The primary focus of this Treatment Improvement Protocol (TIP) is the in utero exposure of infants to illicit drugs. In utero exposure to cocaine and opiates, especially heroin, is highlighted, and there is a brief discussion of methadone. Although the substantial crisis of in utero exposure to alcohol is discussed, it is not the focal concern of this TIP. In addition, this TIP highlights medical and psychosocial services for drug-exposed infants up to 18 months of age and their families. Concerns regarding older toddlers and children are mentioned, but they are not the TIP's focus.

Contents

• What Is A TIP?
• Consensus Panel
• Chapter 1 - Introduction
  • What is Covered in this TIP?
  • Statement of the Problem
  • The Impact of Drug Exposure on Infants
• Chapter 2 - Medical Management of The Drug-Exposed Infant
  • Alcohol Use in Pregnancy
  • Diagnosis of In Utero Drug Exposure
  • Medical Assessment of the Drug-Exposed Neonate
  • In Utero Exposure To Opiates: Effects And Treatment
  • In Utero Exposure To Cocaine: Effects And Treatment
  • Promoting Positive Mother-Infant Interaction
  • Discharging the Drug-Exposed Infant from the Hospital
• Chapter 3 - Followup and Aftercare of Drug-Exposed Infants
  • Early Interventions For Infants
  • Interventions for Toddlers
  • Transition to the Preschool Period
  • Quality Assurance Checklist
  • Training for Child-Oriented Professionals
• Chapter 4 - Psychosocial Services for Drug-Exposed Infants and Their Families
  • Comprehensive Psychosocial Services
  • Treatment For Parents
  • Maternal Health Services
  • Mental Health Services for the Parents
  • Parental Educational/Vocational Services And Employment Assistance
  • Other Social Services
  • Helping Parents or Guardians Obtain Supportive Services
  • Keeping Families Intact
  • Referral to Child Protective Services
  • Followup of Infants In CPS or Foster Care
  • Assuring the Quality of Services For Infants in Foster Care
• Chapter 5 - Ethical and Legal Guidelines
  • Assessment of Mothers and Infants for Drug Use / Drug Exposure
  • Reporting Laws And Laws Governing Confidentiality
  • Issues Arising During Postneonatal Followup
  • Training in Legal And Ethical Issues
• Chapter 6 - Quality Assurance Guidelines
  • Documentation of Referral to Ensure Linkage
  • Compliance with Federal Guidelines For Confidentiality
  • Interagency Agreements
  • Other Important Areas for Monitoring
• Appendix A - Resources
• Appendix B - Sample Programs
• Appendix C - Urine toxicology Guidelines
• Appendix D - Description of IDEA
• Appendix E - Family Service Plan
• Appendix F - Medical Glossary
• Appendix G - Cost Factors
• Appendix H - Federal Resource Panel
• Appendix I - Field Reviewers
• References

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0007 from CSAT. Al Getz, MSW; Anna Marsh, PhD; and Sandra Clunies, MS served as the CSAT government project officers. Lynne Bailey, Carolyn Davis, and Claudia Norris served as contractor writers.

The opinions expressed herein are the views of the consensus panel participants and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.