2. ABOUT THIS HANDBOOK
This handbook was created in partnership with the Pasco County Alliance for Substance Abuse
Prevention and the Healthy Start Coalition of Pasco. It is intended to be a general guide for
practitioners who work with all women of childbearing age. It provides a very brief overview of
clinically validated/evidenced based screening tools that can be employed to determine if a
woman is either at risk for substance abuse or requires a referral for further assessment and/or
treatment.
Local community resources are included in this handbook and can be utilized if the patient’s
needs are determined to exceed the scope of the practice.
This handbook was developed in response to the Statewide Task Force on Prescription Drug
Abuse and Newborns and focuses specifically on the first two policy recommendations laid out
by the task force:
• Provide individuals with the information and skills necessary to stop the problem of
prescription drug abuse to deter the onset of addiction.
• Provide medical training, prenatal health care screenings, methods that detect and
respond to substance exposure at the time of delivery, as well as interventions that
provide services for the newborn as well as the family immediately after birth.
For more information about the Statewide Task Force on Prescription Drug Abuse and
Newborns and its policy recommendations, please visit, http://bit.ly/28L456E
Thank you to all of the individuals and organizations who participated in the effort to reduce
rates of Neonatal Abstinence Syndrome.
3. CONTACT INFORMATION
If you would like additional information about this manual or are interested in learning about the
availability of additional trainings on screening women of childbearing age please contact:
The Healthy Start Coalition of Pasco
Phone: (727) 841-7888
Address: P.O Box 1527
New Port Richey, Florida 34656-1527
Web: www.healthystartcoalitionpasco.com
The Pasco County Alliance for Substance Abuse Prevention
Phone: (727) 597-2284
Address: 8002 King Helie Boulevard
New Port Richey, Florida 34653
Web: www.pascoasap.com
5. NEWBORNS AND PRESCRIPTION DRUG ABUSE
Opiate Addiction- A Public Health Issue for Women and Babies
• One of the unfortunate consequences of opiate addiction is Neonatal Abstinence
Syndrome.
• Use of opiates (group of drugs that are used for treating pain) before, during, and after
pregnancy can result in a drug withdrawal syndrome in newborns called Neonatal
Abstinence Syndrome (NAS), also known as Substance Exposed Newborns (SEN) which
cause lengthy and costly hospital stays.2
• NAS is associated with numerous central nervous system, gastrointestinal, as well as
metabolic, vasomotor, and respiratory signs and symptoms, including high-pitched
crying, seizures, sleep problems, poor feeding, diarrhea, poor weight gain, fever, nasal
stiffness, and rapid breathing.3
• Women who use often show no social signs of problems and may be fearful of
disclosure.
• Early identification of opioid dependent women improves maternal and infant outcomes.
• Therefore, all women should be routinely asked about their use of alcohol and drugs,
including prescription opioids and other medications used for non-medical reasons.4
• Maintaining a caring and nonjudgmental approach is important as it will yield the most
inclusive disclosure and will likely reduce the pregnant woman’s fear of negative
repercussions. It will also increase the probability that she will continue to seek prenatal
care after disclosing any use.4
• It is critical to identify drug use as soon as possible through screening and refer women to
treatment to lower the risk of infant and maternal morbidity and mortality.
6. WHAT IS NAS?
• Occurs when newborns of opioid-abusing mothers are withdrawn from narcotic
exposure. NAS usually manifests within hours to weeks of birth, when the child is
separated from opioids in the mother’s body.
• Symptoms of NAS include hyperactivity of the central and autonomic nervous systems,
uncoordinated sucking reflexes leading to poor feeding, increased irritability, and high-
pitched crying.
Specific drugs often times cause specific problems in the baby and may include the following:
Heroin and other
opiates, including
methadone
Can cause significant withdrawal in the baby with symptoms
lasting as long as four to six months
Amphetamines Low birth weight and premature birth, and may cause
intracranial bleeding in the baby
Cocaine Poor fetal growth, developmental delay, learning disabilities,
and a lower IQ
Marijuana Low birth weight
Alcohol Growth during pregnancy and after birth is slowed. Specific
deformities of the head and face, heart defects, and mental
retardation are seen with Fetal Alcohol Spectrum Disorders
Cigarette
smoking
Generally, smokers have smaller babies than non-smokers.
