Common Goals, Uncommon Solutions: Innovative Collaborations to Prevent and Improve Outcomes For...

Common Goals, Uncommon Solutions: Innovative Collaborations to Prevent and Improve Outcomes For Substance Exposed Newborns

Rebecca Barnett (UT) and Martha Kurgans (VA)

Substance Exposed Newborns: Collaborative Approaches to a Complex Problem

The Crowne Plaza, Old Town Alexandria, Virginia

June 23-24, 2010

NASADADNASADAD represents the nation’s State Substance Abuse Agency Directors, also known as SSAs.

Mission - to promote effective & efficient State substance abuse service systems.

Women’s Services Network (WSN)

“Dedicated to the development and promotion of evidence-based practice that addresses the unique alcohol and other drug prevention, treatment, and recovery service needs of women and their families throughout their lifespan.”

WSN, Cont’d Women’s treatment coordinators from every State

Designated SSA staff member

WSN works to: Expand & improve publicly-funded treatment/ prevention

systems & services;

Facilitate collaboration w/ other State agencies that serve

women & their families; and

Collaborate with CSAT & other federal stakeholders

AccomplishmentsGuidance to States: Treatment

Standards for Women With Substance Use Disorders - Suggested standards for women’s SUD treatment Available on NASADAD/WSN & SAMHSA TIE

websites

Home Pregnancy Test Kit Manufacturer Letter Writing CampaignHome pregnancy test kits should warn about the

risks of using alcoholPositive feedback from NCADD, NoFAS, Governor

of NC, others

WSN and SEN: A Priority2009 Goals:

Educating communities about the vulnerabilities of pregnant women who use substances; and the importance of easily accessible, evidence-based treatment; and,

Increasing knowledge about FASD.

Pregnant and Parenting Committee - Educate policymakers/legislators regarding substance use during pregnancy

Conference calls with experts, SAMHSA’s FASD Center of Excellence

SEN and the SSA ~ 222,000 children are exposed to illicit

substances in utero and over 1 million to illicit drugs and alcohol each year. --National Abandoned Infant Association

(AIA) (April 2008)

Federal Requirements: Substance Abuse Prevention and Treatment (SAPT)

Block Grant Requirement: all States must provide therapeutic services to children whose mothers enroll in SUD treatment

Child Abuse Prevention and Treatment Act (CAPTA) requirement: States must have policies/ procedures in place to notify CPS of substance-exposed newborns & to establish a plan of safe care In many States, includes a referral to SUD treatment

Caring for SEN requires interagency collaboration! But, which partners? What services?

Which Services? In SAPT BG Application, States describe how

they make therapeutic services available to children whose mothers enter SUD treatment 50 States – providers must ensure that children

receive pediatric care, immunizations

22 States – providers must assess children’s mental health/development

21 States – providers must deliver prevention & early intervention services to children

15 States – providers must deliver FASD services

All services delivered directly, or by referral

What Collaborations?Questions sent to WSN listserv, received

26 responses

24/26 States - require providers to ask clients about dependent children

Collaborations which involve the WSN: FASD Task Force (15 States)

Maternal & child health networks emphasizing prenatal screening (9 States)

Early learning councils created by federal stimulus funding (3 States)

Regional Centers, Part C (2 States)

13 States identified being involved in other networks that coordinate services on behalf of children.

Utah Perinatal & Drug Endangered

Children Initiatives

Becky Barnett, LCSWProgram Manager

Utah State Division of Substance Abuse & Mental Health

Substance Exposed Newborns: Collaborative Approaches to a Complex Issue June 23-24, 2010

The Crowne Plaza, Old Town Alexandria, VA

Presentation Summary

Utah State Division of Substance Abuse & Mental Health

Statewide Treatment and Prevention Resources Statewide Coalitions Engaging in Perinatal and Drug

Endangered Children Initiatives: Utah Substance Abuse Advisory Council (USAAV) Drug

Exposed Newborns Committee Utah Legislation on Perinatal Issues Research Studies on Fetal Exposure to Drugs and Alcohol South Main Clinic

Utah Fetal Alcohol Coalition Utah Alliance for Drug Endangered Children

Utah State Division of Substance Abuse and Mental Health (DSAMH)

QUALITYQuality services, programs and systems

promote individual and community wellness.

Identify and promote best practices. Consumers and families are involved in treatment

decisions. Deliver a competent educated workforce. Access to services that are individual specific. Systems are responsive to changing needs. PARTNERSHIP

Partnerships with consumers, families, providers and local/state authorities are strong.

