Planning for Safe Care: What Your Family Drug Court Needs to Know about Opioid Disorders and Serving Affected Mothers and Their Infants

Transcription

1 Planning for Safe Care: What Your Family Drug Court Needs to Know about Opioid Disorders and Serving Affected Mothers and Their Infants Hanh L. Dao, MSW Technical Assistance Manager National Center on Substance Abuse and Child Welfare Children and Family Futures National Association of Drug Court Professionals 22 nd Annual Training Conference Anaheim, CA June 02, 2016

2 A Program of the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment and the Strengthening Partnerships Administration on Children, Youth and Families Children s Bureau Office on Child Abuse and Neglect Improving Family Outcomes

3 Agenda Evidence Based Treatment of Substance Use Disorders Family Drug Courts: A Unique Opportunity Access to MAT and Other Evidence Based Substance Use Treatment Improve Outcomes for Pregnant and Parenting Women with Opioid Use Disorders and Their Infants Plan of Safe Care: Roadmap to Improving Outcomes

4 Opioids are drugs that reduce the intensity of pain signals. The word opioid comes from the word opium, a drug made from the poppy plant. Opiates refers to natural opium derivatives. Opioids? Opioids refers to semisynthetic opiates: Heroin & Prescription Pain Medications

5 The opioid epidemic knows no boundaries; it touches lives in cities, rural counties and suburban neighborhoods across the country. That s why it s so important that we come together both state and federal leaders - and take a coordinated and comprehensive approach to address this crisis. We all have a role to play and fortunately we share common ground and a common commitment to end this crisis. - Secretary Sylvia Burwell, U.S. Department of Health and Human Services 50 State Convening to Prevent Overdose and Addiction September 17, 2015

6 Evidence Based Treatment of Substance Use Disorders

7 Principles of Effective Drug Addiction Treatment: A Research Based Guide 1. Addiction is a complex but treatable disease that affects brain function and behavior 2. No single treatment is appropriate for everyone 3. Treatment needs to be readily available 4. Effective treatment attends to multiple needs of the individual 5. Remaining in treatment for an adequate period of time is critical 6. Behavioral therapies are the most commonly used forms of drug abuse treatment psychosocial treatment is recommended in conjunction with any pharmacological treatment of opioid use disorder [and] at a minimum should include psychosocial needs assessment, supportive counseling, links to existing family supports, and referrals to community services 7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies 8. An individual s treatment and services plan must be continually assessed and modified 9. Many drug-addicted individuals also have other mental disorders 10. Medically assisted detoxification is only the first stage of addiction treatment 11. Treatment does not need to be voluntary to be effective 12. Drug use during treatment must be monitored continuously as lapses do occur 13. Treatment programs should test patients for infectious diseases 7

8 Medication Assisted Treatment A variety of medications are used to complement substance use treatment for different types of substance use disorders including: Tobacco Alcohol Opioids

9 Each medication varies in its ability to: Prevent or reduce withdrawal symptoms Prevent or reduce drug craving Summary Points: Medications Used to Treat Opioid Use Disorders Medical doctors determine the appropriate type of medication, dosage and duration based on each person s: Biological makeup Addiction history and severity Life circumstances and needs

10 As part of a comprehensive treatment program, MAT has been shown to: Increase retention in treatment Decrease illicit opiate use Decrease criminal activities, re-arrest and re-incarceration Decrease drug-related HIV risk behaviors Decrease pregnancy related complications Fullerton, C.A., et al. November 18, Medication-Assisted Treatment with Methadone: Assessing the Evidence. Psychiatric Services in Advance; doi: /appi.ps The American College of Obstetricians and Gyneocolgoists. (2012) Committee Opinion No. 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Obstetrics & Gynecology, 119(5), Dolan, K.A., Shearer, J., White, B., Zhou, J., Kaldor, J., & Wodak, A.D. (2005). Four-year follow-up of imprisoned male heroin users and methadone treatment: Mortality, reincarceration and hepatitis C infection. Addiction, 100(6), Gordon, M.S., Kinlock, T.W., Schwartz, R.P., & O Grady, K.E. (2008). A randomized clinical trial of methadone maintenance for prisoners: Findings at 6 months post-release. Addiction, 103(8), 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), Kinlock, T.W., Gordon, M.S., Schwartz, R.P., & O Grady, K.E. (2008). A study of methadone maintenance for male prisoners: Three-month postrelease outcomes. Criminal Justice & Behavior, 35(1),

