When a pregnant person struggles with substance use, they can feel isolated and overwhelmed. Due to stigma or fear, they may not seek help. However, to achieve the best possible outcomes for both babies and their families, it is vitally important to offer nonjudgmental, compassionate support to pregnant people using substances as early as possible.

Through the Safe, Healthy Infants and Families Thrive (SHIFT) initiative, Prevent Child Abuse Arizona aims to improve the health and safety of prenatally substance-exposed newborns by connecting their families to support. SHIFT coordinates a network of committed partners that deliver family-centered services and reduce the stigma associated with substance use disorder and pregnancy. Network partners work with parents to create a road map for recovery, prenatal care, and establishing safe homes. The goals of SHIFT are to ensure early identification of prenatal substance exposure, reduce time-to-service engagement for parents and infants, increase cross-system coordination, and keep families safely together.

Prevent Child Abuse Arizona (PCA Arizona) currently leads a SHIFT pilot project in Yavapai County and co-leads a project in Maricopa County. The organization was recently awarded a total of $60,000 though a grant from Prevent Child Abuse America and another grant by Blue Cross Blue Shield of Arizona to continue and expand SHIFT in the state.

SHIFT began in 2018 when system leaders throughout the state attended a Policy and Practice Academy with Dr. Ira Chasnoff, a pediatrician specializing in substance-exposed newborns. This team began a SHIFT project in Maricopa County. In 2021, thanks to guidance from the DCS Office of Prevention and judicial leadership of Judge Anna Young, a SHIFT project began in Yavapai County.

The project started with a needs assessment, in which Prevent Child Abuse Arizona convened local obstetric providers, child welfare personnel, family resource centers, and home visitors to conduct a system walkthrough that identified system gaps negatively affecting pregnant parents struggling with substance use. This process revealed that, similar to other counties conducting like assessments, Yavapai County lacked communication, collaboration, and coordination between professionals who work to serve mothers and their substance-exposed newborns. Due to this lack of connection, some obstetric offices reported that they often avoided conducting substance-use screenings because they did not know what to do next for patients who screened positive.

SHIFT partners are trained to use 4Ps Plus©, a validated tool that screens parents for substance use, as well as depression and domestic violence. Providers who administer the screening are equipped to provide brief intervention and connect families with specific resources to begin substance-use treatment and other services that can help them prepare for their new baby.

“SHIFT and use of the 4Ps Plus screening tool offer increased capability—as an agency and a community–to identify more needs of pregnant women,” said one SHIFT collaborator. “And not only to identify, acknowledge, and support those needs, but to do so much sooner for the sake of the mother and baby, and to work with that mother to achieve better outcomes for both.”   One important goal of SHIFT is to safely reduce out-of-home placements for newborns. Current Arizona law requires medical providers who find evidence of substances in a newborn baby’s system to report this finding to the Arizona Department of Child Safety. Last fiscal year, the Arizona Department of Child Safety received nearly 5,000 hotline reports with the tracking characteristic of substance-exposed newborns. This number is 36% higher than it was five years ago. Last month, the first baby of a SHIFT-enrolled family in Yavapai County was born. The mother had enrolled in the program earlier that month, receiving her safety planning materials and connecting with family service providers just a few weeks before her baby arrived. “It was reported the baby did not have signs of neonatal abstinence [symptoms of newborn substance withdrawal],” shared a provider working closely with the mother. “The patient reports that she will stay on the SHIFT program until complete and was very thankful for the support that it gave her. It prepared her for the DCS investigation that she would not have been prepared for otherwise.

               Thanks to investments in SHIFT by partners, including Prevent Child Abuse America and Blue Cross Blue Shield, Arizona has the opportunity to keep more families safe, healthy, and together, offering support to parents as early as possible to achieve the best possible outcomes for babies.

For more information about SHIFT, contact shift@pcaaz.org.