Women who are both pregnant and abusing opioids can be a challenge to healthcare providers who try to get them to participate in substance abuse treatment along with prenatal care. Fear of Child Protective Services (CPS) may also be a barrier towards women seeking care. The purpose of this study was to see how these women perceive CPS. Sixteen women were recruited from an Ohio drug treatment facility and participated in this study. The women were interviewed individually with a combination of self-report and interviewer-guided questionnaires.

Overall, fear over removal of children was a significant concern among participants and was a common barrier to seeking treatment services. Some women believed CPS intervention would be more harmful to their children because they may be exposed to additional risks away from home. A second theme that emerged was the belief that parents could never satisfy CPS regardless of how much effort they put in and participants who had previous run-ins with CPS said they often felt as though they were under surveillance. There tended to be positive feelings if the CPS intervention had good outcomes. Women liked CPS’s transparency and accountability, even if they didn’t agree with the final outcome. Participants who had positive experiences with CPS often emphasized the importance of client-focused interaction in meeting the needs of families and children. The author concluded that good relationships between CPS, parents, and the community is essential. CPS may be able to build better relationships by training caseworkers on substance abuse, community outreach, and engagement.

Falletta, L., Hamilton, K., Fischbein, R., Aultman, J., Kinney, B., & Kenne, D. (May 01, 2018). Perceptions of child protective services among pregnant or recently pregnant, opioid-using women in substance abuse treatment. Child Abuse & Neglect, 79, 125-135.

The Addiction Recovery Mobile Outreach Team (ARMOT) is an intervention in rural Pennsylvania that aims to reduce opiate overdoses by providing case management and recovery services to hospital patients who show signs of substance use disorders. The ‘mobile’ in ARMOT means case managers meet patients bedside to screen and assess them for substance use disorders and link them to treatment programs. The patients also meet with certified peer recovery specialists who help them connect with other community resources while also providing valuable emotional support. One recovery mentor said this about his experience with ARMOT, “Having survived several [overdoses] in my addiction, that is a key demographic [the population that ARMOT serves] that I want to be able to reach out to and try to and try to help them start their recovery process.” ARMOT also educates hospitals, health care providers, and the community on substance abuse disorders and works to reduce the stigma of addiction.

Of the 943 referrals the program received, 622 were screened, 436 completed a Level of Care Assessment, and 331 went to treatment. Implementing a mobile unit presents some barriers as transportation can be a challenge as well as the hours the ARMOT staff are available. For example, the goal of ARMOT was to have the patient see a case manager or peer recovery mentor before they are discharged. However, if a patient entered the hospital at night, they may not want to wait until the next morning to speak with an ARMOT staff member. The solution was to change hours so that staff was available in the evenings, at night, and over weekends.

Check out this video on ARMOT! https://www.youtube.com/watch?v=78p267G79ic

Rural Health Information Hub. (2018, December 5). Addiction Recovery Mobile Outreach Team (ARMOT). Retrieved from https://www.ruralhealthinfo.org/project-examples/940

Rural communities in America face unique challenges when it comes to accessing MAT. A significant challenge rural communities have when it comes to MAT is lack of infrastructure and general workforce to support it. MAT providers in these settings report concerns about time constraints, the lack of behavioral health and psychosocial services in rural communities, as well as medication misuse between patients. Three different states are using unique methods to integrate MAT into healthcare, with the goal making it more accessible to rural populations. Click on the chart to view it.

So what can we learn from how these states are approaching MAT?

1. They are all using collaborative approaches. Agencies that provide medication are combining efforts with behavioral health agencies.
2. They are using MAT to help treat the whole person. The Colorado health group uses services like physical therapy and chiropractic interventions, in addition to MAT, to help treat individuals suffering from chronic pain and OUD.
3. They are getting creative. Rural North Carolina is using technology to reach individuals that may not have otherwise been able to get MAT.

To read more about this topic, please visit this article.

For SAMHSA’s list of Buprenorphine Treatment Practitioner Locations, click here.

