Collaborative Community Court Teams: Implementing Plans of Safe Care - - PowerPoint PPT Presentation

Collaborative Community Court Teams: Implementing Plans of Safe Care

Ken DeCerchio, MSW| Program Director Gail Barber, MSW | Senior Associate

National Quality Improvement Center for Collaborative Community Court Teams Acknowledgement

National FDC Training and TA Program

Statewide System Improvement Program

Quality Improvement Center for Collaborative Community Court Teams Prevention and Family Recovery Program

Peer Learning Court Program In-Depth Technical Assistance (IDTA) Children Affected by Methamphetamine Substance-Exposed Infants IDTA

National Center on Substance Abuse and Child Welfare

Regional Partnership Grants Rounds I-6

Children and Family Futures

Funded by OJJDP Funded by DDCF and TDE Funded by ACF/CB, SAMHSA Funded by ACF/ACYF, CB

Sobriety Treatment and Recovery Teams

Funding by Individual Jurisdictions

1

Change our work’s focus

• Preventing maltreatment
• Preventing unnecessary placement

2

Prioritize the importance of families

• Children must be kept in their communities and schools
• Foster parents must become resources to help support

birth parents

3

Focus our interventions on the well-being of children and their parents

• Address both parent and child trauma
• Don’t cause additional trauma through unnecessary removal

4

Build the capacity of communities to support children and families

• Locally based resources and services
• Supports families need must be located where families

live

5

Develop and support a healthy and stable child welfare workforce

• Competent, skilled and informed
• Capable and visionary leadership

CB’s Goals and Priorities

Understanding the Challenge

18.5% 24.7% 28.5% 32.2% 39.0% 9.3% 9.8% 18.5% 26.5% 30.6% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 National Ohio

Prevalence of Parental Alcohol or Other Drug Use as a Contributing Factor for Reason for Removal in the United States and Ohio, 2000 to 2018

Note: Estimates based on all children in out of home care at some point during Fiscal Year

Source: AFCARS Data, 2000-2018

42.5% 28.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% Neglect Parent Alcohol or Drug Use Parent Unable to Cope Inadequate Housing Physical Abuse Parent Incarceration Abandonment Sexual Abuse Child Behavior Child Alcohol or Drug Use Child Disability Relinquishment Parent Death National Ohio

Percent of Children with Terminated Parental Rights by Reason for Removal in the United States and Ohio, 2018

Source: AFCARS Data, 2018 v1

Note: Estimates based on all children in out of home care at some point during Fiscal Year

18.0% 25.1% 30.1% 32.8% 39.3% 39.2% 8.1% 9.8% 20.6% 27.6% 35.8% 30.8% 0% 5% 10% 15% 20% 25% 30% 35% 40% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 National Ohio

Incidence of Parental Alcohol or Other Drug Use as a Reason for Removal in the United States and Ohio, 2000 to 2018

Note: Estimates based on children who entered out of home care during Fiscal Year

Source: AFCARS Data, 2000-2018

27.8% 36.1% 40.1% 43.6% 52.1% 16.5% 23.1% 28.1% 30.6% 36.3%

• 5%

5% 15% 25% 35% 45% 55% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Under Age 1 Age 1 or Older

Note: Estimates based on children who entered out of home care during Fiscal Year

Source: AFCARS Data, 2000-2018

Incidence of Parental Alcohol or Other Drug Use as a Contributing Factor for Removal in the United States, 2000 to 2018

27.8% 36.1% 40.1% 43.6% 52.1% 13.0% 16.9% 32.0% 42.2% 46.1% 0% 10% 20% 30% 40% 50% 60% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 National Ohio

Source: AFCARS Data, 2000-2018

Percent of Children Under Age 1 with Parental Alcohol or Other Drug Use as a Reason for Removal in the United States and Ohio, 2000 to 2018

Note: Estimates based on children under age 1 who entered out of home care during Fiscal Year

Percent of Children Under Age 1 with Parental Alcohol or Other Drug Use as a Reason for Removal by Ethnicity/Race in the United States and Ohio, 2018

