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Women in Courts Other than Criminal can Fall Through Cracks

Sometimes, Juvenile Court of Knox County Judge Tim Irwin looks at the young women in his courtroom struggling with addiction, about to lose custody of their children, and he wonders if their chances of making it would be better or worse if they’d done something to land themselves in jail.

In criminal court, depending on the county and the situation, they might be eligible for rehab services through one of the state’s Recovery Courts, which give nonviolent, serial offenders a chance for treatment versus jail.

There, if they violate probation and begin using again, Irwin said, they’re put back in jail, “where you can’t have access to your drug of choice. You start the process of getting sober.”

But Irwin doesn’t have the option of getting the women who come through his court treatment, nor does he have the leverage the threat of jail might provide. All he can do is take their children away.

For some women, that’s enough motivation to get clean. It robs others, however, of all hope, and pitches them deeper into the abyss of addiction.

When Irwin took the bench nearly 12 years ago, he said, 300 children were in Juvenile Court custody in Knox County – 51 for committing delinquent acts, 249 for neglect. Today, more than 700 children are in custody, he said, and only about 30 for delinquent acts. The majority of the rest, he said, are the result of opiate-addicted parents, a “public health crisis” taxing both the court and foster care systems.

“Frankly, we don’t see a lot of these people getting well,” Irwin said. “It’s very distressing. It’s one of the most terrible things I have to do, is sever a bond between a young mother and a child. I don’t enjoy it, but we have to err on the side of protecting the child. We are not going to leave a child with an active user of opiates. … It’s unsafe, and we have to protect that child.”

In 2013, Irwin’s court piloted a family recovery court for drug-addicted mothers (and, in some cases, their partners), funded by a grant from the federal Office of Juvenile Justice. Supervised by magistrate Dirk Weddington, it sought to get the parents in treatment with a goal of long-term sobriety and custody of their children.

But there were simply too few resources for treatment, Irwin said – a problem that persists; although there are more resources now, there are also more women who need them.

The women in the program were under a doctor’s supervision and taking an opioid replacement medication, suboxone. The court’s program aimed to wean them off opiates altogether and have them go onto a drug, naltrexone – Vivitrol, in shot form – that blocks the receptor that allows opioid users to feel pleasure from the drug. The problem was, they had to be completely detoxed to start naltrexone.

“The path to recovery is not linear,” Weddington said. “There are setbacks and turns. So when the ladies would experience a setback, if their children were at risk, then the children were removed from their care – and justifiably so, because it’s clear that an opiate addict is not a reliable caretaker.”

But for women on TennCare, losing custody also meant losing benefits – and, consequently, losing coverage for addiction treatment. Though the following year, TennCare temporarily suspended the process by which it checks to ensure people using TennCare are still eligible, it’s now back in place, so women could potentially lose TennCare if having children were the only reason they were eligible, the state said.

Even with private insurance, “you generally get one bite of the apple,” Irwin said. A policy that pays for a 21-day inpatient stay in a facility is unlikely to pay again if the person relapses, he said.

Treatment programs, especially inpatient, generally have waiting lists. Few programs take women who are pregnant.

Criminal court drug recovery programs own their treatment programs and can micromanage them, Irwin said. His court was at the mercy of outside providers who provided the treatment in the parents’ homes, he said, and the court had neither the manpower nor the money to monitor the women as much as necessary. At the program’s end, one of the four achieved sobriety.

Irwin hasn’t ruled out reviving the recovery court, "if we get that treatment piece in place,” he said.

One program his court works closely with now is Susannah’s House, which helps addicted pregnant women and women with children. The nonprofit is funded by donations and grants and doesn’t accept insurance.

“If you do accept insurance, then you are limited by what (the insurer) will allow the women to do” to get well, said the Rev. Rebekah Fetzer, Susannah's House founder and executive director. “Our program is really long-term. It’s not a 28-day, it’s not a six-month, it’s however long it takes them to work through the process and live clean and sober and get their kids back.”

It’s after leaving treatment and regaining custody that women often relapse, she added: “They’re out in the world on their own and haven’t had anybody to support them. We keep them (in the program) and support them.”

That type of support, of “after care, somebody you check in with,” is one of the requirements Irwin wants filled when parents petition his court for custody – along with completion of a treatment program and a documented period of sobriety.

“We’re looking for a time it’s safe for you to be around your children unsupervised, however long that is,” Irwin said. “And it’s different from case to case.”

Sometimes, Fetzer said, sad as it is, that’s never.

“We’ve had some women who come through the program who didn’t need to get their kids back,” Fetzer said. “And we know it – and so do they.”

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