Shared problem solving. Increased consumer and family Involvement. Engage the local authorities in critical issues and

discussions. Strong relationships with local and private

providers. Address Utah issues at the national level.

ACCOUNTABILITYAccountability in services and systems that

is performance focused and fiscally responsible.

Data collection and submission are complete, accurate and timely.

Outcomes are measurable and meaningful. Financial reports are clear, informative and timely. Establish openness and trust with all stakeholders. Monitoring practices are justified and performance-

oriented.

EDUCATIONEducation enhances understanding of prevention and treatment of substance

abuse and mental health disorders.

Improve public awareness of substance abuse and mental health issues and needs.

Reduce stigma and normalize services for people with substance abuse and mental health issues.

Provide training and technical assistance. Disseminate new research and strategies in

prevention and treatment.

LEADERSHIPLeadership understands and meets

the needs of consumers and families.

Create an atmosphere of dignity and respect. Proactive and responsive leaders that are action-

oriented. Visible presence throughout the system. Open to feedback with commitment to follow-up. Foster creative programming and resource

development.

Revised: February 20, 2006

DSAMH OversightTreatment and Prevention Resources

Utah Division of Substance Abuse and Mental Health -Single State Authority 11 Combined Community Substance Abuse and Mental

Health Centers (Salt Lake, Weber, Davis, Heber, Tooele, Summit, Northeastern, Central, San Juan, Southwest, Four Corners)

2 Community Mental Health Centers (Bear River, Wasatch)

2 Community Substance Abuse Centers (Bear River, Utah County)

Utah State Hospital Statewide Substance Abuse/Mental Health Treatment

and Prevention Resources can be located at: http://www.dsamh.utah.gov/

Utah Local Area Map

Utah State Division of Substance Abuse and Mental Health

Agency Contact

Becky Barnett, LCSW, Program Manager

Utah State Division of Substance Abuse & Mental Health (DSAMH)195 North 1950 WestSalt Lake City, Utah 84116Phone: (801) 538-4278Fax: (801) 538-9892E-mail: [email protected]: www.dsamh.utah.gov

Utah Substance Abuse Advisory Council (USAAV)

Structure of Organization

Governor’s Office Utah Commission on Criminal and Juvenile

Justice USAAV Executive Committee


USAAV Executive Committee

Justice Committee DUI Committee UPAC Executive & Prevention Committee Treatment Committee Public Health Committee DORA Oversight Committee Drug-Exposed Newborns Committee


Council Objectives

Provide leadership and generate unity for Utah’s ongoing efforts to combat substance abuse

Recommend and coordinate the creation, dissemination, and implementation of a statewide substance abuse policy

Facilitate planning for a balanced continuum of substance abuse prevention, treatment and justice services

Provide direction for the public education and outreach program to inform women of the risk of using harmful substances during pregnancy


Agency Contact

Mary Lou Emerson, Director

Utah Substance Abuse Advisory Council (USAAV)Commission on Criminal and Juvenile JusticeUtah State Capitol Complex, Senate Building, Suite 330P.O. Box 142330Salt Lake City, Utah 84114-2330Phone: (801) 538-1921E-mail: [email protected]

USAAV Drug-Exposed Newborns Committee

Committee Leadership

Lisa-Michele Church, Co-Chair, Executive Director – Utah Department of Human

Services

Karen Buchi, M.D., Co-Chair Professor of Pediatrics – University of Utah

USAAV Drug-Exposed Newborns Committee Goals

Comment on proposed legislation on drug-exposed newborns issue

Develop a DCFS practice that is consistent statewide on dealing with substance abusing mothers

Develop best practice document regarding substance abusing mothers for hospitals and medical providers

USAAV Drug-Exposed Newborns Committee Goals

Develop training for prosecutors and judges through court improvement that addresses the unique issues presented by substance abusing mothers

Issues include: When to drug test Consent vs. Non-Consent Criminalizing vs. Treatment

USAAV Drug-Exposed Newborns Committee Members

Wasatch County Council Division of Substance Abuse & Mental Health Division of Child & Family Services Utah Department of Health Cornerstone Counseling Center Salt Lake County Behavioral Services Utah Juvenile Court Utah Addition Center Discovery House Planned Parenthood Action Council Utah Attorney General’s Office Utah Council for Crime Prevention U.S. Drug Enforcement Administration Salt Lake City Police Department Statewide Association of Prosecutors Utah Department of Human Services Division of Juvenile Justice Services

