Improving Treatment for Drug-Exposed Infants
Treatment Improvement Protocol (TIP) Series 5

Helping Parents or Guardians Obtain Supportive Services

Mothers of drug-exposed infants display a wide variety of needs and problems that affect their lives and those of their children. These include physical and psychosocial factors contributing to their drug use as well as environmental factors harmful to adequate or healthy lifestyles.

Persons providing assistance to mothers of drug-exposed infants can recognize and work to address the barriers to services that face these women. Such barriers include, but are not limited to:

• Lack of alcohol and drug abuse programs for pregnant and parenting women.
• Lack of transportation to and from service providers.
• Lack of child care or babysitting during service sessions.
• Cost of services.
• Insufficient funding available for substance abuse treatment programs directed to pregnant and parenting women, especially programs that are family-centered and include the mother's other children, the father, and the extended family in the treatment process.
• Lack of sufficient programs that are adapted to the cultural, racial, and linguistic characteristics of the women using the services.
• Lack of sufficient programs that are based in the communities or neighborhoods where the women live.
• Nonsupportive or hostile attitudes of service providers toward drug-using women.
• Stigma associated with drug use, especially drug use by women.
• Lack of knowledge by drug-using women concerning the service options available to them.
• Complex and often inconsistent eligibility requirements and application processes that vary by program.
• Fragmentation of services - lack of a single provider or locale where all needed services can be obtained, including comprehensive health and dental services. (This can be a formidable obstacle when the woman and her children face significant chronic medical problems, such as HIV).

In addition to the above-mentioned barriers to services facing mothers of drug-exposed infants, it is important to recognize several essential components in the development of adequate services for this population of women, as outlined below.

1. Case Management - An essential element for an effective continuum of care is the case management function. This function can be provided through the auspices of virtually any agency, and is needed by every woman and her family. Case management defines, initiates, and monitors the medical, drug treatment, psychosocial, and social services provided to the drug-exposed infant and its family. Case managers serve as advocates to help the woman and her family negotiate the bureaucracy and qualify for public programs such as Medicaid, WIC (Women, Infant and Children), AFDC (Aid to Families with Dependent Children), food stamps, and housing assistance.
   (Please see the section on referrals in Chapter 3, Followup and Aftercare, for an additional listing of public programs.)
   The multiple services coordinated by the case manager are generally provided by a variety of agencies. Some of these services are initiated during or even prior to pregnancy, and may continue long after delivery. Drug- and alcohol-abusing women and their children are also typically referred to a consortium of service providers that may change over time, depending on a patient's individual circumstances.
2. Outreach - To help pregnant, substance-using women and mothers of drug-exposed children learn about the services available to them, service providers should develop the following:
   • Outreach efforts to culturally diverse populations. At least a portion of outreach services should be conducted through nontraditional means, such as through churches, beauty parlors, laundromats, and other social settings. Outreach workers must be sensitive to the racial, ethnic, cultural, and socioeconomic concerns of those being served.
   • Public service announcements (PSAs) advertising services available and aired on radio or TV stations that are popular with groups targeted for services.
   • A 24-hour, toll-free hotline for service information and referrals.
   • Videotapes about services that can be used by community and church groups.
   • Pamphlets advertising the services available.
      
     The outreach worker is crucial to a program's ability to effectively carry out these outreach efforts.
   • Affordability - Discussed below are a number of considerations from the viewpoints of both the patient and the health care facility that can help to ensure that comprehensive services are affordable to all women and families in need of such services.