Miller Temple, K., MD. (2018, March 21). What’s MAT Got to Do with It? Medication-Assisted Treatment for Opioid Use Disorder in Rural America. Retrieved from https://www.ruralhealthinfo.org/rural-monitor/medication-assisted-treatment/

Dipzinski, T. (2018, March 15). New Horizons Substance Use Recovery Network. Retrieved from https://www.ruralhealthinfo.org/project-examples/1006

Peer recovery mentors are used to promote long-term recovery for parents with acute substance use disorder in three domains: 1) sobriety, 2) emotional, relational, and physical health, and 3) positive and self-directed participation in the family and community. SAMHSA supports peer recovery support services as an essential part of recovery and under some circumstances, they may be billed through Medicaid under the Affordable Care Act. As support for peer recovery mentors grows, it is important to understand the specific types of services peer mentors provide, as well as risks and advantages associated with peer mentors’ own sobriety. This study documented the experiences of 28 family mentors in the Kentucky START program over the course of 8 years.

Peer mentors spent a total of 55.3 hours and over 60.5 contacts with each family per month. This was an average of 3.7 contact hours per month. The mentors had on average 40.2 contacts coaching on recovery and 38.5 contacts coaching on daily living skills. The first 7 contacts with the family were made within an average of 23.6 days. During this initial period, the mentors spent an average of 8 hours working with or on behalf of the family. This is important as parents are especially struggling to deal with difficult circumstances. For each no show by the parent or refusal to meet, the likelihood of family separation at the end of the case increased by 24%. Mentor face-to-face visits with the children increased the odds of reunification. For each face-to-face visit, the odds of staying together increased by 9%. On average, intact families had 14 more face-to-face visits than separated families.

Huebner, R. A., Hall, M. T., Smead, E., Willauer, T., & Posze, L. (January 01, 2018). Peer mentoring services, opportunities, and outcomes for child welfare families with substance use disorders. Children and Youth Services Review, 84, 239-246.

Digital Storytelling (DST) is a narrative tool that uses digital media to allow individuals, especially marginalized groups, to tell their everyday story. The Supporting Moms Project used DST as a way to showcase the experiences of women in recovery for substance use disorders during pregnancy who also work as peer mentors with pregnant women with substance use disorders. The goal of this pilot study was to understand the process and meaning of recovery from the perspective of women with lived experiences of perinatal substance use.

Five peer mentors were recruited to participate in a 3-day workshop where participants discussed differences between being “in” recovery and “doing” recovery. The first is described as going through the protocol while the second is active participation and commitment to recovery. The pilot study served as a place for “doing recovery,” as participants connected past experiences to their present lives, formed more profound connections with fellow peer mentors, and developed a sense of purpose as they looked to the future.  The pilot mirrored parts of the peer-mentor experience itself as participants shared their stories and developed supportive relationships. The DST process can increase and strengthen social support for participants, and in this way serve as a therapeutic experience for women in recovery from substance use disorders who also serve as peer mentors.

Paterno, M. T., Fiddian-Green, A., & Gubrium, A. (January 01, 2018). Moms Supporting Moms: Digital Storytelling With Peer Mentors in Recovery From Substance Use. Health Promotion Practice, 19, 6, 823-832.

Although opioid misuse/abuse is considered an epidemic, few randomized control trial (RCT) interventions focus on parental opioid use to improve parenting behaviors and child outcomes. The table below presents a review of parenting interventions among opioid addicted parents. Click on the chart to expand it.

Overall, very few studies (5 total) examine child and parenting outcomes when parents abuse opioids. So far, there are no consistent findings on which parenting practices are associated with improved child outcomes with most studies reporting no significant differences in outcomes. Future studies should focus on including fathers, investigating how parenting programs may reduce opioid use, and distinguish between parental prenatal vs postnatal opioid use.

For further reading, click here to read the full article.

In 2016, Rhode Island was one of the top states for illicit drug use had the tenth highest accidental fatal overdose rates in the United States. In response to this, state leaders created a multi-component strategic plan with the goal of reducing fatal overdoses. The use of peer recovery supporters in targeted environments and the distribution of naloxone kits were part of this strategic plan.

