Building Blocks - A Specialized Program
for Pregnant and Post Partum Woman
Presented by River Region Human
Services
Raymond Pomm, MD, Kristin Barrett, RN, BSN,
Heather Clavette, MA CAP and Fawn Sweeney, BA
RRHS Mission Statement
• The mission of River Region Human Services is
to improve the quality of life for individuals
and families of NE Florida affected by
substance abuse, mental illness,
homelessness, HIV/AIDS and other
communicable illness through outreach,
prevention, intervention, treatment and
housing services.
What is Building Blocks…
• Specialized program for pregnant and post- partum
women in MAT
• Utilizing evidenced-based clinical and educational
information
• Covering conception/pregnancy, delivery and
beyond
• Safe haven for group/clinical support
• Community partnership
• Resource development
Objectives of this course…
• The audience will gain knowledge about the benefit of
further education for the pregnant and post-partum
population.
• The audience will understand the basic topics about
which the pregnant and post-partum population need
to be further educated.
• The audience will have developed a basic
understanding of how to best utilize community
resources for the pregnant and post-partum
population.
Determination of need:
• At any given time, MAT has 60+ pregnant and
post-partum women
• Prior to Building Blocks, pregnant women
received
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Assessment
Individualized tx planning
Counseling
Mother’s Group
Expedited access to residential services
WCFT services
Current Substance Abuse
Percentage Reporting Past Month Use
Services Needed in Women’s
Substance Abuse Treatment
The following services are recommended by the consensus panel and
reinforced by some State standards (CSAT 2007), and these services
may be warranted across the continuum of care beginning with early
intervention and extending to continuing care services. More than
ever, services need to be tailored to women’s needs and to address the
specific hardships they often encounter in engaging treatment
services. Promising practices designed to treat women with substance
use disorders include comprehensive and integrated clinical and
community services that are ideally delivered at a one-stop location.
Note: This list does not incorporate the customary services that are
provided in standard substance abuse treatment, but rather services
that are more reflective of women’s needs.
Services Needed cont’d
Medical Services
• Gynecological care
• Family planning
• Prenatal care
• Pediatric care
• HIV/AIDS services
• Treatment for infectious diseases, including viral hepatitis
• Nicotine cessation treatment services
Health Promotion
• Nutritional counseling
• Educational services about reproductive health
• Wellness programs
• Education on sleep and dental hygiene
• Education about STDs and other infectious diseases; e.g., viral hepatitis and HIV/AIDS
• Preventive healthcare education
Services Needed cont’d
Psychoeducation
• Sexuality education
• Assertiveness skills training
• Education on the effects of alcohol and other drugs on prenatal and child
development
• Prenatal education
Gender-Specific Needs
• Women-only programming; e.g., is the client likely to benefit more from a
same-sex versus
• mix-gender program due to trauma history, pattern of withdrawal among
men, and other
• issues?
• Lesbian services
Services Needed cont’d
Cultural and Language Needs
• Culturally appropriate programming
• Availability of interpreter services or treatment
services in native language
Life Skills
• Money management and budgeting
• Stress reduction and coping skills training
Services Needed cont’d
Family and Child-Related Services
• Childcare services, including homework assistance in conjunction
with outpatient services Children’s programming, including
nurseries and preschool programs Family treatment services
including psychoeducation surrounding addiction and its
• impact on family functioning Couples counseling and relationship
enrichment recovery groups Parent/child services, including
developmentally age-appropriate programs for children
• and education for mothers about child safety; parenting education;
nutrition; children’s substance abuse prevention curriculum; and
children’s mental health needs, including recreational activities,
school, and other related activities
Services Needed cont’d
Comprehensive Case Management
• Linkages to welfare system, employment opportunities, and housing
Integration of stipulations from child welfare, TANF, probation and parole,
and other
• systems Intensive case management, including case management for
children Transportation services Domestic violence services, including
referral to safe houses Legal services Assistance in establishing financial
arrangements or accessing funding for treatment
• services
• Assistance in obtaining a GED or further education, career counseling, and
vocational training, including job readiness training to prepare women to
leave the program and support themselves and their families
• Assistance in locating appropriate housing in preparation for discharge,
including referral to transitional living or supervised housing
Services Needed cont’d
Mental Health Services
• Trauma-informed and trauma-specific services Eating
disorder and nutrition services Services for other cooccurring disorders, including access to psychological and
• pharmacological treatments for mood and anxiety
disorders Children’s mental health services
• Disability Services
• Resources for learning disability assessments
Accommodations for specific disabilities Services to
accommodate illiteracy Services to accommodate women
receiving methadone treatment
Services Needed cont’d
Disability Services
Resources for learning disability assessments
Accommodations for specific disabilities Services
to accommodate illiteracy Services to
accommodate women receiving methadone
treatment.