59.8% 38.7% 69.6% 29.9% 48.1% 55.6% 44.9% 50.0% 52.6% 32.7% 0.0% 20.0% 0.0% 46.6% 48.6% 48.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% NH White NH Black NH AI NH AS NH Pac NH multi Hispanic Unknown National Ohio

Note: Estimates based on children who entered out of home care during Fiscal Year

Source: AFCARS Data, 2018 v1

10% 2.3% 2.6% 4.5% 0% 5% 10% 15%

10% increase in the overdose death rate corresponds with…

Drug Deaths Reports of Maltreatment Substantiated Reports Foster Care Placements

(Radel et al., 2018)

Relationship of Substance Use and Child Welfare Indicators

Parent/Caregiver Child Identify and respond to parents’/caregivers’ needs Initiate enhanced prenatal services

Neonatal, Infancy, and Postpartum

Ensure infant’s safety and respond to infant’s needs

Prenatal

Screening and Assessment

Pre-Pregnancy

Awareness of substance use effects

Childhood and Adolescence

Identify and respond to the needs of the toddler, preschooler, child, and adolescent Respond to parents’/caregivers’ needs Identification at Birth

5 Points Of Family Intervention for Infants with Prenatal Substance Exposure and Their Families

Prenatal

For women with substance use disorders and their infants and families

Prenatal Screening Substance Use Disorder Treatment Birth Protocols

Birth Beyond

Ongoing Support and Services

Opportunities and Challenges

Comprehensive Addiction and Recovery Act (CARA) amendments to the Child Abuse Prevention and Treatment Act (CAPTA)

Overview

Primary Changes in CAPTA Related to Infants with Prenatal Substance Exposure

1974

Child Abuse Prevention and Treatment Act (CAPTA)

2003

The Keeping Children and Families Safe Act

2010

The CAPTA Reauthorization Act

2016

Comprehensive Addiction and Recovery Act (CARA)

2018

Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act)

CARA’s Primary Changes to CAPTA

1. Further clarified population to infants “born with and affected by substance abuse or withdrawal symptoms resulting from prenatal drug exposure,

• r a Fetal Alcohol Spectrum Disorder,” specifically

removing “illegal” 2. Specified data to be reported by States 3. Required Plan of Safe Care to include needs of both infant and family/caregiver 4. Specified increased monitoring and oversight by States to ensure that Plans of Safe Care are implemented and that families have access to appropriate services

PLANS OF SAFE CARE

Lessons from the National Center on Substance Abuse and Child Welfare (NCSACW)

CWS Safety Plan Hospital Discharge Plan SUD Treatment Plan

How is Pl Plan an of

• f Sa

Safe fe Car are e Different?

No one template fits the needs of all communities, settings or families

• Primary, Obstetric and Gynecological Care
• Substance Use and Mental Health Disorder Prevention and

Treatment

• Parenting and Family Support
• Infant Health and Safety
• Infant and Child Development

Domains that might be in a Plan of Safe Care

could do Plans of Safe Care?

• Multi-agency
• Well-trained
• Shared trust and knowledge
• Supportive hand-offs

Who

(Sloper, 2004)

Populations of Women

Lead Agency/Provider

Prenatal Period Identification at Birth & Infant Affected

1. Using legal or illegal drugs, on an opioid medication for chronic pain or on medication (e.g., benzodiazepines) that can result in a withdrawal syndrome and does not have a substance use disorder Prenatal Care Provider in concert with pain specialist or other physician Maternal and Child Health Service Provider Home visiting, early childhood intervention, new parent education, etc. 2. Receiving medication assisted treatment for an opioid use disorder (Buprenorphine or Methadone) or is actively engaged in treatment for a substance use disorder Prenatal Care Provider in concert with Opioid Treatment Provider or waivered prescriber and/or therapeutic treatment provider Therapeutic Substance Use or Opioid Use Disorder Treatment Provider with support from Maternal and Child Health or Child Welfare 3. Misusing prescription drugs, or is using legal

• r illegal drugs, meets criteria for a substance

use disorder, not actively engaged in a treatment program Prenatal Care Provider or High Risk Pregnancy Clinic in concert with substance use disorder treatment agency Child Welfare Services

Child welfare will generally not be involved with a family in the prenatal period unless there is another child with an open case. Partners are important for early engagement of pregnant women in treatment and prenatal care to improve the health and well-being

• utcomes for mother and the infant.