AnchorED was a pilot study designed to send peer recovery mentors to emergency rooms with high rates of accidental opioid overdose. When a patient is treated for an accidental opioid overdose in an emergency department, the hospital staff called a peer recovery mentor to provide consultation before the patient is discharged. The consultation typically takes around 30 minutes and patients received kits containing information on 1) overdose prevention, 2) how to administer naloxone along with naloxone. The program also provided mentors to those who agreed to services after leaving the emergency room. The program also provided individuals with transportation to treatment centers along with linkages to long-term peer mentors.

AnchorMORE, a second pilot study, expanded outreach to include areas of high overdose rates, such as local shelters or needle exchange programs. During regular visits (3-4 times a week), peer recovery specialist teams provided naloxone education, distributed naloxone kits, and offered referrals for addiction treatment services. The specialists also met with local businesses, including bars and restaurants, to train staff on how to respond to an overdose.

Overall, AnchorED peer mentors contacted 1392 individuals through ER visits. Of those, 89% received naloxone training, 87% agreed to engagement with a peer mentor after the ER, and 51% agreed to service referrals. AnchorMORE peer recovery specialists had 8,614 street-based interactions and distributed a total of 854 naloxone kits The most common interaction was for referrals for basic needs such as access to food pantries or transportation assistance. The second most common interaction was for outpatient substance abuse treatment services, while the least common was referrals for inpatient substance abuse treatment services. Fatal overdoses, after connection to a peer specialist and naloxone kit, were not measured. These two pilot studies show the importance of peer recovery specialists for overdose prevention and education, outreach, and resource referral in a variety of settings.

Waye, K. M., Goyer, J., Dettor, D., Mahoney, L., Samuels, E., Yedinak, J. L., & Marshall, B. D. L. (n.d.). Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches. Addictive Behaviors, 89, 85–91. https://doi.org/10.1016/j.addbeh.2018.09.027

The Early Intervention Family Drug Court (EIFDC) was started in 2010 in Sacramento, CA to protect the welfare of children while giving parents the opportunity and resources to access substance abuse treatment services. EIFDC is different from family court in that it is a voluntary pre-plea or administrative court. Participating parents and caregivers receive intensive case management, parenting classes intensive outpatient substance abuse treatment and cognitive behavioral strategies, mental health counseling for adults and children as well as screening and assessment for both substance use disorders and child welfare issues. Initially, EIFDC targeted mothers who had used substances during pregnancy or who had a newborn test positive for substances at the time of delivery. The program has now expanded to include fathers of infants who have been exposed to substances.

Specific to substance abuse treatment services, 86.8% entered treatment after enrollment in EIFDC, 2.1% began treatment the day they started EIFDC, and 9.5% entered treatment before beginning the program. Although the EIFDC parents were not more likely to complete treatment than the comparison parents, they stayed in treatment longer than comparison parents (131.6 vs 102.7 days). Compared to families receiving services and usual,  more EIFDC children remained at home after cases closed (92.1% vs. 69.5%). Overall, the program has led to a decrease in child welfare caseloads, a decrease in traumatic experiences for children and an overall decrease in Child Welfare costs.  For more information on EIFDC, please visit this website.

SAMHSA. (n.d.). Early Intervention Family Drug Court (EIFDC). Retrieved from https://ncsacw.samhsa.gov/technical/rpg-i.aspx?id=80

EPIC is excited to announce a new team member, Ian Murphy. Ian earned his MPH in Behavioral and Community Health Sciences from the University of Pittsburgh. He will handle Needs Portal training and technical assistance.

We are excited to have Ian on the team!

EPIC is excited to announce that our data dashboard is ready! The data dashboard gives you information on EPIC cases in a way that’s easy to understand. You can find the Dashboard under the “Evaluation” menu or click here.

Hover your cursor over the graphs to get the exact data. Information can be separated by county. To only see Pickaway data, please click on the light blue bar graph in the center of the Dashboard. To just see Fairfield data, please click on the dark blue bar graph in the center of the Dashboard.

We will continue to add information to the Dashboard so you can keep track of the cases and timelines.

For more information, please refer to these two documents. The “Getting Started” document will help you start to navigate the Dashboard. The “Explaining the Numbers” document will help you better understand the data on the dashboard.

The EPIC team is excited for you to see the progress that we are making!