Perinatal Substance Exposed Infant Project

This collaborative project is working to address the devastating problem of substance exposed infants in Sacramento County.


Reason: The last time universal testing of infants born in Sacramento County was conducted was in 1992. At that time an average of 2000 substance exposed infants were being born here. Of those births, 500 were being referred to Child Protective Services for intervention.

The community cost of substance exposed infants is staggering. The average cost of a normal birth is $5,000 to 7,000. The cost of a substance exposed infant birth can exceed $100,000. With 2,000 "Postox births" the cost could be over $200,000,000 annually. That doesn’t include costs for foster care placement (over 5,000 in Sacramento), special education requirements or other special healthcare need for children damaged by inutero substance exposure.

We know that Doctors are under-prepared to deal with substance use and abuse issues and those patients are often referred out from a physician’s service if they report their alcohol or other drug problems. We know that even raising the concern about substance use with a patient is difficult and then what…! We also know that many patients who might benefit from brief interventions early in their pregnancy are not even identified for lack of universal screening and brief intervention.

Treatment capacity for users and their infants is also an issue; even through Sacramento County does a better job with limited resources than almost any other jurisdiction. Finally, we know that often a most critical time of recovery, is when clients are returned to their home environment – not conducive to sustaining recovery – because there are no other alternatives.

The other thing we know about this County is that there are a myriad of programs (Birth and Beyond, David Olds – Public Health, Mercy Perinatal, Options for Recovery) that exist, but don’t cover all of the County and don’t work through effective collaboration.


Project: Project Help, in collaboration with the County Public Health and Alcohol and Drug Services Division, has launched a collaborative project, which seeks to bring together all of the disparate players (physicians, hospitals, insurance providers, treatment programs, housing groups, early intervention programs) to the same table and develop a comprehensive plan to address the problem.

Current ideas include:

• The implementation of a universal screening and brief intervention process for all pregnant patients in Sacramento County.
• The implementation of a training program for physicians or their staff on implementing the screening, brief intervention and referral components.
• Establishing an assessment process for patients who screen as at risk to connect them with appropriate treatment resources, whether they need publicly funded services or are covered through private insurance.
• Work with hospitals to establish consistent testing protocols, to ensure that no women and infants in need of services are missed nor discriminated against..
• Working with providers to develop a comprehensive plan to expand treatment capacity that includes treatment services for mothers and infants together.
• Working, long-term, to create a plan for the development of adequate supportive housing, which can be located close to treatment facilities to extend supportive continuation services, increasing the likelihood of successful outcomes.

We already have many committed and interested partners: County agencies (Alcohol and Drug, Public Health, Child Protective Services), Mercy Perinatal Program, insurance providers (Blue Cross) Ob/GYNS and perinatologists (Mercy, Sutter, UC Davis), Mercy Foundation (Housing) and others.

Needs:

• Additional suggestions and ideas for addressing this issue.
• Identification of other critical stakeholders (including hospital administrations, SHRA and others), existing planning efforts and contacts, and help and facilitation in bringing them to the planning table.
• Social marketing ideas to ease patient disclosure and to get them to healthcare professionals for early care and intervention.
• Potential implementation support as components of the project are ready to launch.
• Any other input, suggestions and resources.