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. Author manuscript; available in PMC: 2019 Jan 1.
Published in final edited form as: J Addict Med. 2018 Jan-Feb;12(1):72–79. doi: 10.1097/ADM.0000000000000370

Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot study

Gerald Cochran 1, Valerie Hruschak 2, Walitta Abdullah 3, Elizabeth Krans 4, Antoine B Douaihy 5, Stephanie Bobby 6, Rachel Fusco 7, Ralph Tarter 8
PMCID: PMC5786468  NIHMSID: NIHMS915973  PMID: 29140822

Abstract

Objectives

The public health burden of opioid use disorder (OUD) among pregnant women has significantly increased in recent years. The Optimizing Pregnancy Treatment Interventions for Moms study was a pilot project that examined the feasibility of a patient navigation (PN) intervention model to reduce substance use and improve mental health, quality of life, and to increase engagement with treatment services among pregnant women with OUD.

Methods

A one-group repeated measures pilot study was conducted with treatment seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment. Participants received the patient navigation (PN) intervention delivered as 10 sessions prior to delivery and 4 sessions postpartum. Participants completed assessments at baseline and following the prenatal and postnatal portions of the intervention. Demographics were assessed using descriptive statistics, and general estimating equation analyses were employed to examine changes in health and service engagement across time.

Results

A total of 21 women were enrolled and completed the PN intervention and follow up assessments. Participants reported improvements in abstinence from illicit opioids (B=0.15, 95% CI=0.1–0.2), drug use (OR=5.25, 95% CI=2.1–13.0), and depression (OR=7.70, 95% CI=2.4–25.1). Results also showed non-significant trends suggesting enhancements in general health (B=0.17, p=0.06, 95% CI= 0.0–0.3) and increases in substance use treatment attendance (B=2.15, p=0.07, 95% CI= −0.2–4.5). Most study participants achieved adequate or better prenatal care.

Conclusions

These findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among treatment seeking pregnant women with opioid dependence initiating buprenorphine.

Keywords: Opioid use disorder, pregnancy, patient navigation, buprenorphine

Introduction

The current public health burden of opioid use in pregnancy has dramatically increased in recent years (Patrick et al., 2012). Across the US, neonatal abstinence syndrome (NAS), a drug withdrawal syndrome in infants following chronic in-utero opioid exposure, increased approximately 300% from 1999 to 2013 (Ko et al., 2016). From 2000 to 2009, total hospital costs for NAS increased from $190 million to $720 million (Patrick et al., 2012). Additional consequences of opioid use disorders (OUD) among pregnant women include pre-term delivery and low birth weight. Women with OUD have also been observed to have lower rates of breastfeeding (McQueen et al., 2011; ACOG, 2012; Jones et al., 2012; Shainker et al. 2012) and high rates of psychiatric (Cavanaugh et al., 2010; Unger et al., 2012) and other substance use disorders (Chisolm et al., 2011; Lacroix et al., 2011; Ordean et al., 2013). Nevertheless, OUD among pregnant women is a treatable chronic health condition (NIDA, 2010), especially when women receive comprehensive care to address the complexity of health issues they face.

The standard of care for pregnant women with opioid dependence is to initiate medication for addiction treatment with methadone or buprenorphine (Minozzi et al., 2013) in combination with adjunctive counseling and psychosocial services (Amato et al., 2011a, 2011b). Clinicians and researchers have developed and examined a number of complementary psychological and behavioral interventions for pregnant women with opioid dependence, which have helped facilitate comprehensive care for this population. Yet, results from previous studies have not been clear regarding which behavioral interventions are most effectively paired with agonist therapy (Bickel et al., 1997; Jones et al., 2000; Brigham et al., 2010; Jones et al., 2011; Hutchinson, et al., 2012; Tuten et al., 2012; Ordean et al., 2013).

