St. Vincent Mercy Medical Center

St. Vincent Mercy Medical Center

Healthy Connections SEN Project

Celeste Smith, MA, FLE

Program Coordinator, SVMMC Healthy Connections Program

419-251-2459 Celeste_Smith@mhsnr.org

Background on CAPTA

• What does CAPTA mean?

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 john.lippitt@state.ma.us

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

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