Babies of smokers may also be at increased risk for
premature birth and stillbirth
7. In summary, substance use by women of childbearing age can lead to long-term and even
fatal effects, including:
• Low birth weight • Premature birth
• Birth defects • Sudden infant death syndrome
• Small head size • Developmental delays
• Problems with learning,
memory, and emotional control
The WITHDRAWAL mnemonic is a useful aid to recognizing and remembering the
clinical symptoms of withdrawal:
W ithdrawal
I rritability
T remors
H yperactive, high pitched crying, hypotonia (low muscle tone
D iarrhea, disorganized sucking
R espiratory distress, rhinorrheoa (significant mucous in the nasal cavity
A pneotic attacks (cessation of breathing)
W eight loss
A lkalosis respiratory (a conditionmarked by low levels of carbon dioxide
in the blood due to breathing excessively
L acrimation (shedding more tears than is normal)
Effects on Pregnancy and the Child: Guideline for Healthcare Practitioners
• Chronic heroin abuse is associated with an increased risk of fetal growth restriction,
abruption placentae, fetal death, preterm labor, and intrauterine passage of
meconium. These effects may be related to the repeated exposure of the fetus to opioid
withdrawal and the effects of withdrawal on placental function and may also occur in
other types of opioid abuse.
• First-trimester use of codeine has been associated with congenital heart defects in three of
four case-control studies. No association has been described between the use of other
opioids during pregnancy and an increased rate of birth defects.
• The lifestyle issues associated with illicit drug use put a pregnant woman at risk of
engaging in activities such as prostitution, theft, or violence, to support herself and her
addiction. The consequences of these activities pose a host of risks to the fetus.
• Long-term data for children with in-utero narcotic exposure is limited, but studies have
not found significant decreases in cognitive development with maternal opioid abuse
8. Length of Hospital Stay & Cost of Treating Newborns
• Most newborns diagnosed with narcotics exposure and drug withdrawal symptoms are
admitted to the Neonatal Intensive Care Unit (NICU).
• Newborns with NAS stay in the hospital for an average of 16.9 days compared to 2.1
days for those without NAS.
• The hospital cost for newborns with NAS is estimated to be $66,700 on average
compared to $3,500 for those without NAS.
9. WHO IS AT RISK?
• Substance use is found throughout all social and economic tiers.
• Women who use often show no social signs of problems and may be fearful of
disclosure.
• All women of childbearing age are at risk for having a baby born with NAS.
• As the growth of prescription opiate use and abuse increases, more working and middle
class pregnant women are affected.
• The population of women with opioid dependence is varied, and their circumstances span
the spectrum from heroin addiction, polydrug abuse, prescription opioid abuse,
medication-assisted treatment, and chronic opioid use prescribed for medical indications6
• Clinical providers need to keep in mind these differing contexts to effectively screen for
opioid dependency among all women of childbearing age and identify risk factors in
women and infants with potential opioid exposure6
NEWBORNS & PRESCRIPTION DRUG ABUSE IN
FLORIDA
• Determining the exact number of cases of NAS in Florida is difficult because there is
significant variability in hospital policies and practices used to determine both the
diagnosis and reporting of NAS3
• The intentional misuse of pain medications is the fastest growing drug problem in the
United States. Florida has been the epicenter of prescription drug diversion, resulting in
more women using or abusing prescription opioid drugs7
10. State Trends
Figure 1. Prevalence Rates of Neonatal Abstinence Syndrome Per 10,000 Live Births, 2008-20139
The current report, analyzing data from 2011 through 2013, revealed that the previous increasing trend
has leveled to prevalence rates between 66.7 to 69.6 per 10,000 live births (Figure 1).
Figure 2. Prevalence Rates of Neonatal Abstinence Syndrome Per 10,000 Live Births by
Maternal Race and Ethnicity, 2011-20139
Infants born to white non-Hispanic women have the highest reported prevalence rate of NAS (prevalence
rate = 131.5 per 10,000 live births).
11. Figure 3. Prevalence Rates of Neonatal Abstinence Syndrome Per 10,000 Live Births by
Maternal Age Group, 2011-20139
The prevalence rate among infants born to mothers aged 25-29 years (88.1 per 10,000 live births) was
significantly higher compared to other maternal age categories.