11 Why are the Doors Closed on Medication Assisted Treatment? Stigma 1. Misconception as a moral weakness or willful choice 2. Separation from rest of health care 3. Language mirrors and perpetuates stigma knowledge base regarding evidence based treatment for opioid and other substance use disorders 4. Lack of trust between systems, resulting in medical treatment decisions being made by non-medical professionals Olsen and Shafstein, Confronting the Stigma of Opioid Use Disorder- and Its Treatment, The Journal of the American Medical Association, 2014

12 Almost all (98%) surveyed drug courts reported participants with an opioid use disorder Less than half (47%) reported access to medication assisted treatment Matusow, H. et al., Medication Assisted Treatment in US Drug Courts: Results from a Nationwide Survey of Availability, Barriers and Attitudes. Journal of Substance Abuse Treatment,

13 Recommendations: Medication Assisted Treatment in Drug Courts WHEREAS, addiction to illicit drugs and alcohol is, in part, a neurological or neuro-chemical disorder characterized by chronic physiological changes to brain regions governing motivation, learning attention, judgment, insight, and affect regulation; and WHEREAS, certain medical assisted treatments for addiction including antagonist medications such as naltrexone, agonist medications such as methadone, and partial agonist medications such as buprenorphine have been proven through rigorous scientific studies to improve addicted offenders retention in counseling and reduce illicit substance use, re-arrests, technical violations, re-incarcerations, hepatitis C infections, and mortality National Association of Drug Court Professionals Resolution of the Board of Directors July 17,

14 Drug Court programs should make reasonable efforts to attain reliable expert consultation on the appropriate use of MAT for their participants. This includes partnering with substance abuse treatment programs that offer regular access to medical or psychichiatric services. Drug courts do not impose blanket prohibitions against the use of MAT for their participants. The decision whether or not to allow the use of MAT is based on a particularized assessment in each case of the needs of the participants and the interests of the public and the administration of justice..... National Association of Drug Court Professionals Resolution of the Board of Directors July 17,

15 Statement of Assurance: the treatment drug court(s) for which funds are sought will not deny any eligible client for the treatment drug court access to the program because of their use of FDA-approved medications for the treatment of substance use disorders (e.g., methadone, buprenorphine products including buprenorphine/naloxone combination formulations and buprenorphine monoproduct formulations, naltrexone products including extended-release and oral formulations, disulfiram, and acamprosate calcium). SAMHSA Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Drug Courts (April 10, 2015)

16 Specifically, methadone treatment rendered in accordance with current federal and state methadone dispensing regulations from an Opioid Treatment Program and ordered by a physician who has evaluated the client and determined that methadone is an appropriate medication treatment for the individual s opioid use disorder must be permitted. SAMHSA Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Drug Courts (April 10, 2015)

17 Similarly, medications available by prescription must be permitted unless the judge determines the following conditions have not been met: the client is receiving those medications as part of treatment for a diagnosed substance use disorder a licensed clinician, acting within their scope of practice, has examined the client and determined that the medication is an appropriate treatment for their substance use disorder the medication was appropriately authorized through prescription by a licensed prescriber. In all cases, medication assisted treatment (MAT) must be permitted to be continued for as long as the prescriber determines that the medication is clinically beneficial. SAMHSA Grants to Expand Substance Abuse Treatment Capacity in Adult and Family Drug Courts (April 10, 2015)

18 9 Components of Successful MAT Programs in Drug Court Settings Counseling and other services, plus medication, are essential. Courts are selective about treatment programs and private prescribing physicians. Courts develop strong relationships with treatment programs and require regular communication regarding participant progress. Screening and assessment must consider all clinically appropriate forms of treatment. Judges rely heavily on the clinical judgement of treatment providers as well as the court s own clinical staff. Medication Assisted Treatment in Drug Courts, Recommended Strategies (2015) Legal Action Center, Center for Court Innovation, New York State Unified Court System s Office of Policy and Planning

