When Joan Gillece, Ph.D., toured the maternity unit of the Baltimore City Detention Center a few years ago, she was unprepared for what she saw: dismal, stark surroundings and women despairing in the knowledge that they were about to lose their babies. One woman who had delivered her baby just 24 hours earlier was clutching a picture of her newborn infant under the covers.
"I found out these women were shackled to stirrups while they delivered and sent back to detention from the hospital the following day with a Polaroid picture of their newborn infants," she told Psychiatric News. "That was it."
The infants often went to foster homes. Sometimes they went to live with one of the inmate’s family members.
Gillece, who is director of Special Populations for the Maryland Mental Hygiene Administration, said the mothers, many of whom had been repeatedly traumatized throughout their lives, now had the additional trauma of having their babies taken away from them.
The new mothers weren’t the only ones who suffered. "The babies, due to disruption of their earliest attachments, are at risk for mental health problems down the road," she said.
Gillece envisioned a project where the women would have a secure and nurturing environment in which they could be with their infants. She began meeting with the organizations that would one day become instrumental in addressing the needs of the women inmates and their babies, including the University of Maryland Medical Center, the Department of Housing and Urban Development (HUD), and the Maryland Department of Public Safety and Correctional Services.
She dubbed the project Tamar’s Children, after a project she established in the late 1990s to treat women inmates for trauma and substance use disorders.
As part of the this project, which is known as Tamar, Gillece and Karfgin, who was then its director of clinical services, developed a trauma-treatment protocol for use in the Maryland prisons and jails.
Tamar, Gillece explained, is a woman in the Old Testament who was raped by her half-brother. She ripped her clothing in disgrace and was never heard from again. "We named the program after the Tamars of today," Gillece said. "Tamar" also stands for trauma, addiction, mental health, and recovery.
Many of the women who participate in the Tamar projects have been convicted of nonviolent crimes such as prostitution and various drug offenses, and they have related histories of neglect, physical and sexual abuse, and addiction, Gillece said.
"Our goal in establishing Tamar’s Children," she continued, "was not only to treat the inmates’ trauma and substance use disorders but also to work with them to develop healthy attachments with their babies."
Instead of serving out their sentences in a Maryland prison or jail, women inmates who are in their third trimester of pregnancy and deemed eligible for the program are brought to a community correctional facility located in a converted convent at St. Ambrose Church in Baltimore. Here, the women inmates receive intensive individual and group counseling each day.
Women can enter Tamar’s Children several ways, Gillece explained. While in jail, some are granted special leave status from the Maryland Department of Public Safety and Correctional Services, and others enter the program as a condition of probation or parole.
Gillece said many Maryland judges are supportive of the program, and work with Tamar’s Children staff to establish sentences that fit into the program’s framework—women must participate in the program for at least a year.
Tamar’s Children groups are focused on helping the women manage symptoms related to trauma such as flashbacks, recover from substance abuse problems, develop healthy relationships, and build self-esteem, for instance.
The inmates also receive comprehensive prenatal care, including educational services, through the University of Maryland department of obstetrics and gynecology, which is located nearby at the University of Maryland Medical Center.
Hugh Mighty, M.D., who is chief of obstetrics, gynecology, and reproductive sciences at the University of Maryland Medical System, is chair of the Tamar’s Children Advisory Board.
When it’s time for the women to deliver their babies, they are cared for by Mighty’s staff. "Our women don’t have to go to the emergency room in shackles," said Gillece. "They go right up to the maternity unit and are treated with dignity and respect."
"Anytime you have women who are incarcerated, there is stigma," Gillece continued. "Add that they have prostituted themselves, are pregnant, and addicted to heroin. These are not popular girls. Anywhere."
The birthing experience is a new one for many of the women—including those who are not first-time mothers, she noted. "Many of the women had been using drugs when they had their other babies and hadn’t delivered without being high before—it is a whole new experience," she said.
Afterward, they return to the facility with their babies and begin the task of mothering.
What should be a chaotic scene—nearly 20 women toughened by years on the streets sharing the same space, some with newborn infants, some in their last months of pregnancy, and most coping with heroin addiction and trauma—is anything but.
"There is all this hugging, fixing lunch for one another, and holding one another’s babies," noted Karfgin, who is project director for Tamar’s Children.
When problems do arise between the inmates, she added, they are addressed in group meetings led by one of the psychologists or social workers.
For six months, the women live on the unit with their babies. At the end of the six months, case managers working with the program transfer them to housing in the Baltimore area. The housing is funded by a HUD Shelter Plus Care Grant.
The women continue to come to the unit a few days each week for another six more months to attend Circle of Security groups, an attachment-based intervention developed by researchers based at the Marycliff Institute in Spokane, Wash., in the late 1990s.
The group fosters healthy mother-infant attachment by training mothers to become more sensitive to their infant’s need to explore the world and return for security and comfort, and teaches them how to respond to these needs, Karfgin explained.
As part of their training, the women in the program watch videotapes of themselves interacting with their infants.
"The women can see how they miscue their babies and how their babies miscue them," she noted.
For instance, a child’s movement toward her mother may be misinterpreted as a need for attention rather than a need for connection.
The groups also teach the mothers how to allow their children to regulate their own feelings. Sometimes, when the babies cry or act as though they are uncomfortable, the mothers get frustrated and try to get them to the point where they are laughing or smiling all the time. "The mothers learn to let the babies be themselves and learn how to be there with them."
Tamar’s Children is now entering its second year, and 15 women are enrolled in the program, according to Gillece. Five of the women have moved into their own homes in the Baltimore area but return for group sessions, and all provide peer counseling and support to newer inmates who join the program.
According to Brian Hepburn, M.D., psychiatrist and director of the Maryland Mental Hygiene Administration, the program’s focus on prevention is what makes it so successful.
"We’re all concerned about what happens when infants are separated from their mothers and how that can impact [infants’] lives. This program addresses that issue. Here we have women in jail who have normally been separated from their babies—this is a population that, in many ways, people have given up on."
By helping them to bond with their infants, he continued, "the program disrupts the cycle that results in people ending up in jails or in children who, because of attachment problems, may be at higher risk for antisocial behavior later in life."
More information about Tamar’s Children is available by contacting Joan Gillece, Ph.D., at (410) 724-3238 or Andrea Karfgin, Ph.D., at (410) 212-3660. ▪