Why we are recommending this best practice
Strategies for implementation
- Involve the mother and newborn in outpatient support programs as early as possible, ideally prenatally for the mother. Descriptions of evidence-based programs can be found below.
- Each unit should maintain an updated list of outpatient resources (federal, state, and local) that families can access.
- Arrange a system to refer the mother and newborn to an appropriate outpatient program. The system should clarify who refers (physician, social worker, etc.) and when to refer (upon admission or discharge). Consider a default referral on admit orders.
- Inform and educate mothers on these referrals and highlight the benefits of these programs.
- Potential short-term and long-term neurodevelopmental delays exist for these infants. Early intervention programs, child protective services, and/or health care services are recommended to cover neurodevelopmental, psycho-behavioral, growth and nutrition, ophthalmologic, and family support assessments.
- California Home Visiting Program (CHVP): CHVP oversees implementation of various evidence-based home visiting programs throughout California, including the Nurse-Family Partnership (NFP) and Healthy Families America (HFA), and currently 23 California counties have these evidence-based programs. State-level agency workgroups conduct needs assessments to determine the greatest need for and potential impact from these programs based on factors such as poverty rates, rates of child abuse and neglect, and the ability to find and enroll at-risk parents in particular areas.
- NFP: Geared towards low income, first-time pregnant women. Care starts in pregnancy and follows the dyad until the child reaches two years of age. The mother must be referred before 28 weeks of pregnancy.
- HFA: Geared towards low-income, at-risk families from birth to a minimum of three years.
- Early Head Start: Early Head Start provides preschool and home visiting services geared towards low-income, at risk families. This is one of the few programs that can be started either during pregnancy or after delivery and follows the dyad until the child reaches three years of age.
- CalWORKS: CalWORKS offers a new three-year home visiting pilot initiative that began in January 2019. It is supported by both state General Fund and federal Temporary Assistance for Needy Families dollars. The program provides up to 24 months of home visiting for pregnant and parenting people, families, and infants born into poverty.
- Comprehensive Perinatal Services Program (CPSP):CPSP provides a wide range of services to pregnant women from conception through 60 days postpartum and is designed for low-income, Medi-Cal eligible pregnant and postpartum women. CPSP promotes the delivery of early, continuous, and quality perinatal services to women and their infants by public and private obstetrical providers and is coordinated by a public health nurse. CPSP services, which include standard obstetric services enhanced by nutrition, psychosocial, and health education services, are offered in physician offices, hospitals, community clinics, hospital outpatient clinics, and alternative birth centers.
- Healthy Start: Healthy start targets communities with infant mortality rates that are at least one and a half times the U.S. national average. Women and their families can be enrolled into Healthy Start at various stages of pregnancy, including pre-conception, inter-conception, and post-conception. Each family that enrolls receives a standardized, comprehensive assessment.
- Early Start: Early Start is California’s early intervention program (i.e., Part C of the Individuals with Disability Education Act), providing early intervention services to at-risk infants and children less than three years of age who meet eligibility criteria based on the presence or risk of developmental disability. Services include infant education, occupational therapy, physical therapy, and speech therapy. Referrals can be made from the NICU or newborn nursery and are often coordinated by a social worker, although anyone can make a referral, including parents, medical providers, neighbors, family members, foster parents, and day care providers.
- Home Health Visits: A number of public and commercial insurance companies offer home health visits, usually in response to a medical need. If the patient does not have insurance, or if the patient’s insurance declines to cover the home health visit, the county often will provide a public health nurse. Some counties or local areas have established their own system (e.g,. Palomar Home Health Services).
- California Budget and Policy Center Report: Home Visiting is a Valuable Investment in California’s Families.
- Helping Hands: A Review of Home Visiting Programs in California.
- Nurse Family Partnership.
- Healthy Families America.
- Local First 5 Commission websites and their local programs.
- National Head Start Association.
- Early Head Start.
- California Head Start.
- Comprehensive Perinatal Services Program.
- Healthy Start.
- Early Start.
- Palomar Home Health Services.
- Kocherlakota P. Neonatal abstinence syndrome. Pediatrics. 2014;134(2):e547-561.
- McQueen K, Murphy-Oikonen J. Neonatal Abstinence Syndrome. NEJM. 2016;375(25):2468-2479.