Featuring a lecture by Sara Forward, of the UVM Center on Disability & Community Inclusion (CDCI) and Children’s Integrated Services at the State of Vermont. A half hour training presented as part of the Project SCOPE Vermont series. This training is on Neonatal Abstinence Syndrome (NAS), and how Children’s Integrated Services can provide support for and collaboration with health care professionals. The CDCI is receiving support from the Wyoming Institute for Disabilities (WIND) to improve training & supports for children and families with Neonatal Abstinence Syndrome (NAS). The work is called Project SCOPE: Supporting Children of the OPioid Epidemic.
Neonatal Abstinence Syndrome (NAS) and Children’s Integrated Services
00:00:00:00 – 00:00:47:21
Unknown
All right. Thanks, Jesse. So I’m going to start and I’m going to go pretty quickly through our presentation today, which is really about neonatal abstinence syndrome and some of the looks and feels of some developmental things that might happen for kids with with exposure. I just want to iterate and I’ll continue to reiterate this throughout this presentation, that all of these are things that could be present and none of them are things that will be present necessarily more than any other.
00:00:47:23 – 00:01:07:04
Unknown
I would say sort of interesting case example, I think neonatal abstinence syndrome is really unpredictable and it comes out in lots of different ways or not with children who are exposed. So just keep in mind as we’re talking about some of these things, that what I want you to know most about it is just that it is really variable.
00:01:07:04 – 00:01:26:14
Unknown
The ways in which Nas and others can affect development and that that might look different for different children. So keeping that in mind and I also want to acknowledge that as I look around the room, I see lots of colleagues who’ve worked really closely with you, with their families, and then I see a lot of expertise in the room, a lot of years of experience here.
00:01:26:14 – 00:01:47:21
Unknown
So I’m also going to breeze right through our slides here because I’m interested in having time for questions and hoping that my colleagues will jump right in. And finally, part of this is going to be about neonatal abstinence syndrome, and then the next is going to be about children’s integrated services and the work that we do there. I do work at the at the state integrated services, but I see lots of my colleagues who are out in the field in our crowd today.
00:01:47:21 – 00:02:03:09
Unknown
So I just am also hoping that you will jump in and answer questions and help me to explain some of the work that we’re doing every day in the field so that I’m not the only one talking. And because I know that we have a lot of experts here. So I invite that, please, to jump in and join me as we’re going through some time.
00:02:03:15 – 00:02:27:10
Unknown
And we can go to the next slide, please. So today we’re going to talk about the role of early childhood professionals in monitoring development and the ways in which we might see when there’s an issue and then some early intervention when needed. We’ll discuss milestones and the ways in which we we look at red flags or things that might be something of concern that would increase our ability to make an early intervention.
00:02:27:12 – 00:02:49:01
Unknown
And then we’re going to identify resources, resources and referrals. And we’ll talk a little bit about, again, children’s integrated services and unnecessary referrals that you might want to make for children in your care and then we’ll talk about longer term term development outcomes again, knowing that those really very personal parts. Next slide, please.
00:02:49:03 – 00:03:04:08
Unknown
Oops. Oh, here it comes. All right. So we’re going to talk about the developmental areas, brain development, vision, motor speech and language, cognition and behavior. Next slide, please.
00:03:04:10 – 00:03:31:06
Unknown
So, so right off the bat from birth, brain development can vary kid to kid. Some reports differences in brain development that include reduced structural connectivity within the brain observed in the first 4 to 6 weeks. So this is are our brain scans of kids that that young. And again some of those results and some of those look pretty typical even after four or six weeks.
00:03:31:08 – 00:03:55:03
Unknown
And then in other times we see sort of persistent atypical brain scans. We also see differences in how the amygdala, the amygdala connects to different regions. So lots of differences, again, and structure that could or could not be present altered brain matter that persists throughout childhood. Again, not a given, but in some cases is definitely seen in reduced gray matter in newborns.
00:03:55:05 – 00:04:23:14
Unknown
You can go on to the next slide. So this is a list and I’m not going to go through all these. This is a list of some articles. This is for those of you who really want to geek out on your. And I asked articles around brain development. And basically it just shows the different these articles really go in-depth into what we saw in brain scans in kids compared to sort of typically developing older children who are not exposed.
00:04:23:16 – 00:04:41:13
Unknown
So if you’re looking for some some good bedtime reading, here it is. And if you’re looking for some more cases specific to what you might be seeing in a particular client or family, you can go on to the next slide.