Comprehensive opioid dependence treatment programs proactively engage patients and promote self-management, treatment adherence, and the uptake of community resources (Tsai et al., 2005; Coleman et al., 2009; Amato et al., 2011a, 2011b; de Bruin et al., 2012; Thota et al., 2012; Improving Chronic Care, 2014). Patient navigation (PN) is a health care model designed to manage patients with chronic conditions and has shown to improve quality of care and overall patient outcomes (Tsai et al., 2005; Coleman et al., 2009; de Bruin et al., 2012; Thota et al., 2012; Sarango et al., 2017). PN was first developed and implemented in 1990 by Dr. Harold Freeman (Freeman & Rodriguez, 2011) and focuses on helping patients engage in care and overcome barriers to continued adherence. Since this model was introduced, PN has been tested and utilized for more than 25 years with patients who have chronic diseases such as breast cancer, HIV, palliative care, and behavioral/mental health disorders (McDonald et al., 2007; Robinson-White et al., 2010; Freeman & Rodriguez, 2011; Parker & Lemak, 2011). To our knowledge, PN has not been utilized with pregnant women with opioid dependence. The Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom) study was a pilot project that tested the hypotheses that a PN intervention for pregnant women with opioid dependence seeking treatment would be: (1) feasible and (2) result in reductions for substance use, improvements in mental health and quality of life, and increases in engagement with treatment services.

Methods

Participants

A one-group repeated measures study was conducted in which we recruited treatment seeking pregnant women with opioid dependence initiating buprenorphine maintenance treatment at the UPMC Magee-Women’s Hospital Pregnancy Recovery Center (PRC) from May 12, 2015 to December 19, 2016. The PRC outpatient clinic is an office-based buprenorphine (mono product) treatment program that offers prenatal care, case management, and behavioral health counseling referrals. Potential study participants, identified by the PRC nurse (who was familiar with the study inclusion/exclusion criteria), were referred to the study for eligibility assessment.

Patients were referred to the study for recruitment within ≤2 weeks of buprenorphine induction at the clinic. At the PRC, buprenorphine induction and maintenance dosing is individualized for each patient with doses titrated to mitigate signs and symptoms of opioid withdrawal assessed by the Clinical Opioid Withdrawal Scale (Wesson & Ling, 2003). Buprenorphine doses range from 4 mg daily to 24 mg daily among PRC patients. Patients who expressed interest in participating in the study underwent written consent and screening (i.e., patients were only screened after providing full consent given their referral from the study nurse who was familiar with the study; this was done to reduce burden on patients of having to provide a screening consent and then subsequent consent to participate; Figure 1). Participants were required to be ≥18 years of age, speak English, and have a diagnosis of opioid dependence according to the Diagnostic Statistical Manual (DSM) Checklist (Hudziak et al., 1993), which was verified by medical record review and urine toxicology. Pregnancy status was confirmed by last menstrual period and ultrasound. Women were excluded from participation if they intended to terminate their pregnancy or if they had a psychotic, major depressive, or manic episode in the last 90 days as documented in their medical record. We elected to exclude potential participants with these mental health conditions out of concern for potential challenges for maintaining contact with them through the duration of the project. Women with a gestational age greater than 25 weeks were also excluded because the prenatal portion of the intervention required approximately 14 weeks to deliver (see intervention section below).

Figure 1.

Figure 1

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Study consort chart

Given the very small study budget, a project coordinator administered assessments and provided navigation services. The coordinator was a masters-level research clinician with more than 14 years of experience and training in clinical research and survey administration. The coordinator also had been licensed as a Certified Alcohol and Drug Counselor for 20 years. Assessments were interviewer administered through an iPad tablet and on paper. In total, assessments lasted 30–45 minutes. Assessments were completed in a private room at the PRC, in other private locations convenient to patients (homes), or over the phone. Participants were explicitly instructed that their responses to the questionnaires would have no effect on their status in the project, compensation, or services. Women received $25 for the baseline assessment, $50 for assessment following the prenatal portion of the intervention, and $75 for assessment following the postnatal portion of the intervention. A completion bonus of $50 was given to those who completed all 3 assessments. Participants were given $10 compensation to offset travel costs for each session. This study was approved by the University of Pittsburgh Institutional Review Board.

