-- 
..".. \
CRACK 
BABIES: 
SELECTED MODEL PRACTICBS

'YIClS 
GENER1 
OFFICE OF INSPECTOR 
OFFICE OF EVALUATION AND INSPECTIONS 
JUNE 1990  . . 
- .
. . 
. , _"
OFFICE OF INSPECTOR GENERAL

Il1issionoftheOffc  ofIr1  promoteeffci ncy. effectiveness, 
pe9tor(3eJ1era(OIG) is to 
Humarrvces 
and integrty of pmgr~inth  Vnite, States Depan ntof lIeaIthand 
(HS). lt does thS by '  yeloping  () detec  Ard prevent!rud. waste. and abus 
tlb9s 
Crea  YStatutein'  7 6.  lJSptor  neralkeeps '.JJththe  tary andthe' Congrss
reoIIends 
l?utprogror management problems and 
fll11Yandcllntly infof1ed 
tiveaction.  'IeOIqJt1iormjtsrnssion by COJ1dllCtig aU  l$, investigations  and 
irspedions with approxi elyl.300 sta strategicaly loca  'around the countr. 
OFFICE OF EVALUATION AND INSPECTIONS 
th 
Thine.ponis prouced by the Qfce ofEvaluarlon and Inspetions (OEI), one of  major 
mthePfceof 
offce  withinthe()IG, Audit Servces (OAS) and the Office 
'The Other tWo 
oflnyestigations (QI). TbeOElconducts ins  tions whichartyicallysbon-term stUdies 
designed to detennne progr .effectiven ss. effciency and wlnerabiltyto frud and abuse. 
1Qrepon is descrbes selected IDodel practices which maybe effective in assisting 
clg  posebabies  dtheirfaries  These modls were encountere durg an insption 
tpghoW crack  abies  ect thech  d welf  sys  Thefmdigs from the Crack 
" Bab  $ijspetiol1arcor1  edi. a separte repon, OEI-03-89-01540. 
Thestudyy.as prepar Wlderthe dition of Joy Quil, Regiona Insptor Genera. Ofce 
opf Eev  upatiolneand: I nspetions, RegioIlID.  Parcipatig in thsproject wer thefoUowig
PhiiadelphlaReglon  Washington. D. 
JosephG. White. Project Leader  Alan Levine 
Lois C Lehmarn 
Lida M. Ragone 
Isbelle Buonocore 
Hasford 
Cyth R. 
San Francisco 
Lemesh . 
Cythia A. 
Mahal Schff 
TriciBanniter 
For mor inoration on ths stdy. conta Joseph G. Whte at (215) 596-17.  , .

CRACK BABIES:

SELECTED MODEL PRACTICES

Richard P. Kusrow 
INSPECTOR GENERAL 
OEI..3-89-01542  JUNE 1990
 INTRODUCTION 
PURPOSE 
This repon descrbes selected model pratices which may be effective in assisting 
drg~xpose babies and their famies. 
crk 
These modls were encountere durng an inspetion examng how 
babies afect the 
child welfar system. The findigs frm the Crk Babies inspetion ar contaed in 
separte repon.