00:04:41:15 – 00:04:58:08
Unknown
So these are a bunch of division development issues that might come up. Again, I’m not going to go through every one of them by themselves, but I do want you to be aware that there could be visual issues for kids with. So it means that as you’re thinking about children caring for children, vision should be on your radar.
00:04:58:08 – 00:05:20:22
Unknown
And of course, we know that vision is so important to development for lots of different reasons. In fact, even things like social emotional development for a child, we want to have visual maturation on our our radar as we’re thinking about how best to serve children and also knowing that field vision exams could be a first step, a first doorway into providing services for families, being really careful.
00:05:20:22 – 00:05:48:02
Unknown
If vision exams are a part of their service care area, then you might really be thinking about could have failed vision test, include a need for some more assessment around and ask for prenatal exposure. Onto the next slide. This is just what I covered visual impairment that can have an effect on children’s development due to importance of interacting and exploring an environment.
00:05:48:04 – 00:06:17:04
Unknown
It can also impact social skills, language acquisition, learning and independent skills. We can talk more about that if you have any questions. Next slide, the motor development. So this is our gross motor or how kids are moving their bodies. Research shows that it’s varied, that some infants don’t show any motor developmental delays or differences, and others experience some atypical motor patterns.
00:06:17:06 – 00:06:25:07
Unknown
And we’ll discuss what those look like and empathy, toddler and young children or young adults. Next slide.
00:06:25:09 – 00:06:49:04
Unknown
So in our infants, we may see atypical motor patterns. So that includes fidgety little hands that are moving all the time. Movement, increased occurrence of trauma. Call us. That’s something that we see a lot in children’s integrated services. That’s where the neck is moved to one side and children have trouble moving to the other side. Or it might just be that they just go to one side and they’re not able to move their necks that way.
00:06:49:06 – 00:07:12:16
Unknown
Luckily, that’s something that early intervention can really help with and there are good outcomes predicted if we’re able to catch that early, higher instances of atypical neurological examinations. So those are things like reactions, responsiveness, affiliation or more a lot of neurological things that can happen and that may look a little bit different from peers and for infants and like to draw process.
00:07:12:16 – 00:07:47:12
Unknown
So and remembering that withdraw doesn’t happen and all children have exposure and they won’t always look like this but hypotonia can lead to the back arching as somebody moves into extension. So sometimes we see these kids who can’t come down and they look very tight at tight microphone and then swaddling and nutritious sucking, of course, can help decrease like any baby swaddling and providing that good of deep pressure for an infant and then inviting some sucking for self-soothing.
00:07:47:18 – 00:07:52:21
Unknown
So next slide, please.
00:07:52:23 – 00:08:35:17
Unknown
In toddlers and kids, there are lots of different reviews, lots of different studies. I’m not going to go through all these studies, but one showing 25 kids with exposure in utero. This one basically said that the McCarthy scale is significantly lower for those children. And again, as as Michel pointed out last week to everybody, this needs to be controlled for with Medicaid, thinking about control groups and thinking about Medicaid aid versus on Medicaid patients.
00:08:35:19 – 00:09:01:16
Unknown
And I’m just seeing the chart here. Oh, never mind that. You’re just answering questions. Thanks. And then we have a couple other studies and I won’t go into those, but they’re in the bottom if you’re interested in those and basically significantly lower, significantly lower on the McCarthy scale again, which is the motor development scale that we’ll go to.
00:09:01:16 – 00:09:32:22
Unknown
The next slide. So long term, again, we don’t know. Sometimes it shows that long term functioning motor functioning is fine and then normal ranges and then sometimes it shows that exposed groups performed lower than a control group and some people might have some more anecdotal incidences that you want to talk about after this. Around motor development, I think that varies person to person.
00:09:32:22 – 00:10:06:20
Unknown
Again and again, I’ve seen kids who are really in the typical range, normal range, sometimes even, you know, bouncing off the walls and doing a lot of great motor development stuff. And then other kids who really are significantly struggling. And it’s just so many variables that are at play there that we’ll go on to the next slide. So speech and language development can definitely be affected by NASS Merging research suggests that children with opioid exposure experienced allies in speech and language in childhood children’s integrated services, we’re seeing more and more referrals.
00:10:06:20 – 00:10:31:14
Unknown
And right now speech and language development referrals are the most that we have. So compared to all the other sort of ways that a child might be referred, speech and language is the reason that they would most often be referred to this right now just in the past year or two. And again, so many factors are a part of that, but just know that it is growing, that our need for speak the language of early intervention is growing.
00:10:31:16 – 00:11:00:12
Unknown
And that doesn’t just have to do with an assessment. So many things, including COVID masks and children being at home and all that stuff. And then a current another current study that you can read about here about us has to do with relationship to feeding skills, communication, literacy. All right. Next slide. Thank you. So this is a study about children, about special education children.
