Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women

Hand, Dennis J.; Fischer, Alice; Gannon, Meghan; McLaughlin, Kimberly A.; Short, Vanessa L.; Abatemarco, Diane J.

doi:10.1080/09540261.2021.1908966

Cited by 6 publications

(6 citation statements)

References 80 publications

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“…Navigators often worked collaboratively with clients to identify their goals and priorities [1,2,5,8,13], and develop skills such as self‐management and behavioral change [2,4,9,13]. For example, in the MATER program for mothers with OUD [2], navigators provide clients with “a mindfulness journal, daily planner … laying the groundwork for recovery behaviors, such as developing coping skills through journaling, brief mindfulness practice, and creating daily plans” (Hand et al., 2021, p. 516).…”

Section: Resultsmentioning

confidence: 99%

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review

Harris,

Harrison,

Hazell‐Raine

et al. 2023

Infant Mental Health Journal

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Patient navigation (PN) aims to improve timely access to healthcare by helping patients to “navigate” complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.

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Section: Resultsmentioning

confidence: 99%

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review

Harris,

Harrison,

Hazell‐Raine

et al. 2023

Infant Mental Health Journal

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“…33 Medical provider visit attendance decreased over the 3 COVID-19 phases yet remained relatively high; this is especially notable when considering the unique challenges pregnant and parenting people with SUD face. 14,34 We hypothesize that our expansion of patient-centered, recovery-oriented strategies, such as flexibility in visit type, contributed to the relatively high treatment engagement across the COVID-19 phases. Notably, many participants were pregnant in the first phase, but not in the third phase, which likely contributed to the decrease in medical provider visits independent of COVID-19 because visit frequency typically decreases postpartum.…”

Section: Discussionmentioning

confidence: 99%

“…The study clinic site continues to use a hybrid telehealth/in-person model and low-threshold, flexible buprenorphine prescribing options. Improving clinical communication and workflow with virtual capabilities may help improve well-being among healthcare workers, as burnout is a growing concern 34,40 …”

Section: Discussionmentioning

confidence: 99%

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Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

et al. 2022

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ObjectiveThe COVID-19 pandemic prompted healthcare delivery changes, but the associated impacts on substance use disorder treatment outcomes among pregnant and parenting people are unknown. This study aims to (1) describe COVID-19–driven clinical practice changes, (2) evaluate clinic-level visit attendance patterns, and (3) compare patient-level treatment engagement outcomes across 3 COVID-19 pandemic phases in an OBGYN-addiction treatment clinic.MethodsCOVID-19 phases include pre–COVID-19 (August 2019–February 2020), early COVID-19 (March–December 2020), and COVID-19 vaccine (January–July 2021). OBGYN-addiction treatment clinical practice changes were summarized. Clinic-level attended medical provider visits were analyzed. Patient-level treatment engagement outcomes (buprenorphine continuation, visit attendance, and virtual visits) were assessed in a cohort of pregnant and parenting people enrolled in a clinic research registry. Mixed-level logistic regression models determined the relationship between the COVID-19 phases and the patient-level outcomes.ResultsThe study site made several COVID-19–driven clinical practice changes, including implementing a hybrid virtual/in-person system for medical visits. Clinic-level medical provider appointments increased between the first and second COVID-19 phases and remained high in the third phase. Among participants included in patient-level outcome analyses (N = 27), there were no differences in the early COVID-19 phase compared with the pre–COVID-19 phase in buprenorphine continuation, any visits, or medical visits. There was a decrease in all patient-level outcomes in the COVID-19 vaccine phase compared with pre–COVID-19 (P < 0.05). Virtual visits increased between the first 2 phases and remained high during the third.ConclusionWithin our OBGYN-addiction treatment clinic, implementation of tailored, patient-centered treatment strategies supported clinic- and patient-level treatment engagement throughout the pandemic.

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“…In response to this opportunity for treatment engagement, there has been a call for a comprehensive and compassionate response to address contextual factors contributing to OUD and support families impacted by the ongoing opioid crisis (Hand et al, 2021). A comprehensive approach to prenatal opioid use (2021) emphasizes the role of poverty, adverse childhood experiences, historical trauma, and stigma on the understanding of the context of perinatal OUD.…”

Section: Introductionmentioning

confidence: 99%

An Integrated Mechanistic Model of Mindfulness-Oriented Recovery Enhancement for Opioid-Exposed Mother–Infant Dyads

et al. 2021

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A growing body of neurobiological and psychological research sheds light on the mechanisms underlying the development and maintenance of opioid use disorder and its relation to parenting behavior. Perinatal opioid use is associated with risks for women and children, including increased risk of child maltreatment. Drawing from extant data, here we provide an integrated mechanistic model of perinatal opioid use, parenting behavior, infant attachment, and child well-being to inform the development and adaptation of behavioral interventions for opioid-exposed mother–infant dyads. The model posits that recurrent perinatal opioid use may lead to increased stress sensitivity and reward dysregulation for some mothers, resulting in decreased perceived salience of infant cues, disengaged parenting behavior, disrupted infant attachment, and decreased child well-being. We conclude with a discussion of Mindfulness-Oriented Recovery Enhancement as a means of addressing mechanisms undergirding perinatal opioid use, parenting, and attachment, presenting evidence on the efficacy and therapeutic mechanisms of mindfulness. As perinatal opioid use increases in the United States, empirically informed models can be used to guide treatment development research and address this growing concern.

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Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women

Cited by 6 publications

References 80 publications

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review

Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review

Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

An Integrated Mechanistic Model of Mindfulness-Oriented Recovery Enhancement for Opioid-Exposed Mother–Infant Dyads

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