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07/07/2022
A Wentworth-Douglass Hospital effort supporting pregnant and parenting people and infants impacted by substance use disorder (SUD) and opioid use disorder (OUD), has caught the attention of the White House.
A representative from the Office of Management and Budget at the White House recently reached out to Katie White, a nurse specializing in perinatal substance use disorder at the hospital’s Women and Children’s Unit. Federal officials wanted to learn more about how Wentworth-Douglass supports women and mothers with SUD/OUD and what type of barriers these patients face.
White said the group was interested in Wentworth-Douglass’ holistic approach to the issue and had an hour-long virtual meeting with the hospital’s Women and Children’s SUD Care Team which includes White, certified nurse midwife Jessica Bacon, case manager/navigator Lindsay Ginter, and support from inpatient social workers.
“We talked about access to care based on barriers that these patients experience, like childcare, access to treatment and how those barriers can prevent women from being successful in pregnancy and parenting by not being able to access treatment that has been deemed so important to them,” White said.
One example the hospital team gave of trying to address barriers was supporting patients without photo IDs, and how it makes it nearly impossible for patients to access Medication Assisted Recovery (MAR) on methadone, without this documentation. This barrier, without support, can be the reason patients are unable to treat their opioid use disorder, threatening both their and their fetus’s life. The team also discussed the challenges they faced in getting Naloxone, commonly known by its brand name Narcan, to perinatal patients and caregivers. The life-saving medication is administered after an overdose. In addition, Wentworth-Douglass staff reviewed the work they are doing with the Doorway, a state-sponsored program, to provide access to Naloxone in pregnancy and at hospital discharge.
The White House group is researching and scoping pilot projects from around the country as part of a federal project focused on improving the experience of low-income parents as they move through the major life transition of having a child. Much of the group’s research this summer is focused on holistic models of care for women and the outcomes for infants on Medicaid.
“I’m happy that it’s (perinatal substance use disorder) being looked at in a bigger scope and hopefully the work upstream will continue to support our current community initiatives,” White said. “This is a real need in our area. Such a real thing that each one of us show up every day and have dedicated our careers to supporting.”
Of the nearly 1,500 deliveries at Wentworth-Douglass Hospital in 2001, 180 were identified as needing a coordinated care approach for SUD/OUD. Referrals go to Ginter, who then completes an assessment of social determinants of health to determine what type of support the mother will need, and the barriers they are experiencing, such as access to transportation, insurance, housing, and medication for opioid use disorder, to name a few.
A care team of hospital staff and social workers will then work with the expecting mother to address those needs and provide her with education about what to expect pre- and post-delivery. Following delivery, the social worker will do a “warm hand-off” back to Ginter, who will continue to follow up with the patient to make sure they take part in postpartum visits, perinatal referrals and have any other resources they need.
“Some of the patients still reach out to me often in the postpartum period, but you get a range,” Ginter said. “Now we see patients come back in second pregnancies because they know about the program. We see a lot of success.”
The hospital team also stressed to the White House group that holistic care is an effort that hospitals and medical providers must go “all in” on. The first year of the postpartum period is known to have the highest risk of substance misuse or relapse potential, due to fatigue, stress, and physical demand on caregivers. New Hampshire’s leading cause of pregnancy related deaths and maternal mortality is due to accidental overdose. With such a high risk and, breadth of community impact, the hospital stressed support can’t just stop after delivery.
“You need to invest in the team members. You can’t just have one person in the office or hospital managing it. You need a multidisciplinary team of people and you need to dedicate the hours to it. It takes a lot of time, but it’s worth the investment,” Bacon said.
White gave Wentworth-Douglass credit for investing in the program and said the goal moving forward is to expand outpatient services so they can potentially work with some patients for up to a year after delivery and expand mental health resources.
“All of this work has really been in response to our patients’ needs and the barriers that we experience while trying to connect them to care,” White said. “I was most proud of the fact that our community hospital was recognized for their efforts to support a topic that is still highly stigmatized. I always felt that is what the best part of Wentworth-Douglass is - the fact that we treat this issue like disease that it is.”
White said the White House group is continuing to do research and is speaking with other medical providers. There is a chance that the hospital could hear back from the group again as it finishes its research.