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Drug Free Moms and Babies Project

Drug Free Moms and Babies Project. Growing to Meet the Needs of West Virginia Moms. Christa Lilly, Ph.D. Assistant Professor WVU School of Public Health Dept. Biostatistics Quantitative Evaluator. Learning Objectives.

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Drug Free Moms and Babies Project

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  1. Drug Free Moms and Babies Project Growing to Meet the Needs of West Virginia Moms Christa Lilly, Ph.D. Assistant Professor WVU School of Public Health Dept. Biostatistics Quantitative Evaluator

  2. Learning Objectives • Describe the demographics of Drug Free Moms and Babies program participants. • Compare data from original study with more recent information about program participants. • Discuss outcome data of program participants.

  3. Presenter Disclosures • No relationships to disclose

  4. Pilot Data • Just presented at APHA 2018

  5. WV has the highest age-adjusted drug overdose death rate in the nation1,2 • Impacts pregnancy3 • 20% infants born in WV antenatally exposed to licit/illicit substances4 • Many barriers to care: stigma, transportation, housing, coordination of care to other tx5

  6. A Public Health Solution? • Siloed agencies6 – everyone wants to help, but how? • Influx of federal and state $ • Naloxone availability, Medicaid expansion • Use Pay For Success6 principles to bring everyone to the table, e.g., • Target program across multiple agencies • Supporting solutions through the cross-agency context • Empowering outcomes orientation for providers (not just # of patients) • Contributing to the evidence base

  7. Drug-Free Moms and Babies To develop, evaluate, document, and replicate programs that support healthy baby outcomes by providing: • prevention, • early intervention, treatment, • and recovery services for pregnant and postpartum women with substance use disorders.

  8. DFMB Design Overview Bringing new components to existing infrastructure • Integrated Behavioral Health and Maternity Care • Team-driven (multidisciplinary) • Population-focused (pregnant and post-partum women) • Measurement-guided (systematic, appropriate tools to guide tx) • Evidence-based tx • SBIRT (Screening, Brief Intervention, Referral to Tx) • Long-Term Follow-Up • Work with local and statewide initiatives

  9. Lessons Learned • Takes more time than anticipated • Assembling and integrating existing infrastructure • Integration made a big difference: “Before I felt like we didn’t have a really good system to help the moms who were addicted or having problems, and now I feel like we have a system that actually addresses the problem. In the past, we hardly ever knew about these addicted women until they hit the unit at delivery. It was worse to deal with the fall out than it is to address the problem up front.”-Site 1 Staff • A dedicated staff position is critical • Provide extensive monitoring, coordination “One patient came to us by word-of-mouth. She had been incarcerated, was pregnant, and CPS was involved in her life. She was taking several drugs, including benzos, Subutex, and roxies. We sent her to Pregnancy Connections and she joined the program immediately. She had a difficult pregnancy with bed rest and preterm labor. But she is now clean and has all of her kids. Pregnancy Connections helped her with transportation and connected her to Patchwork to work on her GED. She has a relationship with her mother now and her legal issues are clearing up. She is a real success story.”-Site 3 Staff

  10. Lessons Learned • Collaborative tx team needed to be developed, nurtured, and maintained “I believe the most important part of the role of the Recovery Coach is not to have the experience with babies or pregnancy, but to have the common ground of addiction. This helps participants know that recovery is possible. I know a lot of the ‘tricks’ they use to avoid problems and can break down defenses easier than someone without a recovery experience.” -Site 2 Recovery Coach • Barriers to tx had to be addressed “One woman came to therapy, was doing what she needed to do, and was consistently starting to have negative drug screens. Once she had her baby, she stopped seeing me. I was worried she went back to using after the baby was born. Then one day at the store, she saw me and said, ‘You saved my life.’ She told me how she stopped seeing the guy she was seeing, was still going to NA meetings, and was making some positive changes in her life. And I thought to myself—wow. I didn’t know how much this really impacted her.”-Site 1 Staff

  11. Expansion efforts • Pilot sites continuing in expansion: • Greenbrier Physicians • Thomas Memorial Hospital • WVU Medicine • New sites added: • Weirton • CAMC • Davis • Tug River • Valley Health • Wheeling • Marshall • Others…

  12. Participants • Expansion Data: entered between 1/1/2018-10/18/2018 • 421 Entries from 10 Sites • 16 Readmissions • 405 Unduplicated • More postpartum participants • Pilot Data: 2012-2018 • 597 Entries from 4 Sites • 47 Readmissions • 550 Unduplicated

