Oregon has lost about 20% of treatment beds for pregnant people this year
The Letty Owings Center, Oregon’s largest residential treatment center for pregnant and parenting women, will close permanently at the end of October, ending 37 years during which it offered mothers with children up to age 5 one of their best chances at accessing treatment while avoiding separation through foster care.
Ashley Amorim, 36, was among the center’s last residents. She spent her first night with her son in Room 219, a space that looks like little more than a cramped dorm room, with Jeremiah — the smiley, blue-eyed baby she said gave her the motivation to change her life. Over four months at the center, she worked to break what she said was a 16-year cycle of drug use: taking her medication each day, writing down goals and strategies to prevent relapse, and processing grief and trauma with other mothers and counselors. Child welfare workers allowed 4-month-old Jeremiah to spend two nights a week with her — bonding time that most residential treatment programs cannot accommodate. “It’s a great program,” Amorim said. “It saved my life, and I am very grateful to have been a part of it.”
Central City Concern, the nonprofit that has run the center since taking it over in 1997, is also closing Laura’s Place, a transitional housing facility where about 16 women and their children lived each year after finishing treatment at Letty Owings. The nonprofit said thousands of mothers have come through the center since its founding in 1989, and former residents, a dwindling crew of staff and community partners said they are grieving and worried about what the loss of the center’s 29 beds means for the growing number of people who need both addiction care and parenting support. The closures cap a year in which Oregon has lost around 20% of its residential treatment beds for pregnant and parenting people, according to an InvestigateWest estimate. The losses come as research shows opioid use during pregnancy has increased substantially over the past decade, and as substance use and mental health stand as the leading causes of maternal deaths in Oregon during pregnancy through the first year postpartum.
Fewer beds will mean fewer mothers entering treatment, more families separated through foster care and more lives at risk, said Diana Louise Smith, a certified nurse midwife and clinical lead for Project Nurture, an outpatient program through a Portland hospital that integrates substance use treatment and maternal health care. “We’re probably going to see people die as a result of Letty closing,” Smith said. “Every week, people (are) giving birth to their kids and then not having a place to go to treatment.”
Letty’s closure reflects the broad challenges facing centers that serve pregnant women with substance use disorders, including federal funding cuts, aging infrastructure and rising costs of care as increasingly potent drugs have made both mothers and babies sicker. Program leaders said women have been arriving with more serious health problems over the past decade: purer, more potent methamphetamine has driven more mental health crises and psychosis, while fentanyl takes a long time to leave the body, requiring more time in treatment and higher doses of methadone and buprenorphine. “We’d see a lot of folks really struggling with sleep, struggling with staying awake during the day, struggling with their mood, struggling with unusual thoughts,” said Dr. Amanda Risser, chief medical officer for Central City Concern.
Programs must also be equipped to support women with health complications often linked to homelessness or low access to prenatal care: pregnant women with substance use disorders are at increased risk for hemorrhage and preeclampsia, their babies are more likely to be born premature and underweight, and some experience neonatal abstinence syndrome. Letty staff transported women to and from medical appointments and to the neonatal intensive care unit to visit their newborns.
The center was founded in 1989 by Nancy Anderson, a Portland mother in recovery, and Letty Owings, a longtime high school teacher in Lake Oswego, as heroin and crack cocaine use surged in the late 1980s and early ’90s and northeast Portland was particularly hard hit. Several programs for pregnant people and mothers were created in response to that surge. The two co-founded their center after seeing firsthand that when mothers could not access treatment that accommodated their children, they often went without treatment altogether — an outcome that could be deadly for both them and their children. Ecumenical Ministries of Oregon ran the center until 1997, when Central City Concern took over.
Central City Concern leaders said they hit a breaking point this summer, when they confronted a growing deficit and the building’s need for expensive repairs, and their attempts to transfer the program to another provider hit dead ends. Dr. Andy Mendenhall, the nonprofit’s chief executive officer, said restructuring Letty’s operations to meet clients’ growing needs would have added $2 million in costs each year, on top of a projected $1 million deficit in 2027. That, along with the updates needed to keep the building operational, “made the juice not worth the squeeze,” he said. The nonprofit’s 2025 revenues exceeded $200 million, but it is bracing for losses through Medicaid cuts beginning to take effect this year. Even with extended timelines, no other provider had the capacity to take over Letty — something Mendenhall said “speaks to just the compression and the strain” on the entire landscape of providers.
