Neonatal Abstinence Syndrome Renewal House Improving Outcomes Utilizing

Neonatal Abstinence Syndrome & Renewal House: Improving Outcomes Utilizing a Family. Centered Continuum of Care CAPTASA Conference – January 2014

Disclosures • I have no relevant financial disclosures

Drug Dependent Newborns (Neonatal Abstinence Syndrome) November Update (Data through 11/30/2013)

Quick Facts: NAS in Tennessee • 804 Cases of Neonatal Abstinence Syndrome (NAS) have been reported from January 1, 2013 till November 30, 2013 • In the majority of NAS cases (63%), at least one of the substances causing NAS was prescribed to the mother by a health care provider. • The highest rates of NAS in 2013 have occurred in Sullivan County and the Northeast Region (5. 0 and 3. 5 times higher than the state average, respectively).

Additional Detail for Maternal Sources of Exposure

Maternal Source of Exposure

Cost of Addiction • Average Tenn. Care cost for a healthy newborn: $4, 237. • Average Tenn. Care costs for an infant born dependent on drugs, diagnosed with neonatal abstinence syndrome: $66, 973

Percentage of Newborns in DCS Custody within One Year of Birth, CY 2010 Infants Born in CY 2010 NAS Infants Total # of Infants 56, 498 512 Total # Infants in DCS 754 95 % in DCS 1. 3% 18. 6%

Long-Term Consequences of NAS • At risk for: o Attention deficit Disorder o Hyperactivity o Difficulty transitioning between tasks o Impulse-control o Sleep disorders o Sensory disorders o Future risk of addictive behavior

Laura Berlind, CEO Mary Beth Heaney-Garate, LCSW

Renewal House History • Founded in 1996. • Nashville’s first, largest and most comprehensive treatment & recovery community for women & their children. • Gender-specific treatment. • Residential & outpatient services. • Unique family-centered recovery. • Serve over 200 women and children each year.

Family-Centered Approach • Entire Family is the identified client/patient at RH. • Stigma- Mothers love their children but have a disease. • Treatment requires disruption in the lives of families Resistance. At RH, women don’t have to choose between taking care of their children or taking care of themselves. • Existing systems not equipped to serve familiesshelters, treatment programs, 12 -step groups. • Comprehensive service not widely available. – Only 8. 2% of adults treated

Typical Client Profile • Co-Occurring Substance Use & Psychiatric Disorders • Poverty & Homelessness • Limited Health Care Complex, interlocking needs that require an integrated, multisystem approach • • • Limited Prenatal Care Crime & Violence Child Abuse & Neglect Domestic Violence Sexual Assault Intergenerational Substance Abuse

ACE Study

Mental Health Care Services: Women’s Licensed Treatment (IOP) & Pregnant & Postpartum IOP: Individual & Group Counseling Psychiatric Evaluation Medication Management Family Therapy Dialectical Behavior Therapy (DBT) Mental Health Education Co-Occurring Capable & Trauma-Informed Drug & Alcohol Abuse Education Relapse Prevention Parenting Domestic Violence Relationships & Self-Esteem Spirituality Case Management Services: Community Resources Transportation Aftercare + 6 Months Support in Permanent Housing Life Skills & Vocation Support Services: GED Preparation Job Search & Interview Preparation Budgeting & Finance Cooking & Nutrition Organization Skills Wellness Recover Action Plan (WRAP) Peer Support & Recovery Community Connection: 12 -Step Meetings Certified Peer Coaching & Mentoring Alumnae Association Recovery Housing: Transitional Supportive Housing Permanent 2 -Bedroom Apartments Community Meetings Family & Children’s Early Intervention & Prevention Program: Substance Abuse Prevention Child Abuse Prevention Developmental Assessments Children’s Case Management Communication & Social Skills Resiliency Skills Individual Therapy Individual & Group Parenting Celebrating Families! Children’s Mental Health Services Parent-Child Interaction Therapy Al’s Pals Admissions, Outreach, & Consulting: Training & Education Screening & Assessment Case Consultation Community Engagement Co-located Staff with DCS – Davidson Cty Co-located Staff with DCS – 11 Surrounding Counties

Integration of Mental Health Services • Clinical team meetings include both A&D treatment and mental health staff. • All staff are trained in basic DBT. • Groups are co-led by mental health staff and 12 step based peer recovery support. – Immediate translation of mental health recovery practices into 12 -step concepts.