POSC is a unique

• pportunity for cross-

system collaboration

No single agency can do it alone

Innovations: Quality Improvement Center Collaborative Community Court Teams

Enhance the capacity of CCCTs to appropriately implement the provisions of the Comprehensive Addiction and Recovery Act (CARA) amendments to the Child Abuse and Prevention Treatment Act (CAPTA)

IMPLEMENTATION

Enhance and expand CCCTs’ capacity to effectively collaborate to address the needs of infants, young children, and their families/caregivers affected by substance use disorders (SUDs) and prenatal substance exposure

CAPACITY

Sustain the effective collaborative partnerships, processes, programs, and procedures implemented to achieve the goals of each demonstration site

SUSTAINABILITY

Provide the field with lessons they can apply about effective practices for implementing the requirements of CARA and meeting the needs of children and families affected by substance use disorders

DISSEMINATION

QIC-CCCT Goals

QIC-CCCT Demonstration Sites

Court Models Eight Family Treatment Courts Three Early Childhood/Infant Toddler Courts One Family Treatment Court & Early Childhood Court Two Joint Jurisdiction Family Wellness Courts (Tribal/County)

Collaboration and Partnerships

Core Partners

Child Welfare

15

Substance Use Disorder Treatment

15

Medical/Health Care

12

Children’s Services (including Home Visiting and Early Intervention)

12

Public Health

11

Attorneys

9

Medication Assisted Treatment Providers

9 Demonstration sites strengthened partnerships and expanded Core Team membership with representation from new systems.

• Challenges to building and strengthening

cross-system collaboration: ✓ Concerns about confidentiality ✓ Lack of knowledge about Plans of Safe Care ✓ Limited staff and system capacity ✓ Stigma and bias

Convene Multi-Agency Collaboration Family-Centered Approach Information Sharing Oversight Accountability Focus on Outcomes

Collaborative Courts are well-positioned to help infants affected by prenatal substance exposure and their families

What can Collaborative Community Court Teams do?

Develop collaborative partnerships and linkages between maternal and infant health care providers, hospitals, child welfare, SUD treatment providers (including medication assisted treatment) the court, and early intervention providers. Develop practice, communication, and information-sharing procedures to coordinate the child and family-focused service delivery system. Strengthen collaboration and enhance training and resources for all collaborative partners on the needs of infants, young children, and their families/caregivers affected by substance use disorders and prenatal substance exposure.

What Can Judges Do?

1. For all infants ask, “where is there a plan of safe care for the infant and family/caregiver?” 2. Convene health care providers with other service systems to prevent infant removals when possible 3. Facilitate the use of Title IV-E to keep children with their parent in residential substance use disorder treatment and ensure high quality legal representation for parents and children 4. Ensure reasonable and active efforts requirements are met 5. For all families ask about family time and visitation 6. Count Children of Parents with Opioid and other Substance Use Disorders in the Data Set 7. Ensure states and communities are making good use of available technical assistance and resources

Expanding Target Populations

11 sites expanded their target populations to serve families outside of the collaborative court

Permanency Child Removal Family Preservation Investigation

• r Differential

Response Report or Notification to Child Welfare No Child Welfare Involvement

Pregnant women prior to CW involvement Screened in non- court involved families Screened

• ut

families Collaborative Court Involvement Families

have begun to implement Plans of Safe Care in some capacity

13 sites

reported that the court is involved in implementing or reviewing/asking about Plans of Safe Care

11 sites

have developed a template/document for the Plan of Safe Care in at least some cases

12 sites 7 sites 2 sites 4 sites

Start of QIC

0 sites 12 sites

are either implementing or planning to implement prenatal Plans of Safe Care Current

Implementing CARA Amendments to CAPTA

Questions?

Resources

Reasonable and Active Efforts, and Substance Use Disorders:

A toolkit for professionals working with families in or at risk of entering the child welfare system

Plans of Safe Care:

An issue brief to help Judicial Officers better understand Plans of Safe Care and their role in bringing together community partners to improve systems for infants with prenatal substance exposure and their families.

