A fledgling program at Kalispell Regional Healthcare to put a behavioral health specialist on the hospital's obstetrics team is part of an expanded initiative to help reduce drug and alcohol use among expectant and new mothers.
Leslie Nyman, director of behavioral health at the hospital, told a group gathered in Helena last week that while Kalispell is just six months into the project, there are already some signs it will improve outcomes for pregnant women, moms and babies.
Nyman spoke as part of a summit kicking off a new public-private initiative aimed at reducing the harm from drug and alcohol use during pregnancy that includes the state Department of Public Health and Human Services and Montana Healthcare Foundation.
The project aims to encourage the use of team-based care that coordinates among all the different types of doctors a pregnant woman sees and brings in social service agencies when necessary to tap their resources.
This year, the foundation released a report tying together rising incidents of drug abuse in the weeks before and after giving birth with the increase in children placed in foster care.
Perinatal drug abuse jumped from a rate of nearly 4 percent in 2010 to 12.3 percent in 2016. Meanwhile, the number of children in foster care doubled over the last five years, reaching more than 3,400 in 2017.
Despite that, the report found, only 6 percent of substance use disorder facilities that can bill Medicaid will work with pregnant women.
Aaron Wernham, chief executive officer of the Montana Healthcare Foundation, said there’s not a centralized database for statistics on perinatal drug and alcohol use in Montana, but medical centers, doctors and communities around the state have growing concerns.
“What we do know is when we talk to communities about the health issues that concern them most, this is the single most frequently raised issue, raised at the top of almost all community health assessments and community health needs assessments done in the state over the last couple of years.”
Wernham said while Medicaid expansion has created a way for lower-income Montanans to access treatment, many medical practices don’t screen for substance use disorder issues and there's a shortage of treatment options.
Pregnancy might be the best time to convince a mother to seek treatment, Wernham said. But it can be a delicate period where women can pivot away from health care if they feel embarrassed or ashamed.
Nyman said her doctors in Kalispell observed that, but the new team-treatment approach has helped create strong relationships among women, doctors and social workers.
“When mom’s pregnant, that moment is the biggest window opening we might get for that mom becoming motivated to get treatment and support in an environment that’s not punishing and is seen as helpful,'' she said. "Having that relationship in the clinic, where they go for nine months for very, very intimate talks and exams, is the opportunity to help find out those things and solve those problems. This is an opportunity in our state to make a big difference. People are listening.”
The new initiative builds on a program Kalispell launched four years ago to better coordinate care between obstetrics and addiction treatment services, with an emphasis on connecting women to social services.
Hospital data show that effort led to a 70 percent drop in the number of children born in the hospital who were placed in foster care and shorter stays for babies in the neonatal intensive care unit.
“They got some great outcomes. They felt there were less removals from (child protective services)," Nyman said. "But the bigger outcome is ... (the providers) got to see those moms in a different way. They got to see they cared about their child, wanted their child and were doing whatever they could to keep the baby.”
The new program capitalizes on the previous efforts and is centered around putting a behavioral health employee on the obstetrics team. The person in that position started two months ago. With a grant from the foundation, the employee will eventually incorporate behavioral health and substance use disorder screenings into the regular obstetrics process and has already started working to connect moms with treatment and services.
Kalispell Regional Healthcare hasn’t started reporting data on its new program, but Nyman said she eagerly anticipates data that can show what’s happening and help hospitals around the state learn what works, what doesn’t and where to best spend time and money.
One change Nyman's already observed is that by working more closely with state child protective service workers, doctors are gaining a better understanding of the work they do.
"We’re building a better relationship between providers and child protective workers," Nyman said. “They’re here to help you keep your baby, they’re not here to take the baby away."
Montana Gov. Steve Bullock told providers and social workers gathered at the summit Tuesday that if the project is successful, it won't just reduce the number of children in foster care but will change the future landscape.
“Child well-being isn’t all that’s at stake,” Bullock said. “Really what you’re doing is setting the platform for the future prosperity of our state.”