Status Report on Protecting Our Infants Act Implementation Plan. Recommendations Addressing Systemic Changes

02/07/2019

Recommendations addressed by the following agencies:

1. Increase access to the broad range of contraceptive options for women at risk of experiencing a substance-exposed pregnancy, including barrier free access to long-acting reversible contraception. (Programs & Services, Maternal)

  1. CDC, CMS, HRSA, IHS

2. Provide ready access to effective SUD treatment, including tobacco cessation counseling/treatment, prior to conception and during pregnancy. (Programs & Services, Maternal)

  1. CMS, FDA, HRSA, IHS, NIDA, OASH/OWH, SAMHSA

3. Make available family-friendly relapse prevention and recovery support for parents in recovery. (Programs & Services, Maternal)

  1. ACF/Children's Bureau, CMS, HRSA, IHS

4. Provide ready access to family-friendly SUD treatment for parents. (Programs & Services, Maternal)

  1. ACF/Children's Bureau, CMS, HRSA, IHS, SAMHSA

5. Provide ready access to parental support and early intervention services. (Programs & Services, Child)

  1. ACF/Children's Bureau, CDC, CMS, HRSA, IHS, SAMHSA

6. Provide access to effective and alternative treatment options for pain prior to conception and during pregnancy and breastfeeding (Programs & Services, Maternal)

  1. CDC, CMS, HRSA, IHS, NIDA

7. Promote general public awareness of the effectiveness of SUD treatment, to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal)

  1. ACF/Children's Bureau, CDC, CMS, FDA, HRSA, IHS, SAMHSA, OASH/OWH

8. Promote shift in public perceptions of SUD so that it is regarded as a disease rather than as a criminal or moral problem to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal)

  1. ACF/Children's Bureau, CMS, HRSA, IHS, NIDA, OASH/OWH, SAMHSA

9. Develop effective strategies to support informed decision making around pain management or SUD treatment when these conditions are identified prenatally. (Programs & Services, Maternal)

  1. CDC, FDA, HRSA, IHS, OASH/OWH, SAMHSA

10. Promote non-pharmacologic interventions, such as rooming in, for managing mild to moderate NAS/NOWS. (Programs & Services, Child)

  1. ACF/Children's Bureau, CDC, CMS, HRSA, IHS, NICHD, NIDA, SAMHSA

11. Promote breastfeeding for women who receive opioids for pain or the treatment of OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal)

  1. ACF/Children's Bureau, CDC, CMS, HRSA, IHS, OASH/OWH, SAMHSA

12. Promote breastfeeding of infants of women who receive opioids for pain or OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal)

  1. CDC, CMS, HRSA, IHS, NICHD, OASH/OWH, SAMHSA

13. Provide continuing medical education to the provider for managing pain in the pregnant woman with OUD. (Education, Maternal)

  1. CDC, CMS, HRSA, IHS, SAMHSA

14. Provide continuing medical education to the provider for managing the infant with NAS symptoms. (Education, Maternal)

  1. CDC, HRSA, IHS, OASH/OWH

15. Identify a history of prenatal substance exposure and NAS/NOWS when children receive developmental assessment, early intervention services or enter child welfare. (Data & Surveillance, Child)

  1. ACF/Children's Bureau, CDC, CMS, HRSA, IHS

16. Promote public and health professional awareness of ongoing parental treatment engagement, recovery support, and early-intervention services in family function and mitigation of consequences of prenatal substance exposure and NAS/NOWS. (Education, Maternal)

  1. ACF/Children's Bureau, CMS, FDA, HRSA, IHS, SAMHSA

Examples of agency activities to address recommendations:

*The hyperlinks allow readers to move to the next recommendation the specific agency addresses. For example, the first hyperlink for CDC takes the reader to recommendation #5, which is the next recommendation CDC addresses. The hyperlink for CDC in recommendation #5 then takes the reader to recommendation #6, the next recommendation CDC addresses; etc.

