The training received by program staff helps to determine the quality of services that can be offered by programs serving pregnant, substance-using women and their families.
The array of problems confronting these women suggests that training must be continuous.
The process should begin with an assessment of the training needs of staff and result in a goal-oriented training plan.
Training resources are often close at hand.
Program staff should be canvassed for the skills and knowledge they possess.
Personnel of other community programs represent a wealth of expertise often waiting to be tapped.
Community-based, collaborative training activities offer the added benefit of strengthening the networks that serve pregnant, substance-using women and their children.
The expertise of members of a training team should vary depending on the subject of the particular training being developed or delivered.
Training teams may include a health educator (to develop curricula), nutritionist, social worker, public health nurse, certified alcoholism and drug counselor, program administrator, physician, and mental health counselor.
Training for medical staff, alcohol and other drug treatment providers, and others serving pregnant, substance-using women and their children should address these topics:
Medical guidelines -- basics of prenatal, labor and delivery, perinatal, and postpartum care
Treatment readiness in substance-using women -- understanding aspects of the woman's readiness and/or motivation for treatment
Assessment instruments -- uses and benefits of various instruments to measure substance use, as well as psychosocial, psychiatric, and parental functioning
Dual diagnosis -- techniques for assessment and diagnosis, and treatment planning for mentally impaired, substance-using pregnant women
Women with positive toxicology screens in alcohol and other drug treatment programs -- procedures for referral, counseling, and followup.
Ideally, pregnant women should not be discharged from treatment programs or from prenatal care services because of continual substance use.
Followup care -- approaches for relapse prevention, monitoring, and intervention
Federal and State guidelines for alcohol and other drug treatment -- techniques for assessment and diagnosis, treatment planning, monitoring, and followup care
Confidentiality and reporting -- requirements to report alcohol and other drug use and child abuse and neglect; Federal and State confidentiality provisions
Urine toxicology screening -- procedures for and implications of screening, and the importance of informed consent
Legal issues -- approaches for coping with outstanding warrants, domestic violence, child custody, adoption, foster care, and divorce
Child abuse and neglect -- supportive counseling techniques for improved client functioning and healing, both for the adult or teenage client and for her children
Noncompliant patients -- procedures for the protection of the health and well-being of the mother and child
Gender-specific treatment -- discussion of the special needs of women for transportation, child care, financial support, safe housing, prenatal and postpartum care, issues of sexuality and skills training regarding how to negotiate for safer sex, and sexual abuse and victimization counseling
Sociocultural sensitivity -- discussion of the strengths and challenges presented by race, culture, and socioeconomic circumstances
Incest, adult and child sexual abuse -- discussion of the impact of abuse and issues of anger, fear, and self-esteem
Domestic violence -- discussion of safety concerns, self-worth, independence, legal action, and alternative living environments
Habilitation and rehabilitation -- education of patients in tasks of daily living, skill development, and behavior change
Child development -- discussion of developmental stages, problems, and the special needs of children of substance-using mothers
Developing cooperative agreements between medical, alcohol and other drug treatment, and social service programs -- formal and informal approaches and mechanisms to develop cooperative agreements
Community services -- discussion of the types of services available, eligibility requirements, and barriers to service
Outreach -- identification and recruitment of clients into care
HIV antibody counseling and testing -- procedures for the protection of patients and program staff and approaches for supportive care
Infectious diseases of drug users -- discussion of the signs and symptoms of disease, particularly sexually transmitted diseases, blood-borne infections (e.g., hepatitis B and C), and tuberculosis, and approaches for their prevention and treatment
A comprehensive assessment of each patient entering treatment is needed and should include the following:
History of alcohol and other drug abuse
Psychosocial history
Medical history
Mental health history
A number of assessment instruments are widely used to collect information that is helpful in diagnosis and treatment planning.
Examples of some of these instruments are listed below.
Other instruments are available that illustrate the ways in which individual treatment programs have developed or tailored assessment tools to meet the particular needs of their patient populations.
Examples of some of these latter instruments are also listed.
The listing of a particular assessment instrument in no way implies an endorsement of that instrument, nor is the following list intended to be inclusive or representative of all assessment instruments that may be used by treatment programs.
