Family Therapy for Prenatal Substance Exposure in Portland, Oregon
Two therapists. Focused support. A deeper understanding of what your child and family need.
Your child can be joyful, affectionate, funny, and deeply loving, and family life can still feel unbelievably hard.
Maybe your child moves through the day as if their motor never stops. They seek constant movement, touch everything, struggle to play independently, and need far more supervision than other children their age.
Maybe boundaries lead to hitting, kicking, biting, throwing, or complete overwhelm. Rewards do not seem rewarding. Consequences do not seem to matter. Talking about what happened later leads to denial, confusion, shame, or another explosion.
You may spend every day trying to prevent someone from getting hurt. School may be calling. Siblings may be missing out. Simple experiences like bedtime, getting dressed, using the bathroom, leaving the house, or taking a family vacation may require an enormous amount of planning and support.
And you may be wondering: why is everything so hard, and why is nothing we try working?
A Family Therapy Intensive creates time for us to make sense of the behavior and understand your child and family more fully.
You Are Not Failing, and Your Child Is Not Simply Choosing to Make Life This Hard
A Family Therapy Intensive is an extended therapeutic experience where your family works with both a child therapist and a family therapist together. Instead of trying to fit complex family dynamics into a weekly hour-long appointment, we create dedicated time to understand your child's needs, your family's patterns, and the strengths you already have.
In Family Intensives we are not looking for someone to blame, instead we support the whole family in feeling more connected and better understood. Through play, conversation, observation, and guided family experiences, we help create the kinds of moments that allow real change to happen.
Families raising children with histories of prenatal exposure to opioids, heroin, fentanyl, methamphetamine, cocaine, or multiple substances are often given incomplete and conflicting information.
The support available during infancy may disappear as a child gets older. Parents may be told that their child is too old for a neonatal abstinence syndrome program, while the professionals currently treating the child may have limited knowledge about prenatal exposure, adoption, foster care, trauma, sensory needs, or nervous-system regulation.
Families can end up moving between pediatricians, occupational therapists, psychiatrists, schools, behavioral programs, and mental health providers without anyone bringing the entire picture together.
You may have tried:
Reward charts, prizes, and sticker systems
Time-outs, consequences, or removing privileges
Repeated explanations and reminders
Occupational therapy or behavioral services
Parenting books, classes, and online advice
Medication or changes in medication
Traditional weekly therapy
Carefully controlling routines, foods, screens, and activities
Some of these supports may have helped. Others may have made little difference or worked until your child became overwhelmed again.
The problem is not that you have not tried hard enough. Your family may need more time, greater collaboration, and an approach designed around your particular child.
Prenatal Substance Exposure Is Part of your child’s Story, not their Whole Story
Prenatal substance exposure can affect children differently. The effects may vary depending on the substances involved, the timing and extent of exposure, genetics, prenatal care, birth experiences, early relationships, stress, trauma, placement changes, health, development, and the support available throughout childhood.
Some children with prenatal substance exposure experience few lasting concerns. Others may need support with areas such as:
Attention and impulse control
Sensory processing and sensory seeking
Emotional and nervous-system regulation
Sleep, eating, toileting, or other daily routines
Learning, memory, and executive functioning
Language and communication
Transitions and unexpected changes
Social interaction and personal boundaries
Anxiety, frustration, or intense mood changes
Safety awareness and understanding consequences
Attachment, trust, grief, and family relationships
These experiences are not proof that prenatal exposure caused a particular behavior. They are also not evidence that a child is manipulative, uncaring, or intentionally oppositional.
Every child deserves to be understood as a whole person.
During an intensive, we consider your child’s prenatal and early history without allowing that history to define them. We look at development, relationships, sensory needs, regulation, environment, strengths, stressors, and the patterns that have developed around difficult moments.
Instead of asking only, “How do we stop this behavior?” we also ask:
“What is making this so hard for this child, and what support would make success more possible?”
When Rewards and Consequences Do Not Work
Many parenting approaches assume that a child can pause, remember the rule, predict what will happen, control an impulse, and choose a different response.
But a child who is overwhelmed, highly activated, developmentally delayed, sensory seeking, or struggling with executive functioning may not have reliable access to all of those abilities in the moment.
That can explain why a child may:
Repeat a behavior despite receiving the same consequence many times
Laugh when they get in trouble
Seem genuinely confused about what happened
Care deeply afterward but be unable to stop during the moment
Become more dysregulated when asked to explain or apologize
Want a reward but still be unable to complete the behavior required to earn it
Follow expectations in one environment but fall apart in another
Do well for days or months and suddenly struggle during a transition
Appear to understand a rule without being able to use that knowledge consistently
This does not mean that children do not need boundaries. Children need adults to provide safety, structure, and limits.
The difference is that we develop boundaries around what the child can currently understand and do, not what adults assume they should be able to do based only on their age.
Our goal is not permissive parenting. It is more effective parenting: reducing unnecessary power struggles, increasing felt safety, supporting regulation, and helping caregivers respond with greater clarity and confidence.