Resources for Court Professionals

www.cffutures.org/qic-ccct For more information:

From Policy to Practice: Comprehensive and Coordinated Family-Centered Treatment for Families Affected by Substance Use Disorders QIC-CCCT Demonstration Site Spotlight Webinar: Collaborating to Implement Prenatal Plans of Safe Care

Check out other QIC-CCCT web-based learning

• pportunities by visiting our resource page at:

www.cffutures.org/qic-ccct_resources

Featured Resources:

Web-Based Resources

For more information: www.cffutures.org/qic-ccct

Just Published!

National Quality Improvement Center for Collaborative Community Court T eams Program Summary

Plan of Safe Care Learning Modules

• Brief 1: Preparing for Plan of Safe Care

Implementation

• Brief 2: Collaborative Partnerships for

Plans of Safe Care

• Brief 3: Determining Who Needs a

Plan of Safe Care

• Brief 4: Implementing and Monitoring

Plans of Safe Care

• Brief 5: Overseeing State Plans of Safe

Care Systems and Reporting Data

Five Learning Modules:

Available for download here: https://ncsacw.samhsa.gov/topics/plans-of-safe-care-learning-modules.aspx

Res Resou

• urce

rces s

FREE CEUs!

NCSACW Online Tutorials Cross-Systems Learning

@ www.ncsacw.sam hsa.gov/

Understanding Substance Abuse and Facilitating Recovery: A G uide for C hild Welfare Workers Understanding Child Welfare and the Dependency Court: A G uide for Substance Abuse Treatm ent Professionals Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals

Additional Resources on Collaboration

Web-Based Resource Directory

• Includes research, training materials, webinars and

videos, site examples and other resources

• Topics include substance use disorders and

treatment, medication-assisted treatment, infants with prenatal substance exposure, and supporting families with opioid use disorders Technical Assistance

• Identifying values and principles of collaborative

practice to address differences and develop agency values’, missions and mandates

• Examples of effective collaborative practice between

substance use providers, child welfare and the courts

ncsacw@cffutures.org I 1-866-493-2758 I https://ncsacw.samhsa.gov/

Purpose: Support the efforts of States, Tribes and local communities in addressing the needs

• f pregnant women with opioid use disorders

and their infants and families Audience ▪ Child Welfare ▪ Substance Use Treatment ▪ Medication Assisted Treatment Providers ▪ OB/GYN ▪ Pediatricians ▪ Neonatologists National Workgroup ▪ 40 professionals across disciplines ▪ Provided promising and best practices; input and feedback over 24 months

Available for download here: https://www.ncsacw.samhsa.gov/files/Collaborative_Approach_508.pdf

IDTA Webinars: Spotlight on State Implementation

Addressing Infants With Prenatal Exposure – New York’s Implementation Strategies

Discusses state leaders’ collaborative efforts and strategies to improve outcomes for pregnant women with opioid and

• ther substance use disorders, their infants, and families.

Connecticut’s Approach to Implementing Plans of Safe Care

Highlights Connecticut’s approach for developing Plans of Safe Care, a review of their on-line notification portal for infants with prenatal substance exposure and their families, and their collaborative work with partner agencies.

For more information on IDTA, please visit: https://ncsacw.samhsa.gov/technical/idta.aspx

In-Depth Technical Assistance (IDTA) Case Study

Collaboration Pathways for Infants and Families Affected by Substance Use Disorders: Lessons From New Jersey

For more information on IDTA, please visit:

https://ncsacw.samhsa.gov/technical/idta.aspx

This technical assistance tool provides on-the- ground examples from 12 states and 5 tribes across the country that have implemented comprehensive approaches to Plans of Safe Care for infants with prenatal substance exposure and their families and caregivers. These concrete examples can help states and agencies consider practice and policy system changes to best serve these families in their own communities.

