St. Vincent Mercy Medical Center Healthy Connections SEN Project Celeste Smith, MA, FLE Program Coordinator, SVMMC Healthy Connections Program

Background on CAPTA What does CAPTA mean?

Background on CAPTA Keeping Children and Families Safe Act 2003 Child Abuse Prevention and Treatment Act (CAPTA)

Healthy Connections SEN Project HC Goal: to improve access to and utilization of mental health services for community-based populations of children, adolescents, and their families through integration of primary health care and behavior health care services.

Healthy Connections SEN Project Goal: to increase the compliance with CAPTA requirements in order to maximize child and family social, emotional and developmental outcomes.

Healthy Connections SEN Project Demographics Suburban/urban county Population approx. 455,055 and 313’620 live in the city

Healthy Connections SEN Project Racial composition White 77.5% African American 17.0% Native American 0.3% Asian 1.2% Other 1.9%

Healthy Connections SEN Project Racial composition cont Hispanic of any race 4.5% Hispanic other 2.2%

Healthy Connections SEN Project Objectives: 1.Collaborate with 10 maternal and child serving agencies 2.Develop procedures for identification and referral in obstetrics prenatal, Labor and Delivery, and pediatrics 3.60% of participating infants will receive needed development and social/emotional services

Healthy Connections SEN Project Objectives cont % of participating parents will complete Individual Family Service Plan goals.

Healthy Connections SEN Project Project Activities Development of policies and procedures Training of health care professionals and child protective workers

Healthy Connections SEN Project Services for substance using parents Assessment Education Case management Parenting Classes Infant-parent psychotherapy

Healthy Connections SEN Project Target population Newborns receiving primary care SVMMC FCC SVMMC Labor and Delivery

A Helping Hand: Mother to Mother The Massachusetts SEN Project John A. Lippitt, Ph.D. Project Director, Department of Public Health

A Helping Hand: Mother to Mother VISION: Substance exposed newborns have the opportunity to achieve their full potential through nurturing caregiving GOAL: Enhance identification of and services for substance exposed newborns (SENs), their mothers and families

A Helping Hand: Mother to Mother Growing body of evidence that, except for alcohol, the compromised parenting of the post-natal environment has greater impact on the infant than pre-natal exposure Nurturing caregiving and continuity of caregiver(s) are essential

A Helping Hand: Mother to Mother Newborn: infant under 90 days old Substance exposed newborn (SEN): any illegal use of a substance during pregnancy 3 of 29 Dept. of Children and Families (DCF) offices

A Helping Hand: Mother to Mother Voluntary, complementary, enhanced intervention through DCF Integrate child welfare, substance use, child development, mental health, etc. Services are individualized, strength- based, and family-centered, as well as gender and culturally appropriate

A Helping Hand: Mother to Mother Coordinated services through cross- agency collaboration Monthly Implementation Team meetings to oversee and coordinate local AHH activities Statewide Steering Committee meets every other month

A Helping Hand: Mother to Mother Key partners Dept. of Public Health (DPH): Div. of Perinatal, Early Childhood, & Special Needs DCF: Local Offices & State HQ Substance abuse (SA): local treatment providers, DPH Bureau of Substance Abuse Services, Institute for Health & Recovery

A Helping Hand: Mother to Mother Key partners (continued) Early Intervention (EI): local programs Parent-to-parent support: Federation for Children with Special Needs Mental health, domestic violence Economic support & housing

A Helping Hand: Mother to Mother Family Support Specialist (FSS): a peer, a mother in recovery Engage and maintain mother in substance abuse treatment / recovery Support nurturing parenting Ensure a developmental assessment of the infant and services if indicated through Early Intervention

A Helping Hand: Mother to Mother FSS meets weekly with mother or even more frequently Phone contact and work with family Coordinates very closely with DCF case worker: in touch weekly

A Helping Hand: Mother to Mother Keys to Identification Birthing hospitals and other health care and early childhood service providers Identify best practices for SEN identification and response

A Helping Hand: Mother to Mother Good data on SENs are hard to get SAMHSA: 3.5% of newborns exposed to illegal drugs MA: ~3,000 SENs per year Under-reported on electronic birth certificates (125) and to DCF

A Helping Hand: Mother to Mother Challenges and Lessons Learned Postpartum mothers of SENs often feel overwhelmed by the complex issues facing them Engaging these mothers requires persistence, patience, creativity, and hope

A Helping Hand: Mother to Mother Challenges and Lessons Learned (cont) Identification of SEN cases at DCF and referral to AHH Communication between DCF worker and FSS, especially when DCF worker changes DCF workers may not appreciate / understand the value / role of the FSS

A Helping Hand: Mother to Mother Challenges and Lessons Learned (cont) Accessing & coordinating the multiple services / supports needed Finding the nurturing caregiving for the infant NOW Effectiveness of EI with these families

A Helping Hand: Mother to Mother Results to-date Pilot site #1: 40 SEN cases, 20 offered and accepted AHH since February 2007 Pilot site #2: 10 cases, 6 have accepted AHH since February 2008 Pilot site #3: Hiring FSS

A Helping Hand: Mother to Mother Results to-date (continued) Caseload: 14 – 20 for full-time FSS, with an average six-month duration Cost: average cost per client is $1,800–$2,300, fully loaded Client comments

Four Substance Exposed Newborn Demonstration Projects COLLABORATION Collaboration is a commitment to work together to address a problem and achieve a goal that could not be accomplished by the organizations working individually Three degrees: Linkage, Coordination, Full integration (Leutz)

Four Substance Exposed Newborn Demonstration Projects COLLABORATION (continued) Identify a lead facilitator and a liaison at each agency Hold regular meetings of the core collaborators Build cross-agency knowledge and relationships

Four Substance Exposed Newborn Demonstration Projects COLLABORATION (continued) Develop shared language; define key terms Establish two-way information sharing among the partners Share policies and procedures across agencies

Four Substance Exposed Newborn Demonstration Projects IDENTIFICATION Work to identify pre-natally, at birth, and post-natally in health care Screen: interview with a standard, validated instrument Test: toxicology tests of mother and / or baby when indicated Consistent implementation of identification and response protocol

Four Substance Exposed Newborn Demonstration Projects IMPLEMENTATION Identify or develop a champion at each agency Get buy-in at multiple levels Work to consistently implement policies and procedures

Four Substance Exposed Newborn Demonstration Projects IMPLEMENTATION (continued) Ensure that services that mothers, babies, and families need are available and accessible Know and address legal issues in your state

Four Substance Exposed Newborn Demonstration Projects IMPLEMENTATION (continued) Engagement of these mothers and families is often a challenge Peer worker model has important strengths in building relationship and trust

Four Substance Exposed Newborn Demonstration Projects Ambitious and complex projects Work to build collaboration among service systems using a variety of approaches Goal is enhanced safety and well- being for substance exposed newborns, their mothers and families