of choice, and that created truncated care. They never had a consistent medical professional. And so when they presented to treatment, they presented, you know, with pretty severe medical symptomatology because of their lack of getting medical care.

And so, for Haymarket, this is one of the biggest changes, was really providing medical services because we knew that if we don't address those three conditions simultaneously of substance use disorder, mental health, and primary care, one causes a relapse in the other condition. So, we knew that we had to start providing medical services in a really integrated model for our patients.

Host: Of those programs you just mentioned, Dr. Lustig, I know Kristyn, you used the Peer Doula program. How important was that program to your recovery?

Kristyn Smith: Yeah, I had my baby while I was at Haymarket, while I was on the MATR Hall program. And I think within, like, maybe a week I met my doula. She came and met me maybe about a week and a half. Like, she came and met me. It was very important because, you know, she came to the hospital with me when I had my baby.

She was there when I had my baby. She was there after helping, you know, care for the baby. She was helping me, helping my husband, both of us. And it was amazing. She got me enrolled into this wraparound program. You know, because we came to Haymarket, like I said before, with nothing, absolutely nothing, me and my husband. Just the clothes on our back, and she helped both me and my husband in so many ways. She got us clothes. She printed out my husband's resume for him so he can start looking for jobs. You know, she helped me fill out paperwork for my stamps, my TANF for when the baby was born. she filled out for like little things with like Huggies and stuff that they sent me, care packages for the baby. I got a tub. It was filled with stuff. It was amazing. So, she was awesome.

Host: You can do it with support. I think that's what you're always emphasizing, Dr. Lustig, is this integrative model of support. Kristyn, as you continue your recovery, what would you want women or mothers looking to get treatment or going through their own recovery journey, what would you like them to know?

Kristyn Smith: Just that if I can do it, that anybody can do it. And if you get there and you give the place a chance, then you'll know that you're supposed to be there. And I just hope nobody will leave before the miracle happens. I promise it'll work.

Host: Knowing the success these programs have brought to individuals like Kristyn, Dr. Lustig and Dr. Cothran, what gives you the most hope when you think about the future of women's recovery and maternal health? I'll start with you, Dr. Cothran.

Judith Cothran, MD: And I think, without the services, you know, the fully integrated services that support new moms and their babies, you know, we just see less success. And this should be used as a kind of a benchmark or an example of how this should be done in other institutions. Giving moms a chance to get into recovery and have their babies with them and not threatening to take their child away from them is so important.

Often moms will seek treatment when they're pregnant and they go to the emergency room, and the first thing they hear is that your baby's going to get taken away from you if there's substances found. And we try really not to leave with that kind of negative statement and really focus on the positive, the fact that she showed up for recovery and we want to support her through recovery.

Host: So focusing on building and support over punishment. Dr. Lustig, what are your hopes for the future of these programs?

Dr. Dan Lustig: Well, what was always important for us as we started this project was really being able to offer culturally responsive care to advance health equity. One of the biggest issues and challenges that we are confronted with at Haymarket Center is oftentimes women of color continue to experience significant disparities in maternal health outcomes. Preventive care and access to healthcare services, addressing these inequities requiring more than providing medical appointments, it requires listening, understanding, and delivering care that reflects each woman's unique experiences. And that's what I hope our health center will continue to function as, is this really kind of beacon of culturally responsive care. I think it's important for women to really look at a medical system and not mistrust the medical system, but really have an opportunity to engage in their healthcare for the first time that is stigma-free.

Host: And it makes all the difference. As Kristyn said, a game-changer. Kristyn, I want to thank you so much for sharing your story and wish you continued success. Dr. Cothran and Dr. Lustig, thank you so much for providing comprehensive high-quality care that supports women and mothers. And thank you for sharing how Haymarket is focused on continuing to evolve and expand and be responsive to the community with this care.

Dr. Dan Lustig: Thank you so much, Amanda. And thank you, Kristyn, for having the courage to tell your story. I think that's such a important aspect of what we're doing here today is being a beacon for other women, that have children to come into treatment when they need to.

Kristyn Smith: I hope they find the courage to do it. I know they could do it.

Judith Cothran, MD: Thanks so much for having me, and thank you again, Kristyn, for being here too,

Host: That was Haymarket Center President and CEO, Dr. Dan Lustig, OB-GYN Dr. Judith Cothran, and Kristyn Smith. For more information on the Haymarket Center's Women Services OB-GYN program, visit hcenter.org. Make sure to subscribe to our podcast, share and connect with us on social media at hcenter.org/recoveryunscripted. Thanks for listening to Recovery Unscripted with Haymarket Center.