Supporting Families Affected by Opioids through IECMHC

to the webinar on supporting families affected by
opioids and other substance use disorders through Infant
and Early Childhood Mental Health Consultation. This webinar is brought
to you today through the Federal Leadership of the Substance
Abuse and Mental Health Services Administration in partnership
with the Administration for Children and Families
and the Health Resources and Services Administration. You can see we have a disclaimer
here that talks about how the content, opinions and views
are not necessarily those of the group
that’s bringing this to you. We have three objectives
for this one hour webinar. The first one is to understand
how the use of opioids and other substances in families
affects the social and emotional development and the
cognitive skills of babies and young children. We also want to understand how
opioids and other substance use in families affects the
attachment relationship between the caregivers and the infants. And we’re going to identify
strategies that consultants use to support the work of home
visitors as they work directly with pregnant and parenting
families who may be impacted by substance use. We have three speakers today. I’m
going to introduce those to you. Dr. Ira Chasnoff is the
President of the NTI Upstream. He is a Pediatrician and a
Professor of Clinical Pediatrics at the University
of Illinois College of Medicine. We have Lesley Schwartz
with us today from the Illinois Governor’s Office of Early
Childhood and she is the MIECHV Project Director. MIECHV standing for
Maternal, Infant Early Childhood Home Visiting. And
then my name is Linda Delimata. I am an expert mentor at the
Center of Excellence for Infants and Early Childhood
Mental Health Consultation. Thank you all for joining us. It’s pretty clear that we have
a big problem with substance misuse
and in particular with opioids. It’s such a big problem
we’re calling it a crisis. It is impacting our families,
people are losing their lives, people are going to jail and
if they have infants and young children in their lives, the
children are there without the supports that they need
in order to grow and develop. It takes all of us to join in
and collaboratively decide how we’re going to do this support
to families in order to help this issue. Today we’re going to talk about
consultation in home visiting and how that can be one
part of the problem, not a fix. It is however a way to help
identify those who might need help, a way to open those
conversations and how we can support home visitors as they
navigate this world that they’re experiencing
as they do their work. Although substance use or misuse
may be something that the adult is involved in through their own
behavior, it impacts everyone that’s
around them in a really big way. When we look at the children,
it disrupts their security and security is important
as a child learns and grows. It interferes with the parent
child relationship and we know that the relationship is how
children get their social and emotional skills, how their
cognitive and physical skills develop and it’s one of the most
important pieces of how we help children so we’re going to talk
today a lot about relationships. Here are some things that
we know about opioid issues. These are just some facts
that relate to the children. The number of babies born
with NAS or Neonatal Abstinence Syndrome is increasing rapidly. The number of babies under the
age of one who have been removed from their home due to
substance use doubled between 2005 and 2013. And then substance misuse
accounts for almost half of all out-of-home placements for
children under the age of one. There are so many
complications that go with the use of
substances and with opioids. Complications that might
involve child welfare, that might involve the criminal
justice system, might involve incarceration, treatment, all of
those things affect the child as well as it affects the family
and so we’ll talk today about ways that we can work with
those who support the families. So substance use impacts all the
adults in the family, not just the user. If your mother is using in
the family, it also impacts the people who are also in
that family and working with the child so it could
be the partner, it could be a grandparent
or it could be a sibling. It
is all people who are involved. Sometimes when we treat
that adult we focus only on that adult and the substance
use issue but what we know is because it impacts the whole
family we should be looking at the supports to that child that
are available in all parts of their life so we should also
be including their childcare. We should
be including their preschool. We should be including the home
visitors who work directly with those children and any services
that are available should include all parts of that
person’s life, the whole family. What we know about home
visitors is they’re right there in that family. They focus on the needs and
the development of that child. And what they do in their work
is to look at everything that impacts that child’s growth
and development and to promote healthy ways of interacting, to
promote ways to help that child grow and develop and also to
