WHAT WILL IT BE, LEGISLATORS? -- FOR VULNERABLE INFANTS, VIP OR RIP

We are not very good in this country at prevention. It took Sept. 11 for us
to wake up to terrorism, and the space-shuttle crash to prompt
reconsideration of NASA. And, sadly, it took our own local tragedy for
nightclubs everywhere to rethink fire.

The challenge of prevention is that you must lay out money now for
something in the future. The question remains: If you had saved the money,
would it have turned out okay anyway? In other words, why spend precious
resources for a bad outcome that may not even happen? In Rhode Island,
though, we have a prevention program that actually saves money. The
Vulnerable Infants Program of Rhode Island (VIP-RI) prevents potential
problems for drug-exposed infants by intervening early in their life. This
has proven to be cheaper than waiting for problems to occur.

The program is called VIP because drug-exposed infants (most of whose
mothers while pregnant used cocaine, heroin, alcohol, and/or marijuana) are
vulnerable -- but not damaged. In a good environment, they can do quite
well. (And, of course, all babies are VIPs!) Rhode Island annually has
about 150 such infants involved with the Department of Children, Youth and
Families. The agency must recommend, and then the Family Court must decide,
which of these infants should go home from the hospital with their mothers,
which should be put up for adoption, and which should go into foster care
until a final decision can be made.

How do we decide which mothers get to keep their babies, which mothers do
not, and which mothers may have a chance at reunification? If it is clear
that the child's physical safety is in jeopardy, there is no question. But
most cases are not like this; the concern, rather, is whether the mother
has the ability to care for her child.

Meanwhile, removal from the mother is not necessarily in the child's best
interest. Infancy is when children form attachments -- "bonding." Babies
cannot develop an attachment when their relationship with their parents is
disrupted, or when they are placed in multiple foster homes. Such babies
may later have severe emotional problems.

In 1997, the federal government decided that there were too many children
in foster care (over 500,000), and that multiple foster-care placements
wreaked havoc with children's emotional lives. It therefore passed the
Adoption and Safe Families Act, which requires a permanent placement within
12 months for a child being removed from his or her biological mother.
Through "concurrent planning," while placements are being investigated,
parents are given a chance to change their lives so that reunification
might occur.

Enter the Vulnerable Infants Plan of Rhode Island. Unique to our state, VIP
was set up to work with the Department of Children, Youth and Families and
the Family Court to do two things: 1) get these infants placed in a home as
quickly as possible and 2) comply with the federal Adoption and Safe
Families Act. VIP-RI is based at Women & Infants Hospital, where most of
such babies are born in Rhode Island, although other hospitals are involved.

As soon as a drug-exposed DCYF-involved infant is identified, VIP-RI
administers tests of the mother's substance dependency, mental health, and
nurturing ability, and of the effects of drugs on the infant. The
information is then used in the placement decision and the development of a
treatment plan.

The key to keeping mothers and babies together is the coordination of
treatment and service to meet the complex needs of substance-involved
families. Working with VIP, the Family Court and DCYF have set up a Family
Treatment Drug Court, under Chief Judge Jeremiah Jeremiah; through this
program, DCYF and VIP develop and coordinate a mother's treatment plan, and
if she complies with it she is permitted to keep or be reunited with her baby.

Jay Lindgren, DCYF's director, has noted that "The Report of the Rhode
Island System of Care Task Force: Toward an Organized System of Care for
Rhode Island's Children, Youth and Families," issued in January, clearly
promotes "family-centered practice [that is] evidence-based [and] designed
to address drug use, child abuse and neglect."

VIP-RI has taken this prevention approach for the last two years, and the
results are encouraging. The number of days drug-exposed infants stay in
the hospital has been cut by 60 percent. At Women & Infants, the infants
who don't need special care, which is most of them, represent a cost saving
of $450 a day -- reaching an estimated total last year of $183,000.

Meanwhile, the mothers have shown a significant reduction in mental-health
problems. Fathers have participated, and services have also been provided
to other children in the family.

And for infants who are being removed from their mothers, permanent
placement within one year -- as stipulated by the Adoption and Safe
Families Act -- has been achieved among 62 percent of them.

In 1998, an article in Science showed that America spends upward of $352
million a year on children's special education that has been necessitated
by prenatal cocaine exposure. If we apply this analysis to Rhode Island,
the cost today is $800,000 a year for our cocaine-exposed children.
Therefore, if less than half of that money were spent on VIP, we could
spare the children years of suffering and at the same time save money.

But you have to spend now, during a child's infancy, to prevent problems
later on. And to do that will require appropriations from the General Assembly.