Academic journal article Child Welfare

A Care Coordination Program for Substance-Exposed Newborns

Academic journal article Child Welfare

A Care Coordination Program for Substance-Exposed Newborns

Article excerpt

The Vulnerable Infants Program of Rhode Island (VIP-RI) was established as a care coordination program to promote permanency for substance-exposed newborns in the child welfare system. Goals of VIP-RI were to optimize parents' opportunities for reunification and increase the efficacy of social service systems involved with families affected by perinatal substance use. Findings from VIP-RPs final four years show that by 12 months, 86% of substance-exposed newborns had identified permanent placements and 77% were placed with biological parents or relatives.

The multiple risk factors associated with perinatal substance use, concern about infant safety and legislation mandating expedited permanency decisions contribute to the need for systemic approaches that will lead to thoughtful permanent placements for substanceexposed newborns while allowing parents opportunities to achieve reunification. The Vulnerable Infants Program of Rhode Island (VIP-RI) was developed in response to concerns about the numbers of children in RI placed in foster care and the shortened timeframes for establishing permanency mandated in the Adoption and Safe Families Act of 1997 ([ASFA]; PL. 105-89). VIP-RI is a care coordination program that promotes permanency for substance-exposed newborns in the child welfare system (CWS) by working closely with their parents and the social service agencies, such as child welfare, courts, and substance abuse treatment providers that are major influences in placement outcomes. Findings from the programs initial four years showed that the time substance-exposed infants spent in the newborn nursery beyond medical necessity decreased and that by 12 months of age, 78% of infants were placed with a parent or relative and 84% had identified permanent placements (Twomey, Caldwell, Soave, Fontaine, & Lester, 2010). This paper presents outcomes from the final four years of VIP-RI (October 1, 2005 to September 30, 2009) and discusses the implications of the program's design and implementation for individuals and agencies working with substanceexposed newborns and their parents.

Perinatal Substance Use and CWS Involvement

The widespread increase in drug use by pregnant women beginning in the late 1980s, resultant reporting laws and child removals have contributed to larger numbers of infants with CWS involvement (Smith, 2003; Wulczyn, Hislop & Harden, 2002). Infants spend more time in care and are less likely to reunified (Berrick, Needell, Barth, & Jonson-Reid, 1998; Harden, 2007; Kemp & Bodonyi, 2000; Wulczyn et al., 2002). Using the Cox regression model on adminis- trative data of children in out-of-home placement because of parental substance use, Smith (2003) found substance-exposed infants placed before they were 12 months old had longer times to reunification than children placed when they were older than 12 months. An exam- ination of 11 state agencies' archival foster care data from 1990 to 1997 found that infants younger than 3 months represented the largest cohort of infants entering foster care, had longer stays in fos- ter care, and were less likely to be reunified (Wulczyn et al., 2002).

Drug use during pregnancy raises concerns about the quality of care mothers will be able to provide (Hans, 2002). Risk factors asso- ciated with parental substance use, including co-occurring psychiatric disorders, living in high-risk environments, violence, trauma, and limited social support, compound concerns about the safely and well-being of substance-exposed newborns (Bandstra, Morrow, Mansoor, & Accornero, 2010; Hans, 1999; Kettinger, Nair, & Schüler, 2000). Although there are no uniform child welfare standards of prac- tice about how to respond to prenatal substance exposure (Lester, Andreozzi, & Appiah, 2004; Ondersma, Malcoe, & Simpson, 2001; Ondersma, Simpson, Brenstan, & Ward, 2000), often substance- exposed newborns become involved in the CWS at birth and are placed in foster care (Kemp Sc Bodonyi, 2000; Minnes, Singer, Humphrey-Wall, & Satayathum, 2008). …

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