1. Epidemic Spreading Across the State Erica Wilson M.P.H. Health Promotion Program Director East Region

2. Neonatal Abstinence Syndrome

3. What is it? Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics.

4. What Causes It? Almost every drug passes from the mother's blood stream through the placenta to the fetus. Illicit substances that cause drug dependence and addiction in the mother also cause the fetus to become addicted.

5. What Happens to the Baby? Baby At birth, the baby’s dependence on the substance continues. However, since the drug is no longer available, the baby’s central nervous system becomes overstimulated causing the symptoms of withdrawal.

6. What’s the Incidence of Neonatal Abstinence Syndrome?

8. 626 cases in Tennessee as of 8/30/14 compared to 564 at same point in 2013 Increase of 11%

9. Maternal County of Residence by Region August 30, 2014 # Cases% Cases Davidson315.0 East17928.6 Hamilton71.1 Jackson/Madison20.3 Knox7011.2 Mid-Cumberland589.3 North East8914.2 Shelby274.3 South Central203.2 South East101.6 Sullivan436.9 Upper Cumberland7111.3 West193.0 Total626100.0%

10. East Tennessee continues to account for largest proportion of cases in the state (28.6%) 3rd highest rate in the state (35/1000 births)

11. Exposure source trends in East TN vary from those seen in all cases state-wide

13. Highest rates based on provisional county birth estimates

14. Why is Neonatal Abstinence Syndrome a Concern?

15. The Baby Tragedy and suffering of the babies and their caregivers. With increased likelihood of foster care, families are torn apart.

16. The Cost According to current statistics in Tennessee, the TennCare costs for a healthy newborn were $4,237 compared to an average cost of $66,973 for an infant born dependent on drugs, diagnosed with NAS.

17. The Future There may be other economic, psychological and physiological costs associated with their medical condition at birth since it is not yet known what challenges and needs these infants will have as they grow older.

18. What can we do in Public Health ? NAS became a reportable condition in TN on January 1, 2013 NAS Taskforce was formed July 11, 2013 – Collaborative effort with East Region and Knox NAS/PPI Sub-committee was formed on September 5, 2013

19. Primary Prevention Initiative LARC Pilot Project East Region

20. The Process CollaborationCollaboration –Sheriff/Jail Administrator/Jail Nurse EducationEducation –Partners (Pamphlet) –Participants (PowerPoint and Pamphlet) Referrals (Referral/Follow-Up Form)Referrals (Referral/Follow-Up Form) Clinical ServicesClinical Services Data Collection (Referral/Follow-Up Form)Data Collection (Referral/Follow-Up Form)

21. High-Risk Population Outreach NAS Education Session Referral to HD Clinical Exam at HD Contraceptive Placement Pregnancy Prevention in Population at High Risk for NAS Child

22. 1/14/14 – first education session at Cocke County As of 8/8/14, six sessions have been held –4 at Sevier County Jail –2 at Cocke County Jail 119 total persons educated Anticipated referrals: 75 (63.0%)

23. Females ranging in age 20 – 45 (avg. age: 27) Predominately non-Hispanic white Mostly residents of Sevier and Cocke County, but a few from other areas: CountyNo.Percent Cocke 1432.6% Davidson 12.3% Jefferson 12.3% Knox 12.3% Sevier 2455.8% Out-of-State 24.7% Total 43100.0%

26. Education levels FP barriers –28% of referrals were previous FP patients Specific drug use history including during pregnancy History of unplanned pregnancy

27. Cost Savings Preventing the birth of one drug dependent infant saves an average cost of $66,973.Preventing the birth of one drug dependent infant saves an average cost of $66,973. Preventing the birth of one drug dependent infant in each of the counties in the East Region would be a cost savings of $1,004,595.Preventing the birth of one drug dependent infant in each of the counties in the East Region would be a cost savings of $1,004,595. Preventing the birth of one drug dependent infant in each of the counties in Tennessee would be a cost savings of $6,362,435.Preventing the birth of one drug dependent infant in each of the counties in Tennessee would be a cost savings of $6,362,435.

28. LARC Pilot Update – September 10, 2014 CockeSevierComments Number of Referrals Received 1429Total: 43 Potential Total Savings: 43 times $67,000.00 = $2.8 Mil

29. Questions Erica Wilson M.P.H. Health Promotion Program Director East TN Regional Health Office Erica.Wilson@TN.gov (865) 909-9404 Ext. 103