Intervention

The intervention model in this project was adapted from a study that delivered PN to HIV infected patients with substance use (Metsch et al., 2016). The PN intervention utilizes principles of strength-based case management and motivational interviewing to help connect women to medical care and psychosocial services. PN achieves this by providing information, support, and linkages while offering ongoing follow up and empowerment to overcome barriers and obstacles to work towards long-term success. PN training included 24 hours of didactic and experiential education in patient navigation, which included conceptual information and skills building in the PN model, strength-based case management, and motivational interviewing (Metsch et al., 2016).

The prenatal portion of the intervention consisted of 10 individual sessions with the navigator and was delivered within approximately 14 weeks. Within the sessions, the navigator addressed substantive topics including health care, substance use treatment, and psychosocial services. The navigator helped participants identify/establish individual goals, locate care providers/professionals, prepare to meet with health care providers/professionals, and identify and resolve barriers to engaging in care. For instance, preparation sessions involved the navigator and participant together identifying and writing down topics and questions on notecards she wished to discuss with the care professional. Following these preparation sessions, participants could request the navigator to attend their appointments with them. Upon completing appointments, the navigator focused on debriefing health and psychosocial visits to discuss and overcome challenges or barriers to continued care engagement. For instance, if the participant believed the care professional did not understand her needs, the navigator could help identify what the issue may have been and strategize how to follow up. One prenatal session was devoted to the delivery of HIV and hepatitis C virus (HCV) risk prevention education. Women who completed the intervention before delivery received monthly phone calls from the navigator who encouraged abstinence and treatment adherence. The postnatal portion of the intervention was delivered following birth as 4 sessions over 8 weeks. As with prenatal sessions, postnatal sessions involved the navigator aiding the participant to develop goals, obtain care, and resolve barriers to postpartum treatment adherence as well as obtain psychosocial services, health care, and resources for her baby. A brief checklist was used to evaluate audio recorded sessions intermittently.

Patients who experienced drug use relapse or elected to receive care elsewhere were discharged early from the PRC. In our study, 8 women of the 21 were discharged early (38%), 6 (28.5%) for episodes of relapse and 2 (9.5%) electing to receive care elsewhere. With participants who discharged early, the navigator assisted them to locate, enroll, and remain engaged in buprenorphine maintenance, prenatal care, and other psychosocial services. One participant who was discharged early elected to transition from buprenorphine to methadone—all others remained on buprenorphine.

Measures

Opioid use from 30 days prior to PRC admission until the final assessment was measured by the Timeline Follow Back, a measure that has reliability and content, criterion, and construct validity (Sobell & Sobell, 1992; Sobell et al., 1992). The Drug Abuse Screening Test (DAST) was used to assess substance use severity at baseline, and the first item of the DAST was used to capture any drug use, including opioids, across the span of the study. The DAST is a reliable instrument with demonstrated criterion, construct, and discriminant validity (Skinner et al., 2007). We also used the lifetime and past 30 day heroin use variables from the Risk Behavior Assessment to capture heroin use behaviors, which measure has strong face/content validity and test-retest reliability (Needle et al., 1995). Physical health function was captured by the Short Form-12 (SF-12), which is reliable and has construct validity (Ware Jr. et al., 1996; Ware et al., 2008). Two single-item subscales within this measure asked patients to indicate their level of general health (1=poor, 2=fair, 3=good, 4=very good, 5=excellent) and pain that interfered with work in or out of the home (5=none of the time, 4=a little bit of the time, 3=some of the time, 2=most of the time, 1=all of the time). The Patient Health Questionnaire (PHQ), an 11-item criterion valid and reliable mental health assessment (Spitzer et al., 1999; Spitzer et al., 2000; Hides et al., 2007; Smith et al., 2007), was employed to capture depression and anxiety (Reinert & Allen, 2007).