Recommendation Agency Action Funding Milestones/Status
1. Increase access to the broad range of contraceptive options for women at risk of experiencing a substance-exposed pregnancy, including barrier free access to long-acting reversible contraception. (Programs & Services, Maternal) CDC (move to next CDC)
  • Funds the ASTHO Increasing Access to Contraception Learning Community which provides technical support and opportunities for peer-to-peer learning among states. Several states have shared models of linkage to care to increase access to the broad range of contraceptive options for women at risk of experiencing a substance-exposed pregnancy, including barrier free access to long-acting reversible contraception.
  • Funded
  • End date September 2018
  • Continued efforts to provide technical support and opportunities for peer-to-peer learning among states to increase access to the broad range of contraceptive options for women at risk of experiencing a substance-exposed pregnancy.
  • Funded
  • End date September 2018
  • Implement a Learning Community focused on supporting states as they implement policies and programs targeting identification and treatment of pregnant and postpartum women with OUD and infants with prenatal opioid exposure.
  • Funded
  • 2018-2020
CMS (move to next CMS)
  • Provided TA to states on improving access to the broad range of contraceptive options, but have not necessarily targeted that guidance to women at risk of experiencing a substance-exposed pregnancy. For example, CMS published a CMCS Informational Bulletin (CIB) on this topic: https://medicaid.gov/federal-policy-guidance/downloads/CIB040816.pdf.
  • Funded
  • 4/08/2016
  • Through the Maternal and Infant Health Initiative, CMS provides TA to states on a variety of quality improvement topics, including monitoring utilization the broad range of contraceptive care options. Monitoring utilization is necessary to identify where there are gaps in access and to help target effective interventions to increase access.
  • Provided by staff activities funded through internal FTEs
  • Ongoing
  • Issued State Health Official letter #16-008. This letter discussed the family planning benefit and included the section, "Strategies for Improving Access to Long Acting Reversible Contraceptives (LARC)".
  • Funded
  • 6/14/2016
  • Provides TA to states as requested.
  • Funded
  • Ongoing
HRSA (move to next HRSA)
  • Funds the Health Center Program supporting nearly 1,400 health centers that operate more than 11,000 service delivery sites in every state, DC, and U.S. territories. More than 27 million patients received accessible, affordable, high-quality primary health care services in 2017, including prenatal care for more than 573,000 pregnant women and delivery of more than 299,000 babies. Health centers provide care to patients with high prevalence of OUD or for those who are at risk for OUD, and health centers are required to provide obstetrics, gynecology, and voluntary family planning services.
  • Funded
  • Ongoing
  • Funds the Healthy Start grant program which supports women before, during, and after pregnancy through the baby's second birthday by providing care coordination, health education, linkage to comprehensive health and social services, and engagement with community partners to enhance systems of care.
  • Funded
  • Ongoing
  • Partners with the Federal Region 8 group (HRSA, OASH/Title X, and SAMHSA) to plan a project that will integrate respective agency programs and systems of care at the state level to increase access to services for women, including mental health, SUD treatment, primary care, and social service.
  • Funding TBD
  • To be implemented in 7-9 months
  • Convenes events for stakeholders to share best practices and regional approaches. For example, Region 5 HRSA and OASH staff collaborated to hold a virtual meeting with state agencies to discuss prevention strategies, challenges, and opportunities for the regional OASH Prevention Collaborative to assist in addressing NAS.
  • TBD
  • On hold
IHS (move to next IHS)
  • All IHS Facilities are required to maintain a broad range of prescription methods of contraception per the IHS National Core Formulary. LARC methods and other contraceptives are widely available to IHS patients with a provider trained to prescribe LARC method.
  • Funded
  • Ongoing
  • Provides all IHS pharmacies with OTC emergency contraception.
    • All IHS pharmacies Stock and dispense Emergency Contraception (OTC) upon patient request without a prescription.
  • Funded
  • Ongoing
  • Plans to implement patient advertising surrounding use and availability of LARCs.
  • Funding TBD
  • To be implemented in 10-12 months
Recommendation Agency Action Funding Milestones/Status
2. Provide ready access to effective SUD treatment, including tobacco cessation counseling/treatment, prior to conception and during pregnancy. (Programs & Services, Maternal) CMS move to next CMS)
  • Assesses Medicaid demonstrations for PPW with OUD and their newborns. Explores models of reimbursement that would incentivize provision of a broad range of treatment and recovery services to all Medicaid eligible PPW women, regardless of whether or not their infant receives an NAS diagnosis. Covers many services for pregnant women with OUD and infants affected by NAS, including medical, clinical, and SUD treatment services.
  • Funded
  • Ongoing
  • Issued guidance to states on coverage of tobacco cessation counseling and treatment for pregnant women and has provided TA to states working to improve delivery of cessation services to pregnant women.
  • Funded