00:11:00:12 – 00:11:23:05
Unknown
This is elementary school children that we’re talking about that showed a significantly higher proportion of children with a history. And I diagnosed speech and language impairment. And again, that special education in our elementary age kids study children with a history of and I or and asked were significantly more likely to receive speech therapy than children without a history of what this thing just children born with.
00:11:23:05 – 00:11:53:20
Unknown
And I can experience long term learning challenges in childhood. More studies needed to better understand long term. So like I said, it can really bury a lot. And right now research is still noticing differences and there’s more research to be done because it does vary. Moving on previous next one is a graduate thesis. You can take it for for what that’s worth.
00:11:53:22 – 00:12:23:07
Unknown
Speech language pathology about communication, difficulty is this was an online survey so it was really around like which disorders and some skills around hearing and being able to comprehend and showed that children with an eye for exposure to opioids might be behind children who who did not have exposure. Next slide. And this is another study about speech delays and how prevalent they might be.
00:12:23:07 – 00:12:53:05
Unknown
So you can see in the analysis group, in the high risk group, they had higher, higher percentages than children without exposure. Next slide. So when we’re talking about cognitive development, we’re talking about kids and the ways in which they learn to do what they need to do, executive functioning, all the types of things involved with learning, growing, being able to attend and think things through.
00:12:53:05 – 00:13:19:15
Unknown
Consequence of all that, there’s emerging research suggesting that prenatal exposure can impact cognitive development. So I’m going to go through these slides pretty quickly. Again, there are studies specific to cognitive development. And what I want to say here again is that sometimes we do see cognitive delays and other times we do not or we see delays in certain things like memory or ability to attend or attention.
00:13:19:17 – 00:13:52:05
Unknown
And those are the most those are the most prevalent, I would say, attention related cognitive development issues with children, with anything else. All right. Next slide, please. So data from 13 studies of children of over 500 children with prenatal exposure revealed a significant difference in neurocognitive development for children with prenatal exposure. So there you go. Next slide, please.
00:13:52:07 – 00:14:24:20
Unknown
And again, this one was done. This was a study done with the preschool and elementary school kids and was a meta analysis of 13 different studies. So over 700 children pre no prenatal exposure and about 1300 controls. And there was a significant difference in this study as well. So neurocognitive development, children with prenatal exposure, performing less or lower them than children without exposure.
00:14:24:22 – 00:15:01:06
Unknown
Next slide. And so this one was about assessing children 18 months to three years compared to health control. And so the greatest difference in cognitive abilities was showing significant lower cognitive scores on the Bailey and significant cognitive differences persisted at the three year assessment mark. Next slide, please. This one is about cognitive development. We’re school age and young adults.
00:15:01:09 – 00:15:40:05
Unknown
And again, it was a meta analysis of three studies, 152 kids, and it showed a significant difference in cognitive and neurocognitive development. And again, there lots of variables there and a lot of a lot of differences in the lives of the children involved in the studies. So take it for what it’s worth. Next slide, please. This one is another study comparing kids with prenatal opioid exposure to healthy controls and exposed to boys scored significantly lower on all assessments.
00:15:40:05 – 00:16:06:15
Unknown
But I will say that that’s also true of boys and girls on these assessments. So I’m not sure what this included here. Exposed girls scored lower than the control group that all assessments and did not have significant difference until the final. And the study showed that boys with prenatal exposure had significantly stable or stable lower performance as girls experienced increasing over time.
00:16:06:17 – 00:16:11:11
Unknown
Next slide, please.
00:16:11:13 – 00:16:42:15
Unknown
So the behavior existing research suggests that niacin prenatal opioid exposure does impact behavior throughout childhood. So commonly reported behavioral difficulties in this population are inattention, difficulties with self-regulation and impulsivity. So what I was talking about earlier, issues with attention and ability to attend in school and again, these are lots of reasons that children might be referred to integrated services between 12 and 24 months of age when differences with peers really emerge.
00:16:42:17 – 00:17:06:06
Unknown
So this might be a time when in assessments of children age 0 to 3, you might be looking for if you’re interviewing a farm boy or have a child in your care, you might be looking for differences in behavior and you might be asking some questions about what they look like compared to peers in terms of behavior and that might be a red flag that you might need to do a referral there for some some services.
00:17:06:08 – 00:17:31:15
Unknown
All right. So we’ll talk a little bit more about behavior. Next slide, please. I need to speed up a little bit because we’re we’ve start children’s integrated services to talk about them. So basically, studies show that early behavioral differences children might experience healthy with negative affect, decrease self-regulation. These are the kids who might cry on might be unable to be comforted.