identify and address those that get in the way. So home visitors are uniquely
positioned to take a look at this particular issue. Babies’
brains develop so quickly. These facts are amazing. In the first few years of life,
700 to 1,000 new neurological connections form every second. Each second that child’s
brain is growing and developing. They just grow at lightning
speed and this critical time is so important to brain
development and everything that follows. So kids grow and learn
by processing everything and everyone
that happens around them. They react to their environment. They react to the
relationships that they have. That’s why environmental
relationships are so essential to children’s growth. Home visitors notice. So they’re in the homes of the
families that support them on a regular basis and they
work themselves to establish relationships so sometimes
they’re in those homes weekly. They might spend an hour every
week with the family and they become a part of conversations
about how to help that baby grow and develop. And they are witnesses to
things that are going on with that child and the things
that happen within their home. Together they work with the
family to look at the cognitive, physical, social and emotional
development of that child. They understand the importance
of relationships and they use their own relationships
to connect with the families but they take a look at
whatever stands in the way of that relationship and then they
attempt to address what those things might be. So many times home visitors
do screenings and check. They do
screenings on a regular basis. They’ll be doing screenings on
child growth and development and that includes social
and emotional development. They
might use the ASQ or the ASQ:SE. They do screenings
on maternal depression. They do
screenings on partner violence. And then one of the other
things and the reason that we’re talking today is that they
do screenings on substance use. So your home visitor is on
a regular base taking a look at what are the things
that interfere with that child’s development
including substance use. Your mental health
consultant then is someone who helps support that home visitor. They are there to help that
home visitor focus on how best to help the family. So mental health consultants
aren’t there to provide therapy for families or children. They’re there to partner and
collaborate with the adults in the child’s life. So in the case of
home visiting, that’s who they work with. They work with the home visitor
and their goal is to help build their capacity to strengthen and
support that healthy social and emotional
development of children. Home visitors frequently
work with either pregnant or pre-birth all the way up to age
three and this is that critical time for brain development so a
mental health consultant can be integral to addressing the
issues that interfere with that brain development. So mental health consultants are
not direct service providers but instead they work with the home
visitor and they are supporting them so that they can do
their very best for the family. The mental health consultant
then brings the lens of mental health and relational
behavioral health to the home visitor. One of the things that we do
is to help to understand how the issues related to
substance use and opioid use impact that family. In addition, we give them a safe
place so that they can focus on anything that they need
to in order to identify issues. So let’s say we’re going to walk
through the screening tool about substance use. Sometimes that’s pretty simple
and that screening tool doesn’t identify anything that would
be of concern and that works out real well. But when some things show
up, you have a mental health consultant that a home visitor
can sit down and talk to about here are some things
I found in that screening tool. I’m
not sure what’s the best step. Can we walk
through what might be happening? Can we talk
about what I should do next? Is this a place where I need
to make a referral or is this a place where I need to keep
the conversation going and ask more questions? So it gives the home visitor a
place to walk through all of the issues that they’re addressing
and then to have a reminder that the focus is on secure
and nurturing relationships in combination with the
environment so that we have that healthy brain development
and social and emotional growth. So the mental health consultants
are a support to home visitors and home visitors see and
experience things that can be very difficult. A mental health consultant
is there to help them process through and walk through issues. It gives them a time to
reflect on what’s going on and keep themselves non-judgmental
so that they can keep those conversations going with the
families so that they can help identify and support the
mom as that mom might need some assistance in
getting support for her issues. And they help with words because
sometimes it’s hard to know what to say and how to get into that. Let’s say that I’m a home
visitor and I’m working with a young mom and this young mom is
using a substance of alcohol and she
is pregnant and she is drinking. I’ve had a conversation with her