Closures can happen with little warning. When a Portland women’s residential treatment center run by Volunteers of America Oregon announced a temporary pause in operations in April, its staff scrambled to find safe places for 47 clients; five people who were pregnant or postpartum went to Letty Owings. Volunteers of America Oregon told staff the closure was permanent on April 16. Letty Owings stopped new admissions in July, two months before its own leaders announced it was closing, too.
Funding for Letty Owings is a patchwork of Medicaid billing, grants, contracts and fundraising to fill gaps. The heads of three other residential programs — ones that either focus exclusively on pregnant and parenting mothers or reserve several beds for them within their women’s centers — told InvestigateWest that existing funding streams do not account for the variety of costs involved in caring for both a mother and a young child affected by substance use and trauma; the leaders said they have raised alarms with the Oregon Health Authority in recent years. Centers often lack reliable ways to recoup the costs of clothes, diapers, food and transportation to appointments, or of the skill-based classes that help parents satisfy child welfare requirements to maintain or regain custody. Some programs receive “room and board” reimbursements that pass through counties, but center director Tina Bialas and others said those funds cover only a fraction of the real cost. More health complications have meant more prescriptions — and more staff needed to supervise clients self-administering a dozen or more medications.
“There is an expectation: ‘Oh, this must be the most beautiful time in your life, you had a new baby,’” said Eva Williams, executive director of Willamette Family, which operates a residential program that can accommodate 16 to 20 women depending on how many have children. The picture is more complicated when mothers are simultaneously experiencing withdrawal, adjusting to new medications and recovering from birth, she said. “All of that together requires a substantial amount of care.” Williams said her program is “suffering deeply” in the current funding environment and that state officials have only recently started paying attention. Francesca Barnett, senior program director of Project Network, a Portland residential treatment program focused on Black mothers, said it was “frustrating” that health and child welfare officials launched their team to find solutions only after the Volunteers of America Oregon and Letty Owings closures. “We needed that before they had to make that choice,” she said.
State leaders said they recognize the loss of beds is significant and they intend to act. A spokesperson for Gov. Tina Kotek said the governor has directed the Oregon Health Authority and the Oregon Department of Human Services to create a cross-agency team to find solutions; health officials said the team will kick off this month. “This work is urgent, and the team will be partnering closely with providers to identify practical recommendations that address immediate risks, underlying systemic funding, and operational concerns,” Kim Lippert, a communications officer for the Oregon Health Authority, wrote in an email. Hanna Thomas, a spokesperson for Kotek, wrote in an email that “keeping families together while parents receive care benefits the whole family” and that “the governor believes pregnant and parenting women and their families deserve quality, holistic behavioral healthcare and she is committed to working towards that reality in Oregon.” In the Legislature, state Rep. Rob Nosse, whose district includes the center, called it a “badly needed” resource and said he planned to meet with Central City Concern to learn more. State Sen. Lisa Reynolds, a pediatrician who has focused on perinatal health, said she is exploring whether legislation can address the funding problems and is working with a group of providers on “where we can cut red tape, where we can change the bureaucracy.” Letty’s closure, Reynolds said, has “changed the timeline.”
