By Amy Haddad
Associate Director, Government Affairs, AMCHP
By now, too many of us have personally experienced the toll of the opioid epidemic in our community, our family or our circle of friends. Seventy-eight Americans die every day from an opioid overdose and one infant is born with neonatal abstinence syndrome (NAS) every 25 minutes. Many Title V programs are on the frontlines of efforts within their states to prevent, monitor and address this crisis and we have asked three of them to share their experiences.
Tennessee – by Dr. Michael Warren, Assistant Commissioner, Division of Family Health and Wellness
In 2013, the Tennessee Department of Health made Neonatal Abstinence Syndrome (NAS) a reportable condition. Prior to that time, the Department obtained NAS incidence from hospital discharge data, but this data lagged 12-18 months behind, making program planning/evaluation difficult. The Department (led by Title V) created an online reporting system, allowing for real-time reporting of NAS cases. Surveillance reports are posted online weekly and can be found here. In addition to providing real-time estimates of NAS incidence, the reports also provide information on the exposure source, allowing for targeted efforts at prevention.
Tennessee also used Title V funds to support five mini-grants to academic and community partners to answer key questions related to addressing the NAS epidemic. The grants required a partnership between an academic institution and a community stakeholder and focused on five topic areas: optimal management of NAS infants and pregnant women, barriers to contraceptive use, provider knowledge/behavior, and risk models for identifying mothers most at risk for delivering a baby with NAS. Study summaries and final project reports can be found here.
New Hampshire – by David LaFlamme, State MCH Epidemiologist
The New Hampshire Perinatal Substance Exposure Task Force works to identify, clarify, and inform The Governor's Commission on Alcohol and Drug Abuse, Prevention, Treatment, and Recovery about issues related to perinatal substance exposure including: ways to lessen the barriers pregnant women face when seeking quality healthcare; aligning state policy and activities with best medical practices for perinatal women and their children; and increasing public awareness about the dangers of exposure to prescription and illicit drugs, alcohol and other substances during pregnancy.
The work of the task force over the past few years has included:
- Focus groups with pregnant or newly parenting women in treatment to inform our understanding of the barriers and enablers to successful recovery.
- A literature review to determine the current understanding of best practices for methadone dosing for medication assisted treatment in the population of pregnant and newly parenting women.
- Site visits to multiple Opioid Treatment Programs to determine their priorities when treating pregnant and newly parenting women and to develop an understanding of the ancillary services which are needed to help these women be successful in their attempt for recovery and successful parenting.
- Working closely with the March of Dimes and the Northern New England Perinatal Quality Improvement Network to assess need, and develop a model for wrap around services to meet the recovery needs of our population.
- Working to improve communications between obstetrics, pediatrics, and addiction medicine specialists so that women are receiving a unified message about how to best care for themselves and their babies.
- Actively working with Public Health, the Division of Children, Youth and Families, the New Hampshire Legislature, as well as representatives from the medical community to enhance communication around improving care in New Hampshire for these at risk families as it pertains to our state laws.
Massachusetts – by Debra Bercuvitz, Coordinator, Perinatal Substance Use Initiative
When Massachusetts conducted its recent five year needs assessment for the Title V Block Grant, perinatal substance use was identified as an emerging concern requiring response. Therefore, a priority was established to address substance use among women of reproductive age to improve individual and family functioning. Activities to meet this priority are dependent on strong collaborative relationships including with: other Massachusetts Department of Public Health Bureaus, e.g. the Bureau of Substance Abuse Services; statewide clinical quality improvement collaboratives, e.g. NeoQIC (Massachusetts Perinatal-Neonatal Quality Collaborative); and community partners e.g. birth hospitals, Early Intervention programs, and behavioral health treatment providers.
One current Title V initiative is a pilot, with funding assistance from the Bureau of Substance Abuse Services, to engage families of babies with Neonatal Abstinence Syndrome (NAS) in Early Intervention (EI) services. In Massachusetts, a NAS diagnosis conveys a year of automatic eligibility for EI. Typically, referrals to EI happen from a number of sources including birth hospitals and the Department of Children and Families (child welfare agency). There can be many barriers for families of babies with NAS to accept EI services including a desire to minimize service providers especially after the return home, and feelings of guilt and shame. Child welfare referrals can be interpreted as mandatory by families, even though EI is voluntary. Face-to-face services with families are not billable until appropriate paperwork has been completed. This short-term pilot will allow 17 EI programs to meet with families of babies with NAS in the hospital for a "getting to know each other" visit, free of any paperwork or intake process. The effort is based on a pilot initiated in 2015 by Barbara Prindle-Eaton of Cape Cod Child Development with Cape Cod Hospital. These EI programs will also be part of the hospital discharge planning process in the hospitals where that is not already occurring.
The Massachusetts Title V activities are geared towards decreasing the impact of opioid use on families with young children in the Commonwealth, but are also geared towards the longstanding challenges of other substances, including alcohol and tobacco. Another current Title V initiative, building on past and current federal funding, is to support the use of mothers in recovery as peer models to help pregnant women engage in treatment and other supportive services. A Learning Collaborative has been convened with monthly phone calls to unite the efforts of the sites across the state using this intervention strategy.