EFFECTIVE INTERVENTIONS FOR NEWBORNS WITH DRUG EXPOSURE AND THEIR FAMILIES

Harolyn M.E. Belcher, M.D., M.H.S.Associate Professor of PediatricsJohns Hopkins School of MedicineDirector of ResearchThe Family Center at Kennedy Krieger Institute

Objectives Identify key components of effective

programs

Project STRIVE

HUGS (Home-U-Go Safely)

Dayspring Community Programs, Inc.

Components of Effective Programs for Newborns with IUDE and Their Families

Integrated comprehensive program services

Evidence-based interventions

Culturally responsive

Accessible

Family centered

HUGS Study: Caregiver Child Interaction

Butz et al., 2002

HUGS Study: Parent Child Interaction

STRIVE Goals

Promote coordinated multi-organization services for pregnant drug dependent women & their infants

Increase the availability of prevention, early intervention, & treatment services

Decrease AOD use among pregnant participants

Improve birth & child developmental outcome

Maternal Demographics (N=80) Age (mean): 28.1 years (20-39) Never married: 59.5% Mean years of education: 10.7 (7-15) 66.2% did not complete HS 79.7% unemployed 79 % previous arrest history Race/Ethnicity

African American: 63.3% White: 30.4% Hispanic: 3.8%

Age at First Use

Alcohol: 15.8 years (5-26 yrs)

Marijuana: 16.2 years (6-25 yrs)

Cocaine/Heroin: 20.5 years (12-33 yrs)

Maternal Psycho-social History 52% had co-morbid psychiatric illnesses

83% had experienced physical violence

64.3% had experienced sexual abuse/rape

23% had experienced sexual abuse as a child

*p<.05;**p<.01

Birth Outcomes

Birth Outcome STRIVE Infants(n=57)

Foster CareInfants (n=15)

APGAR 1min 7.88 7.77

APGAR 5 min 8.71 8.80

Gestational Age 38.14 35.77

Birth Weight(gm)**

3000.42 2274.47

Birth Length(cm)*

47.54 44.52

Head Circumference(cm)*

33.61 31.66

Butz, et al.

HUGS Study

Longitudinal randomized study (birth to 6 years) Home-based developmental intervention

(16 visits in 18 months)

Prenatal cocaine and/or opiate exposed children (N=204)

Non-exposed community controls (N=50)

Infant and Maternal Demographics (Drug Exposed Cohort)

Infant Mean Birth Weight : 2817 g

+ 427 Mean Head Circumference:

33 cm + 1.4 Mean Length: 48.2 cm + 2.7 Mean Gestational Age: 38.4

wks + 1.5 Mean Length of Stay: 9 days

+ 6.5 Gender (female): 51% Apgar 1 minute <7: 18% Apgar 5 minute <7: 3%

Maternal Mean Age (years): 28 + 5 Education (>HS grad):

47.8% Unemployed: 94.5% Never married/single:

85% Tobacco use: 84.2% Race (African American):

97%

Butz et al., 2001

Effectiveness of Home-Based Nursing Intervention

100 2 and 3 year old children with intrauterine cocaine and/or opiate exposure and their caregivers

Home based nursing intervention (N=49) 16 home visits from birth to age18 months parent education & health monitoring

Standard care (N=51) Outcome: Child Behavior Checklist &

Parenting Stress Index

Results and ConclusionsButz et al., 2001

Children in the HUGS intervention group had significantly lower scores suggestive of less emotional or behavioral problems when compared to children in the Standard Care group Total behavior (p=0.04) Internalizing behavior (p=0.05) Externalizing behavior (p=0.02) Anxiety-Depression subscale (p=0.009)

Dayspring Programs, Inc.

“To improve the quality of life for children and families, focusing on those affected by substance abuse, homelessness and poverty.”

Housing Continuum

Client Referrals Treatment &Recovery Community Integration

SUPPORTIVE SERVICESWe value community, creating linkages &

partnerships for resources that assist families to become stable, children to live in nurturing

environments and individuals to become more productive citizens.

What Does Dayspring Do? Rental assisted

housing & support services

Long term residential drug treatment

Head Start child developmental services

How Does Dayspring Partner With Johns Hopkins?

Johns Hopkins Early Learning Center

Bright Spaces Project painted, purchased materials and

supplies for a child care area Holiday food and gift giving

JHH School of Nursing Vision and Hearing Screening for Head Start childrenHealth activities with housing families

Family Accomplishments FY 2009

• 13 families moved out of housing program successfully• 55% of parents were working• 30% of parents were in school• 99% of children were enrolled and attending school• 0% child abuse incidents• 86% of families remained drug free

“Dayspring Gave Us Back Our Family”