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

Plans of Safe Care Presenters  Kristin Funk,  FEAT, OR  Heidi Mason,  A Helping Hand, MA  Celeste Smith  Healthy Connections, OH  Gretchen Read  C-SIMI, CO

Plans of Safe Care 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

Plans of Safe Care Specialized Staff  Recovery support (FEAT)  Peer workers (AHH)  Master’s level case managers (HC)  Specially trained CPS workers (C-SIMI)

Family Early Advocacy and Treatment Project FEAT Lane County, Oregon

Plans of Safe Care 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

Plans of Safe Care 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

Plans of Safe Care 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

Plans of Safe Care  Referrals from:  Hospitals  Prenatal providers  Treatment  Child welfare  Courts  Community agencies FEAT Family Advocate

Plans of Safe Care Family Advocate Satisfaction Surveys N=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

Plans of Safe Care Percent of mothers who reported drug use prior to receiving family advocate services

Plans of Safe Care Family Advocate Clients N=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

Plans of Safe Care

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.”

Plans of Safe Care 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.”

Plans of Safe Care 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.”

Plans of Safe Care 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

Plans of Safe Care 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.”

Plans of Safe Care SEN identified in hospital SEN remained with parent SEN removed (placed in foster or relative care) 2008 N=27 (20 cases opened) 14  7 opened and sent to treatment with mother.  7 closed at assessment 13  6 returned  4 adopted  3 in foster care 2009 N=33 (21 cases opened) 23  11 opened (10 sent to treatment with mother)  12 closed at assessment 10  2 returned to mother in treatment within 1-2 months.  8 in foster care Investigated Child Welfare SEN cases in Lane County

Plans of Safe Care 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.

Plans of Safe Care 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.

Plans of Safe Care  Liz Twombly  FEAT Co-Coordinator, University of Oregon Early Intervention Program   Contact Information

Heidi Mason Family Support Specialist A Helping Hand: Mother to Mother Massachusetts

Plans of Safe Care  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 AHH Partners

Plans of Safe Care  Voluntary home-visiting practice  Mothers of SEN <90 days old  Peer Worker = Mother in Recovery A Helping Hand: Mother to Mother (AHH)

Plans of Safe Care Referral Process

Plans of Safe Care  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 AHH Peer Worker Model

Plans of Safe Care 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

Plans of Safe Care  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 Peer Recovery Workers Strengths

Plans of Safe Care Peer Training  Stages of Change/Motivational Interviewing  Relational-Cultural Theory  Substance Use Disorders 201  Home visiting safety protocols  CPR and universal health precautions

Plans of Safe Care Peer Training  Using supervision  Confidentiality and boundaries  Early Childhood Development  Mandated reporting guidelines  Community resources  Recovery Coach Academy

Plans of Safe Care 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

Plans of Safe Care Services Received by Mothers upon Exit n=65

Plans of Safe Care Outcomes  At time of closing of 65 cases:  Physical Custody  45 with mother  9 with relatives  9 in foster care  8 reunified

Plans of Safe Care

Healthy Connections Ohio Plan of Safe Care

Plans of Safe Care  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 Healthy Connections Project

Plans of Safe Care Healthy Connections Objectives  Collaborate with maternal and child serving agencies  Promote consistent identification protocols  Link infants with services  Assist parents in completing service plans

Plans of Safe Care Healthy Connections Strategies  Training  Provide wrap around services

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

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

Plans of Safe Care Contact Information Celeste Smith, MA, PC

Plans of Safe Care 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

Plans of Safe Care Contact Information Gretchen G. Read, M.S.W. Supervisor, Child Welfare Services Denver Department of Human Services, Denver, CO