  • Ongoing
  • TA to states to improve delivery of cessation services to pregnant women continues to be available for states.
  • Funded
  • Completed
  • Funded
  • Completed
  • Managed Care Regulations allow the option to continue Medicaid capitation payments to managed care plans that provide services through an IMD (and services to enrollees while they are patients in an IMD) in lieu of in-patient psychiatric or inpatient SUD services covered by Medicaid in other settings, subject to strict limitations (see 42 CFR 438.6(e)). Some states have enrolled pregnant women into managed care and, with the managed care flexibilities, been able to provide more treatment options than were otherwise available in the state plan. https://federalregister.gov/a/2016-09581
  • Funded
  • Ongoing
  • Funded
  • Ongoing
  • Working with CMMI to develop a potential demonstration or model to improve access to treatment for pregnant women.
  • Funded
  • Ongoing
  • Through IAP, CMS is supporting states to strengthen and improve their SUD delivery systems.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to provide access to effective SUD treatment.
  • Funded
  • Ongoing
FDA (move to next FDA)
  • Ensures labels of products indicated for OUD emphasize weighing benefit of treatment versus risk of untreated OUD.
  • Funded
  • Ongoing
HRSA (move to next HRSA)
  • Expands access to behavioral health screening and treatment in health centers and other primary care settings. Examples include:
    • In September 2017, awarded $200 million to 1,178 health centers across the nation through the AIMS grant to add more behavioral health personnel, leverage health IT, provide training, and support the expansion of mental health services, SUD treatment, and their integration into primary care.
    • In September 2018, awarded $352 million to 1,232 health centers across the nation through the Expanding Access to Quality Substance Use Disorder and Mental Health Services (SUD-MH) grant to expand access to SUD and mental health services. These funds will support health centers in implementing and advancing evidence-based strategies, including expanded MAT services.
    • Provides the RHOP with approximately $2.5 million for 10 rural health organizations across nine states to help community members struggling with OUD find local treatment options and recovery support services through partnerships with local healthcare providers and other community-based groups.
    • Supports testing evidence-informed interventions for integrating behavioral health with primary medical care for people living with HIV using an implementation science model to develop tools and resources to guide implementation locally at Ryan White HIV/AIDS Program provider sites.
    • Convenes events for stakeholders to share best practices and regional approaches. For example, Region 5 HRSA and OASH staff collaborated to hold a virtual meeting with state agencies to discuss prevention strategies, challenges, and opportunities for the regional OASH Prevention Collaborative to assist in addressing NAS.
  • Funded
  • Ongoing
IHS move to next IHS)
  • Provides tobacco cessation training for various healthcare disciplines (e.g., pharmacists, nurses) on universal tobacco use screening (Ask-Advise-Refer).
  • Funded
  • Ongoing
  • Makes tobacco treatment services available in outpatient clinics with expanded access to OTC and prescription treatments for nicotine dependence.
  • Funded
  • Ongoing
  • Makes counseling and support services available for pregnant women.
  • Funded
  • Ongoing
  • Creates best practices recommendations to build treatment capacity and assist with early intervention and referral to treatment for OUD.
  • Funded
  • Ongoing
  • Creates a series of webinars on trauma-informed care principles.
  • Funded
  • Ongoing
  • Implements webinars to provide information on illicit substance use in pregnancy, opioid maintenance, and prevention strategies (to be revised to support new guideline implementation).
  • Funded
  • Ongoing
  • Plans to publish on the Opioid Dependence Management public domain page and to provide trainings through the IHS TeleBehavioral Health Center of Excellence.
  • Proposed Funding TBD
  • Contingent on funding
NIDA (move to next NIDA)
  • Funds research on effective treatments of any SUD, including smoking cessation in mothers during pregnancy. An example of recent efforts includes research on Cognitive-Affective Substrates of Smoking: Targets for Maternal Behavior Change.
  • Funded
  • Ongoing
  • Continues to fund research to improve understanding of the most effective treatments before and during pregnancy in achieving abstinence.
  • Funded
  • Ongoing
OASH (move to next OASH)
OWH (move to next OWH)
  • Through the Office on Women's Health Prevention Awards (OWHPA) grants, awarded 6 out of the 20 grants organizations training health professionals using SBIRT. Grantees are in Regions 1, 2, 4, 5, and 7.
  • Funded via cooperative agreement for FY 17-FY19
  • Ongoing
  • In March 2017, OASH/OWH initiated a 1-year partnership with IHS to support work to address the problem of opioid misuse among women of reproductive age in the AI/AN communities, including PPW. Specifically, the IAA supports
  • Funded via IAA and contract in FY17
  • Written recommendations will be released later in 2018 and will then be disseminated
  • national training, education, and guidance through development of written recommendations on the screening, diagnosis, and management of opioid dependence among AI/AN women of reproductive age and AI/AN newborns. These documents are being developed with ACOG and the AAP.
 