and I’ve talked about how this can interfere with the health of
her baby, with the relationships with her young child and that
it’s a real important thing for her to consider reducing or
eliminating the use of alcohol. And then I’m in her home the
next week and she’s still using and I talk about it again. And so what might be happening
with that home visitor is they’re getting frustrated. They’re thinking that
they’re not having an impact. They’re
not sure what to do next. They can sit down with their
home visitor and talk through this situation and then find
words that remain supportive and non-judgmental so that we can
open that channel, so that we can help that
mom get the support she needs. What you might want to say
is you need to stop drinking but what you really need to
say so that you are opening that conversation might be something
like I am concerned, which gives a different message. It is the relationship between
the mental health consultants and the home visitors that
provide that support and safe place to talk and it is the
relationship between the home visitors and the families
that provides that safe place to take action. This
is a collaborative relationship. There’s not one person
telling another one what to do. This is how we work together in
partnership to make some things move forward. Mental health consultants
provide also assistance in referral. So let’s say you’ve walked
through all of the issues that you feel we can do in home
visiting and the next step is going to be let’s
refer that person to treatment. That is so hard to do sometimes. There needs to be many steps
taken and your mental health consultant can help with what we
call a “warm referral”, make the connection with the next step,
talk to the agency that will be receiving the referral, make
some connections between them, potentially set the path going
so that this isn’t a referral where no one then gets back
to them so having that “warm referral” makes
this a much easier process. I am going to turn this over
to Lesley Schwartz now to talk about the
Illinois MIECHV work. Lesley.>>LESLEY
SCHWARTZ: Thank you, Linda. Illinois has long valued
the role of Infant Mental Health Consultation in Home Visiting. Since its inception, MIECHV
in Illinois has funded infant mental health consultation
and offered it to all of our programs. Concurrently at the inception
of MIECHV, we also recognize the importance of screening prenatal
mothers for substance abuse, depression
and domestic violence. To that end, we collaborated
with Dr. Ira Chasnoff to train our
home visitors on the 4P’s Plus©. The 4P’s Plus© is a validated
screening tool for prenatal mothers at risk for tobacco,
alcohol, illicit drug use, depression
and domestic violence. After our home visitors
began integrating the 4P’s Plus© screening tool it become
apparent that they would benefit from ongoing
support around using the tool. Not only did they need support
on how to talk to mothers about the results of their screens but
they also needed to understand and address their own biases. We knew that the infant mental
health consultants could provide just that in all the ways that
Linda just described to you. We decided then to cross
train the infant mental health consultants on the 4P’s
Plus© and we connected them with Dr. Ira Chasnoff who implemented
a train the trainers so that the consultants could train
the home visiting programs. Cross training the infant mental
health consultants in the 4P’s Plus© was not only a good fit
given their expertise in mental health and substance
abuse issues but it also made sense logistically. The consultants already had
established relationships with program supervisors and home
visitors and they also already had regular
scheduled in-person meetings. Essentially the consultants
could bring the training to the programs and this eliminated any
barriers related to traveling to training or waiting for the next
available training because the training could be brought to the
programs where they wanted it and when they needed it. It was also helpful when there
was staff turnover because the consultants could get new
staff up to speed much quicker. This arrangement with the
consultants has worked out so well in Illinois that we
expanded the curriculum that our infant mental health consultants
are cross trained on and even asked them to develop
specialized curriculums on topics that home
visitors were interested in. So in addition to the 4P’s
Plus©, the infant mental health consultants in Illinois can
train home visiting programs on the Mothers and Babies Programs
which is a depression prevention curriculum we
implement in partnership with Northwestern University. The infant mental health
consultants also train on the futures about violence, healthy
moms happy babies curriculum which addressing
intimate partner violence. And we have the infant mental
health consultants develop their own training for home
visitors working with parents with special needs. We look forward to continuing
this partnership between infant mental health and Dr. Ira
Chasnoff and it is at this point that I get to pass it on
to Ira to discuss the role home visitors play
in prenatal opioid exposure.>>DR.
