St. Vincent Mercy Medical Center

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St. Vincent Mercy Medical Center

• Healthy Connections SEN Project
• Celeste Smith, MA, FLE
• Program Coordinator, SVMMC Healthy Connections
  Program
• 419-251-2459 Celeste_Smith_at_mhsnr.org

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Background on CAPTA

• What does CAPTA mean?

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Background on CAPTA

• Keeping Children and Families Safe Act 2003 Child
  Abuse Prevention and Treatment Act (CAPTA)

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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.

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Healthy Connections SEN Project

• Goal to increase the compliance with CAPTA
  requirements in order to maximize child and
  family social, emotional and developmental
  outcomes.

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Healthy Connections SEN Project

• Demographics
• Suburban/urban county
• Population approx. 455,055 and 313620 live in
  the city

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Healthy Connections SEN Project

• Racial composition
• White 77.5
• African American 17.0
• Native American 0.3
• Asian 1.2
• Other 1.9

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Healthy Connections SEN Project

• Racial composition cont
• Hispanic of any race 4.5
• Hispanic other 2.2

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Healthy Connections SEN Project

• Objectives
• Collaborate with 10 maternal and child serving
  agencies
• Develop procedures for identification and
  referral in obstetrics prenatal, Labor and
  Delivery, and pediatrics
• 60 of participating infants will receive needed
  development and social/emotional services

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Healthy Connections SEN Project

• Objectives cont.
• 4. 75 of participating parents will complete
  Individual Family Service Plan goals.

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Healthy Connections SEN Project

• Project Activities
• Development of policies and procedures
• Training of health care professionals and child
  protective workers

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Healthy Connections SEN Project

• Services for substance using parents
• Assessment
• Education
• Case management
• Parenting Classes
• Infant-parent psychotherapy

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Healthy Connections SEN Project

• Target population
• Newborns receiving primary care SVMMC FCC
• SVMMC Labor and Delivery

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A Helping Hand Mother to Mother
The Massachusetts SEN Project John A. Lippitt,
Ph.D. Project Director, Department of Public
Health 617-624-6017 john.lippitt_at_state.ma.us

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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 1,8002,300,
  fully loaded
• Client comments

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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)

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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

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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

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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

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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

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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

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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

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Four Substance Exposed Newborn Demonstration
Projects

• Ambitious and complex projects
• Work to build collaboration among service systems
  using a variety of approaches
• Goal is enhanced safety and well-being for
  substance exposed newborns, their mothers and
  families