  • throughout the IHS system (partnership with IHS and OASH/OWH)
  • This IAA also supports the development of a structured, comprehensive approach to prenatal care and SUD treatment in Billings, MT, an area of particularly high need. This process has included extensive process mapping, and data collection has been conducted at two clinical sites (Lame Deer and Crow) clinics.
  • Funded via IAA and contract in FY17
  • Report will be released later in 2018 and will then be disseminated throughout the IHS system (partnership with IHS and OASH/OWH)
  • In FY 2018, OASH/OWH is partnering with the HRSA Office of Women's Health on an initiative to produce a care coordination model for women impacted by opioids who receive healthcare services via HRSA-administered programs. This 2-year initiative will involve a two-phase series of working consultation meetings leading to a final guide that will include care coordination and implementation resources. Meetings will be held with stakeholders from all 10 HHS regions. OASH/OWH and HRSA will engage with regional staff to assist with follow-up consultation and foster sustainable partnerships generated during the meetings. Plans to develop and disseminate the care coordination models and resources.
  • Funded via IAA in FY18, FY19 funding TBD
  • FY18-20 (partnership between HRSA and OASH/OWH)
SAMHSA (move to next SAMHSA)
  • Expanded the PPW program to three states to expand systems of care for PPW and their families (in 2017, MA, NY, and VA). In addition, 19 residential treatment providers received PPW grants to provide comprehensive SUD care for women and their children.
  • Grant funded (CARA)
  • FY17-FY22 and FY18-FY23
  • Included a set-aside for PPW women's services in the SABG, which provides states with formula grants (noncompetitive grants based on a predetermined formula).
  • Grant funded (State Block Grant)
  • Ongoing
  • Funded 14 states (AR, AZ, DE, FL, IN, KY, MA, ME, MS, MN, OH, TX, WV, and MT) through the Opioid State Targeted Response strategy to target pregnant women and their newborns.
  • Grant funded (21st Century Cures Act)
  • FY18, FY19 funding
  • Provides MAT-PDOA funding to states to enhance and expand MAT and recovery support services for individuals with OUD. Three grantee states are focusing specifically on pregnant women with OUD (KY, LA, and MA).
  • Grant funded (21st Century Cures Act)
  • MAT-PDOA program: 8/1/2015-9/30/2020
Recommendation Agency Action Funding Milestones/Status
3. Make available family-friendly relapse prevention and recovery support for parents in recovery. (Programs & Services, Maternal) ACF (move to next ACF)
Office of Head Start (move to next OHS)
  • Early Head Start and Early Head Start-Child Care Partnerships, provide early, continuous, intensive, and comprehensive child development and family support services to low-income infants and toddlers and their families, and pregnant women and their families.
  • Funded
  • Ongoing
  • Implements the Regional Partnership Grant Program. This program is designed to improve the well-being of children affected by parental substance abuse through the support of interagency collaborations and the integration of programs, services, and activities designed to increase the well-being, improve the permanency, and enhance the safety of children who are in, or at risk of, out-of-home placements as a result of a parent or caregiver's substance abuse. Of the program strategies and activities allowable under the grant program, include quality substance abuse treatment for parents and families that include access to comprehensive substance abuse treat programs where children can live on-site with mothers. The programs are designed to meet the needs of the entire family by providing access to MAT, trauma-specific services, and continuing care and recovery support.
    • Funded the second cohort of these five-year grantees from 2012-2017 and had 17 grantees, a third cohort of 4 five-year grantees was funded in 2014, and grants will conclude in 2019. Continuing this critical work, in September 2017, the Children's Bureau funded the fourth cohort of 17 grantees for five years.
  • Grant funded
  • Ongoing; to be completed by 2022
CMS move to next CMS)
  • See responses to number 2. Medicaid may reimburse certain services provided along a continuum of treatment for behavioral health conditions.
  • Funded
  • Ongoing
  • CMS provides TA to states as requested.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to make available family-friendly relapse prevention and recovery support for parents in recovery.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
HRSA (move to next HRSA)
  • Expands access to behavioral health screening and treatment in health centers and other primary care settings. Examples include:
    • In September 2017, awarded $200 million to 1,178 health centers across the nation through the AIMS grant to add behavioral health personnel, leveraged health IT, provided training, and supported the expansion of mental health services and SUD treatment and their integration into primary care.
    • In September 2018, awarded $352 million to 1,232 health centers across the nation through the SUD-MH grant to expand access to SUD and mental health services. These funds will support health centers in implementing and advancing evidence-based strategies, including expanded MAT services.
    • RHOP provides approximately $2.5 million for 10 rural health organizations across 9 states to help community members struggling with OUD find local treatment options and recovery support services through partnerships with local healthcare providers and other community-based groups.
    • Supports testing evidence-informed interventions for integrating behavioral health with primary medical care for people living with HIV using an implementation science model to develop tools and resources to guide implementation locally at Ryan White HIV/AIDS Program provider sites.
    • Convenes events for stakeholders to share best practices and regional approaches.
