Birth to 3 Program Opioid Settlement Funds

Below is a subsection of the approved core strategies and approved uses for opioid settlement funds that closely relate to the Birth to 3 Program population. The complete list is contained within Schedule A and B of Exhibit E (PDF) in the final Opioid Settlement Agreement signed by all states and referenced in 2021 Wis. Act. 57. Counties may reference the entirety of Exhibit E as they develop grant proposals. Any questions relating to application of core strategies and approved uses can be directed to the DHS Birth to 3 Program inbox at: DHSBirthTo3@dhs.wisconsin.gov.

Core strategies (schedule A)

C. Pregnant and postpartum women

1. Expand Screening, Brief Intervention, and Referral to Treatment (SBIRT) services to non-Medicaid eligible or uninsured pregnant women;

2. Expand comprehensive evidence-based treatment and recovery services, including medication-assisted treatment (MAT), for women with co-occurring opioid use disorder (OUD) and other substance use disorder (SUD)/mental health disorders for uninsured individuals for up to 12 months postpartum; and

3. Provide comprehensive wrap-around services to individuals with OUD, including housing, transportation, job placement/training, and childcare.

D. Expanding treatment for NAS

1. Expand comprehensive evidence-based and recovery support for NAS babies;

2. Expand services for better continuum of care with infant-need dyad; and

3. Expand long-term treatment and services for medical monitoring of NAS babies and their families.

I. Evidence-based data collection and research analyzing the effectiveness of the abatement strategies within the state

Approved uses (schedule B)

E. Address the needs of pregnant or parenting women and their families, including babies with NAS

Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH conditions, and the needs of their families, including babies with NAS, through evidence-based or evidence-informed programs or strategies that may include, but are not limited to, those that:

1. Support evidence-based or evidence-informed treatment, including MAT, recovery services and supports, and prevention services for pregnant women—or women who could become pregnant—who have OUD and any co-occurring SUD/MH conditions, and other measures to educate and provide support to families affected by Neonatal Abstinence Syndrome.

2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months postpartum.

3. Provide training for obstetricians or other healthcare personnel who work with pregnant women and their families regarding treatment of OUD and any co-occurring SUD/MH conditions.

4. Expand comprehensive evidence-based treatment and recovery support for NAS babies; expand services for better continuum of care with infant-need dyad; and expand long-term treatment and services for medical monitoring of NAS babies and their families.

5. Provide training to health care providers who work with pregnant or parenting women on best practices for compliance with federal requirements that children born with NAS get referred to appropriate services and receive a plan of safe care.

6. Provide child and family supports for parenting women with OUD and any co-occurring SUD/MH conditions.

7. Provide enhanced family support and child care services for parents with OUD and any co-occurring SUD/MH conditions.

8. Provide enhanced support for children and family members suffering trauma as a result of addiction in the family; and offer trauma-informed behavioral health treatment for adverse childhood events.

9. Offer home-based wrap-around services to persons with OUD and any co-occurring SUD/MH conditions, including, but not limited to, parent skills training.

10. Provide support for Children’s Services—Fund additional positions and services, including supportive housing and other residential services, relating to children being removed from the home and/or placed in foster care due to custodial opioid use.

J. Leadership, planning, and coordination

Support efforts to provide leadership, planning, coordination, facilitations, training, and technical assistance to abate the opioid epidemic through activities, programs, or strategies that may include, but are not limited to, the following:

1. Statewide, regional, local or community regional planning to identify root causes of addiction and overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the greatest needs for treatment intervention services, and to support training and technical assistance and other strategies to abate the opioid epidemic described in this opioid abatement strategy list.

2. A dashboard to (a) share reports, recommendations, or plans to spend opioid settlement funds; (b) to show how opioid settlement funds have been spent; (c) to report program or strategy outcomes; or (d) to track, share or visualize key opioid- or health-related indicators and supports as identified through collaborative statewide, regional, local or community processes.

3. Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative, cross-system coordination with the purpose of preventing overprescribing, opioid misuse, or opioid overdoses, treating those with OUD and any co-occurring SUD/MH conditions, supporting them in treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid epidemic described in this opioid abatement strategy list.

4. Provide resources to staff government oversight and management of opioid abatement programs.

K. Training

In addition to the training referred to throughout this document, support training to abate the opioid epidemic through activities, programs, or strategies that may include, but are not limited to, those that:

1. Provide funding for staff training or networking programs and services to improve the capability of government, community, and not-for-profit entities to abate the opioid crisis.

2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid misuse, prevent overdoses, and treat those with OUD and any co-occurring SUD/MH conditions, or implement other strategies to abate the opioid epidemic described in this opioid abatement strategy list (e.g., health care, primary care, pharmacies, PDMPs, etc.).

Increase access to and coordination with other supports, services, and interventions available in the community for targeted populations.

