Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome

Abstract

Objective: To identify factors associated with referral and enrollment in early intervention (EI) for infants with neonatal abstinence syndrome (NAS). Methods: We conducted a retrospective cohort study of 256 infants born with NAS (2006-2013) at a tertiary care hospital in (Springfield), Massachusetts, linking maternal-infant birth hospitalization records with Department of Public Health EI records. We calculated the percent of infants retained at each step in the EI enrollment process over the first 3 years of life. We conducted separate multivariable logistic regression analyses to identify factors associated with EI referral and enrollment. Results: Among mothers, 82% received medication-assisted treatment at delivery, 36% endorsed illicit drug use during pregnancy, and 76% retained custody of their child at discharge. Among infants, 77% were referred to EI and 48% were enrolled in services. Of infants discharged to biological parents, 81% were referred to EI versus 66% of infants discharged to foster care (p ≤ 0.05); this difference persisted in multivariable analysis [adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09-4.86]. Infants in the highest tertile for length of stay had 2.70 times the odds of EI enrollment (95% CI, 1.37-5.31). Conclusion: Fewer than half of the eligible infants with NAS were enrolled in EI services. Discharge to a biological parent and longer hospital stay had the strongest associations with EI referral and enrollment, respectively. Efforts to improve EI referral rates during the birth hospitalization, particularly among infants discharged into foster care, and close follow-up for

Hospital Care of Opioid‐Exposed Newborns: Clinical and Psychosocial Challenges

“…As part of Plans of Safe Care, providers may be well‐positioned to initiate referrals for early intervention, home visiting, and other programs designed to provide developmental or wrap‐around support for families. Under Part C of the Individuals with Disabilities Education Act, many states offer early intervention on the basis of NAS as an automatic qualifying diagnosis; however, attrition of eligible families along the referral and enrollment process is substantial 49 . A standardized approach to discharging opioid‐exposed newborns includes referrals to available resources and discussion of their importance with families and may increase utilization and decrease variation in care 50 …”

“…Under the Child Abuse Prevention and Treatment Act (CAPTA), states are required to develop Plans of Safe Care for women and newborns affected by OUD, with the goal of fostering collaboration between healthcare and social service organizations around care of these families. 48 Given the variable interpretation of Plans of Safe Care across the US, providers should be knowledgeable about state and local statutes and reporting requirements related to parental substance use.…”

Mothering from the Inside Out: Addressing the Intersection of Addiction, Adversity, and Attachment with Evidence-Based Parenting Intervention

“…Upon being referred for parenting support, mothers with addictions may struggle to fully engage for a variety of reasons [ 19 ], leading to notable discrepancies between the number of mothers who are referred for support versus the number of mothers who enroll (and remain) in services [ 20 •]. Recent qualitative work suggests that mothers who are referred for skills-based programs often experience fear, guilt, and shame about their substance use that prevent them from engaging, as well as hesitation to open up to their providers despite a strong desire to feel genuinely understood and cared for [ 21 •].…”

Engagement in Early Intervention Services Among Mothers in Recovery From Opioid Use Disorders

“…[15][16][17] Despite the availability of free EI services, fewer than half of eligible infants with NAS are enrolled in EI in Massachusetts. 18 EI seeks to promote active parental engagement, which encompasses emotional involvement and commitment. 19,20 Understanding of parental health beliefs, thoughtful communication, and development of collaborative relationships between parents and providers facilitate the engagement of parents of children with developmental delay in EI.…”