Figure 4. Prevalence Rates of Neonatal Abstinence Syndrome Per 10,000 Live Births by
Maternal Education Level, 2011-20139
Live births among women with less than high school education also have a high NAS prevalence rate
(114.7 per 10,000 live births).
12. Local Trends-Pasco County, Florida
• Neonatal Abstinence Syndrome is also a growing epidemic in Pasco County, Florida.
• Among all 67 Florida counties, Pasco County had the fourth highest frequency of
Neonatal Abstinence Syndrome within Florida between 2011 and 2013, with a frequency
of 256 children per 10,000.
• The 6th Judicial District, which includes Pinellas and neighboring Pasco County, have
one of the highest incidences in the state of Florida of prescription drug deaths11
Table 1: Number of Newborns Diagnosed with Drug Withdrawal Syndrome in Pasco,
County, Florida
Year # of Newborns
Diagnosed6
# of Live
Births
2012 34 4,736
2011 33 4,699
2010 20 4,802
2009 16 4,945
2008 7 5,303
Total 110 24,485
Based on livebirths w/779.5 and/or 760.72
The data provided by AHCA were selected around two ICD-9-CM*
diagnosis codes concerning substance exposure in newborns. (1) 779.5:
Drug withdrawal syndrome in newborn of dependent mother .This code
includes any addictive drug, and does not discern prescription drugs
from non-prescription drugs. (2) 760.72: Narcotics affecting fetus or
newborn via placenta or breast milk.
13. BARRIERS TO SCREENING AND REFERRALS
Misperceptions regarding the benefits of methadone maintenance during pregnancy, ongoing
stigma directed toward mothers affected by addiction, and actions by court or child protective
agency personnel that counter evidence-based harm reduction strategies all contribute to the
pervasive challenges for substance abusing women and their children12
.
Some common barriers reported by professionals that work with women of childbearing
age include:
• Time
• Stigma
• Screening Compliance
• Referral Issues
• Self-report: patients provide socially desirable answers
14. THE BENEFITS OF SCREENING
Screening can have several immediate benefits:
1. Identification of women at risk of having a NAS baby
2. The earliest possible intervention or referral to specialized treatment
3. Improvement in maternal and infant outcomes
4. Opportunity for education to be provided about the risks of illicit drug use
5. The 5-10 minutes of screening followed by an appropriate intervention is a modest
investment that can result in enormous cost benefits in the long term
15. OVERCOMING BARRIERS
A number of clinical methods have been developed to detect substance abuse. Educated
guessing based on clinical experience may identify some users, but is heavily dependent
on the practitioner’s attitudes and experiences. The majority of at-risk women who do not
fit stereotypic molds will be missed. The most effective method for detecting substance
abuse is utilizing a screening tool. The recommended screening tools that will be covered
in this training are a combination of the following strategies:
Strategies Overview
5-A’s A brief, five step intervention program,
referred to as the “5 A’s” model, is
recommended in clinical practice. The 5 A’s
are: Ask. Advise, Assess, Assist, and
Arrange.
CAGE-AID A 4-item screening tool to help indicate
whether a problem with alcohol or drug use
may exist.
Motivational Interviewing A goal-oriented, client centered interview
style for eliciting behavior change.
Five Step Intervention Program (5A’s)
Step 1: Ask
Supportive inquiry about use of drugs or alcohol can open the door to referral and treatment. In
order to elicit an honest response, a safe and respectful environment is essential.
• Ensure staff understands the importance of a positive and nonjudgmental attitude in
establishing a trusting relationship and welcoming environment.
• Be empathetic, genuine, and supportive when asking about use; consider the clients’
needs, current life situation, and potential barriers to stopping use (i.e. no support, limited
finances, lack of knowledge of resources, fear of repercussion, etc.).
• Observe and protect client confidentiality.
• Ask every question in a health context. This lessons the stigma associated with the topic
and expresses concern for the health of the mother and baby.
• Know how to respond, including discussions of risk of use, benefits of stopping use, and
resources for further assessment and/or treatment.
• Offer a culturally appropriate screening in the client’s primary language.
16. CAGE-AID Screening Tool
For Alcohol and Drug Abuse
Patient Name: Patient #: Date:
Question YES NO
Have you ever felt you should cut down on your drinking or drug
use?
Have people annoyed you by criticizing your drinking or drug use?
