Project Nurture Expansion Study

项目总结 在过去的20年里，美国的孕产妇死亡率增加了四倍 妊娠期物质使用障碍。怀孕期间使用药物与不良反应有关 孕产妇和婴儿的健康结果。许多障碍阻碍了协调良好和高度协调的 药物使用障碍妇女的优质孕期和产后护理：无法获得产科治疗 愿意为患有药物使用障碍的女性提供医疗服务的提供者；竞争 儿童福利和必要医疗服务的需求；药物使用障碍的可获得性有限 允许儿童参与的治疗方案，并提供育儿支持资源。产妇保健联盟 提供者、物质使用治疗机构、州社会服务机构和医疗补助资金合作伙伴 2015年，俄勒冈州在波特兰地区的三家诊所测试了一种名为“培育项目”的护理模式。项目 育儿结合了产妇护理、药物使用障碍治疗、同伴/助产士支持和案例 在单一环境中进行管理。在单一护理环境中获得这些服务减少了护理障碍， 促进提供商之间的更多协作，从而创造一个更具支持性的环境 对母亲的期望。护理是以一种非评判和了解创伤的方式提供的，这是 重要的是考虑到有药物使用的女性经历的应激性生活事件的高发率 无序。一项同行评议的研究发现，培育项目与减少虐待儿童有关 和将儿童安置在寄养中心，以及增加产前探视。来自一家独立公司的初步数据 评估人员还建议，项目养育可能会减少早产，减少新生儿重症监护，以及 增加物质使用障碍治疗的参与度。俄勒冈州州长正在扩大培育计划以 五个农村和服务不足的县。这项研究的目标是建立所需的经验证据 在其他州复制培育项目。虽然初步调查结果表明，培育项目改善了 短期和长期的母婴结局，我们建议进一步调查，以回答三个关键问题 问题：(1)与改善结果相关的项目培育的关键要素是什么；(2)如何 这些要素将在农村和服务不足的环境中实施；以及(3)项目的有效性是什么 农村地区的育儿和母亲何时使用甲基苯丙胺和多种物质？因此， 本研究旨在实现以下四个目标：(1)评估项目培育在以下方面的影响 妊娠、分娩、新生儿和儿童福利结果；(2)评估项目养育对卫生保健的影响 支出；(3)描述项目培育的实施情况；(4)确定项目的关键要素 培育和支持复制和传播。这项研究将提供州、地区和组织 领导复制项目培育和创建安全和非污名化护理所需的信息 为患有药物使用障碍的孕妇提供环境。

PROJECT SUMMARY In the past 20 years, the United States (US) has seen a fourfold increase in the prevalence of maternal substance use disorders during pregnancy. Substance use during pregnancy is associated with adverse maternal and infant health outcomes. Numerous barriers impede the delivery of well-coordinated and high- quality pregnancy and postpartum care for women with substance use disorder: lack of access to obstetrics providers who are comfortable with providing medical care to women with substance use disorders; competing demands from child welfare and necessary medical services; and limited availability of substance use disorder treatment programs that allow children and provide parenting support resources. A coalition of maternity care providers, substance use treatment agencies, state social service agencies, and Medicaid funding partners in Oregon tested a care model called Project Nurture in three clinics in the Portland area in 2015. Project Nurture combines maternity care, substance use disorder treatment, peer/doula support, and case management in a single setting. Access to these services in a single care setting reduces barriers to care and facilitates increased collaboration among providers, which creates a more supportive environment with realistic expectations for mothers. Care is delivered in a non-judgmental and trauma-informed manner, which is important given the high prevalence of stressful life events experienced by women with substance use disorder. A peer-reviewed study found Project Nurture to be associated with reductions in child maltreatment and placement of children in foster care, and increases in prenatal visits. Preliminary data from an independent evaluator also suggest that Project Nurture may reduce preterm births, reduce intensive neonatal care, and increase engagement in substance use disorder treatment. Oregon's Governor is expanding Project Nurture to five rural and underserved counties. The objective of this study is to establish the empirical evidence needed to replicate Project Nurture in other states. While preliminary findings suggest that Project Nurture improves short- and longer-term maternal-infant outcomes, we propose further investigation to answer three critical questions: (1) What are the key elements of Project Nurture associated with improved outcomes; (2) how can these elements be implemented in rural and underserved settings; and (3) what is the effectiveness of Project Nurture in rural regions and when mothers are engaged in methamphetamine and polysubstance use? Thus, this study is designed to accomplish the following four aims: (1) Assess the effects of Project Nurture on pregnancy, birth, neonatal, and child welfare outcomes; (2) Assess the effect of Project Nurture on health care expenditures; (3) Describe implementation of Project Nurture; and (4) Identify critical elements of Project Nurture and support replication and dissemination. This study will provide state, regional and organizational leaders the information needed to replicate Project Nurture and create a safe and de-stigmatized care environment for pregnant women living with substance use disorder.