Mitigating Risks of Substance Exposed Infants and Their

Families

Dixie L. Morgese, BA, CAP, ICADC

Learning Objectives

• Review models of risk determination (PPOR, ATOD, and CAN)

• Discuss risk mitigation strategies used in home visiting and family coaching

• Gain understanding of Strengthening Families Protective Factors as a Framework

• Learn strategies for enhanced risk mitigation using the Protective Factors Framework

Risk Screening & AssessmentRisk Screening & Assessment

• Perinatal Periods of Risk (PPOR)Perinatal Periods of Risk (PPOR)

• Alcohol, Tobacco, & Other DrugsAlcohol, Tobacco, & Other Drugs

• Child Abuse & NeglectChild Abuse & Neglect

• Other - DevelopmentalOther - Developmental

• Protective FactorsProtective Factors

Perinatal Periods of RiskPerinatal Periods of Risk

• Biopsychosocial ApproachBiopsychosocial Approach• Age, Weight, History LBW or loss, Illness & Age, Weight, History LBW or loss, Illness &

Infection,Infection,• Practical Support, Stressors, Access, Practical Support, Stressors, Access,

EnvironmentEnvironment• Mental Health& PPD, Substance Use, Violence, Mental Health& PPD, Substance Use, Violence,

Hunger, Timing of Pregnancy, RelationshipsHunger, Timing of Pregnancy, Relationships

Alcohol, Tobacco & Other Drugs*

• 5 P’s Screening Instrument (includes violence)

• ASI – Addiction Severity Index - onset, type of substance, frequency, dosage, route of administration. (concentrate on three months prior to and during pregnancy)

• Stages of Change (Readiness)

Stages of Change

Child Abuse & Neglect

• History of Maltreatment or Domestic Violence

• Timing & History of Pregnancy

• ACES - Adverse Childhood Experiences

• Criminal History

• Indicators vs. Predictors

Protective Factors

• Family Resilience

• Social Connections

• Parent Knowledge of Child Development

• Nurturing and Attachment

• Social and Emotional Competence

• Practical/Concrete Support in Times of Need

Strength Based Family Strength Based Family Support Planning - PrenatalSupport Planning - Prenatal

• Medical Risk – access, awareness, support, address barriers – carry pregnancy to term, coordinate with prenatal clinical provider, ICC.

• Behavioral Health - supports, resilience, history of success, social connections, parenting, childbirth ed. & plan, options.

• Environmental – housing, preparation, safety.

Strength Based Family Support Strength Based Family Support Planning - BirthPlanning - Birth

• Multi-disciplinary staffing activities to support birth plan

• NICU staff support, handling techniques, nurturing & attachment, breastfeeding, social connections – labor support

• Substance Abuse & Mental Health Treatment Options

• Medical – linkage to and coordination with pediatric and developmental services.

Strength Based Family Support Strength Based Family Support Planning - InfancyPlanning - Infancy

• Linkage to pediatric and developmental services• Ensure caregivers are aware of unique needs of infant• Consider all caregivers with access• Address safe sleep• Consider respite• Foster self regulation and routine – access to child care

services• Siblings• Child Welfare systems that may be involved.• Strive for Social Equality, Parent Engagement, and foster

empowerment.

Post Partum

• Post Partum check-up – family planning, follow up on health conditions, ongoing health care access.

• Post Partum Depression – support exercise, self care, personal awareness, social connections.

• Recovery – twelve step support, follow up on recovery plan.

• Other

Address Barriers

• Fear of systems

• Unresolved Trauma

• Transportation

• Employment/Income

• Health Care

• Treatment

• Child Care

• Housing

Questions?

Thank You!!