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

1. Programs Should Be Comprehensive

As many services as possible should be offered at one site or effectively linked to existing services in the community. To meet the complex and extensive treatment needs of this population, programs must provide:

• Legal advocacy
• Child protective services
• Prenatal medical care for women
• Pediatric care for the infant
• HIV testing and counseling
• Preconception education and family planning services
• Womens' chemical dependency treatment
• Education and job training
• Coordination of social services
• Developmental assessment of children
• Child care
• Case management
• Parenting education
• Mental health services
• Support groups
• Transportation
• Housing
• Domestic violence counseling.

2. Programs Should Be Confidential and Accessible

Substance-using women are often distrustful of social service systems and "helping" agencies because they fear criminal reprisals, moral judgements, and loss of their children to protective services. Programs must therefore ensure confidentiality and accessibility in order to be effective and inviting to women. Barriers to participation such as lack of child care or transportation must be eliminated.

3. Programs Must Be Collaborative and Coordinated

Collaboration among professionals from different disciplines is recommended. To meet the large number and variety of treatment needs of these patients and to assure integration and avoid fragmentation of services, professionals must clearly define and coordinate their roles. Collaboration is recommended among the many agencies often concurrently serving these women and their families. To provide a unified and coordinated approach among agencies, case management must take place.

4. Interventions Must Be Intensive

The problems of these women - lack of healthy social support systems, the disease of chemical dependency, and parenting infants with behavioral difficulties - require an intensive program response. Programs must make a long-term commitment to clients, and staff should be readily accessible and have frequent contacts with clients. Practical recommendations for creating intensive interventions include home visits, the use of drop-in centers, and crisis telephone lines operating on a 24-hour basis.

5. Programs Must Have a Supportive Orientation

Women in these programs are often emotionally fragile and vulnerable. Interventionists who forge supportive therapeutic bonds foster the woman's motivation to recover and desire to be a good parent. Programs should offer women the opportunity to build a relationship with a few key interventionists.

Many current drug treatment programs based on the therapeutic community model use a confrontational group process approach that is quite successful with men. Most treatment experts believe that chemically dependent pregnant women require specialized treatment models that include groups made up solely of these women in order to encourage contact and interaction, peer support, and focus on common problems.

6. Programs Should Be Culturally Competent

Program staff need to be responsive to the specific racial, ethnic, and cultural backgrounds of women using the service.

7. Residential Treatment and / or Drug-Free Housing Must Be Available

Treatment experts strongly recommend that patients be encouraged to leave their living environments where drugs may be readily available and commonly used. Options include residential treatment programs for those most severely chemically dependent, as well as drug-free housing for all others. Children must always be included in all residential options.

8. Programs Should Include Parent Education and Quality Child Care

Women want to be good parents. Often their natural inclinations are unsuccessful because their drug-exposed infants are difficult to parent. Sensitive parent education can help them understand their babies and care for them effectively. "Hands on" experiences in parenting should be part of any residential treatment program. The integration of infants and young children into residential treatment programs should be done in a manner that supports the mother-infant bond as well as allows mothers time and energy for recovery.

Quality infant care is especially important for drug-exposed infants. Special attention should be paid to the development of a bond between infants and their principal caregivers. When addicted mothers are in treatment or meetings or otherwise engaged, it is important for infants to be cared for in a manner that promotes trust and security.

SOLID FOUNDATION

P.O. Box 19183
Oakland, CA 94619
415-482-3217

The Solid Foundation operates two residential programs for women: Mandela House and Keeler House, serving five or six women. The program provides comprehensive treatment, including prenatal and perinatal care and education in child development (with an emphasis on the special needs of drug-exposed children), transportation, job training, GED preparation, nutrition information, religious counseling, personal grooming, group and individual counseling, and a therapeutic nursery. Women live in the house with their infants for 12 to 18 months. Mothers are involved in the design, policies, and implementation of the program and often volunteer for service after graduation. The program has received many awards.

CHEMICAL ADDICTIONS RECOVERY EFFORTS (CARE) CLINIC

Children's Hospital
5208 Claremont Avenue
Oakland, CA 94609
415-652-3783

CARE is an outpatient treatment program for up to 65 chemically dependent mothers and their drug-exposed infants, age 0 to 3 years, offering services both in the home and onsite. The focus is to help mothers maintain custody of their children, help mothers remain drug free, and help the children developmentally. Services include: comprehensive medical and psychosocial services, weekly group sessions, recovery support groups, weekly staff home visits, parent education, therapeutic developmental nursery for children with developmental delays, support in obtaining transportation, housing, child care, and material items.

PROTOTYPES WOMEN'S CENTER

845 East Arrow Highway
Pomona, CA. 91767
714-624-1233

PROTOTYPES provides a wide range of services to substance-using women and their children and has both a long-term residential treatment program and an outpatient program. The residential program serves 55 women and up to 30 children for a period of 9 to 18 months. The program has four treatment phases: orientation, stabilization, reparenting, and community re-entry, with the women assuming increasing responsibility in each phase. Core activities of the program include: chSUPical dependency education, individual and group counseling, women's health issues group, family treatment, household responsibilities, vocational training, aftercare planning (including a "buddy" who assists in seeking Employment and gaining independence), recreational activities, and participation in 12-step groups. Specialized groups include: pregnancy, grief and loss, communication skills, relapse prevention, women's survivors, and parenting training. Children's activities include a therapeutic nursery, play groups, parent-child outings, and after-school tutoring for school-age children.