1 / 42

Collaborative Interventions for Newborns and Parents Affected by Substance Abuse

Collaborative Interventions for Newborns and Parents Affected by Substance Abuse. Jean Twomey, Ph.D. Brown Center for the Study of Children at Risk Brown Alpert Medical School. Abandoned Infants Assistance Resource Center National Center on Substance Abuse & Child Welfare

hasad
Download Presentation

Collaborative Interventions for Newborns and Parents Affected by Substance Abuse

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Collaborative Interventions for Newborns and Parents Affected by Substance Abuse Jean Twomey, Ph.D. Brown Center for the Study of Children at Risk Brown Alpert Medical School Abandoned Infants Assistance Resource Center National Center on Substance Abuse & Child Welfare Substance Exposed Newborns: Collaborative Approaches to a Complex Issue Old Town Alexandria, VA June 24, 2010

  2. Overview Perinatal substance use & child welfare involvement • How to meet the needs of • Parents • Infants • Social service agencies Collaborative Interventions • Vulnerable Infants Program of Rhode Island (VIP-RI) • Rhode Island Family Treatment Drug Court (RI FTDC)

  3. Perinatal Substance Use and Child Welfare InvolvementParents, Infants, Social Services

  4. Perinatal Substance Use & Child Welfare Involvement • Associated with growing numbers of infants in child welfare system • “Crack epidemic” in 1980s • Substance-exposed infants admitted to foster care rose from 7% (1987) to 29% (1992)(Goerge &Harden, 1993) • Policy & practice about how to safeguard substance-exposed infants vary from state to state • No uniform standards or philosophy on how best to intervene

  5. Substance Use during Pregnancy • Major public health & social problem • 5% of pregnant women use illicit drugs (National Household Survey on Drug Use & Health 2006-2007) • Extent of concern reflected in involvement of multiple social service systems

  6. Current Conceptualizations of Drug Use • Chronic brain disease • Indicator of multiple problem areas • Cannot be treated as a discrete diagnosis • Comprehensive, multidimensional treatment needed • Effective treatment ~ continuing care & monitoring (McLellan, Lewis, O’Brien, Kleber, 2000)

  7. Public Policies Matter • Approaches influenced by public policy & public perception • impact of prenatal exposure • reactions to pregnant substance users • Punitive actions do not advance maternal, fetal or child health interests (Flavin & Paltrow, 2010) • Policies need to promote & reinforce help seeking behaviors

  8. Treatment Works • Evidenced-based research ~ effectiveness of multiple treatment approaches • Mothers more likely to successfully complete treatment when programs recognize importance of parent-child relationship • Help parent to be emotionally responsive & nurturing—not just how to manage child behaviors Focus on mother-infant relationship Collaboration among social service systems Home visitation Residential Motivational interviewing & contingency management

  9. Perinatal Substance Use: Parents • Associated risk factors add to concerns about parenting abilities • Lack of role models for how to be a nurturing parent • Parents can be attached to their babies & not want to lose them even when they are not able to take care of them (Lederman & Osofsky, 2004) Co-occurring psychiatric disorders Domestic violence Lack social supports Trauma Unaddressed medical needs Limited vocational & educational experiences

  10. Barriers to Treatment • Limited availability of programs for pregnant & parenting women • Stigma • Concerns about separation from children • Fears about losing custody • Lack of resources • Insurance, transportation, child care • Addressing basic needs may be priority • Housing, food, transportation, heat

  11. Perinatal Substance Use: Infants • Mandated reporting; ensuring infant safety often leads to out-of-home placement • Longer time in care, less likely to be reunified, more likely to be re-reported • Disruptions in attachment • Increased risk for psychological, developmental, behavioral, physical problems • Stress & trauma associated with separation & loss

  12. Optimizing Outcomes for Infants in Placement • Monitor case closely • Focus on child’s physical & psychological health & development • Ameliorate effects of disruptions in relationships by ensuring consistent, nurturing caregiving • Consider child’s established psychological ties • Reunify or if removal likely to be permanent, act quickly • Frequent contact with parents needed to establish & sustain relationship • Minimize lengthy separations & multiple moves

  13. Pressures Faced by Social Service Agencies • More global expectations • Growing awareness of complex parental needs • Immediate and long-term concerns about substance-exposed infants • Increased accountability • Mandated time frames for permanency • Budget & staff cuts