BACKGROUND 
Durg  Crk 
the  Babies inspection. we found that public and private agencies ar strgglig 
to cope with the incrased volume of drg-expose inants and the multiple servce need of 
their famlies. Servces ar provide to fames considere to be at ' high-risk." Some 
indicators of high-risk famy cirumtaces ar poveny. substace abuse. famly disruption. 
and abuse or neglect. 
Agencies identied may servce prblems. Some agencies have prblemtsr pgro.v idig early 
intervention servces. comprehensive cas maagement, and casworker  Study 
spe 
respndents ar also concerned about the  educational nee of these chidrn and the 
lack of interagency coordation. 
In ths repon, we descbe pratices being use by public and prvate agencies. and State and 
adss 
local governnts to  some of these problems. 
The Crak Babies insption found that the problems cause by crk ar inseparble frm the 
progr 
larger issue of prenata exposur to other drgs includig alohol. Accordgly.  and 
lite 
procedurs descbe in ths repo ar not  to those dealg with crk or cocaie 
exposur. 
METHODOLOGY 
qua 
We collecte inormtion in 12 metrpolita ar durg the lat  of 1989. 
adistrto  cawor, 
Respondents include chid welfar  and  hospita soal servces 
sta. prvate agency reprsentatives. foste parnts, Sta and local offals. and national 
prgr  prurs 
expert. These respndents idntied  and  which they considere 
prgr 
assistig drg~xpose babies and their fames. Whe al 
effective in  cite in ths 
repo were contate and most were visite we did not atmpt to assess their effectiveness.  CATEGORIES OF MODEL PRACTICES 
This repon is a selection of model practices which may be effective in assisting drg~xposed 
babies and their famlies. 
Practices are presented in eight categories: 
COMMUNIT OUTREACH AND EARLY INTERVENTION 
II.  COMPREHENSIVE SERVICES IN ONE LOCATION 
II.  EDUCATION FOR DRUG-EXPOSED CHILDREN 
IV.  CASE MANAGEMENT 
PROFESSIONAL TRAINING 
VI.  MANAGEMENT PRACTICES 
VII. 
INTERAGENCY COORDINATION 
VIII. PRIVATE INmATIES 
More inormtion on these pratices can be obtaed frm contatS liste in the appendi.  I ' 
I. 
COMMUNITY OUTREACt: AND EARLY INTERVENTION 
Communty outrach involves going into neighborhoo to find drg abusing women and 
their childrn. The next step is to encourge them to use avaiable medical and socal services, 
Aggressive outrach getS women and childrn to servces they would not othexwise receive. 
Early intervention means identifyig problems in their early stages and providig appropriate 
services in ordr to prevent serious problems. 
progr 
The followig four  provide outrach and/or eary intervention to fames in their 
communities. 
MaternitY Outeach Mobile (MOM) Proiect is adistere by the Deparent of Human
The  Marn 
Servces (DHS). Commssion on Public Health, Offce of  and Chid Health. in the 
Disaict of Columbia. The MOM Project conducts early identication and trattent of 
high-risk populations thugh scning. referr. and follow-up. The project i!ta response to 
the high inant mortty rates in the Distrt. 
The MOM tagets pregnant women. parnting women, and inants in high-risk aras. The van 
canvasses neighborhoo, par. and shopping aras lookig for mothers and inants. It also 
taes referr fr DHS and a varety of other soures. 
Outrach workers in the van  risk women and inantS intO the MOM project. 
tr to enrll high-
The workers then refer women for car to the nearst health center or health car provider. 
The MOM van sta also ta women to appoinnnnts and follow-up to be sur women ar 
using the servces. 
prgr 
St. Luks/Roosevelt HosDital Center New Yor City. ha tWo  with its Community 
Servces for Chidrn and Fames: the Prvention Unit and the FU't Step Unit. Since the 
ounitSf afr eafartee w ithb they hos pitta,h theeir cli nths haove ascssp to ithte waide  rage of servces
Ch 
The New Yor City  Welfar Admtrtion (CWA) contrts with bOth unts and 
provides a lae porton of their fudig. The Firt Step Unit also reeives  2S  percent of its 
budget frm prvate sours and foundations. 
The Prvention Unit sees muti- of whom ar referr by CWA. At 
prblem fames, most 
fams 
least 6 of thir 42  must be "bor baby" prevention referrs. The unt is stafed by 
soial worer, psychologits, and vo unter home visito. 
deas 
The Prvention Unit seks to  the incidence of child 
prvent foste car placment, 
abuse and neglect, imve the parnts' abilty to deal with psycho-soc crses. and promote 
sta 
the persnal development of parnts and chidrn. The  assumes cas maagement and 
coo  th famy with personalze coordation strtegies. ,The
clical respnsibilty for 
seces includ counselig, crsis intervention, home visits, and parnt  hild 
intetion therpy.  -- -,.  -;-"
The Firt Step Unit serves 24 pregnant teenagers and teenage mothers with infants. Staed by