Have you ever felt bad or guilty about your drinking or drug use?
Have you ever had a drink or used drugs first thing in the morning
to steady your nerves or to get rid of a hangover?
Score
Item responses on the CAGE questions are scored with a 0 for “no” and a 1 for
“yes.” A higher score is an indication of alcohol or drug abuse problems. A total
score of two or greater is considered clinically significant.
Note: This screening tool is not intended to be used for diagnostic purposes but
only as a tool to indicate whether a problem with alcohol or drug use may exist. It
is recommended that primary care physicians lower the threshold to one positive
(“yes”) answer to cast a wider net and to identify more patients who may have
substance abuse issues.
17. Step 2: Advise
This is an excellent opportunity to educate the patient and her partner about the adverse effects of
drug use and the benefits of stopping at any time. Stress that cessation of use should occur with
the guidance of a medical and/or substance abuse professional as the sudden stoppage of some
substances may have adverse effects of the mother and baby.
• Assume that all women have some knowledge of the effects of drugs, alcohol, and
cigarettes before, during, and after pregnancy.
• Ask what the woman knows, then fill in the missing pieces and clarify misconceptions.
• These messages should be reinforced through pre-pregnancy, pregnancy, and postpartum
via discussions, educational literature, and other materials.
• Inform, do not PREACH
• Recommend reducing her use and set reasonable goals for doing so
Step 3: Assess
• When a woman denies use (score of 0)
o Acknowledge this wise choice
o Review the benefits of abstinence from substances
o Continue to routinely screen (screening should ideally occur at every encounter)
o Remain supportive, encouraging, and non-judgmental
• When a woman admits use (score 1-4)
o Inquire about substance use
o Inquire about interest in change
Step 4 and 5: Assist and Arrange
• Referral to Treatment:
o Discuss the benefits of treatment and offer to provide the woman with a referral to
a local substance abuse treatment center.
o If the woman is unwilling to make that commitment, ask if she would like some
information to take with her if she should change her mind.
o Schedule the next visits, continue to maintain interest in her progress, and support
her efforts in changing.
o Monitor and follow up on any co-existing psychiatric conditions.
18. • Making a Referral:
o Know your resources. Keep a current resource guide in your office.
o Tailor your referral suggestions to the patient.
o Keep her needs, available resources (i.e. transportation), and health insurance
coverage in mind when making a referral.
o If possible, make the referral while the patient is in the office. If not, at a
minimum, provide her with a number that she can call herself to either get
information or schedule an appointment.
o Discuss potential strategies (i.e. individual counseling, 12 step programs) and
offer her choices. Research has shown that people who are given choices are more
successful in treatment.
o Maintain communication with the substance abuse treatment provider to monitor
the patient’s progress and adherence to treatment.
o Request that the patient sign a release of information so that this communication
with other providers (substance abuse, mental health, primary care, etc.).
o Encourage and support any reduction in use.
• Harm Reduction Strategies:
o Evaluate and refer for underlying problems.
o Encourage the woman to keep track of substance use and to honestly disclose it
during visits so that her treatment can be planned accordingly.
o Recommend reducing her use and set reasonable goals for doing so.
o Intersperse use with periods of abstinence.
o Encourage a safe route of drug administration.
o Help her to explore substitutes for the substance.
o Suggest changes in diet, exercise, activities that may support reduction in use.
o Encourage her to avoid drug using friends and discuss how she can build a
positive support network.
o Discuss contraceptive methods for after delivery and make a plan.
19. MOTIVATIONAL INTERVIEWING
The clinician practices motivational interviewing with five general principles in mind:
1. Express empathy through reflective listening.
2. Develop discrepancy between clients' goals or values and their current behavior.
3. Avoid argument and direct confrontation.
4. Adjust to client resistance rather than opposing it directly.
5. Support self-efficacy and optimism.
Express Empathy
Empathic motivational interviewing establishes a safe and open environment that is conducive to
examining issues and eliciting personal reasons and methods for change. Your attitude should be
one of acceptance, but not necessarily approval or agreement, recognizing that ambivalence
about change is to be expected.
