St. Vincent Mercy Medical Center

1. St. Vincent Mercy Medical Center Healthy Connections SEN Project Celeste Smith, MA, FLE Program Coordinator, SVMMC Healthy Connections Program 419-251-2459 Celeste_Smith@mhsnr.org

2. Background on CAPTA • What does CAPTA mean?

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

4. 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.

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

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

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

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

9. Healthy Connections SEN Project Objectives: • Collaborate with 10 maternal and child serving agencies • Develop procedures for identification and referral in obstetrics prenatal, Labor and Delivery, and pediatrics • 60% of participating infants will receive needed development and social/emotional services

10. Healthy Connections SEN Project Objectives cont. 4. 75% of participating parents will complete Individual Family Service Plan goals.

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

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

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

14. A Helping Hand: Mother to Mother The Massachusetts SEN Project John A. Lippitt, Ph.D. Project Director, Department of Public Health 617-624-6017 john.lippitt@state.ma.us

15. 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

16. 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

17. 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

18. 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

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

20. 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

21. 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

22. 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

23. 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

24. A Helping Hand: Mother to Mother • Keys to Identification • Birthing hospitals and other health care and earlychildhood service providers • Identify best practices for SEN identification and response

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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)

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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