Listen to Women The Peer Healthy Start Program Dixie Morgese, CAP, ICADC Helena Girouard, Pritzker Fellow
Learning Objectives • Understand the nature and scope of substance use disorder among pregnant and parenting women. • Identify two changes to the CAPTA Act related to Plans of Safe Care for Pregnant Women and Infants • Understand the value of the parent story when developing engagement strategies
A Mother’s Journey The power of the narrative.
Somebody said, “You’ve got potential”
Working With Peers 19
Peer Recovery Specialists • Certified through the Florida Certification Board • Lived experience with substance use and recovery • Utilize models such as SMART Recovery, SBIRT, WRAP, and available 12 Step networks • Inform the work of the Healthy Start program • Participate in Plans of Safe Care • Provide training to Healthy Start staff, DCF, Community Based Care, Judiciary, and others.
Four Types of Peer Support 1. Emotional - peer specialists demonstrating empathy and compassion while remaining honest, and non-judgmental. Informational 2. Informational -support sharing knowledge, information, and at times providing instruction on various topics 3. Affiliation - facilitate learning of social skills, build community, and give a person a sense of belonging 4. Instrumental - giving concrete assistance to help accomplish tasks such as providing transportation to access a community or social service 21 Image from Bing.com Creative Commons use allowance
Parent Partners • Lived experience in the child dependency system • At least 12 months recovery • Policies to support boundaries • Reflective Supervision and Practice • Develops relationships with providers • Trains Case Management and DCF Child Dependency staff • Informs the work – policy, workforce development, practice, consumer families • Networking in the workplace
Parent Partner Program • Modeled after the Iowa Parent Partner Program • Parents with lived experience support parents who have an open judicial dependency case • Uses reflective practice to improve family-worker relationships • Coordinates a Family Engagement Advisory Board to inform the work and the program • Uses Protective Factors as a framework for Family Engagement • Uses Reflective Practice as a quality improvement tool • Funded by Community Partnership for Children in Circuit 7
Recruiting Peers works best when… • Relationships are real and developed with the organization. • There is a training program that allows peers to “experiment” with using their new found skill in safe and supportive surroundings. • There is an onboarding process that allows time to learn the environment, processes, and expectations. • Challenges are addressed early and specifically. • Performance improvement is a journey that is not punitive or intimidating. • There is a path toward upward mobility in the organization. 24
Key Issues, Trends, and Policies • Peers help us understand what we are dealing with. • Their experience has informed a deeper appreciation for the nature and scope of substance use disorder during pregnancy. • New laws provide opportunities for us to explore their important role
Florida • 2005 - 2016 an escalating trend of narcotics use began to emerge – specific areas show extremely high rates. Increase of 1147% 18.7 per 1,000 live births. • Aggressive state and municipality action resulted in reduction of Pill Mill activities and more regulation through pharmacies and licensed facilities. • Use of heroin is increasing. • Increased pregnant women addicted to opiates or opioid managed. • Contributing to child maltreatment and NICU admissions. • Policies related to Medicaid and child dependency creates challenges.
Key Issues • Significant increase in number of pregnant women addicted to prescription drugs since 2005. • Systems may not know how to respond to trauma and “self-medicating” as a coping mechanism. • Medication Assisted Treatment (MAT vs. illicit use) may still contribute to safety concerns for babies. • High number of child removal rates associated with Parental Substance Abuse (over 50%). • Post partum depression and pain management needs contribute to potential risk for relapse. • Multiple systems of care need to be coordinated to “wrap around.” • Policies may be misaligned across some disciplines.
Terms • CAPTA –Child Abuse Prevention and Treatment Act – Keeping Children and Families Safe Act reauthorized CAPTA and provides requirement for hospitals to report substance exposed newborns to child welfare. • CARA - Comprehensive Addiction and Recovery Act of 2016 – resulted in additional language associated with Plans of Safe Care • MAT – Medication Assisted Treatment – use of medication as a harm reduction strategy for people with substance use disorders that put them at significant risk for negative health outcomes including sepsis, Hepatitis B & C, HIV, staff infection/MRSA, overdose and suicide.
Terms • Buprenorphine – Buprenorphine is a semisynthetic opioid derivative of thebaine. It is a mixed partial agonist opioid receptor modulator that is used to treat opioid addiction in higher dosages, to control moderate acute pain in non-opioid-tolerant individuals in lower dosages and to control moderate chronic pain in even smaller doses. (Subutex, Buprenex, Temgesic, Cizdol, Norspan, Butrans) • State Regulation/Self Regulation – ability to adapt to external stimulation. • Protective Factors Framework – risk mitigation that includes specific factors to include resiliency, social connections, social and emotional competence, knowledge of child development, nurturing and attachment, practical support.
Neonatal Abstinence Syndrome • Neonatal Abstinence – term given to the condition of an infant under one month of age born to a drug affected mother – withdrawal • Withdrawal – set of symptoms as the body attempts to remove an addictive substance • Kindling – adverse impact of repeated withdrawal during pregnancy. • Must be accurately assessed • May be controlled by using therapeutic measures and often medication
Significant Increase in Infants with NAS in Florida 2005 - 2016 Agency for Health Care Administration Diagnostic Codes for Infants born in Florida from 2005 to 2016 4500 4000 3500 3000 2500 2000 1500 1000 500 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 ICD-9-CM779.5 ICD-CM-760.72 ICD-9-CM779.52 ALL
CD CDC C researchers fou ound that during 2008 2008–2012, 2012, on on average, 28% 28% of of wom omen aged 15 15-44 44 ye years with privat ate health insurance and 39% of women enrolled in Medicaid filled a pr prescrip iptio ion n writ itten n by a a he healt althc hcar are pr provide ider for an an opio pioid id me medic dicatio ion. n. CDC’s Morbidity and Mortality Weekly Report
Primary Changes in CAPTA/CARA 1. Further clarified population to “born with and affected by substance abuse, withdrawal symptoms or Fetal Alcohol Spectrum Disorder, specifically removing “illegal” 2. Required Plan of Safe Care to include needs of both infant and family or caregiver 3. Specified data to be reported by States 4. Specified increased monitoring and oversight for States to ensure that Plans of Safe Care are implemented and that families have access to appropriate services
Peers Assist With Developing a Plan of Safe Care • Identify immediate stressors and coping capability – “I remember when I was going home with my baby…” “What are your plans for keeping your baby happy and safe?” • Use Motivational Interviewing Techniques – What are some of the good things about the way you have been doing things lately? Tell me about… • Coordinate with other partners – multi-sector collaboration • Identify support systems/respite/child care – knowing what kinds of challenges may lay ahead • Environmental Safety – housing stability/safety • Considering the following as immediate needs are addressed: ¡ Family Planning ¡ Communication ¡ Partner Coercion ¡ Transportation
Elements for Consideration 1. History – substance use, mental health, physical health, previous verified maltreatment 2. Medical Concerns – infant, mother, other children in the home 3. Caregiver Efficacy – any and all caregivers ability to care for unique needs of infant 4. Living Arrangements – environmental safety and stability 5. Supports and Protective Factors – address factors in framework 6. Partner – relapse rate for women with partners of PWID
Peer Accountability • Clear job description and supporting policies • Onboarding to orient peer workforce to workplace expectations and processes for handling challenges. • Supervision that occurs regularly, reflectively and balances wellness and self care with responsibilities and requirements. • Helping peers understand accountability of persons receiving services. • Establishing “second chance” considerations for relapse and planning with employees for differentiating the employer role from therapeutic role. 36
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