"I have been searching for resources on how to care for my child with NAS, yet there is not anything easily accessible that I can understand" -Local Parent of a child with NAS in West Virginia
Prior to the start of the experiential component of my doctoral capstone, I conducted a needs assessment.
Local foster parents have reported that they have frequently had placements of an infant with Neonatal Abstinence Syndrome (NAS) and did not have access to resources that allow them to best understand NAS and care for the child in their care.
A local early intervention therapist with 20+ years of experience stated that over 50% of her caseload were exposed to substances in utero, and she has seen an increase in these numbers over the past ten years. She states that she has had to continually research NAS and interpret information to provide her clients' caregivers with information they can easily understand.
The incidence of neonatal abstinence syndrome (NAS) in the U.S. is roughly 7 cases per 1000 births and is 33 cases per 1000 births in West Virginia (Ko et al., 2016).
My Research
In addition to a needs assessment, I evaluated available literature to determine available sources and to find if there was a gap in the literature.
Infants with NAS are often born preterm, experience feeding difficulties, and require extended hospitalization (Creanga et al., 2012).
Symptoms of NAS include sensory seeking or sensory avoidant behaviors, delayed motor and social skills, and impaired cognition (Anbalagan & Mendez, 2022).
Whether opioids are taken as prescribed or abused by the mother during pregnancy, neonate outcomes are very similar, presenting symptoms right after birth, including but not limited to tremors, increased muscle tone, high-pitched crying, seizures, feeding difficulties, and temperature instability (Patrick et al., 2015).
Many infants with NAS would benefit from occupational therapy; however, foster care turnover often prevents access to early intervention services (Peacock-Chambers et al., 2019).
Children with NAS frequently require coping and calming techniques to participate in daily habits, roles, and routines (Cochran et al., 2020).
As the incidence of NAS increases, there will be an increased need for early intervention, community, and school-based services (Carlson, 2019).
My mentors
Dr. Jill Linder served as my faculty mentor throughout the experiential component of my doctoral capstone. Dr. Linder has experience providing occupational therapy services to pediatric, adult, and geriatric clients. She is passionate about expanding her knowledge through research in neuroscience and neurological rehabilitation. She is currently a practicing clinician at the Parkview Rehab outpatient clinic in Fort Wayne, Indiana.
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Shanna Carter, OTR/L served as my expert mentor throughout my doctoral capstone from the initial planning phase until the end of the experiential component of my capstone. Shanna graduated with a degree in occupational therapy from Lenoir-Rhyne University in 2000. Shanna has been providing occupational therapy services for over twenty years where she has worked in home, school, and clinic-based settings. She has worked in early intervention in North Carolina and West Virginia and has discovered that supporting and engaging the entire family promotes the most success and fulfillment for everyone.
My Site
My doctoral capstone site was at River Valley Child Development Services Center for Addiction, Research, Education, and Support in Huntington, West Virginia.
RV CARES has a goal of providing quality comprehensive services to children exposed to Substance Use Disorder and their families in order to promote healthy brain and body development through positive and nurturing relationships.
My areas of study included: (1) Program and Policy Development and (2) Advocacy
My Accomplishments
Completed three continuing education courses including NICU Interventions, Supporting Functional Development in Early Intervention, & Early Co-Regulation in Infants and Young Children for a total of 9 contact hours.
I obtained approval from the Huntington University Institutional Review Board to learn caregiver's knowledge surrounding NAS, caring for their child, and symptoms or delays that are commonly seen. This study had a total of 10 participants.
Based on the results of my pre-test, I was able to design a series of handouts for caregivers on symptoms of NAS, strategies for infants and toddlers with NAS regarding sensory input, sleep, feeding, social interaction, attention, learning, and play. These handouts were then presented to caregivers at my first community event.
I was able to develop three case studies to show the complexities of infants and toddlers with NAS. These case studies can be used by occupational therapy students and practitioners as a learning tool to expand their knowledge and think through the OT process.
Through evaluating the literature, it became evident that different substances have different effects on a fetus. Below is a guide to assist practitioners with understanding some common symptoms of the most common substances infants may be exposed to in utero .
The rate of NAS has continued to climb over the past decade. A recorded presentation was made to assist practitioners in understanding the numbers and how their state compares to national averages.
A website was developed for caregivers and professionals to have an easily accessible place to find resources, suggested product links, handouts, and suggested research articles surrounding NAS.
As many individuals use information as a primary source to find or learn information. I chose to create an Instagram account to easily relay information surrounding NAS and how it pertains to early intervention, feeding strategies, sleep, and more.
“Whoever welcomes one little child such as this in My name welcomes Me.” ~Mark 9:37
My Impact
The contributions I made to the profession include making resources including case studies, substance guide, and an updated NAS statistics presentation available to students and practitioners through my website that I plan to keep updating throughout my career to continue to advocate for this population.
I am hopeful that the resources for caregivers that I developed will impact the lives of many infants and toddlers with NAS for years to come as they along with suggested feeding products and toys will be available online to all caregivers as well as hard copies were made available at my site for future participants in the RV CARES program.
My Future Plans
Following graduation, I plan to practice in a pediatric setting and continue to gain knowledge on Neonatal Abstinence Syndrome to best aid future clients with substance exposure and consult with local resource centers with education & strategies surrounding NAS.
Contact Information:
Email: htissenbaum9@gmail.com
References
Anbalagan S, Mendez, M.D. (2022) Neonatal Abstinence Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK551498/
Carlson, K. & Kiernan, K. (2019). Narratives of Neonatal Abstinence Syndrome. Archives of Psychiatric Nursing 33(3), 275-283. https://doi.org/10.1016/j.apnu.2019.01.011
Cochran, J. D., Jarrett, T., & Baus, A. (2020). Characteristics of neonatal abstinence syndrome in a rural clinic population: Using electronic medical health records for tracking. Online Journal of Rural Nursing & Health Care, 20(2), 194–212. https://doi.org/10.14574/ojrnhc.v20i2.625
Creanga, A., Sabel, J. C., Ko, J.Y., Wasserman, C. R., Shapiro-Mendoza, C. K., Taylor, P., Barfield, W., Cawthon, L., & Paulozzi, L.J. (2012). Maternal drug use and its effect on neonates: A population-based study in Washington State. Obstet Gynecol. 119(5), 24-33. https://doi.org/10.1097/AOG.0b013e31824ea276
Ko, J. Y., Patrick, S. W., Tong, V. T., Patel, R., Lind, J. N., & Barfield, W. D. (2016). Incidence of neonatal abstinence syndrome - 28 states, 1999-2013. MMWR Morb Mortal Wkly Rep, 65(31), 799- 802. http://dx.doi.org/10.15585/mmwr.mm6531a2
Patrick, S. W., Dudley, J., Martin, P. R., Harrell, F. E., Warren, M. D., Hartmann, K. E., Ely, E. W., Grijalva, C. G., & Cooper, W. O. (2015). Prescription opioid epidemic and infant outcomes. Pediatrics, 135(5), 842–850. https://doi.org/10.1542/peds.2014-3299
Peacock-Chambers, E., Leyenaar, J. K., Foss, S., Feinberg, E., Wilson, D., Friedmann, P. D., Visintainer, P., & Singh, R. (2019). Early Intervention Referral and Enrollment Among Infants with Neonatal Abstinence Syndrome. Journal of developmental and behavioral pediatrics: JDBP, 40(6), 441–450. https://doi.org/10.1097/DBP.0000000000000679