• Communicates respect for and acceptance of clients and their feelings
• Encourages a nonjudgmental, collaborative relationship
• Allows you to be a supportive and knowledgeable consultant
• Sincerely compliments rather than denigrates
• Listens rather than tells
• Gently persuades, with the understanding that the decision to change is the client's
• Provides support throughout the recovery process
Developing Discrepancy
Motivation for change is enhanced when clients perceive discrepancies between their current
situation and their hopes for the future. Discrepancy is initially highlighted by raising your
clients' awareness of the negative personal, familial, or community consequences of a problem
behavior and helping them confront the substance use that contributed to the consequences.
• Developing awareness of consequences helps clients examine their behavior.
• A discrepancy between present behavior and important goals motivates change.
• The client should present the arguments for change.
20. Avoiding Arguments
Arguments with the client can rapidly degenerate into a power struggle and do not enhance
motivation for beneficial change. The goal is to "walk" with clients (i.e., accompany clients
through treatment), not "drag" them along (i.e., direct clients' treatment).
• Arguments are counterproductive.
• Defending breeds defensiveness.
• Resistance is a signal to change strategies.
• Labeling is unnecessary.
Rolling With Resistance
Resistance is a signal to you to change direction or listen more carefully. Resistance actually
offers you an opportunity to respond in a new, perhaps surprising, way and to take advantage of
the situation without being confrontational.
• Momentum can be used to good advantage.
• Perceptions can be shifted.
• New perspectives are invited but not imposed.
• The client is a valuable resource in finding solutions to problems.
Self-Efficacy
Improving self-efficacy requires eliciting and supporting hope, optimism, and the feasibility of
accomplishing change. This requires you to recognize the client's strengths and bring these to the
forefront whenever possible.
• Belief in the possibility of change is an important motivator.
• The client is responsible for choosing and carrying out personal change.
• There is hope in the range of alternative approaches available.
21. REFERRAL
Referrals that may be appropriate for substance abusing pregnant women include but are not
limited to:
• Substance abuse treatment centers (residential and outpatient)
• Methadone clinics
• Childbirth preparation classes
• Support groups (i.e. Alcoholics Anonymous (AA), Narcotics Anonymous (NA))
• Pain management (if there is a genuine issue with chronic pain)
• Public assistance/medical assistance/food stamps/transportation/housing
• WIC Nutrition Program
• Child care
• Parent skill-building services (i.e. Healthy Start)
• Education and career-building support
• Legal services
• Mental health services
• Domestic violence counseling and services
• Pediatric follow-up care for infant (medical/developmental)
It is important to let the patient know that such programs are available in her area and encourage
her to access them. Offer to assist her if needed. In Pasco County, directing a patient to call the
211 information/referral line can be a way to initiate this process. At her next appointment,
follow up with the patient to ensure that the service was successfully accessed. Be aware of what
barriers may have prevented her from accessing that service in the past and be prepared to offer
support.
Anytime a patient is referred to or accesses another service, particularly one related to her
substance abuse or mental health issues, it is vital that communication occur between the
referring source (i.e. obstetrician) and the other provider. A best practice is to have the patient
sign an authorization to disclose protected health information (this should be written in her
primary language and verbally reviewed with her), to ensure continuity of care and appropriate
treatment planning. It is important to let the patient know how the shared information will be
used to assist in the care of both she and her baby.
22. Community Resources
For Pregnant Women with Substance Abuse Issues
Programs of BayCare Behavioral Health
1 (866) 762-1743: Access Center number for all BayCare locations and services in Pasco
County. All potential clients must call this number first. They will be directed to the appropriate
facility at that time.
Name of Program: Adult Treatment Center
Type of program: Outpatient mental health and substance abuse
services
Address: 8002 King Helie Blvd
New Port Richey, Fl 34653
Phone Number for
Potential Clients:
1 (866) 762-1743 (Access Center)
Hours of Operation: M-Th 8:00am-6:30pm, Fridays 8:00am-5:00pm
Cost: Determined when the potential client contacts
the Access Center
Insurance: Medicaid, Medicare, commercial insurance, and
state funding is available for clients who meet
criteria.
Notes:
• Accepts pregnant women 18 years and up.
• Mental health, substance abuse, medication management services
available.
23. Name of Program: BayCare Community Recovery Center
Type of program: Inpatient residential facility
Address: 6040 Indiana Ave.
New Port Richey, Fl 34653
Phone Number
for Potential
Clients:
Registration center (877) 692-2922. This number
can also provide assistance for other services.
