Grant to boost care for addicted mothers

LEBANON – Dartmouth-Hitchcock has been awarded a $2.7 million federal grant under the 21st Century Cures Act to provide support to obstetrical practices across New Hampshire in implementing effective screening and treatment for pregnant women with opioid use disorders.

In 2015, 7.8 percent of newborns to New Hampshire residents at Dartmouth-Hitchcock Medical Center in Lebanon were diagnosed with Neonatal Abstinence Syndrome (NAS) and rates of NAS in New Hampshire hospitals have increased nearly fivefold over the past 10 years. Untreated, perinatal substance use is associated with significant morbidity and mortality for women and their infants, including infectious disease, premature birth, poor fetal growth, and neonatal withdrawal leading to prolonged hospitalization.

Staff of the hospital’s Center for Addiction Recovery in Pregnancy and Parenting will use their skills and experience to implement and nurture high-quality integrated services for this population across the state. It will provide implementation support, a toolkit of resources for practices, some initial behavioral health staffing support and ongoing clinical consultation to bolster practices as they get their programs started.

“Our goal is to take our experiences at Dartmouth-Hitchcock over the past five years and help other health care providers to build treatment capacity across the state so women can receive high quality evidence-based treatment in their own communities,” said Dr. Julia R. Frew, director of the Center for Addiction Recovery in Pregnancy and Parenting and Moms in Recovery program.

The two-year federal grant – disbursed to Dartmouth-Hitchcock through a contract with the New Hampshire Department of Health and Human Services and approved by the New Hampshire Executive Council in late January – allows the hospital to assist seven maternity care practices around the state in developing their own integrated Medication Assisted Treatment programs within the maternity care setting, serving pregnant and newly postpartum women. The funding continues through June 2019.

Cheshire Medical Center/Dartmouth-Hitchcock in Keene is the first site and has already been offering components of such a program. Other maternity care sites include Dartmouth-Hitchcock clinics in Nashua and Bedford, as well as non-Dartmouth-Hitchcock practices in Berlin, Laconia, Littleton and Dover.

Each program will provide MAT with buprenorphine (Suboxone), group and individual addiction treatment, psychiatric consultation, recovery coaching, and case management services.

“While this is not a telemedicine program, we plan to also offer consultation to other hospitals and clinics through teleconferencing, which will allow us to conduct learning collaboratives, and to provide consultation to providers at each practice regarding complex cases,” Frew said.

“This grant is another recognition of the critically important work being spearheaded by Dartmouth-Hitchcock providers,” said Dartmouth-Hitchcock CEO and President Dr. Joanne Conroy. “The opioid crisis continues to impact our state, and initiatives like our CARPP program are making a tremendous difference in the lives of mothers who struggle with substance misuse and their children. I’m very proud that Dartmouth-Hitchcock was awarded this major funding and grateful to our federal delegation in Washington, who lobbied on behalf of this program, and to the state for its continued confidence in Dartmouth-Hitchcock.”

Moms in Recovery, the hospital’s addiction treatment program in Lebanon for pregnant and parenting women, serves as a model for the statewide program. It offers clinical services, including integrated substance use, mental health, obstetric and pediatric services. The goal is to support obstetrical practices in the identification of opioid use in the women they serve and the subsequent treatment to help them on a path to recovery.

Since its inception, the program has served 120 pregnant women, the vast majority of whom began treatment during pregnancy and have continued in the program postpartum. Outcomes for program participants and their newborns have been excellent, dramatically improving the health of both mothers and babies, reducing the number of days in the hospital and cutting costs by more than half.

Dartmouth-Hitchcock has also been the recipient of grants from the New Hampshire Charitable Foundation and the March of Dimes to develop programs and materials to treat pregnant women with opioid use disorders.