1. Mitigating Risks of Substance Exposed Infants and Their Families Dixie L. Morgese, BA, CAP, ICADC

2. Learning Objectives Review models of risk determination (PPOR, ATOD, and CAN) Discuss risk mitigation strategies used in home visiting and family coaching Gain understanding of Strengthening Families Protective Factors as a Framework Learn strategies for enhanced risk mitigation using the Protective Factors Framework

3. Risk Screening & Assessment Perinatal Periods of Risk (PPOR)Perinatal Periods of Risk (PPOR) Alcohol, Tobacco, & Other DrugsAlcohol, Tobacco, & Other Drugs Child Abuse & NeglectChild Abuse & Neglect Other - DevelopmentalOther - Developmental Protective FactorsProtective Factors

4. Perinatal Periods of Risk Biopsychosocial ApproachBiopsychosocial Approach Age, Weight, History LBW or loss, Illness & Infection,Age, Weight, History LBW or loss, Illness & Infection, Practical Support, Stressors, Access, EnvironmentPractical Support, Stressors, Access, Environment Mental Health& PPD, Substance Use, Violence, Hunger, Timing of Pregnancy, RelationshipsMental Health& PPD, Substance Use, Violence, Hunger, Timing of Pregnancy, Relationships

5. Alcohol, Tobacco & Other Drugs* 5 P’s Screening Instrument (includes violence) ASI – Addiction Severity Index - onset, type of substance, frequency, dosage, route of administration. (concentrate on three months prior to and during pregnancy) Stages of Change (Readiness)

6. Stages of Change Contemplation Preparation Action Maintenance Pre- Contemplation

7. Child Abuse & Neglect History of Maltreatment or Domestic Violence Timing & History of Pregnancy ACES - Adverse Childhood Experiences Criminal History Indicators vs. Predictors

9. Protective Factors Family Resilience Social Connections Parent Knowledge of Child Development Nurturing and Attachment Social and Emotional Competence Practical/Concrete Support in Times of Need

10. Strength Based Family Support Planning - Prenatal Medical Risk – access, awareness, support, address barriers – carry pregnancy to term, coordinate with prenatal clinical provider, ICC. Behavioral Health - supports, resilience, history of success, social connections, parenting, childbirth ed. & plan, options. Environmental – housing, preparation, safety.

11. Strength Based Family Support Planning - Birth Multi-disciplinary staffing activities to support birth plan NICU staff support, handling techniques, nurturing & attachment, breastfeeding, social connections – labor support Substance Abuse & Mental Health Treatment Options Medical – linkage to and coordination with pediatric and developmental services.

12. Strength Based Family Support Planning - Infancy Linkage to pediatric and developmental services Ensure caregivers are aware of unique needs of infant Consider all caregivers with access Address safe sleep Consider respite Foster self regulation and routine – access to child care services Siblings Child Welfare systems that may be involved. Strive for Social Equality, Parent Engagement, and foster empowerment.

13. Post Partum Post Partum check-up – family planning, follow up on health conditions, ongoing health care access. Post Partum Depression – support exercise, self care, personal awareness, social connections. Recovery – twelve step support, follow up on recovery plan. Other

14. Address Barriers Fear of systems Unresolved Trauma Transportation Employment/Income Health Care Treatment Child Care Housing

15. Questions? Thank You!!