Drug Exposed Newborns Committee

Committee Contact

Elizabeth Sollis, Public Information Officer

Department of Human Services195 North 1950 WestSalt Lake City, Utah 84116Phone: (801) 538-3991E-mail: [email protected]: http://dhs.state.ut.us/

Substance Abuse Treatment for Pregnant Women & Pregnant Minors

House Bill 316 (Now Statute)

Chief Sponsor: Eric K. Hutchings Requires local substance abuse authorities to ensure

that all substance abuse treatment programs (that receive public funds) provide pregnant women and pregnant minors:

Priority admission into treatment A comprehensive referral for interim services if

treatment is not available within 24 hours If treatment programs are unable to admit a pregnant

woman or minor within 48 hours, providers are to contact the DSAMH for assistance

Education and Outreach Regarding Substances Harmful During Pregnancy

House Bill 38 (Now Statute)

Chief Sponsor: Ronda Rudd Menlove Directs the Division of Substance Abuse and Mental

Health within the Department of Human Services to conduct public education and outreach to pregnant women and women who may become pregnant regarding:

The risk of using substances that are harmful during pregnancy

Treatment available to avoid or stop the use or abuse of substances

Legal protections pertaining to receiving treatment services

Amendments Related to Substances Harmful to Pregnancy

House Bill 299 – (Now statute)

Chief Sponsor: Ronda Rudd Menlove Repeals outdated language related to a public

education and outreach program Requires posting of a warning by alcohol

retailers related to the effects of consuming alcohol during pregnancy

Alcohol Warning Sign(House Bill 299)

WARNING

Drinking alcoholic beverages during pregnancy can cause birth defects and permanent brain

damage for the child

Call the Utah Department of Health at 1-800-822-2229 with questions or for more information

Umbilical Cord Research StudyNovember 10, 2005

Testing for Fetal Exposure to Illicit Drug Using Umbilical Cord Tissue vs. Meconium

Journal of Perinatology (2006), 11-14 (2006 Nature Publishing Group) D Montgomery, C Plate, SC Alder, M Jones, RD Christensen Department of Women and Newborns, Intermountain Health Care and

McKay Dee Hospital, Ogden UT, USA The United State Drug Testing Laboratories, Des Plaines, IL, USA The Department of Family and Preventive Medicine, University of Utah, Salt

Lake City, Utah, USA

Address Correspondence To: Robert D. Christensen, MD, Neonatology

Intermountain Healthcare4403 Harrison Blvd, Ogden, UT 84403Phone: (801) 387-4300; Fax: (801) 387-4316E-mail: [email protected]

Umbilical Cord Research Study May 5, 2008

Using Umbilical Cord Tissue to Detect Fetal Exposure to Illicit Drugs: a Multi-Centered Study in Utah and New Jersey

DP Montgomery, CA Plate, M Jones, J Jones R Rios, DK Lambert, N Schumtz, SE Wiedmeier, J Burnett, S Ali, D Brandel G Maichuck, CA Durham, E Henry RD Christensen

Address Correspondence To: Robert D. Christensen, MD, Neonatology

Intermountain Healthcare

4403 Harrison Blvd, Ogden, UT 84403

Phone: (801) 387-4300; Fax: (801) 387-4316

E-mail: [email protected]

McKay-Dee Hospital Center

Umbilical Cord Research Study Contact

Dianne P. Montgomery, APRN Intermountain Healthcare

McKay-Dee Hospital CenterNewborn Intensive Care Unit4401 Harrison Boulevard, Ogden, Utah 84403Phone: (801) 387-4324E-mail: [email protected]:

http://intermountainhealthcare.org/HOSPITALS/MCKAYDEE/SERVICES/Pages/home.aspx

Utah Prenatal Substance Abuse Prevalence Study

Study Objectives (October 28, 2009)

Determine the prevalence and patterns of prenatal substance use among women delivering infants in Utah hospitals

Identify maternal and infant risk factors associated with maternal substance use in urban Utah

Compare these finding to prevalence studies done previously to identify trends in the maternal population in Utah

Utah Prenatal Substance Abuse Prevalence Study

New Umbilical Cord Study

Principal Investigator: Karen F. Buchi, M.D.

Department of Pediatrics Division of General Pediatrics University of Utah

P.O. Box 581289 Salt Lake City, Utah 84158 Phone: (801) 585-6943 E-mail: [email protected]

Co-Investigators: Michael W. Varner, M.D.