00:17:31:17 – 00:17:47:21
Unknown
They may have increased sensory seeking behaviors. So wanting to sex sex all day long or wanting to have that without Bobby or that blanket close to their face to increase ability to self-soothe. Next slide, please.
00:17:47:23 – 00:18:15:12
Unknown
Toddlers and pre preschool kids, we see lots of different behavioral capacities impeded and and that might mean that they have hyperactivity they might have more tantrums. You know this is a kid who goes from 0 to 60 has lots of lots of issues dealing with transitions or with moments, unexpected things that happened during the day. Or they might be children who are harder to calm down after an upset.
00:18:15:12 – 00:18:45:06
Unknown
We only see lots of behaviors here are around just an inability to move from one thing to the next or to regulate in a typical way. Next slide. And school age. Thank you. Mental Health Studies of School Age. Associate History of prenatal exposure and other substances. When we use the strengths and difficulties questionnaire children showed significantly higher differences in the subscale.
00:18:45:06 – 00:19:26:04
Unknown
So emotional problems hyperactivity problem contact or peer problems, pro-social behavior issues. If there are children who are struggling to regulate. And for that reason, of course, experiencing social and emotional upsets. Next slide. And this is another study that was done that examined cognitive and social emotional functioning of children with mothers receiving substance abuse treatment while pregnant. And it showed that basically children born to mothers with with substance abuse treatment in their background did have more mental health problems.
00:19:26:06 – 00:19:54:10
Unknown
You can move on. Great longitudinal. This was another study with school age kids and it basically showed children throughout childhood. So it assessed them both at 4.5 years of age and then 8.5 in school. So children at eight and a half had more significantly and significantly more regulatory problems reported by caregivers and teachers compared to their comparison group.
00:19:54:12 – 00:20:00:14
Unknown
You can move on to the next slide, please.
00:20:00:16 – 00:20:22:02
Unknown
All right. So let’s talk a little bit about children’s integrated services. And again, I’ve got my colleagues here, so jump in. If I’m not explaining something. Well, we basically have four service areas early intervention, specialized child care, early childhood family, mental health and strong family home. And onto the next one, we’ll talk about each of those individually. Great.
00:20:22:03 – 00:20:52:02
Unknown
So this is our population where prenatal to six years of age, we get about 54 or 5400 referrals annually and 1500 kids served monthly. 62% of the kids that we serve last year were Medicaid recipients and went through that last little thing, 50%. Here we go. We can move to extra 50%, receive early and then early intervention. I think it’s early intervention.
00:20:52:02 – 00:21:09:00
Unknown
So we have early intervention is our primary service so that 0 to 3, it’s basically special education for kids, 0 to 3. So that’s that part B of the Part C of the Individuals with Disabilities Act. You can move on to the next slide.
00:21:09:02 – 00:21:37:09
Unknown
So our early intervention population that 50% of kids are kids at risk of developmental disabilities and we offer lots of different services developmental education, occupational therapy, physical therapy and speech and language pathology. And then we have II as part of that Part C idea, actually Individuals with Disabilities Education Act for kids 0 to 3. So the state must ensure that kids receive services.
00:21:37:11 – 00:22:00:11
Unknown
This is federally mandated services for children free of funding. As part of that grant, we get two and a half million dollars a year as the state to cover the cost of these services, and it’s paid through a monthly case rate, referral service and fee for service. Next slide, please.
00:22:00:13 – 00:22:31:17
Unknown
So specialized child care is our next piece, and that is assisting families in accessing and maintaining child care placements with with qualifications. And there are grants to provide transportation for kids who are eligible. And there are some grants, special accommodations, grants for child care programs. And this is for inclusion of children who might have a trauma background or developmental delay or an neurotypical profile or neurotypical a profile, a typical profile.
00:22:31:18 – 00:22:59:16
Unknown
There we go. And might need some individual aid or assistive devices to be included in a child care setting. These are also our specialized child care are also where kids who are in foster care provide are provided child care. Next slide, please. And we’ve got our home visiting program. So I see a lot of nurses on the call with us here today.
00:22:59:21 – 00:23:19:07
Unknown
So we have a sustained home visiting program and responsive home visiting. And that means registered nurses or family support are sustained home visiting those registered nurses who deliver long term structured evidence based home visiting. And then we have our maternal and child health nurses and family support workers who provide regular home visits in response to time limited needs.
00:23:19:11 – 00:23:32:17
Unknown
So these visits are well-being, parenting skills, social connections and other immediate needs of a family with a child. Next slide, please.
