by Jo Dee Gottlieb, Todd Davies, and Shanen Wright
America’s opioid epidemic has permeated into almost every corner of the country. As with epidemics of the past, children are the most vulnerable to the detrimental health effects brought about by widespread drug use. This is most severe in West Virginia, which has the highest incidence of Neonatal Abstinence Syndrome (NAS) in the nation—33.4 per 1,000 babies (Ko et al., 2016)—with a consequent inundation of the foster care system (Child Welfare Information Gateway, 2014). But Huntington, West Virginia, labeled by news agencies as “America’s drug death capital” (Drash & Blau, 2016), has started to turn the tide through a coordinated community effort to provide treatment services for the entire family.
Let’s start by looking at the average mother who has entered the Maternal Addiction Recovery Clinic (MARC) at Marshall University Health Services in Huntington for prenatal care. We’ll call her “Lucy.”
Lucy is a 28-year-old woman with hepatitis C who is pregnant with her third child. She smokes a pack of cigarettes a day, has used heroin for several years, and has a major depressive disorder. Her two other children are in the custody of her mother. Lucy has completed one semester of college in hopes of being a nurse. She enters MARC’s Medication Assisted Treatment (MAT) program in the ninth week of her pregnancy and has failed three previous attempts in recovery programs. Lucy wants to save her baby, but is afraid of being labeled, losing her baby to child protective services, and the pain associated with withdrawal. For the first few weeks, Lucy sits quietly in group sessions, but begins engaging in supportive conversation with her peers more and more until, after about 12 weeks, she begins to stabilize on treatment and produce consistently negative drug screens.
Lucy’s baby is born exhibiting symptoms of NAS. The baby shows an elevated temperature, sweating, tremors, irritability, excessive crying, hyperactive Moro reflex, myoclonic jerks, skin mottling, sleep disturbances, vomiting, sneezing, abdominal cramping, excoriation, yawning, diarrhea, tachypnea, poor feeding, and excessive/disorganized suck (Behnke, Smith, et al., 2013). The baby is experiencing withdrawal symptoms and needs special care from Lily’s Place, a neonatal abstinence care center in Huntington that uses therapeutic handling methods along with best-practice weaning techniques.
After a few weeks, the baby is stable and is released into Lucy’s custody following completion of a Child Protective Services (CPS) assessment. Without the stability provided by the MAT program while she was pregnant, Lucy’s baby would have had a high likelihood of being remanded to the state’s custody.
Lucy is an amalgamation of hundreds of women who participate in MAT programs in Huntington annually. Some are successful, like Lucy; some are less successful. Lucy’s baby represents approximately one in five children who are born prenatally exposed to neuroactive substances in the community of Huntington (Loudin et al., 2017). Each baby born with NAS exhibits different symptoms, and while the symptoms may wane after a few weeks with proper care, the long-term effects are not known (Andrews, Davies, Foote-Linz, & Payne, 2018). As the number of babies born with NAS continued to grow, so did Huntington’s concerns and efforts to address the challenge. The community was struggling to figure out how to address the opioid crisis that came on sudden and hard. Resources to treat NAS were still being developed and health care professionals were concerned about babies being released into uncertain environments. Educators were concerned about the number of children affected by NAS entering the school system. Each group was doing its best to address the issues from their own perspective. But often, programs were developed in isolation and ended up competing for resources.
Then, in 2017, a group of health care professionals started talking about what happens when these babies go home and what supports could be put in place for the babies and their caregivers. A collaborative effort began to form, with more and more professionals, stakeholders, and leaders meeting regularly to share strategies. This led to the birth of Healthy Connections, a community coalition designed to serve women struggling with substance use disorder.
Healthy Connections recently began providing direct care navigation services to women and their families and kinships. In our scenario, Lucy’s recovery through Healthy Connections starts with meeting with a social work-trained Family Navigator who conducts a comprehensive psychosocial assessment of Lucy’s needs. The Family Navigator connects Lucy to a peer support coach, to a support group for similar mothers, and offers her options for recovery services. With her permission, the Family Navigator also reaches out to the baby’s father and the extended family to facilitate family connections and build a healthy network for the baby while supporting the mother in her recovery.
