ReducingNeonatalAbstinenceSyndromeinPascoBorn Drug Free Pasco Initiative

Outline• What is Neonatal Abstinence Syndrome?• Populations At Risk • Pasco County, Florida • Barriers to Screening • How to Screen• How to Refer

• Available Resources• Benefits of Screening and Referrals

WhatisNeonatalAbstinenceSyndrome?

• Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms that affect the central nervous, gastrointestinal, and respiratory systems in the newborn when separated from the placenta at birth.

• Maternal substance use of opioids, benzodiazepines, barbiturates, and alcohol can cause NAS.

(Casper and Arbour, 2013)(Jones and Fielder, 2015)

Substanceusebywomenofchildbearingagecanleadtolong-termandeven fataleffects,including:

• Low birth weight• Birth defects• Small head size• Problems with memory and learning • Premature birth • Sudden infant death syndrome • Developmental delays

MedicalCosts

• At the national level, the annual cost for treating NAS newborns is estimated to be $2.4 million dollars

• 77.6% paid by Medicaid programs

Whoisatrisk?

"ALL women of childbearing age"

BUT,Women with illicit drug use tend to be

• White and/or Hispanic;• young; with little, late, or no

prenatal care; and• choose opiates, heroin,

methadone, or prescription pain medication as their drug of choice.

(Casper and Arbour, 2013)

Demographics

• Florida babies discharged from the hospital with NAS return home to their previous living condition 89% of the time.

SymptomsofNAS• Seizures • Trembling (tremors) • Vomiting• Diarrhea• Excessive crying or high

pitched crying• Fever

MoreaboutNAS

• Specific drugs often times cause specific problems in the baby and may include the following:

• Heroin and other opiates, including methadone• Withdrawal in babies with symptoms may last as long as four to six

months• Develops in up to 94% of drug-exposed infants

PascoCounty,Florida- Epidemic• Among all 67 Florida counties, Pasco County had the fourth highest

frequency of Neonatal Abstinence Syndrome within Florida between 2011 and 2013, with a frequency of 256 children per 10,000.

Year # of Newborns Diagnosed # of Live Births 2012 34 4,7362011 33 4,6992010 20 4,8022009 16 4,9452008 7 5,303

TheInterventionHow can we help reduce NAS in our community?

BarriersofScreeningandReferrals

• Time • Stigma• Screening Compliance• Referral issues • Self-report: patients provide

socially desirable answers

Whatarethe5-A's?

Ask About past year drug useAdvise Patient about drug useAssess Readiness to quitAssist Patient in making changesArrange Treatment or Follow-up care (Referral)

This brief intervention gives patients a chance to learn about their drug use from an objective third party with training.

Goal of Each A

Ask

• Create a respectful environment• Ensure staff understands the importance of a positive and nonjudgmental

attitude in establishing a trusting relationship and welcoming environment

• Protect client confidentiality• Ask every question from the screening

CAGE-AIDQuestion YES NOHave you ever felt you should cut down on your drinking or drug use?

Have people annoyed you by criticizing your drinking or drug use?

Have you ever felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover?

Score

Advise

• Score the screening• Inform, do not PREACH• Set a goal

Assess

When a Woman Denies Use (Score of 0)• Acknowledge this wise choice• Review the benefits of abstinence

from substances• Re-screen and conduct lab testing• Remain supportive, encouraging,

and non-judgmental

When a Woman Admits Use (Score 1-4)• Inquire about substance use• Are they interested in change

MotivationalInterviewingA goal-oriented, client-centered interview style for eliciting behavior

change.

TimetoPracticeFind a partner and lets practice these skills

Arrange

Referral Options• Resource Guide• ASAP (http://www.pascoasap.com/resources/)

• The ASAP website provides the patient and health care providers with for-profit sites that treat substance use

• SAMSHA (https://findtreatment.samhsa.gov/) • The ASAP website provides the patient and health care providers with

not-for-profit sites that treat substance use• Future 2-1-1

OverviewofOvercomingBarriersStrategies Overview

5-A's A brief, five step intervention program, referred to as the “5 A’s” model, is recommended in clinical practice. The 5 A's are: Ask, Advise, Assess, Assist, and Arrange.

CAGE-AID A 4-item screening tool to help indicate whether a problem with alcohol or drug use may exist.

Motivational Interviewing A goal-oriented, client-centered interview style for eliciting behavior change.

BenefitsofScreening

• Early Detection• Early Intervention

BenefitsofPrevention

• Cost• Decreased Hospital Stay• Healthier Women• Improved Bonds• Personal Gratification• Decreased Morbidity

Questions?