The instruments included here are used or recommended by some treatment providers.
A collection of sample assessment instruments is available as a package from the National Clearinghouse for Alcohol and Drug Information (NCADI), P.O.
Box 2345, Rockville, MD 20852, 1-800-729-6686.
The specific instruments included in the package are identified below as "available from NCADI." Other assessment instruments are available commercially and may be ordered individually from the sources listed.
The ASI is a highly structured clinical interview designed for a trained technician to use to rate the severity of problems in six areas: medical, psychiatric, legal, family and social, employment and support, and use of alcohol and other drugs.
Source: McLellan, A.T.; Luborsky, L.; O'Brien, C.P.; and Woody, G.E.
An improved evaluation instrument for substance abuse patients: The Addiction Severity Index.
Commented out ElementJournal of Nervous and Mental Disease 168:26-33, 1980.
Available from NCADI.
This 22-question instrument was developed as an adjunct to the ASI.
Source: Maternity, Infant Care-Family Project, Medical and Health Research Association of New York City, Inc., 225 Broadway, New York, NY 10007.
Available from NCADI.
This 20-page self-administered questionnaire covers substance use patterns and treatment, psychological and behavioral issues, legal history, employment, education, activities and peer support, family history, health status, and current or imminent crises.
Source: Operation PAR, Inc., 10901-C Roosevelt Boulevard, Suite 1000, St.
Petersburg, FL 33716.
Available from NCADI.
This section presents a model program and sample budget for State agency and local treatment staff to use in providing services for pregnant, substance-using women.
The section identifies specific services, presents staffing patterns, and includes costing assumptions recommended by experts from the fields of alcohol and other drug treatment and mental health.
A model program has been designed with the understanding that not all States or localities are able to begin new programs.
This model program is intended to be used as a guide or standard for developing a program, adding new services, or incorporating some of the guidelines into an already-existing program.
The sample budget is based on the model program and lays out the requirements and formulas for estimating program costs.
The cost assumptions can be tailored to conditions that prevail in different geographic areas.
For example, to estimate labor costs in a specific location, the prevailing salary/wage rates should be substituted for the rates used here.
A list of Medicaid reimbursement rates for various medical procedures is presented as a guide.
These rates represent the average reimbursement rate paid to States.
A program's actual reimbursement rate for individual procedures may vary.
Additional help on how to tailor the cost model is provided later in this section.
The model program is specifically designed to meet the special needs of pregnant, substance-using women.
The goal of the program is to provide comprehensive services that are appropriate and sensitive to the needs of the target population -- services that will enable women to secure prenatal care and other support throughout pregnancy, to achieve a successful delivery, and to receive 3 months of postpartum care.
Services will be provided by a multidisciplinary team of health professionals, including medical or psychiatric social workers, obstetrical/gynecological (Ob/Gyn) specialists, clinical nurse practitioners, and outreach workers.
All health care services will be provided in one setting, with the exception of laboratory work.
If the patient needs to undergo medical withdrawal or be hospitalized, referrals will be made to the appropriate programs.
The model program will provide outreach services, laboratory workups, obstetrical and gynecological physicals, social work intervention, and appropriate followup services.
In addition, the program will provide diagnosis, evaluation, and short-term clinical interventions, along with medical management, to avoid exacerbation of symptoms and unnecessary hospitalizations.
A case management model is used and will be directed by the medical or psychiatric social worker to ensure that concrete services, advocacy, referral, and linkages to other service providers in the community are available.
The woman's transition into providing child care and parenting will be facilitated by a complete and thorough assessment of her needs and the development of a comprehensive treatment plan.
The staffing pattern for the model program is designed around a rotating team concept.
There will be four treatment teams consisting of an outreach worker, medical or psychiatric social worker, Ob/Gyn physician, and clinical nurse practitioner.
Each treatment team will have a caseload of no more than 20 women, and the overall program capacity will be 80 slots.
Initial staffing, outreach, intake, and patient scheduling will vary, and it may take several months for the program to be fully operational.
During the first few months of program startup, the four outreach workers will be on-call each week.
Based on their experience and knowledge of the treatment field, the workers will provide outreach to women who are suspected alcohol and other drug abusers.
