The Experience of Intimate Partner Violence Among Pregnant Women Seeking Treatment for Opioid Use Disorder

Introduction: Intimate partner violence (IPV) is a major health issue among those with substance use disorder. A history of partner violence is associated with increased health problems and less improvement in treatment. The perinatal period is a time of increased risk of IPV for women, as well as a key opportunity for opioid use disorder treatment intervention. The purpose of this study is to characterize the experience of partner violence and evaluate the typology of sequelae associated with it in a population of pregnant women seeking medication assisted treatment for opioid use disorder. Methods: The population of interest in this study is pregnant or parenting women seeking treatment for opioid use disorder at MATER, a comprehensive addiction treatment center in Philadelphia, PA. The main data source used was the Biopsychosocial Document, a form completed by patients upon entry into the program. Data from 168 respondents were used to capture the frequency and character of intimate partner violence as well as related sequelae. Descriptive statistics including means and standard deviations for continuous data and count and percent frequencies for categorical data, will be used to describe the data. Results: Experience of IPV was very common among the study population, with 62.3% of participants reporting abuse as an adult. Among women who had experienced IPV, the types of abuse with the most frequency were physical (87.9%) and sexual (66.7%). The full spectrum of abuse including psychological, financial, and stalking was observed. Of note, even among those respondents who did not self-report IPV, rates of abuse subtypes were non-zero. This study will further analyze recent drug use, previous treatment attempts, sexual exploitation, and experience of childhood abuse and their associations to violence experienced as an adult. Conclusion: Opioid use disorder treatment programs are likely to engage women experiencing intimate partner violence, and treatment initiation represents an important area of potential intervention. Next steps should include qualitative interview-based research into this population’s experience of intimate partner violence to further elucidate best methods of support

Examining the Associations Between Addiction Severity and Prior Adverse Childhood Experiences in Pregnant Women Receiving Treatment for Opioid Addiction

Introduction: Opioid use during pregnancy poses risk to both the mother and fetus, including fetal loss and pre-term birth. Prior research suggests that adverse childhood experiences (ACEs) are a plausible antecedent to opioid abuse. However, there is insufficient understanding of the association between prior ACEs, familial history of substance use, and treatment outcomes in pregnant women receiving treatment for opioid addiction. Methods: A retrospective chart review will be used to review data from 167 MATER patients who entered treatment between 1997 and 2017. Descriptive statistics will be utilized to characterize the study population. Regression and chi-square analyses will be conducted to establish whether demographic factors and history of substance use differ as a function of child abuse. Results: We expect to observe a positive association between number of ACEs, number of family members with a history of substance use, duration of treatment, and number of relapses. We anticipate that demographic variables such as race and education will moderate this association. Conclusion: Understanding what associations may exist between ACES and addiction severity could identify potential interventions to improve psychosocial health and quality of parenting behaviors in pregnant women who are receiving treatment for opioid addiction. Additionally, having this understanding could improve treatment outcomes for patients and providers’ ability to deliver trauma-informed care

Prevention, Intervention and Evaluation of Maternal Child Health Programs and Practices

PowerPoint presentation given by Diane Abatemarco, PhD, MSW

Office Based Prevention of Child Abuse and Neglect: Lessons Learned from the Practicing Safety QuIIN Project

Parental behavior effects child psychosocial development. Parents who once had the benefits and supports of extended families and communities are now more isolated in their parenting. The isolation of families increases stress. New parents receive little education and support to deal with stress and the added stress of a newborn or their very young children. This poster presentation will describe a quality improvement project based in pediatric practices. The study was designed to test methods to increase anticipatory guidance, screening, and referral for psychosocial development. The project included physician use of chart data to identify outcomes of their enhanced care. The study included quantitative and qualitative methods (i.e. in depth interviews surveys, etc.) to determine physician adoption of prevention bundles. 15 practices throughout the U.S. adopted new practices to screen and refer for maternal depression, infant crying, toileting and discipline. Physicians do not typically use the chart data to inform their practices but will if prompted as shown in this study. Outcome measures such as developmental assessments can be used by physicians to determine the impact and quality of care of interventions on child health. This work demonstrates that physicians can play an important role with the use of enhanced tools to treat the “new morbidities” that arise in the first three years of life

More Social Needs Endorsed by Caregivers of Young Children Experiencing Everyday Discrimination

Background: Both discrimination and social needs are underlying risk factors for poor health outcomes; however, there are no studies looking at how feelings of discrimination impact reporting of social needs in the pediatric health care setting. Objective: To compare caregiver report of social needs and desire for help addressing social needs in the pediatric primary care setting based on respondents’ experiences with discrimination. Methods: We conducted a cross-sectional study of caregivers of children aged 2-5 in an urban primary care setting. Caregivers completed a tool to screen for 15 social needs and desire for help to address these needs, with in-person assistance available. The tool was adapted based on qualitative data with this same population and included items from the PHQ-2, 2-item food insecurity screener, and WE CARE survey. The short version of the “Everyday Discrimination Scale” was also completed, and caregivers were categorized as experiencing everyday discrimination if they responded “rarely”, “sometimes”, or “often” on any of 5 types of discrimination. If caregivers experienced everyday discrimination, they were also asked about perceived basis for discrimination. T-tests were conducted to compare the number of reported social needs and number of needs for which a caregiver desired help between groups based on experience of everyday discrimination and type of discrimination. Results: One hundred seventy-eight caregivers (94% mothers, mean age 32) of diverse racial and ethnic backgrounds (29% white, 61% black; 10% Hispanic) completed the screening tool. Sixty-seven percent had public insurance, and 35% were from households with an annual income below $20,000. Fifty-three percent of caregivers reported everyday discrimination, especially in regards to being treated with less respect and receiving poorer service in stores and restaurants (Figure 1) and most commonly on the basis of race (48%), gender (38%), and age (31%). Both caregivers who endorsed everyday discrimination in general, and those endorsing discrimination specifically by gender and age, reported a significantly higher number of social needs and number of social needs for which they wanted help (Table 1). Conclusions: In an urban population of mostly young Black mothers, the majority endorsed feeling some degree of everyday discrimination. Despite this, caregivers who endorsed feelings of discrimination, especially because of their gender and age, reported more social needs and a greater desire for help addressing these needs. This suggests that caregivers feel comfortable reporting sensitive social needs in the context of a child’s healthcare setting even though they may experience everyday discrimination. These findings may also suggest an association between experienced discrimination and social needs, with both potentially influenced by similar sociodemographic factors