social worker and volunteer home visitors. the unit seeks to improve parntig skils. reduce 
psycho-soial strss, foster personal development. increas self-estem. and reuce potential 
foster car placement. The home visitors help incras the mother s knowledge of the 
physical and emotional needs of her baby. The sta suppons the mother in "dealing with 
futu. 
the choices for her 
conflct and strsS, and motivate her to consider 
Harbor/UCLA Medical Center in Torrce. Caorna  Substance AbusinR Mothers
The  has a 
(SAM) Clinic  The SAM Clinic provides suppon and car to pregnant women adcted to 
illicit drgs. Eighty percent of the infants born to women attndig the clinic have ben drg
fr at bin. The infants have a reuced incidence odf pereamastu ty and low-bin weight, 
shoner neonata stays. fewer perinata deaths. and  nee for foster car as 
prgr 
compar to other babies born to adcte women not in ths 
Sta include a clic coordnator, periatologist, developmenta psychologit, psychitrt, 
nur 
dietician, and  educator. as well as petrcians. OB-GYN house sta, and certed nure 
midwives. The servces prvide ar prenata car. peatrc car, soal servc. case 
maagement, chemical dependency tratmnt, parnt edupcaltaiogn. .s uppo grups. indiviual 
and grup counselig. community outrach. and famy  The fundig for these 
Prgr 
servces comes from the county Drg Abuse  and State funds set aside for hospita in 
tagete counties. 
There is also a clinic for childrn of substace-abusing mother th dos developmenta 
inteal durg 
testig and assessment. Babies ar followed at 4-month  their fit year and 
6-month interval thereafte. 
The  Center for Famly Likin Broklyn, New Yor is a multi-sece ag0e0nc y servg the
Sunset Park communty of Broklyn, a por neighbooo of some 98. people. 
pri 
While its  focus is to  eir own homes thugh a varety of 
susta chidrn in  prgr 
supportve servces. it reently develope a pilot fostesr faam  y  in which foster 
fames ar matched with natu fams with the  neighbooo when placement is 
necessar. Suppo by a contrt with the New Yor Chid Welfar A  strtion. the 
pur 
progr  is to reuce the trum of separosn efors c haidrin  who have to be removed 
to keep siblip together, and to offer mor intensive  towar famy 
reuncation. Af chin ar retued to their parnts, th famy is encourged to rema 
connecte with the Cente for ongoing suppo and risk reucton. The Cente has found 
neighborhoo foste famy homes for 64 chidrn and ha retued 33 to their parnts. 
counlig; 
The Cente's famy servces include individua grup, and famy  psychological 
progr 
inant/oder/parnt  foste grdparnts; 
and psychiatrc assessments; an 
employmnt servces and job plaement; emergency foo an advocac cliic; and extensive 
school-bas acvities. The lattr include school-age chid car seces at tWo schools, as 
sum  prgr. 
well as tWo ten cente and  day camp  The Center for Famy Life has develope servces that ditly meet the nee of its 
neighborhoo clients. It is involved in developing the community as well as with individual 
and famly clients. This commtment is reflecte in the Center s policy of being available to 
the neighborhoo 7 days and evenings a week. 
II. COMPREHENSIVE SERVICES IN ONE LOCATION 
Central locations offerig comprehensive servces ar a preferr approach for reaching and 
servng drg-addcted women and their famies. Servce nee include medcal car, 
dite 
counseling, and social servces. The facilties provide servces  at the 
multi-diensional nee of drg-afecte famlies. The avaibilty of a varety of services at 
one location maes it easy and convenient for fames to accept seces. 
th 
Descptions of  facilties which provide comprehensive servces to drg-adcte women 
and their childrn follow. 
Fames. 
Marrn LUlher Kinll ir. Hospital in Los Angeles, Caornia is a county facilty where four 
progr ar avaiable for drg-expose babies and their fames. These progr ar pan of 
progr 
an umbrell  caled Shield for 
progr 
The flIt  prPrijyec t Support provides prenata car and outpatient drg tratment 
clients referr  by the hospita The Caorn Deparnt of Chdrn s Servces 
prgr  me 
(DeS) can madate individua parcipation in the  by  of a coun orr. The 
Prgr 
fu4ig. 
county Drg Abuse  provides 
clic 
The seond progr High-Risk Inant Follow-up, is a  th prvides medcal car for 
inants and ensurs they reeive necessar serces. It is for chidrn from 0 to 5 year of age 
who have developmenta nee or ar at high-risk. Chdrn ar referr frm other Shield for 
Fames prgr  progr 
as well as by DeS, hospitas, and other foste car agencies. The 
is fude by the county Deparnt of Health Servces. 
Ki 
The th progr is Assitace and Relief to  (AR), a chid abuse p  ject for high-rik 
women funde by the Sta. Upon reommendation frm OC, the coUt ca ordr mothers 