  13. Expansion - Participants Regional representation consistent with site locations (N=316) • N=126 (40%) • N=1 (0%) • N=4 (1%) • N=34 (11%) • N=102 (32%) • N=49 (15%) • Out of state N=107 (mostly OH) 1 2 4 3 5 6

  14. Demographics Expansion (N=376) • Race/Ethnicityconsistent with Appalachian demographics(87.3% White) • Maternal Age: 26.5 (Range 16-41) • Number in Household: 3.3 (Range 1-8) • Number of Living Children: 1.9 (Range 0-8) • Marital Status: • Never married: 71.9% • Married: 16.6% • Other: 11.5% • Cohabitation (for those not married): Yes: 56.2% • Planned Pregnancy: 18% Pilot sites (N=550) • Race/Ethnicity consistent with Appalachian demographics (93.1% White) • Maternal Age: 26.3 (Range 16-43) • Number in Household: 3.1 (Range 1-8) • Number of Living Children: 1.9 (Range 0-8) • Marital Status: • Never married: 68.7% • Married: 17.8% • Other: 13.5% • Cohabitation (for those not married): Yes: 59.6% • Planned Pregnancy: 14%

  15. Expansion • Housing: • Living in a permanent residence: 71% • Living with friends/family: 23% • Living in temporary housing: 2% • Residing in shelter: 1% • Homeless: 2% • Employment: • Not employed: 66.5% • Part-time: 11.5% • Full-time: 22%

  16. Demographics Expansion: Education • No HS degree: 21% • HS degree/GED: 46% Income • <$15k: 61% Insurance • Medicaid: 92% Intention to Breastfeed • 50% Pilot: Education • No HS degree: 33% • HS degree/GED: 51% Income • <$15k: 67.9% Insurance • Medicaid: 92.8% Intention to Breastfeed (Outcome) • 63%

  17. Substance Use Expansion Pilot Alcohol: 11.7% Tobacco: 79.1% Cannabis: 54% Stimulant: 16.2% Hallucinogens: <1% Opioids (non-prescribed): 64.6% • Alcohol: 11.5% • Tobacco: 77% • Cannabis: 65% • Stimulant: 22% • Hallucinogens: <1% • Opioids (non-prescribed): 34% • Depressants: 7%

  18. Care and Treatment Expansion Enrolled in Treatment (N=127) • Drugs (100%) • Alcohol (0%) • Both (0%) Treatment Types (can be more than one) • MAT: N=118 • Counseling: N=59 • Intensive Outpatient: N=5 • Brief Intervention: N=19 Pilot Enrolled in Treatment (N=494) • Drugs (95.6%) • Alcohol (1.6%) • Both (2.8%) Treatment Types (can be more than one) • MAT: 290 (52.7%) • Counseling: 303 (55.1%) • Intensive Outpatient: 62 (11.3%) • Brief Intervention: 373 (67.8%)

  19. Pilot • For program completers (N=393) Outcomes

  20. Summary: Demographics • DFMB Program is continuing to reach high-risk, medically-underserved women, including high percentages of: • Low education • Low income • Medicaid insurance • Unplanned pregnancies

  21. Summary: Outcomes • Positive urine drug screens decreased from 80% at first trimester to 29% at delivery, consistent with pilot sites • Other outcome results still forthcoming

  22. Thanks to the DFMB Eval Team!

  23. References 1Hedegaard H, Warner M, Minino AM. Drug Overdose Deaths in the United States, 1999-2015. NCHS Data Brief. 2017(273):1-8. 2 Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. Trends and Patterns of Geographic Variation in Mortality From Substance Use Disorders and Intentional Injuries Among US Counties, 1980-2014. JAMA. 2018;319(10):1013–1023. 3Center for Behavioral Health Statistics and Quality. 2016 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD. 2017. 4Stitely ML, Calhoun B, Maxwell S, Nerhood R, Chaffin D. Prevalence of drug use in pregnant West Virginia patients. W V Med J. 2010;106(4 Spec No):48-52. 5Sigmon SC. Access to treatment for opioid dependence in rural America: challenges and future directions. JAMA Psychiatry. 2014;71(4):359-360. 6 McClure D, Mitra-Majumdar M, Fass J. Rethinking the Opioid Crisis: Using Seven Pay for Success Principles to Better Understand and Address the Crisis. Urban Institute;2018.

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