mcstart: history & overview monterey county screening team for assessment, referral, and...

MCSTART: MCSTART: History & OverviewHistory & Overview

Monterey County Screening Team for Assessment, Referral, and

Treatment of Substance-Exposed Children

Chris Shannon, MCCDP, Ex. Dir.

Pre-Natal Exposure in Pre-Natal Exposure in Monterey CountyMonterey County

• 800 pregnancies exposed annually

• Combination exposure

• Meth & alcohol most prevalent

• Prevent/modify effects thru early intervention

Diagnostic Considerations Diagnostic Considerations for Substance-Exposed for Substance-Exposed Children Children

• Attention disorders• Anxiety and mood disorders• Developmental disorders• Language based disorders• Attachment disorders• Learning disabilities• Post traumatic stress disorder

Without early interventionWithout early intervention

Streissguth, et

al., 1996

It doesn’t take a village—It doesn’t take a village—but it takes a well-but it takes a well-coordinated team!coordinated team!

• Trans-disciplinary (parents/caregivers are most important members of the team)

• Targeted, flexible interventions, based on• Comprehensive assessment

MCSTART Early MCSTART Early Intervention:Intervention:the difference of a lifetime the difference of a lifetime . . .. . .• Inter-Disciplinary Clinic

• Located 130 Church St, Salinas• County-wide accessibility and

outreach• Pre-Natal Prevention and intervention• Assessment and early intervention of

developmental, social/emotional, and neurobehavioral disorders

• Policy Component

Public/Private Partnership Public/Private Partnership and Collaborationand Collaboration

• Door to Hope, lead agency• DSES, Family and Children’s Services• Monterey County Children’s Behavioral

Health• Monterey County Community Health• The Parent Center, Salinas Adult

School

MCSTARTMCSTART Multi-disciplinary Multi-disciplinary StaffStaff• Physician

• Child Psychiatrist• Physician’s

assistant• 3 Clinical Ph.D• PhD intern• 2 Psychiatric

Social Workers• 2 Occupational

Therapists

• Speech Therapist• PHNs• Parent Educators• 3 Case Managers• Mentor Coord.• 15 – 20 mentor

parents• Supervisory &

Support staff

Capacity DevelopmentCapacity Development

• 450 - 500 young children annually

• 30 – 50 high risk pregnant women

• 140 dependency court families

• 24 – 30 training events annually

• 800 participants annually

MCSTART FISCAL NEEDS & MCSTART FISCAL NEEDS & STRATEGIESSTRATEGIES

• $2 million annual budget• Difficulties w/ capital funding• Blended & braided funding streams

• First 5 (primary developmental source)

• SA/HIV, formerly OFR• TCM• Title IV E• EPSDT (primary long-term source)

History of DevelopmentHistory of Development

• 1994 & 1998 Dr. Chasnoff addressed DSES, families and community

• 1997 used OFR funds to develop SPARK parent training program for foster/adoptive parents of drug-exposed children

• 2000-01 explored options for reunified families

Development (cont.)Development (cont.)

• Feb. 2002 Dr. Ira Chasnoff and Sid Gardner, Children & Family’s Futures, chaired a Community Summit to address the needs of substance exposed children

• June 2002 team attended Clinical Institute at Children’s Research Triangle, Chicago

• August 2002 developed First 5 grant proposal for MCSTART

Development (cont.)Development (cont.)

• MOU’s developed: Door to Hope↔CBH↔CH↔SAS↔First 5

• Clinic opened 2003• Leadership Institute w/ Children’s

Research Triangle June 2003 w/ over 20 leaders from Board of Supervisors, Health Dept., DSES, MCOE, MD’s, SARC, foundations, & parent educators

Best & Evidence-Based Best & Evidence-Based PracticesPractices

• Chasnoff’s SART• Theraplay®• Circle of Security• Sensory Integration• Therapeutic Listening• FASCETS• How Does My Engine Run?• PCIT• Consultation from Child Trauma Center

MCSTART OUTCOMESMCSTART OUTCOMES

DemographicsDemographicsn= 570 children; 110 pregnant n= 570 children; 110 pregnant womenwomen

Ethnicity

• 61% Hispanic• 28% Caucasian• 9% African-Am• 2% Asian/Pacific Islander

Geographical LocationGeographical Location

• 49% Salinas• 35% Monterey Peninsula• 5% North County• 9% South County• 2% Watsonville

Family StructureFamily Structure

• 60% biological parent(s)

• 14% adoptive parents• 20% relative

caregivers• 15% foster parentsNote: Placements of

children change (79% of caseload involved w/ CPS)

Photo Digital Analysis Photo Digital Analysis for FASfor FASMCSTART ResultsMCSTART Results

• 55% absent any facial features

• 35% mild FAS• 8%

moderate FAS• 2% severe

FAS

ScreeningScreening

Instruments:• Ages & Stages Questionnaire

(ASQ)• ASQ:SE• Parental Stress Index (PSI)• Life Stages Progression (LSP)

ASQ/ASQ:SE ResultsASQ/ASQ:SE Results

• 62% below cut-off levels 1st year of operation

• 54% below cut-off levels 2nd year of operation

• Social Emotional & Communication delays most prevalent (38% & 19%)

• Personal Social (15%) & Problem Solving (13%)

• Gross & Fine Motor (13% & 10%)

OutcomeOutcomere-screen @ 6 months 0-3 yrs. & re-screen @ 6 months 0-3 yrs. & annually @ > 3 yrs.annually @ > 3 yrs.

• 100% improved Personal Social• 75% improved Gross Motor• 64% improved Social Emotional• 60% improved Fine Motor• 58% improved Problem Solving• 44% improved CommunicationChange in placement dramatically affects outcome

Parental Stress IndexParental Stress Index• 1/3 of bio moms

high • 1/5 relative high• 1/10 foster/adoptive

high• > 3 children in

home high• 94% of these

scores decreased after intervention

Life Stages Progression Life Stages Progression IndexIndex

• Nurturing Scale: 79% target enrollment, 93% after 12 months

• Discipline Scale: 80% target enrollment, 100% after 12 months

• Support of Development Scale: 68% target enrollment, 79% after 12 months

• Safety Scale: 85% target enrollment, 100% after 12 months

Occupational Therapy Occupational Therapy ServicesServices

• OT capacity maximized• Clinic & staff currently being expanded• Sensory Profile & Peabody

Developmental Scales• Improvements noted in motor skills,

self-soothing, self-regulation, problem solving, motor planning, sensory defensiveness, attention, behavior

ChallengesChallenges• Accessing services for moderately

delayed children• Engagement & retention of biological

substance-abusing mothers • Parenting skill-building• Capacity maximized• Intensive case management• Inter-team & inter-agency

communication