Clients may also call 1 (866) 762-1743 (Access
Center)
Hours of
Operation:
Office hours are M-F 8:00am-4:00pm
Cost: Sliding scale for patients with no insurance.
Insurance: Commercial insurance if residential is on the
policy,
private pay, and state funded beds are available for
clients who meet criteria.
Notes:
• Accepts pregnant women. These women are referred out for
detox. Patients on Methadone are not accepted.
• There are approximately 10-12 beds available for women.
• Average length of stay is 30 to 80 days. This is dependent on the
client’s treatment needs.
• Services offered include: individual/group counseling (on such
topics as mental health, substance abuse, co-dependency), case
management, transportation to appointments and to AA and NA
meetings, and parenting classes.
• Weekend outings are available
• Visiting hours for friends and families are on Sundays.
24. Name of Program: Doris Cook Smith
Type of program: Adult and child outpatient facility
Address: 14527 7th
Street
Dade City, Florida 33523
Phone Number for
Potential Clients:
(813) 428-6181 or (866) 762-1743 (Access
Center) (for initial appointments)
Hours of Operation: M-Thur 7:30-6:00pm; Fridays 7:30-5:00pm
Cost: There is no sliding scale.
Insurance: There are multiple funding sources for clients
who are unable to pay.
Medicaid, Medicare, and commercial insurance
are accepted (exceptions: United, FHP and
Medipass).
Notes:
• Services include: individual/group counseling (for both mental
health and substance abuse issues) and medication management,
anger management, healthy relationships and parenting
25. Name of Program: Integrated Stabilization Unit (ISU)
Type of program: Residential inpatient detoxification
Address: 8002 King Helie Blvd.
New Port Richey, Florida 34653
Phone Number for
Potential Clients:
1 (866) 762-1743 (Access Center)
Hours of Operation: Facility is open 24/7. Admissions are done
24/7.
Cost: Determined when client contacts the
Access Center or (ISU).
Insurance: Funded beds are available. Private pay and
private insurance accepted.
Notes:
• Does accept pregnant women if meets center guidelines. Good
resource for a woman who is interested in getting pregnant but first
requires this service.
• There are ten beds available for women.
26. Name of Program: Care Coordination Program (C.C.P.)
Type of program: Offers care navigation and support services to
pregnant and post-party's women who are at risk
for, or have delivered a substance exposed
newborn.
Address: 8002 King Helie Blvd.
New Port Richey, Florida 34653
Phone Number
for Potential
Clients:
(727) 207-6643 (Deborah Vosburgh, Pasco), (727)
277-6243 (Abby Wilso, Hillsborough) or (727)
809-0910 (Stephanie Campbell, Pinellas).
Hours of
Operation:
M-Th 8:00am-7:00pm, Friday's 8:00am-5:00pm
Cost: Determined when the potential client contacts the
Access Center.
Insurance: Medicaid, Medicare, commercial insurance (not
United), and state funding is available for clients
who meet criteria.
Notes:
• Accepts pregnant women 18 years and up or emancipated pregnant
women.
• Coordination, assessment, referral, education, and help with baby
items.
27. Programs at BayCare Hospitals
Name of Program: Special Additions
Type of program: Educational class for pregnant women who believe
that their baby may have been exposed to any
substance (includes tobacco, alcohol, prescription
drugs, illegal drugs, etc.)
Address: Countryside Mease Hospital
3231 McMullen Booth Road
Safety Harbor, Florida 34695
Phone Number
for Potential
Clients:
(727) 725-6621
Hours of
Operation:
Classes are offered on either the third or fourth
Wednesday of the month.
Cost: None
Insurance: Not applicable
Notes:
• No referral needed. Patient to call the number listed for
information.
• Pasco County residents welcome to participate.
• Partners are encouraged to attend the class with the pregnant
woman.
28. Programs of Operation PAR
Name of Program: COSA
Type of program: Outpatient substance abuse
treatment
Address: 2000 4th
St. South
St. Petersburg, Florida 33705
Phone Number for Potential
Clients:
727-499-2335 (Assessment Center)
Hours of Operation: M-F 8:30-5:00.
Cost: Dependent upon patient’s ability to
pay.
Insurance: Medicaid and private insurance
accepted.
Notes:
• Accepts pregnant women 18 and older with substance abuse issues.