Department of Obstetrics & Gynecology, University of Utah Carla Suarez

Division of General Pediatrics, University of Utah Sponsors:

Utah Commission on Criminal and Juvenile Justice Utah Division of Substance Abuse and Mental Health

South Main Clinic

Collaboration between the Salt Lake Valley Health Department and Salt Lake County Behavioral Services

Intended to provide perinatal services (including OB/GYN and Pediatric services) for women who are:

Hard to reach High risk young women who are pregnant with

substance abuse issues and children

South Main Clinic

Primary Project Goal

Encourage women with high risk pregnancies and substance use issues to:

Attend perinatal services early Receive substance abuse treatment services Receive nurse based case management services Receive public health services (WIC, immunizations, etc.)

Project Outcome

Deliver children who are drug free and healthy Encourage women to participate in treatment and recovery

services during pregnancy and after delivery

South Main Clinic Goals

Develop a substance abuse treatment clinic within the Salt Lake Valley Health Department’s South Main Clinic

Develop a model which integrates behavioral health and physical health care into a holistic prenatal clinic

South Main Clinic Goals

Based on the project experience, develop a replicable model which includes: The clinic practice model The collaborative model The financing model which will demonstrate

the long term benefits of this project

Use this model to secure funding from the state legislature

South Main Clinic Oversight

Michelle Moyes (LPC) provides therapeutic home based services to women at the South Main Clinic:

Monitors 28 women, either through their pregnancy or after the birth of their children

Provides individual therapy to 8 women

South Main Clinic

Program Contact

Michelle Moyes, LPC

Salt Lake County Behavioral Services2001 South State StreetSalt Lake City, Utah 84190Phone: (801) 856-0046E-mail: [email protected]: http://www.substanceabuse.slco.org/

Utah State Fetal Alcohol Coalition Initiatives

Alcohol Tobacco and

Other Drug Activities (ATOD)

Creation of a Brochure for At-Risk Groups

Includes information on: Fetal effects from alcohol, tobacco and other drugs Confidentiality and priority status for women to enter

treatment facilities, including safety from prosecution if women are actively seeking treatment

Creation of an Electronic Survey, Focus Groups and Interviews with Key Informants

Zoomerang Survey developed resources for health care providers who provide services for women of reproductive age

Key informant interviews with: Ob-Gyn Nurses Women of child bearing age State Health, Substance Abuse and Mental Health

Providers

“Talk About It” Agency Challenge

State and County Agency Directors challenged employees to share ATOD

brochures with other individuals

“Stall Talk” Project

Stickers were placed in public restrooms (for men and women) where liquor was

served and sold

“Alcohol and Pregnancy Don’t Mix”

The materials were tested with a target group A media campaign was developed with Baby

Your Baby regarding concerns for alcohol, tobacco and other drugs used in pregnancy

Liquor Bag Message

A message that “Alcohol and Pregnancy Don’t Mix” were placed on store liquor

bags distributed throughout Utah

Educational cards were placed on the liquor store counter

Materials are available in English and Spanish

Fetal Alcohol Awareness Day

Governor Jon M. Huntsman, Jr. signed a proclamation designating September 9th,

2009 as Fetal Alcohol Awareness Day

in the State of Utah

A variety of activities and media events were shared on this day

SAMHSA FASD Center for Excellence:http://www.fascenter.samhsa.gov/links/links.cfm

ATOD Brochures and Posters

Available on the UFAC Website: http://www.utahfetalalcohol.org/resources.html#other-res

“Mothers Who Stop Using Alcohol, Tobacco and Drugs of Abuse at Any Time During Pregnancy Increase the Chance That Their Baby Will Be Born Healthy”

“All Drinks With Alcohol Can Hurt An Unborn Baby” “Alcohol Can Hurt an Unborn Baby” “Going Out with your Friends: GOOD MIX...Drinking if

you think you’re pregnant: BAD MIX” “Alcohol and Pregnancy Don’t Mix” Liquor Bags and

Stickers for Liquor Bottles

Utah Fetal Alcohol Coalition

Agency Contact

Julia Robertson, Program Manager

Chair of the Utah Fetal Alcohol Coalition (UFAC)Utah Department of Health/Pregnancy Riskline44 North Mario Capecchi DriveSalt Lake City, Utah 84114-4682Office Phone: (801) 538-9161Toll Free Number (Pregnancy Riskline): 1-800-822-2229E-mail: [email protected] Website: http://www.utahfetalalcohol.org/Pregnancy Riskline Website: www.pregnancyriskline.org

Utah Alliance for Drug Endangered Children

The Utah Alliance for Drug Endangered Children involves professionals who are addressing the

health risks and psychological needs of children who are exposed to environments where

drugs are manufactured

The ultimate goal is to rescue, defend, shelter, and support Utah’s endangered children.

