Oregon's Largest Treatment Center for Mothers Closes, Taking 29 Beds

The Letty Owings Center in northeast Portland closes permanently on Oct. 31, ending 37 years of residential addiction treatment for pregnant women and mothers with young children and removing 29 beds from a state that has already lost roughly a fifth of its residential capacity for that population in the past year, according to an estimate by InvestigateWest.

Central City Concern, the nonprofit that has run the center since 1989, is also closing Laura's Place, a transitional housing program where about 16 women and their children lived each year after finishing treatment at Letty. When the closure was announced in September, the organization cited mounting financial deficits and rising care costs.

A building designed around children

Letty was not a standard residential program with a nursery bolted on. Mothers could bring children up to age 5, and the children were cared for at an in-house licensed child care center. Staff took babies so that postpartum women could sleep, helped with bottle feeding when breastfeeding was difficult, and ran classes in financial literacy, grief and parenting alongside clinical treatment. Child welfare workers could allow a mother in treatment to keep her child overnight during the week — the arrangement that let Ashley Amorim spend two nights a week with her four-month-old son, Jeremiah, while she lived at the center.

Amorim, 36, moved out on Oct. 8 after four months, describing a 16-year cycle of drug use that she said the program interrupted. "It's a great program," she told InvestigateWest. "It saved my life, and I am very grateful to have been a part of it."

She was one of the last residents. By her move-out day the building, which once housed nearly 20 mothers and their children, had emptied out.

Why the numbers stopped working

The pressures described by providers are not unique to Portland: federal funding cuts, buildings that have outlived their systems, and the rising cost of caring for patients who arrive sicker than they did a decade ago as the drug supply has grown more potent. Leaders from three other Oregon programs serving pregnant and parenting people told InvestigateWest they had raised alarms with the Oregon Health Authority in recent years.

The demand side has moved the other way. Research cited in the reporting shows opioid use during pregnancy has increased substantially over the past decade, and in Oregon substance use and mental health conditions are the leading causes of death among pregnant women and new mothers through the first year postpartum. A state that closes beds while both curves move in the same direction is making a decision about who gets treatment, whether or not it says so.

Diana Louise Smith, a certified nurse midwife and clinical lead for Project Nurture, an outpatient program at a Portland hospital that pairs addiction treatment with prenatal care, was blunt about the arithmetic. "We're probably going to see people die as a result of Letty closing," she said. "Every week, people are giving birth to their kids and then not having a place to go to treatment."

The state's answer so far

A spokesperson for Gov. Tina Kotek said the governor has directed the Oregon Health Authority and the Department of Human Services to form a cross-agency team to find solutions, and health officials said the group would begin meeting this month. Kim Lippert, a communications officer for the health authority, described the effort in an email as urgent and said the team would work with providers to identify "practical recommendations that address immediate risks, underlying systemic funding, and operational concerns."

That is a planning process standing where a licensed facility used to be. The reporting on the closure describes no replacement beds and no timeline for the team's recommendations.

What disappears with the beds

Residential programs that accept children are scarce because they are expensive: ratios are driven by both the clinical needs of the mother and the supervision needs of a child, and the payer mix is dominated by Medicaid. Outpatient programs like Project Nurture can manage early recovery for many women, but they cannot substitute for a placement that keeps a mother and her child together when home is not safe. Without one, the alternatives are foster care separation or no treatment at all — and the second option tends to end in an emergency department.

"Are we the canary in the coal mine?" said Tina Bialas, the center's director, who will be laid off at the end of November. "I think we are."

Thirty-five years later, an alumna watches

Lynn James-Kiona arrived at Letty in 1991 after losing custody of two children during her addiction, willing to do what it took to keep the son she was carrying. She is a member of the Yakama Nation, and she has described how counselors helped her see what intergenerational trauma had done in her family — a mother cut off from her language and culture after being sent to boarding school — and how staff stayed with her through nights when she woke up feeling paralyzed.

She went on to found the Mary Kiona Foundation, a nonprofit named for an ancestor that works on community services and housing. She is a tribal elder now. The program that got her there is closing, and the mothers who gave birth this week in Portland hospitals have one fewer door to walk through.

Women seeking residential care with their children can search residential treatment programs, and Oregon's integration of addiction care into prenatal settings is described in earlier coverage of Project Nurture and state efforts. Medication for opioid use disorder remains the standard of care in pregnancy; treatment options are listed here.