Building Blocks - A Specialized Program for Pregnant and Post Partum Woman

1. Building Blocks - A Specialized Program for Pregnant and Post Partum Woman Presented by River Region Human Services Raymond Pomm, MD, Kristin Barrett, RN, BSN, Heather Clavette, MA CAP and Fawn Sweeney, BA

2. RRHS Mission Statement • The mission of River Region Human Services is to improve the quality of life for individuals and families of NE Florida affected by substance abuse, mental illness, homelessness, HIV/AIDS and other communicable illness through outreach, prevention, intervention, treatment and housing services.

3. What is Building Blocks… • Specialized program for pregnant and post- partum women in MAT • Utilizing evidenced-based clinical and educational information • Covering conception/pregnancy, delivery and beyond • Safe haven for group/clinical support • Community partnership • Resource development

4. Objectives of this course… • The audience will gain knowledge about the benefit of further education for the pregnant and post-partum population. • The audience will understand the basic topics about which the pregnant and post-partum population need to be further educated. • The audience will have developed a basic understanding of how to best utilize community resources for the pregnant and post-partum population.

5. Determination of need: • At any given time, MAT has 60+ pregnant and post-partum women • Prior to Building Blocks, pregnant women received • Assessment • Individualized tx planning • Counseling • Mother’s Group • Expedited access to residential services • WCFT services

6. Current Substance Abuse

7. Percentage Reporting Past Month Use

8. Services Needed in Women’s Substance Abuse Treatment The following services are recommended by the consensus panel and reinforced by some State standards (CSAT 2007), and these services may be warranted across the continuum of care beginning with early intervention and extending to continuing care services. More than ever, services need to be tailored to women’s needs and to address the specific hardships they often encounter in engaging treatment services. Promising practices designed to treat women with substance use disorders include comprehensive and integrated clinical and community services that are ideally delivered at a one-stop location. Note: This list does not incorporate the customary services that are provided in standard substance abuse treatment, but rather services that are more reflective of women’s needs.

9. Services Needed cont’d Medical Services • Gynecological care • Family planning • Prenatal care • Pediatric care • HIV/AIDS services • Treatment for infectious diseases, including viral hepatitis • Nicotine cessation treatment services Health Promotion • Nutritional counseling • Educational services about reproductive health • Wellness programs • Education on sleep and dental hygiene • Education about STDs and other infectious diseases; e.g., viral hepatitis and HIV/AIDS • Preventive healthcare education

10. Services Needed cont’d Psychoeducation • Sexuality education • Assertiveness skills training • Education on the effects of alcohol and other drugs on prenatal and child development • Prenatal education Gender-Specific Needs • Women-only programming; e.g., is the client likely to benefit more from a same-sex versus • mix-gender program due to trauma history, pattern of withdrawal among men, and other • issues? • Lesbian services

11. Services Needed cont’d Cultural and Language Needs • Culturally appropriate programming • Availability of interpreter services or treatment services in native language Life Skills • Money management and budgeting • Stress reduction and coping skills training

12. Services Needed cont’d Family and Child-Related Services • Childcare services, including homework assistance in conjunction with outpatient services Children’s programming, including nurseries and preschool programs Family treatment services including psychoeducation surrounding addiction and its • impact on family functioning Couples counseling and relationship enrichment recovery groups Parent/child services, including developmentally age-appropriate programs for children • and education for mothers about child safety; parenting education; nutrition; children’s substance abuse prevention curriculum; and children’s mental health needs, including recreational activities, school, and other related activities

13. Services Needed cont’d Comprehensive Case Management • Linkages to welfare system, employment opportunities, and housing Integration of stipulations from child welfare, TANF, probation and parole, and other • systems Intensive case management, including case management for children Transportation services Domestic violence services, including referral to safe houses Legal services Assistance in establishing financial arrangements or accessing funding for treatment • services • Assistance in obtaining a GED or further education, career counseling, and vocational training, including job readiness training to prepare women to leave the program and support themselves and their families • Assistance in locating appropriate housing in preparation for discharge, including referral to transitional living or supervised housing

14. Services Needed cont’d Mental Health Services • Trauma-informed and trauma-specific services Eating disorder and nutrition services Services for other co-occurring disorders, including access to psychological and • pharmacological treatments for mood and anxiety disorders Children’s mental health services • Disability Services • Resources for learning disability assessments Accommodations for specific disabilities Services to accommodate illiteracy Services to accommodate women receiving methadone treatment

15. Services Needed cont’d Disability Services Resources for learning disability assessments Accommodations for specific disabilities Services to accommodate illiteracy Services to accommodate women receiving methadone treatment.