  • Funded
  • Ongoing
IHS move to next IHS)
  • Several Indian healthcare Tribal programs have created perinatal substance use programs to include residential treatment programs as well as outpatient treatment models. Several best practice models are in place.
  • Funded
  • Ongoing
  • Advocate for expansion of culturally appropriate prenatal care and SUD treatment models.
  • Funded
  • Ongoing
  • IHS facilities promote comprehensive prenatal care that places an emphasis on screening, early detection, and referral to treatment for woman using opioid in pregnancy.
  • Funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
4. Provide ready access to family-friendly SUD treatment for parents. (Programs & Services, Maternal) ACF move to next ACF)
Children's Bureau move to next CB)
  • Grant Funded
  • Ongoing; to be completed by 2022
CMS move to next CMS)
  • See responses to #2 and #3.
  • Funded
  • Ongoing
  • CMS provides TA to states as requested.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to make available family-friendly SUD treatment for parents.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
  • States may request TA through the Medicaid IAP in developing proposals and implementation plans per the 1115 SUD opportunity described in State Medicaid Director Letter #17-003
  • Funded
  • Ongoing
HRSA (move to next HRSA)
  • See #3. HRSA achieves this recommendation through health centers and other primary care settings.
  • Funded
  • Ongoing
IHS move to next IHS)
  • Provides tobacco cessation training to various healthcare disciplines (e.g., pharmacists, nurses) on universal tobacco use screening (Ask-Advise-Refer).
  • Funded
  • Ongoing
  • Makes tobacco treatment services available in outpatient clinics with expanded access to OTC and prescription treatments for nicotine dependence.
  • Funded
  • Ongoing
  • Makes counseling and support services available to pregnant women.
    • Best practices recommendations to build treatment capacity and assist with early intervention and referral to treatment for OUD.
    • A webinar series on trauma-informed care principles.
  • Funded
  • Ongoing
  • Provides webinars on illicit substance use in pregnancy, opioid maintenance, and prevention strategies (to be revised to support new guideline implementation).
  • Funded
  • 12 months
  • Plans to publish on the Opioid Dependence Management public domain page and to provide trainings through the IHS TeleBehavioral Health Center of Excellence.
  • Proposed funding TBD
  • Contingent on funding
SAMHSA move to next SAMHSA)
  • Awarded 20 Family Drug Court grants in 2017 with a funding opportunity announcement for 2018 in development.
  • Grant funded
  • September 2017, 20 new FTDC grantees
  • Required existing PPW Program activities to include relapse prevention and recovery support services for parents and other family members in recovery. Each project must demonstrate its capacity to carry out these services as part of the project design.
  • Grant funded (CARA)
  • FY17-FY22
  • Expanded capacity in non-PPW treatment sites, where women with SUD also receive treatment services to provide prevention and recovery support services from a family-centered perspective.
  • Grant funded; ATTC's provide training and education to non-PPW treatment sites
  • 2015 to present
  • Ensured SABGs require that pregnant women receive preferential admission to SUD treatment and expenditures for women's services by each state in a given fiscal year must meet maintenance-of-effort requirements as a minimum.
  • Block Grant funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
5. Provide ready access to parental support and early intervention services. (Programs & Services, Child) ACF move to next ACF)
Office of Head Start move to next CDC)
  • Early Head Start and Early Head Start-Child Care Partnerships, provide early, continuous, intensive, and comprehensive child development and family support services to low-income infants and toddlers and their families, and pregnant women and their families.
  • Funded
  • Ongoing
  • Grant funded
  • Ongoing; to be completed by 2022
CDC move to next CDC)
  • Funds PQC of perinatal care providers and public health professionals working to improve pregnancy outcomes for women and newborns in states and nationally. Efforts include improving identification of and care for infants with NAS
  • Grant funded
  • Ongoing -- 2022
  • CDC's Learn the Signs. Act Early. program aims to improve early identification of developmental delays and disabilities, so children and families can access early intervention and other support they need. The program offers free tools to help all parents and other caregivers learn the signs of healthy development, track their young child's developmental milestones, and act early if there is ever a developmental concern.
  • Funded
  • Ongoing
CMS move to next CMS)
  • States are required to make available all medically necessary services found at section 1905(a) of the Social Security Act for children under age 21 in accordance with the EPSDT benefit, whether or not the treatment services are included in the state plan.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to provide ready access to parental support and early intervention services.
    • Potential considerations include wrap-around and other integrated care strategies to support children and families.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
HRSA (move to next HRSA)
  • Convenes events for stakeholders to share best practices and regional approaches. For example, Region 5 HRSA and OASH staff collaborated to hold a virtual meeting with state agencies to discuss prevention strategies, challenges, and opportunities for the regional OASH Prevention Collaborative to assist in addressing NAS.
  • Funded
  • Ongoing
IHS move to next IHS)
  • Adopted the Family Spirit curriculum.
  • Proposed funding
  • Ongoing
  • Plans to expand peer recovery models.
  • Funding TBD
