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BETHLEHEM, Pa. (AP) — At Tracey Maholland's home in Bethlehem this summer, a typical family scene unfolded.
Her 16-year-old daughter was getting ready for work. Her 10-year-old son played video games in front of the TV. Her youngest was out on a basketball court in the neighborhood.
When the cable guy dropped by the family's new house, Maholland hurried to help him. It was a typical afternoon picture of a mother and her children, on a sunny day when school was out.
Typical, yet remarkable, considering the rocky path of Maholland's life: At 37, she is a recovering drug addict who abused both heroin and methamphetamine, even as her three daughters and two sons looked to her to guide them through the pitfalls of childhood.
Maholland's children have seen a lot. Domestic violence, unstable homes and their mother going to jail and rehab. Her eldest, now 20, spent much of her school years being raised by her grandparents. Maholland's 16-year-old ended up battling addiction of her own. There were days in which, to meet their basic needs, they were forced to rely on relatives or neighbors or to fend for themselves.
"As close as you can come to losing them, I came," said Maholland, who has been sober nearly 18 months and says her family is doing better than ever. "Before, I didn't want the kids to see what I was doing. Now, I'm happy and they're happy because of it."
Struggles like Maholland's are only becoming more commonplace, as Pennsylvania grapples with a heroin epidemic fueled by cheap access to the drug and the overprescription of painkillers that act as a gateway. But seldom do families speak publicly about addiction and its impact on children, given the stigma and shame that surrounds it.
Instead, the story of drug abuse's reach is often kept to hospital intensive care units, where babies born dependent on opiates cry inconsolably as their first weeks of life are spent in withdrawal. Or in the halls of social work, where caseworkers struggle to keep families together while ensuring that mom or dad's drug problem doesn't bring their children harm.
Or in police logs, which document parents who overdose in front of their children, endanger them in unkempt homes or bring them in tow to drug deals. Or in early-morning drug raids, when investigators are surprised to find a young son or daughter living with the person they arrested.
"To have a child with them, your first reaction is you're furious over it. 'How could you be doing this?' " said Bethlehem Township police Sgt. Rick Blake, who heads vice investigations for the department. "The problem is, they're no longer thinking rationally at that point. The addiction is the center of their universe."
Jump in foster placements
On track with the heroin crisis, the number of children in foster care in Pennsylvania has leapt in three years, reaching 15,995 at the end of 2015, state statistics show. That's a 14 percent increase from the 14,004 of 2012.
In one of those years, 2014, parental substance abuse was a factor in more than 56 percent of the cases in which infants were removed from their homes, according to the Center for Children's Justice, a nonprofit in Berks County.
Alongside that, more than 7,500 babies were born from 2010 to 2014 with drug dependencies they received in utero, according to Pennsylvania Medicaid statistics obtained by the children's justice center. And those were tip-of-the-iceberg numbers that do not account for newborns whose mothers had private insurance, as six in 10 Pennsylvanians do.
Dr. Kimberly Costello, the director of neonatology at St. Luke's University Health Network, estimates that at least once every two weeks, a newborn is diagnosed at St. Luke's with neonatal abstinence syndrome — a medical term for the problems faced by infants exposed to opiates in the womb.
"It is very unusual for us not to have a baby suffering from NAS," said Costello, who described the numbers as "absolutely" on the rise.
Weaning the babies from their addictions typically takes three weeks in intensive care, in which they slowly receive lessening doses of morphine to combat their symptoms, Costello said. Even treated, their conditions are heart-rending, she said.
The newborns vomit from crying so much, have repeated diarrhea that causes severe diaper rash, and constantly scratch their faces in their agony. When they are finally ready to go home, they are at greater risk of abuse such as shaken-baby syndrome, given the difficulties in keeping them consoled, Costello said.
"You don't realize what people, especially kids, are seeing. And they saw a lot, they really did."
— Tracey Maholland, Bethlehem
"It is really possibly the most pathetic situation you can see in our NICU," Costello said. "It is just a very difficult thing to watch."
Cynthia and David Bonilla of Allentown have witnessed that first hand, and with their own daughter.
David, 29, became hooked on opiates at age 16 after a car accident in which his mother died and he was seriously injured. He started on prescription painkillers then moved to heroin. At the height of his addiction, he was using eight bags a day.
Cynthia, 26, started using heroin as a teen. The couple met at a drug rehabilitation center and have been married for four years, with a son who is 3 and a daughter who is 2.
Their daughter was born addicted. The couple watched helplessly as she went through withdrawal, shaking uncontrollably in her hospital crib.
"It ripped my heart out," David said.
The couple admits they were overwhelmed and unable to take good care of their babies.
"We both come from families with a lot of problems," Cynthia said. "We didn't have a lot of support, just each other."
With their agreement with Lehigh County, their son and daughter are in foster care as they work to kick their habits and turn their lives around. The children are enrolled in SafeStart, a Head Start program in east Allentown that serves 64 at-risk children, the majority of whom were born to mothers who abused drugs or alcohol while pregnant.
Since the children are often sensitive to light and sound, the center is decorated in muted colors and lights are kept low.
Therapists are on hand, and in each classroom there is a one-way mirror. This is used by caseworkers and others who must observe the children and report their findings to a judge.
Parents are permitted to visit as often as they wish. That helps families like the Bonillas, who must show in court that they have taken steps toward being better caregivers.
If all goes well, the Bonillas expect to be reunited with their children this fall. The parents have been able to stay clean with methadone therapy. David has a job.