16. Services Needed cont’d Staff and Program Development • Strong female role models in terms of both leadership and personal recovery • Peer support • Adequate staffing to meet added program demands • Staff training and gender-competence in working with women • Staff training and program development centered upon incorporating cultural and • ethnic influences on parenting styles, attitudes toward discipline, children’s diet, level of • parenting supervision, and adherence to medical treatment • Flexible scheduling and staff coordination (Brown 2000)

17. Services Needed cont’d Staff and Program Development • Adequate time for parent–child bonding and interactions • Administrative commitment to addressing the unique needs of women in treatment • Staff training and administrative policies to support the integration of treatment services • with clients on methadone maintenance • Culturally appropriate programming that matches specific socialization and cultural • practices for women

18. Client Demographics • Average age - young to mid 20’s • Caucasian • Lacking healthy support • Lacking financial resources • Unemployed • No transportation • Substance dependent • Behavioral/psychiatric issues • Multiple prior births • Prior adoption • Minimal to no prior medical services

19. Issues facing pregnant and post-partum women • Lack of prenatal care • Poor history of primary care • Lacking knowledge of nutrition and healthy lifestyle • Lacking knowledge of pregnancy process • Lack of knowledge of post-natal care of opiate dependent newborn • Knowledge deficit of MAT with pregnancy • Effects • Withdrawal • Breastfeeding • Dose increases

20. Issues facing pregnant and post-partum women – cont’d • More challenging behavioral/psychiatric issues • Poor parenting skills • Lacking coping skills • Difficulty coordinating care • Lacking knowledge of resources/support • Adoption issues • Enticed by money • Enticed by support • Enticed by medical care provided

21. How was Building Blocks conceived? • RRHS created a PSR group with full curriculum and incentives • Despite specialized program, it was not embraced by the client population • Multidisciplinary team discussed that this PSR style of group was not benefiting our pregnant and post-partum women And so…the seed was planted and conception occurred!!

22. Gap Analysis for Performance Improvements: Building Blocks

23. Goal of Building Blocks • To REACH our pregnant post-partum women R – Rapid response to needs E – Education and Empowerment A – Access to resources C – Collaborate and Coordinate H – everyone Helping everyone

24. Challenge: Staff Buy In • Discussed with the multidisciplinary team • Presented foundational ideas

25. Response • Immediate acceptance • No push back • Embraced with excitement

26. Choosing a Facilitator • Needed individual with specific characteristics • Passionate • Dedicated • Self-motivated • Independent • Autonomous • Broad knowledge of pregnancy-related issues This program could die at the hands of the wrong facilitator!

27. Creating the Curriculum • Team effort • Medical Director • Director of Nursing • Director of Medication Assisted Treatment • Counselor • WCFT – Woman Children Family Treatment Staff • AmeriCorp members

28. Creating the Curriculum cont’d • Wanted to expand upon current program • Change process utilized • Team met on multiple occasions • Delegation of responsibilities occurred • Important goal was to REACH out to community partners And so…7 months later…Building Blocks prematurely delivered!

29. Who Collaborated? • Department of Health – Dieticians & Nutritionist • Woman’s Center of Jacksonville– Domestic Violence • DCF – “Who are we and what can we offer” • Healthy Mothers, Healthy Babies Coalition of N. FL • La Leche • North Florida Child Safety – Wolfson Children’s Hospital • Planned Parenthood • Independent Pharmacist

30. Who Collaborated? • UF Department of Pharmacy • RN’s and LPN’s • MAT Counselors • CPR Instructor • Adoption Attorney • Working on: Pediatrician, Primary care MD, OB/GYN

32. Curriculum • Week 1 • February 19th • Your Health - Before, during and after pregnancy (Family Medicine) • Importance of Prenatal care/vitamins (Family Medicine) • Week 2 • February 26th • Pregnancy Expectations - 1st Trimester (RRHS) • 2nd and 3rd Trimester (RRHS) • Week 3 • March 5th • Maintaining a Healthy Pregnancy (OBGYN) • Signs and Symptoms, "What do they mean?" (OBGYN)

