Project Nurture Expansion Study

项目摘要 在过去的20年里，美国（US）的孕产妇死亡率增加了四倍， 怀孕期间的物质使用障碍。怀孕期间使用药物与不良反应有关 产妇和婴儿的健康结果。许多障碍阻碍了提供协调良好和高效率的 药物使用障碍妇女的优质妊娠和产后护理：缺乏产科服务 提供者谁是舒适的提供医疗服务的妇女与物质使用障碍;竞争 儿童福利和必要医疗服务的需求;以及物质使用障碍的有限供应 治疗计划，让儿童和提供育儿支持资源。产妇护理联盟 供应商，物质使用治疗机构，国家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 养育结合了产妇护理，物质使用障碍治疗，同伴/导乐支持和案例 管理在一个单一的设置。在单一的护理环境中获得这些服务减少了获得护理的障碍， 促进了提供者之间的合作，这创造了一个更加支持性的环境， 对母亲的期望护理是以一种非判断性和创伤知情的方式提供的， 重要的是，考虑到使用药物的妇女经历的紧张生活事件的发生率很高， disorder.一项同行评议的研究发现，“培育项目”与虐待儿童的减少有关。 将儿童安置在寄养家庭，增加产前检查。来自独立机构的初步数据 评估人员还建议，项目培育可以减少早产，减少新生儿重症监护， 增加对物质使用障碍治疗的参与。俄勒冈州州长正在扩大培育项目， 五是农村和贫困地区。本研究的目的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;（3）项目的有效性如何 在农村地区以及母亲使用甲基苯丙胺和多种物质的情况下进行养育？因此，在本发明中， 本研究的主要目的是：（1）评估培育计划对儿童的影响， 妊娠、分娩、新生儿和儿童福利结果;（2）评估养育项目对卫生保健的影响 （3）描述项目培育的实施情况;（4）确定项目的关键要素 促进和支持复制和传播。这项研究将提供国家、区域和组织 领导复制培育项目所需的信息，并创建一个安全和去污名化的护理 孕妇生活与物质使用障碍的环境。

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.