IRA CHASNOFF: Thank you, Lesley. It is my pleasure
to be with all of you today. I’ve been working with home
visiting programs in several states and have found that home
visitors really can get to the heart of the matter especially
when we’re talking about very high risk families affected by
depression, domestic violence or substance use. Now I’ve been asked to
talk about the neurobiology of prenatal opioid exposure
but I want to reiterate a very important point. As we discuss the impact of
opioids, we have to understand and remember that children grow
and develop in the context of relationships and so we have to
look at opioid use and prenatal opioid exposure through that
lens of relationships and ask how the exposure does affect
the development of relationship between the mother and infant. We’re looking at this from the
perspective of attachment and let’s make sure we
understand what attachment is. Attachment is the
interconnectedness between human beings and it requires each of
those human beings to read the other’s cues and to respond
appropriately to those cues. In the context of the
mother infant relationship, the important thing to remember is
that attachment is not the sole responsibility of the mother
but the infant must have those same capabilities. The infant must be able to read
the mother’s cues and respond appropriately
to the mother’s cues. So an infant affected
by prenatal substance exposure starts with one strike against
him when it comes to fulfilling his role in attachment. We’re going to
begin our discussion on the placental side. We’re
going to talk about the mother. The mother must be accessible
to the infant and responsive to the infant. Now in our research over the
years in looking at this issue, we’ve identified six factors
affecting relationships in women who are chemically dependent. The first is negative heritage. We learn to be parents from our
own parents and in many cases as documented through the ACEs
Studies, a woman who is using substances as an adult often
came from a family in which there was substance abuse,
domestic violence, mental health difficulties in the family and
so that right there sets her up for having no role model when
she was a child, no role model for positive parenting. We know also that many
of the women come to us with a significant history of trauma. In our own research with
this population as well as the research of many others, we find
that at least 90% of women who are using substances
during pregnancy have suffered significant early trauma. Children who grow up in homes
that have substance abuse or domestic violence in the home,
we look at those families as avoidant families because
they operate outside the context of systems. They avoid getting involved
with healthcare systems and other treatment programs and
so a child who grows up socially isolated learning to keep
secrets is going to grow into an adult who is socially isolated. The other issue is cognitive
functioning because a lot of our work is psycho-educational. To discuss this, I want to give
a good example of how substance use can affect cognitive
functioning in the adult. The MRIs you see here, the two
top and bottom on the right, are a woman
with chronic alcoholism. I know that our discussion
today is opioids but you have to recognize that the most common
form of substance use by women is polydrug use. So that again from our data we
find that about 81% of women who are using opioids are
also using alcohol, tobacco and often marijuana. Now the two on your left,
top and bottom, are normal MRIs. Two cuts looking from the back
toward the front of the brain. I’ll draw your attention in
the top one on the left to this open space. This is called the ventricles so
these are the ventricles and the ventricles are open spaces in
the brain through which spinal fluid flows to nourish
the brain, so top and bottom. Now if you look to the right,
this is a woman with chronic alcoholism and the first thing
you see is the open space that the ventricle
has expanded quite a bit. This is because alcohol kills
off brain cells and what that produces as the brain cells die
off in the periventricular area you get expansion of
the ventricle and this affects global cognitive functioning. In the bottom two, on the left
is the normal and what you can see here, this structure
right here is called the corpus callosum. The corpus callosum
is responsible for moving information from one side of the
brain to the other so that’s how you connect
the two sides of the brain. If you look at the bottom right
MRI, the same cut through the brain but you can
see significant thinning of the corpus callosum. What this means clinically
is that there is difficulty in connecting the right and left
sides of the brain so the woman has difficulty making
decisions, looking at long-term consequences, understanding
the consequences of behavior so these are all aspects of
