Background & Goals
In the US, the number of perinatal women with a substance use disorder (primarily opioid) has dramatically increased over the past decade and continues to escalate. The Appalachia region, and Kentucky in particular, lead the nation in perinatal substance use disorders (SUDs). This epidemic has profound immediate and lifelong maternal and child health implications, including neonatal abstinence disorder. However, the majority of pregnant women are unable to access essential services and private Medication Assisted Treatment (MAT) clinics often have long wait lists with cost-prohibitive feeds.
Thus, a multifaceted, interdisciplinary and collaborative approach is critical to addressing the complexities of treatment and support services for individuals addicted to opioids during pregnancy. Nurses are foundational in providing the "vision" and the "glue" to create, operationalize and sustain comprehensive treatment and support for these deserving women and their families. Currently, PATHways and Beyond Birth programming is reaching 38 of the 100-low resource, high need KY counties.
PATHways and Beyond Birth are innovative programs provide comprehensive, trauma informed wrap around support to women with SUD and their children, provided by nursing, social work, obstetrics, psychiatry, behavior health, pediatrics, family practice and hepatology. This model’s innovative approach of effective transdisciplinary collaboration is the key component that has allowed the programs to become sustainable. Beyond Birth is within the University of Kentucky Supportive Mental Health and Addiction Recovery Treatment program (SMART Clinic).
The model also goes beyond perinatal treatment, with Beyond Birth providing services up to 5 years after birth. The perinatal nurse facilitator and peer support team is the ‘’primary glue’ to the program. This team leads weekly perinatal education and addiction recovery sessions, provides trauma-informed individual counseling, referrals to community resources to improve their access and to safe housing, and job training and/or secondary education all while coordinating a peer-mentoring program with participants who has successfully maintained recovery for 12 months.
PATHways and Beyond Birth are two partner programs that were developed and created with an interdisciplinary team of healthcare professionals and led by the University of Kentucky (UK) College of Nursing, Perinatal Research and Wellness Center team in collaboration with UK Department of Maternal-Fetal Medicine and Psychiatry. From 2013-2020, Federal, State and University funding and private funding provided an infrastructure to create the PATHways and Beyond Birth programs for perinatal women with SUD. To date, these successful and sustainable programs continue to provide comprehensive treatment and support services to perinatal women despite grant funding ending due to unique partnerships.
Evidence of Success
When compared to a matched cohort of women prior to and after implementation, women in PATHways carried their infants longer gestation (p = .035), and their babies were less likely to experience NAS (p<.001). Further, the nurse facilitator-peer sessions were the only component of PATHways that significantly impacted relapse rates (e.g. for every one additional session increase, women were 15% less likely to relapse).
In a comparison study of 64 NICU/NACU infants whose mother’s participated in PATHWAYS, only 2 infants required medication for NAS compared to 12 of those that were not. Further, PATHWAYS infants had a length of stay 7 days shorter than those not enrolled in the program.
PATHWAYS and Beyond Birth have served over 600 perinatal women in the past 7 years.