In the absence of a stable, nurturing home environment, the infant already compromised by drug exposure probably will be at increased risk of adverse outcome throughout infancy and childhood.
A comprehensive range of social services can promote stability and nurturing.
Several factors should be kept in mind when developing comprehensive social services for drug-exposed infants and their families.
- Efforts should be made to guarantee that services are sensitive to the cultural and racial backgrounds of the women using the services.
Innovative means of accomplishing this cultural competency, including extensive community involvement, should be explored.
Community involvement might include participation from: concerned families and residents in the community, community organizations, and church groups, and current or former patients in the program and their families.
Community involvement can go a long way toward addressing not only issues of cultural sensitivity, but also concerns about lack of resources and funding through the contribution of volunteer services.
- Utilization of outreach workers can provide programs with an important way to augment a wide range of services, encouraging more "one-on-one" contact with the mother and her family.
Program administrators should work to ensure that sufficient funding is available to hire and maintain outreach workers as key personnel in program operations.
- Community-based organizations (CBOs) should be utilized to support the range of social services that can be offered to the substance-using woman and her family.
Programs operating out of large institutions (such as hospitals) should strive to develop collaborative relationships with CBOs.
Efforts should be made to establish ongoing mechanisms for networking between institutionally based programs and CBOs serving drug-exposed infants.
- Whether provided at a single site or at a number of agencies throughout the community, services available to women and families caring for drug-exposed infants should be accessible, coordinated, and comprehensive.
Linkages among agencies are crucial.
Many experts in the field urge that comprehensive services be provided by interdisciplinary teams at a single site.
This concept is consistent with the policy recommended by the National Commission on Infant Mortality.
However, this "one-stop-shopping" approach may not be feasible in many communities.
Because of the variety of services required to appropriately serve drug-exposed infants and their families, many community-based agencies often provide these services.
Specific agencies in the community can offer a unique approach or focus that might be difficult to achieve in a single agency.
Due to lack of effective networking mechanisms among agencies (as well as overburdened workloads), problems often arise when one agency is unaware of services provided by another.
For these and other reasons, accessing services from one agency to another can be problematic. As previously mentioned, programs receiving Block Grant monies set aside to treat women and women with dependent children are required by law to provide women and their children with a comprehensive range of services, either directly or through referral.
Thus, when multiple sites are involved, the sites or agencies should carefully coordinate with one another so that needed services are provided without duplication of effort.
Case management is crucial in helping to ensure access to appropriate services.
Agencies may wish to consider the establishment of structured mechanisms to foster effective interagency communication regarding the provision of services to drug-exposed infants and families.
Other approaches might also be taken into consideration such as home-based nursing and counseling.
Access to treatment may be enhanced if services are decentralized and close to the people being served. Easy access to public transportation is important. Decentralized services in the form of home-based nursing and counseling can also facilitate collaboration with CBOs.
Comprehensive health and psychosocial services for drug-exposed infants include substance abuse treatment for the mother, health services, mental health services, social services, and educational, vocational, and employment services.
Key features of these services include:
- Cultural competence
- Utilization of outreach workers and community-based organizations
- Accessible, coordinated services with interagency linkage mechanisms
- Nontraditional approaches, such as home-based services.
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