We also assessed patients for engagement in substance use counseling using the Treatment Services Review (TSR)-6. The TSR has demonstrated reliability and is criterion and construct valid (McLellan et al., 1992; McLellan et al., 1998; McLellan et al., 1999; Allen & Wilson, 2003). The Adequacy of Prenatal Care Utilization (APNCU) Index was also applied with each of the women in the study. The APNCU uses the data of when prenatal care was initiated and the number of prenatal visits until delivery to calculate a ratio of observed to expected visits, which is classified into four categories: inadequate (received less than 50% of expected visits), intermediate (50%–79%), adequate (80%–109%), and adequate Plus (110% or more). The APNCU does not measure the quality of prenatal care and depends on the accuracy of the patient or health care provider's recall of the timing of the first visit and the number of subsequent visits. Finally, we assessed social support of participants using the Material Social Support Index (MSSI), a test-retest reliable and criterion valid instrument (Pascoe & French, 1990) that provides a 0–39 support score (higher values corresponding to higher social support).

Study feasibility was defined as whether the PN intervention could be successfully implemented in a Western Pennsylvania outpatient buprenorphine clinic offering prenatal care and psychosocial services. Feasibility also included whether this study could be implemented within the project budget and the 2 year funding period (Rajadhyaksha, 2010).

Analyses

Demographic and health characteristics were assessed using descriptive statistics. To examine changes in health characteristics across time, we developed general estimating equation (GEE) models for individual outcomes with time as the independent variable. For continuous indicators, we employed the Gaussian distribution, and for the dichotomous outcomes binomial. We employed the autoregressive residuals (AR1) structure to account for repeated observations across time. All models were adjusted for number of sessions participants attended and whether participants received an early discharge from the PRC clinic. We tested for a time by early discharge interaction in our GEE analyses in order to assess whether patients who discharged early from the PRC had differing responses to the PN intervention. Data were analyzed using Stata SE 14.1.38

Results

Demographics

Figure 1 displays the total number of patients seen at the PRC over the study period, the number of patients referred to the study and consented, the numbers of participants who did not continue in the study, and the number of patients who completed the study. A total of 25 patients were consented, and 4 patients did not continue in the study: 1 participant was withdrawn after completion of the post-consent screening given she did not qualify on the DSM Checklist. Two participants experienced miscarriages (these women were provided with the necessary support and resources when discontinuing the study). One participant was withdrawn after the fifth session as she was no longer reachable. Thus, 21 participants in total completed the study. Table 1 displays participant demographics of these women who participated in, and completed the study. The average age of the women was 29.7 years (standard deviation [SD]= 5.77); 95% were White (n=20); 81% (n=17) possessed a ≤high school education, and 62% (n=13) were employed. The average number of other children among participants was 1 (SD=1.27).

Table 1.

Baseline participant characteristics by discharge status

Total
(N=21)		 Early
Discharge
(n=8)		 No Early
Discharge
(n=13)
Demographics % (n)
  Agea 29.7 (5.7) 27.3 (5.3) 31.2 (5.6)
  High school or less 62 (13) 87.5 (7) 46.2 (6)
  Unemployed 80.1 (17) 87.5 (7) 76.9 (10)
  White 95 (20) 87.5 (7) 100 (13)
  Number of childrena 1.3 (1.2) 1.5 (1.7) 1.2 (1)
Behavioral and mental health
  At risk drinking 4.8 (1) 0 (0) 7.7 (1)
  ≥Moderate nicotine dependence 38.1 (8) 37.5 (3) 38.5 (5)
  Depressionb 57.1 (12) 87.5 (7) 38.5 (5)
  Anxiety 19.1 (4) 37.5 (3) 7.7 (1)
  Days outpatient SUD treatment in last 28a 1 (1.7) 0 (0) 1.1 (2)
  Drug abuse severity scorea 7.1 (1.9) 7.9 (1.2) 6.6 (2.1)
  Lifetime heroin use 85.7 (18) 100 (8) 76.9 (10)
  Heroin use in 30 days before enrollment 52.3 (11) 75 (6) 35.5 (5)
  Injection heroin use in 30 days before enrollment 38.1 (8) 50 (4) 30.1 (4)
Physical health
  Paina 3.9 (1.5) 3.6 (1.5) 4 (1.6)
  General healtha 2.8 (0.6) 2.6 (0.7) 2.8 (0.6)
Maternal social supporta 12.8 (6.6) 13.8 (4.9) 12.2 (7.6)
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a