Services Needed cont’d
Staff and Program Development
• Strong female role models in terms of both leadership and personal
recovery
• Peer support
• Adequate staffing to meet added program demands
• Staff training and gender-competence in working with women
• Staff training and program development centered upon
incorporating cultural and
• ethnic influences on parenting styles, attitudes toward discipline,
children’s diet, level of
• parenting supervision, and adherence to medical treatment
• Flexible scheduling and staff coordination (Brown 2000)
Services Needed cont’d
Staff and Program Development
• Adequate time for parent–child bonding and
interactions
• Administrative commitment to addressing the unique
needs of women in treatment
• Staff training and administrative policies to support the
integration of treatment services
• with clients on methadone maintenance
• Culturally appropriate programming that matches
specific socialization and cultural
• practices for women
Client Demographics
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Average age - young to mid 20’s
Caucasian
Lacking healthy support
Lacking financial resources
Unemployed
No transportation
Substance dependent
Behavioral/psychiatric issues
Multiple prior births
Prior adoption
Minimal to no prior medical services
Issues facing pregnant and post-partum women
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Lack of prenatal care
Poor history of primary care
Lacking knowledge of nutrition and healthy lifestyle
Lacking knowledge of pregnancy process
Lack of knowledge of post-natal care of opiate
dependent newborn
• Knowledge deficit of MAT with pregnancy
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Effects
Withdrawal
Breastfeeding
Dose increases
Issues facing pregnant and post-partum
women – cont’d
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More challenging behavioral/psychiatric issues
Poor parenting skills
Lacking coping skills
Difficulty coordinating care
Lacking knowledge of resources/support
Adoption issues
– Enticed by money
– Enticed by support
– Enticed by medical care provided
How was Building Blocks conceived?
• RRHS created a PSR group with full curriculum and incentives
• Despite specialized program, it was not embraced by the
client population
• Multidisciplinary team discussed that this PSR style of group
was not benefiting our pregnant and post-partum women
And so…the seed was planted and conception
occurred!!
Gap Analysis for Performance Improvements:
Building Blocks
1. Future State
Increase knowledge
base of pregnant and
post partum woman
through education and
collaboration with
community partners.
2. Current Situation
Pregnant and post partum
woman receive the basic
information about
pregnancy.
3. Bridge to Close Gap
1. Collaborate with
community partners.
2. Provide holistic view of
treatment during and
after pregnancy.
3. Incorporate medical and
clinical.
Goal of Building Blocks
• To REACH our pregnant post-partum women
R – Rapid response to needs
E – Education and Empowerment
A – Access to resources
C – Collaborate and Coordinate
H – everyone Helping everyone
Challenge: Staff Buy In
• Discussed with the multidisciplinary team
• Presented foundational ideas
Response
• Immediate acceptance
• No push back
• Embraced with excitement
Choosing a Facilitator
• Needed individual with specific characteristics
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Passionate
Dedicated
Self-motivated
Independent
Autonomous
Broad knowledge of pregnancy-related issues
This program could die at the hands of the wrong
facilitator!
Creating the Curriculum
• Team effort
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Medical Director
Director of Nursing
Director of Medication Assisted Treatment
Counselor
WCFT – Woman Children Family Treatment Staff
AmeriCorp members
Creating the Curriculum cont’d
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Wanted to expand upon current program
Change process utilized
Team met on multiple occasions
Delegation of responsibilities occurred
Important goal was to REACH out to community
partners
And so…7 months later…Building Blocks
prematurely delivered!
Who Collaborated?
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Department of Health – Dieticians & Nutritionist
Woman’s Center of Jacksonville– Domestic Violence
DCF – “Who are we and what can we offer”
Healthy Mothers, Healthy Babies Coalition of N. FL
La Leche
North Florida Child Safety – Wolfson Children’s Hospital
Planned Parenthood
Independent Pharmacist
Who Collaborated?
