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

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

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

Formative Research about Shared Decision Making in the Treatment of Opioid Use Disorder in Pregnant Women

Background Shared Decision Making (SDM) is an evidence-based practice that involves a discussion between a health care professional and patient to reach a mutual agreed upon treatment plan.(1) A recent nationally-representative study indicates that only 39% of physicians use SDM for 50% or fewer Pregnant Women with Opioid Use Disorders (PWOUD).(2) Little is known about factors that affect SDM among PWOUD. This research project aimed to address this knowledge gap.https://jdc.jefferson.edu/pharmacyposters/1027/thumbnail.jp

Understanding Social Needs of Families with Young Overweight Children in an Urban Primary Care Setting: A Mixed-Methods Study

Unmet social needs, such as stable housing, reliable access to food and treatment of parental depression are associated with childhood overweight. Little information exists on parental perception of addressing these needs. We sought to understand the perspective of parents of young overweight children on how to best address social needs in the primary care setting. We conducted a mixed-methods study. The 11-item WE CARE survey, PHQ-2, and 2-item food insecurity screener were used to screen for social needs. Semi-structured interviews were conducted with English-speaking parents of overweight (BMI ≥ 85%) children 2-5 years of age with Medicaid. Interviews assessed parental perception about addressing social needs in the primary care setting. Twenty-two parents participated. Parents responded positively to having a social need 46 times on the WE CARE survey, with the majority being in the areas of smoking cessation and employment. However, parents reported that they did not want to address the majority of these needs at the visit. Only 2 of 11 parents who screened positive for depression on the PHQ-2 endorsed wanting help to address mood, and only 1 in 10 who screened positive for food insecurity endorsed wanting help accessing food. Two salient themes arose during the interviews that influence asking for support: 1) level of comfort disclosing needs and 2) family resourcefulness and resiliency. Discomfort was associated with parental fear of being considered neglectful and involvement of child protective services. Though a majority of parents found the screener to be useful, they suggested reframing to highlight support available, emphasizing how resources may benefit the child. Screening tools may benefit from adaptation for families are uncomfortable asking for support or who are resourceful at meeting their needs. Emphasizing the non-punitive nature and providing information on resources upfront may promote resource utilization among this patient population

Diane J. Abatemarco\u27s Story

Diane J. Abatemarco, PhD, MSW, Professor, Associate Dean, Jefferson College of Nursing; Executive and Founding Director of Maternal Addiction Treatment, Education and Research (MATER) Cente

Delay discounting of pregnancy- and condom-protected sex among methadone-maintained women

Introduction Over 80% of pregnancies are unintended among women with opioid use disorder (OUD; Heil et al., 2011). Use of effective contraception is uncommon in this population (Terplan et al., 2015). Initiating and using effective contraception involves delays: to obtain the method from a provider, to become protected after initiating use. Interventions that include delay reductions among other elements have increased contraceptive use (Heil et al., 2016; Secura et al., 2014). Women with OUD have reported greater likelihood of engaging in unprotected sex at shorter delays to acquiring protection from sexually-transmitted infection (STI) than women without OUD (Herrmann et al., 2014). There is no current method for assessing how delays to pregnancy protection affect sexual decision-making. The present study was designed to evaluate a novel tool for measuring how delays to pregnancy protection affect self-reported likelihood to engage in protected vs. unprotected sexual intercourse