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Novel treatment, social services program improves outcomes for opioid-dependent mothers

Study finds Oregon’s Project Nurture is associated with lower rates of child maltreatment, foster care placement, increased prenatal visits
Beautiful pregnant woman is lying down on a bed at hospital room. Handsome doctor is checking fetus heartbeat and fetus position at mother belly by using stethoscope. She nearly gives birth next month
With the rate of pregnant women with opioid use disorder on the rise, Project Nurture was developed. The program is a novel intervention model that combines maternity care, substance use treatment and social services coordination. (Getty Images)

The rate of pregnant women with opioid use disorder, or OUD, when giving birth more than quadrupled from 1999 to 2014, according to the Centers for Disease Control and Prevention. This indicates a significant public health concern related to adverse health outcomes for both mother and child. Impacts may range from preterm labor or neonatal abstinence syndrome, to adverse child welfare outcomes and early foster care placement.

In response to this growing concern, Oregon-based health care organizations and substance treatment centers collaborated in 2014 to develop Project Nurture, a novel intervention model that combines maternity care, substance use treatment and social services coordination for women who struggle with addiction.

A new study published in the April issue of the journal Health Affairs says that, since its inception, Project Nurture has helped to reduce the necessary placement of children in foster care by more than 8 percentage points. The rate of reported maltreatment within the child’s first year of life also declined by approximately 7 percentage points.

John McConnell, Ph.D.
John McConnell, Ph.D.

“These outcomes are significant,” says the study’s lead investigator John McConnell, Ph.D., director of the Oregon Health & Science University Center for Health Systems Effectiveness. “They point to Project Nurture’s positive outcomes for mothers and children as well its potential to reduce the burden on the foster care system.”

McConnell and a team of researchers at OHSU, Kaiser Permanente Northwest and Portland’s Central City Concern evaluated more than 1,500 Medicaid enrollees across the state of Oregon who had hospital births and concurrent OUD diagnoses between the years 2012 – 2017, comparing outcomes for women giving birth in the county served by Project Nurture to outcomes for similar women in Oregon counties not served by Project Nurture

In addition to the positive outcomes related to child welfare, the analysis suggests that Project Nurture also helped increase the number of prenatal visits, as well as hospital length-of-stay, for new mothers diagnosed with OUD.

“The effectiveness of Project Nurture is promising; however, additional challenges such as long-term financing, secure data sharing and expanded treatment options for a broader set of substance abuse disorders must be met in order to ensure the program maintains its success and influence in integrating health care and human services in the years ahead,” says McConnell.

This research was supported by the OHSU Circle of Giving.

A collaboration between CODA, Legacy Health, LifeWorks NW, OHSU and Providence Health & Services, Project Nurture is a Center of Excellence model that integrates maternity care and addiction treatment for women who struggle with addictions, as well as pediatric care for their infants.

A special edition dedicated to the integration of social services and health, the April issue of Health Affairs includes additional research and insight from experts across OHSU, as well as the OHSU-PSU School of Public Health:

  • A case study - led by Shauna Petchel,  senior project manager at the Center for Health Systems Effectiveness at OHSU, and doctoral candidate at the OHSU-PSU School of Public Health – explores how Oregon-based health and human services leaders perceive the risks and benefits of cross-sector work. Additional information available here
  • A poem by OHSU School of Medicine student Alex Sievert sheds light on patient care experiences. Entitled “Admission,” the piece was a winner of the 2019 Narrative Matters poetry contest.
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