Define, develop, refine, and increase access to the Dartmouth-Hitchcock Perinatal Addiction Treatment Program (PATP). Also, develop a 5-year plan for a sustainable continuum of care.
An urgent imperative to expand access to perinatal addiction treatment has been recognized in our service areas. This population is vastly underserved and growing in number as a result of the opioid crisis in New Hampshire among women of childbearing age.
Dartmouth-Hitchcock recognizes that population health improvements are achieved via a shared vision and aligned resources of the whole community: individuals, large health care systems, small organizations, and multi-disciplinary collaboratives, so this project engages an integrated approach of physical health, mental health, and substance use treatment.
This effort seeks to improve perinatal and infant outcomes of childbearing families through a focus on reducing long-term morbidity and mortality for both mother and child. (See CHaD Research Improves Outcomes, Lowers Costs for NAS Babies for more details.)
This project has three objectives:
- Optimize current services with evidence-based components of care, curriculum development, and team effectiveness.
- Improve access to comprehensive treatment for pregnant women who have substance use disorders by expanding capacity and capability of care teams.
- Develop a 5-year plan for a comprehensive continuum of care in the region.
Performance is demonstrated by both process and outcome measures at each phase of programming: pregnancy, birth, post-partum, family recovery, and childhood to age 5. Investigational cohorts include participants of PATP and non-participating childbearing women with substance use disorders (SUD) living in the defined service region.
- Childbearing women with opiate addiction and their babies
Process/systems being improved
- Integration of Psychiatry and Obstetrics (see Improving Access to Maternity Care for Women with Opioid Use Disorders: Colocation of Midwifery Services at an Addiction Treatment Program (PDF))
- Screening tools and practices
- Evidence-based addiction treatment
- Alignment with community resources on shared goals
Provider teams involved
- Population Health
- Maternal/Fetal Medicine
- Case Management
- Behavioral Health
Economics of care
- This project seeks to improve efficiency in the delivery of care to both mother and baby affected by substance use as well as impacting the overall population costs by decreasing incidence of infectious disease, rate of overdose, adverse childhood events, and burden on child protection services.
- Julia Frew, MD, is a practicing psychiatrist at Dartmouth-Hitchcock Medical Center, Lebanon NH, Assistant Professor of Psychiatry and Obstetrics and Gynecology at the Geisel School of Medicine, and serves as Associate Director of Residency Training.
- Daisy Goodman, CNM, DNP MPH is a practicing midwife at Dartmouth-Hitchcock Medical Center, Lebanon, NH, and a Clinical Assistant Professor of Obstetrics and Gynecology, and of Community and Family Medicine at Geisel School of Medicine. She teaches health care quality improvement methods at The Dartmouth Institute and leads a regional project to improve outcomes for pregnant women with opioid use disorders in addition to her role in the Perinatal Addiction Treatment Program. (See D-H Perinatal Addiction Treatment Program Receives Grant for more details.)
- Leslie DeMars
- Mary Kay Jankowski
- Christine Spring
- William Torrey
- Victoria Flanagan
- Steven Chapman
- Margaret Minnock
- Katrin Tchana
Learning and data
Both process and outcome data are being collected and tracked over time with focus on understanding the statewide rates of childbearing women with addiction disorders. Rates of screening, rates of treatment, and resulting impact on health outcomes of both mother and baby are being tracked.
- Guidelines for identification and management of substance use and substance use disorders in pregnancy (World Health Organization)
Neonatal Abstinence Syndrome (NAS)
- Neonatal Drug Withdrawal (PDF) (American Academy of Pediatrics)
Evidence based treatment
- Jones, H, Deppen, K, Hudak, M et al. Clinical care for opioid-using pregnancy and postpartum women: the role of obstetric providers. Am J Obstetrics and Gynecology 2014: 302-310.
- Wright, E, Terplan, M, Ondersma, S, et al. The role of screening, brief intervention, and referral to treatment in the perinatal period. Am J Obstetrics and Gynecology 2016: 539-547.
- Principles of Substance Abuse Prevention for Early Childhood (National Institute on Drug Abuse)
- New Hampshire Division for Children, Youth, and Families, reports and resources
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