On-The-Ground: How States are Addressing Plans of Safe Care for Infants with Prenatal Substance Exposure and their Families

For more information on NCSACW, please visit: https://ncsacw.samhsa.gov/

Purp rpos

• se:

e: The brief offers implementation considerations that professionals can draw from when implementing peer or recovery specialist models in their communities. Audie ienc nce: e: Administrative and executive- level professionals from:

• Child Welfare
• Substance Use Disorder Treatment
• Courts

Ava vaila lable e for for dow

• wnload here

ere: https://n /ncs csacw.samh acw.samhsa.gov/ sa.gov/fi file les/pe s/peer19_bri er19_brief.pd ef.pdf

Key Infor forma mant nt Inter ervi view ews: s: Representatives from four programs–2 peer support programs and 2 recovery specialist programs–that have demonstrated positive child welfare and recovery outcomes for families

Available for download here: https tps://n /ncsa csacw cw.s .samhs amhsa. a.go gov/f v/files es/unde understan rstanding ng-trea eatm tment ent-508 08.pdf pdf

• This TA tool is designed to equip

professionals who refer parents to SUD treatment with a fundamental understanding

• f treatment.
• The tool includes a list of questions child

welfare or court staff can ask treatment providers to ensure that effective linkages are made.

• With the knowledge gained, professionals

will be able to make informed referral decisions for services that are a good fit to meet the parent and family’s needs.

NCSACW Training Toolkit

Visit our website to download the training toolkit: https://ncsacw.samhsa.gov/training/toolkit/

The National Center on Substance Abuse and Child Welfare (NCSACW) developed the Child Welfare Training Toolkit to educate child welfare workers about substance use and co-occurring disorders among families involved in the child welfare system. The training is intended to provide foundational knowledge to help child welfare workers:

• Understand substance use and co-occurring disorders.
• Identify when substance use is a factor in a child welfare case.
• Learn strategies for engaging parents and families in services.
• Understand potential effects for the parent, children, and

caregivers.

• Learn the importance of collaboration within a system of care.

Through a deeper understanding of these topics, child welfare workers can apply knowledge gained to their casework and improve their own practice.

Raising the Bar!

Family Treatment Court Best Practice Standards

Standards & Provisions

Just Released!

https://www.cffutures.org/fdc-tta/ftc- best-practice-standards-2019/

This report highlights work between the Minnesota Department of Health Services and Tribal partners to improve coordination with substance use disorder treatment, child welfare and maternal and child health agencies as a part of a three and a half- year engagement in the Substance Exposed Infants (SEI) In-Depth Technical Assistance (IDTA) program. The insights provided in this report are the result of a listening tour conducted in 2018 with program staff from five Tribal partners sites who implemented different collaborative care models for working with pregnant Native American women and their families.

For more information on IDTA, please visit:

https://ncsacw.samhsa.gov/technical/idta.aspx

Contact Information

Ken DeCerchio Program Director Center for Children and Family Futures kdecerchio@cffutures.org Gail Barber Senior Program Associate Center for Children and Family Futures gbarber@cffutures.org

• Behnke, M., & Smith, V. C. (2013). Technical Report. Prenatal substance abuse: short and long-term effects on the exposed fetus. American Academy of Pediatrics, 131(3), e1009-e1024.
• Centers for Disease Control and Prevention. (2017). Births: Final Data for 2015. National Vital Statistics Reports, 66(1).
• Child Abuse Prevention and Treatment Act of 1974 s. 1191 (USA)
• Comprehensive Addiction and Recovery Act of 2016 s. 524 (USA)
• Fullerton, C. A., Kim, M., Thomas, C. P., Lyman, D. R., Montejano, L. B., Dougherty, R. H., … Delphin-Rittmon, M. E. (2014). Medication-Assisted Treatment With Methadone: Assessing the Evidence. Psychiatric Services, 65(2), 146–157.

• Grossman, M. R., Berkwitt, A. K., Osborn, R. R., Xu, Y., Esserman, D. A., Shapiro, E. D., & Bizzarro, M. J. (2017). An Initiative to Improve the Quality of Care of Infants With Neonatal Abstinence Syndrome. Pediatrics, 139(6), e20163360.

