St. Vincent Mercy Medical Center Healthy Connections SEN Project Celeste Smith, MA, FLE Program...

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

• What does CAPTA mean?

Background on CAPTA

• Keeping Children and Families Safe Act 2003 Child Abuse Prevention and

Treatment Act (CAPTA)


• 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.


Goal: to increase the compliance with CAPTA requirements in order to maximize child and family social,

emotional and developmental outcomes.


Demographics

• Suburban/urban county

• Population approx. 455,055 and 313’620 live in the city


Racial composition

• White 77.5%

• African American 17.0%

• Native American 0.3%

• Asian 1.2%

• Other 1.9%


Racial composition cont

• Hispanic of any race 4.5%

• Hispanic other 2.2%


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


Objectives cont.

4. 75% of participating parents will complete Individual Family Service Plan goals.


Project Activities

• Development of policies and procedures

• Training of health care professionals and child protective workers


Services for substance using parents

• Assessment

• Education

• Case management

• Parenting Classes

• Infant-parent psychotherapy


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]


• 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


• 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


• 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


• 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


• Coordinated services through cross-agency collaboration

• Monthly Implementation Team meetings to oversee and coordinate local AHH activities

• Statewide Steering Committee meets every other month


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


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


• 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


• 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


Keys to Identification

• Birthing hospitals and other health care and early childhood service providers

• Identify best practices for SEN identification and response


• 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


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


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


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


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


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)


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


COLLABORATION (continued)

• Develop shared language; define key terms

• Establish two-way information sharing among the partners

• Share policies and procedures across agencies


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


IMPLEMENTATION• Identify or develop a champion at

each agency

• Get buy-in at multiple levels• Work to consistently implement

policies and procedures


IMPLEMENTATION (continued)• Ensure that services that mothers,

babies, and families need are available and accessible

• Know and address legal issues in your state


IMPLEMENTATION (continued)

• Engagement of these mothers and families is often a challenge

• Peer worker model has important strengths in building relationship and trust


• 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

St. Vincent Mercy Medical Center Healthy Connections SEN Project Celeste Smith, MA, FLE Program...

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