  • 12 months
  • Plans to expand screening and intervention recommendations based on emerging research.
  • Funding TBD
  • TBD
SAMHSA move to next SAMHSA)
  • Project LAUNCH grantees implement a variety of parenting support evidence-based practices that are tailored to meet the specific population of the community. Many of these interventions focus on parenting and promotion of early life parent/child relationships. Project LAUNCH efforts also connect families and facilitate referrals to parenting support programs, including for caregivers with SUD and in recovery. LAUNCH grantees create pathways to early intervention services and have also focused on building the capacity of the early intervention workforce to better address the needs of families with SUD and children who have been impacted by parental SUD.
  • Grant funded
  • Ongoing; program began in FY08 and new cohort will be awarded in FY18
Recommendation Agency Action Funding Milestones/Status
6. Provide access to effective and alternative treatment options for pain prior to conception and during pregnancy and breastfeeding. (Programs & Services, Maternal) CDC (move to next CDC)
  • CDC's Treating for Two initiative does not provide access to treatment options, but it works to identify the safest treatment options for the management of common conditions before and during pregnancy and to improve the availability and quality of data to help inform clinical management decisions for pregnant and reproductive-aged women and their healthcare providers. Treating for Two also conducts ongoing research and surveillance of medications commonly used to manage health conditions during pregnancy and associated adverse outcomes including structural birth defects.
  • Unfunded
  • Ongoing
CMS move to next CMS)
  • Non-opioid, non-pharmacologic pain management therapies can be coverable under Medicaid state plan authority if they meet benefit requirements under 1905(a) of the Social Security Act.
  • Funded
  • Ongoing
  • CMS provides TA to states as requested.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to provide access to effective and alternative treatment options for pain during pregnancy and breastfeeding.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
HRSA (move to next HRSA)
  • Through the AIM initiative, dozens of partners and experts developed a maternal safety bundle (best practices) for hospitals on the obstetric management of women with opioid dependence. Now 14 state-based teams and hospital systems are launching these best practices in hospitals and improving access to care for women and babies.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Provides many alternative treatment options for pain control based on National Core Formulary and Patient Referred Services to external providers such as physical therapy. The Indian Health Manual Chronic Non-Cancer Pain Management Policy (IHM Chapter 30) includes strategies to reduce chronic opioid exposure and encourages alternative treatments. The IHS National Core Formulary includes several non-opioid medications and patients have access to additional non-opioid treatment modalities via Purchased Referred Care.
  • Funded
  • Ongoing
NIDA move to next NIDA)
  • Funded research new approaches to reducing pain, prescription opioid use, and misuse in pregnancy.
  • Funded
  • Ongoing
  • Continues funding for this research to increase available data and form recommendations.
  • Funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
7. Promote general public awareness of the effectiveness of SUD treatment, to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal) ACF (move to next ACF)
Children's Bureau move to next CB)
  • NCSACW's mission is to improve family recovery, safety and stability by advancing practices and collaboration among, organizations and courts working with families affected by substance use and co-occurring mental health disorders and child abuse and neglect. The NCSACAW, including TA and initiatives described earlier in this document, the NCSCAW provides additional TA and resources to promote general public awareness of the effectiveness of SUD treatment to reduce barriers to seeking treatment prior to conception and in early pregnancy. These include: providing a variety of resources including publications, tutorials and webinar recordings to promote awareness; presenting at a variety of conferences throughout the year to a multidisciplinary group of professionals at both the national and state level; and actively engaging in the dissemination of the productions and publications they produce and have produced.
  • Funded via contract between ACF/SAMHSA
  • Ongoing
CDC (move to next CDC)
  • Leading the Treating for Two initiative to identify the safest treatment options for the management of common conditions before and during pregnancy and to improve the availability and quality of data to help inform clinical management decisions for pregnant and reproductive aged women and their healthcare providers. Treating for Two also conducts ongoing research and surveillance of medications commonly used to manage health conditions during pregnancy and associated adverse outcomes including structural birth defects.
  • Unfunded
  • Ongoing
FDA move to next FDA)
  • Makes announcements of approval of products for substance use treatment that are based on substantial evidence of effectiveness.
  • Funded
  • Ongoing
  • Encourage development of products to treat SUD.
  • Funding TBD
  • Ongoing
HRSA move to next HRSA)
  • Addresses this recommendation through a number of BH/SUD or cross-cutting programs mentioned above:
    • The AIMS and SUD-MH supplemental funding for health centers, which encourage community engagement and education.
    • AIM initiative
    • RHOP
    • Healthy Start Grant Program
  • Funded
  • Ongoing
