The Hippo


May 31, 2020








Roots for Recovery. Courtesy Photo

New moms in recovery
OB practices, hospitals take on larger treatment role


 Over the past year, obstetrical practices and hospitals like Catholic Medical Center have made significant strides to provide opioid addiction treatment to prenatal and postpartum patients. Now, some additional grants promise to expand such programs.

Roots for Recovery
In January 2017, CMC launched the Roots for Recovery program for pregnant women and new moms. It was created with grants from the Digital Federal Credit Union and the New Hampshire Charitable Foundation, and it was modeled somewhat after programs in California, according to Roots coordinator Renée Maloney.
“It’s an incentive-based program. It’s the only one in the area, I believe the only one in New Hampshire,” Maloney said.
As rewards for making appointments at the clinic, patients collect beads for a sort of charm bracelet. When they collect a certain amount, they earn things like car seats, infant carriers and pack-and-plays, Maloney said.
At first, patients come twice a week. Earlier in the week they come for Suboxone treatment and later in the week they come for group counseling with a licensed addiction counselor. Once they are stable on the medication, the Suboxone visits change to every two weeks, but the group counseling meetings are still weekly.
“To start in the program you do have to be pregnant,” Maloney said, but after they deliver, they can stay on for another year if they can’t find any other treatment programs.
The expecting mothers tour the special care nursery and meet the nurses. As part of the program, they learn how to read certain signs of neonatal abstinence syndrome, or NAS, and provide soothing techniques to comfort the baby experiencing withdrawal symptoms.
“The more education they can get prenatally, the better outcome they will have. And they feel comfortable here because it’s all done on one campus,” Maloney said.
The pregnant women also interact with women who delivered babies through the program and learn from them. Nicole Pendenza, director of women and children services at CMC, said the Roots program was born out of the special nursery for NAS babies. She said the nursery follows a family-centered model of care that encourages mothers to be involved and stay with the baby from the beginning. Ten years ago, when the nursery first opened, Pendenza said, about 2 to 3 percent of the patients had substance use disorder. Now, it’s closer to 5 or 6 percent. But the length of stay has decreased on average as they use more non-pharmaceutical soothing techniques. Getting the expectant mothers treated and trained early has helped with that.
Statewide ramp up
Julia Frew, a doctor at Dartmouth-Hitchcock in Lebanon and the medical director of its Moms in Recovery program, said creating support services and accessibility for pregnant women is key to getting them treatment.
“Things like transportation [to appointments] can tend to be very difficult,” Frew said.
Frew is also the director of the recently formed Center for Addiction Recovery in Pregnancy and Parenting. The center received a $2.7 million federal grant under the 21st Century Cures Act to support Dartmouth and seven other obstetric practices with implementing and scaling up things like medication-assisted treatment, counseling, transportation, insurance, employment support, on-site child care and case management.  
Frew said most of the money will be going to the practices, while CARPP will serve as a “center of excellence” to provide knowledge, training and implementation assistance and act as a facilitator between participating clinics that may compare notes and share best practices.
Frew said one of the biggest shifts she’s observed in the state over the past three years is the broader medical community stepping up to tackle the opioid epidemic.
“I think now there’s much more recognition that there will never be enough psychiatrists and addiction providers to meet the amount of need there is,” Frew said.
A program called Perinatal Addiction Treatment has been in place at Concord Hospital’s maternity ward for the past few months serving about 20 parents with Suboxone, according to Peter Evers at Riverbend Community Mental Health.
Many of the state’s newest maternity treatment programs came out of a $3 million initiative from the New Hampshire Charitable Foundation that was announced last October. An average of $1 million is expected to be granted per year in 2017, 2018 and 2019. An initial $50,000 grant was awarded to Hope on Haven Hill in Rochester, a $194,000 grant helped with the creation of the CARPP program at Dartmouth, and $82,000 was granted to Memorial Hospital in North Conway to support its “A New Life” program.
Several other grants were awarded to hospitals and community health centers to hire social workers, lay the groundwork for informational campaigns or fund research into neonatal abstinence syndrome and fetal alcohol syndrome. 

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