19 SAMHSA Family Treatment Drug Court (FDTC) Cohort IL Department of Children and Family Services County of Marion, IN, Superior Court King County, WA, Superior Court County of Sacramento, CA Superior Court of CA, County of Alameda County of Commissioners of Charles County, MD Pima County of AZ, Pima County Juvenile Court Harris County, TX (ITC) Department of MH and SA Services, OK Jefferson County Commission, AL Pasco County, FL

20 Family Drug Courts Stage for Transformation Improving Outcomes for Pregnant Women, Infants & Children

21 Our clients get to feel like what it means to be wrapped in services and our social workers get to see what it means to really provide wraparound services. -DCFS Social Worker (FDC assignment) At first I didn t want my baby to come to a rehab hospital, but I am so glad I did, because she is now healthy and I am confident I can take care of her at home -Parent Envelope mothers in an embrace that is maternal, loving but firm [teach that] they will only be able to care for their babies, if they fist take care of themselves stay the course even if you must go back to inpatient rehab or lose temporay custody of your baby; because in the end, the child welfare agencies really do want to reunite mother and child. -Children s Specialist, MD

22 Pregnant Women with Substance Use Disorders Mental Health and Trauma Two thirds co-occurring mental health disorders (Benningfield 2010) Past 30 days: Mood disorder (50%), Anxiety (40%), PTSD (16%) Childhood trauma: 50-90% physical or sexual abuse (Cormier 2000) 67% their parents used drugs (Finnegan 1991) 60-80% past year intimate partner violence (Engstrom 2012, Tuten 2004) Social functioning Inadequate social supports Basic needs Terplan, M. Substance Use and Use Disorder in Pregnancy: Screening, Treatment and NAS

23 Pregnant Women with Substance Use Disorders Stigma shame and guilt Prior poor experience(s) with service providers Terplan, M. Substance Use and Use Disorder in Pregnancy: Screening, Treatment and NAS

24 Pregnant women with opioid and other substance use disorders have a unique set of needs across multiple domains that affect both obstetric health and outcomes and substance use treatment Gold Standard: Comprehensive, coordinated service delivery Adapted from Terplan, M. Substance Use and Use Disorder in Pregnancy: Screening, Treatment and NAS

25 Prescription Opioid Use Among Pregnant Treatment Admissions Martin, C.E., et al., Recent trends in treatment admissions for prescription opioid abuse during pregnancy. Journal of Substance Abuse Treatment (2014),

26 Rate of NAS per 1,000 Hospital Births Incidence of Neonatal Abstinence Syndrome Over Time The mean length of stay for infants with NAS is 16.4 days at an average cost of $53, Year Patrick SW, et. al. Neonatal Abstinence Syndrome and Associated Healthcare Expenditures United States, JAMA May 9;307(18):

27 New England East South Central Source: 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 Journal of Perinatology, 35(8),

28 Matusow, H. et al., Medication Assisted Treatment in US Drug Courts: Results from a Nationwide Survey of Availability, Barriers and Attitudes. Journal of Substance Abuse Treatment, A quarter 26% surveyed drug courts reported availability of medication assisted treatment for pregnant participants

29 Clinical Standards of Care: Treatment of Opioid Use Disorders in Pregnancy Decisions to use opioid agonist medications in pregnant women with opioid use disorder revolve around balancing the risks and benefits to maternal and infant health.women with opioid use disorder who are not in treatment should be encouraged to start opioid agonist treatment with methadone or buprenorphine monotherapy (without naloxone) as early in the pregnancy as possible. American Society of Addiction Medicine, National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (2015)

30 Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise. American College of Obstetricians and Gynecologists and American Society of Addiction Medicine, Committee Opinion on Opioid Abuse, Dependence, and Addiction in Pregnancy Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy

31 Mothers receiving methadone and buprenorphine monoproduct for the treatment of opioid use disorders should be encouraged to breastfeed American Society of Addiction Medicine, National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (2015)

32 Services for pregnant and breastfeeding women with substance use disorders should have a level of comprehensiveness that matches the complexity and multifaceted nature of substance use disorders and their antecedents in this population. World Health Organization, Guidelines for the Identification and Management of Substance Use Disorders in Pregnancy (2014)

33 Interventions should be provided to pregnant and breastfeeding women in ways that prevent stigmatization, discrimination, criminalization, and marginalization of women seeking treatment to benefit themselves and their infants. World Health Organization, Guidelines for the Identification and Management of Substance Use Disorders in Pregnancy (2014)

