Years into Victoria Richardson’s addiction, every choice was rooted in how to continue using drugs. Until this one.

“I was five months pregnant with my son and using heroin, and I knew I couldn’t do that anymore,” she said. “I knew I had to change so my kids wouldn’t grow up the same way I did.”

A counselor pointed her to a special treatment center for pregnant women and mothers, a homelike environment where everyone stays together and learns or relearns how to be a family. She thrived. Her son Zakari is now a playful and energetic toddler, living with his mom and 1-year-old sister in their first apartment.

Time will show if he’s ultimately a success among the children of current and former drug users, who can suffer emotionally, behaviorally and intellectually from their parents’ addiction, even if the kids never used drugs themselves.

Those effects are perhaps most apparent in Cecil County, a rural and picturesque enclave in Maryland’s northeast corner that for years had the state’s worst overdose rate, fueled by easy access to heroin, fentanyl and other substances trafficked along I-95.

Now, the county holds another troubling superlative: the state’s highest rate of children in special education, which experts tie to the prior generation’s drug use.

This has led to a shift in the way education and health officials view the opioid epidemic. They have come to believe reducing the generational harm will take a focus on the whole family, rather than each individual with a substance-use disorder. Across the county, an informal network is developing ways to track down more children and get them help as early as possible — including while their mothers, like Richardson, are still pregnant.

There are family-focused peer counselors at a needle exchange site, a mommy-and-me treatment center, and programs inside public schools for current and future students, all aimed at ensuring kids get the attention they need.

Paying for all of this is a challenge. There aren’t enough programs for everyone, especially children, and there is a nationwide health care worker shortage. There also isn’t widespread understanding of how to treat pregnant women and entrenched stigma that keeps people from seeking treatment. And then there is the reality that sometimes addiction is stronger than the will to be a parent.

While many in Cecil have come around to a new approach, more needs to change around the country, say experts and providers, including Mary Gamble, director of the Brantwood Family Services in Elkton, where Richardson was treated.

She said even when relationships seem irreparably strained, treatment that doesn’t recognize family bonds “doesn’t really account for the world most of us live in.”

The cycle

Many of those who suffer substance use disorders grew up in homes where others were drug users.

Richardson believes she modeled her drug use on what she saw in childhood and said she was left vulnerable to abuse. She spiraled, becoming homeless and relying on prostitution at times to pay for more drugs.

Pregnancy presented her with a choice, and she went to treatment.

Richardson gave birth to Zakari at Brantwood, one of a small number of facilities in Maryland allowing children. It opened in 2019 after a county task force called for more places for women with substance use disorders to go instead of jail.

How opioids affect fetuses isn’t entirely known, said Dr. Christopher Welsh, an addiction specialist and University of Maryland associate professor of psychiatry. But it’s common for people with substance use disorders to drink alcohol, smoke tobacco, eat poorly and forgo prenatal care — all proven to be harmful during pregnancy, he said.

That can cause babies to be born prematurely and underweight, with initial breathing and feeding problems. They can also be stillborn, die as infants or have lasting health problems.

Richardson said she cared more properly for herself once she was in treatment and recovery. She was prescribed methadone, a drug used to curb opioid addiction that’s proven safe for pregnancy. She started eating regular meals and challenged herself to give up the comfort of cigarettes. She saw doctors regularly and went to counseling.

Zakari was born in withdrawal from the methadone Richardson had been taking, then spent a month in the neonatal ICU for a breathing complication. But because he was born into treatment, he may have avoided some of the harms stemming from the physical and mental abandonment of an addicted parent, Welsh said.

At Brantwood, Zakari was in a safe and stable environment. It’s set up as a regular home, with bedrooms parents share with their children. They prepare for real life by helping the kids get ready for the school bus or day care. Mothers and kids can attend group therapy.

Most Brantwood residents have to learn coping skills and parenting skills, said Gamble, the director. Some mothers are ordered by the courts to the facility, which serves pregnant women and their children up to age 10.

In recovery, some women feel like they’re becoming a new parent all over again.

“When people are in active addiction, no matter how much they want to be with their children, their brains are hijacked,” Gamble said. “They can get over active addiction and deal with the cravings, but then they have to reengage with their children. It’s not always all sunshine and roses.”