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UF Department of Pharmacy
RN’s and LPN’s
MAT Counselors
CPR Instructor
Adoption Attorney
Working on: Pediatrician, Primary care MD,
OB/GYN
Curriculum
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Week 1
February 19th
Your Health - Before, during and after pregnancy (Family Medicine)
Importance of Prenatal care/vitamins (Family Medicine)
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Week 2
February 26th
Pregnancy Expectations - 1st Trimester (RRHS)
2nd and 3rd Trimester (RRHS)
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Week 3
March 5th
Maintaining a Healthy Pregnancy (OBGYN)
Signs and Symptoms, "What do they mean?" (OBGYN)
Curriculum
• Week 4
• March 12th
• Drug use and Pregnancy (RRHS – Nursing)
• Alcohol (FAS) and Tobacco use and Pregnancy (RRHS - Nursing)
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Week 5
March 19th
MAT and Pregnancy (RRHS - Nursing)
Relapse risk/prevention (RRHS)
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Week 6
March 26th
WCFT - What is it?/Resources (WCFT staff)
Ins and Outs of prescription meds (Pharmacist - Andy)
Curriculum
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Week 7
April 2nd
Benefits of Exercise - Discussion (RRHS - Amanda)
Exercise while pregnant - Practice (RRHS - Amanda)
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Week 8
April 9th
CPR (RRHS Ms. Yvette)
CPR (RRHS Ms. Yvette)
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Week 9
April 16th
Domestic Violence (Women’s Center)
Seeking Safety (RRHS)
Curriculum
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Week 10
April 23rd
DCF - Who are we? (DCF)
Dependency Drug Court - Who are we? And reunification (DDC)
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Week 11
April 30th
Nutrition during pregnancy (Nutritionist)
Nutrition for your child (Nutritionist)
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Week 12
May 7th
Maintaining a Healthy Baby (Pediatrician)
Signs and Symptoms, "What do they mean?" (Pediatrician)
Curriculum
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Week 13
May 14th
Birth defects (Pediatrician)
SIDS prevention (Healthy Mothers/Healthy Babies Coalition)
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Week 14
May 21st
Pregnancy and emotions (RRHS)
Planning for delivery - emotions, body, home, hospital (Family Medicine)
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Week 15
May 28th
Lamaze (Community)
Breastfeeding (La Leche)
Curriculum
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Week 16
June 4th
Introducing newborn to the home (Planned Parenthood)
Child proofing the home (RRHS)
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Week 17
June 11th
Budgeting for a newborn (RRHS)
Baby shower planning - What a baby needs (RRHS)
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Week 18
June 18th
Family Planning, Contraception (Planned Parenthood)
Birth, abortion, adoption choices (Planned Parenthood)
Curriculum
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Week 19
June 25th
Process of adoption (WCFT or Community)
Car Seat Education (Fire Department)
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Week 20
July 2nd
Day Care - What to look for (RRHS)
Bonding after delivery (WCFT)
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Week 21
July 9th
Post Partum signs and symptoms (RRHS) Dr. Taylor/ Dr. Blackmore
Mental Health and Pregnancy (Daphne) Dr. Taylor/ Dr. Blackmore
Curriculum
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Week 22
July 16th
Parenting - PPP (WCFT)
Single Parenting (WCFT)
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Week 23
July 23rd
Father's relationship (WCFT)
Healthy boundaries with extended family (RRHS)
Curriculum
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Week 24
July 30th
Grief - loss of a child, miscarriage, still birth (RRHS) Dr. Taylor
Community based recovery (RRHS)
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Week 25
August 7th
HIV, Hepatitis, STDS (Health Department)
HIV, Hepatitis, STDS (Health Department)
So how did we measure success?
Survey…pre, mid and post
1. Comfortable with pregnancy
2. Comfortable with post-partum
3. Symptoms and issues in 1st trimester
4. Symptoms and issues in 2nd trimester
5. Symptoms and issues in 3rd trimester
Survey…cont’d
6. Knowledge of effects of my nutrition on baby
7. Knowledge of effects of drugs on baby
8. Knowledge of benefits of exercise
9. Knowledge of nutrition for newborn
10. Knowledge of potential medical problems for
my newborn
Survey…cont’d
11. Knowledge of potential mental health issues
12. Comfort with parenting a newborn
13. Knowledge of importance of breastfeeding
14. Knowledge of sexual trauma
15. Knowledge of community resources
Pre Survey Results
Questions
2
52
46
0&1
2&3
4&5
Mid Survey Results
Questions
0
2
0&1
2&3
4&5
98
What were the real successes?
“I’ve really enjoyed this group and have acquired
quite a bit of knowledge and thoroughly enjoyed
having a place to come and talk about things I
am going through with people who have been
through the things I’ve been through THANKS”
More Successes….
“This group has been highly informative. I have
gained knowledge each week that I couldn’t
have on my own. It has positively impacted my
life and that of my family. I would recommend it
to all new mothers”
More Successes….
“I am not pregnant but even so, I do Ms. Fawns
group. I learn so much and I feel that I want to
know more. She is an amazing individual.”
More Successes….
“I have only been to a few meetings, but so far I
am enjoying the program very much. I look
forward to learning more and more in the
program. I am very happy to be a part of it.”
Lessons Learned
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Clients learn that staff do care about their needs
Clients learn that they have support amongst their peers
This specialized population is hungry for information
Confirmed that our original treatment planning was not sufficient
Affirmed that community partners are invested in helping this specialized
population
Our true outcome….
THANK YOU FOR YOUR TIME
QUESTIONS