to attnd the prgr The AR progr reives its fundig frm a State-adistere 
Fedra grt for mol progr dealg with chid abuse. 
aid 
The foun prgr Edn Inant,  and Famy Development Cente, consists of early 
fams 
developmenta assistace for drg-expose newbos and their  with spial needs. 
TPher gprro gr  fudig comes frm the Ubnaitse  pWary,g Dr C, and the county Drg Abuse
Edn offer center and home- focusg on parnta ski 
development. Mother parcipate in both for a tota of 1 ye. 
The center-bas prgr includes parntig clases, counlig, psychological evaluations,
bas prgr  fuer 
and Cocaie Anonymus metigs. Edn s home- includs  counseling, 
sk, 
implementaon of new parntig  and application of new maagement skills. It also 
includes famy assessment with an indiviualze tratnt pla develope with famy input.  Family Health Center in Mi  , Florida is a tratment community for female substace 
abusers which allows mothers to keep their childrn with them while attending the program 
The Center offers comprehensive prima car and adction services which include 
Curntly 
outpatient services, day tratment, and residential components.  there are 15 
residential beds, with 25 more being planned. 
The Center receives fundig from the U. S. Depanent of Health and Human Services and the 
progr 
Florida Depannt of Health and Rehabiltative Servces. The residential  lasts 6 to 
ear 
9 months, is self-paced and employs a token system. The token system allows patients to 
nee 
points  to move though tratment phass. 
The residential progr s goal is cognitive grwt. In adtion to drg tratment, enrollees 
receive vocational trning, tutoring for high school equivalency diploma, parnting and 
nutrtion classes, psychological counseling, AIDS prevention trning, trsitional housing, 
car. Women attend physical fimess and an clases, along with 
child car, and health 
communty soial events and Narotics and Alcoholics Anonymus metings. 
To gruate, a woma must be employed for 90 days, have $500 saved possess 
facilty-approved housing, and have or be workg towar her high school diploma. After 
reuir 
parcipation is  in an outpatient program which includes radom drg 
graduation, 
testing. Center sta conduct follow-up if the women do not attnd. 
Women s Anne in Tacoma Washigton provides trsitional housing for women (and
The 
their childrn) recovering frm drg and alcohol abuse. To live in the Anex, women must 
have attnde or be attnding drg tratmnt and be in school or workg. The Annex 
consists of seven houses with a resident maager and cas maager on-site at al times. The 
fr. 
sta assist women in seurg servces and resoures they nee to stay drg-
The houses ar designed to offer a suptprosvep hoonme,  envinmnt for women and their 
workshops. Women also 
childrn. Servces includ chid car,  reation, and 
have access to employmnt and education rferso   and referr inormtion. The women may 
stay as long as necessar to mata drg- sobriety and wor towar ,independence. 
More inormtion on Women s Anex is provide in Section vm, Prvate Intiatives. 
II. 
EDUCATION FOR DRUG-EXPOSED CHILDREN 
Serious conce exist about the futu impact of drg-e~pose babies on school systems. 
Drg~xpose babies ar considere liely to have developmenta, behaviora, psycho-soial 
learg  prgr wi 
and  problems which school systems and prschool  face. With early 
masttam  progr 
intervention, may professionals believe these chidrn can be  Both 
strctu  prgr 
descbe below prvide a  educational  for preschool chidrn. 
reseh prgr 
Los Anieles UniJW School Distrct has a pilot  for drg-expose 
The 
chidrn whih uses speal local and State education funds. Since its inception in 1987, 
parcipate 
childrn between the ages of 3 and 6 have  progr 
The  tagetS marginal childrn, I.e., those who may ultimately be integrted into 
regular classroms. Childrn ar referr to the progr by the Deparnt of Childrn 
Services, foster parntS, and relatives. Upon referral, the sta perform an initial child 
assessment to detennne if the program is appropriate. The program s initial goals ar to 
nee of drg~xposed 
develop strategies for teaching regular teachers about the unique 
determne if there ar similar characteristics among drg-expose childrn. 
childrn, and 
stated in the program manual, "There is no tyical profie of a drg~xposed child, and as 
such, each child must be educate as an individual with parcula strngths and 
vulnerabilties. .. 
ai 
Three other program  are: 
to identi preschool childrn at risk for behaviora and developmenta learing 
drg 
problems due to prenata  and/or alcohol e~posUJ; 
to develop effective strtegies and provide strctu learg experiences to promote 
cogrtive, communicative, psycho-soial and moto development of chidrn prenatay 
exposed and