• The father of the baby can receive treatment as well if needed.
• Patient is linked with a case manager and followed through to
delivery.
• Linkage to additional services available.
29. Name of Program: PAR Village
Type of program: Inpatient residential substance abuse
treatment facility
Address: 13800 66th
Street North
Largo, Florida 33771
Phone Number for
Potential Clients:
1-888-PAR-NEXT (Assessment Center)
Hours of Operation: 24/7
Cost: Cost is determined when the potential client
contacts the assessment center.
There is a self pay piece and there are
several funding sources available.
Insurance: Medicaid not accepted.
Notes:
• Accept pregnant and post partum women and their children (up to
age 7. This is situation specific).
• Length of stay averages from 30-180 days. Depends on the
patient’s needs.
• Program services include: individual/group/family therapy,
vocational training, mental health treatment, and medication
management.
• This program accepts women who are on methadone. However,
they receive their methadone treatment at another PAR facility.
30. Name of Program: Methadone Clinic (Pasco County location)
Type of program: Outpatient
Address: 7729 Washington Street
Port Richey, Florida 34688
Phone Number for
Potential Clients:
(727) 816-1200
Hours of Operation: M-F 5:30am-2:00pm for scheduled
appointments.
M-F 6:00am-9:30am walk-ins accepted for
initial assessment.
Cost: Dependent on the patient’s ability to pay
Insurance: Only Medicaid accepted
Notes:
• Accepts pregnant women 18 and older.
• Offers methadone maintenance and other patient services
31. Name of Program: Methadone Clinic (Pinellas County location)
Type of program: Outpatient
Address: 6150 150th
Ave. North
Clearwater, Florida 33760
Phone Number for
Potential Clients:
1-727-499-2335 (Assessment Center)
Hours of Operation: M-F 5:30am-2:00pm. (Sat and Sunday)
6:30am-10:00am
New patients are only seen between
6:30-10:00am.
Cost: Depends on patient’s ability to pay
Insurance: Medicaid accepted
Notes:
• This facility works with a group of obstetricians who are willing to
accept
pregnant women on methadone. They also work closely with
Bayfront hospital.
32. Other Community Resources
Name of Program: Premier Community HealthCare Nurse-Family
Partnership
Type of program: A program in which a registered
nurse will assist women in their
homes who are having their first
child. The registered nurse will be
assisting the first time mothers
throughout their pregnancy and this
service continues until the child's
2nd
birthday.
Address: 37912 Church Avenue
Dade City, Florida 33525
Phone Number for Potential
Clients:
(352) 518-2000
Hours of Operation: Mon, 7am-7pm; Tues-Fri, 7am-
4pm
Cost: Free to all eligible women.
Insurance: Free to all eligible women.
Notes:
• Eligible women; pregnant with her first child, meets income
requirements, and lives in the service area.
33. Name of Program: A First Step Counseling
Type of program: Outpatient
Address: 5837 Main Street
New Port Richey, Florida 34652
Phone Number for Potential
Clients:
(727) 841-0229
Hours of Operation: Monday and Friday 10:00am -
5:00pm
Tuesday-Thursday 10:00am-
9:00pm
Cost: Depends on the service.
Classes are $25/week.
Insurance: Some insurance are accepted and
private pay
Notes:
• Accepts pregnant women
• Services offered include: substance abuse counseling, mental
health counseling, couples counseling, parenting classes and others
• Average length of treatment is between 8 to 16 weeks
34. Pasco County Health Department Locations:
Call for hours of operation and services provided.
