neonatal abstinence syndrome & renewal house: improving outcomes utilizing a family- centered...
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Neonatal Abstinence Syndrome & Renewal House:
Improving Outcomes Utilizing a Family-Centered
Continuum of CareCAPTASA Conference – January 2014
Disclosures
• I have no relevant financial disclosures
Drug Dependent Newborns(Neonatal Abstinence Syndrome)
November Update (Data through 11/30/2013)
Quick Facts: NAS in Tennessee
• 804 Cases of Neonatal Abstinence Syndrome (NAS) have been reported from January 1, 2013 till November 30, 2013
• In the majority of NAS cases (63%), at least one of the substances causing NAS was prescribed to the mother by a health care provider.
• The highest rates of NAS in 2013 have occurred in Sullivan County and the Northeast Region (5.0 and 3.5 times higher than the state average, respectively).
Additional Detail for Maternal Sources of Exposure
Maternal Source of Exposure
Cost of Addiction
• Average TennCare cost for a healthy newborn: $4,237.
• Average TennCare costs for an infant born dependent on drugs, diagnosed with neonatal abstinence syndrome: $66,973
Percentage of Newborns in DCS Custody within One Year
of Birth, CY 2010
Infants Born in CY 2010 NAS InfantsTotal # of Infants 56,498 512
Total # Infants in DCS 754 95
% in DCS 1.3% 18.6%
Long-Term Consequences of NAS
• At risk for:o Attention deficit Disordero Hyperactivity o Difficulty transitioning between taskso Impulse-controlo Sleep disorderso Sensory disorderso Future risk of addictive behavior
Laura Berlind, CEO
Mary Beth Heaney-Garate, LCSW
Renewal House History• Founded in 1996.
• Nashville’s first, largest and most comprehensive treatment
& recovery community for women & their children.
• Gender-specific treatment.
• Residential & outpatient services.
• Unique family-centered recovery.
• Serve over 200 women and children each year.
Family-Centered Approach• Entire Family is the identified client/patient at RH. • Stigma- Mothers love their children but have a
disease. • Treatment requires disruption in the lives of
families Resistance. At RH, women don’t have to choose between taking care of their children or taking care of themselves.
• Existing systems not equipped to serve families- shelters, treatment programs, 12-step groups.
• Comprehensive service not widely available.– Only 8.2% of adults treated
Typical Client Profile• Co-Occurring
Substance Use & Psychiatric Disorders
• Poverty & Homelessness
• Limited Health Care
• Limited Prenatal Care• Crime & Violence• Child Abuse & Neglect• Domestic Violence• Sexual Assault• Intergenerational
Substance AbuseComplex, interlocking
needs thatrequire an integrated, multisystem approach
ACE Study
Case Management Services:Community Resources
TransportationAftercare
+ 6 Months Support in Permanent Housing
Life Skills & Vocation Support Services:GED Preparation
Job Search & Interview PreparationBudgeting & FinanceCooking & NutritionOrganization Skills
Wellness Recover Action Plan (WRAP)
Women’s Licensed Treatment (IOP) & Pregnant & Postpartum IOP:Co-Occurring Capable & Trauma-Informed
Drug & Alcohol Abuse EducationRelapse Prevention
ParentingDomestic Violence
Relationships & Self-EsteemSpirituality
Admissions, Outreach, & Consulting:Training & Education
Screening & AssessmentCase Consultation
Community EngagementCo-located Staff with DCS – Davidson Cty
Co-located Staff with DCS – 11 Surrounding Counties
Peer Support & Recovery Community Connection:
12-Step MeetingsCertified Peer Coaching & Mentoring
Alumnae Association
Family & Children’s Early Intervention & Prevention
Program:Substance Abuse Prevention
Child Abuse PreventionDevelopmental Assessments
Children’s Case ManagementCommunication & Social Skills
Resiliency SkillsIndividual Therapy
Individual & Group ParentingCelebrating Families!