Website: http://utahdecalliance.org/


Utah Best Practice Guidelines for Medical Evaluation of Children Found in

Drug Exposed Settings

Law Enforcement Recommendations Child Protection Recommendations Medical Recommendations

Form located at: http://utahdecalliance.org/ Click on the following links:

Forms Protocols


Program Contact

Chris Chytraus, RN, BSN, CPM, Program Manager

Utah State Department of HealthFostering Healthy Children44 Medical DriveP.O. Box 144671Salt Lake City, Utah 84114-4671Office: (801) 584-8598E-mail: [email protected]: http://health.utah.gov/

Thank you…

DBHDSVirginia Department of

Behavioral Health andDevelopmental Services

Virginia’s Experience

Virginia’s Collaborative Efforts to Serve Substance Exposed

Newborns

Martha Kurgans LCSW Department of Behavioral

Health and Developmental Services (DBHDS)

Substance Exposed Newborns: Collaborative Approaches to a Complex ProblemThe Crowne Plaza, Old Town Alexandria, Virginia

June 23-24, 2010



Thanks to my Virginia Colleagues

Home Visiting Consortium (HVC)

Catherine Bodkin LCSW Virginia Department of Health (VDH)** Ashley Barton, Department Medical Assistance (DMAS) Ann Childress, Department of Social Services (DSS) Linda Foster, Virginia Department of Health (VDH) Phyllis Mondack, Department of Education (DOE) Lisa Specter, Children’s Health Investment Project (CHIP) of Virginia Vivian Horn, Department of Medical Assistance (DMAS) Mary Ann Discenza, Part C Early Intervention (DBHDS) Johanna Schuchert, Stop Child Abuse Now (SCAN) Martha Kurgans, Department of Behavioral Health and

Developmental Services (DBHDS)


Behavioral Health andDevelopmental Services Thanks to my Virginia Colleagues

Substance Exposed Newborn(SEN) Workgroup

Joan Corder-Mabe (VDH) Linda Foster (VDH) Cathy Bodkin (VDH) Rita Katzman (DSS/CPS) Ashley Barton (DMAS) Molly Clark (DMAS) Karen Durst (Part C) Joe Borzelleca MD , VCU Health Systems Patty Hartigan (Project LINK) Martha Kurgans (DBHDS)**



SEN Efforts in Virginia

• Services for Pregnant and Parenting Women

• Virginia’s Perinatal Legislation

• Substance Exposed Newborn Workgroup

• Perinatal Screening and Brief Intervention

• Home Visiting Consortium (HCV)



VIRGINIA



Virginia:

• 95 counties• 39 independent cities

• State Administered; Locally Controlled 40 Community Service Boards (CSBs) 35 local Departments of Health 120 local Departments of Social Services



VA’s Perinatal SA Services

DBHDS Treatment Oversight• 40 Community Service Boards (CSBs)• 8 Project LINK sites• Perinatal SA residential: 3 programs receive state support• Residential SA services for women with children: 1 program

receives state support

Perinatal Residential Capacity• 5 Virginia programs accept pregnant women but only 4 allow

women to keep their newborns with them in treatment.



Project LINK

• Links women to community resources to provide a continuum of prevention, early intervention & treatment services.

• Provides intensive case management for pregnant, parenting and at risk women. Additional services – including home visiting -vary depending on the community’s needs & resources.

• At start up, each site was required to have an interagency Executive Group, an Implementation Team and Community Network.

• 8 sites serve 14 communities 5 sites implemented at an individual CSB in 1992 1 additional site funded 1999 2 sites serving multiple CSBs funded in 2000



Project LINK sites

• Region Ten CSB (Charlottesville)

• Rappahannock Area CSB (Fredericksburg)

• Hampton Newport News CSB (Hampton Newport News)

• District 19 CSB (Petersburg)

• Blue Ridge Behavioral Health (Roanoke)

• Virginia Beach CSB (Virginia Beach)

• Northern Virginia (Alexandria, Arlington, Fairfax Falls Church, Loudon, Prince William CSBs)

• Cumberland (Cumberland , Dickenson & PD1 CSBS)



Virginia’s Substance Exposed Infant Legislation (1998)

• Code of Virginia §63.2-1509: medical providers must file a report with CPS whenever they suspect a newborn was exposed in utero to alcohol or a controlled substance

• Code of Virginia §32.1-127: hospitals must develop a discharge plan for identified substance using postpartum women and refer them to their community service board (CSB) to implement the plan.