to faciltate the successful trsition of prenatay expose chpidrrgn tro  a regular 
education settg or to the least restrctive speial education 
The progr provides morng classes that last 3 hour and 20 miutes for preschool-age 
sta 
childrn and full-day classtehs fo r chidrn  year and olde. The  cinhcliunde,  a soial worker, 
providig 
psychologist, doctor, and  teachers. Each teacher handles 6 to 8 
consistency and reliabilty thugh day routies. Th approh strngtens a child' 
envinmnt. 
matery over the 
self-contrl and builds a sense of 
The chid's home lie is also considere an essenntei pean  of the curulum; home visits and 
classes ar conducte When  the famy is offere menta health 
parnt education 
servces. Parnta confdence and competency ar incras thugh intervention strtegies 
which strngten the positive interation betWeen chid and famy. 
Head Sta is a chi development progr for preschool chidrn frm low,.income famies. 
It is funde by the U.S. Deparnt oaf Hdeatlethr aend  Hum Servs, Ofce of Hum 
Development Seces. Prjects ar  at the loc leveL 
prgr  re  seg 
In reent yea, Head Sta  arund the countr  thy ar  incrasing 
numbers of dysfuctional fames, may with drg abuse aprsble ms. Hea Sta famies may 
have spal nee and experience diculty coping with  of day livig. A number of 
progr 
Head Sta  have crate unque local parerships with menta heath centers and 
adss  mol progrs 
chid welfar agencies to  these problems. A surey of prblems and 
is contaed in  Dysftina Ftllus in tM Head Stan 
the November 1989 OIG repon, 
Program: Meeting the Chalenge,  (OAI-09-89-0100).  --  ._- '
IV. CASE MANAGEMENT
adcte 
Quality cas maagement can htlp ensur that drg- mothers and their childrn 
receive essential servces. Cas management means guidig fames to servces including 
health car, counseling, physical therapy, drg rehabiltation, parnting classes, and vocational 
trning. 
progr  dit 
Two  which provide both case management and  servces to drg-adcted 
mothers and their babies ar descrbe below. 
Caorn 
Center for the Vulnerable Child (CVC) in Oakand,  provides cas maagement 
The 
to high-risk chidrn. Two evc goal ar to "met the heath car, developmenta and socia 
nee of vulnerable chidrn" and to "coordate servces to provide comprehensive car. 
The evc servces ar funde primay thugh money frm private foundations. 
Cl 
evc progr  clic 
The Chemical Addction Recovery Effons (CARE)  is one  The 
nur, 
serves chemicaly dependent women and their drg-expose inants. A peatrcian, 
and therapist/cas maager with specia chemical dependency expertse sta the clic. 
The CAR Clic provides both medical and counselig servces. Medcal servces include 
developmenta assessment, and parnt trg. Sta spalsts visit homes to 
pediatrc car, 
teach fames about the reovery proess and their inant s development Mothers alo gai 
suppon thugh individual counselig,  famy therpy. 
grup metigs, and 
The cas maager s role adjusts to clint nee. The cas maager may see "as problem 
sece 
modl, advocate, broker, assessor, planer,  monitor, reord keeper, 
solver, role 
therapist, collabotor, and detective." Furer, the cas maager consults with speiasts and 
varty of seces. 
communty providers to offer mother and chid a 
Perinata OUteach Project in Washigtn, D.C. prvis in-home skied nuring, socia 
The 
servces, and prfessional therutic seces to prna an potpar patients and at-risk 
newbos. The Prject seed approxitely 800 clints in 1989. An estite 80 percent of 
the babies served wer frm drg-afecte fames.- The prje is maaged by Chldrn 
Ca 
Home Health  Servces with fudig frm the D.C. Commssion of Public Health, Offce 
Mate an 
of  Chid Heth. Clnts ar referr by local hospita and the Deparent of 
Hum Ser.