• Havnes, I., Bukten, A., Gossop, M., Waal, H., Stangeland, P., & Clausen, T. (2012). Reductions in convictions for violent crime during opioid maintenance treatment: A longitudinal national cohort study. Drug and Alcohol Dependence, 124(3), 307–

• Kitzman H, Olds D, Cole R, et al. Enduring effects of prenatal and infancy home visiting by nurses on children: follow-up of a randomized trial among children at age 12 years. Arch Pediatr Adolesc Med. 2010;164(5):412-418.
• May, P.A., and Gossage, J.P.(2001).Estimating the prevalence of fetal alcohol syndrome: A summary. Alcohol Research & Health 25(3):159-167. Retrieved October 21, 2012 from http://pubs.niaaa.nih.gov/publications/arh25-3/159-167.htm
• Mehta, P. K., Bachhuber, M. A., Hoffman, R., &American Srinivas, S. K. (2016). Deaths From Unintentional Injury, Homicide, and Suicide During or Within 1 Year of Pregnancy in Philadelphia. Journal of Public Health, 106(12), 2208–2210.

• Metz, T. D., Rovner, P., Hoffman, M. C., Allshouse, A. A., Beckwith, K. M., & Binswanger, I. A. (2016). Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012. Obstetrics & Gynecology, 128(6), 1233–1240.

• Milliren, C. E., Gupta, M., Graham, D. A., Melvin, P., Jorina, M., & Ozonoff, A. (2017). Hospital Variation in Neonatal Abstinence Syndrome Incidence, Treatment Modalities, Resource Use, and Costs Across Pediatric Hospitals in the United States,

• Patrick, S. W., Davis, M. M., Lehmann, C. U., & Cooper, W. O. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology, 35(8), 650–655. doi:10.1038/jp.2015.36
• Radel, L., Baldwin, M., Crouse, G., Ghertner, R., & Waters, W. (2018). Substance Use, the Opioid Epidemic, and the Child Welafare System: Key Findings from a Mixed Methods Study. Office of the Assistant Secretary for Planning and Evaluation.

• Sarah Haight et al., “Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014,” Morbidity and Mortality Weekly Report 67 (August 10, 2018): 845-849, http://dx.doi.org/10.15585/mmwr.mm6731a1.
• Substance Abuse and Mental Health Services Administration. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH, Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD:

• Substance Abuse and Mental Health Services Administration (2011, 12). SAMHSA announces a working definition of “recovery” from mental disorders and substance use disorders. Retrieved from https://www.samhsa.gov/newsroom/press-

• Substance Abuse and Mental Health Services Administration. Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and

• Substance-Exposed Infants: A Report on Progress in Practice and Policy Development in States Participating in A Program of In-Depth Technical Assistance September 2014 to September 2016- Executive Summary. (2017). Retrieved from:

• The American College of Obstetricians and Gynecologists. (2012) Committee Opinion No. 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Obstetrics & Gynecology, 119(5), 1070-1076.
• U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. Adoption and Foster Care Analysis and Reporting System. (2000-2017). Available from

• Velez, M., & Jansson, L. M. (2008). The opioid dependent mother and newborn dyad: non-pharmacologic care. Journal of Addiction Medicine, 2(3), 113.
• Velez, M. L., & Jansson, L. M. (2014). Perinatal Addictions: Intrauterine Exposures. Textbook of Addiction Treatment: International Perspectives, 2333–2363. doi:10.1007/978-88-470-5322-9_100
• Wachman, E.M., Schiff, D.M., Silverstein, M. (2018) Neonatal Abstinence Syndrome: Advances in Diagnosis and Treatment. JAMA, 319(13), 1362–1374. doi:10.1001/jama.2018.2640.
• Werner, D., Young, N. K., Dennis, K., & Amatetti, S. (2007). Family-centered treatment for women with substance use disorders: History, key elements and challenges. Substance Abuse and Mental Health Services Administration Department of

• Whiteman, V. E., Salemi, J. L., Mogos, M. F., Cain, M. A., Aliyu, M. H., & Salihu, H. M. (2014). Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States. Journal
• f Pregnancy, 2014, 1–8. doi:10.1155/2014/906723
• Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. Substance‐ Exposed Infants: State Responses to the Problem. HHS Pub. No. (SMA) 09‐4369. Rockville, MD: Substance Abuse and Mental Health Services

References