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Nicole Callahan

Nicole Callahan, a 29-year-old social worker for the Confederated Salish and Kootenai Tribes, said her daughter was her primary motivation for starting treatment for drug use. The Ronan resident, who was featured in recent series called "Addicted and Expecting'' by the Missoulian and University of Montana Journalism School, has been clean for five years with the help of counseling and a Suboxone prescription.

Drug use during pregnancy is a growing problem in Montana, and mothers searching for help have few places to turn.

A 2017 report by the Montana Healthcare Foundation found that only 6 percent of Montana’s state-licensed substance use disorder treatment programs serve pregnant women or young families. The number of children in foster care has doubled since 2011 to over 3,200, with most children removed due to their parent’s substance abuse.

Hospitals across the state have also seen an increase in the number of babies born exposed to drugs in the womb. Among Medicaid patients, that percentage grew from 3.7 percent in 2010 to 12.3 percent in 2016. Those numbers don’t include women who weren’t tested or whose babies didn’t have symptoms at birth.

Despite the growing problem, there are some simple ways that hospitals, social service providers, and criminal justice workers can improve outcomes for mothers and their babies.

The Montana Healthcare Foundation released a report last week, titled “Strategies to Address Perinatal Substance Use Disorders,” which outlines several ways to create “team-based prenatal care.”

The foundation assembled an initiative around perinatal drug use in January, and has since been researching how other states have found success addressing perinatal drug use.

Aaron Wernham, Montana Healthcare Foundation CEO, said the organization started this initiative due to “the seriousness of this problem, of having women all over the state with a really hard illness — an addiction — who aren’t able to get treatment while they’re pregnant, combined with the fact that we found great evidence that this is a health problem where we can make a difference.” 

The report released Thursday outlines three low-cost measures that other states have used to significantly improve outcomes for mothers with substance abuse disorders and their infants.

The first involves pairing prenatal care with substance abuse treatment. Wernham said that could mean giving every woman who comes to the hospital for prenatal care a questionnaire to find out if they are struggling with alcohol or drug use.

Those with a positive screen would immediately be referred to care — either treatment or counseling — that could help intervene early in their pregnancy. Montana currently does not have a universal policy for screening pregnant women for substance use at prenatal appointments.

The second recommendation is to improve collaboration between health care providers, child welfare workers, social services and the judicial system. One example of this is inviting Child Family Services to work with women throughout their pregnancy instead of only becoming involved after a baby is born affected by perinatal drug use.

At Kalispell Regional Hospital, which in 2014 began implementing this kind of team-based response to substance abuse disorders in pregnant women, foster care placement has declined nearly 70 percent, according to hospital statistics.

The average length of stay there for drug-exposed babies in the neonatal intensive care unit has dropped by 11 days, or more than half, from 2014 to 2016, radically reducing bills typically paid by the state through Medicaid.

Those findings were highlighted in a joint investigation by the Missoulian and the University of Montana Journalism School called "Addicted and Expecting'' that was published in December.

The Montana Healthcare Foundation awarded Kalispell Regional a $50,000, two-year grant to improve its neonatal intensive care unit protocol for managing infants with neonatal abstinence syndrome, a condition that results from exposure to opioid drugs in the womb. Wernham points to their success as an example of what other hospitals in the state can achieve.

“These are low-cost interventions,” Wernham said. “It’s not fancy stuff.”

The final recommendation involves addressing social needs like homelessness, domestic violence, and a lack of transportation to and from prenatal appointments and counseling. The goal is to create a team-based approach that helps connect the many services pregnant women need while recovering from substance abuse.

Montana Healthcare Foundation will be awarding millions of dollars in grants to hospitals that deliver babies across the state to implement these changes.

Yesterday, Wernham hosted a webinar to announce the initiative to eligible applicants across the state. More than 40 institutions were represented on the call, and he encourages any other institutions interested in a grant to contact the foundation.

“We want somebody in the community to take charge of this problem and develop a solid team-based approach to providing both prenatal care and addictions treatment side by side,” Wernham said.

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