  14. Importance of How Social Services Agencies Function • Impact treatment & permanency outcomes • Without attention to families’ multiple needs reunification unlikely or, if occurs, unlikely to remain permanent • Complementary approaches that address parent & infant needs

  15. Collaborative Interventions Vulnerable Infants Program of Rhode Island (VIP-RI)

  16. Vulnerable Infants Program of Rhode Island (VIP-RI) • Federal demonstration grant to work with child welfare system & family court to • Secure permanency for substance-exposed infants within Adoption & Safe Families Act (ASFA) guidelines • Optimize parents’ opportunities for reunification • Care coordination program • Improving ways social service systems deliver services and interface will positively impact families

  17. Adoption and Safe Families Act (ASFA) • Purpose~expedite permanency, reduce “foster care drift” • Shift from prioritizing reunifying families in almost all circumstances • Makes health & safety of children a priority • Permanency hearings within 12 months of foster care placement • Termination of parental rights if in foster care 15 of prior 22 months • Mandates concurrent permanency planning

  18. Overview of VIP-RI • Criteria for participation • Involvement in child welfare because of substance use during pregnancy • Referrals • Majority from maternity hospital • Community agencies, self-referral • Available to partners • Infants followed until permanency • When reunification not feasible, work with parents to relinquish parental rights

  19. VIP-RI: Care Coordination • Engages parents early • Identifies parent & infant needs • Established partnerships with agencies ensure • Parents/infants get appropriate services • Minimizes time on waiting lists • Are given consistent messages • Everyone is a stakeholder in infant’s permanent placement • Increase communication among social service agencies • Attend court hearings, provide input, monitor progress until permanency

  20. VIP-RI: The First 4 Years(Twomey, Caldwell, Soave, Fontaine, & Lester, in press) • Maternal Demographics • Ages ranged from 17 to 43 (N = 195) • 89% single • Education • 61% high school graduates or equivalent • 37% less than high school • Infant Demographics • 55% male (N = 203) • 72% full-term

  21. Placement Outcomes • At discharge from VIP-RI significantly greater percentage of infants placed with biological parent • 56% at discharge vs. 32% at enrollment • No change in placement for 43% of infants following hospital discharge • 44% remained with a biological parent • 22% remained with family member • By 12 months, identified permanent placements for 84% of infants

  22. LessonsLearned from VIP-RI • Intervene early • Maximize parents’ opportunities to engage in services • Instill hope • Connect families to services matched to their identified needs • Provide ongoing support • Coordinate with all social service providers to increase collaboration

  23. Collaborative Interventions Rhode Island Family Treatment Drug Court(RI-FTDC)

  24. Rhode Island Family Treatment Drug Court (RI FTDC) • Grew out of partnership with VIP-RI • Established in September 2002 • Specifically for perinatal substance users • Primary purposes: • Permanency within ASFA time frames • Optimize potential for parents to reunify

  25. Family Treatment Drug Court • Interactive, therapeutic approach • More informed judicial decisions regarding child placement and permanency • Coordinates provision of services • Intensive case monitoring • Frequent court reviews • Hearings less frequent as participant progresses • Incentives & sanctions

  26. Comparison of RI FTDC & Standard Court Outcomes • VIP-RI participants enrolled in RI-FTDC (N = 79) & standard family court (N = 58) • Cohorts were comparable • Time to initial reunification significantly quicker for RI-FTDC participants • Within 1st 3 months, reunification for RI-FTDC participants was (73%) compared to standard family court (39%) 

  27. Average Time to First Reunification With Mother 100 90 RI-FTDC 80 Standard Family Court 70 60 50 Percent Reunified 40 30 20 10 0 - 3 4 - 6 7 - 9 10 - 12 13 - 15 16 - 18 19 - 21 22 - 24 Months to Reunification

  28. Longitudinal Outcomes of RI FTDC Participants(Twomey, Miller Loncar, Hinckley & Lester, under review) • 54 substance-exposed infants whose mothers participated in RI FTDC • Assessments done at 6 month intervals between 12 to 30 months of age • Permanent placements for substance-exposed infants • Infantdevelopmental outcomes • Functioning of mothers after RI FTDC involvement

  29. Maternal Outcomes: Measures 12 & 24 Months • Substance Abuse Subtle Screening Inventory (SASSI) • Identifies potential for substance dependence • Brief Symptom Inventory (BSI) • Identifies psychological symptom patterns • Adult-Adolescent Parenting Inventory (AAPI-2) • Identifies high-risk parenting & child rearing attitudes 12 & 30 Months • Child Abuse Potential Inventory (CAPI) • Assesses risk for child abuse • Parenting Stress Index (PSI) • Measures level of parental stress that may adversely affect parenting