00:23:32:19 – 00:23:58:11
Unknown
Early childhood family mental health in addresses and events or detect social, emotional and behavioral mental health development needs. Often these referrals come through child care or come through a primary doc and they expand a young child’s access to mental health services that might look like therapy and might also look like child parent child interactive therapy or parent child psychotherapy.
00:23:58:17 – 00:24:27:06
Unknown
There are lots of different interventions that we might do for a child who who is eligible for early child and family mental health. Next slide. Lucius integrates the early childhood system across sectors. So if you look at this little map here, we see pediatric medical home, the early child. It’s basically everywhere. A child is in their home, at their medical home, and then in their early care educational program.
00:24:27:11 – 00:24:59:16
Unknown
And this works across all sectors with all different partners, specializes in child care with KDB and FSB. We’ve got our nurse home visitors who are in the home, who are doing home visits and doing healthy things like strong families from on or the healthy grow. And then we have the ideas part, see and the agency of Education that is really overseeing some of those education programs after a child is three years old and early childhood family, mental health, which is the Department of Mental Health.
00:24:59:18 – 00:25:05:09
Unknown
Next slide, please.
00:25:05:11 – 00:25:35:14
Unknown
So it’s an interdisciplinary team. It’s also basically we have our state team and then we have our fiscal agent contractor. So those are the designated agencies or those who are holding a contract with the state to provide these services to families. Then we have our regional sysadmin team that does all the roles and all the billing and all the stuff to make sure that everybody gets paid for what they’re doing and that we’re reporting to our federal grantees grantors on what we’re doing.
00:25:35:14 – 00:25:53:00
Unknown
And then we have our local coordinators for the individuals who are working with our regional teams and making sure that referrals are streamlined and that we’re getting services in a timely matter. And finally, we have our regional intake and referral meetings. Those are meetings for all the partners who might be a part of a child’s team to come together and talk about what’s going on.
00:25:53:02 – 00:26:23:00
Unknown
Next slide, please. This is how serious it’s structured. You can see a map here of our different networks of community providers, so you can see we have 12 different districts across the state and families and providers work together on one plan. You’ve probably heard of one plan, or you might be well versed and maybe you write them in all events and Middlebury serve under integrated Family Services contracts or help.
00:26:23:02 – 00:26:52:02
Unknown
So some of it’s a little bit cut off there, but somebody from St Albans or Middlebury maybe can jump in and tell us more about that one. It’s time for questions Quickly. So basically, this is a map of how children come in to children’s integrated services or the families connection they’ll be referred to since the CAC coordinator will receive that referral by day five.
00:26:52:02 – 00:27:14:06
Unknown
Initial contact with a family will be determined to make sure that they have a plan for next steps. By day 45, they’ll be an intake screening assessment and evaluation and an initial one plan meeting where one plan will be developed with goals and outcomes. Next slide, please. And these are all the mandated timelines around how we’re providing services to kids.
00:27:14:06 – 00:27:35:17
Unknown
This is something we made up it as part of our federal contract. So basically, day one family signs of consent services must be done within 30 days. We have an ongoing one planned monitoring. So every six months we’re looking at that one them with a family, how we’re doing on our shared goals, the goals that the family created around their kids.
00:27:35:19 – 00:27:52:17
Unknown
And our review must happen every six months. And then finally we have an annual review where we’re looking at goals. We’re noticing when a child has met goals and when we need to tweak or change service delivery. The reason for so much monitoring is that so much happens in the life of a child 0 to 3 years old.
00:27:52:19 – 00:28:13:04
Unknown
So much growth and development happens that every six months, really that child is like a whole different kid. All the parents out there will probably agree with me, but this is a really important time to keep monitoring and to keep shifting the ways in which we’re delivering services so that we best meet the needs of a child working toward developmental goals.
00:28:13:06 – 00:28:36:20
Unknown
Next slide, please. This is just an introduction to the one plan. Again, I think most of you are really familiar with it, and if you’re not, it’s the Vermont’s Individualized Family Service plan. That’s something that’s federally mandated so that a family really is the driver of the plan for how their child will receive services and what goals their child is working on.
00:28:36:22 – 00:29:04:18
Unknown
It’s comprehensive, comprehensive across settings and across service delivery and providers. That means that a child’s schools around speech and language, along with a child’s goals around motor control or motor development and behavior could all be a part of a one plan. It’s an overview of the primary stages of this program. So so it basically will include all those services that we just talked about.