Outrach sta rrk mother and child to ensur they ar gettg aduate mecal car. The 
Prject also helps prvent duplication ,and frgmtnhtat ion of seces to ths high-risk 
population. Sta nurs conduct an average of  to five in-home viits per emognt.h . Durg 
potpar 
these viits, they teh wOlDn about prenata and  car and chid 
so 
fianci 
The sta counsel individual about educational,  secep, ragndr .e mploymnt 
nee, and assist fames in acssing mecal and foo supplement  They also 
identi progr and ma appropr refeIr bas on individua famy nee. 
T".-- ". 
.. ,
V. PROFESSIONAL TRAINING 
;f . 
adcted women and drg-exposed childrn have specific 
Prfessionals who work with drg-
trning nee. The trning components cited below include recognizing substace abuse and 
and social servces nee of drg-expose babies and their famlies. 
identiying the medical 
National Association for Perinaral Addiction Research and Education (NAPARE) has 
The 
develope and disseminated trning curcula for soial servce and health car professionals. 
They have offere to shar this curcula with child welfar agencies and physicians 
associations. Recognizig that professionals often tae inaduate substace-abuse histories, 
NAPARE emphasizs the nee to tae comprehensive substace-abuse and lifestyle histories. 
The curcula includes guidelines for reognzing, assessing, and tratig substace-abuse 
cases. It is designed for physicians, social servce and drg and alohol casworkers, and 
famly cour judges and attorneys. 
The University of Caorn at Los Angeles  Proiect TEAS (TraininR, Eduation 
develope 
and ManaRemenr Skills) to trn workers to deal with the special nee of drg~xpose babies 
TES "
placed with foster parnts and relative cargivers. The  curculum supprt a 
mol 
servce delivery  which is interdsciplinar in pratice, integency in focus, and holitic 
in its approach towards infant, famy, and cargiver nee. 
Prject TES was funde by the National Cente on Chd Abuse and Neglcct frm Apri 
1986 thugh May 1988. The project has since ben c~pande to include biological parnts 
and is suppone by the Los Angeles County Boar of Supervsors and the Dterp arent of 
Childrn s Servces. Prject TEAM also has a contrt with thc county to  physicians 
about issues concerng drg~xpose babies. 
Curntly, thc U.S. Deparnt of Education s Hadicappet Crhgdr n s Ealy Education
Prgr  prgr  prvi 
is fudig an expansion of the  to  and tehncal assistace 
to public and private agencies workg with chemicaly dependent fames in communities 
thughout Caorn The progr crates skied interdscpli team of chid protective 
tu, 
scrvces nwourkrergs  and public health nurs. These team,  inanhetlps c.ar givers crate 
healthy,  envinmnts for their drg-cxpo 
fit 
Traning for th chid proteve worrs and public health nurs lasts 6 months. The 
inuuon  inant, 
phasc of  concerns the effects of substacc-abuse on the developing fetus, 
child, parntS an cnti famy. Th phas also involves establishig gudelies for 
collraon. 
assessmen  intecntion, and interagency 
The seond phas is a clical component consitig of cas maagcment, individual 
Tea 
with 
consultaons, and monthy sma-grup consultaons.  conduct home viits 
inants and cargiver. Thc trees alo atnd grup metigs to diuss issues relatig to 
an 
thesc babies  their foste parnts. 
W. ? . :7'"  ,. 
 .. .... .
VI. MANAGEMENT PRACTICES 
Severa States and local governments have established maagement practices to improve 
trcking and supervsion of child welfar cases involving drg exposur. These pratices 
include automated centr registres, special drg baby units, and fast trking of the legal 
process. Although severa States and cities have these pratices, only" one example of each is . 
cited. 
Many States have centr registres where child abuse and neglect cases are reponed In 
Florida these cases ar referr to the Deparnt of Health and Rehabiltative Servces 
Deparnta ditive 
Florida Abuse ReRisrr was established by  in October 
(HS). The 

