By Attya Chaudhry
Senior Program Manager, Health Systems Transformation
Association of Maternal & Child Health Programs
The opioid crisis continues to appear in headlines across the U.S. The Centers for Disease Control and Prevention estimates that 91 Americans die every day from an opioid overdose. State Title V programs are witnessing first-hand the impact of this epidemic on women of reproductive age, infants, children, and families. The opioid epidemic has caught the attention of lawmakers at all levels of government, prompting various responses and calls to action. With limited resources and competing state priorities, it is imperative for state agencies, health care providers, substance abuse treatment centers, and other community partners to coordinate their responses to the crisis and leverage their efforts for greater impact.
Because the opioid crisis so intimately affects women, infants, youth and families, Title V programs have an important role to play as a partner, convener, and stakeholder. As importantly, Title V programs provide a unique maternal and child health (MCH) view of the epidemic, which focuses on prevention and intervention. The case studies highlighted below illustrate the leadership role of state MCH programs in responding to the opioid crisis through cross-sector partnerships.
Kentucky Title V participates in a workgroup to develop model hospital guidelines for treatment and services for infants with Neonatal Abstinence Syndrome (NAS) and their mothers. Activities include distributing a checklist for hospital discharge planning to assure a smooth transition to community services, identifying case managers for mothers and infants, and care coordination.
Since the passage of the federal Comprehensive Addiction and Recovery Act (CARA) in 2016, the New Hampshire MCH program has worked with partners, including the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery; the state Department of Health and Human Services Bureau of Drug and Alcohol Services; the state DHHS Division of Children, Youth, and Families; and hospitals and birth attendants to develop a safe plan of care for any infant affected by illicit drug use or NAS, as required by CARA.
New York Title V represents the Department of Health on an interagency opioid surveillance workgroup, an outgrowth of the Governor's Heroin Task Force. The workgroup monitors opioid overdose deaths in the state and regularly reports these deaths to counties. Furthermore, the workgroup has developed a comprehensive website for opioid-related data in New York. This database provides recent data and trends on opioid prevalence; health care utilization (emergency department visits and hospitalizations); NAS and opioid use; and mortality rates at the state, regional, and county levels.
Vermont Title V serves on the Care Alliance for Opioid Addiction, a statewide partnership of clinicians and treatment centers. The alliance has implemented the Children and Recovering Mothers Team (CHARM) initiative. Designated as a model program by the U.S. Substance Abuse and Mental Health Services Administration, the initiative uses a regional approach involving a multidisciplinary group of agencies serving women with opioid use disorders, and their families, from pregnancy through the first year of infancy. The team provides women and families with coordinated, comprehensive care from the child welfare, medical (including obstetrics and pediatrics), and substance use treatment systems. CHARM is based on a model of early and ongoing intervention that includes identification of substance use during pregnancy, engagement in prenatal care, medication-assisted treatment, counseling, and education for families on caring for infants with prenatal exposure to opioids.
West Virginia Title V is a founding member of the West Virginia Perinatal Partnership: a multiagency, state collaboration that seeks to improve the health of mothers and babies. The partnership's Substance Use During Pregnancy Committee developed an NAS toolkit, guidelines for substance screening and testing of pregnant patients at outpatient visits (antepartum and postpartum), and policy recommendations related to drug and alcohol use in pregnancy.
The strategies outlined above are included in an AMCHP issue brief, The Opioid Epidemic: Implications for MCH Populations. Although there is no single strategy to address this complex issue, MCH and Title V programs are demonstrating the importance of partnerships and a coordinated response to address this multifaceted problem.