The recovery

Richardson was never separated from Zakari, or from her daughter, Khalani, who was born in the homeless shelter where she lived for a time after leaving Brantwood.

More often, children end up in foster care or with friends or relatives. That’s where Voices of Hope comes in.

The organization was launched in 2013 as a landing spot for people with substance use disorders. They recently added family-focused peer recovery specialists, who might make the first call to help someone reconnect with a family member. It can be an especially difficult step for parents.

“With their children, people have immense guilt and shame,” said Jennifer Tuerke, Voices for Hope’s executive director. “They don’t think they have rights because they hurt them so badly, and peer counselors support them, making calls to their children so they can start seeing them again. It gives them something to go to treatment for, or stay in recovery for.”

Voice of Hope operates two recovery houses in Cecil where women go after initial treatment to relearn how to manage their lives. They can’t yet accommodate children, but host regular family events and help mothers develop family reunification plans.

Sherry Matthews has been living for months in one of the houses, a small rambler on a tree-lined street with modern amenities and staff working out of an office in the garage. Matthews constantly thinks about being with her girls, ages 6 and 7. She is grateful her mother took them in when she was in and out of rehab, but worries that’s harmed their bond and the kids’ mental health.

“When I was using, I loved drugs more than my children,” said Matthews. That’s hard for her to fathom now.

Her childhood was focused on school and sports. That changed in college when she started drinking before moving on to cocaine and heroin. When others stopped, she couldn’t.

She spent time unhoused and committing petty crimes. Matthews said her first baby died while she was in jail. Now she’s sober and working at a warehouse. Her family reunification plan included finding her own home where she can see her girls more, if not live with them.

Her housemate, April Rhoades, turned to drugs when her oldest son died in a car accident and she was “self-medicating.” Her guilt and sadness over neglecting her younger boys, who were also grieving, were compounded when she said one son was abused in someone else’s care.

At first, she only saw the boys, ages 8 and 12, once a month in person and once more on Zoom, as they were in foster care in separate counties. One has ADHD and a special education plan at school.

More recently, she was diagnosed with cancer, but has been working in a retail store as she gets treatment and studies to become a community health worker. And she sees her kids a lot more.

“I want them with me,” said Rhoades. In her mind, and her family plan, “I keep doing the next right thing so I can get them back.”

The schools

Jennifer Hammer, associate superintendent for education services in Cecil schools, knows what children like Rhoades’ are facing. She said they can become anxious, withdrawn and unable to learn in traditional ways, even if they are “quite bright.”

They may need tutoring in their classes, frequent small breaks from the classroom, and regular sessions with professional therapists, in addition to medications for mood disorders. About 17% of Cecil’s students needed an accommodation in class, surpassing the state rate of 12.8%, according to the latest data available in 2022.

School and county officials have been trying to get ahead of the problems by aggressively pursuing parents. They use their contacts in the community, sometimes going door to door, to encourage people who are pregnant or have young children to participate in their Judy Centers, state-funded programs in high-poverty schools in partnership with local health departments and providers.

“We try to identify students before they show up on our doorstep at 4 or 5 [years old],” Hammer said. “Some show up with significant needs.”

Some aren’t ready, and officials have had to refer children to child protective services when their surroundings are unsafe.

Richardson goes to weekly playdates at a Judy Center, which gives her another chance to bond with her kids as they play. She can ask questions, learn from other parents and staff, and feel part of a community. School officials say the regular supervised playtime helps the children develop social skills and emotional regulation needed for kindergarten.

The county schools now house 10 of the state’s 86 centers, more than any jurisdiction except Baltimore. Cecil is applying for three more.

“More often than not, everyone wants what’s best for the child,” said Mandy Feeney, program coordinator for early childhood education in the Cecil County Public Schools. “Families see hope here. They don’t want to continue the cycle.”

State testing shows readiness for kindergarten in Cecil, like many jurisdictions, dropped during the pandemic, but Cecil rebounded by the 2022-2023 school year when 39% were deemed ready. That’s now just below the state average of 42%.

