1. EFFECTIVE INTERVENTIONS FOR NEWBORNS WITH DRUG EXPOSURE AND THEIR FAMILIES Harolyn M.E. Belcher, M.D., M.H.S. Associate Professor of Pediatrics Johns Hopkins School of Medicine Director of Research The Family Center at Kennedy Krieger Institute

2. Objectives  Identify key components of effective programs  Project STRIVE  HUGS (Home-U-Go Safely)  Dayspring Community Programs, Inc.

3. Components of Effective Programs for Newborns with IUDE and Their Families  Integrated comprehensive program services  Evidence-based interventions  Culturally responsive  Accessible  Family centered

4. HUGS Study: Caregiver Child Interaction Butz et al., 2002

5. HUGS Study: Parent Child Interaction

8. 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

9. 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%

10. 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)

11. 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

12. *p<.05;**p<.01 Birth Outcomes

13. 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) Butz, et al.

14. 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%

15. 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 Butz et al., 2001

16. Results and Conclusions Butz 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)

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

18. Housing Continuum Client Referrals Treatment &Recovery Community Integration SUPPORTIVE SERVICES We 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.

19. What Does Dayspring Do?  Rental assisted housing & support services  Long term residential drug treatment  Head Start child developmental services

20. 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 children Health activities with housing families

21. 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

22. “Dayspring Gave Us Back Our Family”