34 Neonatal Abstinence Syndrome (NAS) An expected and treatable condition that follows prenatal exposure to opioids Symptoms begin within 1-3 days after birth, or may take 5-10 days to appear and include: Blotchy skin; difficulty with sleeping and eating; trembling, irritability and difficult to soothe; diarrhea; slow weight gain; sweating; hyperactive reflexes; increased muscle tone Timing of onset is related to characteristics of drug used by mother and time of last dose The American College of Obstetricians and Gynecologists. (2012) Committee Opinion No. 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Obstetrics & Gynecology, 119(5), U.S. National Library of Medicine, National Institutes of Health. Neonatal Abstinence Syndrome. Retrieved from on July 24, 2014 Hudak, M.L., Tan, R.C. The Committee on Drugs and the Committee on Fetus and Newborn. Neonatal Drug Withdrawal. Pediatrics. 2012, 129(2): e540 Jansson, L.M., Velez, M., Harrow, C. The Opioid Exposed Newborn: Assessment and Pharmacological Management. Journal of Opioid Management. 2009; 5(1):47-55

35 Neonatal Abstinence Syndrome: Treatment Non-Pharmacological Treatment Swaddling Breastfeeding Calm, low-stimulus environment Rooming with mother Pharmacological Treatment Individualized based on severity of symptoms Standardized scoring tool to measure severity of symptoms Assessment of risks and benefits The overarching goal of treatment is to soothe the newborn s discomfort and promote mother-infant bonding. American Academy of Pediatrics, Committee on Drugs (1998). Neonatal Drug Withdrawal. Pediatrics, 101(6), ; Hudak, M.L., Tan, R.C. The Committee on Drugs and the Committee on Fetus and Newborn. Neonatal Drug Withdrawal. Pediatrics. 2012, 129(2): e540; Jansson, L.M., Velez, M., Harrow, C. The Opioid Exposed Newborn: Assessment and Pharmacological Management. Journal of Opioid Management. 2009; 5(1):47-55; Jones, H., Kaltenbach, K., Heil, S., Stine, S., Coyle, M., Arria, A., O Grady, K., Selby, P., Martin, P., Fischer, G. (2010). Neonatal Abstinence Syndrome After Methadone or Buprenorphine Exposure. New England Journal of Medicine, 363(24):

36 Complex Interplay of Factors across a number of models with and without covariates, environmental risk accounted for more variance in developmental trajectories than did prenatal exposure. Interaction of various factors prenatal and environmental factors Family characteristics Prenatal care Exposure to multiple substances: alcohol and tobacco Other health and psychosocial factors have a significant impact The American College of Obstetricians and Gyneocolgoists. (2012) Committee Opinion No. 524: Opioid Abuse, Dependence, and Addiction in Pregnancy. Obstetrics & Gynecology, 119(5), ; Emmalee, S. B. et al. (2010) Prenatal Drug Exposure: Infant and Toddler Outcomes. Journal of Addictive Diseases, 29(2), ; Baldacchino, A., et al. (2014). Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis. BMC Psychiatry, 14(104);

37 Strategies to Improve Outcomes for Pregnant Women, Infants and Families

38 Child Abuse Prevention and Treatment Act (CAPTA) health-care providers involved in the delivery or care of substance exposed infants must notify child protective services, and a plan of safe care 38 is to be developed for these infants.

39 CAPTA 2010 Clarifications Except that such notification shall not be construed to Establish a definition under Federal law of what constitutes child abuse or neglect; or Require prosecution for any illegal action. 39

40 CAPTA Intent To identify infants at risk of child abuse and neglect as a result of prenatal substance exposure, so appropriate services can be delivered to the infant and mother, ensuring the safety and well-being of infants, their mothers and their families

41 CAPTA Plan of Safe Care: Preparing for Baby s Arrival and Beyond Comprehensive multi-disciplinary assessment Multiple intervention points: pregnancy, birth and beyond Addresses needs of mother, infant and family Structure in place to ensure coordination of, access to, and engagement in services

42 Ideally, developed prior to the birth event

43 Multi-Disciplinary Assessment Coordinated across disciplines Identify the mother and infant s physical, social-emotional health and safety needs Identify the mother s strengths and parenting capacity Includes assessment of risk and safety factors to determine infant placement (differentiating risk and safety factors related to parental opioid use)

