Helping pregnant women in Indiana overcome addiction is a priority for the health of both these mothers and their children. Babies born to opioid-addicted mothers often suffer from neonatal abstinence syndrome, which causes withdrawal symptoms in newborns in addition to long-term problems that are not yet fully understood.
Helping pregnant women overcome addiction with personalized approach
Encouragingly, pregnancy is an ideal time to help women tackle addiction, as most women are highly motivated to protect their children from harm. A significant challenge, however, is building trust with women who have experienced a great deal of hardship.
Litzelman’s project, "A community-based addiction reduction plus policy innovations program for Indiana," aims to close this trust gap by providing a personal link between opioid-addicted pregnant mothers in Central Indiana and the many resources available for their recovery. By training and supporting community health workers who come from the same communities as addicted mothers and who have experience with addiction, the project will test a new, personalized approach to recovery at a critical time in life.
The project, called CARE Plus, builds on an existing program called WeCare that aims to reduce infant mortality in Central Indiana by connecting disadvantaged women of childbearing age to organizations that provide health services and other resources such as employment or nutrition assistance.
One in six of the participants in WeCare report abusing prescription opioids or other drugs. The community health workers’ peer-coaching model has been successful in helping WeCare participants address these problems, providing a trusted source of information and guidance. CARE Plus will enhance the WeCare program by focusing specifically on women who are pregnant and continuing to support them for at least one year after they give birth.
In addition to its unique focus on extending pregnancy care through the first year of motherhood, CARE Plus takes a new approach by avoiding the rigid practices commonly seen in drug treatment programs.
Recognizing that opioid-addicted pregnant women face a number of extreme stresses and constraints, CARE Plus is testing a “patient-led” approach that acknowledges each woman’s present state of readiness to change and helps her determine her own steps toward recovery.
Community Health Workers’ are essential in this process because they have a clear understanding of the communities in which participants live – often in settings with high rates of drug use, violent crime, and unemployment and insufficient housing, transportation, and nutritious food. The workers will work with women one-on-one, in the patient’s home or at another place of her choosing, connecting regularly to plan how to address obstacles to recovery as they arise.
CARE Plus participants will also be able to opt-in to text messaging services from the project leaders that offer information and encouragement in line with the participant’s goals.
This “human-centered design” approach also extends to the broader structure of the program. Litzelman and other project leaders will meet each week with the community health workers, offering support but allowing them to determine the discussion topics and to advise one another on solutions.
Similarly, the project will collect a wide range of information on the experiences of each the workers, not only answering preset questions about participants’ health outcomes but also looking for unexpected events and patterns. At the conclusion of the two-year pilot program, Litzelman hopes to have a new model for addressing addiction among pregnant mothers and reducing neonatal abstinence syndrome that can be promoted among health care providers, community organizations, and policymakers.