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: info@renewalhouse.org

Website: www.renewalhouse.org

Tel: (615) 255-5222