CCO launches treatment program for expectant moms with addictions

Portland Business Journal, April 29, 2015

pregnancyWomen addicted to heroin or who have other substance abuse problems are often very reluctant to seek out prenatal care when they get pregnant.

Portland-based Health Share of Oregon is trying to overcome that attitude by creating a safe environment. The largest Coordinated Care Organization, Health Share used part of its $3.26 million state Transformation Fund grant to get Project Nurture off the ground.

“When we created Project Nurture, there wasn’t a place where women could get respectful, nonjudgmental care while they were struggling with addiction,” said Dr. Helen Bellanca, Health Share’s Maternal Child Family Program Manager.

Project Nurture is up and running at two sites — the Legacy Midwifery Clinic and CODA’s Portland Recovery Center. LifeWorks Northwest is collaborating with Legacy to provide the addiction piece at that site. CODA, the oldest opioid addiction treatment program in Oregon, is partnering with Oregon Health & Science University’s Family Medicine.

Project Nurture is an outgrowth of conversations that began two years ago, when Bellanca asked maternal health providers about gaps in care.

“Consistently, across the board, (we heard) when women have mental health or substance abuse issues, the system is not set up to meet their needs,” Bellanca said.

Health Share, who provides Medicaid services to 252,272 members, already had several initiatives in place focused on mental and maternal health. The original goal with Project Nurture was to bring addiction experts into maternity clinics.

Then CODA approached Health Share about turning the model around and providing the services at its center, where it runs a methadone program. Methadone and other medication-assisted therapies for opioid addicted pregnant women are “very safe” and the recognized standard of care, said Alison Noice, CODA’s director of addiction medicine treatment.

“It’s the opioid withdrawal that puts the baby at the great risk,” Noice said.

Each site has enrolled about eight women in the program. At least 20 more are eligible.

“They’re reluctant to sign up for various reasons,” Bellanca said. “Either they’re not at a place in their addiction where they’re interested, or they feel vulnerable about having their child removed.”

Bellanca said the goal is to keep the moms and babies together. Often, these women don’t show up for medical care until it’s time to deliver. The cost can be three times higher, too, since their infants often are premature and end up in neonatal intensive care and are later placed in foster care.

“When they avoid prenatal care, something is more likely to go wrong,” Bellanca said.

Project Nurture includes peer support, individual care, breastfeeding support and well baby visits. Bellanca said she hopes the program grows to three or four sites. Another family medicine clinic has expressed interest.

Health Share invested around $120,000 at each site for the first year. Then the goal is for them to be self-sustaining. CODA has other grant funding as well.

Bellanca said the women will be tracked to see if pre-term birth rates go down and if there’s a cost savings.