  • Funding Preventing Opioid Misuse in Pregnant Women & New Moms Challenge. HRSA is using prize competitions to encourage innovative solutions for improving the health of mothers and children across the U.S. This challenge seeks low-cost, scalable, technology solutions that will address barriers that limit access to quality treatment, care, and support services for those with OUD, including pregnant women and new moms.
  • Funded
  • Ongoing
IHS move to next IHS)
  • Through IHS HOPE Committee, updates the Pain Management and Opioid Dependence Management websites to expand information surrounding SUD treatment and prevention. A Patient Information section for the general public is under development.
  • Funding TBD
  • Ongoing
  • The IHS is in the process of creating a community and layperson MAT overview to introduce the public to general concepts such as what an opioid is, MAT, and the risks of perinatal substance use to reduce stigma surrounding MAT in tribal communities.
  • Funding TBD
  • 12 months
  • Is considering a digital story-telling initiative
  • Funding TBD
  • 12 months
SAMHSA move to next SAMHSA)
  • Co-leads an interdepartmental work group with HRSA and ACF titled Children and Families Impacted by the Opioid Crisis.
  • Federal effort- no funding required
  • Two work group meetings held
  • Under the Project LAUNCH grant, grantees partner at the state level and community level to provide education and messaging regarding SUD treatment options and best practices for PPW. Dissemination efforts target primary care, home visiting, community services, community members and early care and education. While LAUNCH efforts do not focus exclusively on awareness and education about SUD, some grantees have embedded this into their efforts.
  • Grant funded
  • Ongoing; first cohort awarded in FY08; new cohort targeting AIAN communities will be awarded in FY18, date TBD
  • Publishes a white paper through NCSACW and Court Professionals to identify the best treatment fit for families.
  • Contract funding
  • September 2018
  • Identifies materials on the availability and importance of seeking treatment before and early in pregnancy and develops and distributes materials in partnership with the National Recovery Month Planning Partner's network.
  • Funded
  • Included in Recovery Month Toolkit 2018 (in progress) by June 2018
  • Included information in the 2018 National Recovery Monthly toolkit targeting healthcare providers and highlighting the concept, "What You Can Do: Promoting General Public Awareness of the Effectives of SUD Treatment to Reduce Barriers to Seeking Treatment, Prior to Conception and in Early Pregnancy."
  • Funded
  • Included in Recovery Month Toolkit 2018 (in progress) by June 2018
OASH (move to next OASH)
OWH (move to next OWH)
  • In 2017, awarded 20 cooperative agreements on primary and/or secondary prevention of prescription and illegal opioid misuse by women across the lifespan to public and private nonprofit entities in 20 cities in 15 states. Funded projects were designed to promote and extend partnership and collaboration among state departments of health and other state, tribal, and local public health-focused entities; academic institutions; and private and public nonprofit and community organizations. Each entity has committed to substance abuse prevention and is working to improve the health and well-being of women and girls.
  • Funded via cooperative agreement for FY 17-FY19
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
8. Promote shift in public perceptions of SUD so that it is regarded as a disease rather than as a criminal or moral problem to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal) ACF (move to next ACF)
Children's Bureau move to next CB)
  • NCSCAW provides a variety of TA activities and resources to promote general public awareness to education communities about SUDs and their treatment, including reducing barriers to seeking treatment prior to conception and in early pregnancy. In particular such efforts including a variety of online tutorials and curriculum designed to education various different professionals across disciplines, including those from child welfare and the courts about SUD and SUD treatment as well as other publications mentioned earlier including, A Collaborative Approach to the Treatment of Pregnant Women With Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical, and Service Providers and the Executive Summary for SEI IDTA. In addition, related recent webinars include: Partnering to Support Families Affected by Opioid and Other Substance Use Disorders; Supporting Families in Child Welfare Affected by Opioid and Other Substance Use Disorders; A Framework for Intervention for Infants with Prenatal Exposure and Their Families; Early Identification and Treatment of Prenatally Exposed Infants; and Collaborative Approaches to Treating Pregnant Women with Opioid Use Disorders. Recordings and slides from these webinars can be found at: https://ncsacw.samhsa.gov/resources/videos-and-webinars/webinars.aspx.
  • Funded
  • Ongoing
CMS move to next CMS)
  • Funded
  • Completed
  • Continuing to provide TA to states around SUD delivery reform.
  • Funded
  • Ongoing
HRSA move to next HRSA)
  • The AIMS and SUD-MH supplemental funding for health centers, which encourage community engagement and education.
  • Funded
  • Ongoing
  • Supports voluntary, evidence-based home visiting services for at-risk pregnant women and parents with young children up to kindergarten entry. Activities include:
    • In FY17, the program provided training, TA, and resources to grantees on NAS.
    • Training helps state programs use mental health consultation to improve home visitors' capacity to support families experiencing opioid use and caring for babies with NAS.
    • During regional calls, states discuss NAS activities and share successful strategies. The program will release an issue brief highlighting state examples of effective home visiting practices and early childhood systems activities for families impacted by OUD.
    • Several states have enhanced home visiting activities to address opioid use among families with young children.
   
