Shaun Cross: Maddie’s Place creating a space to heal for infants and mothers

By Shaun Cross

The ongoing opioid crisis has brought with it another crisis: A growing number of children born with neonatal abstinence syndrome, meaning the infants were exposed to drugs – legal or illegal – during pregnancy.

To learn more about the prevalence of the problem and possible solutions, the Washington Legislature created a pilot project in 2023. The state Health Care Authority was directed to fund the operations of Maddie’s Place’s for two years, plus contract with Washington State University to conduct research on the clinic’s model of care for infants and parents.

The results of that research were to be submitted to the Legislature by Sunday. Unfortunately, the final report will likely be delayed until after the legislative session has begun, but a draft report shows staggering numbers for local drug use and incidence of NAS, as well as success stories in how Maddie’s Place is working with infants and parents.

The report disclosed that Spokane County’s NAS rate in 2022 was 340% the national average in 2021 (the last year national data was available) and 188% the state average for 2022. Between 2021 and 2022 the number of substance-exposed infants in Spokane County surged by 61%! The state NAS rate also surged between 2021 and 2022.

The numbers for substance-exposed infants in 2023 and 2024 aren’t available, but based on other drug-related data, it’s highly likely that the numbers have increased. EMS overdose responses in Spokane doubled between 2022 and 2024. Overdose deaths in Spokane continued to climb in 2023 and 2024. Fentanyl seizures have skyrocketed since 2022.

To help counteract those numbers, Maddie’s Place provides free medical and nonmedical care, in a low stress, homelike environment, to infants suffering from neonatal abstinence syndrome. In addition, we provide a full menu of wraparound services for the parents of our infants, including free room and board, case management and other social services. While we can (and occasionally do) provide morphine to our infants, which is what typically happens in the NICU, we have a non-pharmacologic approach to NAS (based on a 2021 Harvard/Johns Hopkins peer reviewed study) using a variety of handling, feeding and PT/OT techniques.

If possible, we strive to have the infant and birth parent heal together at Maddie’s Place, enabling them to coregulate during a preciously short window of opportunity, called the fourth trimester. Right now, many of these infants are not bonding with their birth parent while the infant is being treated in the hospital. Almost 3 out every 5 mothers who stay at Maddie’s Place are homeless when they come to our facility.

And these services are working. The draft report concludes: “It is clear that infants improved while at Maddie’s Place.”

Local providers interviewed by WSU noted some disturbing substance use trends in Spokane over the past few years because of increased polysubstance and fentanyl use. This new trend has had a negative impact on maternal and neonatal care efficacy in our local hospitals. The report concluded neonates in Spokane are requiring additional interventions and longer courses of treatment for their substance withdrawal symptoms. WSU found the average infant at Maddie’s Place had been exposed to four substances with 74% of the infants exposed to fentanyl.

The report includes the observations of 15 of the mothers who stayed at Maddie’s Place with their infants. Several said their infants would have gone into foster care without Maddie’s Place. Of the 41 mothers who stayed at Maddie’s Place (out of 71 infants), 38 (92.7%) have custody of their infants today, are housed and are in recovery themselves.

The report concludes with a request to the state Legislature for future resources to be dedicated for expanded research on NAS prevalence and the outcomes at Maddie’s Place for infants and families. It recommends a robust cost/benefit analysis of our model of care versus the costs associated with the care our health care system is currently providing.

The 2025 legislative session begins next month. Maddie’s Place is seeking continued funding for its operations for the next two years, the introduction of a new Medicaid reimbursement model, plus funding for expanded research by WSU.

Success stories in the ongoing national drug crisis are few and far between. Maddie’s Place represents a light in the dark, a new approach to the drug crisis, one that could become a model for the nation and a source of pride for Spokane.

Shaun Cross is the president and CEO of Maddie’s Place. Maddie’s Place opened its doors in October 2022 and has 80 employees who provide nurturing medical care and related wraparound support to substance exposed newborns and their parents.