The Family Navigator collaborates with CPS to promote safety and stability and offers Lucy the services of Healthy Connections’ Knowledge in Developmental Steps (KIDS) Clinic. The KIDS Clinic helps children build healthy brains and bodies through healthy relationships early in life. It provides a pediatrician, pediatric neurologist, psychologist, physical therapist, speech language pathologist and social worker all in a one-stop location for children needing these services. Lucy’s baby is also enrolled in Healthy Connection’s River Valley Center for Addiction Research, Education, and Support (CARES), a specialized child development program designed for children age birth to two who experienced NAS. These services continue through the first five years of the Lucy’s child’s life at which time Healthy Connections collaborates with the educational system to make a smooth transition into school.
The Healthy Connections wraparound approach to helping families with a wide range of needs became a reality in 2018. The coalition has continued to grow and gain support from faith-based leaders, law enforcement, public and private health care systems, schools, policy-makers, researchers/scientists, and those affected by substance use disorder. The group not only provides direct services for families, but also advocates for the expansion of treatment services and policy change, researches and implements best practices, and seeks to eliminate substance use disorder stigma by educating health care professionals, service providers, local media, and the general public. Healthy Connections also coordinates its efforts with a wide variety of other community initiatives that include prevention programs, harm reduction, continuum of recovery programs, school-based services, and the implementation of Screening/Brief Intervention/ Referral to Treatment (SBIRT) to address substance use disorder.
We do not yet fully understand long-term effects of NAS or why its severity varies from child to child. So Healthy Connections’ researchers are collecting data that will help us better understand and develop prevention and treatment strategies that can be replicated across the nation and around the world. The group is also developing a social marketing campaign to help mothers like Lucy get the services they need and reduce overall substance use disorder stigma in the community. Researchers also will measure the effectiveness of messaging and media type to determine the best way to market services to women like Lucy and create an environment conducive to positive change.
While Huntington may be the epicenter of nation’s opioid epidemic, it’s also at the forefront of developing strategies that can be replicated to help turn the tide nationwide. To learn more, please visit www.HealthyConnectionsWV.org.
Jo Dee Gottlieb, MSW, LCSW, serves as director for the Bachelor of Social Work program within the College of Health Professions at Marshall University. She earned her MSW at University of Pittsburgh and has been a licensed social worker for over 30 years. Her practice experience includes work in mental health, family preservation, children’s services, and medical social work. She is the coordinator of Title IVE Child Welfare Program at Marshall University, and serves on Board of Directors for TEAM for WV Kids and on the advisory board for Healthy Connections.
Todd Davies is the Director of Research Development and Translation and manages the Marshall Clinical Research Center, a newly developed hub for clinical trial activity, at Marshall University. In addition, he works on with building translational protocols for research at Marshall and developing a rural research network throughout Central Appalachia.
Shanen Wright serves as Quality Insights’ Director of Innovation, a role that involves leading multiple strategic initiatives, including efforts to infuse science, developing and facilitating the organization’s innovation engine and overseeing Quality Insights’ relationship with Healthy Connections. He has also directed Quality Insights’ Home Health Quality Improvement National Campaign for more than ten years, and has more than 20 years of healthcare social marketing and branding experience.
Andrews, L., Davies, T. H., Foote-Linz, M., & Payne, M. (2018). Polydrug Abuse and Fetal Exposure: A Review. Journal of Pediatric & Child Health Care, 3(1), id1019.
Behnke, M., Smith, V. C., et al., (2013). Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009-1024. doi:10.1542/peds.2012-3931
Child Welfare Information Gateway. (2014). Parental substance use and the child welfare system. Washington, DC: Author. Retrieved from https://www.childwelfare.gov/pubs/factsheets/parentalsubabuse.cfm
Drash, W., & Blau, M. (2016). In America’s drug death capital: How heroin is scarring the next generation. CNN Health. Retrieved from https://www.cnn.com/2016/09/16/health/huntington-heroin/index.html
Ko, J. Y., Patrick, S. W., Tong, V. T., Patel, R., Lind, J. N., & Barfield, W. D. (2016). Incidence of Neonatal Abstinence Syndrome – 28 States, 1999-2013. MMWR Morb Mortal Wkly Rep, 65(31), 799-802. doi:10.15585/mmwr.mm6531a2
Loudin, S., Werthammer, J., Prunty, L., Murray, S., Shapiro, J. I., & Davies, T. H. (2017). A management strategy that reduces NICU admissions and decreases charges from the front line of the neonatal abstinence syndrome epidemic. J Perinatol. doi:10.1038/jp.2017.101