Infants born to substance dependent women are more likely to be low birth weight and, depending on the substance, to experience neonatal withdrawal syndrome


B. Service Delivery and Treatment



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B. Service Delivery and Treatment:

Assessment:

  • Assessments include:

    • Exploration of woman’s thoughts and intentions regarding the pregnancy and provision of options and referrals for adoption or pregnancy termination as needed.

    • Exploration of pregnancy and child bearing, including any losses, and provision of resources for support,

    • Review of current prenatal care status, and referrals for care if woman does not have a provider;

    • Assess status of partner and family or chosen family support.

    • Assess risk of HIV and hepatitis and refer for testing and treatment as needed.

    • Assess mental status with particular attention to depression and other mood disorders.

    • Assess for intimate partner violence or sexual exploitation and need for intervention.

    • Assess current use of drugs, alcohol and tobacco. Assess for appropriate level of care for treatment and stage of change in recovery.

Treatment Planning:

  • Treatment Plans: Treatment plans identify needed resources and referrals, including plan for follow up or warm-handoffs and communication between providers.

    • Focus on recovery goals and needed supports to meet these goals

    • Focus on prenatal care, nutrition and self-care during and after pregnancy

    • Discuss engaging family and social supports

    • Discuss and refer as needed for medication assisted treatment.

    • Educate about cutting down or quitting tobacco use. Provide counseling and referral as needed.

    • Utilize Plan of Safe Care template, or similar document. (www.healthrecovery.org/safecare)

Service Provision:

  • Staff obtain signed consent forms for communication with other involved providers for ongoing collaboration.

  • Staff support mother to develop a Plan of Safe Care at any point prenatally or after delivery.

  • Staff will help client collect documents for her portfolio for DCF of evidence of her treatment involvement and successes, including letters of support, results of urine drug screens, and other accomplishments.

  • Staff are able to respond compassionately to past losses of child or custody.

  • Staff are able to assess mental status, with particular attention to depression and refer for services as needed.

  • Staff periodically assess risks of intimate partner violence or sexual exploitation.

  • Staff support mother with relapse prevention and safety planning for herself and her baby.

  • Staff support mother to tour birth hospital and help her self-advocate and ask questions about pain management and postpartum care of baby.

  • Staff facilitate breastfeeding, including education on the benefits of breastfeeding, having a designated nursing space, access to clean and high-quality breastfeeding equipment, flexible schedules for nursing mothers, and unimpeded access to lactation consultants or peer breastfeeding support persons.

  • Staff discuss family planning options for postpartum period, including the availability of Voluntary Long-Acting Reversible Contraceptives (V-LARCs).

  • Staff facilitate communication with DCF when a woman has an open case to help prepare for any DCF involvement postpartum.

  • Staff create a NAS-friendly environment, if they serve postpartum women with their infants, including: supporting rooming-in at the hospital, low sound, low lighting, flexible schedules for postpartum women, staff capacity to support mother and offer her breaks, and encouragement of skin-to-skin contact and breastfeeding.

  • Staff will educate all pregnant and parenting clients on separate safe sleep environments and in residential programs will monitor that safe sleep practices are used for all infants under 2 years of age, including a separate, empty crib, with a firm mattress, free of pillows, blankets, bumpers, or toys.

Education of Individuals

  • All female clients are provided information about risks related to substance use and tobacco/nicotine use that are specific to pregnancy, the importance of family planning, and the benefits of treatment engagement for women and infants.

  • Staff offer ongoing pregnancy and parenting groups that utilize evidence-based clinical interventions that are trauma-informed and gender-specific.

  • Staff educate women on non-pharmacological treatment for Neonatal Abstinence Syndrome, including the importance of calm, stable environments, skin-to-skin contact, breastfeeding, and Safe Sleep.

  • Women who are pregnant or parenting are offered regular psychoeducation groups about child development, parenting, and the effects of developmental trauma on parenting styles. Women are strongly encouraged to utilize services, such as Early Intervention (EI), Family Resource Centers and other home-visiting services to support their parenting and child’s development.


III. MEASURES:




  • Increases in number of pregnant women served

  • Established Qualified Service Organization Agreements focused on services for pregnant women, infants, and families

  • Increases in referrals to other agencies for services for pregnant women, infants and families


IV. RESOURCES:

The JOURNEY Recovery Project is an interactive web resource for pregnant and parenting women who have questions or concerns about opioid and other substance use. The JOURNEY focuses on the stories of women with lived experience, offering information, hope, encouragement, and resources for every step of their perinatal journey. The JOURNEY project can be explored independently or used as a curricular tool in a facilitated setting.

Massachusetts Perinatal Quality Collaborative: Maternal Opioid Use During Pregnancy Toolkit.

Pregnancy and Opioids, guidance document crated by Partnership for Drug-Free Kids, (www.drugfree.org) and The Medicine Abuse Project.

TIP 2: Pregnant Substance-Using Women, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services.

TIP 51: Substance Abuse Treatment: Addressing the Specific Needs of Women, Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services.

The Neonatal Quality Improvement Collaborative of Massachusetts, provides a collection of policies, guidelines, and educational materials developed by different hospitals and organizations participating in the collaborative.




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