The genesis for the Family Intervention Response to Stop Trauma (F.I.R.S.T.) Legal Clinic began on a return trip from a permanency planning summit during which it was revealed that 12 to 15 babies are being removed every month in our county. Neil Weiss, an attorney from our office who had attended the summit, began to think about how we could begin to advocate “upstream,” before a child entered into state custody. Weiss has the unique mix of an incredible work ethic combined with a stubborn inability to accept the status quo. Based on his vision and leadership, a plan began to form to begin a medical-legal partnership to addresses the trauma of children being unnecessarily separated from their parents due to removal into the foster care system. This partnership would create a multidisciplinary team to offer wraparound services to prioritize prevention with the goal of completely avoiding children being removed from their home.

The F.I.R.S.T. Clinic offers a free attorney for a parent prior to the normal CPS appointment process, stable housing, streamlined access to drug/alcohol evaluations and treatment, employment and skills training support, and a nurse-parent partnership for first time mothers in which an assigned nurse works with a family for the first two years of a child’s life. This clinic would be revolutionary because instead of waiting until after removal of the child to appoint a lawyer, the F.I.R.S.T. Clinic works with pregnant moms and new mothers prior to CPS intervention in order to access drug and alcohol services, organize family resources, and hopefully avoid removal of the child altogether.

The F.I.R.S.T. Clinic model acts as a team in a first responder style. The average response time from calling the F.I.R.S.T. Clinic to direct contact with a lawyer is less than 20 minutes. Clients are identified and referred to the F.I.R.S.T. Clinic by hospital social workers, drug and alcohol counselors, and treatment facilities. Pregnant mothers and new mothers who are the subject of a CPS investigation and who are not currently court involved with that baby qualify for the F.I.R.S.T. Clinic. Ideally our clients are referred to the F.I.R.S.T. Clinic months prior to the birth of their child so we can safety plan CPS involvement together. Early intervention also allows us to mitigate one of the biggest issues our clients face: homelessness.

Along with the legal advocacy, the F.I.R.S.T. Clinic provides an entire support structure for a parent and child. The team includes a resource navigator who helps assist with a direct connection to clean, stable housing that can be used as a secure address to discharge to after successful completion of treatment. Another service that the clinic offers is a veteran parent (parent ally). This is a parent who has successfully navigated the CPS system and reunified with their child. The veteran parent accompanies the attorney and acts as compassionate and emotional support for the new participant. This fulfills a role that an attorney isn’t necessarily equipped to take on and provides an advocate who is more able to connect and communicate with the parent.

“I want mother’s coming into the F.I.R.S.T. Clinic to be empowered and to feel completely supported. I want them to have the time they need to heal and focus on themselves and to gain the tools they need to permanently avoid their family being caught up in the system in the future.”

—Gina Wassemiller, F.I.R.S.T. Clinic veteran parent and 2019 ABA Reunification Hero Award recipient

The housing component of our F.I.R.S.T. Clinic offers 18–24 months of safe and supportive housing run by a parent ally. Our region, like so many others, faces a pervasive problem of chronic homelessness. A parent successful in becoming clean is simply not enough if they are then discharged to the streets. Also, as the F.I.R.S.T. Clinic continues to grow and expand, we’re working with our local community college to put in place additional employment resources and life skills classes for parents on-site so that new families are leaving the F.I.R.S.T. Clinic with the tools they need to never have contact with CPS in the future.

Studies show that the removal of children from their parents causes significant long-term trauma. “Trauma often causes significant neurological and physiological changes to children’s growing brains and bodies. The science regarding such changes is robust and compelling.” The F.I.R.S.T. Clinic is an innovative, upstream, medical-legal partnership that recognizes the trauma that separation has on children. Utilizing the F.I.R.S.T. Clinic is a preventive way to change the trajectory of family crisis, minimize trauma, and prevent involvement in the foster care system.

The F.I.R.S.T. Clinic endorses the evidence-based model of Eat, Sleep, Console (ESC) as a way to treat parents with substance abuse issues, and ESC has radically altered medical mindsets on how to treat infants who are born with Neonatal Abstinence Syndrome (NAS). The ESC model encourages keeping babies with mothers, promoting breast-feeding and skin-to-skin contact as well as other comfort measures. When ESC was rolled out, some of the biggest skeptics of the model were the nurses helping to oversee implementation. After all, why let these mothers who caused the harm to their children now be part of the solution? Following a dramatic 93 percent decrease in the use of morphine to treat babies who had the benefit of ESC with their mothers, the same nurses who once had reservations have become avid supporters. In addition, in just 7 months, the University of North Carolina Children’s Hospital at Chapel Hill dropped their lengths of stay for NAS from about 11 days to 5 days by moving from the old model of scheduled morphine dosing treatment for babies to the ESC model, according to a report at the Pediatric Hospital Medicine meeting. The use of morphine also dramatically decreased from 93 percent of infants transferred to the hospital’s inpatient floors for NAS to just 12 percent, with no downsides for infants or moms.