Level 3 Safeguarding Training for GP’s 2013: Pregnancy & Substance Misuse

Nicola Nelson Specialist Midwife 07786 250 915

The local picture: April 2012 – March 2013

149 notifications received Methadone 16 (+ 5 previously treated with;

completed programme) Heroin 15 (+13 hx now treated with methadone) Crack cocaine 20 (+ 10 hx) Alcohol 58 (+ 9 hx) Mephadrone 1 Ketamine 3 Subutex 1 Remainder: cannabis, XTC, benzodiazepines,

cocaine, LSD, codeine

Neonatal outcomes

Total number of births to women known to SAAM in 2012 (financial year) = 68 women gave birth / 70 babies born @ HUH

Total opiate exposed = 7NAS (admitted to NNU) = 3Stillbirths = 2

Safeguarding 37 referred to Children’s Social Care Babies born subject to CP plans = 15 Babies removed from mothers care =

2

Common challenges in safeguarding

Multiagency communication Indentifying / engaging the male partner / father of baby

Maternal engagement

The SAAM MW

Care co-ordination (Egroups etc)Case load the most chaotic / vulnerable

30/40 reviewCare planningLiaison with drug treatment provider

Discharge planning

Common challenges in involving GPGP’s don’t know of Specialist Midwife service

GP’s not aware can refer direct to Specialist Midwife

Problems communicating the urgency of a situation to surgery staff

Involvement in EgroupRepresentation @ ICPC

Best Practice: a case History Tiffany Turner is a 37 year old Caucasian

woman, G1 P0. She has a history of heroin use (smoked) and is in receipt of 48 mls methadone daily (prescribed by her GP) at the time of booking. Tiffany engages well with her GP for methadone scripting. She is currently experiencing some emotional problems due to relationship difficulties with her partner (father of the baby) and her GP is arranging counselling for this. Tiffany is employed as a care worker in a residential home for people with learning difficulties and works night shifts.

Time Line 16/08/12 GP referral to Maternity Services @

8/40. Indicates hx substance misuse and current methadone.

23/0812 referral reviewed by SAAM Midwife & PHMW.

20/09/12 pregnancy booking appointment with PHMW, client advises she has smoked heroin x2 since pregnant. Referred to CSC.

18/10/12 telephone call to client by SAAM Midwife to introduce self and service. Advised re methadone management. Appointment scheduled > 20/40 USS. Egroup commenced

Time Line 20/11/12: home visit by SAAM Midwife. CSC have

referred to LADO. Next SAAM appt @ 30/40. SAU referral made.

00/12/12Professionals meeting @ GP surgery: HV, PHMW, Psychiatric Cons SAU, GP, SAAM Midwife, SW, community Psychologist

10/01/13: 30/40 review with SAAM Midwife @ ANC 16/01/13: Professionals meeting @ GP surgery:

HV, PHMW, Psychiatric Cons SAU, GP, SAAM Midwife, SW, community Psychologist. CSC case closed no further action.

22/01/13: Intrapartum care plan uploaded onto EPR

Time Line 29/03/13: SVD, live male infant, 9/10/10,

3160g 03/04/13: mixed feeding, NAS: transferred to

NNU

Positive outcomes

Good communications enabled MA Team to assess and work with risk appropriately. Risk was ‘managed’ rather than eliminated. Concerns may otherwise have been responded to differently; could have resulted in un-necessary CP process. Baby safeguarded appropriately, family supported appropriately.

Further Reading All London Child Protection procedures. 4th Edition. 2010. London Safeguarding Children Board Signs of Safety. Turnell A & Edwards S. 1999. Russell House Publishing, London. Pregnancy and complex social factors. 2010. NICE guideline 110 Hidden Harm. (2003) Home Office.