1988 to provide a single statewide 800 toll-fr number for reportng all suspeted child abuse 
The HRS regulations  all newborns "who 
and neglect cass.  reuir centrize reportg of 
ar born to mothers who ar adcte or have abuse drgs durg the chidbearng period" 
The Deparent also reuirs that drg-afecte famlies and substace-abusing pregnant 
women "be given the highest prority in servce prvision. 
The  DelJarenl of Childen s Servictesh (D CS) in Los Angeles ha established tWo  high-risk 
drg bab  The units perform  functions: emergency responsc, custody 
investigatiounntS.s  , and famy tmhat enance. They opera on a vercal cas mol, where each 
ord 
fuctions in  to ensur consistency in case maagement. 
casworker perform al 
referr 
When an inant is fIrt  DCS intae evaluatOrs usc a spal high-risk intae form. 
When informtion obtaed mets selecte crteri the baby is referr to the high-risk unit 
for asscssment. 
soial worker use a speial risk asscssment gude for inants prenatay expose to 
In the unt, 
with persnal intervews, aids in determg the inant s placement. 
drgs. The gude, along 
If the inant canot be saely released to the mother, a custoy petition is fied in coon If the 
chid is alowed to go home with the mother, a famy matenance plan is develope 
A legal pross known as  'fast tracking  has ben imlemente in Dad County, Florida 
The proess helps expete the less complex dependency cass thugh the coon system by 
spc ti 
prscbing  slots for chi welfar cass. This results in quicker placement 
deisions. FUt trkig is a cooate effon among Florida'  Deparnt of Health and 
Rehabiltave Seces, the Juvenie Justice System. and the Sta Attey Genera's Ofce.  , -. -... -; -. " 
VII. INTERAGENCY COORDINATION
ar 
Interagency coordiation is necessar to ensure that services to famlies  available, 
accessible, and not duplicated. Lack of coordnation among service providers is a major 
problem cas managers face in offering multiple servces to drg-affected famlies. The 
adss 
following two program ar using interagency coordiation to  the issues and 
consequences of drg use in their communities. 
adss 
Illnois Model is an innovative interagency coordiate effon to  the needs of
The 
cocaine and other drg-exposed infants. The agencies pancipating in and funding the project 
Depanent of Childrn and Famy Servces, the ilinois Deparnt of 
are the Illnois 
Alcoholism and Substace Abuse, and the tNhati onal Association for Periata Addction 
Researh and Education (NAPARE). The  agencies use an education, prevention, 
coordiated 
referr, and  intervention strtegy. 
ma 
The Ilinois Modl has "reuced systems barers to integrted servces and  available a 
full complement of servces to high-risk famlies." The Modl has provide integrted 
40 
medical substace-abuse, and soial servces to over  mothers and inants since 1986. 
One of the modl's components is a conf1dntial, tOll-fr "Coaie Baby" Helpline. The 
helpline provides inonntion and referr to individual in five midwestern states. The 
toll-fr number is staed by a peatrcian and  peatrc nur pratitioner who refer 
drg traannt. 
women to clics and physicians for medcal car and 
th  trg 
The agencies have co-sponsore  national  conferences and develope a national 
newslettr to provide an educational forum about cocaie use and pregnancy. The N APARE 
has also develope curcula to trn medical. soal servce, and substace..abuse 
professionals to reogn, refer, and trat cocaie-afecte inants. 
Governor s Commsion for a Drull Free Indna was establihed by cxecutivc ordr in
The 
May 1989 to exame Indiana s overa drg prblcm with speia emphasis on local issues 
crk 
such as  abuse. Commssion members have divers backgrunds in youth servces, law 
enforcement, business, education, chid welfar and pro  tion servces, medcinc, drg and 
alcohol abus and tratmnt, and othcr soal servces. 
The commsion servcs as an umbrella organzation to suppon local coordation and 
initiativcs in 1b war agait drgs. It trks local fuds. inorm the Governor of local nee, 
and advis locties of Sta legislanvc intiatvcs. 
prgr 
Fundig is drwn frm a varcty of Fedra and State  includig thc Alcohol, Drg 
Cral 
Abuse, and Menta Health block grt,  Juspticre gblorc k grt, Natona Highway Safety 
funds, and Indian s Drg Fre Communties grt 
7"- . .
.. " 
- -
VII. PRIVATE INITIATIVES
Severa progr visited durg the Crack Babies inspection were initiated with private funds. 
These progrs were private sector responses to curnt soial problems. Two of the the 
progrs 
described now receive some public funding. 
acquir 
Women s Annex (previously descrbe) was funde by a local attrney who 
The 
seven houses and renovated them into housing for women reoverig from drg adction. 
Severa of the houses were formrly crk houses. The servces ar funde thugh private 
conttbutions and the Washingtn State Division of Alcohol and Substace Abuse. 
Children s Home SoCietY of Miam, Florida offers a varety of servces for infants and
The 
childrn to age 18. They provide pregnancy counselig, adption servces, residential foster 
car, foster homes for childrn with AIS, emergency shelters for inantS and childrn, soial 
servces for developmentaly delayed childrn, and grup homes for tens. Their servces 
now under contrt with the Florida Deparent of Health and Rehabiltative Servces. 
In 1986, Burger King, with help frm other local businesses, buit the facty contang their 
adnistrtive offces and an emergency shelter. Funds to constrct the inant center were 
donated by a local foundation. A signcant porton of the Socty s operational costS ar pai 
for with Unite Way funds and private conttbutions. 
fornia Medical Center in Los Angeles rus a progr  Rebirth for substace
The  progr  caled  drg 
The  provides education on maternal  abuse to 
abusing mothers and their inantS. trs 
mothers in hospitas. Rebin also  cargiver on the spial nee of the 
nur 
drg-withdrwig inant A  conductS follow-up home visitS to check the inant and 
prgr 
which reives no publi money, is fude by the 
answer any questions. The 
Caorna Communty Foundation and private donaons. 
. __0"  . -- /' "'-- -
APPENDIX