What Is a Family Therapy Intensive?
A Family Therapy Intensive is an extended, personalized therapeutic experience in which your family works with both a child therapist and a family therapist.
Rather than squeezing a complicated family system into one 50-minute appointment, we create dedicated time to understand:
What happens before, during, and after difficult moments
What your child may be communicating through behavior
How sensory, developmental, relational, and emotional needs overlap
Which expectations fit your child’s current abilities
What helps your child feel safe enough to accept support
How caregivers can respond consistently without losing themselves
How the needs of siblings and other family members can be protected
Where your family is already succeeding
What needs to change at home, at school, or across your child’s support team
The intensive may include parent conversations, child-centered play, observation, family activities, caregiver coaching, collaborative problem-solving, and time to practice new ways of responding together.
Your intensive is tailored to your family. We will talk with you before scheduling about who should participate, what concerns feel most urgent, and how the experience can be structured around your child’s developmental and regulation needs.
Why Your Family Works With Two Therapists
Complex behavior affects the child and the entire family. Supporting only one part of the system can leave parents trying to piece everything together on their own.
During your intensive:
Your child therapist focuses on your child’s experience. Through play, movement, observation, and developmentally appropriate interaction, the child therapist considers your child’s communication, sensory preferences, emotions, relationships, strengths, and nervous-system needs.
Your family therapist focuses on the family system. The family therapist helps caregivers understand recurring patterns, reduce conflict, establish realistic expectations, and build responses that support safety and connection.
Both therapists collaborate in real time. We can support your child and caregivers simultaneously, notice patterns from more than one perspective, and work toward shared goals.
This team approach offers more than an additional set of hands. It creates space for your child’s needs and the caregivers’ experiences to receive meaningful attention.
An Intensive May Be a Good Fit if…
Your child has a known or suspected history of prenatal exposure to substances, and:
Aggression, biting, hitting, kicking, or throwing has become difficult to manage safely
Your child becomes intensely overwhelmed by limits, transitions, or everyday demands
Sensory seeking, constant movement, or impulsivity consumes much of the family’s attention
Your child has very limited awareness of danger or repeatedly gets hurt
School or childcare is calling frequently or sending your child home
Your child needs near-constant adult participation or supervision
Toileting, hygiene, bedtime, eating, or leaving home has become a recurring struggle
Your child does well in structured settings but falls apart at home, or the reverse
Family outings and vacations feel impossible
Siblings are affected by the amount of attention or crisis management one child requires
Your child has been diagnosed with, or is being evaluated for, ADHD, autism, PDA, anxiety, ODD, developmental differences, or sensory needs
Traditional rewards, punishments, and behavior plans have not created lasting change
You have multiple providers but no shared understanding of what your child needs
Weekly therapy feels too slow or fragmented for what your family is experiencing
You are exhausted and need more than another list of parenting tips
You do not need to wait until your family reaches a breaking point. Wanting to understand your child and create more sustainable family life is enough.
What We Will Work Toward Together
In our intensives we offer is the time and collaboration to help your family develop a clearer path forward. Depending on your family’s needs, we may work toward:
Understanding the needs beneath recurring behaviors
Recognizing early signs of overwhelm before a crisis escalates
Creating realistic, developmentally appropriate expectations
Responding to aggression while protecting safety and connection
Reducing shame, blame, and repeated power struggles
Building more effective routines for difficult parts of the day
Supporting your child’s capacity for co-regulation
Helping caregivers use shared language and consistent responses
Protecting time, attention, and emotional safety for siblings
Identifying accommodations that could help at home or school
Rebuilding trust after hard moments
Creating a practical plan your family can continue using
We want you to leave with more than insight. We want you to have a more compassionate and useful understanding of your child, concrete next steps, and greater confidence about what to do when family life becomes hard again.
Therapy That Understands Adoption and Foster Care From the Inside
Prenatal substance exposure is often intertwined with adoption, foster care, kinship care, separation, grief, unanswered questions, and complex relationships with first families.
These experiences deserve care and nuance.
Substance use disorder is a health condition, and prenatal exposure does not tell us everything about a child’s story. We also do not minimize the realities your child and family may be living every day. Our clinicians bring both specialized professional knowledge and lived experience:
Helene Hanson, CSWA | Child and Family Therapist
Helene is an attachment-focused play therapist, an adoptee, an adoptive parent, and an active foster parent. She spent many years as an inclusive early childhood educator before becoming a therapist.
Helene helps children communicate through play, movement, and relationship. Her work centers curiosity over judgment, connection over compliance, and a deep respect for each child’s strengths, nervous system, and story.
Katie Statman-Weil, EdD, LCSW | Parent and Family Therapist
Katie is a family therapist, child-development specialist, biological parent, and adoptive parent through foster care. Her work is grounded in attachment, trauma, child development, neuroscience, and practical support for families facing complex behavior.
Katie is also the author of Trauma Responsive Strategies for Early Childhood and provides consultation and professional development to educators, schools, and organizations nationwide.
