Studies show babies of mothers who do not receive prenatal care are more susceptible to complications before or at birth. When an expecting mother suffers from substance abuse, the risk to newborns is compounded, and the need for prenatal care vital.
In spring 2016, Jordan Valley Community Health Center in Springfield, in partnership with Preferred Family Healthcare, received a grant to address this issue amid a rise in substance abuse among prenatal patients.
“My role in the process is to engage in early screening, brief intervention, and potentially referral for treatment for women who do come in for prenatal care but are at risk or currently using a substance of some sort during pregnancy,” says Chip Wolf, a behavioral health consultant with the project.
The Women’s Substance Abuse grant, run through Jordan Valley’s Women’s Health Department, covers any service not paid for by Medicaid or a patient’s insurance. The two year, $325,000 grant is distributed by the U.S. Department of Health and Human Services.
Since it was awarded, nearly 390 unique women have gone through the screening process.
Identifying Patients
Women initially complete a four-question screen that helps identify potential health effects that may occur during their pregnancy. Should that alert officials to any red flags, Wolf then prepares a second screen before proceeding with treatment options. He says it’s key that patients feel comfortable offering details about any alcohol or substance abuse. According to Wolf, women have been pretty forthcoming for the most part.
“The therapeutic alliance or the relationship really at that first session’s really pretty important,” he says. “So we do try to keep it pretty light, pretty focused, and really with the end result being that there’s kind of a sense of hope and possibilities of not only receiving help but really being supported through the pregnancy.”
The most common substance Wolf encounters is tobacco. While legal, treatment options are available for the unsafe practice.
“Then beyond that [tobacco], it’s kind of a mixture,” says Wolf, with screenings detecting illicit substances including opiates and methamphetamine.
Wolf says while there are active users he’s treated, others will seek help mainly because of the risk factors from their history of substance use. There’s also abusers, he’s learned, have recently stopped using when they found out they were pregnant.
“So it’s kind of a great time to intervene with them because there is more of a sense of vulnerability and openness to help because they are pregnant and they recognize this isn’t just about me.”
He’ll also perform a basic needs assessment to determine if the patient is in safe, permanent housing, has access to food, and support from family and friends.
Treatment
“Women who really are moderate or light users we might do some brief education with, we might do some follow up. But with our women who maybe are struggling more with a mental health side of things we spend much more time.”
Wolf notes that depression or anxiety can often come first, and as those mental health issues become more pronounced patients tend to self-medicate. So it’s the primary issue officials want to fix.
“Because as anxiety eases, depression eases, the need to maybe self-medicate begins to change. And so that’s really where we try to approach it.”
On average, each patient will undergo three treatment sessions.
There’s also medication assisted treatment, which deals with women struggling with opioid addiction.
“It, for lack of a better word, kind of blocks the nerve receptors, which calms the brain, which then lets us do treatment. So they’re not struggling with cravings and urges or ‘When do I get my next dose?’… They can really still their brain and let us come in.”
The medication is safe to use during pregnancy and even while the mother is breast feeding, says Wolf.
“Moms who continue to use and go to hospitals, baby ends up in NICU a week, two weeks to go through withdrawal. But with medication assisted treatment, often our experience so far it’s reduced NICU stays down to babies don’t even go to NICU.”
Reaching Those in Need
Wolf says healthcare officials work hard to reduce the stigma associated with substance abuse during pregnancy.
While they hope patients visit them within the first trimester, he says it’s not uncommon for women to seek care past 33 weeks into their pregnancy. But in general, Wolf sees patients between weeks 5 and 14.
He adds that some women will delay seeking treatment due to factors other than substance abuse.
“Frequently I have women who are not in safe, permanent housing. So I have a community support specialist who works alongside me as I take a list of those needs I engage that person to work directly with our patient to go out and work on things like food, clothing, shelter, support,” Wolf says.
He says they try and ease their anxiety so the patient can focus on their health and that of their baby.
Jordan Valley partners with several organizations in the region to spread the word on its program, and also can be a referral agency for women who seek treatment elsewhere. Additionally, it will reach out to substance abuse treatment groups.
No past or present patients of the program were willing to speak with KSMU for this story.
Trickle Down Health
The Jordan Valley grant, now in its second year of operation, comes as public perception on substance abuse is shifting. No longer is it predominantly considered a crime issue, but an issue of public health. For Wolf, the hospital can in part play a role in quelling not only one person’s addiction disease, but preventing the spread to others.
“We know one step out what populations this is impacting. So we’ve got the patient, but then we have the patient’s children. And maybe we have the patient’s children’s children. And so it really becomes a community issue of a huge scope.”
Wolf says educating these women on the severity of the issue starts early, through sharing statistics on what linkage drug use has with risks like premature birth, low birth weight and miscarriage.
Long-term Care
Wolf says some insurance only offers assistance 60 days after a child is born. But the grant allows the hospital to extend treatment well beyond that time period.
“Because we know that transition from having the baby to back at home and trying to get everything settled – that’s one of the high-risk times. Postpartum depression, which is a pretty common phenomenon with women in general, multiplied in intensity when you may be struggling with addiction or something like that,” says Wolf.
The Women’s Substance Abuse grant runs through February 2018. The clinic says it’s interested in re-submitting the grant application with a more narrow focus, but Wolf says there could be a way to sustain the program without grant assistance.