Mean (SD).

b

Depression p=0.03, all other baseline differences p>0.05.

Baseline Health

There were no significant differences for participant characteristics based on early discharge status from the PRC, with the exception that a larger portion of the women discharged early screened positive for depression at baseline (87.5% [n=7] vs. 38.5% [n=5], p=0.03). Overall, 19% (n=4) scored positive for anxiety, and the mean number of days in SUD treatment in the 28 days before consent was 1 (SD=1.65). Average substance abuse severity was 7.1 (SD=1.9), indicating substantial substance use issues. Most women had used heroin in their lifetime (85.7%, n=18), and approximately half (52.3%, n=11) had used it in the 30 days before enrollment, with 38.1% (n=8) injecting. For physical health, participants reported that pain, on average, impacted their work in or out of the home “little of the time” (Mean [M]=3.9, SD=1.53), and their general health, on average, was good (M=2.8, SD=0.62).

Health Improvements

In terms of health improvements across the intervention, study participants reported increases in unadjusted abstinence for illicit opioid use (Figure 2), beginning the study with just over one-half of days abstinent in the past 30 (early discharge: 61%, SD=13.5, no early discharge: 68%, SD=13) and increasing to more than 90 percent at the prenatal (early discharge: 91%, SD=12.1, no early discharge: 100%, SD=0.01) and postnatal follow ups (early discharge: 95%, SD=0.02, no early discharge: 96%, SD=0.01).

Figure 2.

Figure 2

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Unadjusted illicit opioid use average percent days abstinent

In terms of improvements examined with the GEE analyses adjusted for number treatment sessions attended and early discharge status (Table 2), significant time effects showed increases for percent days abstinent (B=0.15, 95% CI=0.1–0.2) and improvements in any drug use ([opioid or any other drug] OR=7.62,95%CI= (2.8–21.0) and depression (OR=7.70, 95% CI=2.4–25.1). Results also showed non-significant increases in substance use treatment attendance (B=2.15, p=0.07, 95% CI= −0.2–4.5) and overall health quality (B=0.17, p=0.06, 95% CI= 0.0–0.3). Interactions for time and early discharge status were not significant for any outcome (p>0.05).

Table 2.

Time effects of repeated measures analysis of outcomesa

Outcome Bb SEc pd 95% CIe
Opioid percent days abstinent 0.15 0.02 0.00 (0.1–0.2)
Substance use treatment 2.15 1.20 0.07 (−0.2–4.5)
Maternal social support 0.43 0.81 0.60 (−1.2–2.0)
General health 0.17 0.09 0.06 (0.0–0.3)
ORf SE p 95% CI
Any drug use (including opioids)g 7.62 3.9 0.00 (2.8–21.0)
Depressionh 7.70 4.64 0.00 (2.4–25.1)
Anxietyi 1.71 0.92 0.32 (0.6–4.9)
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a

Models adjusted for total number of sessions and early discharge from medical home.

b

B=beta.

c

SE=standard error.

d

p= probability-value.

e

95% CI= 95% confidence interval.

f

OR= odds ratio.

g

Coded: no drug use =1, any drug use=0.

h

Coded: no depression=1, depression=0.

i

Coded: no anxiety=1, anxiety=0.