behavior that can be affected by chronic alcoholism. The other thing we know is that
women who are using substances have a significantly higher rate
of co-occurring mental health disorders than do men who
have substance use disorders. And we see that psychological functioning is affected. The two diagnoses we make most
commonly in pregnant women who are using alcohol
and drugs are depression and borderline personality. Now depression it would be
pretty clear as to the effects on that maternal infant
relationship but let’s talk about borderline
personality just for a moment. Borderline personality
is when the individual is very ecocentric, looks at everything
that happens in the world as it affects him or her. There’s a lack of empathy. There’s no understanding of
what they do and say how that affects others. And so you can imagine
now a woman who has a borderline personality, imagine how that
affects her responsiveness to the infant. And then finally the
sixth factor is substance use. Now this is the neuro-biological
cycle of attachment and I’d like to start up here where the red
asterisks is and we’re going to follow this cycle around. The neuro-biological basis
of attachment resides in the dopamine
system and the oxytocin system. Dopamine is a
neurotransmitter and dopamine is key to regulatory behavior. You’re going to hear
me talk a lot about regulation. The other is oxytocin. Oxytocin is produced in the
brain by the hypothalamus and it’s often referred
to as the cuddle hormone. That is the hormone that drives
attachment and when you make an attachment with another
individual whether it’s an infant or another
adult that fires off oxytocin. So if we take the typical
situation we have an adult woman with properly functioning
dopamine and oxytocin pathways. She becomes pregnant and
both her prenatal and postnatal caregiving environment are
providing dopamine and oxytocin responses to her
growing attachment to her fetus. This allows the fetus then
to begin developing appropriate dopamine and oxytocin pathways
so once the infant is born, he is born with appropriate
neuroendocrine development. That results in infant
attachment behaviors which of course drives increasing
oxytocin and dopamine responses. You have ongoing environmental
influences but this infant grows into an adult with an intact
attachment system so that when that individual is an adult
they’re ready to start human cycle all over again. Now the difficulty we get into
is that chronic administration of drugs of abuse such as
opioids or cocaine substantially reduces oxytocin levels in the
hypothalamus so now one of the key pathways of
attachment has been affected by substance abuse. Where that leaves us in the
cycle then is that if substance abuse disrupts oxytocin
levels and so you get decreased oxytocin produced in the adult
brain during the prenatal and postnatal period the mother’s
oxytocin levels are reduced which means there’s decreased
stimulation for the development of
the infant’s oxytocin systems. You get impaired attachment
behavior, ongoing environmental influences so that as that
infant grows into an adult he has an attachment system
that has been hampered by his prenatal
exposure to substances of abuse. And so you can see that just
looking at oxytocin responses we have a biological
basis to inhibiting the appropriate attachment. And so let me remind you
children grow and develop in the context of relationships driven
by the oxytocin hormonal system and
the dopamine receptor system. So
let’s talk about the infant now. We’re going to talk about the
biological basis of the effects of prenatal drug
use on the catecholamine system. Now the catecholamines are also
known as neurotransmitters and the key neurotransmitters
are dopamine, norepinephrine, serotonin but we’re
going to focus on dopamine. We’ve already been talking about
the importance of dopamine in the attachment cycle. Related to substance
abuse, dopamine as I said is the regulatory center of the brain
but it also is the pleasure center of the brain. So for example, when you
eat food, you fire off dopamine. That’s
why we enjoy eating so much. The reason drug users use drugs
is to get that dopamine affect. For instance, with
methamphetamine, methamphetamine acts at the presynaptic
junction, the electrical message of nerve stimulation travels
down the pathway, is picked up by the dopamine, the electrical
message is carried across the nerve gap, the dopamine releases
the electrical message and then dopamine circulates back
to the proximal nerve ending. This is called re-uptake so
that’s why we never run out of dopamine because
of this re-uptake process. Now methamphetamine causes
excess release of dopamine across the nerve gap so
that’s how a person gets high from methamphetamine. Cocaine there’s a normal amount
of dopamine that crosses the nerve gap but then cocaine
blocks dopamine re-uptake so you get excess dopamine
at the postsynaptic junction. That gives you the high. Today’s