CONTACTS: 
I. COMMUNITY OUTREACH AND EARLY INTERVENTION 
Maternity Outreach Mobile Project 
Paaicia Thompkis 
Office of Maternal and Child Health 
Commssion of Public Health 
Deparent of Human Servces 
166 L Stret, NW 
Washington, DC 20036 
(202) 673-4551 
St. LukeslRoosevelt Hospita Center 
Hershm 
Joane Johnson-
West 114th Strt and Amterda Avenue 
New York City, NY 10025 
(212) 523-2122 
HaborlUa. Medcal Center -
Clic 
Substace Abusing Mothers 
M. Lynn  MD. 
Yoneku 
1000 West Caon Strt 
Torrce, CA 90509

(213) 533-3565 
Center for Famy Ute 
Siste Ma Paul DSW 
Strt 
345 43rd 
Broklyn, NY 11232 
(718) 788-3500 
II. COMPREHENSIVE SERVICES IN ONE LOCATION 
Ma  MD. 
Luther Kig Jr. Hospita 
Xylia Bean, 
12021 South WWngtn Avenue 
Los Angeles, CA 9059 
(213) 603-457 
A-
' VI  -- 
. - .. -
Famly Health Center 
Toni Shamplai 
5361 NW 22nd Avenue 
Miam, FL 33142

(305) 637-6400 
Women s Annex 
Jacquelyn Nonnan 
2024 South J Stret

Tacoma WA 98405 
(206) 383-0104 
II. EDUCATION OF DRUG-EXPOSED CHILDREN 
Los Angeles Unified School Distrct

Dr. Phillip Callison 
Assistat Superintendent

Division of Special Education 
450 Nonh Grad 
9051 
Los Angeles, CA 
(213) 625-6701 
Sta 
Head 
Oennie Murhy, Jr. 
Head Sta Burau Associate Commsioner 
O. Box 1182
330 C Strt, 

Washigton, DC 20013 
(202) 245-0572 
IV. CASE MANAGEMENT
Center for the Vulerble Chd 
M..H
Neil Haon,  MD., 
s Hospita Mecal Center 
Strt 
747 52nd 
946 
Oakan CA 
(415) 428-3783 
Prgr
Perinat Outrach 
Lida Mauro 
Ca Sers 
n ' s Home Health 
111 Mihigan Avenue, 
Washigtn, DC 20010

(202) 939-4917 
n & -, "'-
 - -- - -
V. PROFESSIONAL TRAINING 
;f . 
National Association for 
Perinata Addiction Research and Education 
Judy Burison 
Hubbar Street 
11 East 
Suite 200 
Chicago, IT 60611 
(312) 329-2512 
Prject T.

Judy Howar, M. 
UCLA Deparent of Pediatrcs 
Intervention Prgram 
1000 Vetera Avenue 
23-10 Rehabiltation Center 
Los Angeles, CA 9024-0797 
(213) 825-4821 
VI. MANAGEMENT PRACTICES
Florida Abuse Registr 
Judy Rosenbaum 
Senior Management Analyst 
Health and Rehabiltative Servces 
401 NW 2nd Avenue 
10t Floor, South Wmg 
Miam, FL 33128 
(305) 377-5301 
Los Angeles Drg Baby UnitS 
Gerhar Moland

Chidrn s Servces AdmsU'ator 
Deparnt of Chidrn s Servces 
Exposition Pa Ofce 
Vent 
3965  Avenue 
Los Angeles, CA 9037 
(213) 730342 
Trakig 
Florida Past 
Charles Edlstein 
Consultat to the Chef Judge 
Juvenie Justice Center 
330 N.W. 27th Avenue 
Miam, FL 33142

(305) 638-6185 
A-
A._- .. i". . - ..
 . F :\.
VII. INTERAGENCY COORplNATION
Ilinois \1odel 
nionJ. Association for 
rinJrJ. Addiction Research and Education 
urison 
J llJ Y B 
11 Elsr Hubbard Street 
Suire 200 
Chicago, II 60611

(12) 329-2512 
Governor s Commssion for a Drg Free Indiana 
Joseph Mils 
150 West Market Stret

Suite 703 
Indianapolis, IN 46204 
(317) 232-1142 
VIII. PRIVATE INITIATIVES
Women s Annex 
Jacquelyn Nonnan 
2024 South J Stret

Tacoma, WA 98405 
(206) 383-0104 
Children s Home Society 
Mar Louise Cole, Ph. 
Executive Director 
800 NW 15th Street 
Nfan, FL 33136-1495 
(305) 324-1262 
California Medcal Center 
Nfnda Ofiano

1401 South Grad Avenue 
Los Angeles, CA 90 15 
(213) 748-2411