Substance-Exposed Infants: Policy and Practice

Presented by Nancy K. Young, Ph.D., Director


National Center on Substance Abuse and Child Welfare
www.ncsacw.samhsa.gov
714-505-3525
June 20, 2006

A Program of the
Substance Abuse and Mental Health
Services Administration
Center for Substance Abuse Treatment
and the
Administration on Children, Youth and Families
Children’s Bureau
Office on Child Abuse and Neglect

MISSION

Overview

Substance-Exposed Infants

The Policy Context

The Policy Context

No One Agency

The SEI issue does not “belong to” any one agency, because it demands

No single agency can deliver all of these

The Needed Partners

Collaboration on SEI issues requires roles for

Substance-Exposed Infants

The Numbers

The Numbers

Use During Pregnancy

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003

Substance Used (Past Month) 1st Trimester 2ndTrimester 3rd Trimester
Any Illicit Drug      
Alcohol Use      
Binge Alcohol Use      

Use During Pregnancy

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003

Substance Used (Past Month) 1st Trimester 2ndTrimester 3rd Trimester
Any Illicit Drug 7.7% women
315,161 infants
   
Alcohol Use 19.6% women
802,228 infants
   
Binge Alcohol Use 10.9% women
446,137 infants
   

Use During Pregnancy

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003

Substance Used (Past Month) 1st Trimester 2ndTrimester 3rd Trimester
Any Illicit Drug 7.7% women
315,161 infants
3.2% women
130,976 infants
 
Alcohol Use 19.6% women
802,228 infants
6.1% women
249,673 infants
 
Binge Alcohol Use 10.9% women
446,137 infants
1.4% women
57,302 infants
 

Use During Pregnancy

SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002 and 2003

Substance Used (Past Month) 1st Trimester 2ndTrimester 3rd Trimester
Any Illicit Drug 7.7% women
315,161 infants
3.2% women
130,976 infants
2.3% women
94,139 infants
Alcohol Use 19.6% women
802,228 infants
6.1% women
249,673 infants
4.7% women
192,371 infants
Binge Alcohol Use 10.9% women
446,137 infants
1.4% women
57,302 infants
0.7% women
28,651 infants

How are we doing at identifying and providing services to pregnant and parenting women who need treatment?

Women and Pregnant Women in Treatment

Number of Substance-Exposed Infants

Estimates are that 10-11% of all newborns are prenatally exposed to alcohol or illicit drugs; this translates to:

A Graphic View

82.7 million children and youth age 0 to 17 years

How are we doing at identifying substance-exposed infants?

Most are not identified and…

Most go home…

75-90% of substance-exposed infants are undetected and go home.

Why?

A Policy and Practice Framework

Five Points of Intervention

The Five Points of Intervention

Policy and Practice Framework: Five Points of Intervention

1. Pre-pregnancy awareness of substance use effects

2. Prenatal screening and assessment

3. Identification at Birth

4. Ensure infant’s safety and respond to infant’s needs

5. Identify and respond to the needs of

The 10-State Study

Methods and Design

The 10-State Descriptive Study

The 10-State Study

The 10-State Study

Findings, Models and Implementation

State Policy, Practice and Models

1. Pre-Pregnancy

Findings

1. Pre-Pregnancy

Findings

1. Pre-Pregnancy

Implementation

2. Prenatal Screening and Services

Findings

2. Prenatal Screening and Services

Implementation

2. Prenatal Screening and Services

Implementation

3. Screening and Testing at Birth

Findings

3. Screening and Testing at Birth

Findings

3. Screening and Testing at Birth

Implementation

4. Post-Natal Services to Infants and Children

Findings

4. Post-Natal Services to Infants and Children

Implementation

4. Post-Natal Services to Parents

Findings

4. Post-Natal Services to Parents

Implementation

States’ Coordination Efforts

Findings

States’ Coordination Efforts

Implementation

States’ Coordination Efforts

Implementation

Summary

Substance-Exposed Infants: Policy and Practice

Opportunities for advancing policy

The barriers to collaboration on SEI issues

How could a state self-assess its current collaboration on SEI issues?

An example: self-assessing current prenatal services

A second example: self-assessing screening at birth

The Message of the Missing Numbers

Why are substance-exposed births important?

An Ethical Perspective on SEBs

An example of the ethical tradeoffs:

Parental Substance Use – It’s Not Just About Moms

CAPTA Implementation: Developing a plan of safe care

Issues for State Consideration

Long-Term Developmental Impact

Issues for State Consideration

The Role of Alcohol

Issues for State Consideration

Toxicology Screens

Issues for State Consideration

Verbal Screening Tools

Chasnoff’s 4 P’s Plus

Issues for State Consideration

Testing/Identification

Issues for State Consideration

The Role of Dependency/Family Court

The Policy Questions

Opportunities for Advancing Policy

Opportunities for Advancing Policy

Conclusions

Four key policy challenges:

Conclusions

Four key policy challenges:

Recent Products

Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers
(A short monograph for front-line workers)

Visit
www.ncsacw.samhsa.gov

ANNOUNCING

conference@cffutures.org

Sources

Office of Applied Studies. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 03–3836, NHSDA Series H–22). Rockville, MD: Substance Abuse and Mental Health Services Administration at http://oas.samhsa.gov/2k3/pregnancy/pregnancy.htm

Hamilton BE, Martin JA, Sutton PD. (2003) Births: Preliminary data for 2002. National vital statistics reports, 51 (11), Hyattsville, Maryland: National Center for Health Statistics at http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_11.pdf

National Institute on Alcoholism and Alcohol Abuse. (2000). Tenth Special Report to Congress on Alcohol and Health. Washington, DC: Department of Health and Human Services at http://www.niaaa.nih.gov/publications/10report/intro.pdf

National Institute of Drug Abuse. (1998). Prenatal Exposure to Drugs of Abuse May Affect Later Behavior and Learning. NIDA Notes, 13 (4) at http://www.drugabuse.gov/NIDA_Notes/NNVol13N4/Prenatal.html

U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2003 (Washington, DC: U.S. Government Printing Office, 2005) at http://www.acf.hhs.gov/programs/cb/publications/cm03/cm2003.pdf

U.S. Department of Health and Human Services, Administration on Children, Youth and Families. Child Maltreatment 2002 (Washington, DC: U.S. Government Printing Office, 2004) at http://www.acf.hhs.gov/programs/cb/publications/cm02/cm02.pdf

Christian. (2004). Substance-Exposed Newborns: New Federal Law Raises Some Old Issues. Washington, DC: National Council of State Legislatures at http://www.ncsl.org/print/cyf/newborns.pdf

The Alan Guttmacher Institute. (October 1, 2004) State Policies in Brief: Substance Abuse During Pregnancy. Washington, DC: author at http://www.guttmacher.org/statecenter/spibs/spib_SADP.pdf

National Clearinghouse on Child Abuse and Neglect Information. (2004). State Statutes Series 2004. Parental Drug Use as Child Abuse: Full-Text Excerpts of State Laws. Washington, D.C.: National Clearinghouse on Child Abuse and Neglect. [Accessed 12-08-2004 at http://nccanch.acf.hss.gov].

Vega, W., Noble, A., Kolody, B., Porter, P., Hwang, J. and Bole, A. (1993). Profile of Alcohol and Drug Use During Pregnancy in California, 1992: Perinatal Substance Exposure Study General Report. Sacramento, CA: CA Dept of Alcohol and Drug Programs