00:29:04:22 – 00:29:33:06
Unknown
And it’s a guide for conversations. So it’s a place where families can really talk about strengths, resources, concerns and priorities. It’s also an accountability measure of service grade basically for the services that we’re going to deliver. And it includes family content so that we’re really explaining to families what we’re going to do, making sure that they understand what we’re going to do, that they’ve been the drivers behind the services and that they’re consenting to having those services for their child next month.
00:29:33:08 – 00:29:55:01
Unknown
Okay. This is Jessie Hayes here. This is the last slide. That’s it. Perfect. All right. So I wanted to save a little time. And we do have a couple of minutes left, I think if I’m right, Jessie, so that if people have questions, they could offer them now. Absolutely. There is one in chat from Pam Cummings. Yeah. One for Middlebury or St Albans.
00:29:55:01 – 00:30:29:14
Unknown
Explain their contract when we get the question. Perfect. I’m just looking to see who we have from Middlebury. Don’t be shy, guys. I had Heather, some kids in St Albans. I’ll just jump in. It just means that mental health services are rolled in as well. It’s sort of being separate. Right. Thanks, Heather.
00:30:29:16 – 00:30:53:14
Unknown
Any other questions or any sort of comments about what we just talked about a little bit? Anything about children’s integrated services or any There’s more that I missed. Two of our experts on the phone want to jump in.
00:30:53:16 – 00:31:31:02
Unknown
Can anyone refer to these services? Great question. The answer is yes. And a family can self-refer. So now and then we do get a family that calls and says, I need help. What do I what can I do? And that’s great. We really encourage that. Never other question. Our website, Children’s Integrated Services, just Google Children’s Integrated Services. Here is the list of our regional coordinators.
00:31:31:02 – 00:32:02:01
Unknown
So depending on the area that you’re looking to make a referral and you’ll see the CAC coordinators contact info there and that’s the best way to make a referral. Okay, call and I’ll let you know. Next steps. Yeah. Jessie. So so I do want to leave a little bit more time for four questions and that there was a lot of information that you shared so people might still be in process.
00:32:02:03 – 00:32:45:22
Unknown
So thank you for that. I want to take a moment to just add that this this question of of connecting these children and families or how to connect these children and families to children’s integrated services is the main reason that we’re doing this training series. So there Vermont has a very innovative model in children’s integrated services. And Vermont also, by a lot of standards, has a fantastic response to to children with neonatal abstinence syndrome and families that have experienced opioid exposure more generally and we’re struggling with the connection between those.
00:32:46:00 – 00:33:10:04
Unknown
And so as as our center was looking at this training series when it became available as state partners, we’re thinking about should we do this or not? It was really this issue of of how can we help these children and families that are eligible for children’s integrated services to to get connected for referrals to happen and for supports to start.
00:33:10:06 – 00:33:31:20
Unknown
And we do have another message in chat. Yes. From community. Thank you for that question. So the question is what would you recommend for follow up If a child qualifies for children’s integrated services? The parents are not following through with the service part, isn’t it? And I think a lot of us can jump in and offer suggestions on that.
00:33:31:22 – 00:33:52:22
Unknown
And the ultimate truth is that families are responsible for and they’re very able to say no. If they don’t want services for their child, they can say that. So that can be, you know, and, you know, you might have been in a situation where you might say that’s part of a case that you’re building with a family around.
00:33:52:24 – 00:34:15:16
Unknown
Are they able to access services that are essential to their child? But unless it’s something that’s mandated, it isn’t something where we can say you have to have these services for your child. They get to choose from the parent teacher.
00:34:15:17 – 00:34:36:11
Unknown
So this is a question specific specifically around and I see we have a couple of of our medical providers on here, and I am going to punt this to you guys. But the answer to this question is yes, but maybe Michelle or somebody can talk, Dr. Shepherd, to talk a little more about this. So the question from Fran is, is there a safe way for a pregnant woman to continue medication assisted treatment?
00:34:36:13 – 00:35:05:17
Unknown
And the answer is yes, but I’ll give it to somebody who knows more about my. That’s a great question, Ben. The answer is they should all continue buprenorphine or methadone treatment throughout pregnancy. It is the best treatment for opioid use disorder, and it is actually dangerous for people to discontinue their medication without really close monitoring. And it’s generally not recommended stop.
00:35:05:17 – 00:35:30:02
Unknown
It’s recommended to continue as it provides the best chance of remaining in recovery in that first year of life after the baby’s born. Thank you, Dr. Shepherd. And can I see your next question about referrals? Are referrals for CIC tracked? Yes, they are. We were we keep track of every referral that comes in and every child that is referred.