conversation is about opioids. Opioids act on the midbrain and
what happens if you look at the green representing an opioid,
morphine, opioids attach to the opioid receptors,
which is the yellow here. When the morphine in this case
attaches to the opioid receptor, this decreases the release of
gamma aminobutyric acid, GABA, and this sends a
signal to release more dopamine. And so morphine by blocking
dopamine receptors stimulates the brain to release more
dopamine and again that’s how you get the high. So what are the effects
of prenatal opioid exposure? Well we’ve already said
that dopamine is the regulatory center of the brain. It’s the pleasure center of the
brain but dopamine also acts on smooth muscle so that anytime
someone uses any opiate as well as tobacco, cocaine,
methamphetamine one of the first affects is tachycardia, an
increased heart rate because the heart is made
completely of smooth muscle. The other major organ of the
body that is present in half the population
of the world is the uterus. The uterus is all smooth muscle
so when an individual uses any of the substances that
we’ve been talking about, it stimulates uterine contractions
which is why you get increased rates of preterm labor
and delivery in infants whose mothers use any
of the variety of substances. You also get high rates of low
birth weight, low birth length, a small head circumference,
increased rates of still birth and increased rates
of sudden infant death syndrome. So these are the basic
medical effects of prenatal opioid exposure. But where I want to turn is
to neonatal abstinence syndrome. I want to make sure we’re all
talking about the same thing. There are some
key questions I would like to address. What is true
neonatal abstinence syndrome? How does this differ from
neurobehavioral difficulties in an infant? What factors might
affect diagnostic labeling? And when it comes down to it,
is it really that important to differentiate NAS and
neurobehavioral difficulties? So let’s talk about
neonatal abstinence syndrome. NAS is defined as the signs
and symptoms that occur when a newborn prenatally
exposed to opiates experiences opioid withdrawal. From the time the definition of
neonatal abstinence syndrome was set through publications by the
American Academy of Pediatrics, the American College of
Obstetricians and Gynecologists, multiple other organizations,
it has always stated that it is prenatal exposure to
opiates that produces neonatal abstinence syndrome. Neonatal abstinence syndrome can
be present at birth or it can present as much as 24 hours
after birth depending on when the
mother last used her opiates. It usually peaks at about three
to four days and in its acute phase
can last up to about six weeks. But we published an article
several years ago that describes what we call the subacute phase
of neonatal abstinence syndrome and that can last
up to seven to eight months. Now just for a moment
let’s turn to neurobehavior. In a nutshell, neurobehavior
is the way we as humans interact with and respond
to both the internal and external environment. It’s driven by the operation
of the nervous system and is expressed through behavior. The reason I bring this up
is that there are a variety of nonnarcotic drugs that have
been shown to cause psychomotor behavior in infants that looks
like on the surface neonatal abstinence and has been
described as neonatal abstinence syndrome related to alcohol,
barbiturates, SSRIs or Diazepam. I would challenge that thinking
because if you look carefully at each of the descriptions under
each of these drugs you’ll see that they have something in
common with neonatal abstinence. There’s hyperactivity. There’s crying. There’s irritability
for almost all of them. Barbiturates especially
can produce severe tremors. There have been seizures
described with SSRIs and Diazepam has also been
said to produce a neonatal abstinence syndrome. But if we explore this more
carefully, we can differentiate NAS from neurobehavior. Let me just point
out, NAS produces many of the neurological
signs we’ve talked about. They’re listed here as
do neurobehavioral difficulties. But when you move to the other
systems, the gastrointestinal, the respiratory and the
autonomic nervous system, that’s where you differentiate
NAS from neurobehavior. We did studies about 25
years ago that showed that the diagnosis of NAS is often
driven by racial and social class considerations. And we showed in those studies
that African American, lower socioeconomic populations are
much more likely to have their babies diagnosed with NAS
as opposed to infants born to white, middle class women
especially with insurance that the infants present exactly the
same way and in fact in many of the cases it was documented
the mother had used opiates but those infants are diagnosed
with seizer disorders or neurobehavioral difficulties. There are racial and social