They will engage the women and facilitate their entry into the program for prenatal care, delivery, and followup.
The four clinical nurse practitioners will function as the intake team.
Their duties will include facilitating all necessary workups prior to the first prenatal visit and physical examination by the physician.
All laboratory tests will be completed and results given to the physician for review within 1 month.
Unless there is a medical emergency, an appointment with the physician will be scheduled for the patient within the first 2 months of the first trimester.
The physician will see the patient on a monthly basis during the second trimester and weekly visits will be scheduled during the third trimester.
It is anticipated that two part-time Ob/Gyn specialists should be able to handle the expected caseload.
The four medical or psychiatric social workers will serve as case managers.
They will initiate case management services toward the end of the first trimester -- after the patient has undergone preliminary assessment.
Each case manager will be responsible for ensuring the patient has access to services within the program and in the community, and will serve as a liaison between the patient and her treatment team.
The case manager will work with the patient to ensure that she understands her treatment, including all pertinent medical procedures, laboratory tests, preparation for childbirth, and followup plans.
Additionally, the case manager will provide supportive counseling as needed, facilitate communication between all members of the treatment team, and conduct case conferences among all those involved in the woman's care, including community- based programs or services.
Clinical nurse practitioners will help train the mother in such key areas as child care, parenting, and nutrition.
After delivery, the medical or psychiatric social worker will work with the clinical nurse practitioner to facilitate the appropriate integration of the woman and her child into the community.
The following section looks at the costs associated with the operation of the model program to provide comprehensive medical care and case management services for pregnant, substance-using women that is described above.
The sample budget is based on a static patient population of 80 slots per year.
The total number of patients served by the model program will be greater than the number of slots allocated, since patients will enter and leave at different points in the treatment continuum.
The model program budget is based on these assumptions:
The average length of stay in the model program is 1 year.
The model program is fully operational.
A range of salaries is presented, although the total budget reflects the high end of the range.
Actual salaries will vary by geographic area.
Two half-time physicians are hired for a total of one full-time equivalent (FTE) position.
Laboratory charges are based on a limited national survey and on single-unit prices.
Actual costs will vary by geographic area, particularly if volume- discounts are available.
Costs for sonograms are not included.
An administrative overhead charge of 20 percent of total wages and fringe benefits is included in the model budget to provide for the costs of administrative supervision and support.
The fringe benefit rate is calculated at 30 percent.
A transportation allowance of $20 per patient slot is included in the budget to cover the cost of bus tokens, cab vouchers, and so forth.
The budget does not include indirect costs necessary for the operation of a facility.
Examples of indirect costs that should be considered part of an operating budget include
The sample budget does not include costs for delivery of the baby or for alcohol and other drug treatment, including medical withdrawal.
These costs would be incurred regardless of the new services a program might offer, and vary from State to State.
The program budget also does not look at reimbursement issues.
Before deciding to implement this program, Federal, State, local, and third party reimbursement programs need to be studied.
These reimbursement sources may pay for part or all of any new services suggested by this model.
The need for comprehensive services for pregnant, substance-using women is clear.
The model program offers a case management approach to address the total needs of this population.
Given the complexities of treating pregnant, substance-using women and the relative lack of resources, a significant number of women do not receive adequate care.
The information provided in the guidelines, along with the suggestions in this section for program design, staffing, and costing, are intended to guide States and local treat- ment programs in their efforts to provide services to this population.
Sample Program Budget
Pregnant, Substance-Using Women Sample Program Budget Program Capacity for 80 Treatment Slots
Personnel Costs
Position
Full Time equivalents needed
Salary Range Per Year
Estimated Cost*
Program Director
1
$45,000-65,000
$65,000
Nurse Practitioner
4
$30,000-40,000
$160,000
Physician (Ob/Gyn)
1
$100,000-120,000
$120,000
Psychiatric/Medical Social Worker
4
$30,00-45,000
$180,000
Outreach Worker
4
$20,00-30,000
$120,000
Total Wages
$645,000
Fringe Benefits @ 30% of wages
$193,500
Total Personnel Costs
$838,500
Other Costs
Cost
Laboratory (80 patients @ $783.42)
$62,674
Clinical Supplies (80 patients @ $40)
$3,200
Publications
$1,000
Training and Conferences ($250/staff member)
$3,500
Transportation ($20/patient)
1,600
Administrative Overhead @ 20% of wages and fringes
$167,700
Total Other Cost
$239,674
Total Personnel and Other Costs
$1,078,174
*Estimated personnel costs were calculated using the high end of the salary range. These costs will vary widely by State and locale.