44 Differentiating Risk and Safety Factors Related to the Use of Opioids Assessment of risk and safety factors to determine whether: Pre-natal The newborn exposed to opioids and/or other substances should be placed in protective custody. Post-natal Opioids and other substance use affects parents ability to safely care for their children. Chronic pain or other medical conditions maintained on medication Actively abusing or dependent on heroin Misuse of own prescribed medication Misuse of nonprescribed medication In recovery from opioid addiction & maintained on methadone or buprenorphine (e.g. MAT) Adapted from Dr. Cece Spitznas, White House Office of National Drug Control Policy 9;307(18):

45 Different Situations Require Different Responses: Comprehensive Assessment Parent Risk Factors Parental substance use Parenting skills and competences Parental mental health; co-occurring Trauma History of childhood abuse Child Risk Factors Age Prenatal Exposure Behavior Trauma Mental health Adolescent substance abuse Family Risk Factors Basic necessities Employment Housing Family connections and resources Domestic Violence 45

46

47 COMPONENTS OF PLANS OF SAFE CARE FOR INFANTS, MOTHERS AND FAMILIES AFFECTED BY PRENATAL SUBSTANCE EXPOSURE DOMAINS SERVICES AND SUPPORTS Mother Health Pregnancy and Post-partum care Medical home is designated that is consistent with the family s insurance plan and has responsibility for the primary care needs for the mother and family. Medical homes are often designated in States with Medicaid managed care plans Medication management is assessed and the Medical Home provider has responsibility to oversee including liaison with methadone or other medications used in assisting treatment Pain management Contraception and pregnancy prevention Support with breastfeeding Substance Use and Timely access to treatment is ensured by referrals and appropriate feedback across agencies. Mental Disorders Engagement and retention outreach services and on-going recovery supports Prevention, Appropriate treatment (gender-specific, family focused, accessible, medication assisted treatment, trauma) Intervention and Mental health services including symptoms of depression and anxiety Treatment Intervention for domestic partner and family Violence Substance use and mental health treatment for partner and other family members Parenting/Family Coordinated care management Support Home Visiting follow up services are provided including infant care, parent/infant boding, nurturing parenting guidance and skill development, safe sleep practices, and maternal support Child Care in developmentally appropriate programming when needed by the family Income support and safety net benefits eligibility determination and employment support Safe and stable housing determinations are made Need for transportation is assessed Infant Health Linkage to a medical home for infant primary health care is provided Need for high-risk infant follow-up Care is determined Referral to specialty health care as needed

48 Structure: Access and Continued Engagement Designate agency charged with leading the development of the Plan of Safe Care Ongoing support and monitoring to ensure continued engagement in services Information sharing protocols

49 Five Points of Intervention Pre-Pregnancy Awareness of substance use effects Legend System Linkages Prenatal Screening and Assessment Initiate enhanced prenatal services Child Identification at Birth Parent Post-Partum Ensure infant s safety and respond to infant s needs Respond to parents needs Infancy & Beyond Identify and respond to the needs of the infant, toddler, preschooler, child and adolescent Identify and respond to parents needs

50 Expanding the FDC Partnership MAT and substance use treatment providers who are knowledgeable and experienced in working with pregnant women Mother s medical providers OB/GYN and others Infant s medical providers Pediatrician, Neonatologists and others Early Childhood Home Visiting Programs

51 A Collaborative Approach Women with opioid and other substance use disorders are identified during pregnancy Engaged into prenatal care, medical care, substance use treatment, and other needed services A Plan of Safe Care for mother and baby is developed.reducing the number of crises at birth for women, babies, and the systems!