00:35:30:02 – 00:35:52:20
Unknown
So if you’re concerned that you might have made a referral or if you’re interested in how many referrals have been made for a child, you can be contact. It will say that that is it’s confidential information. So unless you have permission from a family, we wouldn’t be able to disclose if a referral had been made. But if you’re working with a family as a DCF worker, then certainly that might be something where where you have access to that information just depends on it.
00:35:52:23 – 00:36:40:12
Unknown
But yes, we keep track of those and those are available to families. And then Pam gave a great suggestion Routines based interviewing can help families and prioritizing schools for their families and just create some client so thankful suggestion other questions or comments? Okay. Well, I’m certainly available if you have any specific questions around this, I encourage you just to call me or email and I’ll put my my contact information in the chat here.
00:36:40:14 – 00:37:07:23
Unknown
Feel free to reach out. I’d love to hear from you. Great. Thank thank you so much, Sarah. And thank you so much to everyone for those those questions. And look, I just got the contact information from you. Where you trying to send that to everyone or. Yeah. Oh, I think it just came to me so I can have that.
00:37:08:00 – 00:37:28:20
Unknown
Yes. But while you’re doing that, maybe I need to introduce our case presenter Who needs the introduction? Sarah Ford is going to present a case today Related deterrence, Integrated services. So I’m going to let her take it away. Open. You already did that? Yeah, I was going to do that for you. Okay, So get back to screen sharing.
00:37:28:22 – 00:37:52:09
Unknown
But just before I turn it over to you, I know some of you experienced this already, others haven’t. So just quick, quick intro to how the case presentations work. So Sarah is going to share a case with some background information, and the goal is for you to shift from sort of participant learner approach to your as a consultant.
00:37:52:11 – 00:38:21:12
Unknown
So listen actively to what’s going on and after after she’s done, the first opportunity is ask any clarifying questions. So we’ll have a brief period where you can ask her questions. And then after that, we’re going to break up into smaller groups. I believe we’ll break up into four groups. And that’s that’s our opportunity for those small groups to discuss recommendations and resources related to the case.
00:38:21:15 – 00:38:44:24
Unknown
And then after all of that is shared, then we’re going to summarize all that information and give it to the case. Presenter So again, a plug for any of you that are there thinking about being a case presenter you get a summary of all of the resources and recommendations that this fairly large group of your colleagues statewide can offer.
00:38:45:01 – 00:39:11:07
Unknown
So that’s a framework. So Rae, what she’s done, again, the first questions are just clarifying questions, information that you would need in order to provide recommendations or resources then we’ll give the small groups to share with that. All right. So, Sarah, I’ll let you get started as I figure out how to share my screen again. Great. Thanks. So I am presenting for a serious colleague and someone that I’ve worked with for a lot of years.
00:39:11:07 – 00:39:28:09
Unknown
She and I were able to take a good amount of time so that she could explain what’s going on with the case that she’s working on right now. And she really is looking for active support. So this isn’t the case that’s resolved. This is something that she’s working on currently. So any sort of thoughts or ideas that you might have for her would be much appreciated.
00:39:28:09 – 00:39:44:00
Unknown
She wasn’t able to be here herself today, but I am going to share with her anything that you have any sort of ideas, and it is a pretty interesting case here. So I’ll get started just telling you a little bit about the case. So if you have really specific questions about it, I might not know the answer, but we did talk pretty extensively about what’s going on.
00:39:44:00 – 00:40:06:16
Unknown
So I feel like I have a good sense she is a mental health provider. I don’t know if I put this in either and works closely with her regional team and that referral, the referral to her was for some behavioral research. She provides behavioral supports specifically for poor families, adoptive and foster families in her area, and then works pretty closely the CPS to around services.
00:40:06:18 – 00:40:36:18
Unknown
So we can go to the next slide or. Yes, so she’s a family and mental health provider and she offers case consultation and addresses social emotional support needs for children. 0 to 12. Next slide, please. So this was a set of adoptive parents and there they were referred to the provider when child care expressed concerns about the child’s development and social and emotional learning.
00:40:36:18 – 00:41:04:21
Unknown
At 20 months of age, child was presenting with lagging verbal skills, high energy, low coordination, difficulty regulating and self-soothing, and trouble with age appropriate executive functioning and following routines of the day and child care. Birth Mom relinquished parental rights voluntarily at three days postpartum. A child was born at 33 weeks after maintaining good contact with prenatal providers, and mom was following maintenance on.