Adequacy of Prenatal Health Care

Table 3 depicts the scores of the participants’ prenatal care calculations. Among non-early discharge participants, 5% (n=1) received adequate plus prenatal care (110% or more of expected visits), 46% (n=6) adequate (80–109%), 15% (n=2) intermediate (50–79%), and 31% (n=4) inadequate (<50%). Among early discharge participants, 37% (n=3) had adequate of prenatal care, 25% (n=2) had intermediate level of care, and 25% (n=2) had inadequate level of care. We did not have access to prenatal care information for 1 participant with an early discharge. For the participants with inadequate utilization, 2 of the 6 participants met standards for adequate utilization but started their visits too late (after 4 months) and therefore were classified as inadequate.

Table 3.

Prenatal care index calculations (N=21)

Level of care Total
% (n)		 Early
discharge
38% (n=8)		 No early
discharge
62% (n=13)
Adequate Plus (>110%) 5 (1) 0 (0) 1 (1)
Adequate (80% – 109%) 43 (9) 37 (3) 46 (6)
Intermediate (50% – 79%) 19 (4) 25 (2) 15 (2)
Inadequate (less than 50%)a 28 (6) 25 (2) 31 (4)
Information Not Available 5 (1) 13 (1) 0 (0)
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a

2 participants (1 early discharge and 1 no early discharge) met standards for adequate but started visits too late (after 4 months) therefore were classified as inadequate.

Discussion

A total of 21 treatment seeking participants were recruited into this pilot study and completed the PN intervention along with the 3 corresponding assessments. This project was successfully implemented and completed within the PRC clinic and within the study timeframe and budget. Results of the PN intervention showed a significant improvement in illicit opioid use abstinence and significant decreases in drug use and depression. Results also showed non-significant trends suggesting possible improvements in general health and increases in substance use treatment attendance across the intervention. These improvements were observed for women who remained within the PRC setting and for those discharged early, as evinced with the absence of significant interactions between time and early discharge status. While comparisons between the early discharge and non-early discharge patients were not a priori, they provide a valuable contrast for the performance of PN among participants within the PRC clinic and those obtaining services in other community settings throughout region. Altogether, these findings provide support that PN is a feasible adjunctive intervention that shows promise for health improvements among pregnant women with opioid dependence initiating buprenorphine care.

Most study participants also had adequate or greater prenatal care utilization, with similar proportions among those with and without early discharge. These findings not only have important implications for maternal health but child health and welfare as well. With specific reference to fetal health, prenatal drug exposure often results in delays to infants’ physical, cognitive, social, and emotional development, and these challenges can persist into adolescence and even adulthood (Fisher et al., 2011). In addition to negative developmental effects, children of parents who use drugs are at an elevated risk for abuse and neglect (Hall et al., 2016). As a result, families with these circumstances have high levels of child welfare involvement, and parents with drug use histories are often rated as high risk (Brook et al., 2010). When children are removed from parents with substance use disorders, these children have a low likelihood of returning home (Mirick & Steenrod, 2016). Reunification rates have been found to be lower for parents with opioid use than for parents who use alcohol (Choi & Ryan, 2007; Grella et al., 2009) or cocaine (Choi & Ryan, 2007). Thus, optimizing participant engagement in addiction treatment and prenatal care are paramount intervention targets for this population.

Study outcomes support the need for further testing of the PN intervention among treatment seeking women with opioid dependence. Future research should seek to replicate and expand upon the efficacy of this intervention and its potential usefulness for managing opioid dependence among pregnant women. Subsequent studies should follow a blinded randomized controlled design order to examine the independent effects of the PN intervention compared to those receiving routine care. Such a study design would help to control for potential threats to internal validity, such as recall, social desirability, and interviewer biases as well as control for other threats such as maturation, which could be a consideration in the current study given the length of time and physiological changes occurring among participants during the study timeframe. Additional research may also seek to include pregnant women who are initiating methadone treatment, given differing methods of administration and patient management compared to office-based buprenorphine care. Subsequent studies will also benefit greatly from including longer follow-up periods with women in order to monitor change beyond the 2 months observed in this project. Further, follow up should include child outcomes for engagement in pediatric care and neonatal growth and development.