Alcohol and other drug treatment programs have increasingly used quality assurance (QA) techniques to maintain or improve the level of care provided to patients and to contain costs.
In addition, a quality assurance component is often mandated for the licensure and reimbursement of treatment programs.
Every treatment program should have an ongoing and active quality assurance program.
Experience has demonstrated that pregnant, substance-abusing women entering treatment need a wide range of support services.
To provide this comprehensive level of care, treatment staff must marshall the resources of a host of other agencies through referral and collaboration.
The careful monitoring of these referral and interagency collaborative activities on behalf of patients is a key quality assurance function for treatment programs.
Monitoring should cover these aspects:
Documentation of referrals and the sharing of patient information
Compliance with Federal and State confidentiality regulations
Preparation of interagency agreements
Assurance of linkage and documentation of collaborative activities
It is well known that merely making referrals for patients neither ensures that services are received nor guarantees the quality of the services that are delivered.
One of the key functions of a QA program is to monitor the process of referral.
A well-designed QA program will routinely select a sample of all patient records and related referrals and monitor these sources to ensure that linkage has occurred.
Documentation must be made of the results of the monitoring and related actions taken to correct any problems and improve services.
Examples of quality assurance monitoring activities are as follows:
Monitor patient records to ensure that proper referrals were made.
Monitor patient records to ensure that appropriate and necessary information was shared with the referral agency (e.g., reason for the referral and problems to be addressed).
Monitor referral logs, payment vouchers, or other referral documentation for completeness and appropriateness (e.g., Is payment appropriate to the services provided?).
Monitor patient records to ensure that linkage was documented (e.g., Was the patient evaluated and accepted for services?).
Monitor patient records for notes of treatment progress and/or continued service (e.g., regular documentation of treatment progress), or documentation that services were no longer needed (e.g., documentation of the followup services that were being provided and why services were no longer needed).
Every agency that provides services to pregnant, substance-using women must ensure that internal policies and procedures comply with both Federal and State confidentiality and reporting regulations (see Guideline 17 -- Confidentiality and Reporting).
Once compliance is ensured through the development of policies and staff training, a process of quality assurance monitoring should be developed to routinely review a sample of all program records.
Documentation must be made of the results of such monitoring and related actions taken to correct any problems and improve services.
Examples of quality assurance monitoring activities are as follows:
Monitor for documentation that service providers informed patients of their rights to confidentiality and offered information about possible court involvement.
Monitor for documentation that service providers informed patients of all laws that were relevant to their specific circumstances.
Monitor to ensure that there is a written informed consent on file whenever there were discussions concerning patients with individuals or organizations outside the treatment facility.
Monitor to ensure that the written informed consent is time-limited, content-specific, person-to-person, signed, and witnessed.
In order for interagency collaboration and linkage to be successful, there must be a written document that clearly delineates the responsibilities of the cooperating agencies.
Interagency agreements, at a minimum, should have these characteristics:
Describe the services to be provided by each agency.
Describe the referral process to be used and the documentation requirements of each agency.
Establish a timeframe for the review and possible revision of the agreement.
Examples of quality assurance monitoring activities are as follows:
Monitor to ensure that the referring agency provided all appropriate and necessary patient information to the referral agency.
Monitor to ensure that there is documentation that the referral agency provided all agreed-upon services in a timely manner.
Monitor to ensure that the referral agency provided documentation to the referring agency of patient progress, continued need for services, or readiness for termination of services.
Additional aspects of linkage and collaborative activity that are appropriate for quality assurance monitoring include:
Monitor to ensure that linkage occurred, as demonstrated by the acceptance of patients into followup care.
Monitor to ensure that there is documentation for patients who were not accepted for treatment (e.g., reasons why patients were not appropriate for the facility, and what steps were taken to link patients to appropriate services).