Together, we understand that expertise matters, and that families also need therapists who can sit with the parts of adoption, foster care, and parenting that are difficult to explain to someone who has never lived them.
What This Intensive Does, and Does Not, Provide
Family Therapy Intensives provide mental health treatment and family support. They do not replace medical or developmental care.
We do not diagnose neonatal abstinence syndrome in older children, determine which prenatal exposure caused a particular difficulty, prescribe medication, or replace assessment by a pediatrician, developmental pediatrician, psychologist, occupational therapist, speech-language pathologist, or other qualified professional.
When appropriate and with your written permission, we can collaborate with members of your child’s existing support team. We can also help you think through what additional questions or referrals may be useful.
If your child is at immediate risk of seriously harming themselves or someone else, an outpatient intensive may not provide the level of crisis support your family needs. We will discuss safety and fit during the consultation process.
Family Therapy Intensives in Portland, Oregon
With Connection offers in-person Family Therapy Intensives at our welcoming child- and family-centered office in Northeast Portland.
We support adoptive, foster, kinship, biological, and blended families from Portland, Beaverton, Hillsboro, Tigard, Lake Oswego, West Linn, Gresham, Milwaukie, Vancouver, and surrounding Oregon and Southwest Washington communities, as well as those who travel from other states.
Families sometimes travel to Portland for an intensive because it can be difficult to find therapy that brings together:
Prenatal substance exposure
Adoption and foster-care competence
Child development
Attachment and trauma
Neurodiversity-affirming practice
Play-based child therapy
Family therapy
Lived experience as adoptees, foster parents, and adoptive parents
If you are considering traveling for an intensive, contact us so we can discuss your family’s needs, clinical eligibility, scheduling, and whether our service is the right fit.
Frequently Asked Questions
Is NAS the same as prenatal substance exposure?
Not exactly. Neonatal abstinence syndrome, or NAS, describes a group of withdrawal-related conditions that can occur in newborns following exposure to certain substances. Neonatal opioid withdrawal syndrome, or NOWS, refers specifically to opioid withdrawal during the newborn period.
Older children do not continue to have NAS or NOWS, but they may have a history of prenatal substance exposure or a history of being diagnosed with NAS as an infant. Families often search for “NAS in older children” because that is the language they were originally given. We will help you use more accurate language while taking your child’s complete history seriously.
Can you tell whether my child’s behavior was caused by prenatal exposure?
Usually, no single behavior can be attributed to prenatal exposure alone. Development, genetics, neurodivergence, sensory processing, relationships, medical needs, stress, trauma, school environment, sleep, and other factors may all influence what you are seeing.
Our work is not to prove one cause. It is to understand your child’s current needs and help your family respond more effectively.
Does my child need an official diagnosis?
No. Your child does not need a particular diagnosis to be considered for an intensive. We begin with the concerns affecting your child and family now.
Is this only for adoptive or foster families?
No. We welcome adoptive, foster, kinship, biological, guardianship, and blended families. We understand that prenatal exposure and substance use can be connected to complicated histories, relationships, grief, and stigma. Your family will be treated with dignity and without judgment.
Do you only offer intensives for families with children prenatally exposed to substances?
No, we also offer intensives for families with children with trauma histories, behavioral issues, and foster care and adoption experience.
Is this a parenting class?
No. An intensive is personalized therapy, not a general parenting curriculum. We will not hand you a standard behavior program and assume it should work for every child.
Caregiver support and coaching may be part of the experience, but the purpose is not to blame or grade your parenting. It is to understand what is happening and develop responses that fit your child and family.
Will my whole family participate?
That depends on your family’s goals, the age and needs of your child, sibling considerations, and safety. Some portions may involve caregivers alone, the child with a therapist, or family members together. We will develop the structure with you before the intensive.
What if my child already has a therapist, occupational therapist, psychiatrist, or school team?
An intensive may complement your child’s existing care. With appropriate written authorization, we can collaborate with other providers so that your family is not left carrying information between disconnected systems.
Do you accept insurance?
With Connection is an out-of-network provider. Payment for an intensive is divided into two equal payments. One is due two weeks before the intensive and the second is due the day the intensive begins. We can provide a superbill for possible out-of-network reimbursement. Insurance coverage varies, so we encourage families to contact their plan before scheduling. To check with your out-of-network benefits you can use our guide here. We will provide a clear estimate of expected costs before the intensive begins.
How much does this cost?
Please see our Fees Page for our current rates.
How long is a Family Therapy Intensive?
The structure is personalized according to your child’s age, regulation needs, family goals, and clinical fit. Typically intensives are 2-5 days. We will discuss the recommended schedule during your consultation and planning process.
Your Family Deserves More Than Another List of Things to Try
You may have spent months or years searching for the right reward, the right consequence, the right therapist, or the right explanation.
You may love your child fiercely and still feel exhausted by what your family is carrying.
Both can be true.
A Family Therapy Intensive offers something different: time to slow down, understand what is happening beneath the behavior, and build a plan around your real child and your real family.
You do not have to keep piecing this together alone.