Limitations

While there were a number of positive outcomes associated with the PN intervention, there were also limitations to the current project. One limitation is the absence of an adequate sample size for assessing the effect of the intervention on a variety of outcomes. While significant improvements were noted for opioid abstinence, any drug use, and depression; it is possible that effect of the intervention on other important behaviors was not detected given the study’s small sample size. We also acknowledge the lack of route of administration information from non-injection non-heroin users. It will be important for future research to capture these data to better differentiate the impact of the intervention among women with varying substance use behaviors. An additional challenge was early discharge from PRC wherein the navigator worked with participants to transition and/or reinitiate care. As noted, 8 of our 21 participants were discharged early from the PRC. The importance of the PN intervention is particularly apparent given the absence of significant interactions between early discharge status and time. While this circumstance produced a natural comparison group for outcomes analysis, the study navigator spent a great deal of time traveling to meet with participants and contacting them to continue their engagement in care, which has the potential of being cost prohibitive in a fee-for-service system and may be better implemented within bundled payment managed care. We also recognize we do not have a measure of therapeutic alliance between the navigator and the patient, which relationships may have important repercussions for treatment outcomes (Elvins & Green, 2008). Future research should include such a measure to capture this important aspect of treatment. Similarly, we did not assess acceptability of the intervention with patients through surveys or open-ended interviews. Future work would benefit from capturing such information. Capturing these data could also help to illuminate social desirability bias that could have been introduced into the outcome measures resulting from the assessments being conducted by the coordinator who provided the navigation services. However, we have confidence in the validity of participant outcomes given (1) our assurance to them their survey responses would not impact their services or compensation and (2) that our multivariate analyses controlled for number of sessions, which potentially served as a soft proxy for exposure to the navigator and opportunity for relationship development. An additional limitation is the absence of urine toxicology. Due to the nature of the pilot study, limited budget, and travel of the study staff to meet with participants in various locations for sessions and follow up appointments (especially those with an early discharge), we did not collect these data. Future research should include as part of its protocol urine toxicology to confirm self-report. However, given previous research that shows a 94% agreement rate for opioid users’ timeline follow back self-reports compared to biological toxicology (Hjorthøj et al., 2012), we expect our results are by and large accurate. Finally, this study only recruited women who were seeking treatment; therefore, the findings herein are limited to this population.

Conclusion

Opioid dependence among pregnant women is a serious and chronic health condition. While there has been previous adjunctive psychosocial approaches tested to support initiation and maintenance of buprenorphine care, a single model has yet to immerge as a standard. This project has helped to demonstrate the feasibility and preliminary efficacy of a PN model for pregnant women with OUD. Additional research is required to build on this groundwork for establishing this approach as an evidence-based practice for this patient population.

Acknowledgments

Sources of Support

Research in this publication was supported by a grant from the Staunton Farm Foundation (Dr. Cochran) and the National Institute on Drug Abuse under Award Number K23DA038789 (Dr. Krans).

Contributor Information

Gerald Cochran, University of Pittsburgh, School of Social Work, School of Medicine, 4200 Forbes Ave. #2006, Pittsburgh PA, 15260, Phone: (412) 624-2325, Fax: (412) 624-6323.

Valerie Hruschak, University of Pittsburgh, School of Social Work.

Walitta Abdullah, UPMC, Magee-Womens Hospital.

Elizabeth Krans, University of Pittsburgh, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute.

Antoine B. Douaihy, University of Pittsburgh, School of Medicine.

Stephanie Bobby, Pregnancy Recovery Center, UPMC, Magee-Womens Hospital.

Rachel Fusco, University of Pittsburgh, School of Social Work.

Ralph Tarter, University of Pittsburgh, School of Pharmacy.

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