Home Visiting Hybrid for High Risk Moms- Calvert County Health Department (Calvert County FY 18 and beyond- Annual)

Story Behind the Curve

FY 22: The progarm continues to see a decrease in the number of moms who deliver babies with a negative toxicology screen for un-prescribed substances. In  FY22, there were 15 babies born to mothers participating in the program receiving Medicated Assisted Treatment for Opioid Use Disorder. Of the 15 babies born, 7 had a positive toxicology screen for unprescribed substances.  The most common positive toxicology screen was for marijuana.  Although this indicator is trending in the wrong direction, program staff do report a decrease in the amount of use and the frequency of use among particiapants. For example, participants report an overall reduction in marijuana use throughout their pregnancy. 

FY21: Several participants delivered out of the county and staff were uable to obtain a copy of the toxicology screen. In the future, Case Management staff will pursue releases of information to be able to get toxicology results on delivery. Additionally, several babies tested positive for Marijuana, not opiates or other un-prescribed substances. 

FY 20-21: The program is noticing an decrease in the number of moms who delivered babies with a negative toxicology screen for un-prescribed substances. Because the case numbers are low, it is difficult to say that this is a trend, as two or three births in either direction has a major impact in the percentages. For example, In HFY1, the percentage dropped to 82%, with 9 of 11 babies born free from un-prescribed substances. In the first half of FY21, 7 of 10 babies were born free from un-prescribed substances. The Health Department will continute to closely monitor changes and patterns. 

Partners

The program receives referrals from local medical providers. Providers are required to complete a Prenatal Risk Assessment (PRA) for pregnant woman with medical assistance and forward it to the Health Department within 10 days. Referrals to the program also come from the Department of Social Serivces, the Healthy Families Home Visiting Program, Calvert County Behavioral Health and other service providers. 

What Works

This program uses a three pronged approach to support high risk moms and thier infants: 1) Case management services to coordinate care for high risk mothers and their infants during pregnancy and after birth; 2) Clinical services with Behavioral Health Therapist, as well as, Medicated Assisted Treatment to address mental health and substance use needs; 3) Placement of Long Acting Reversible Contraceptives (LARC) to prevent unintended pregnancy. 

Action Plan

FY22: In an effort to address the increase in the number of babies born to program participants with a positive toxicology screen for un-prescribed substances, the program will implement a Contingency Management conponent. 

Pregnant and postpartum women who are introduced to contingency management are more likely to be willing and able to engage in substance use disorder treatment and reduce use of illicit drugs such as cocaine and heroin. Contingency Management is one of the most effective approaches to treating SUDs. Typically implemented in clinical settings, contingency management relies on “operant conditioning” or providing rewards to individuals based on their level of behavioral change. In the case of marijuana use, the behavioral change would be period of abstinence.

When implementing contingency management, the program will:

1. Arrange for regular testing to ensure that the individual is abstaining from substance use.

2. Provide agreed-upon and tangible rewards, such as vouchers, when the individual abstains.

3. Withhold the reward or incentive from the individual when substance use is detected.

4. Assist the individual in establishing alternate and healthier activities to replace the rewards derived from substance use.

Many programs use this practice during pregnancy to promote healthy prenatal behavior in women, such as reducing or quitting substance misuse. Contingency management has proven effective for helping pregnant women quit smoking. It is also effective for helping women in general abstain from cocaine, tobacco, and heroin.

Source: Substance Abuse and Mental Health Services Administration (SAMHSA). Preventing the Use of Marijuana: Focus on Women and Pregnancy. SAMHSA Publication No. PEP19-PL-Guide-2 Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2019.

Program Summary

The program provides high-risk pregnant and postpartum women with case management, by a registered nurse, to improve outcomes by assisting with early entry into prenatal care, coordination of services and follow-up care in the postpartum period. Case management includes linkages to obstetric providers, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), social services, dental care, health insurance enrollment, behavioral health services, and community resources. A licensed clinical therapist offers a weekly support group for participating mothers with Substance Use Disorders (SUD) at no cost. CCHD also coordinates a Medicated Assisted Treatment (MAT) clinic and offers Subutex for pregnant women with opioid dependency. Free Long Acting Reversible Contraceptives (LARC) are offered to program participants at no cost. CCFN funds awarded to CCHD are used to cover the cost of program supplies, such as LARC and infant supplies, including: Pack-N-Plays, Car Seat Assistance Program fees, and infant feeding supplies.

Target Population

The target population for this program are Pregnant women with a history of substance use and/or mental health issues that are single parents, low income and/or have a history of adverse childhood experiences.

Local Highlight

From FY18 through the first half of FY21, 69 babies were born to program participants receiving prental case management, of which 61 (88%) were delivered with a negative toxicology screen for un-prescribed substances. 

Data Discussion

FY21: Several participants delivered out of the county and staff were uable to obtain a copy of the toxicology screen. In the future, Case Management staff will pursue releases of information to be able to get toxicology results on delivery. Additionally, several babies tested positive for Marijuana, not opiates or other un-prescribed substances. 

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