The state’s capacity picture remains thin and largely uncounted: Oregon does not specifically track residential beds for pregnant people, nor the prevalence of substance use disorders among them, even as the state’s rate of substance use disorders exceeds the national rate. Over the center’s nearly four-decade existence, Oregon’s demand for substance use treatment has only grown, and its overdose death rate climbed for most of the past two decades before beginning to drop in 2024, though health officials said they are uncertain how federal health care cuts might affect that trend. Mendenhall cited an analysis by HealthShare of Oregon, a coordinated care organization serving the majority of Portland-area Medicaid enrollees, which estimated around 550 pregnant people needed treatment for psychosis, stimulant or opioid use disorders in 2024. Even if only a quarter of those patients needed residential treatment, they would likely exceed the entire state’s bed capacity for pregnant and parenting people today. Capacity can fluctuate based on a facility’s staffing and the needs of its clients, but InvestigateWest estimated roughly 120 such beds remain, most along the I-5 corridor. Growing the state’s supply of residential treatment beds has been a priority of Kotek’s administration since she took office in 2023 — investments from the state Legislature and the Oregon Health Authority have helped spur more than 200 new beds, with another 400 in development.
Bialas, the center’s director since 2021, will be laid off at the end of November. She said she wonders whether Letty’s loss signals more to come. “I just wonder, are we the canary in the coal mine?” Bialas said. “I think we are.” The community has long filled gaps around the program’s budget — diaper drives, furniture donations, quilts sewn for graduating mothers and Christmas gifts bought for the children by churchgoers in West Linn and Portland. “Church grandmas and grandpas write out their $25 checks,” Bialas said, her face crumpling as tears spilled down her cheeks. “It breaks my heart I have to tell them that we’re closing.”
The center’s reach shows in its alumni. Lynn James-Kiona arrived in 1991 after losing custody of two children during her addiction, determined to do whatever it took to keep her newborn son. Separation from her own children had left James-Kiona with familiar wounds and fears. Letty Owings and programs like it specialize in caring for both mothers and children during the transitions of early recovery and postpartum life: staff hold babies so mothers can get a few hours of sleep or bottle-feed when breastfeeding is difficult, women build peer connections and skills through financial literacy, grief and parenting classes, and their children receive care at in-house licensed child care centers. James-Kiona said counselors helped her understand how intergenerational trauma factored into her addiction — as a Black woman and a member of the Yakama Nation whose mother had been cut off from her language and culture after being sent to boarding school. She recalled nights when she woke up feeling paralyzed, her body “reliving something my mind couldn’t remember,” while a woman working the graveyard shift folded laundry and talked with her through the night. Letty’s staff showed her and her son unconditional love, she said. “I didn’t get that nowhere — not even from my own mom or my own community. I was always judged, you know, about what I got and what I don’t got, and they took me with nothing but the clothes on my back and pregnant, and let me in,” James-Kiona said. Thirty-five years later, James-Kiona is a tribal elder and founder of the Mary Kiona Foundation, a nonprofit named after her late ancestor that focuses on community services and housing; she reconciled with the children she had lost more than a decade ago, and the son who stayed with her at Letty Owings is now a real estate broker with five children of his own. “I don’t think people understand how healing a family is way bigger than just getting clean,” she said. “I don’t think people understand what places like this could do, and how powerful children are. Now I’m able to be there not only for my kids, but for my grandchildren, too.”
Amorim packed up her things on Oct. 8 in a mostly vacant hall that once bustled with nearly 20 other mothers and their children. Among her belongings were a baby swing for Jeremiah, a handmade quilt and a custom sobriety coin shaped like a sunflower, with the words love, hope, spirit and faith at its center. “It’s really sad to me that they’re closing and are not going to be able to help any more women and children,” she said. “What are we going to do now? How are they going to get the help that they need?” The pause on admissions had let Amorim retain her spot in a program that usually carried a waiting list of more than 20 women while she returned to the hospital several times for infection treatment. After moving out of Letty, she, Jeremiah and his father, Brian — who also completed treatment this year — have spent their first days together as a family of three at a clean and sober house in Hillsboro. Child welfare is still involved, but Amorim said she and Brian are so far on track to regain full custody of their son. She thinks Jeremiah would have had a very different future if not for Letty. “Seeing my son for the first time and holding him has made every single thing worth it,” Amorim said. “Really, it has been challenging, but at the same time, it’s been nothing but motivation for me to just do better and to be better for him.”
This article is based on reporting by Kaylee Tornay of InvestigateWest, originally published by InvestigateWest and distributed through a partnership with The Associated Press.