TABLE 3. Strategies to address opioid use disorder among pregnant and postpartum women and infants prenatally exposed to substances — Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community, state action plans,* 12 states,† 2018.
| Focus area | Strategies |
|---|---|
| Access to and coordination of quality services |
• Add a focus on pregnant and postpartum women and infants to statewide opioid initiatives and obtain internal state stakeholder confirmation |
| • Communicate, collaborate, and coordinate within the state to avoid duplication of effort among agencies and organizations on OUD and NAS | |
| • Develop a MAT provider network map for pregnant and postpartum women with OUD using various state sources to share with stakeholders and the public | |
| • Implement evidence-based strategies to engage women in OUD treatment by building community-based service capacity to improve trauma-informed and family-centered care | |
| • Develop protocols and implementation processes for plans of safe care that include provision of services for postpartum women as caregivers for infants prenatally exposed to substances | |
| • Implement a PQC to coordinate OUD treatment networks, provide standards of care, disseminate communication and training on addressing stigma during care, and catalog social/wraparound services for pregnant and postpartum women and infants prenatally exposed to substances (e.g., nutrition and mental health services, housing services, parenting support, or early intervention) | |
| • Incorporate specific services and early education initiatives for infants prenatally exposed to substances into existing state frameworks and policies focused on infants and children | |
| • Improve care coordination and transition care from hospital discharge to pediatric services for postpartum women with OUD and infants prenatally exposed to substances | |
| Provider awareness and training |
• Educate providers and the health care community on the importance of MAT and counseling services |
| • Educate providers and the health care community on requirements for plans of safe care requirements | |
| • Implement provider training on clinical standards and treatment using the prescription waiver to increase the number of active, listed, and licensed MAT providers | |
| • Train facility-based, prenatal, and community health care providers and program staff members on the SBIRT practice for pregnant women and caregivers of infants prenatally exposed to substances | |
| • Implement a PQC to develop clinical protocols, prescribing protocols, and standardized services for the treatment and management of pregnant and postpartum women with OUD, and the treatment and management of infants prenatally exposed to substances, including infants with NAS | |
| • Develop perinatal care practice standards and protocols for universal screening of prenatal and postpartum OUD, and facility-based screening for infants prenatally exposed to substances | |
| • Develop protocols for rapid quality improvement on care coordination of pregnant and postpartum women with OUD and infants prenatally exposed to substances | |
| • Develop a framework and training for implementing plans of safe care in all jurisdictions and communities | |
| Data, monitoring, and evaluation |
• Develop protocols to measure and evaluate rapid quality improvement on care coordination of pregnant and postpartum women with OUD and infants prenatally exposed to substances (e.g., PQC) |
| • Develop a standardized data system to aid in identifying pregnant and postpartum women who use or misuse substances and infants prenatally exposed to substances, and collect information to meet Child Abuse Prevention and Treatment Act of 2016 reporting requirements | |
| • Identify standard data elements, data collection practices, and case definitions for OUD and NAS surveillance in birth hospitals | |
| • Establish a data-sharing process to identify eligibility for, referral to, and enrollment in special programs or social services for infants with NAS using data from multiple information systems to monitor early identification and connections to systems of care | |
| Financing and coverage |
• Identify and expand coverage to increase access to inpatient or residential OUD treatment and comprehensive services for postpartum women with infants |
| • Collaborate with stakeholders to implement a care bundle for postpartum women with OUD and infants prenatally exposed to substances, including infants with NAS | |
| • Develop and implement a plan to provide and reimburse integrated, wraparound services for infants prenatally exposed to substances, up to age 1 year | |
| • Work with insurers, including Medicaid, to change prior authorization prescribing requirements for MAT, ensure full insurance coverage up to 1 year postpartum, and remove special requirements for prescribing approved medications | |
| • Identify sources for funding (e.g., Medicaid and federal grants) to support training efforts statewide and implementation of standardized clinical care | |
| Ethical, legal, and social considerations | • Develop nonstigmatizing messages for providers of substance use prevention and treatment and social and child welfare services on support of pregnant and postpartum women with OUD and infants prenatally exposed to substances, including those with NAS |
| • Train providers on implicit bias and antidiscrimination of pregnant women with mental health conditions or who use and misuse substances | |
| • Coordinate with statewide antistigma campaigns to address stigma toward pregnant and postpartum women who use and misuse substances, and infants prenatally exposed to substances | |
| • Standardize family-focused policies and practices across state agencies and health care organizations for postpartum women with OUD and infants prenatally exposed to substances |
Abbreviations: MAT = medication-assisted treatment; NAS = neonatal abstinence syndrome; OUD = opioid use disorder; PQC = perinatal quality collaborative; SBIRT = screening, brief intervention, and referral to treatment.
* State action plans include an action document, presentation materials, and in-person discussions at the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community kick-off meeting in 2018.
† Alaska, Florida, Illinois, Kentucky, Nevada, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington, and West Virginia.