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Rescuing Moms and Babies from

Maternal Substance Use Disorders
Marty McCaffrey, MD, CAPT USN (Ret)
UNC School of Medicine
Background
• Maternal substance use disorder and infant drug
withdrawal or neonatal abstinence syndrome (NAS) are
at epidemic proportions in North Carolina and play an
increasingly significant role in maternal and infant
morbidity and mortality.
• NAS rates have risen approximately 300% in North
Carolina over the last 5 years. NAS management
demonstrates dramatic variations in care leading to
extended hospital stays with significant social, medical
and fiscal impacts. The transition to home for these
mothers and their infants is also a very vulnerable
period which requires significant support.
Aim
• Create a model of support for the care of mothers with substance
abuse disorder and their infants that includes the antepartum
period, delivery, birth hospitalization of mother and baby, but
extends beyond discharge for six months.
• Pair a small hospital and its referral center in a regional area.
• Focus on building a system of support for optimal health outcomes
in situations of maternal substance use via best practices, peer
support, and regular contact with maternal child social workers
specifically trained in trauma cognitive behavioral therapy.
• Improve compliance of mothers with substance use disorders with
rehabilitation, reduce custody actions by CPS, improve compliance
with well child checks and immunizations, reduce hospital
readmissions, and reduce length of stay for infants with NAS.
• This proposal could be piloted in two regions initially with a plan to
spread (based on funding, support, collaboration) in 1or 2
subsequent phases.
Reach
• The pilot would serve four hospitals in two
perinatal regions in the state initially.
• These facilities could be identified based on
need (severity of the substance use epidemic)
and hospital willingness to participate.
• The model developed will be one that can be
deployed statewide.
Proposed Methods
• Include all key elements of the AIM Bundle for Maternal Opioid Use…and
more…of course.
• PQCNC develops a web based data warehouse to support submission of
hospital data related to key metrics that will include maternal and
pediatric measures.
• PQCNC partners with Horizons Program staff, CC4C, DMA, DPH and other
state agencies engaged in providing support to mothers and babies in the
selected regions. These meetings will identify resources currently available
for families and seek opportunities to augment services which may exist.
• Specific metrics and targets might include maternal compliance with
rehabilitation, maternal stress levels, completing well child visits,
readmissions to the hospital, CPS custodial actions and LOS for the initial
NAS hospitalization.
• Partner with CC4C to analyze baseline data in the identified regions for a
number of pediatric related metrics. We will partner with other identified
agencies (DMA, BCBSNC, DPH, State Center for Health Statistics and
others) to collect baseline data related to maternal substance abuse.
Proposed Methods
• Identify and hire a maternal substance use disorder peer support
counselor (1.0 FTE) and a licensed maternal child social worker
trained in cognitive behavioral therapy (1.0 FTE) for each region.
• A total of 4 personnel will be hired to support the care in these 2
regions. These individuals will initiate contact with mother before
hospitalization, or both mom and baby during the birth
hospitalization.
• They will continue this support with every other week peer support
visits and monthly social worker visits.
• A psychologist with certification in training for trauma cognitive
behavioral therapy training for the licensed maternal child social
workers will be contracted as a 0.2 FTE. The supervisor will be
available to train and provide support to peer support and social
work staff in the two regions.
Impact
• Improve maternal adherence to rehab plans
• Improve the bonding experience in the hospital
• Improve breastfeeding rates
• Reduce need for pharmacologic therapy in infants
• Reduce hospital LOS for baby after birth
• Improve compliance with rehab post delivery
• Improve pediatric well child care compliance
• Reduce infant readmission rates
• Reduce CPS actions with families
Supporting Materials
• PQCNC has experience with its prior NAS
initiative
• AIM Bundle for women with opioid use
disorder
https://safehealthcareforeverywoman.org/pat
ient-safety-bundles/obstetric-care-for-women-
with-opioid-use-disorder/