• DBHDS, DSS, VDH, the Board of Medicine and the Office of the Executive Secretary of the Supreme Court were mandated to provide an annual implementation study regarding the legislation in 1999, 2000 and 2001.



Legislative Workgroup’s Findings

• Few women & infants identified.• Misinformation cross systems re: legislation, 42CFR and mandates

governing respective services.• CSB staff had difficulty locating, engaging and retaining

postpartum hospital referrals.• Providers lacked necessary expertise.• Little communication / collaboration within or between systems. • Policies, procedures, expertise, awareness and willingness

address problem varied across Commonwealth.• Collaboration “personality driven”.• Virginia’s locally administered, state supervised social and human

services system posed “challenges” to effecting change.

->



Legislative Workgroup’s Recommendations

• Collect Data regarding substance exposed infants & their mothers

• Interagency collaboration between DSS, VDH and DBHDS

• Specialized training for local DDS (LDSS) workers and interdisciplinary training for professionals working with perinatal substance use

• Interagency protocols/agreements between LDSS, CSBs and hospitals to improve collaboration



Efforts Generated by the Legislative Workgroup

• DBHDS Sponsored discipline specific & interdisciplinary trainings for SA, CPS, & health care providers re: SA, perinatal SA, 42CFR, SE infant legislation, collaboration etc. increased training

• Perinatal Substance Use: Promoting Healthy Outcomes brochure developed by DSS, VDH and DBHDS. 2nd edition

• DBHDS, DSS and Office Executive Secretary of the Supreme Court (OES) submitted joint request for in-depth TA from NASACW to address substance affected families involved with child welfare system

• Substance Exposed Newborn (SEN) Workgroup



Substance Exposed Newborn (SEN) Workgroup

• In 2005, brought health, child welfare, early intervention, Medicaid, SA together to identify how we might improve identification of SEN and services for their moms.

• Chose to develop Perinatal SA screening guidelines formedical providers other providers that serve women in their homes

e.g. Early Intervention, child welfare, home visiting.

• Identified menu of preferred screening tools for pregnant women



Perinatal Screening and Brief Intervention

• 2008: Virginia was one of 10 states to receive approval from federal Medicaid to reimburse providers for substance use screening & brief intervention services.

• DBHDS collaborated with DMAS to identify approved tools. Requested DMAS approve specific tools for use with special populations: pregnant women, adolescents and older adults

• DBHDS requested input from SEN Workgroup and Virginia’s Home Visiting Consortium (HVC) regarding preferred perinatal tools. Also identified an integrated screening tool.

• DMAS unable offer Medicaid reimbursement for time spent screening for MH or IPV - unless provider uses an integrated SA/MH/IPV tool.



Perinatal Screening and Brief Intervention

• DBHDS developed guidance regarding screening and brief intervention for pregnant women

• Perinatal SBI tools and guidance information available at http://www.dbhds.virginia.gov/Screeners.htm

• Plan to link website to Virginia’s Departments of Health, Medical Assistance, Social Services and other stakeholders



Sharing Data

• Working with DSS to gather data regarding outcomes of SEN reports to CPS at delivery. Seeking data regarding the number of reports that were: “not founded” but family received services. “not founded” and family received no services. “founded” and child removed.

Of children removed, how many children were placed• in foster care?• in kinship care?• for adoption?

• Plan to analyze data and identify implications for services



Virginia’s Home Visiting Consortium (HVC)

• Governor's Work Group on Early Childhood Initiatives Need for state government efficacy & effectiveness in difficult

budget times Knowledge regarding infant brain development

• In 2006, brought initiatives together that work with prenatal periods and those that serve child care and schools (2 -5 yrs)

• Sought integrated, non-duplicative, efficient services with documented outcomes

• HVC reports to the Early Learning Advisory Council created in 2009 as required by the federal Head Start Act, replacing the GWG.



Virginia’s Home Visiting Consortium (HVC)

• Includes state supported home visiting programsBaby Care (DMAS)Healthy Start /Loving Steps (VDH)Healthy FamiliesEarly Childhood Special EducationHead Start / Early Head Start (DOE)Early Intervention Part C (DBHDS)CHIP of Virginia Comprehensive Investment ProjectProject LINK (DBHDS)Resource Mothers (VDH)Medicaid Managed Care (DMAS)



Home Visiting Services (2009)

Of 132 localities, 121 offer some type of home visiting service:

97 localities are served by more than 1 program

9 localities have no programs except Part C and B

22 localities only have capacity to serve 10 or fewer families

35 localities have none to scarce capacity



Virginia’s HVC

• Virginia Department of Health (VDH) serves as lead agency. MOA addressing collaboration & funding signed by participating agencies in 2007.