Monitor to ensure that there is documentation for the discharge of pregnant patients.
Although the discharge of pregnant patients from treatment is not recommended, occasions may arise that necessitate this course of action.
There must be full documentation of the rationale for discharge and the attempts that were made to maintain patients in treatment.
For example, when patients are discharged for noncompliance, there must be documentation of the steps taken to encourage treatment compliance.
Similarly, there should be documentation of the referral of patients to alternative treatment.
Monitor to ensure that there is documentation of the referral of patients when the agency was unable to provide necessary services (e.g., Are patients referred to a methadone program when needed?).
Monitor to ensure that patients have a treatment plan listing all required services and that there is documentation of patient progress for all referred services.
premature detachment of a normally situated placenta.
adjudicate:
to pronounce or decree by judicial sentence.
AIDS:
acquired immunodeficiency syndrome. A disease characterized by opportunistic infections (e.g., Pneumocystis carinii pneumonia, candidiasis, Kaposi's sarcoma) in immunocompromised persons; caused by the human immunodeficiency virus (HIV) and transmitted by exchange of body fluids.
amniocentesis:
a procedure whereby fluid is aspirated from the amniotic sac through the abdomen.
anergy:
absence of demonstrable sensitivity reaction in a subject to substances that would be antigenic (immunogenic, allergenic) in most other subjects. Anergia; lack of energy.
anomaly:
deviation from the average or norm; anything structurally unusual or irregular or contrary to a general rule.
anorexia:
diminished appetite, aversion to food.
asymptomatic:
without signs or symptoms.
bacteremia:
the presence of viable bacteria in the circulating blood.
booting:
any drug solution, such as cocaine or heroin, mixed with blood aspirated into a syringe and then injected into a vein, repeated one or more times to clear the syringe barrel and tip of any of the drug residue. Heavy blood contamination of the syringe may contribute to colonization with bacterial pathogens and to the more likely transmission of the human immunodeficiency virus (HIV).
case manager:
one who defines, initiates, and monitors the medical, drug treatment, psychosocial, and social services provided for the woman and her family.
cervical dysplasia:
abnormal tissue development of the uterine cervix.
chancroid:
an acute bacterial infection characterized by single or multiple ulcers or sores in the genital area; an infectious venereal ulcer with a soft base.
chlamydia:
a sexually transmitted disease manifested by mucopurulent endocervical discharge and inflammation of the endocervical columnar epithelium. Symptoms may be moderate or scanty discharge, urethral itching, and burning on urination, but patients are often asymptomatic.
condylomata:
a wart-like excrescence at the anus, vulva, or on the glans penis caused by the human papilloma virus (HPV).
congenital:
existing at birth. Refers to certain mental or physical traits, anomalies, malformations, or diseases which may be either hereditary or due to an influence occurring during gestation up to the moment of birth.
premature detachment of a normally situated placenta.
adjudicate:
to pronounce or decree by judicial sentence.
AIDS:
acquired immunodeficiency syndrome. A disease characterized by opportunistic infections (e.g., Pneumocystis carinii pneumonia, candidiasis, Kaposi's sarcoma) in immunocompromised persons; caused by the human immunodeficiency virus (HIV) and transmitted by exchange of body fluids.
amniocentesis:
a procedure whereby fluid is aspirated from the amniotic sac through the abdomen.
anergy:
absence of demonstrable sensitivity reaction in a subject to substances that would be antigenic (immunogenic, allergenic) in most other subjects. Anergia; lack of energy.
anomaly:
deviation from the average or norm; anything structurally unusual or irregular or contrary to a general rule.
anorexia:
diminished appetite, aversion to food.
asymptomatic:
without signs or symptoms.
bacteremia:
the presence of viable bacteria in the circulating blood.
booting:
any drug solution, such as cocaine or heroin, mixed with blood aspirated into a syringe and then injected into a vein, repeated one or more times to clear the syringe barrel and tip of any of the drug residue. Heavy blood contamination of the syringe may contribute to colonization with bacterial pathogens and to the more likely transmission of the human immunodeficiency virus (HIV).
