Problem: Drug overdose is the leading cause of maternal death in Texas. More than 60% of children in custody of Texas Child Protective Services (CPS) have substance use listed as a contributing factor in their CPS case, compared to the national rate of 34%. Pregnant and postpartum women and infants are a special population impacted by substance use and require a coordinated response from multiple sectors to ensure optimal outcomes for both the mother and her infant.
Purpose: In 2018, needs and readiness assessments were conducted in Houston, Texas, focused on improving care and service coordination for pregnant women with substance use disorder (SUD). The purpose of this paper is to briefly describe the results of the assessments and discuss how the Covid-19 pandemic has impacted implementation of the recommendations.
Methods: In late 2018, 59 stakeholders from 5 different sectors were interviewed to assess the current system of care and identify recommendations they felt would improve outcomes for pregnant women with SUD. These interviews were followed by 5 collaborative meetings with stakeholders to finalize the recommendations, and a readiness assessment (n=25) to determine the feasibility of implementing the recommendations. The goals of this survey were to determine which of these recommendations were most important, had organizational support for implementation, and would result in improvements within a year of being implemented. Interviews were conducted again in 2020 (n=9) to describe the progress that had been made on the recommendations and assess the impact the Covid-19 pandemic has had on implementing programs and initiatives that support peripartum women with SUDs.
Results/Discussion: The stakeholder interviews revealed substantial cross-sector misunderstanding about each sector’s roles and responsibilities. Further, several barriers to coordination were identified. Interviews and collaborative meetings led to the development of 25 recommendations that would improve cross-sector collaboration. There were 25 completed responses to the readiness survey focused on implementing these recommendations. Of the recommendations, 9 had above-average ratings on importance and had ratings indicating substantial short-term impact for pregnant women. Six additional recommendations had above-average ratings on importance, but it was determined that their benefits take longer to be seen. Progress made towards 8 of the recommendations and how the Covid-19 pandemic has impacted this progress are described.
Implications: The Covid-19 pandemic has created both opportunities and barriers to progress in the treatment and care of pregnant women with SUD. This analysis identifies resulting changes that must be considered for future planning and intervention implementation