00:41:04:23 – 00:41:38:16
Unknown
Next, we child spent four weeks in the queue being premature with no symptoms of withdrawal. After the first 72 hours, adoptive parents entered child life at day four provided consistent care Ever since adopting at 16 months of age, child met physical developmental milestones and gross motor and cognition on the later side of normal the first year. But parents and child care began to notice lagging skills with peers when a child entered daycare for two months of age.
00:41:38:18 – 00:42:07:08
Unknown
Next time. Primary areas of concern. Right now, parents are concerned about autism. Child seems not to hear or notice other children, although that does look different. One on one with an adult provider notices that parents are concerned about child’s prenatal and birth history. So this is my colleague. The colleague is now noticing that parents are concerned. They’re anxious to diagnose functioning as related to trauma of adoption.
00:42:07:10 – 00:42:40:06
Unknown
And neither parent has significant experience with opioid use disorder, misuse disorder other than adopting their child. Both are very concerned about what lagging social skills might mean for their child long term. Next slide, please. For the goals here. I’m a provider. I would like to help parents to understand what needs is and what it is not, and to empower parents to feel they can get support for themselves and their child barriers.
00:42:40:06 – 00:43:23:02
Unknown
These parents are doing lots of unhelpful research on their own, which is making them panic, and parents may have unrealistic expectations about what assessment and services will be available to them. In a very rural community. Next slide. But I’m happy to take questions or if anything was unclear. Just to be clear, I have a question. Sorry, The child is currently 20 months old now, is that right?
00:43:23:04 – 00:44:00:24
Unknown
These parents have any other kids at all, birth parents or their adopted children in the home? Yes, they have another adopted child who’s five. And I’m seeing the question, do you have any screening information? And as QC was done by the primary doc after this, after parents requested it because the child care had expressed concerns. So they did the ask us, see and it was it did show significant concern around social emotional learning, concerns about hearing.
00:44:00:24 – 00:44:48:24
Unknown
Has there been screening for that? I don’t know about hearing. I’m not sure if that’s that’s happened. And has there been an EEG done or a seizure activity? No seizure activity reported. In fact, they reported a lot of clean health bill, of clean health and kid being very healthy in general, although this is a child whose pandemic baby hasn’t had a lot of exposure to illness, is the child enrolled in any programs or services currently?
00:44:48:24 – 00:45:18:03
Unknown
Nope. The child just started daycare about months ago, I think, she said. That makes sense. Yeah, she’s 20 months old, so 4 to 6 months ago or so and that was due to COVID. So they had they had kept this child home and now this child is involved because they were able to find a spot finally and have staffing, but no other services, and then wondering about their underlying thoughts about children with diagnosis such as autism impacting them.
00:45:18:05 – 00:45:50:17
Unknown
Yes, I think that is at play. Parents are just super really willing to have support, but they do live in a really rural area and I think they’re really worried and I also it also sounds from the provider like this is a really different experience from the one that they had with their other adopted child who is very typically developing and high functioning parents connected with any support groups for foster or adoptive parents.
00:45:50:17 – 00:46:14:16
Unknown
Great question. The answer is no, they did not. They always knew that their objective was adoption and they haven’t. They have a couple of friends who have also adopted but are not part of any formal. They didn’t have a great experience fostering and adopting, and they haven’t stayed connected with any groups, although they do have a couple of friends that they get together with occasionally.
00:46:14:19 – 00:46:38:05
Unknown
Although COVID again has really kept them isolated since this child can be connected to family network. Yeah, lots of great stuff coming in in the chat. I wonder if we want to break into groups just so that we can catch some of this, some of this, some of these questions. I’ll just answer a couple of the questions that I know has the child sleeping history.
00:46:38:05 – 00:47:01:06
Unknown
I meant to add that something is a concern for this child and they have an erratic, sort of really difficult bedtimes, really difficult time at napping, especially at childcare and a lot of difficulty waking up as well, very groggy out of it. And as a child bonding with parents and siblings. Yes, great question. They have a loving relationship at home.
00:47:01:06 – 00:47:23:24
Unknown
Lots of does really well. It sounds like one on one with an adult and is more responsive, more affected and with good sort of back and forth and sort of certain return stuff with an adult. But it needs to be one adult with the child. No other distractions. The other child doesn’t need to be there like all that for the child to do.
00:47:23:24 – 00:47:49:12
Unknown
Well. So there are lots of suggestions which are great. Curious about regulation interactions before 14 months. Another good clarifying question Because of COVID, this child stayed at home with one parent all for the entire time since they were released from the. So this child has not had any previous social interaction because of COVID. So parent actually quit her job to care for this child at time.
00:47:49:14 – 00:48:05:23
Unknown
Well, both children come. Okay. I think we might be ready for our breakout rooms.
