June 14, 2021

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Grants expand postnatal care to substance-exposed newborns

SPRINGFIELD — Massachusetts has been among states to enact legislation and fund pilot programs to provide services to newborns exposed before birth to opioids and other substances and at risk for a form of withdrawal known as Neonatal Abstinence Syndrome.

Mercy Medical Center, part of Trinity Health Of New England, is among five hospitals in the commonwealth to receive Health Policy Commission grants totaling $1.4 million to target what is done after discharge to keep these babies safe and healthy as well as their caregivers.

In applying for the grant Mercy involved a working group under Dr. Robert Roose, its chief medical officer with a background in addiction services, to address what an award to it would fund – a model of care designed to coordinate data and follow-up services for such patients who deliver at Mercy’s Family Life Center for Maternity.

“Once the program is implemented the mother should feel a much more seamless experience and feel that her care is better coordinated, is facilitated and supported,” said Roose of the expected result from Mercy’s $300,000 grant. “Her care providers, if she has accepted care, will be more informed and in sync about what her needs are and what are the treatment and care plan for her and her newborn.”

Roose, who was part of Gov. Charlie Baker’s Opioid Addiction Working Group in 2015, called such coordination “key.”

“We will have the resources and abilities to initiate treatment to connect people to care and to coordinate that care both for the mother and the child,” Roose said. “The experience will be one that is really felt through follow-up phone calls through providers being aware of what changes in conditions and changes in care plan are for ongoing support of that first year post-delivery.”

Roose called Massachusetts a “leader in expanding access to care” that is evidence based for substance use disorders and investing in related programs and innovative models that meet the community’s need.

HPC has had a Mother and Infant-Focused Neonatal Abstinence Syndrome Investment Program since 2016. The current grants are from its newer Cost-Effective, Coordinated Care for Caregivers and Substance Exposed Newborns (C4SEN) Investment Program.

Earlier HPC funding, Roose noted, focused on prenatal and in-hospital care with some aftercare, while current funding concentrates on follow-up services and care that studies have shown as equally important to healthy outcomes.

“This is a grant that focused more on what happens after delivery over the first year of the newborn’s life and that year of postpartum period for the mother,” Roose said. “The impetus for investing in some new models is because this is really an important time in both people’s lives. With the right types of programs the rewards from them are felt not only by individuals but by others.”

The 1996 opening of the Family Life Center in a $6 million, 25,000-square-foot, stand-alone facility with 12 patient beds restored maternity services to Mercy after a 25-year absence.

Roose said it is among the first level 1 maternity centers in recent years to follow “best practices for women with substance use disorders, particularly those with opioid use disorder.”

Treatment for NAS may be therapeutic – keeping exposed babies in a darker, quieter environment and encouraging breastfeeding and bonding with mothers – and may also involve an opioid like morphine for a time, depending on an infant’s assessment score for withdrawal signs like vomiting and poor feeding.

“Mercy stood out for having practices that supported the mother rooming in with their infant after delivery, providing breast-feeding support and encouragement for women which we know both of those things in combination support healthier outcomes for the mother-baby dyad,” Roose said.

“The pediatricians who are onsite 24/7 are also experienced in treating the Neonatal Abstinence Syndrome and have protocols to manage that when that does occur for the newborns.”

He added that it has been part of “our culture and routine work at the Family Life Center to be a welcoming environment for the newborns and their mothers who have struggled with opioid use disorder or who are on Medication Assisted Treatment for opioid use disorder.”

Maternal opioid-substitution programs are said to help pregnant women maintain prenatal care, and better manage their disorder than trying to withdraw from opioids and possibly exposing the fetus to repeated periods of withdrawal. Buprenorphine and methadone are two drugs that are considered “safe and effective treatments for opioid use disorder during pregnancy,” according to the National Institute on Drug Abuse.

Roose said mothers who are on methadone can be given it “onsite while they are admitted.”

“If someone needs new services, we have an addiction medicine consultation service for which we have addiction medicine physicians and providers who will assess the need and initiate treatment and connect people to care and that has been in place for three years,” Roose said.

He said babies born dependent can be treated with medication and if their needs exceed that of Mercy’s level one nursery the newborns are transferred to Baystate Children’s Hospital which has a level 3 neonatal intensive care unit.

Prenatal exposure can result in infants needing for a period of time pharmacological treatment for opioid withdrawal shortly after birth.

Current state data indicates and that 13.8 infants per 1,000 births are diagnosed with NAS and that the largest number are born to white women aged 25 to 29.

The committee formed at Mercy around the HCP grant application included leadership staff from the Family Life Center, Mercy’s inpatient addiction consultant service, Brightside for Families and Children, which provides in-home behavioral health services for families that have children with behavioral health needs, Trinity’s out-patient pediatric medical groups, and leadership from substance use disorder treatment programs that are now operated by MiraVista Behavioral Health Center in Holyoke.

“The intent of pulling together this steering committee was to assess current resources, where any gaps might be and the opportunity that was presented to us to apply for funding to better enhance and expand the services we provide for this at-risk population,” Roose said.

“There is an important dynamic that can result in a woman struggling with substance use disorder upon recognizing that she is pregnant and that shift can often be something that stimulates a strong interest and desire for recovery and engagement in treatment. It can be highly motivating factor for many women.”

He added, “It is essential that women have the ready access to the support and connection that they need and unfortunately the system speaking broadly has not been well coordinated with the substance use disorder system often very separate and fragmented from prenatal care or maternity care which is often separate and fragmented from pediatric care and that is just three different areas.”

“Oftentimes people need additional social services or peer recovery support or transportation or housing assistance and navigating all of that with systems not well-stitched together can create challenges and ultimately have consequences,” Roose said.

“The flip side to that is if you can help coordinate, if you can communicate and there can be a team wrapping around someone, then you can have a real positive impact on not only the mother but potentially generations. What happens with children early in life is often an imprint or very influential in what will shape the rest of their life. We know that to be very true. Even what happens during pregnancy can often influence and shape the rest of someone’s life.”

Roose praised HPC grants for being “oriented toward testing and piloting innovation and gathering data evaluation of the programs and if found effective, stimulating further investment for the more widespread dissemination of those programs.”

“This is the exciting part,” Roose said. “Oftentimes these are relatively small investments that determine what the best practices may be and then they result in widespread policy change to support those models impacting the population on a statewide or broader scale.”

The current HPC grants were awarded to hospitals in support of their substance-exposed newborn programs over a 21-month implementation program.

Awardees and their funding amounts include Baystate Franklin Medical Center in Greenfield, $299,993; Berkshire Medical Center in Pittsfield, $300,000; Mercy Medical Center in Springfield, $299,978; Southcoast Hospitals of New Bedford, $287,541; and South Shore Hospital iN Weymouth, $274,030.

Baystate was first recipients of an HPC investment grant for addressing these population’s needs. Its Engaging Mothers for Positive Outcomes with Early Referrals (EMPOWER) program is based out of both its Springfield campus, as well as Baystate Franklin in Greenfield.

The Moms Do Care EMPOWER Program at Franklin, the recipient of the current grant that was applied for by Dr. Marcia VanVleet, a neonatal specialist, provides care to between 30 to 40 clients every year in Franklin County, and can also enroll mothers who are postpartum with children up to 3 years.

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