"I can wake up and start my day, without feeling sick or like my skin's on fire," David said. "With heroin, you're crippled."
Cynthia said she's looking forward to having her children home.
"I'll be able to concentrate, to look at them and really see them. Instead of thinking about whether I'm going to be sick because I don't have any heroin," Cynthia said.
When parents are addicts
If there is a message that social service caseworkers want to send to parents with addiction, it is this: We are here to help your family, not take away your kids.
Caseworkers get involved with families for any number of reasons: a parent who gets arrested, a child found wandering away from the home, a relative or teacher who was concerned about the child's well-being. Often, parents will try to hide their addictions from social workers, who learn of them only after that first drug test comes back.
"Families that are drug addicted are the hardest to get on board," said Shannon Snyder, a caseworker at the Northampton County Children, Youth and Families Division. "Because it is such a shameful, secretive thing."
Addiction presents a special problem for the social services, which operate under strict time frames once a child is removed from the home. Under the law, children are entitled to a permanent home in 15 to 22 months of their removal — preferably with their parents, but if not, through adoption.
Sobriety is an often lengthy process pitted with rehab and relapses, officials said. That can make those mandated time limits harder to meet, especially if parents are resistant to social workers.
In the end, Northampton County Children and Youth Administrator Kevin Dolan estimates that 85 to 90 percent of parents who end up losing their parental rights have substance abuse problems.
"By the time you get to termination, you've exhausted everything you can," said Kezzy Johnson, another Northampton County caseworker. "You've tried to give them chance after chance after chance. It's exhausting to get to that. It is sad."
Monroe County Judge Jonathan Mark is the co-chairman of a state workgroup established by the Office of Children and Families in the Courts to study substance abuse and its impact on child welfare. Mark said more needs to be done to identify parents with addictions early in the process.
Treating drug addiction as a public health issue — and not a moral failing — would go a long way toward helping families be more frank about the problems before them, he said.
"If you can get those people into the services early, you'd be amazed at the results you can get," Mark said.
The heroin and opioid epidemic is the rare issue that's grabbed the attention of lawmakers on both sides of the aisle, said U.S. Sen. Bob Casey, who came to Allentown in early August to tour Lehigh Valley Hospital's neonatal intensive care unit.
The Pennsylvania Democrat co-authored the 2015 Protecting Our Infants Act, which requires more federal research on addicted babies and their mothers.
"When it comes to opiate abuse and the addiction problem we've heard so much about and learned so much about, it's almost impossible to describe the scope of the problem," Casey said. "This is a crisis. We've got to meet it head-on.
Rebuilding a life
Maholland, the Bethlehem mother of five, said she decided to tell her story publicly because she wants people to know that addiction has a face.
There are chapters that she is not proud of.
The arrests for petty crime: for helping steal her father's identity, for passing a bad check in Bethlehem.
The 44 days she spent in jail.
The toll on her family.
A decade ago, her eldest daughter moved in with Maholland's parents. Her 13-year-old daughter lives with the girls' father.
Her middle daughter has had battles of her own with drugs and depression. At 16, she has spent time in residential centers for children, and attended outpatient treatment and Narcotics Anonymous meetings.
"It used to be really bad," said the teen, whose name is being withheld by The Morning Call to protect her privacy. "Like I would get in fistfights with my sisters and stuff like that. We would all be fighting over things."
Maholland knew better than to abuse drugs. She comes from a law enforcement family, her father a retired Lower Saucon Township police sergeant, and the father of her daughters also a policeman.
Maholland said she began using in her late 20s, after she met her now-estranged husband, the father of her two boys. She started with prescription pills and eventually a friend suggested heroin, which she and her husband began snorting, she said.
Maholland said she got clean for several years in 2010, after her husband was jailed in Northampton County Prison — where he is also being held today. But in the summer of 2014, she started using again.
This time, it was methamphetamine. She'd snort it or, once her nose got torn up, swallow it like a pill as much as five times a day.
Through both addictions, she tried to keep it from her children. But even Maholland's sons — the babies of the family — recall more of the past than she would wish.
"There were times when the boys would say, they saw Mommy and Daddy with a straw in their nose," Maholland said. "You don't realize what people, especially kids, are seeing. And they saw a lot, they really did."
As she spoke, her 9-year-old son came into the backyard of the double home on the South Side and sidled up to his mother.
"Remember when you didn't come home for a long time?" he asked her, a reference to the 21 days she spent in rehab last year.
"Yeah, three weeks to get better," she responded.
"Why did you need to get better?" pressed the child, whose name is also being withheld by the newspaper.
"Because I was sick," she told him.
Maholland is now enrolled in Northampton County's drug court, an innovative program that diverts people with drug problems out of the justice system and into treatment. Before she went to rehab, she said, she was living in a hotel with only her 10-year-old son still with her. In the lead-up, she was so angry, she had broken her hand a couple times hitting things in frustration.
Today, Maholland said, she is trying to rebuild the life her family deserves. When she spoke with The Morning Call in June, she had been living in her new home for three weeks, after moving out of her parents' house. She has been working at a thrift shop in Hellertown since October.
She and her children go hiking together now, and swimming, she said. They joke around, laughing and having fun like never before.
Occasionally, she gets reminded how different things are, like when she was talking to her mother the other day about her 9-year-old son.
"She said to me, '(He) said you're not mad anymore,' " Maholland recalled.
Information from: The Morning Call, http://www.mcall.com
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