2017 minnesota summit on prenatal substance use and infant ... · pdf file2017 minnesota...

2017 MINNESOTA SUMMITON PRENATAL SUBSTANCE USE

AND INFANT EXPOSUREJuly 28, 2017

Prenatal Substance Use and Infant Exposure

By Shirley M. Cain, J.D., Native American Equity Agency Policy Specialist

“White Earth mom lost her pregnant daughter to overdose”“After 17 times in treatment, this addict pins hope on new drug”

Minnesota’s headlines

• “Whit “White Earth mom lost her pregnant daughter to overdose e Earth mom l “White Earth mom lost her pregnant daughter to overdose pregnant daughter to overdose

Minnesota’s headlines

• “He sold drugs to his own community; now he fights for redemption”

Minnesota data

• Minnesota ranked first among all states in 2015 for deaths due to drug poisoning among American Indians/Alaska Natives.

• More than one in ten pregnancies among American Indian women have a diagnosis of opiate dependency or abuse during pregnancy. Compared to non-Hispanic whites, American Indian women are 8.7 times more likely to be diagnosed with maternal opiate dependency or abuse during pregnancy.

Minnesota data

• More than half of pregnant Minnesota women who are known to be opioid dependent are still prescribed opioids for pain during pregnancy. The rate of prescribed opioids for pain during pregnancy is twice as high among American Indians then among other Minnesotans.

Minnesota information

Minnesota information – source

• http://www.mprnews.org/story/2016/04/18/opioid-overdose-epidemic-explained

Minnesota information

• Native Americans in Minnesota died of opioid overdoses at a rate nearly five times higher than that of white Minnesotans between 1999 and 2014, according to data from the Center for Disease Control.

• African-Americans also died at a rate higher than whites.

Opioid Epidemic

• Written Testimony of Nancy K. Young, Ph.D.

• Director, Children and Family Futures, Inc.

• Before the United States Senate Committee on Finance

• Examining the Opioid Epidemic: Challenges and Opportunities

• Tuesday, February 23, 2016

• 215 Dirksen Senate Office Building

Strategies for Prevention/Intervention

• 1. Identification – who needs Substance Use Treatment?

• 2. Timely Access – Assessment process or Rule 25.

• 3. Recovery Support Services – Managed recovery services and monitor compliance with treatment.

• 4. Comprehensive Family Services – two generation family centered services to help with parent-child relationships.

• 5. Increased Judicial Oversight – drug courts as an example.

• 6. Cross-Systems Response – multiple teams working together.

• 7. Collaborative Structures – communication is key.

5 R’s for policy and practice for core outcomes

• 1. Recovery

• 2. Remain at Home

• 3. Reunification

• 4. Reoccurrence

• 5. Re-entry

Strategies and outcomes

• Ensuring that these strategies include a focus on infants with prenatal substance exposure will develop a workforce that is prepared to work in today’s environment.

• Staff training and communication protocols must provide concrete and pragmatic information.

Office of Women’s Health Report

• White Paper: Opioid Use, Misuse, and Overdose in Women

• This paper was prepared for the U.S. Department of Health and Human Services Office on Women’s Health with contract support from NORC at the University of Chicago. December 2016.

Office of Women’s Health Report

• Opioid misuse during pregnancy is especially risky as it not only impacts the health of the woman but also can impact that of her unborn child.

Office of Women’s Health

• Infants with Neonatal Abstinence Syndrome (NAS) may have uncoordinated sucking reflexes that can lead to poor feeding, irritability, and high-pitched cries.

• Infants born to mothers who misused opioids during pregnancy must be monitored and treated accordingly.

InBrief: The Science of Neglect

http://developingchild.harvard.edu/resources/inbrief-the-science-of-neglect-video/

Office of Women’s Health

• Medicaid programs can consider pharmacy benefit management strategies

Office of Women’s HealthCDC Guidelines for Prescribing Opioids for Chronic Pain

• Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative care and end-of-life care.

• Clinicians should establish treatment goals with patients, and include a plan for discontinuation of opioid therapy if risks outweigh benefits.

Guidelines for Prescribing Opioids for Pain

• When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of OUD (methadone, buprenorphine, and naltrexone) and overdose.

• Clinicians should review patients’ history of controlled substance use and consult Prescription Drug Monitoring Programs (PDMPs) to determine risk for overdose.

Medication Assisted treatment by SAMSHA

• People take opioids for medical reasons.

