In recent years there has been a substantial increase in prescription drug abuse and that has been paralleled by an increase in neonatal abstinence syndrome (NAS). NAS refers to the withdrawal symptoms experienced by infants exposed to drugs. From 55% to 90% of infants will experience withdrawal at birth following exposure to drugs passed from mother to infant in the womb.
Some symptoms of withdrawal in babies may include:
- Tremors (trembling)
- Irritability (excessive and high-pitched crying)
- Sleep problems
- Tight muscle tone
- Vomiting
- Poor feeding
- Stuffy nose, sneezing
- Fever or unstable temperature
States are seeing significant increases in the numbers of NAS infants. Tennessee has seen a ten-fold increase in the past 10 years. The cost of stabilizing a newborn with NAS is about $63,000 in Tennessee. One-fourth of newborns diagnosed with NAS are placed in state custody within one year of birth. And 40% of referrals to an IFPS program in Tennessee involve NAS infants.
Referrals are often made to IFPS while infants are still in the hospital. It is critical to prepare the parents for the baby’s discharge. Infants may experience withdrawal symptoms for up to six months and parents describe this time as an “emotional roller coaster.” The Wisconsin Association for Perinatal Care has a helpful guide for parents available here: http://www.perinatalweb.org/assets/cms/uploads/files/Methadone_Guide%20for%20Parents_2013_v4.pdf. There is also a guide for service providers: http://www.perinatalweb.org/assets/cms/uploads/files/Methadone_Facts%20for%20Providers_2013_v4.pdf.
Many women who are drug-dependent also have psychiatric disorders. Wraparound services are recommended for these women and IFPS is an excellent example of wraparound service. A good overview of NAS nationwide and treatment protocols is available here: http://www.astho.org/Prevention/NAS-Neonatal-Abstinence-Report/.
When infants are placed in out-of-home care for abuse or neglect (which includes NAS referrals), there is a new court approach called Safe Babies Court Teams. The goal is to change local systems to improve outcomes and prevent future court involvement in the lives of very young children. This approach includes training professionals, providing resources, encouraging collaboration, and increasing parent-child contact, mental health capacity and placement stability. Thus far, two evaluations indicate that the Court Teams Project is experiencing success in reaching its goals. For more information, visit: http://www.zerotothree.org/maltreatment/safe-babies-court-team/.
IFPS programs looking for additional resources can find a comprehensive model published by the federal SAMHSA agency. The Screening and Assessment for Family Engagement, Retention, and Recovery (SAFERR) model is designed to help practitioners respond to families affected by substance abuse disorders. The SAFERR model promotes a coordinated approach involving the child welfare system, drug and alcohol services, and the courts. Many of the shared principles reflect the values of IFPS services: children deserve to live in safety, families are capable of defining their needs, strengths, and can actively participate in the development of case plans, removal of children should occur only when there are no other options to ensure safety, and staff should have the knowledge, skills, tools, empathy, and resources to do their jobs well. The SAFERR model is available here: https://www.ncsacw.samhsa.gov/files/SAFERR.pdf.
Posted by Priscilla Martens, Executive Director
National Family Preservation Network