1. Addressing the drug affected infant population and tools to end destructive cycles  Amy Baumann- BSW- Safe Babies Healthy Families  Colleen Allen- MSW, APSW certification- Waukesha Memorial Hospital  Karen Villarreal- BA in Psychology- Safe Babies Healthy Families

2. Objectives  Statistics  Committees in Waukesha County  Accomplishments and Goals  Universal Screening Tool  Assessment of SBHF  Home Visiting  Future Concerns

3. Statistics  Nationally the rate of NAS increased from 2009-2012 from 3.4 to 5.8 infants per 1000 births  In Wisconsin and surrounding states it was 6.9 per 1000 births in 2012 (463 babies in 2014)  In Waukesha it was 7.3 per 1000 births in 2014 (28 babies) (We know that this number is extremely under reported)  Nationwide both neonatal and maternal hospital stays together cost $944 Million in 2012

4. Statistics  90% of highest risk families in Waukesha County CPS had AODA concerns (both in and out of home placements)  160,000 people in Wisconsin abuse opiates  23% of people who use heroin become dependent  In 2014 there were 47,055 drug overdoses in the United States  There were 853 overdoses in Wisconsin in 2014 (more than car fatalities)  There has been a 200% increase in opiate deaths between 2000 and 2014

5. Difficulties in quantifying  Babies are coded in many different ways, instead of as a NAS baby  Different descriptors  As a result, funding is hard to get because of the lack of data  Hopefully this will be changing as state leaders see the need  Our local group is trying to collect more local data

6. Waukesha County  Drug Affected Infant Workgroup began with B-3, Public Health and DHHS seeing a need in our community  Invited SBHF, local hospitals, Waukesha Comprehensive Treatment Center, and other community agencies to the table  What hospitals were seeing  Began meeting quarterly

7. Structure of Group Currently  Now we meet every other month  Attendees: SBHF, Waukesha Memorial Hospital, Aurora Summit, Public Health, B- 3, Waukesha County HHS, Waukesha Comprehensive Treatment Center, Parent’s Place, State Representatives, Addiction Resource Council, Hebron House, Lutheran Social Services, Parents,etc.  Developed 3 subgroups  Became a pillar of the Waukesha Heroin and Other Illicit Drug Taskforce

8. Pregnancy Subgroup  Education and coordination of care Consistent message to the families on what to expect Connect these families as early as possible with community providers  Universal screening tool  Identify a standardized algorithm for patients identified at risk

10. Hospital Stay Subgroup  Consistency with care and treatment guidelines Compare protocols and policies Work with WAPC Training and education for staff Universal screening tool for doctors Building a screen in EPIC

11. Perinatal Dependency Clinic  WMH is in the beginning stages of opening a clinic  Will be able to prescribe suboxone, subutex and vivitrol  There will be a coordinator (RN or SW), pharmacy support and a clinical psychologist/therapist (individual and/or weekly groups)  It will be co-managed with their OB during pregnancy and then to internal medicine post delivery  Patients would do medical appointments in the morning and individual and group therapy in the afternoon.

12. Community Subgroup  Educate providers and community on services available Professional Binder Family Folder  Connect with partners that can outreach to families  Support Group for Pregnant and Parenting Mom’s -Parent’s Place

13. Successes  Created a universal referral form for SBHF, PH and B-3.  Brought multiple hospital systems to the same table Sharing best practice Shared what each system has tried Reduces amount of patient playing the system  Opened the discussion with Waukesha Comprehensive Treatment Center  Have brought trainings to the group from state level  Created a binder for professionals  Created a family folder for families  All hospitals are calling CPS if baby tests positive  Educating families on what to expect during the process and what babies experience  Cross training- ex: B-3 and CPS

15. Work in progress  Discussing with the Taskforce to add our professional binder to the website they are creating  Easier to keep updated  Talking with 211  Update current binder and family folder  Working on universal screening tool for doctors and getting into EPIC

20. Importance of Home Visiting  Not all families are opened to CPS  Coordinate with B-3  Continue to monitor and do ASQ and SE  Better relationships with DHHS, agencies and hospitals  Continuum of care  Able to get participants feedback  Preparing parents as what to expect through process

21. Home Visiting Challenges  Families facing these struggles take more time  Higher risk for abuse and neglect  Attachment and bonding challenges  Harder to keep these families engaged- especially as a voluntary program  Smaller case loads  Funding is difficult

22. Hospital Challenges  Expensive to test umbilical cord  Universal screening protocol would need to come form WAPC  Doctors and hospitals would need the screen as an electronic record  Between Waukesha and Milwaukee there is a lot of competition and places for families to go  Families hospital and doctor hop