About

The Leadership Institute is a community-based learning and planning experience that focuses on developing a system of care for pregnant and parenting women at risk for alcohol, tobacco and illicit drug use and, for those children who are born affected by prenatal exposure, ameliorating the effects through early intervention and the use of research-proven treatment strategies.

The Leadership Institute has two dimensions:

1. Preventing prenatal substance exposure.

2. Helping young children who have been substance-exposed (and other high-risk children) early in life when there is time to make a difference in their lives. 
   

In combination, these two dimensions help a community avoid the human and financial costs of prenatal substance exposure and serious emotional and behavioral problems of early childhood.

The case of Jose makes a strong argument in favor of early intervention.

The Case of José 
Jose is a child in a rural California County.  At first glance his story is one of an unstable home, disordered parents and, ultimately, his own self-destructiveness.  But, on closer inspection, it also is a story of fragmented services, another child lost in a morass of good intentions but poor follow-up.  A review of what happened along the way was created when Jose was thirteen years old. 

Jose’s difficulties were known as early as kindergarten when he was referred to the school’s high risk program.  Before José was in second grade, seven referrals had been made to the Department of Children and Family Services (DCFS) on his behalf.  In first grade it was noted in his Individual Education Plan (IEP) that he was testing very low academically and had severe behavior problems.  In second grade his records included references to “enuresis, conduct disorder, anxiety, a possible learning disability” and a request for a mental health consultation that was dropped due to lack of follow up.  The family was in crisis, and three more referrals were made to DCFS citing a lack of supervision, alleged physical abuse and possible drug use.  By the sixth grade, José was viewed as out of control and dangerous.  He experienced frequent suspensions from school and was placed on probation after he stole his father’s car.  He was expelled after he assaulted a student.  Jose finally received a full mental health assessment at the end of sixth grade, several years after it was first requested. At age 13 Jose has a first grade reading level and has been expelled from school for fighting.  He is gang involved, uses drugs and is noncompliant with court orders.  Jose’s mental health records indicate he is “sad, depressed, paranoid; has nightmares; wets his bed; and experiences insomnia”. 

The review of Jose’s case showed that 23 different agencies had come into contact with the family over a seven-year period.  Several of the agencies were delivering similar services to multiple members of the family, and in many instances the services for each family member were being duplicated by several agencies at the same time.  We can assume that none of the agencies set out to fail Jose, and no professional with whom he came in contact was indifferent to his problems. But the community must ask, “How could so much effort and money yield so little real help for this young boy?”  And, perhaps more importantly, “How can we do better for the Jose’s in our system today and tomorrow?” 

When we visit other communities and share Jose’s story, community leaders inevitably acknowledge that they have their share of Jose’s – too many.  

The human cost of lost potential and the suffering that could have been avoided is clearly represented in the case of Jose.  But, we must also consider the financial costs.  One iconic statistic makes the case - children like Jose often find themselves in foster care, and because there is no suitable and willing family for them, they live in group homes.  The costs for these group homes vary from place to place, but the $3000 per child per month paid in Southern California by San Bernardino County means the county spends $6M each month for group homes - $72M/year. 

There are many other costs - special education, medical and dental, foster care and all too often courts and corrections.

Does The Leadership Institute Work?
“I have been in the maternal child health field for many years, and for the last 20 years, we have been trying to address the problem of prenatal substance abuse in our county.  It was not until our team attended the Leadership Institute's Leadership Institute, that we actually were able to implement a perinatal substance use assessment program with our Obstetricians and begin screening all pregnant women in our county for the use of tobacco, alcohol and illicit drugs.  We have accomplished more in the last three years than we had been able to do in 20 years.  The institute helped us focus on our vision, set goals and objectives, and develop a scope of work that was easy to implement and support within our community.” - Jan Campbell, RN, PHN, Maternal Child and Adolescent Health Director, San Luis Obispo, Ca.

Where is The Leadership Institute Being Implemented?
The red dots indicate the states in which The Leadership Institute is being implemented.  In some cases single counties/regions have begun the process, for example Tulsa, Oklahoma, is the only location in Oklahoma implementing the process.