Serving Substance-Exposed Infants in New Hampshire

Impact Highlight: In regions where the GPL helped pilot new tools and data tracking strategies, more substance-exposed infants and their families were enrolled in home visiting programs, including via prenatal referrals from healthcare organizations.

Challenge:

• When infants are born with substance exposure, they are often removed from their parents’ care and placed in state custody. In 2018, approximately one in four of New Hampshire’s critical child safety incidents involved a substance-exposed infant. However, few families with substance-exposed infants were benefitting from available home-visiting programs.
• Leaders in New Hampshire wanted to find a way to prevent harm to babies, stabilize families earlier, and prevent disruptive investigations and removals.
• New Hampshire’s child welfare and public health agencies and the Governor’s Perinatal Substance Exposure Task Force proposed better collaboration between healthcare providers, child welfare staff, and other stakeholders to implement Plans of Safe/Supportive Care (POSC). These plans offer voluntary community-based supports to parents and their babies.

 Innovation:

• The GPL helped New Hampshire build a referral process pathway for staff in prenatal healthcare settings and child welfare offices to connect families to home visiting programs.
  • This included creating a toolkit of talking points for staff, guides for which programs might be a good fit for families and how to connect families to those services, as well as referral tracking tools and other resources for medical staff to more easily make referrals to home visiting programs.
• The GPL helped workers in New Hampshire’s Division for Children, Youth and Families better collaborate with contracted peer support workers to engage and support families with substance exposed infants, including by implementing Plans of Safe Care.
• The GPL supported home visiting contract managers at the Department of Health and Human Services as they explored ways to consistently track data and build continuous quality improvement processes.
  • During the pilot, contract managers monitored home visiting providers’ success at recruiting and enrolling this population into their programs.
• The GPL elevated the voices of mothers with lived experience of substance use while pregnant by organizing a focus group. The mothers’ insights were then shared with leaders and medical and other service providers in New Hampshire. Insights included:
  • Having a baby can be a very stressful experience and being connected to services sooner is helpful.
  • A Plan of Safe Care offered late in the pregnancy or right after delivery can feel like a punishment rather than a supportive option.
  • Moms want to know what will happen to their baby who is born with a substance in their system so they can prepare for next steps.

Results:

• Before the referral pathway pilot, very few families with substance-exposed children were getting into services. Between July 2020 and January 2021, the share of substance-exposed infants and their families who enrolled in home visiting programs increased from less than 5% statewide:
  • to 11% for families referred from healthcare settings in the pilot areas.
  • to 38% for families referred by child welfare staff in the pilot areas.