• For children with prenatal opioid exposure
• For families affected by opioid use disorder

Early intervention programs may identify infants, toddlers and families affected by opioid exposure through several coordinated methods:

1. Hospital and prenatal screening—Hospitals and healthcare providers screen pregnant women and newborns for substance exposure using medical histories, interviews, toxicology tests, and assessments for NAS. Positive findings often trigger referrals to early intervention services.
2. Referrals from healthcare providers—Pediatricians, obstetricians, nurses, and substance use treatment providers refer infants and families when opioid exposure is known or suspected.
3. Mandatory reporting and plans of safe care—Under federal law in the United States, states must have procedures for notifying child welfare agencies when infants are affected by prenatal substance exposure. These notifications often include a plan of safe care, which connects families to early intervention, healthcare, and support services.
4. Developmental screenings—Early intervention specialists assess infants and toddlers for delays in cognitive, physical, language, social-emotional, and adaptive development. Prenatal opioid exposure and signs of developmental delay may qualify children for services.
5. Community partnerships—Programs collaborate with home visiting agencies, public health departments, social service organizations, and substance use treatment programs to identify and support families.
6. Family self-referral—Parents or caregivers who are concerned about their child’s development or who need support related to substance exposure can contact early intervention programs directly.

Below are examples of evidence-based trainings, programs, and interventions for infants, toddlers, and families that have demonstrated effectiveness in promoting family healing, strengthening parent-child attachment, and building resilience.

• Using support, services, and interventions that have demonstrated effectiveness
• Expenditures are directly related to mitigating the effects of opioid use disorder and related challenges on infants, toddlers, and their families

Some evidence-based intervention examples developed in Wisconsin and other states include:

• SafeCare is a program for children ages 0-5 at risk of abuse and neglect, as well as their parents and caregivers. It helps parents recognize and respond to children’s cues and develop other parenting skills.
• The Incredible Years® – Toddler Basic Program is a group-based program designed to strengthen parent-child attachment and is designed for parents with toddlers ages 1 to 3 and The Incredible Years® – Parents and Babies Program serving parents and their infants (0 to 12 months).
• Celebrating Families!  offers prevention and intervention to promote family healing and improve family relationships. It is a family-inclusive, trauma-informed, skill-building program for families affected by parental substance use disorders with infants and children up to 17 years.
• Nurturing Parenting Program for Parents and their Infants, Toddlers, and Preschoolers – The California Evidence-Based Clearinghouse for Child Welfare includes family-centered interventions for parents with goals that include promotion of nurturing parenting skills and prevention of child abuse and neglect.
• The Families Moving Forward Program incorporates cognitive behavioral therapy, motivational interviewing, and caregiver support and coaching. It is a promising practice for children with a fetal alcohol spectrum disorder and their families.
• Infant massage
  • International Loving Touch Foundation
  • Infant Massage USA
• Parents & Their Infants, Toddlers & Preschoolers is a program run by Nurturing Parenting. Nurturing Parenting programs are a family-centered and trauma-informed initiative designed to build Nurturing Parenting skills as an alternative to abusive and neglecting parenting and child-rearing practices.
• Circle of Security is an innovative intervention program designed to improve the developmental pathway of children and their parents.
• Triple P is an evidence-based parenting and family support system designed to give parents and caregivers simple, practical strategies to help build strong family relationships, confidently manage children’s behavior, and prevent behavioral or emotional problems before they start.
• Your Journey Together helps to improve parenting skills with Your Journey Together (YJT), a research-based, trauma-informed curriculum designed to build resilience in vulnerable children and their families.
• Attachment, Regulation, and Competency (ARC) is an evidence-based, flexible treatment model designed for children and adolescents from birth to early adulthood who have experienced complex trauma, along with their caregiving systems.

• Hospitals
• Pediatricians
• Child welfare agencies
• Community organizations
• Substance-use treatment providers
• Other programs serving infants and toddlers such as Home Visiting, childcare, and Early HeadStart.

The Grant Enrollment, Application and Reporting System (GEARS) will be used to report expenditures for the DHS Birth to 3 Program opioid settlement funds. The website provides useful information on locating profiles, creating and filling out expenditure reports, and includes links to downloadable forms and the GEARS manual.

DHS will provide quarterly progress report to the Wisconsin Joint Committee on Finance as outlined in 2021 Wis. Act. 57.

County Birth to 3 programs who receive the settlement funds must report the following information to DHS:

• Describe the overall progress on this project during this reporting period.

• Describe any problems or delays the project is experiencing and plans or efforts undertaken to resolve them.

• Describe any identified project or technical assistance needs that DHS may be able to assist with.

• List the services provided by this project and the number of people served by each.

• Describe any successes or positive outcomes that occurred as a result of receiving.

Quarterly reporting for all projects, including a detailed list of expenditures, must be emailed to the DHS Birth to 3 Program at DHSBirthTo3@dhs.wisconsin.gov according to the schedule below.