Maternal Stress and Breastfeeding Intention in Pregnant Women with Opioid Use Disorder

Introduction: Breastfeeding rates are low among women in treatment for opioid use disorder (OUD). Information on determinants of breastfeeding intention can help inform the design of breastfeeding promotion interventions for this population. The objective of the study was to examine associations between maternal characteristics, including stress, and breastfeeding intention among pregnant women in treatment for OUD. Methods: Fifty-six pregnant women who were receiving treatment for OUD at Thomas Jefferson University’s Maternal Addiction Treatment Education & Research (MATER) program completed a survey, which included questions on demographics, psychosocial characteristics, breastfeeding history, and breastfeeding intention. Maternal stress was measured using the Perceived Stress Scale-10 (PSS). Characteristics and PSS scores were compared between women who intended to breastfeed and women who did not. ­­­­ Results: The majority of the participants were white (63.2%), smoked (73.7%), in committed relationships (56.1%), and with at least one other child (70.2%). Total PSS scores were not significantly different between women with intention to breastfeed and women without (19.9 vs. 19.6, P=0.874). Breastfeeding intention was higher in women who had a history of breastfeeding (94.5% vs 61.9%, P=0.021). Women who smoked were less likely to report breastfeeding intention than women who did not smoke, though results were not statistically significant (74.4% vs 80%, P=0.739). Conclusion: Future studies with larger sample sizes would be useful to further evaluate the association between breastfeeding history and breastfeeding intention. If an association is found, future interventions promoting breastfeeding in women undergoing treatment for OUD could focus on women who have not previously breastfed

Treatments for opioid use disorder among pregnant and reproductive-aged women.

The increased prevalence of opioid use disorder and access to medical insurance is subsequently increasing the likelihood that medical professionals will encounter individuals with opioid use disorder. Sharp increases in opioid use disorder among women mean that obstetricians, gynecologists, and other reproductive medicine providers may be especially likely to encounter such patients. Medical professionals\u27 understanding of treatment for opioid use disorder and their roles in their patients\u27 treatment may increase referrals to treatment, reduce stigma, and improve the quality of medical care. Treatment for opioid use disorder falls into four overlapping domains: medication management, medical care, behavioral/mental health care, and psychosocial support. In this review, we discuss these domains with an emphasis on pregnant women and women of reproductive age. Treatment for opioid use disorder is most effective when all providers coordinate care in an informed, nonjudgmental, patient-centered approach

Assessing the Role of Virtual Social Networks in the Treatment Progress of Mothers Recovering from Opiate Addiction

Introduction: Social engagement is a significant contributor to the treatment success of individuals with prior substance use. This project aims to determine if social engagement improves the progression through and experience of treatment of mothers with prior opioid use at an inpatient recovery facility. We hypothesize that increased social engagement will improve treatment progress and experience. Methods: The project is centered on mothers seeking treatment for opioid use at an urban inpatient treatment facility. The study obtains qualitative and quantitative data through interviews and therapy sessions. The data informs the extent and quality of social engagement and individual perspectives of the facility residents on their current social engagement. The data was evaluated for major themes and analyzed using basic statistics (mean and mode). Results: 92.35% of social engagement discussions in therapy sessions were neutral or positive, and 45% of interviewees were interested in family therapy. The average number of support persons mentioned during each therapy session was 1.44, and the most often mentioned type of social support was the resident’s partner or father of her baby. The most common time duration spent engaging with support persons was up to 1.5 hours per week. Conclusion: The preliminary data is insufficient to conclude if the data supports that increased social engagement leads to improved treatment progress. This current data requires the integration of interview data with data reported from therapy sessions to better assess treatment experience. Long-term observation is necessary obtain a broader perspective on the development of social engagement and its impact on treatment progress

Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder.

Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods: Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results: Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions: The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population

Health Status and Preventive Health Services Among Reproductive-Aged Women in Treatment for Opioid Use Disorder

OBJECTIVE: To assess the utilization of preventive health services and the prevalence of chronic health conditions among a cohort of women in treatment for opioid use disorder (OUD). METHODS: Ninety-seven women who were receiving treatment for OUD from a single urban treatment program completed a self-administered anonymous online questionnaire that asked about demographics, health, receipt of preventive health services, and utilization of health care. Descriptive statistics were used to describe data. RESULTS: More than one-third of respondents reported that their health was fair or poor, whereas one-quarter were very concerned with their health. Most participants (59%) reported at least one chronic health condition; nearly 1 in 5 reported two or more conditions. Less than half of respondents had received a routine medical examination in the past year. Vaccine uptake was low; 56% received the coronavirus disease 2019 vaccine and 36% received the annual influenza vaccine. CONCLUSIONS: Women in treatment for OUD could benefit from enhanced health care to address the high rates of chronic diseases and risk factors and underutilization of recommended preventive health services. Interventions and models of care that aim to enhance utilization of such services, and ultimately improve the health of this vulnerable population, may be worth exploring