Little Road
10841 Little Road
New Port Richey, Florida 34654
(727) 619-0300
Denton Ave
11611 Denton Avenue
Hudson, Florida 34667
(727) 861-5661
Main Street
5640 Main Street
Suite 100
New Port Richey, Florida 34652
(727) 841-4425
Dade City
13941 15th
Street
Dade City, Florida 33525
(352) 521-1450
Land O' Lakes
4135 Land O’ Lakes Blvd.
Land O’ Lakes, Florida 34639
(813) 558-5173
Zephyrhills
4717 Airport Road
Zephyrhills, Florida 33540
(813) 780-0740
Cox Elementary
37615 Martin Luther King Blvd.
Dade City, Florida 33523
Holiday, Fl 34690
(727) 943-5505
35. WIC (Women, Infants, and Children) Locations:
Main Street
5640 Main Street
Suite 100
New Port Richey, Florida 34652
(727) 841-4425
Mon-Thur 7:30am-5:00pm; Friday 8:00am-12:00pm; 3rd
Sat. of the month
8:30am-12:30pm
Hudson
11611 Denton Avenue
Hudson, Florida 34667
(727) 861-5661
Mon-Thur 7:00am-5:30pm, Friday Closed
Land O' Lakes
4135 Land O’ Lakes Blvd.
Land O’ Lakes, Florida 34639
(813) 558-5173
Mon-Fri 8:00am-5:00pm
Dade City
13941 15th
Street
Dade City, Florida 33525
(352) 521-1450
Mon-Thur 7:30am-6:00pm
Zephyrhills
4717 Airport Road
Zyphyrhills, Florida 33540
(813) 780-0740
Mon-Thur 7:30am- 6:00pm. Friday, closed.
36. References
1. Schrock, S. (2012, October 28). More and more babies are being born with addictions. Star-
Telegram . Fort Worth, TX.
2. National Institute on Drug Abuse, 2015
3. The Statewide Task Force on Prescription Drug Abuse & Newborns (2013). February 2013
Final Report. Retrieved from: http://myfloridalegal.com/webfiles.nsf/WF/RMAS-
94LJPF/$file/Statewide_Task_Force_on_Prescription_Drug_Abuse_and_Newborns_Final_
R eport.pdf
4. Committee on Health Care for Underserved Women and the American Society of Addiction
Medicine. (2012). Opioid abuse, dependence, and addiction in pregnancy. The American
College of Obstetricians and Gynecologists (524), 1-4.
5. Murphy-Oikonen, J., Montelpare, W. J., Southon, S., Bertoldo, L., & Persichino, N. (2010).
Identifying infants at risk for neonatal abstinence syndrome: a retrospective cohort
comparison study of 3 screening approaches. Journal of Perinatal & Neonatal
Nursing, 24(4), 366-372 7p.
6. Association of State and Territorial Health Officials,. (2016). Neonatal Abstinence
Syndrome. Arlington, VA: Centers for Disease Control and Prevention. Retrieved from
7. Centers for Disease Control and Prevention (2012). MMWR Weekly: CDC Grand Rounds:
Prescription Drug Overdoses – a U.S. Epidemic. January 13, 2012 / 61(01);10-13
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm?s_cid=mm6101a3_w
8. Florida Department of Law Enforcement, Drugs Identified in Deceased Persons by Florida
Medical Examiners. October 2012. Available from:
http://www.fdle.state.fl.us/Content/getdoc/fa86790e-7b50-45f3-909d-c0a4759fefa8/2011-
Drug-Report_Final.aspx
9. Florida Department of Health,. (2015). Neonatal Abstinence Syndrome Data Summary.
Retrieved from http://www.fbdr.org/pdf/NAS_FLDOH_2011_thru_2013.pdf
10. LOCAL TRENDS
11. Medical Examiner District Six. Pasco & Pinellas Counties. Year 2011 Medical Examiner
Annual Report. Available from: http://www.pinellascounty.org/
forensics/pdfs/2011ARfinal.pdf
12. Florida Department of Children & Families,. (2013). Partnership for success (pp. 2-6).
Retrieved from http://www.dcf.state.fl.us/programs/samh/docs/pfs/PFS%20Newsletter-
January%202013.pdf
13. Florida Agency for Healthcare Administration (AHCA) http://ahca.myflorida.com/
Data Selection: The data provided by AHCA were selected around two ICD-9-CM*
diagnosis codes concerning substance exposure in newborns. (1) 779.5: Drug withdrawal
syndrome in newborn of dependent mother .This code includes any addictive drug, and
does not discern prescription drugs from non-prescription drugs. (2) 760.72: Narcotics
affecting fetus or newborn via placenta or breast milk. Excludes anesthetic and analgesic
drugs administered during labor and delivery (ICD-9-CM 763.5), drug withdrawal (ICD-
9-CM 779.5), and cocaine (ICD-9- CM 760.75). All selected data excludes fetal alcohol
syndrome (ICD-9-CM 760.71). Selected data include primary and secondary diagnoses;
the number of newborns is unduplicated.
