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

Issues Arising During Postneonatal Followup

During postneonatal followup of the drug-exposed infant, the following should be noted:

1. Caregivers need to be aware of their own attitudes and feelings regarding substance-using women of childbearing age, because attitudes and feelings may hinder the ability of the provider to form a therapeutic alliance. A successful treatment intervention for the mother of a drug-exposed infant demands a therapeutic alliance between mother and provider, and should include: a nonjudgmental, nurturing approach; honest and open communication; and clear and concise shared expectations. Moreover, the provider of care should be aware of the complex psychosocial environment of drug-using women. This environment may include poverty, domestic violence, sexual abuse (including incest), homelessness, depression and other coexisting psychiatric disorders, intergenerational history of substance use, and the absence of healthy parenting.
2. Since chronic substance use is recognized as a relapsing disorder, programs and providers should:
   • Develop policies and procedures to keep patients in treatment, work with relapsing mothers, and foster the mother-infant dyad.
   • Recognize critical periods and issues of relapse and develop strategies to support the mother and protect the infant through relapse episodes. Relapse alone should not be grounds for reporting to a child protection agency, or for placing the child in foster care.
   • Be aware that the safety and well-being of the infant need to be protected. Notwithstanding the confidentiality requirements and the therapeutic alliance with the mother, a report to child protective services may be necessary and even legally required if the mother's substance use is seriously impairing her parenting ability.¹
3. In dealing with drug-exposed infants, successful treatment of the mother-infant dyad requires that agencies and providers of care:
   • Establish interactive working relationships in order to coordinate all aspects of care.
   • Develop mechanisms so that case-specific information can be shared while respecting confidentiality and with appropriate informed consent.
   • Provide comprehensive services that include, but are not limited to:
     • Medical care for mother and infant, including acute care, well baby screens, immunizations, developmental assessment and followup, preconception counseling, and necessary medications.
     • Mental health care including alcohol and other substance use treatment, family therapy, and identification and treatment of coexisting psychiatric disorders.
     • Psychosocial interventions including parenting training, child development education, anticipatory guidance, assistance in obtaining public benefits, protection from domestic violence, child care, education, and vocational and job training.