st. vincent mercy medical center healthy connections sen project celeste smith, ma, fle program...
TRANSCRIPT
St. Vincent Mercy Medical Center
Healthy Connections SEN Project
Celeste Smith, MA, FLE
Program Coordinator, SVMMC Healthy Connections Program
419-251-2459 [email protected]
Background on CAPTA
• Keeping Children and Families Safe Act 2003 Child Abuse Prevention and
Treatment Act (CAPTA)
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.
Healthy Connections SEN Project
Goal: to increase the compliance with CAPTA requirements in order to maximize child and family social,
emotional and developmental outcomes.
Healthy Connections SEN Project
Demographics
• Suburban/urban county
• Population approx. 455,055 and 313’620 live in the city
Healthy Connections SEN Project
Racial composition
• White 77.5%
• African American 17.0%
• Native American 0.3%
• Asian 1.2%
• Other 1.9%
Healthy Connections SEN Project
Racial composition cont
• Hispanic of any race 4.5%
• Hispanic other 2.2%
Healthy Connections SEN Project
Objectives:1. Collaborate with 10 maternal and child
serving agencies2. Develop procedures for identification and
referral in obstetrics prenatal, Labor and Delivery, and pediatrics
3. 60% of participating infants will receive needed development and social/emotional services
Healthy Connections SEN Project
Objectives cont.
4. 75% of participating parents will complete Individual Family Service Plan goals.
Healthy Connections SEN Project
Project Activities
• Development of policies and procedures
• Training of health care professionals and child protective workers
Healthy Connections SEN Project
Services for substance using parents
• Assessment
• Education
• Case management
• Parenting Classes
• Infant-parent psychotherapy
Healthy Connections SEN Project
Target population
• Newborns receiving primary care SVMMC FCC
• SVMMC Labor and Delivery
A Helping Hand: Mother to Mother
The Massachusetts SEN Project
John A. Lippitt, Ph.D.Project Director, Department of Public Health
617-624-6017 [email protected]
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
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
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
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
A Helping Hand: Mother to Mother
• Coordinated services through cross-agency collaboration
• Monthly Implementation Team meetings to oversee and coordinate local AHH activities
• Statewide Steering Committee meets every other month
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
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
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
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
A Helping Hand: Mother to Mother
Keys to Identification
• Birthing hospitals and other health care and early childhood service providers
• Identify best practices for SEN identification and response
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
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
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
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
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
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
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)
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
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
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
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
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
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