The UNC Horizons Program:

Focus on Helping the Maternal-Child Dyad with Neonatal Abstinence Syndrome

Hendre Jones, PhD ! Elisabeth Johnson, PhD ! Evette Horton, PhD ! Carl Seashore, MD

Horizons Strategy
Provide Clinical Excellence for Women and Children

Teach and Disseminate Knowledge

Generate New Knowledge

Horizons Model of Care

Trauma and Addiction Treatment Residential and Outpatient Care Childcare and Transportation

Medical Care OB/GYN Psychiatry Parenting Education and Early Intervention

Vocational Rehabilitation

Horizons clinic

!! Team includes: Nurse practitioner (NP), case manager, and therapist !! NP provides primary obstetrical care and manages women taking Suboxone !! Case manager provides assistance and access to community resources and services !! Therapists provides counseling !! Psychiatrist is available as needed for evaluation and medication management

Horizons Clinic
!! Team educates women on recovery and addiction and works to motivate women to participate in treatment !! Team collaborates with nursery staff to educate women about NAS !! Incentives to participate in services include: ! Assistance with parking ! Gas vouchers ! Mommy Bucks ! Transportation by Horizons van driver

Recognition and Management

Referral and Long-Term Follow-up for Exposed Infants
!! DSS involvement ! This can and should be seen as supportive, not punitive ! Often past history with DSS precludes acceptance !! CDSA referral from the nursery ! Can be difficult depending out county and resources !! Ongoing treatment for mother and family ! Learn your local resources !! Preschool when available

Recognition and Management

!! PCP, OB/GYN, Pediatrician! ! Engage all players before delivery for planning! ! Early testing in mother during gestation in addition to mother and baby at delivery is key! ! Evidence-based protocols exist for Labor & Delivery and Newborn! !! Anesthesiologist! ! Pain management plan! !! Newborn Nursery Team! ! Infant assessment, Finnegan Scales, nonpharmacologic treatments, breastfeeding! !! Neonatal Critical Care Team! ! Symptomatic Infants, Acute Withdrawal!

Post-natal NAS Issues

!! Parents need continued education and support at home !! In the first few months, these infants can be difficult to sooth/irritable, have difficulties transitioning and maintaining sleep, and have feeding issues !! This can put infants at risk for insecure attachment !! Parents frequently have other stressors

UNC Horizons Postnatal Protocol

!! Visit from child therapist within first week of delivery, even if in NICU !! Focus on infant strengths, learning infant cues !! At 6 weeks: Referrals for developmental assessments (Early Intervention) including Speech/Language, Occupational Therapy, Physical Therapy, and Social-Emotional Assessment !! Support Dyad: Weekly Child Parent Psychotherapy (CPP)

UNC Horizons Postnatal Protocol

Further support via Parent Education during Substance Use Treatment !! Attachment-based parenting program: Circle of Security-Parenting http:// circleofsecurity.net/ !! Nurturing Parenting Program for Substance Abuse http://www.nurturingparenting.com/

Summary

!! Treatment for NAS occurs during the pregnancy, post-delivery, and in the home !! Treatment for mother, infant, and the dyad !! Focus on strengthening attachment relationship !! Focus on helping parents learn to read and respond to their infants cues !! Referrals to early intervention paramount

Questions

Thank you for joining us!

Webinar Contacts
Hendre Jones, PhD Elisabeth Johnson, PhD Evette Horton, PhD UNC Horizons Program 127 Kingston Drive Chapel Hill, NC 27514 919.966.9803

Carl Seashore, MD

General Pediatrics and Adolescent Medicine UNC School Of Medicine Chapel Hill, NC 27514 919.966.2504