Nevada's CARA Plan of Care for Infants Affected by Substance Use

Brian Sandoval Governor Julie Kotchevar, Ph.D. Administrator Richard Whitley, MS Director Ihsan Azzam, Ph.D., M.D. Chief Medical Officer Nevada s CARA Plan of Care Department of Health and Human Services Division of Public and Behavioral Health SAPTA and Maternal and Child Health Program Presented by: Judy DuMonte Date: August 2018 Department of Health and Human Services 1

Presentation Objectives Understand anticipated revisions to the Nevada Revised Statutes (NRS) requiring healthcare providers to submit a CARA Plan of Care for infants affected by illegal and legal perinatal substance use. Understand what the CARA Plan of Care is and how it works. Substance Use Disorder Stigma Department of Health and Human Services 2

What is the CARA Plan of Care? In 2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) to address the opioid epidemic. Requires health and human services providers to develop a plan and provide treatment services to treat infants born with Neonatal Abstinence Syndrome and their families. The Infant Plan of Safe Care for Nevada is called the CARA Plan of Care. Department of Health and Human Services 3

How it Works Case maintained open for in-home or foster placement Partner with treatment provider on follow up Report screened in for investigation Mom/Baby Identified Determination of Investigation Local or State CPS CPS notifies reporting hospital and treatment provider that there is no CPS involvement Report screened out for investigation Birthing Facility/Provider develops Case closed - refer to treatment provider Data collected; Resources identified; Audit plans Summary report provided to DCFS for federal reporting CARA Plan of Care Division of Public and Behavioral Health Referral accepted; treatment documented and provided to DPBH Substance Use Treatment Providers CARA Plan of Care Documented (electronically) Report generated and sent Department of Health and Human Services 4

CARA The goal of CARA is NOT to remove children or punish mothers for drug use but to ensure the child is safe and address the health and substance use disorder treatment needs of both the affected infant and family or caregiver. The CARA Plan of Care is meant to facilitate communication and coordination among service providers to support the well- being of the infant, as well as identify services for the caregiver(s). Department of Health and Human Services 5

CARA Plan of Care A health care provider that delivers or provides medical services to an infant in a medical facility and who, in his or her professional occupational capacity, knows or has reasonable cause to believe that the infant has been affected by a fetal alcohol spectrum disorder or prenatal substance abuse or is experiencing withdrawal symptoms resulting from in utero drug exposure the medical facility shall ensure a Comprehensive Addiction and Recovery Act (CARA) plan of care is in place prior to or upon the infant s discharge. Department of Health and Human Services 6

CARA Plan of Care The Nevada CARA Plan of Care must ensure the safety and well-being of infants following the release from the care of healthcare providers, by: 1) address the health and substance use disorder treatment needs of the infant and affected family or caregiver; 2) monitor the plans by the Division of Public and Behavioral Health to determine whether and how local entities are making referrals and delivering appropriate services to the infant and affected family or caregiver; and 3) Develop the Nevada CARA Plan of Care for infants affected by any or all substances. Department of Health and Human Services 7

CARA Plan of Care Form Department of Health and Human Services

Nevada CARA Plan of Care Form Components Infant s Medical Care Prenatal exposure history Hospital care (NICU, length of stay, diagnosis) Other medical or developmental concerns Pediatric care and follow-up Referral to Early Intervention and other services Other Mother s Medical Care Prenatal care history Pregnancy History Other medical concerns Screening and education Follow-up care with OB-GYN Referral to other health care services Mother s Substance Use & Mental Health Needs Substance Use history Mental Health history Treatment history Medication assisted Treatment history Referrals for services Family/Caregiver History and Needs Family history Living arrangements Parent-child relationships Prior involvement with child welfare Current services Other needed services Child safety and risk concerns Department of Health and Human Services 9

Roles and Responsibilities The CARA Plan of Care form is completed at the hospital prior to discharge by a social worker, registered nurse, or other qualified hospital staff. Upon completion, hospital staff perform the following tasks: o Upload the completed CARA Plan of Care form into the hospital s electronic health record system (EHR) o Submit the completed form to the Nevada DPBH and the local child welfare agency o Provide a copy of page 4 and 5 to the infant s family/caregivers Follow-up will occur by the Nevada DPBH. The Perinatal Substance Use Treatment Network and Women s Services Coordinator will collect the CARA Plan of Care forms to monitor plan of care interventions. Department of Health and Human Services 10

Referral Resources Sober Moms, Healthy Babies sobermomshealthybabies.org The Sober Moms Healthy Babies (SMHB) website is part of an effort launched by Maternal and Child Health (MCH) Programs and the Substance Abuse Prevention and Treatment Agency (SAPTA). The SMHB website focuses on preventing substance misuse during pregnancy and providing women, their families, and providers information on resources and treatment options. Nevada 211 nevada211.org Nevada 2-1-1, a program of the Money Management International (MMI), is committed to helping Nevadans connect with the services they need. Whether by phone or internet, our goal is to present accurate, well-organized and easy-to-find information from state and local health and human services programs. Substance Abuse Prevention and Treatment Agency (SAPTA) dpbh.nv.gov/Programs/ClinicalSAPTA/Home_-_SAPTA/ The Substance Abuse Prevention & Treatment Agency (SAPTA) administers programs and activities that provide community-based prevention and treatment. Home Visiting Resource Directory dpbh.nv.gov/Programs/MIECHV/dta/Publications/Nevada_Home_Visiting_(MIECHV)_-_Publications/ Nevada Home Visiting exists to develop and promote a state-wide coordinated system of evidence-based home visiting to support healthy child development. Community resources helpful to families and young children have been compiled in this directory. Most are organized according to county or region of location; however, please also see the statewide resources section for additional services available. Department of Health and Human Services 11

Thank you, Judy DuMonte Perinatal Substance Use Treatment Network Nevada Department of Health and Human Services Substance Abuse Prevention and Treatment Agency 4126 Technology Way, Suite 200, Carson City, NV 89706 Telephone: (775) 684-2217 Email: jdumonte@health.nv.gov Fax: 775-684-4185 Department of Health and Human Services 12