case manager:
one who defines, initiates, and monitors the medical, drug treatment, psychosocial, and social services provided for the woman and her family.
cervical dysplasia:
abnormal tissue development of the uterine cervix.
chancroid:
an acute bacterial infection characterized by single or multiple ulcers or sores in the genital area; an infectious venereal ulcer with a soft base.
chlamydia:
a sexually transmitted disease manifested by mucopurulent endocervical discharge and inflammation of the endocervical columnar epithelium. Symptoms may be moderate or scanty discharge, urethral itching, and burning on urination, but patients are often asymptomatic.
condylomata:
a wart-like excrescence at the anus, vulva, or on the glans penis caused by the human papilloma virus (HPV).
congenital:
existing at birth. Refers to certain mental or physical traits, anomalies, malformations, or diseases which may be either hereditary or due to an influence occurring during gestation up to the moment of birth.
cross training:
]to be trained in several disciplines to facilitate broader coverage in a treatment unit.
dysuria:
difficulty or pain in urination.
diaphoresis:
increased perspiration.
dyspnea:
shortness of breath.
embryo:
the developing organism from conception until approximately the end of the second month.
endocarditis:
inflammation of the lining of the heart.
epidemiology:
the study of the relationship between various factors that determine the frequency and distribution of diseases in human and other animal populations.
fetus:
the unborn young from the end of the eighth week to the moment of birth.
folliculitis:
an inflammation of the hair follicles. The lesions may be papules (small skin elevations) or pustules.
fungal infections:
a general term used to describe those diseases caused by diverse morphological forms of yeasts and molds.
genitourinary:
pertaining to the organs of reproduction and urination.
gestation:
the process, state, or period of pregnancy.
gonorrhea:
a sexually transmitted disease manifested by an inflammation of the genital mucus membrane.
hairy leukoplakia:
a white lesion appearing on the tongue of patients with AIDS. The lesion appears raised, with a corrugated or "hairy" surface, due to keratin projections (a substance found in the dead outer corneal skin layer and in hair and nails).
hemangiomas:
a congenital anomaly in which a proliferation of vascular endothelium leads to a mass that resembles neoplastic tissue. It can occur anywhere in the body, but is most frequently noticed in the skin and subcutaneous tissue.
hepatitis:
inflammation of the liver, usually from a viral infection, but sometimes from toxic agents.
hepatomegaly:
enlargement of the liver.
herpes simplex:
a virus that in humans causes fever blisters, usually on the lips and external nares (nose), and also on the genitalia. This virus may also cause acute stomatitis and meningoencephalitis.
histoplasmosis:
Darling's disease. An infectious disease manifested by a primary benign pneumonitis similar to primary tuberculosis.
HIV:
human immunodeficiency virus. The virus occurring in humans that causes a condition that results in a defective immunological mechanism, opportunistic infections, and eventually in the disease process know as AIDS (acquired immunodeficiency syndrome).
hyperpnea:
breathing that is deeper and more rapid than is normal at rest.
hyperpyrexia:
an abnormally high fever.
hypotonia:
having a lesser degree of tension in any part of the body.
icterus:
relating to or marked by jaundice.
infant:
a child under the age of 1 year.
Kaposi's sarcoma (K.S.):
malignant neoplasm occurring in the skin and sometimes in lymph nodes, manifested by cutaneous lesions consisting of reddish-purple to dark blue macules, plaques, or nodules. It is seen mostly in men and as an opportunistic disease in AIDS patients.
ketoacidosis:
enhanced production of ketone bodies due to alcohol or diabetes.
lymphadenopathy:
any disease process affecting a lymph node or nodes; clinically refers to enlargement of nodes.
meconium:
the first intestinal discharge of the newborn infant.
microcephaly:
pertaining to abnormal smallness of the head.
morbidity:
pertaining to severe illness.
mortality:
pertaining to death.
mucopurulent:
containing or composed of mucus and pus.
myoclonic:
spasm or twitching of a muscle.
neonate:
a newborn. Refers to the period immediately following birth and continuing through the first 28 days of life.
neurotropic:
a virus or drug that has an affinity for nerve cells or tissue.
nosocomial:
denotes a new disorder not related to patient's original condition that is associated with being treated in a hospital, e.g., a hospital-acquired infection.