Thomson Estates Elementary School, a high-poverty school in Elkton, has a Judy Center and other ways to help students in the classrooms. School leaders liberally dole out hugs, high-fives and rewards, like a sticker for small daily achievements.

There are far more serious needs there, though. Some kids struggle to control anger or other emotions and can’t always sit through class. There is a room for students with regularly scheduled therapy sessions with trained professionals.

There also is a “student support center,” a staffed room, painted in calming colors and filled with books and games. Students can take themselves, or be sent by a teacher, when they can’t sit still and focus or control their emotions and need a few minutes away from class.

Most Cecil elementary, middle and high schools have support centers too, though federal pandemic-era funding expired and they are slated to close, which Hammer calls “very upsetting.” Last year, the center at Thomson Estates logged 1,700 student visits.

Resources are “highly strained” for students with special education needs, a number that has jumped 22% in the past decade, said Hammer.

There were 2,821 students with disabilities in fiscal year 2024 and about 460 teachers, paraprofessionals and other staff to support them.

Assessing each child’s needs has been complex, said Dr. Ira Chasnoff, a researcher and consultant who helped develop programs in Cecil. Every child has a different set of evolving circumstances, said Chasnoff, president of NTI Upstream and a professor of clinical pediatrics in the University of Illinois College of Medicine.

“We have to watch the child’s behavior, then match the level of need,” he said. “It’s complicated and difficult and may vary from one day to the next, especially if something has happened at home.”

The hope

There are other Cecil families offering hope for a better future.

Aaron and Erin Wright have jobs and own a house and two trucks. On a recent day, Erin hustled her 11-year-old daughter Ryleigh off to her horseback riding lesson. Aaron tore his 7-year-old son Patrick away from his soccer ball to go to a neighborhood festival.

Before they met, Aaron and Erin were addicted to drugs, living in unstable housing and tangling with the criminal justice system before they were ready for treatment. It strained relationships and separated them from their kids. Aaron said he didn’t even learn he had a son from a previous relationship until Patrick was a year old.

Erin said she lived in her car with her then year-old daughter. She’d turned to prescription pills and then street drugs after a bad marriage dissolved and she was recovering from a gunshot wound to her leg. She went to treatment in 2016 after overdosing in the front seat.

Aaron said his spiral began when he was a child and watched a relative overdose and was abandoned at home. He smoked, drank, turned to heroin and landed in prison before seeking treatment.

He and Erin met in 2017 while they both were in recovery, but had little time for the normal joys of courtship. Erin had reclaimed Ryleigh from foster care; Aaron soon began his 10-month custody battle for Patrick. That has turned into a passion to revamp the court process to make it easier to reunite families.

As a newborn, Patrick suffered through opioid withdrawal and was prescribed multiple medications and therapies.

“Failure to thrive,” Aaron said the doctors called it.

When Aaron and Erin got custody of Patrick, they had him reassessed and eventually got him off all the medications. He and Ryleigh are both now healthy, active and strong students. The parents still take medications to stave off cravings, and the whole family goes to support group meetings at Voices of Hope, where the Wrights also both work.

“We don’t hide it from them,” Aaron said.

Erin said people like her and Richardson are motivated by being with their children and have a better long-term chance if people “look at addiction as a family disease and treat the whole family.”

“That’s what will make a difference.”

It has for Richardson.

Now that she has a home for herself and her two kids, she is working on repairing other family relationships with her mother and sister, as well as the father of her children, Deontee Murray.

On a recent day, Zakari easily made his way over to Murray, who delighted in an embrace from his son. Khalani toddled over after getting a diaper change and a snack.

Finances are still a struggle, as Richardson said she gets no child support and Murray doesn’t keep in regular contact. But her children will soon enter a Head Start education program so she can get a job, possibly in retail, an area where she is experienced. She’s launched a GoFundMe page to help pay her $885 monthly rent and pay off the $2,000 she owes the last day care provider after public assistance she was counting on fell through.

She said she is focused on giving her kids a more comfortable life, and feels satisfied that the toughest thing in Zakari’s life at the moment is his 1-year-old sister, who steals their mother’s attention and sometimes pulls his hair.

“It’s tough as a single mom, but worth it,” she said. “I just try to make every moment count for us.”