Western Montana is not immune to the hidden epidemic of substance abuse, and as a result there are significant numbers of babies born exposed to powerful drugs like opioids.
Substance use disorders (SUD) have been especially devastating to families in Missoula. The number of children in foster care in Missoula County more than doubled from 124 in 2012 to 268 in 2016, and parental substance use is identified in 65 percent of foster care placements in Montana, according to a recent report from Montana Child and Family Services Division.
"Pregnant women with SUD are vulnerable to many risks, including domestic violence, homelessness and poverty, and on top of that, are barred from access to some of Missoula’s addiction services," said Lauren Wilson, a pediatric hospitalist at Community Medical Center and Providence St. Patrick Hospital.
Withdrawal symptoms are dangerous to babies after they are separated from their mother's bloodstream, so local hospitals have programs in place to safely and confidentially wean the babies off the drugs. The goal is also to help get the family on a path toward physical and mental health, and prevent the necessity of the state stepping in to place the baby in foster care.
Community Medical Center recently rolled out a progressive, evidence-based new method for treating newborns with opioid exposure, called Eat-Sleep-Console, or ESC.
The old method included separating the babies from their mothers after birth and giving the babies timed injections in decreasing amounts of methadone, while reducing stimulating environmental inputs like lights.
The new method keeps the babies with their mothers as much as possible, and methadone is only given if the baby can't be consoled, fed or put to sleep for an hour. Based on evidence from other places, the new method drastically decreases the amount of methadone needed to wean the baby off its physiological need for drugs.
"We’re very excited about this, and its proven impact in keeping families together," Wilson said. "CMC has begun to fundamentally change care for infants with Neonatal Abstinence Syndrome [the term for babies' withdrawals], using the Yale University-based ESC method, which has shown reductions in foster care placement through actively engaging parents."
Numerous studies show adverse childhood experiences such as separation from the mother cause long-term negative health effects, so the goal with ESC is to prevent that from happening and keep the mother involved.
Community Medical Center and Providence St. Patrick Hospital also each recently won identical grants from the Montana Health Care Foundation, which have allowed the hospitals to implement a fully integrated, Missoula-wide model to address substance abuse before and after birth.
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CMC used the $150,000 grant to hire a Licensed Addiction Counselor, Janie Quilici, to help guide new mothers to treatment options, and they hope to gather enough positive outcome data to prove the position is worth being funded permanently beyond the initial two years. St. Pat's will implement coordinated education with office-based screening, brief intervention and referral to therapies.
"All moms can come here and get prenatal care without being judged," Quilici explained. "We want to be somewhere where they can talk about their fears and struggles and connect with more resources. Some moms are afraid they'll get cut off or go to jail, but that's not the case."
Madalyn Crouch, the nurse care coordinator at CMC, said the general public doesn't understand that mental health is a huge part of substance abuse.
"These women aren't out there trying to do bad things," she said. "For whatever reason, maybe because of a car accident, they started using narcotics for pain relief and got addicted. But the majority of them still want to do the best for their baby."
Crouch said CMC's staff is trained to help mothers find education, counseling and ongoing care options instead of drugs.
Wilson said Anna Semple from the Missoula City-County Health Department has put together a Neonatal Abstinence Syndrome working group. It will include the Montana Department of Children and Families, local drug treatment programs, the Missoula Urban Indian Health Center, both hospitals and other public health groups.
"I don’t think there’s another city in Montana with such extensive collaboration," Wilson noted.
CMC is also focusing on implementing integrated behavioral health in all its outpatient clinics, including the Maternal-Fetal Medicine clinic. According to the Montana Health Care Foundation, integrated behavioral health is the term used for providing patients with coordinated physical and behavioral health care.
Individuals struggling with mental illness or substance use disorders are often at greater risk for chronic health issues, and coordinating a patient’s physical and mental health care can help improve chronic conditions and reduce health care spending.
"Sixty percent of the population has a mental health condition at some point or another," explained Liz Davies, a licensed clinical social worker and the behavioral health manager at the Community Physician Group and Providence Medical Group. "And 60 percent of them have other physical issues. If you're not treating the whole person you're missing an opportunity to have successful outcomes."