33. Curriculum • Week 4 • March 12th • Drug use and Pregnancy (RRHS – Nursing) • Alcohol (FAS) and Tobacco use and Pregnancy (RRHS - Nursing) • Week 5 • March 19th • MAT and Pregnancy (RRHS - Nursing) • Relapse risk/prevention (RRHS) • Week 6 • March 26th • WCFT - What is it?/Resources (WCFT staff) • Ins and Outs of prescription meds (Pharmacist - Andy)

34. Curriculum • Week 7 • April 2nd • Benefits of Exercise - Discussion (RRHS - Amanda) • Exercise while pregnant - Practice (RRHS - Amanda) • Week 8 • April 9th • CPR (RRHS Ms. Yvette) • CPR (RRHS Ms. Yvette) • Week 9 • April 16th • Domestic Violence (Women’s Center) • Seeking Safety (RRHS)

35. Curriculum • Week 10 • April 23rd • DCF - Who are we? (DCF) • Dependency Drug Court - Who are we? And reunification (DDC) • Week 11 • April 30th • Nutrition during pregnancy (Nutritionist) • Nutrition for your child (Nutritionist) • Week 12 • May 7th • Maintaining a Healthy Baby (Pediatrician) • Signs and Symptoms, "What do they mean?" (Pediatrician)

36. Curriculum • Week 13 • May 14th • Birth defects (Pediatrician)  • SIDS prevention (Healthy Mothers/Healthy Babies Coalition) • Week 14 • May 21st • Pregnancy and emotions (RRHS) • Planning for delivery - emotions, body, home, hospital (Family Medicine) • Week 15 • May 28th • Lamaze (Community) • Breastfeeding (La Leche)

37. Curriculum • Week 16 • June 4th • Introducing newborn to the home (Planned Parenthood) • Child proofing the home (RRHS) • Week 17 • June 11th • Budgeting for a newborn (RRHS) • Baby shower planning - What a baby needs (RRHS) • Week 18 • June 18th • Family Planning, Contraception (Planned Parenthood) • Birth, abortion, adoption choices (Planned Parenthood)

38. Curriculum • Week 19 • June 25th • Process of adoption (WCFT or Community) • Car Seat Education (Fire Department) • Week 20 • July 2nd • Day Care - What to look for (RRHS) • Bonding after delivery (WCFT) • Week 21 • July 9th • Post Partum signs and symptoms (RRHS) Dr. Taylor/ Dr. Blackmore • Mental Health and Pregnancy (Daphne) Dr. Taylor/ Dr. Blackmore

39. Curriculum • Week 22 • July 16th • Parenting - PPP (WCFT) • Single Parenting (WCFT) • Week 23 • July 23rd • Father's relationship (WCFT) • Healthy boundaries with extended family (RRHS)

40. Curriculum • Week 24 • July 30th • Grief - loss of a child, miscarriage, still birth (RRHS) Dr. Taylor • Community based recovery (RRHS) • Week 25 • August 7th • HIV, Hepatitis, STDS (Health Department) • HIV, Hepatitis, STDS (Health Department)

41. So how did we measure success?

42. Survey…pre, mid and post 1. Comfortable with pregnancy 2. Comfortable with post-partum 3. Symptoms and issues in 1st trimester 4. Symptoms and issues in 2nd trimester 5. Symptoms and issues in 3rd trimester

43. Survey…cont’d 6. Knowledge of effects of my nutrition on baby 7. Knowledge of effects of drugs on baby 8. Knowledge of benefits of exercise 9. Knowledge of nutrition for newborn 10. Knowledge of potential medical problems for my newborn

44. Survey…cont’d 11. Knowledge of potential mental health issues 12. Comfort with parenting a newborn 13. Knowledge of importance of breastfeeding 14. Knowledge of sexual trauma 15. Knowledge of community resources

45. Pre Survey Results

46. Mid Survey Results

47. What were the real successes? “I’ve really enjoyed this group and have acquired quite a bit of knowledge and thoroughly enjoyed having a place to come and talk about things I am going through with people who have been through the things I’ve been through THANKS”

48. More Successes…. “This group has been highly informative. I have gained knowledge each week that I couldn’t have on my own. It has positively impacted my life and that of my family. I would recommend it to all new mothers”

49. More Successes…. “I am not pregnant but even so, I do Ms. Fawns group. I learn so much and I feel that I want to know more. She is an amazing individual.”

50. More Successes…. “I have only been to a few meetings, but so far I am enjoying the program very much. I look forward to learning more and more in the program. I am very happy to be a part of it.”