Lengthened & Deepened Continuum of Care • Additional 6 months of supportive servicesthrough transition to permanent housing • Recovery Peer Support & Alumni Program • “Transitions” Case Manager • Children’s Program Case Manager & Children’s Activities Coordinator • Children’s Psychiatric Services

Program Capacity • Family Residential Program: 16 Apartments – 32 -35 families/year (1 mother + 2 children) – Target 12 – 18 months LOS • Outpatient Treatment for Women: 12 seats – 60 women/year – 12 weeks • Celebrating Families: 15 families – 11 weeks

Targeted Gains Sobriety & Stable Mental Health • Clean time and consistent psychiatric care Improving infant, mother, and family health • 100% drug-free babies born to RH mothers • 100% receive prenatal & postpartum care • 100% women & children obtain regular health care (check-ups, vaccinations, etc. ) Breaking the cycle of addiction & poverty • Women complete co-occurring treatment • Exit with education/employment • Exit with stable housing

Targeted Gains (con’t) Improving Mother-Child Attachment • 100% of mothers receive evidence-based parenting curriculum • Children leave with improved developmental assets • Improved family function Reducing Adverse Childhood Experiences (ACE) • Sober parent • Family reunification – closed DCS cases • Safe & stable home environment • Closed legal cases

Family Residential Program 2013 Gains • 54% Completed IOP Treatment • 43% Employed • 68% Established Permanent Housing • 6 Drug-Free Infants Born • 82% Maintained or Improved Child Custody Rights • 100% of Children scored ≥ 31 on the Search Institute’s Developmental Asset Assessment

Outpatient Treatment Program – 2013 Gains • 98% Prepared Individualized Treatment Plans • 73% Achieved 30 Consecutive Days Sober • 53% Completed Treatment

Memorial Foundation ASI Study Domains Average Admission ASI Composite Score Average Outcome ASI Composite Score Average Change in ASI Composite Score Medical Status 0. 301 0. 286 -0. 007 Employment and Support 0. 838 0. 468 -0. 317 Drug Use 0. 224 0. 037 -0. 179 Alcohol Use 0. 281 0. 035 -0. 237 Legal Status 0. 238 0. 047 -0. 19 Family/Social Status 0. 324 0. 13 -0. 176 Psychiatric Status 0. 426 0. 157 -0. 262 *54 of 75 clients interviewed had complete datasets for comparison purposes. Outcome ASI scores are shown for all 75 clients, however, the average change represents the 54 clients with a complete data set.

Memorial Foundation ASI Study Of the 75 clients interviewed in this study*: • 56% have stable employment • 81% have permanent housing • 92% were sober for the last 30 days * All client information was self-reported in the assessment.

Family Connection Grant Project Evaluation • Improved internalizing behaviors (suicidality, selfinjurious behavior, depression, anxiety, adjustment to trauma) • Improved externalizing behaviors (danger to others, criminal behavior, interpersonal relationships, antisocial behavior, anger, substance use, impulsivity) • Improved social connection factors (family, social functioning, social connectedness, community connection)

Hope, Resiliency & Continued Recovery

Dr. Roland Gray, Volunteer Medical Director Laura H. Berlind, Chief Executive Officer Mary Beth Heaney-Gárate, LCSW, Chief Clinical Officer Email: info@renewalhouse. org Website: www. renewalhouse. org Tel: (615) 255 -5222