class considerations here that come into play. Now why is it important that
we not approach our diagnosis this way? It’s because the difference
between NAS and neurobehavioral difficulties affects the
actual treatment of the infants. All infants who have
been prenatally exposed who are having NAS or
neurobehavioral difficulties the general approach,
the nonpharmacologic approach is similar. You swaddle the infant and it’s
best to swaddle the infant in a flexed midline position. Now some people
call that the fetal position. It’s not really. It’s a self-soothing position
so tightly swaddled in a flexed position with a pacifier. Studies have shown that sucking
on a pacifier raises internal opiate levels. Use low lighting and if possible
an oscillating crib and avoid abrupt changes so going in and
picking up the infant suddenly. Now you can imagine
how infants with neurobehavioral difficulties or NAS would do
in a NICU with all the flashing lights and alarms so
many hospitals have developed a quieter
nursery for these infants. For both groups of infants NAS
or neurobehavioral difficulties frequent
small feedings are best. And then the last step and
here’s the important point we want to use medications only
in the cases when absolutely necessary for
neonatal abstinence syndrome. You do not want to give
morphine, methadone, paregoric, phenobarbital, the medications
most commonly used to treat NAS to an infant with
neurobehavioral difficulties who was not exposed to opiates. And even for NAS, it is a last
step and the great majority of infants do not require
medication if they are provided the appropriate
support of management. As infants get older through
three years of age, I’ve listed here some of the difficulties
that the infants can show over those first three years and if
you notice they all are based to regulatory behaviors. That is the
common theme for most children prenatally exposed. IQ is not affected. Global cognitive functioning is
not affected except by alcohol but all the other substances
global cognition is completely normal, sometimes perhaps in
the low normal range but in the normal range. Where the children over the
short and long-term periods get into difficulties is
with the regulatory behaviors. State regulation arousal,
abnormal sleep states so they never get into a deep sleep,
difficulties with habituation, reflexes can be hypertonic
as well as hypo-reflexive. They have difficulty with
self-soothing and as they get older difficulty
with attention, transitions and modulation of affect. It is no wonder then that based
on these regulatory difficulties that children often
are diagnosed with ADHD but we published an article just last
year that showed the high rate of misdiagnosis
in prenatally exposed infants. In fact, we took random sampling
from a population of about 3,000 children and
then looked at their diagnosis. What we found is that 85.6% of
children with prenatal alcohol and drug exposure
were misdiagnosed and the great majority were
on inappropriate medications. If you would like more
information, you can contact me through our website. We have
a variety of materials there. I hope I’ve given you some
answers today but I also hope I’ve raised a lot of questions
because there is a lot of work to do that tells us that we need
to do a better job with these families and
especially with these infants. So Linda, I’ll turn it
back over to you. Thanks.>>LINDA DELIMATA:
Thank you, Dr. Chasnoff. That was very informative. What we know is that infant
mental health consultants are there to support and what
we’re talking about today is home visitors but early care
and education people as well in understanding how the impact of
opioids is affecting the babies and the children. So we learned a great deal about
relationships and how opioids affect and impair relationships
but also what can we do to help with this. If your home visitor has this
information that is shared with them through a training
or through mental health consultation they have a better
chance to support the families as
they work through these issues. So if they understand the effect
and impact and then they have some ideas and some tools to say
here are some things that we can help you with such as the
management, how to swaddle, use a pacifier, bring the lights
down in order to increase their chances of positive
social and emotional growth. We have the ability as
mental health consultants to be reflective and to be supportive,
to listen and then to offer ideas and together we support
those families so that they can have the best chance that
the home visitor can offer them. Thank you for joining us and
please visit our website for tip sheets, resources and more
information about Infant and Early Childhood Mental Health
Consultation including how consultants can help address
the use of opioids and other substances among
families with young children.

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