• Home Visiting is a strategy. Services & desired outcomes vary depending upon each program’s mission. Certain Virginia HV programs focus on the child; others on the parent.

• VA chose to improve the cooperation between different HV models and focus on common issues and needs rather than select one HV model.



Virginia’s HVC

• The HVC seeks to improve the quality, efficiency and effectiveness of early childhood home visiting services in Virginia through interagency collaboration and has focused on five areas:

State policies and procedures Technical assistance to local coalition and communities Core training for all early childhood home visitors Interagency efforts to improve screening, data collection and

evaluation processes Collaborative programs with medical providers and child care

providers.



HVC Activities

• Created Universal Referral form to facilitate referrals and follow-up between HV programs and community services

• Identified core competencies & training needs

• Developing needed trainings & a mechanism to coordinate and monitor training

• Identifying common data elements & exploring mechanism for collecting data

• Developed Virginia Home Visiting Consortium Client Tracking Form (DRAFT) – a resource for communities



HVC Training

• Vision for Training Multidisciplinary Build on existing trainings Flexible Tiered Include system of evaluation

• Partnered with James Madison University (JMU) to develop, coordinate and track HVC training efforts, gather evaluation, provide certificates.

• Developed website http://homevisitingva.com



HVC: 12 Core Trainings

1. Introductory Community Collaboration

2. Mental Health – Adult

3. Mental Health – children

4. Confidentiality

5. Child Development 0-6

6. Child Development Screening and Working with the Medical Home

7. Substance Use: Risks, Effects in Pregnancy and Early Childhood Development

8. Identifying Risks Using Screening Tools: Mental Health, Family Violence, Substance Use, Perinatal Depression

9. Creating Home Environments that Promote Healthy Early Childhood Development

10. Conducting Effective Home Visits

11. Child Abuse and Neglect: Risks, Recognition and Reporting

12. Maximizing Community Resources through Effective Referrals



HVC: Specialized Trainings / Targeting Specialized Audiences

Target Audience• Reflective Supervision ( based on Healthy Families)Specialized Trainings Identified for Future Development• Involvement of Fathers • Language Skills and Emerging Literacy • “Floortime” or Activities “On the Go”, “Learning Games” • Motivational Interviewing and Engagement Strategies • Increasing Multicultural Awareness • Breastfeeding: Supporting Early Childhood Development • Strategies to Promote Healthy Birth Outcomes (Preventing Low

Birth Weight and Infant Mortality)

• Brain Development of Young Children



Cobbling together our Training Series involved Collaboration

• Introductory Community Collaboration (Title V/VDH, DOE, Head Start)

• Mental Health – Adult (Title V funds/VDH, Head Start)• Mental Health – children (Title V funds/VDH, Head Start)• ConfidentialityConfidentiality (Title V funds/ VDH, DOE, Part C)• Substance Use: Risks, Effects in Pregnancy and Early Childhood Substance Use: Risks, Effects in Pregnancy and Early Childhood

DevelopmentDevelopment (one time SAPT BG funds/DBHDS ) (one time SAPT BG funds/DBHDS )• Child Abuse and Neglect: Risks, Recognition and Reporting (DSS

course)• Reflective Supervision (Healthy Families course adapted for HVC)• Family Violence (VDH Family Violence Prevention grant)• Safe Home Environment (VDH, Head Start)



New HVC Partnerships

• Oral Health Workforce Development GrantHV receives referrals from dental hygienist working

with WIC and schools- evaluates all family members oral health, discusses nutrition habits, makes sure keep dental appointments.

• Family Violence Prevention grantSupport trainingFoster connections to sheltersFoster connections to family planning clinics

• Environmental Toxins Training and assessment tool for Safe Home



HVC’s Substance Use Module

• “Substance Use: Risks, Effects in Pregnancy and Early Childhood Development”

Focus group held June 1,2010 to identify home visitors needs & concerns

Develop 1 day (6 hr) curriculum: August 2010 Develop Training of Trainers: August 2010 Conduct 14 regional trainings: September –

December 2010



Substance Use ModuleCourse Objectives

• Learn that substance abuse is a chronic, progressive disease that can also be hereditary

• Recognize signs and symptoms of addiction and recovery

• Recognize other psychosocial and medical problems that frequently co-exist with substance abuse and may need attention

• Recognize that childhood trauma and intimate partner violence are often associated with substance use and other risky behaviors.

