Developing Plans of Safe Care for Substance Exposed Newborns

1. Developing Plans of Safe Care for Substance Exposed Newborns Lessons from Four CAPTA Demonstration Projects

2. Presenters • Kristin Funk, • FEAT, OR • Heidi Mason, • A Helping Hand, MA • Celeste Smith • Healthy Connections, OH • Gretchen Read • C-SIMI, CO

3. Postnatal Environment • Compromised parenting, which is linked to substance use, has as great, if not greater, negative effects on child development than prenatal substance exposure Lester, Andreozzi, & Appiah, 2004 Messinger et al., 2004

4. Specialized Staff • Recovery support (FEAT) • Peer workers (AHH) • Master’s level case managers (HC) • Specially trained CPS workers (C-SIMI)

5. Project FEATLane County, Oregon Family Early Advocacy and Treatment http://eip.uoregon.edu/projects/feat

6. Safe Care of SEN • Prenatal Interventions • Peer Workers/Family Advocates • Identification and Safe Care Planning at Birth • Postnatal Interventions • Peer Workers/Family Advocates/Case Managers • Linkage with Community Resources • Comprehensive Family Treatment • Early Intervention

7. FEAT Family Advocates • Housed at parent support agency in Eugene, Oregon (Relief Nursery) • Understanding of recovery / peer worker • Knowledge of community resources • Awareness of parenting skills and and child development • Male FA to work with fathers

8. Concrete & Flexible Services • Prenatal and postnatal services • Support and service coordination • Develop relationships and agreements with women’s treatment providers • Flexible and creative meeting places/ times

9. FEAT Family Advocate • Referrals from: • Hospitals • Prenatal providers • Treatment • Child welfare • Courts • Community agencies

10. Family Advocate Satisfaction SurveysN=39 • 67% met FA when pregnant • 23% met FA at birth (in hospital) • 10% met FA at treatment/other • 46% had open Child Welfare case at exit • 6 Months = Average age of baby at exit

11. Percent of mothers who reported drug use prior to receiving family advocate services

12. Family Advocate ClientsN=94 (closed cases) • 96% families at the poverty level or low income. • 86% mothers were not employed • 81% mothers reported partner/spouse substance abuse • 66% mothers did not have a valid driver’s license • 56% mothers reported being isolated. • 56% mothers were victims of DV • 51% mothers were adult victims of abuse/neglect • 51% families had no transportation

14. Family Advocate Interview “The most important thing I do, from my perspective, is instilling hopefulness in women who don’t already have it. The willingness to change.”

15. Family Advocate Client Interview “[The Family Advocate] was great the whole time. She knows what she is doing, and the fact that she has been there too makes a big difference than other people that don't really know how it feels to deal with child welfare. And she helped me take my son home.”

16. Child Welfare Focus Group “Delivery is a time when mom is motivated to get help… Women will do anything in the moment after delivery. When we can give them a treatment bed, it makes a huge difference. Having to wait for assistance meant mom was less motivated 3 weeks or 3 months later.”

17. FEAT (SEN) Team • Multidisciplinary team • DHS Intake / ART Team • FEAT Family Advocate • Treatment Providers • Hospital staff • Meets at hospital when substance exposed newborn is identified

18. Child Welfare Focus Group “Child Welfare always carries the stigma of removing kids. When we come with a team (SEN Team), it gives parents a sense that we’re committed and involved and trying to preserve the family, rather than just remove the baby. Parents are engaging quicker.”

19. Investigated Child Welfare SEN cases in Lane County

20. Child Welfare and Early Intervention • Early Intervention & Child Welfare are partners in implementing CAPTA • All substantiated child welfare cases must be referred to EI for developmental screening (children under 3) • Referrals to EI are part of safe care planning for SEN.

21. Safe Care Recommendations • Develop Interagency workgroups. • Intervene prenatally. • Create specialized staff positions • Peer Model • Create “differential” responses to SEN and their families. • Create or enhance family treatment programs. • Refer to Early Intervention • Check your state’s eligibility criteria for Part C.

22. Contact Information • Liz Twombly • FEAT Co-Coordinator, University of Oregon Early Intervention Program • ltwombly@uoreon.edu • http://eip.uoregon.edu/projects/feat/

23. A Helping Hand: Mother to MotherMassachusetts Heidi MasonFamily Support Specialist

24. AHH Partners • Massachusetts Department of Public Health (MDPH): • Div. of Perinatal, Early Childhood, & Special Needs • Early Intervention • Bureau of Substance Abuse Services • MA Dept of Children & Families • Brandeis University • Partners: • Institute for Health & Recovery • Community HealthLink, Square One, Federation for Children with Special Health Needs • Birth Hospitals

25. A Helping Hand: Mother to Mother (AHH) • Voluntary home-visiting practice • Mothers of SEN <90 days old • Peer Worker = Mother in Recovery

26. Referral Process

27. AHH Peer Worker Model • A mother in recovery works with mother of SEN to… • Engage and support mother in treatment/recovery • Support nurturing parenting • Ensure EI assessment • Make referrals • Work collaboratively with Child Welfare to support service plan

28. Engagement Strategies • Diaper Incentive • Square One – Bonus Redemption Points (supported by external funding) • Meet with Peer Worker • Bring baby to appointment • Accomplish goals • Participating in groups

29. Peer Recovery WorkersStrengths • Being a mother in recovery • Teach new habits of sobriety • Provide parenting support and guidance • Maintain focus on early childhood development; make referrals as needed

30. Peer Training • Stages of Change/Motivational Interviewing • Relational-Cultural Theory • Substance Use Disorders 201 • Home visiting safety protocols • CPR and universal health precautions

31. Peer Training • Using supervision • Confidentiality and boundaries • Early Childhood Development • Mandated reporting guidelines • Community resources • Recovery Coach Academy

32. Challenges of Peer Model • Triggers or negative personal memories • Working with people from your ‘using’ past • Other collaborating professionals may not value peer’s experience as much as academic credentials

33. Services Received by Mothers upon Exitn=65

34. Outcomes • At time of closing of 65 cases: • Physical Custody • 45 with mother • 9 with relatives • 9 in foster care • 8 reunified

36. Healthy ConnectionsOhio Plan of Safe Care

37. Healthy Connections Project • Location: Toledo, OH • Lead agency: St. Vincent Mercy Medical Center • Target population: Pregnant users of any substance and SEN • Key staff: Program coordinator, clinical therapist and Bachelor’s level case manager

38. Healthy Connections Objectives • Collaborate with maternal and child serving agencies • Promote consistent identification protocols • Link infants with services • Assist parents in completing service plans

39. Healthy Connections Strategies • Training • Provide wrap around services

40. Plan of Safe Care • Existing collaboration among: • Pediatricians • Obstetricians • Early Intervention • Substance disorder treatment • Parenting services • HC case manager

41. Plans of Safe Care, cont. • HC work with family drug court

42. Contact Information Celeste Smith, MA, PC Celeste_Smith@mhsnr.org 419-251-2459

43. C-SIMI Baby Steps • Location: Denver, CO • Lead agency: Denver Department of Human Services • Target population: pregnant substance-using women with no other children; substance-using women with newborns ≤ 72 hours with open CPS case • Key staff: Project Coordinator and specialized child welfare case workers

44. Contact Information Gretchen G. Read, M.S.W. Supervisor, Child Welfare Services Denver Department of Human Services, Denver, CO 720.944.2352