St. Charles Center for Women’s Health in Redmond began universal urine testing of pregnant women for alcohol and other drugs in the third quarter of 2015. They consistently found that at least 20% of the women tested positive. The clinical leadership viewed this result with alarm due to the obvious risk to successful deliveries of healthy babies. St. Charles Center for Women’s Health and BestCare Treatment Services SUD Outpatient Services are co-located in the same building in Redmond. St. Charles Center for Women’s Health has committed physicians and strong behavioral health consultants and a nurse care manager. BestCare has an existing staff person at our Redmond office who is skilled and experienced at outreach and engagement of women with severe substance use disorders (SUD). St. Charles and BestCare collaborated to determine if we could improve the clinical outcomes for these women and their newborns.
Our project has been to develop the partnerships, workflows, messaging, and outreach approaches to successfully embed a SUD clinician in the clinic to build relationships and demonstrate engagement in services with the women who screen positive for a substance use disorder. The SUD clinician uses an Intentional Peer Support model to engage the women given their current motivation for change and life circumstances. Much of our preliminary work with them involves providing resources and emotional support.
“Moms engaged with the MOMS program have benefited from having a peer mentor work with them. This has allowed them to talk with someone who has first-hand experience in the challenges of substance use while pregnant, having their child placed in the foster care system and working through recovery and the legal processes to gain custody of their child again. Many moms have worked closely with the mentor as support during the legal and court process.”
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- The purpose of this project is to help women with substance use disorders recover and reach a better place for themselves and their babies. Women who continue to use alcohol and other drugs while pregnant tend to have a severe substance use disorder (SUD), have many psycho-social needs, creating a high risk for multiple health and social problems for their unborn child. There is strong evidence showing that drug use during pregnancy leads to lower birth weight, shortened gestational period, and smaller size and smaller head circumference. Those substances we are targeting for treatment include alcohol, opiates, and methamphetamines. The expense of the delivery is a quantifiable amount, but only a small part of the personal, social, and economic costs for these babies. Infants who are born to mothers who use illicit drugs are at risk for multiple challenges to their health and well-being. Overwhelmingly research evidence demonstrates that women who use drugs are motivated to obtain treatment once they find out they are pregnant. If approached in the right way, this crisis can be an opportunity. Pregnancy can be a moment of readiness, a window of opportunity, which can change the course of women’s lives and dramatically improve the lives of their children.
- This project was implemented by St. Charles Health System and BestCare Treatment Services.
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The project attempted to:- Foster continued engagement with our outreach worker.
- Increase the women’s follow-through with regular prenatal care.
- Have the women engage in SUD treatment services.
- Continue engagement between the outreach worker and the women and their baby. The goal is to help the women navigate the steps to provide a healthy environment for their baby and for the baby to receive the necessary and timely access to medical/dental providers and social services they may be eligible for.
Urine drug screens of new OB patients shows continued use of THC and other substances, predominately meth use has remained consistent in numbers. Patients have been referred to Best Care Treatments services and the MOMS peer mentor when they test positive for any substance other than THC.
Those patients engaged with the MOMS program had a significant improvement in attendance to prenatal appointments compared to those patients who declined to participate in the MOMS program.
Most women were able to take their baby home after delivery, tracking if the baby was able to stay with the family over time proved to be a challenge if the patient did not stay involved in the program or moved.
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- 2020 and 2021 have been harder to engage women in treatment. If this has been a case to social distancing restrictions, increased lack of stable housing or other factors, hasn't been fully determined by our team yet. Patients are continuing to be engaged in whatever capacity they are willing to accept, and new opportunities have been created for engagement, such as a virtual support group.
- COVID has created some challenges, but those have been worked through. Best Care now has a dedicated RN Care Coordinator and Social Worker dedicated to this program. Virtual and in person support groups have now been started. Some staffing turn over created some delays as well, but with more individuals on the MOMS program team, these staffing challenges are now easier to work through.
With the global pandemic impacting our workflows for the last 2 years, workflows had to shift as St. Charles was unable to continue to embed a SUD clinician in our practice. However, even with the challenge created from the pandemic we were still able to offer services from the MOMS program to women.