As sadly noted in the May 12 OBSERVER’s View, “Use of drugs becomes alarming” during pregnancy, no baby child entering this world deserves such a terrible greeting. In addition to suffering with Neonatal Abstinence Syndrome, children exposed to substances in the womb face lifelong challenges. The devastating impact on our children and society remains a hidden consequence of the opioid epidemic.

Neonatal Abstinence Syndrome is a clinical diagnosis and means that the newborn is in withdrawal because the substances received from the mother’s use during pregnancy are suddenly gone. Prenatal substance exposure results in substantial short- and long-term effects on the child. Short-term withdrawal symptoms may be severe and intense and can cause significant illness and long scary hospital stays. Long-term consequences affect the brain and nervous systems. These infants and children are at high risk of child abuse and neglect. All of this results in lifelong challenges for the child and huge strains on families, the education system, and many other systems throughout the child’s life.

At five times the New York state rate, the high rate of newborns affected by maternal use of substances has been a grave concern in Chautauqua County for several years. This concern resulted in a highly collaborative local coalition dedicated to building bright futures for our children and families: Strong Starts Chautauqua, the first initiative of its kind in the state.

In 2019, it was determined that a more coordinated and purposeful effort was needed to address the significant crisis of prenatal substance use in our county. Strong Starts Chautauqua (SSC) was founded with a 3.5-day Leadership Institute at UPMC Chautauqua led by Ira Chasnoff, M.D., one of the nation’s leading researchers in the field of child development and the effects of maternal alcohol and drug use on the newborn, infant, child, and adolescent.

Strong Start Chautauqua is a community-driven coalition of over 50 partners, including county government, medical and mental health providers, UPMC Chautauqua, school districts, childcare and preschool providers, community-based and social care organizations, Jamestown Community College, and philanthropic foundations. It supports all the County’s young children and their families through community education and outreach, information and referral, maternal and early childhood risk screening, and connection to resources that help young children thrive. This universal effort comprises Tier 1 of the four-tiered Screening, Assessment, Referral and Treatment (SART) Model.

Actual SSC data shows the local effects of prenatal alcohol and substance use and serves as a call to community action. From October 2020 through October 2022, Strong Start Chautauqua prenatal care providers screened 543 pregnant women in Chautauqua County for substance use utilizing the 4Ps Plus. Pediatricians and other early childhood providers screened close to 2,737 children up to 5 years old with the Ages & Stages Questionnaire-3 and the Children’s Screen for Regulatory Behaviors. In summary:

¯ 62% of pregnant women were using a substance that could change the structure or function of the developing fetal brain before they were aware they were pregnant.

¯ The rate of alcohol use went down after the women realized they were pregnant, but the use of tobacco, marijuana, and other drugs went up.

¯ These rates are among the highest found in any community or state that is implementing a universal screening approach with the SART Model.

¯ 48% of children up to 5 years old are having trouble regulating their behaviors and emotions to appropriately respond to life around them.

¯ Children are burdened with developmental delays and behavior and sensory problems.

¯ The behavior problems grow worse as the children’s developmental demands increase.

¯ A definite link was found between the number of newborns with NAS and the tracked information of the Preschool Special Education program four years later.

¯ Special education services are putting increasing fiscal demands on all Chautauqua County systems.

Strong Start Chautauqua’s clinical teams then develop treatment plans and services that meet each child and family’s specific needs. Work is currently underway to expand the universal Tier 1 screening practices throughout Chautauqua, Cattaraugus, and Allegany Counties and include Tiers 2-4 of the SART Model. This will greatly increase early diagnosis and ensure access to the appropriate services needed to help these children succeed.

The Federal Child Abuse Prevention and Treatment Act (CAPTA) and Family First Preventive Services Act (FFPSA) have helped health and child welfare professionals in working together better to make sure that the health and safety needs of vulnerable infants and children are met. Policies and strategies have been put in place in Chautauqua County and show a shift in focus from basic child safety and health to a more holistic approach.

The effects of the opioid epidemic will be felt for generations. We are fortunate to have so many individuals and organizations doing great prevention work, providing education, resources, and treatment services, and addressing the social determinants of health that impact alcohol and substance misuse. Risk is not destiny – prevention and early intervention work.

We must continue to work together on proven, equitable, and sustainable strategies that result in a healthier community for all. SSC is one such strategy. For more information on SSC, visit strongstartschaut.com or call 716-359-1417.

Christine Schuyler is Jamestown Community College’s program director for healthcare initiatives. Dr. Lillian Vitanza Ney is a member of the Chautauqua County Board of Health. Both are members of the Strong Starts Chautauqua Leadership and Clinical Advisory teams.