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153 Presentation BOARDER BABIES AND DRUG-EXPOSED CHILDREN IN THE NATION'S CAPITAL VIJAYA L. MELNICK, Ph.D. University of the District of Columbia Center for Applied Research and Urban Policy 4200 Connecticut Avenue, N.W. Washington, DC 20008 The 1988 National Household Survey on Drug Abuse indicated that 11 percent of women of childbearing age had used illicit drugs within the past 30 days.1 In a 1989 survey of 44 selected hospitals (with 36 reporting) by the Chicago-based National Association of Perinatal Addiction Research Education (ÑAPARE), an average of 11 percent of infants were prenatally exposed to drugs (range 0.4 percent to 27 percent).2 Analysts consider 11 percent to be an underestimate for the District of Columbia and perhaps for other such urban areas as well. Consider the following: • Of the 2,186 infants delivered at D.C. General Hospital in 1989,22 percent of the mothers self-reported abuse of illicit drugs; • 479 of these infants (22 percent of the total births) were prenatally exposed to drugs; • 274 infants (13 percent of total births) tested positive for cocaine or crack; • 342 infants (72 percent of the drug-exposed infants) were born to mothers with no record of prenatal care; • 194 infants (40 percent of the drug-exposed infants) were pre-term.3 An estimated 10,000 live births occur annually in the District. Even if one assumes that 15 percent are prenatally exposed to drugs—a very conservative Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 154 Boarder Babies and Drug-Exposed Children estimate given the findings from D.C General Hospital—1,500 drug-exposed infants are born each year. A random toxicology screening by the National Children's Hospital Medical Center reported that 20 percent of the infants and toddlers tested positive for cocaine, indicating that these children were either exposed before they were born or live in an environment of drug abuse and are either passively inhaling cocaine or accidentally ingesting it.3 If these estimates are accurate, about 6,200 of the 31,000 children age four or younger who live in the District are prenatally or subsequently exposed to illicit drugs, and may continue to live in an environment of drug abuse. The psychosocial and developmental costs of such drug exposure are high. But failure to intervene is even higher. ÑAPARE estimates that excess health care costs—those that result from not treating a substance-abusing pregnant woman as opposed to providing timely treatment—amount to approximately $24,000/infant during the first 30 days of life alone. So if we assume that 15 percent of the 10,000 infants bom in the District are prenatally exposed to substances, excess health care cost for these infants alone is about $36 million during the first 30 days of their lives. If the baby continues to live in a hostile environment of neglect and abuse, the medical, emotional, and social costs continue to climb. The Mayor's Advisory Board on Infant and Maternal Health, on which I serve, sponsored a 1989 study on "boarder babies" in the District of Columbia's hospitals. This study, researched and authored by Dr. Marty Beyer4, combined with Congressional testimonies, prompted the U.S. Congress to issue a mandate to the D.C. Department of Human Services (DHS) to sponsor a project to research and recommend appropriate strategies to address the needs of boarder babies, infants prenatally exposed to substance abuse, and children living in substance-abusing environments in the District of Columbia. Through an interagency agreement with the DHS Office of Early Childhood Development (OECD), the Center for Applied Research and Urban Policy (CARUP) of the University of the District of Columbia (UDC) designed, managed , and implemented this project, which is presently underway. The project is a collaborative endeavor between CARUP and OECD. To prepare for the project, we supplemented reading materials by first organizing a series of 12 seminars. The purpose of the seminar series was to inform the research team about similar programs elsewhere, major issues of concern to both providers and clients, and service needs of the target populations . The seminars featured service providers, representatives...

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