Children’s Mental Health ServicesParent-Child Interaction Therapy
Al’s Pals
Recovery Housing:Transitional Supportive Housing
Permanent 2-Bedroom ApartmentsCommunity Meetings
Mental Health Care Services:Individual & Group Counseling
Psychiatric EvaluationMedication Management
Family TherapyDialectical Behavior Therapy (DBT)
Mental Health Education
Integration of Mental Health Services
• Clinical team meetings include both A&D treatment and mental health staff.
• All staff are trained in basic DBT.• Groups are co-led by mental health staff and 12-
step based peer recovery support. – Immediate translation of mental health recovery
practices into 12-step concepts.
Lengthened & Deepened Continuum of
Care• Additional 6 months of supportive services-
through transition to permanent housing• Recovery Peer Support & Alumni Program• “Transitions” Case Manager• Children’s Program Case Manager & Children’s
Activities Coordinator• Children’s Psychiatric Services
Program Capacity• Family Residential Program: 16 Apartments
– 32-35 families/year (1 mother + 2 children)– Target 12 – 18 months LOS
• Outpatient Treatment for Women: 12 seats– 60 women/year– 12 weeks
• Celebrating Families: 15 families– 11 weeks
Targeted GainsSobriety & Stable Mental Health• Clean time and consistent psychiatric care
Improving infant, mother, and family health• 100% drug-free babies born to RH mothers• 100% receive prenatal & postpartum care• 100% women & children obtain regular health care
(check-ups, vaccinations, etc.)
Breaking the cycle of addiction & poverty • Women complete co-occurring treatment• Exit with education/employment• Exit with stable housing
Targeted Gains (con’t)Improving Mother-Child Attachment• 100% of mothers receive evidence-based parenting
curriculum• Children leave with improved developmental assets• Improved family functionReducing Adverse Childhood Experiences (ACE)• Sober parent• Family reunification – closed DCS cases• Safe & stable home environment• Closed legal cases
Family Residential Program
2013 Gains• 54% Completed IOP Treatment
• 43% Employed
• 68% Established Permanent Housing
• 6 Drug-Free Infants Born
• 82% Maintained or Improved Child Custody Rights
• 100% of Children scored ≥ 31 on the Search
Institute’s Developmental Asset Assessment
Outpatient Treatment Program – 2013 Gains
• 98% Prepared Individualized Treatment Plans
• 73% Achieved 30 Consecutive Days Sober
• 53% Completed Treatment
Memorial FoundationASI Study
Domains Average Admission ASI Composite Score
Average Outcome ASI Composite Score
Average Change in ASI Composite Score
Medical Status 0.301 0.286 -0.007
Employment and Support
0.838 0.468 -0.317
Drug Use 0.224 0.037 -0.179
Alcohol Use 0.281 0.035 -0.237
Legal Status 0.238 0.047 -0.19
Family/Social Status 0.324 0.13 -0.176
Psychiatric Status 0.426 0.157 -0.262
*54 of 75 clients interviewed had complete datasets for comparison purposes. Outcome ASI scores are shown for all 75 clients, however, the average change represents the 54 clients with a complete data set.
Memorial FoundationASI Study
Of the 75 clients interviewed in this study*:
• 56% have stable employment
• 81% have permanent housing
• 92% were sober for the last 30 days
* All client information was self-reported in the assessment.
Family Connection Grant Project Evaluation• Improved internalizing behaviors (suicidality,
selfinjurious behavior, depression, anxiety, adjustment to trauma)
• Improved externalizing behaviors (danger to others, criminal behavior, interpersonal relationships, antisocial behavior, anger, substance use, impulsivity)
• Improved social connection factors (family, social functioning, social connectedness, community connection)
Hope, Resiliency & Continued Recovery
Dr. Roland Gray, Volunteer Medical Director
Laura H. Berlind, Chief Executive Officer
Mary Beth Heaney-Gárate, LCSW, Chief Clinical Officer
Email: [email protected]
Website: www.renewalhouse.org
Tel: (615) 255-5222