52 & Discussion

53 Hanh Dao, MSW Technical Assistance Manager National Center on Substance Abuse and Child Welfare Technical Assistance ncsacw.samhsa.gov

54 2-Part Webinar Series A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical and Service Providers Partnering to Treat Pregnant Women with Opioid Use Disorders, Lessons Learned from a Six Site Initiative

55 CHARM Collaborative: Case Study Department of Children and Families Department of Corrections Department of Health, Alcohol & Drug Abuse Programs Department of Health, Maternal and Child Health Department Healthcare Access (Medicaid) 1. Engage women in prenatal care as early in the pregnancy as possible 2. Reduce cravings and withdrawal symptoms using medication assisted treatment (MAT: methadone or buprenorphine) 3. Engage women in substance abuse counseling 4. Provide social support and basic needs referrals for the family 5. Coordination occurs prior to the birth event, and beyond. Child welfare assessment 30 days prior to the birth event. Goal: Improve the health and safety outcomes of babies born to women with a history of opioid dependence

56 How it Works: Key Elements A Shared Philosophy: Improving care and supports for mothers is the most important factor in helping to ensure the health and safety of infants. Sharing information is critical to providing the best care and services to moms and babies. Regular, monthly meetings to discuss and staff cases.

57 Pregnancy Comprehensive Assessment: Confirm Pregnancy, Assess for Opioid Dependency, Assess for Additional Needs Enhanced Prenatal Care: Urine Drug Test; Monitoring of Prenatal Visits; Monitoring for Relapse or Dose Adjustment Assessment for & Engagement in Medication Assisted Treatment Substance Abuse Counseling: Required for all Women Receiving MAT Prenatal Neonatal Consultation: Education on Newborn Care and Neonatal Abstinence Syndrome Our Care Notebook: Developed by CHARM women; Includes Resources, Personal Stories, and Encouragement

58 Birth and Postnatal Care Needs Identified and Plan of Care Developed Prior to Labor and Collaboratively Neonatal Abstinence Syndrome Assessment and Treatment Parent(s)/Caregiver(s) Trained to Administer Pharmacological Treatment to Infants Post-Discharge, when necessary Intense Level of Support Provided: Assistance and Support Available 24 hours, 7 days

59 Infancy, Postpartum and Ongoing Care Follow-up Services Continue for Both Mother and Infant Infant Visits NeoMed Clinic Regularly Until months Infant Visits Include Monitoring of Growth and Development; Parent Education on Child Development,Safe Sleep, Breastfeeding, etc. Continued Monitoring of and Support Provided to Parent(s)/Caregiver(s) who Administer Pharmacological Treatment to Babies with NAS

60 Collaborative Staffing: Indicators of Strengths and Concerns Attendance and engagement at prenatal appointments Participation in substance use counseling and other services Progress in Recovery Medication Assisted Treatment Infant s treatment and development needs Mother-Infant Bonding Partner s/household engagement in substance use treatment Family Support Co-Occurring Issues: Domestic Violence, Mental Health, etc. Social services needs

61 About: Prevalence and Incidence Treatment of Opioid Use Disorders Treatment of Opioid Use Disorders in Pregnancy Neonatal Abstinence Syndrome Access to Medication Assisted Treatment Policy Resources Site Examples

62 FDC/Drug Court resources on MAT Medication Assisted Treatment in Drug Courts, Recommended Strategies (2015) Legal Action Center, Center for Court Innovation, New York State Unified Court System s Office of Policy and Planning Online Medication Assisted Treatment Course: 9 Modules National Drug Court Institute (2016)

63 Understanding Treatment of Opioid Use Disorders Treatment-for-Opioid-Addiction-Facts-for-Families-and-Friends/SMA

64 Understanding Treatment of Opioid Use Disorders in Pregnancy Medication Assisted Treatment During Pregnancy, Postnatal and Beyond ation-assisted-treatment-during-pregnancy-postnataland-beyond The Use of Medication-assisted Treatment during Pregnancy: Clinical Research Update Treatment of Opioid Use Disorders in Pregnancy and Infants Affected by Neonatal Abstinence Syndrome

65 Journeys of Hope, Mommies and Babies Overcoming Neonatal Abstinence Syndrome Texas State Department of Health Services Stronger Together, NAS Soothing Techniques for Mommies and Babies Texas State Department of Health Services Understanding Neonatal Abstinence Syndrome University of Maryland Medical Center Describes Neonatal Abstinence Syndrome symptoms, screening/identification, and treatment.

66 Collaborative Initiatives Initiatives Burlington, VT: CHARM Ohio: MOMS Maine: Snuggle ME Delaware Pennsylvania

67 NCSACW Online Tutorials Free CEUs! 1. Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers 2. Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals 3. Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals Updated September 2015: New content including updates on opioids and Family Drug Courts!

68 Additional Training Resources

69 Additional Resources 69