Data development with Mission Health regarding Neonatal Abstinence Syndrome underway.
Story Behind the Curve
Substance use disorders in pregnancy are an emerging concern in Buncombe county and the Western North Carolina region. About 236 babies were delivered with positive toxicology at Mission Hospital in 2015 and it is projected that will increase to around 375 in 2016. Additionally, 85% of children in foster care were placed there related to substance abuse issues and many of those children were under the age of 2. About 50% of women with Substance Use Disorders who engage in prenatal care do not maintain adequate care, and while OB providers in the region have become more comfortable in caring for women with these issues, they lack connections to substance abuse services.
Mothers presenting early in pregnancy face obstacles to engaging in services in a timely manner due to poor linkage to substance abuse services and insurance among others. There is no standardized screening or referral process and both varying with provider understanding of addiction and substance use disorder support needs. As a results, the timeliness of linkage to services varies. Because Medication-Assisted Treatment (MAT) is considered the treatment of choice for pregnant women with opioid dependence/abuse, even those adherent in MAT programs may bear children with neonatal abstinence syndrome. Most commonly, babies have methadone or polydrug dependence. Long inpatient stays for Neonatal Abstinence babies can lead to difficulties for mother-baby bonding and logistical hurdles for mothers on outpatient MAT.
The Protecting Our Infants Act of 2015 was passed by congress and signed by the president to study and develop recommendations for preventing and treating prenatal opioid use disorders and NAS. This was a result of the urgency of the situation. From 2000 to 2012 the number of infants displaying symptoms of drug withdrawal after birth increased approximately fivefold nationwide. Neonatal Abstinence Syndrome (NAS) results in more complicated and longer initial hospitalizations than other newborns experience. For more information on the act read here.
What works in Buncombe County:
Mission NAS Project:Duke Endowment awarded Mission Health a grant to support the Neonatal Abstinence Syndrome program, which was developed to wean babies who were exposed to drugs while in utero. The program was developed here at Mission Hospital in Asheville, and has since become a worldwide protocol. This program will aid in solidifying and educating eligible families.
Regional Perinatal Substance Use Disorder Program Proposal/Recommendations: Regional Project Coordinator/Manager that is responsible for development of regional consortiums of care to provide the range of services needed and manages the engagement/navigator programming and staff. A minimum of 5 engagement specialists is recommended that would utilize the Community Health Worker Model for women through their first year postpartum. These staff members would be staffed at various community organizations such as Women’s Recovery Center, Smoky Care Coordination/CCNC, Possibly NFP/Others/Community Service Navigators (HHS). Additionally the role of NAS Coordinator currently at Mission/MAHEC is promising for expansion to regional coverage. To eliminate barriers to treatment, co-location of MAT programming and providers of high risk OB care should be co-located.SUD providers in western sub-regions providing treatment groups with childcare and nutrition as well as transportation when appropriate. Obstetrical Medical Home Program funding for routine care plus SAIOP in SUD subset of high risk patients. OB practice could be required to have a MOA with SUD agency to provide services in order to qualify. Develop regional residential options beyond/expand Mary Benson House. Develop Mobile Crisis role in connecting those diagnosed in ED’s across the regional program.
What works in other communities:
UNC Horizons:For Women Horizons offers a comprehensive recovery and relapse prevention
program for substance abuse, a range of treatment options including
residential and outpatient services, individual and group counseling, medication assisted treatment for opioid
dependent pregnant and non-pregnant women, OB/GYN and psychiatry services, assistance with finding employment, creating a
budget and managing finances, and help with creating healthy relationships and
healing from abuse and violence.
For children Horizons provided evaluation, treatment and referral to early
intervention services, and on-site child care. Additionally, Horizons offers family therapy, trauma-recovery programming, attachment-based parenting education and
guidance, individualized case management, and transportation to and from treatment services
The Substance Treatment and Referral Program (STAR): A program through the Gaston County Department of Healthy and Human Services. This program is targeted towards pregnant and parenting women and aims to deliver high -quality outpatient drug and alcohol services in a safe and familiar settings such as the DHHS maternity clinic. Provides screening and assessment, education, supportive counseling and treatment, and advocacy, while also referring patients to community agencies. Click here to read more.
Substance Use Disorders in Pregnancy-Community Team Initiative is working with CHIP staff to identify results and indicators to facilitate collective efforts to reduce substance use in Buncombe County.