Diagnosis and treatment of substance use disorder among pregnant women in three state Medicaid programs from 2013 to 2016

Lynch, Victoria; Clemans-Cope, Lisa; Howell, Embry; Hill, Ian

doi:10.1016/j.jsat.2020.108265

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…6 Rates of substance use disorders (SUDs) among pregnant and parenting women are concerningly high, particularly among lowincome women. One study examining three state Medicaid programs from 2013 to 2016 found 11.3% of postpartum women had a SUD, 7 and an examination of delivery hospitalizations between 2000 and 2018 revealed that the prevalence of SUD diagnoses has been increasing. 1 Among those who achieved abstinence in the last month of pregnancy, rates of relapse can be as high as 80% in the two years after delivery.…”

Section: Background Prevalence Of Perinatal Substance Usementioning

confidence: 99%

Study Protocol for a Randomized Controlled Trial of the Parent Child Assistance Program: A Case Management and Home Visiting Program for People Using Substances During Pregnancy

Maher,

Stoner,

Gerlinger

et al. 2024

Preprint

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Background Perinatal substance use can have significant adverse effects on maternal and child health and family stability. Few interventions are specifically designed to address this significant public health problem. The Parent-Child Assistance Program (PCAP) is a three-year case management and home-visiting intervention that seeks to help persons with at-risk substance use during pregnancy to achieve and maintain substance use disorder recovery and avoid exposing future children to substances prenatally. Although the program has consistently shown substantial pre- to post-intervention improvements in its participants, PCAP remains to be tested with a rigorous randomized controlled trial (RCT). This study protocol describes a randomized controlled trial that aims to examine the effectiveness of the intervention compared to services as usual in affecting primary outcomes related to substance use and family planning. Secondary outcomes will concern connection to recovery support services and family preservation. Methods Using an intent-to-treat design, the study will recruit from two metro areas in Oklahoma and enroll 200 individuals who are pregnant or up to 24-months postpartum with at-risk substance use during their current or most recent pregnancy. Participants will be randomly assigned, stratified by location, to receive either PCAP or services as usual for three years. Participants in the PCAP condition will meet with their case manager approximately biweekly over the course of the intervention period, in their local communities or in their own homes whenever possible. Case managers will assist with goal setting and provide practical assistance in support of participants’ goals. Primary and secondary outcomes will be assessed at baseline and 12, 24, and 36 months post-baseline using the Addiction Severity Index interview and a self-administered survey. Discussion Results from this trial will help to gauge the effectiveness of PCAP in improving parent and child well-being. Results will be reviewed by federal clearinghouses on home-visiting and foster care prevention to determine the strength of evidence of effectiveness with implications for federal financing of this program model at the state level. Trial Registration: This study was registered at clinicaltrials.gov (NCT05534568) on 6/8/2022.

show abstract

Section: Background Prevalence Of Perinatal Substance Usementioning

confidence: 99%

Study Protocol for a Randomized Controlled Trial of the Parent Child Assistance Program: A Case Management and Home Visiting Program for People Using Substances During Pregnancy

Maher,

Stoner,

Gerlinger

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Rates of substance use disorders (SUDs) among pregnant and parenting women are concerningly high, particularly among low-income women. One study examining three state Medicaid programs from 2013 to 2016 found 11.3% of postpartum women had a SUD [ 7 ], and an examination of delivery hospitalizations between 2000 and 2018 revealed that the prevalence of SUD diagnoses has been increasing [ 1 ]. Among those who achieved abstinence in the last month of pregnancy, rates of relapse can be as high as 80% in the 2 years after delivery [ 8 ].…”

Section: Background {6a}mentioning

confidence: 99%

Study protocol for a randomized controlled trial of the Parent–Child Assistance Program: a case management and home visiting program for people using substances during pregnancy

Maher,

Stoner,

Gerlinger

et al. 2024

Trials

View full text Add to dashboard Cite

Background Perinatal substance use can have significant adverse effects on maternal and child health and family stability. Few interventions are specifically designed to address this significant public health problem. The Parent–Child Assistance Program (PCAP) is a 3-year case management and home-visiting intervention that seeks to help birthing persons with at-risk substance use during pregnancy to achieve and maintain substance use disorder recovery and avoid exposing future children to substances prenatally. At-risk refers to a level of substance use that creates problems in the individuals’ lives or puts them or their children at risk of harm either prenatally or postnatally. Although the program has consistently shown substantial pre- to post-intervention improvements in its participants, PCAP remains to be tested with a rigorous randomized controlled trial (RCT). This study protocol describes a randomized controlled trial that aims to examine the effectiveness of the intervention compared to services as usual in affecting primary outcomes related to substance use and family planning. Secondary outcomes will concern connection to recovery support services and family preservation. Methods Using an intent-to-treat design, the study will recruit from two metro areas in Oklahoma and enroll 200 birthing individuals who are pregnant or up to 24 months postpartum with at-risk substance use during their current or most recent pregnancy. Participants will be randomly assigned, stratified by location, to receive either PCAP or services as usual for 3 years. Participants in the PCAP condition will meet with their case manager approximately biweekly over the course of the intervention period, in their local communities or in their own homes whenever possible. Case managers will assist with goal setting and provide practical assistance in support of participants’ goals. Primary and secondary outcomes will be assessed at baseline and 12, 24, and 36 months post-baseline using the Addiction Severity Index interview and a self-administered survey. Discussion Results from this trial will help to gauge the effectiveness of PCAP in improving parent and child well-being. Results will be reviewed by federal clearinghouses on home-visiting and foster care prevention to determine the strength of evidence of effectiveness with implications for federal financing of this program model at the state level. Trial registration ClinicalTrials.gov NCT05534568. Registered on 6/8/2022.

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“…Previous studies have established the detrimental effects of substance use on neonatal outcomes, including increased risk of congenital anomalies, impaired growth, neonatal abstinence syndrome, and potential long-term intellectual disability [6] . Pregnant patients with SUD are at risk of insufficient or late presentation to prenatal care, increased utilization of emergency department visits, and APOs [7] , [8] . Previous studies have failed to provide an in-depth understanding of the impact of SUD on individual APOs.…”

Section: Introductionmentioning

confidence: 99%

Perinatal substance use disorder: Examining the impact on adverse pregnancy outcomes

Ragsdale,

Al-Hammadi,

Loux

et al. 2024

European Journal of Obstetrics & Gynecology and Reproductiv

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Diagnosis and treatment of substance use disorder among pregnant women in three state Medicaid programs from 2013 to 2016

Cited by 6 publications

References 24 publications

Study Protocol for a Randomized Controlled Trial of the Parent Child Assistance Program: A Case Management and Home Visiting Program for People Using Substances During Pregnancy

Study Protocol for a Randomized Controlled Trial of the Parent Child Assistance Program: A Case Management and Home Visiting Program for People Using Substances During Pregnancy

Study protocol for a randomized controlled trial of the Parent–Child Assistance Program: a case management and home visiting program for people using substances during pregnancy

Perinatal substance use disorder: Examining the impact on adverse pregnancy outcomes

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