ocular:
pertaining to the eyes.
odynophagia:
pain on swallowing.
paresthesia:
an abnormal sensation, such as burning, pricking, tickling, and tingling.
perinatal:
occurring during, or pertaining to, the periods before, during, or after the time of birth, i.e., from the 28th week of gestation through the first seven days after delivery.
postnatal:
occurring after birth.
prenatal:
occurring before birth.
prophylaxis:
to guard against or take precautions that will prevent either disease or a process that can lead to disease.
pruritus:
itching.
psychotropic:
pertaining to drugs used in the treatment of mental illness; affecting the mind.
pyoderma:
skin infection characterized by the formation of pus.
retinitis:
inflammation of the retina, which may be caused by the cytomegalovirus (CMV).
seborrheic dermatitis:
overactivity of the sebaceous glands resulting in a scaly macular eruption that occurs primarily on the face, scalp (dandruff), and pubic and anal areas.
septicemia:
systemic disease caused by the spread of microorganisms and their toxins via the bloodstream.
sonogram:
an image obtained by ultrasound, used to produce an image of the fetus.
splenomegaly:
enlargement of the spleen.
spontaneous abortion:
the loss of an embryo or fetus prior to the stage of viability at about 20 weeks of gestation as a result of natural causes (not artificially induced).
Drug-Exposed Infants and their Families: Coordinating Responses of the Legal, Medical and Child Protection System. Washington, DC: the Association, 1990.
Options For Recovery: Services For Alcohol and Drug Abusing Pregnant and Parenting Women and Their Infants. A Report to the California Legislature,1991.
The prevalence of illicit drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. New England Journal of Medicine 322:1202-1206, 1990.
"Trends in Diagnosed Drug Problems Among Newborns: United States, 1979-1987." Paper presented at the 118th Annual Meeting of The American Public Health Association, New York, October 1990 (revised).
A Practical Guide to Intervention in Health and Social Services with Pregnant and Postpartum Addicts and Alcoholics: Theoretical Framework, Brief Screening Tool, Key Interview Questions, and Strategies for Referral to Recovery Resources. State of California Grant for Training and Cross-Training in Health, Social Services, and Alcohol/Drug Services, 1990.
Neonatal abstinence syndrome: Assessment and pharmacotherapy. In: Rubaltelli, F.F. and Granati, B., eds. Neonatal Therapy: An Update. Amsterdam, New York, Oxford: Elsevier Science Publishers, 1986, pp. 10-144.
These treatment improvement guidelines for pregnant, substance-using women were prepared using protocols and other materials that were developed by a broad range of programs from across the Nation. Many of these programs currently receive grant funds through the Center for Substance Abuse Prevention (formerly the Office for Substance Abuse Prevention [OSAP]). The Consensus Panel gratefully acknowledges the assistance of CSAP in providing access to these grantee materials. The Panel is also grateful to the many professionals in the alcohol and drug treatment field who so generously provided access to their program materials. These contributing programs are listed below.
The suggestions and comments of expert field reviewers were particularly helpful in enhancing the quality of the final guidelines. These individuals were selected to review and comment on the draft document based on their knowledge of and concern for the special needs of pregnant, substance-using women. The Consensus Panel appreciates and acknowledges the time and substantive quality of their comments. These individuals are also listed below.
These treatment improvement guidelines for pregnant, substance-using women were prepared using protocols and other materials that were developed by a broad range of programs from across the Nation. Many of these programs currently receive grant funds through the Center for Substance Abuse Prevention (formerly the Office for Substance Abuse Prevention [OSAP]). The Consensus Panel gratefully acknowledges the assistance of CSAP in providing access to these grantee materials. The Panel is also grateful to the many professionals in the alcohol and drug treatment field who so generously provided access to their program materials. These contributing programs are listed below.
The suggestions and comments of expert field reviewers were particularly helpful in enhancing the quality of the final guidelines. These individuals were selected to review and comment on the draft document based on their knowledge of and concern for the special needs of pregnant, substance-using women. The Consensus Panel appreciates and acknowledges the time and substantive quality of their comments. These individuals are also listed below.
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