Neonatal Abstinence Syndrome & Renewal House: Improving Outcomes Utilizing a Family-Centered Continuum of Care CAPTA

1. Neonatal Abstinence Syndrome & Renewal House: Improving Outcomes Utilizing a Family-Centered Continuum of Care CAPTASA Conference – January 2014

2. Disclosures I have no relevant financial disclosures

4. Drug Dependent Newborns(Neonatal Abstinence Syndrome)November Update (Data through 11/30/2013)

5. 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).

6. Additional Detail for Maternal Sources of Exposure

7. Maternal Source of Exposure

8. 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

9. Percentage of Newborns in DCS Custody within One Year of Birth, CY 2010

11. Long-Term Consequences of NAS • At risk for: • Attention deficit Disorder • Hyperactivity • Difficulty transitioning between tasks • Impulse-control • Sleep disorders • Sensory disorders • Future risk of addictive behavior

12. Laura Berlind, CEO Mary Beth Heaney-Garate, LCSW

13. 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.

14. 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

15. 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 Abuse Complex, interlocking needs that require an integrated, multisystem approach

16. ACE Study

17. Mental Health Care Services: Individual & Group Counseling Psychiatric Evaluation Medication Management Family Therapy Dialectical Behavior Therapy (DBT) Mental Health Education Recovery Housing: Transitional Supportive Housing Permanent 2-Bedroom Apartments Community Meetings Women’s Licensed Treatment (IOP) & Pregnant & Postpartum IOP: Co-Occurring Capable & Trauma-Informed Drug & Alcohol Abuse Education Relapse Prevention Parenting Domestic Violence Relationships & Self-Esteem Spirituality Family & Children’s Early Intervention & Prevention Program: Substance Abuse Prevention Child Abuse Prevention Developmental Assessments Children’s Case Management Communication & Social Skills Resiliency Skills Individual Therapy Individual & Group Parenting Celebrating Families! Children’s Mental Health Services Parent-Child Interaction Therapy Al’s Pals Case Management Services: Community Resources Transportation Aftercare + 6 Months Support in Permanent Housing Life Skills & Vocation Support Services: GED Preparation Job Search & Interview Preparation Budgeting & Finance Cooking & Nutrition Organization Skills Wellness Recover Action Plan (WRAP) Admissions, Outreach, & Consulting: Training & Education Screening & Assessment Case Consultation Community Engagement Co-located Staff with DCS – Davidson Cty Co-located Staff with DCS – 11 Surrounding Counties Peer Support & Recovery Community Connection: 12-Step Meetings Certified Peer Coaching & Mentoring Alumnae Association

18. 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.

19. 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

20. 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

21. Targeted Gains Sobriety & 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

22. Targeted Gains (con’t) Improving Mother-Child Attachment 100% of mothers receive evidence-based parenting curriculum Children leave with improved developmental assets Improved family function Reducing Adverse Childhood Experiences (ACE) Sober parent Family reunification – closed DCS cases Safe & stable home environment Closed legal cases

23. Family Residential Program2013 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

24. Outpatient Treatment Program – 2013 Gains 98% Prepared Individualized Treatment Plans 73% Achieved 30 Consecutive Days Sober 53% Completed Treatment

25. Memorial FoundationASI Study

26. 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.

27. 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)

28. Hope, Resiliency & Continued Recovery

29. 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