developing plans of safe care for substance exposed newborns lessons from four capta demonstration...
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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, 2004Messinger 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)
http://eip.uoregon.edu/projects/feat
Family Early Advocacy and Treatment
Project FEATLane 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 ClientsN=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
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 [email protected] http://eip.uoregon.edu/projects/feat/
Contact Information
Heidi MasonFamily Support Specialist
A Helping Hand: Mother to MotherMassachusetts
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 WorkersStrengths
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 Exitn=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 ConnectionsOhio
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
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 ServicesDenver Department of Human
Services, Denver, CO720.944.2352