• Doctors prescribe opioid medication to treat pain and sometimes for other health problems such as severe coughing. The medication comes in a pill, a liquid, or a wafer. It also comes in a patch worn on the skin. Examples of prescribed opioid medications include:

• Codeine—an ingredient in some cough syrups and in one Tylenol® product

• Hydrocodone—Vicodin®, Lortab®, or Lorcet®

• Oxycodone—Percocet®, OxyContin®, or Percodan®

• Hydromorphone—Dilaudid®

• Morphine—MSContin®, MSIR®, Avinza®, or Kadian®

• Propoxyphene—Darvocet® or Darvon®

• Fentanyl—Duragesic®

• Methadone.

Medication Assisted Treatment

• Has an opioid addiction turned someone you care about into “somebody else”?

• Is there something that can be done to help your friend or loved one overcome this addiction?

• Medication-assisted treatment is one way to help those with opioid addiction recover their lives. There are three, equally important parts to this form of treatment:

• Medication

• Counseling

• Support from family and friends.

Medication Assisted Therapy

• Addiction

• Craving

• Loss of control

• It is not usually possible to taper off an addiction. More help is needed because the cravings are so strong and the fear of withdrawal is so great

Medication Assisted Therapy

• Opioid addiction is a chronic disease, like heart disease or diabetes.

• A chronic disease is a medical condition for life.

Recovery

• “For me, recovery is about creating a better life for myself and for my family and ultimately for my community. Because when I’m better, they’re all better.” Tom C.

Health and Human Services Policy

• Supporting the Development of Young Children in American Indian and Alaska Native Communities Who Are Affected by Alcohol and Substance Exposure

• U.S. Department of Health and Human Services Policy Statement

Health and Human Services Policy

• Early childhood programs should incorporate the following issues into staff training:

• Forming strong relationships with families – bonding and belonging.

• Communicating with families

• Identifying, understanding, and addressing biases about alcohol and substance misuse – nonjudgmental.

• Understanding trauma – signs, impact on child development, how to work with trauma-exposed children.

• Understanding the signs of neglect and abuse – support programs.

• Supporting children’s development across all domains – developed or delayed in development.

• Conducting developmental and behavioral screenings –talk with family and refer.

Health and Human Services Policy

• This policy statement advances HHS’s vision for healthy AI/AN children and strong tribal nations, centered on traditional strengths by:

• Raising awareness

• Highlighting culturally-based and evidence-based strategies Supporting tribal efforts to coordinate and leverage services and activities

• Identifying culturally/linguistically responsive resources

What are other states doing?

• Ohio, for example, has launched a pilot program aimed at helping pregnant women who use opiates deliver healthy babies.

• Medicaid expansion allows for more resources. .

What are other states doing?

• In Illinois, three counties are served by a “recovery coach” programpaid for by a federal funds and administered by a nonprofit. Parents get help navigating addiction treatment and additional support, such as parenting classes and help finding jobs and housing.

What are other states doing?

• Specialized court dockets, such as family drug courts, can also help.

What are other states doing?

• Vermont is expanding a program that wraps more support around parents.

What are other states doing?

• “Our staff goes out on that first call and screens the family for substance abuse right then,” said Kim Coe, director of residential and community treatment at Lund Family Center

• Although a Lund screener only monitors the parent until he or she enters treatment, that’s enough to improve outcomes for families, Coe said.

What are other states doing?

• Those that serve families best, Young said, help parents get into treatment and stay sober. Often, such approaches bring together everyone involved, from child-welfare caseworkers to the judge overseeing the case. “We now know what works,” she said.

What are some tribes doing?

• Tagwii Plus – is for women who are pregnant and/or have minor children who are entering treatment, currently receiving treatment or have completed primary treatment.

Tagwii Plus, Fond du Lac Tribe

• They are assigned a Recovery Coach who helps them with the following

• child care/child care development services

• Transportation

• pretreatment/treatment/health/rehabilitative activities

• trauma services

• peer recovery support groups

• alumni groups

• job search activities

• parenting skills and child development

• education, job training, FASD, SUD and Safe Infant Sleep Education

• medical, dental or other physical health care services

• therapeutic interventions and trauma services for women to address issues of relationship, emotional, sexual and physical abuse

• housing support and assistance and financial management

Tagwii Plus

• The Recovery Coaches coordinate:

• consultation and monitoring from counselors, case workers, physicians, physical fitness instructors, spiritual healers and/or clergy, probation officers and dieticians.

• The participants are also drug tested and participate in sobriety feasts.

Tagwii Plus

• The goals are to:

• increase access to substance abuse services

• achieve family reunification

• keep mothers and children together

• help reduce substance-exposed births

• aid communication between child welfare workers and substance abuse treatment providers.

Bright Beginnings –Minneapolis American Indian Center

• The goal of the Bright Beginnings Recovery Support Program is to help American Indian women achieve and maintain recovery in order to

• Keep families intact

• Support healthier environments for families.