  30. Infant Outcomes: Measures 18 & 30 Months • Child Behavior Checklist (CBCL)-Ages 1½-5 • Identifies problem behaviors 30 Months • Attachment Q-sort • Assesses attachment • Child Bayley Scales of Infant Development - 3rd ed • Measures cognitive abilities • Developmental Indicators for the Assessment of Learning – Revised (DIAL-R) • Measures motor, conceptual & language skills

  31. RI FTDC Study: Maternal & Infant Demographics • Maternal Demographics • Ages ranged from 19 to 45 (N = 52) • 89% not married • Education • 40% high school graduates or equivalent • 20% some post secondary education, but no college degrees • Infant Demographics • 56% male (N = 54) • 74% full-term

  32. Permanency Outcomes • At 30 months: • 90% of infants living in homes identified as permanent placement • 79% (N = 48) reunified with biological mother

  33. Infant Attachment • Q-Sort ~ compares attachment behaviors of sample to Secure Ideal Prototype • Q-Sort ~ attachment score is derived for each child • Attachment score per child is correlated with Secure Ideal Prototype • Correlation range of -1.00 to 1.00 • Higher correlations indicative that child is similar to Secure Ideal Prototype Attachment Q-Sort attachment scores of ASFA sample is comparable to the SecureIdealPrototype of a clinical sample correlations Only 41% of study sample is comparable to the Secure Ideal Prototype of a non-clinical sample r=.32 r=.20 r=.21

  34. Infant Outcomes - 18 & 30 Months: Behavior Problems (CBCL) Higher score = greater presence and severity of symptoms 50 = mean 60- 63 = borderline clinical range >63 = clinical range

  35. Infant Outcomes - 30 Months: Cognition (Bayley) 89.0 (8.71) 100 (15) 91.98 (12.81) 100 (15)

  36. Infant Outcomes - 30 Months: Motor, Conceptual & Language (DIAL-R)

  37. Summary of Developmental Findings • Most infants not exhibiting behavioral problems or cognitive delays • Possible areas of concern • Attachment may be affected by even minimal disruptions in placement • 22% of Bayley language composite scores fall below the clinical cutoff • DIAL-R results provide a comparison of how child outcomes can be interpreted when different standards are applied to assess potential problem areas • Whether or not these findings are indicators of incipient difficulties in learning or infant-caregiver relationships depends on many factor • appropriate developmental stimulation, adequate resources, nurturing homes that remain constant, maternal functioning

  38. Maternal Outcomes • 81% of mothers graduated from RI FTDC • 7% of graduates relapsed • Mothers who did not graduate significantly more likely to relapse • SASSI: Probability of substance dependence disorder increased at 24 months • BSI: Psychiatric symptoms increased at 24 months

  39. Maternal Outcomes • AAPI-2High-risk parenting attitudes changes between 12 and 24 months • Worsened in 2 out of 5 domains • inappropriate expectations • restricts power & independence • Improved in 1 out of 5 domains • role reversal • CAPI Risk for child maltreatment closer to sample with abuse history • PSI Parenting stress increased between 12 & 30 months

  40. Importance of Ongoing Collaboration • Even with positive permanency outcomes chronic issues are not easily resolved • Conceptualize permanency as an ongoing state • normalize interventions for families who would benefit from periodic or more intensive attention & support • Recognize changing family circumstances • when mothers move away from supportive services • as infant needs evolve into the needs of toddlers and preschoolers

  41. Power of Collaboration • Collaboration benefits families and the social service systems that work with them by increasing efficacy and more positive outcomes • Ongoing access to treatment needed to • promote adaptive parental functioning • prevent re-entry into the child welfare system • maintain placement stability • optimize infant developmental outcomes • Benefits of cross-fertilization ~ broaden perspectives in ways that better meet needs of families affected by perinatal substance use

  42. Funding Sources • VIP-RI was supported by grants from • Children’s Bureau & Abandoned Infants Assistance • Robert Wood Johnson Foundation, Center for Substance Abuse Treatment • After ASFA: Outcome of the RI-FTDC was supported by • Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program Collaborators RI FTDC Study Barry Lester Cynthia Miller Loncar Suzy Barcelos Winchester Matthew Hinckley VIP-RI Barry Lester Rosemary Soave Lynne Andreozzi Fontaine Donna Caldwell

More Related