• Recognize the different was parental substance use/ substance use in the home can affect children and when to seek help

• Learn the importance of screening, brief intervention and referral to treatment –especially for pregnant women


Behavioral Health andDevelopmental Services Course Objectives (cont’d)

• Understand the federal confidentiality laws (42cfr) and Virginia’s laws regarding substance exposed newborns and be able to explain them to clients

• Learn basic principles of motivational interviewing

• Be able to explain to clients what treatment services are available for individuals with an SUD and for children who’ve been affected and how and where to refer them for services

• Identify local resources

• Explain how they can best support someone who may have a problem

• Recognize that the home visitor may have personal reactions to or experiences with those who use substances



High Risk Screening Course

• “Identifying Risks Using Screening Tools: Mental Health, Family Violence, Substance Use, Perinatal Depression”

• Course will offer providers a menu of screening tools identified through other interagency initiatives

Substance use tools: SEN Workgroup Additional Substance use and mental health tools:

DBHDS’s SBI Workgroup Perinatal Depression tools : VDH’s Perinatal Depression

Workgroup Family Violence/Intimate Partner Violence (RADAR/VDH) Child Development: DMAS’s ABCD Grant



High Risk Screening Curriculum

Still to be decided:

• Preferred format for risk screening training: Face to face? Web based? Combination?

• Will we recommend or require that all programs screen? Programs concerns:

Data collection Documentation Other



Information that Home Visitors Need to Know

• Substance use exists on a continuum Home visitors can provide important prevention, early intervention, referral and supportive services to substance using individuals and substance affected families

• Substance abuse is a chronic, progressive diseaseEarly screening, brief intervention and referral to treatment is an effective intervention. Relapse is a part of this disease.

• Substance use often occurs with other risky behaviors and concerns e.g. mental illness, family violence, abuse, neglect

• Children are important motivators for their parents The majority of parent’s want what is best for their children; however, many need help recognizing and changing their own risky behaviors.



Goals for HV Programs Related to Substance Use

1. Provide guidance and support to other HV programs

Educate staff regarding the process of addiction and recovery. Help home visitors recognize and address substance use

along a continuum. Educate and train staff regarding the benefits of high risk

screening and referral to treatment. Identify available SA, MH and IPV community resources. Help home visitors learn how to support individuals who need

treatment for their own substance use or who have been affected by someone else’s use.

Increase home visitors comfort, competence and willingness to address substance use.



Goals for Substance Use Providers

1. Enhance Project LINK staff’s expertise and skills addressing early infancy concerns

Enhance staff’s knowledge regarding early brain development and optimal child health.

Train and educate staff regarding the importance of developmental screening and referral for services.

Identify available community resources for children’s services – including other home visiting services.

Help LINK coordinate care and/or transition services with other home visiting services when indicated.

2. Educate CSBs regarding the availability of home visiting services in their community and how to coordinate services with them.



Obstacles We’ve Addressed

• Funding commitment

• Commitment of time for training

• Identified a vision of how home visiting services connect to early childhood development

• Getting out of our silos– Example: Medicaid is re-doing their Baby Care screening form to

fit the HVC goals for defining risks and data elements



Challenges We Face

• Child care and medical providers lack awareness of how HV services can be helpful

• Range of programs and worker skills in every community is different

• Mistrust between local HV programs

• Staff concerns about having time to deal with such complex, ongoing problems

• Building relationships with CSBs to ensure ready access to SA and MH services

• Worker safety



Challenges and Opportunities for the HVC

• Data collection for evaluation

• Sustaining quality HV training

• Ongoing support of supervisors

• Identifying funding to sustain and expand services. Explore ways to blend and braid funding; access available Medicaid funding and maximize other resources

• Health Care Reform Legislation offers new partners and avenues for funding



Home Visiting Block Grant

• Funding for the Affordable Care Act (ACA)Maternal, Infant & Early Childhood Home Visiting Program begins Summer 2010

– 1st yr funding for VA: $1,411,739

• Initial application due July 9, 2010

• Every state must submit needs assessment in September 2010. Assessment must include information regarding state’s substance abuse capacity.

• VDH - with assistance from HVC- will complete VA’s needs assessment. Unknown if VDH will be selected to administer grant.

• HVC is conducting hearings in various regions of the state and will also offer a survey on-line to gather local comments on the needs .



“The Future‘s so bright I gotta wear shades”*

*Timbuk3

Common Goals, Uncommon Solutions: Innovative Collaborations to Prevent and Improve Outcomes For...

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