P3B299: Three Years’ Experience Enhancing the Medical Home for Children with Prenatal Drug Exposure and Their Families with Baby Steps

Background: Baby Steps is a 2-generational, trauma-informed, patient and family-centered perinatal care coordination program and follow-up clinic for families affected by prenatal drug use/exposure. Program goals include: (1) improve perinatal and early childhood care coordination and medical home access. (2) ensure comprehensive health, developmental, and behavioral screening and follow-up. (3) prevent and mitigate the effects of ACEs and build resilience. (4) provide education and support to caregivers.

Project Description: The purpose of this presentation is to describe initial program implementation and evaluation results using aggregate electronic health record data and provider/partner surveys. Program referrals are received from both hospital and clinic providers. The multidisciplinary Baby Steps team consists of a pediatrician/medical director, nurse, care coordinator, speech-language pathologist, dietician, audiologist, physical therapist, and occupational therapist. Community partners include a licensed mental health and drug treatment provider and early interventionist. The care coordinator provides support to families during and after pregnancy. Infants and children are followed every 3-6 months during the first five years of life in the clinic. The “arena style” assessment by the Baby Steps team targets needs of the child, caregiver, and family to provide education and resources. During each visit, the team shares recommendations for home through a “Family Note,” provides education and resources, and coordinates community referrals. Discussions of recovery and resilience are intended to help foster a healthy community around the family to promote success.

Discussion: Types of prenatal substance exposure among 98 program infants and children included opiates (46.9% prescribed buprenorphine)), marijuana (40.8%, methamphetamine (39.8%), benzodiazepine (18.4%), and alcohol (7.1%). 36.7% of patients had a family history of drug use in the father, and 16.3% had incarcerated parent(s). 39.7 % of parents/caregivers reported four or more adverse childhood experiences (ACEs). 63.3% were Department of Children’s Services (DCS)-involved. 74.5% of patients had developmental delay. All patients were referred to early intervention. Referrals for speech therapy (79.6%), occupational therapy (38.8%), physical therapy (30.6 %), audiology (21.4%), and mental health/recovery (58.2%) were common. One-month post-visit, parents/caregivers reported implementing recommended tips at home (100%), being very or extremely satisfied with services (98.9%), and accessing all recommended resources (80.7%). A survey of healthcare and community partners suggested that they thought the program was effective in identifying health, developmental, or behavioral issues (100%), coordinating care (70%), and supporting parenting (80%). The Baby Steps program was positively assessed by parents/caregivers and healthcare/community partners. Notable program strengths are the inter-professional and community collaborations/ partnerships that were developed.

Conclusion: This program's future directions include enhancing support for families in the program through monthly support groups, improving access to addiction medicine and primary care services for caregivers, preventing ACEs and the effects of ACEs and prenatal drug exposure, and expanding the program to meet the significant need in the region.