• The program will provide services to;

• American Indian pregnant women or women who have recently delivered, and

• Have a history of substance abuse.

• The program will also work with American Indian women who have had prior experience with the child welfare system.

• Phone: 612.879.1786

• www.maicnet.org

White Earth Urban Maternal Outreach and Mitigation Services (UMOMS)• a White Earth Nation tribally licensed out-patient treatment

program for pregnant and post delivery Native American women who are struggling with an opioid substance use disorder.

• We combine culture, medicated assisted therapy, and mental health services.

• Traditional Prenatal Support helps pregnant women connect to our Lifeways, and Mino Bimaadiziiwin (the Good life).

White Earth Urban Mom’s

• Traditional Teachings

• Asemaa/Tobacco Ceremony

• Relaxation and Visualization

• Letter to your baby

• Birthing Practices

• Group-Work-Body-Mapping

White Earth Urban Mom’s

• Pregnancy collage

• Life ways, (Experiential)

• Prenatal Development

• Birth Plan

• Flower and Water

White Earth Urban MOM’s

• They are on a Sacred Journey ~ Our unborn are Sacred..

• Respect your unborn, nurture their growth.

• Love and protect them.

• For more information, please call the White Earth Urban MOMS at 612-872-2398 1730.

White Earth MOM’s

• Overview

• The Maternal Outreach and Mitigation Services (MOMS) program has a goal of tapering the medication Sub Oxone down over time so a mother can maintain sobriety. Most clients can taper off in 18 months. Overall, it is focused on building positive relationships in a safe and judgement free environment.

White Earth MOMS

• The following services are provided through the MOMS program:

• Intensive out-patient

• Case management

• Mental health services

• Parenting groups

• Cultural groups, circles, beading, crafts

• Medication-assisted treatment referrals

• Prenatal care

White Earth MOMS

• Harm reduction services

• Links to spiritual services

• Parenting, early childhood education

• Cooking and nutrition classes

• Support services for infants and children

•Contact

• For more information call 218-936-2442, or email julie.williams@whiteearth-nsn.gov.

Family Spirit – Leech Lake

• Participants are included and encouraged to attend any Leech Lake Band of Ojibwe events, ceremonial events/meetings, classes offered regarding culturally related issues such as sewing moccasins, regalia, traditional birthing practices, cradle board making, or any programs available through Family Spirit or community and Leech Lake Tribal College.

State funded programs

• Women’s Recovery Services in Minnesota: Cross-site Findings Executive Summary

• Cumulative Evaluation Results of a 5-year Minnesota Initiative Serving Chemically Dependent Women and their Children: 2011-2016

• OCTOBER 2016

• Prepared by: Wilder Research

Wilder Report

• Higher levels of service resulted in better outcomes.

• Clients who received a higher “dosage” of service - that is, more intensive case management services – did better in several key outcome areas such as sobriety (at closing and follow-up), treatment completion, substance-free births, employment, housing, system involvement, and family stability.

Wilder Report

• Several factors play an important role in predicting clients’ sobriety and stability.

• Sobriety.

• Clients were more likely to be sober at closing if they had been engaged in their case planning.

Wilder Report

• With the exception of pregnancy status, all of these factors also predicted sobriety at the 6- and/or 12-month follow-up.

Wilder Report

• Family stability. Several of these same factors were found to predict overall family stability, as well as other factors like participation in AA/NA at closing, not being involved in child protection at closing, not having a mental health diagnosis at closing, and receiving mental health services – or being connected to a mental health clinic or therapist – at closing.

Wilder Report

• Women’s relationships with others also played a key role. Important is that sense of belonging.

• Clients identified the emotional support they received from program staff and their relationships with their children as critical to supporting their sobriety and general well-being.

Wilder Report

• These findings suggest the need for continued support related to sobriety after case closing (e.g., aftercare services), and to address other ongoing and related challenges that persist, such as issues around affordable housing, physical health, and employment and income.

Minnesota Department of Human Services

• Integrated Care for High Risk Pregnancies

• The Integrated Care for High Risk Pregnancies (ICHRP) Initiative is a grant program approved by the State legislature in 2015.

• It directs the Minnesota Department of Human Services to award grants to newly-formed “qualified integrated perinatal care collaboratives.”

• The funds will be used to help providers, local service entities, and communities work together to achieve healthier birth outcomes, in areas of the state where birth outcomes are known to be significantly compromised.

• For more information: Contact Fritz Ohnsorg, fritz.ohnsorg@state.mn.us, Phone: (651) 431-5807.

Conclusion

• Contact information:

• Shirley M. Cain, Native American Equity Policy Specialist

• E-mail: shirley.cain@state.mn.us

• Phone (651) 431-4708