  • Addresses this recommendation through three programs mentioned above:
    • Testing evidence-informed interventions for integrating behavioral health with primary medical care for people living with HIV
    • AIM initiative
    • RHOP
  • Funded
  • Ongoing (AIM to be completed 8/21/18)
  • Sponsored at least two webinars on this topic that are targeted to Healthy Start and Home Visiting grantees. One addresses the unique issues related to pregnant women in tribal communities and common reasons they do not self-report substance use because of fear of child removal or legal action.
  • Funded
  • Ongoing
IHS move to next IHS)
  • Developed seven-part series on perinatal substance use, treatment of opioid-exposed infants, culturally based treatment models/strategies, and overview of the IHS breastfeeding guideline.
  • Complete
  • Complete
  • Through IHS HOPE Committee, continuously updates the Pain Management and Opioid Dependence Management websites and plans to expand access to SUD treatment and prevention. A Patient Information section for the general public is under development as are future updates to the websites.
  • Funding TBD
  • 12 months
  • Increases knowledge and skillsets of providers by continuing community education. A new curriculum will be created to support guideline implementation.
  • Funding TBD
  • 12 months
NIDA move to next NIDA)
  • Informs the public that SUD is a disease through outreach work on many agency levels.
  • Funded
  • Ongoing
  • Continues to present public talks and publish about the disease of drug addiction.
  • Funded
  • Ongoing
OASH move to next OASH)
OWH move to next OWH)
  • In March 2017, OASH/OWH initiated a 1-year partnership with IHS to support work to address the problem of opioid misuse among women of reproductive age in the AI/AN communities, including PPW. Specifically, the IAA supports national training, education, and guidance through development of written recommendations on the screening, diagnosis, and management of opioid dependence among AI/AN women of reproductive age and AI/AN newborns. These documents are being developed with ACOG and the AAP.
  • Funded via IAA and contract in FY17
  • Written recommendations will be released later in 2018 and will then be disseminated throughout the IHS system.
  • The IAA also supports the development of a structured, comprehensive approach to prenatal care and SUD treatment in Billings, MT, an area of particularly high need. Successful strategies developed in the Billings in this IAA will be leveraged across IHS.
  • Funded via IAA and contract in FY17
  • Report will be released later in 2018 and will then be disseminated throughout the IHS system.
SAMHSA move to next SAMHSA)
  • Through multiple efforts conducted by CSAT/OCA, addresses the public perception of SUD as a treatable condition. Focused Recovery Month 2017 on families and community in recovery.
  • Funded
  • September 2017
  • Worked with the PPW Program to identify evidence-based treatment programs for PPW who have had or are at risk of developing SUDs to use as case studies in the Road to Recovery TV and radio series.
  • Funded
  • April 2018
  • Through CSAT/OCA's National Recovery Month observance/campaigns, addresses the issue of discriminatory practices toward those seeking SUD treatment or are in recovery from SUDs.
  • Funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
9. Develop effective strategies to support informed decision making around pain management or SUD treatment when these conditions are identified prenatally. (Programs & Services, Maternal) CDC (move to next CDC)
  • Leading the Treating for Two initiative to identify the safest treatment options for the management of common conditions before and during pregnancy and to improve the availability and quality of data to help inform clinical management decisions for pregnant and reproductive aged women and their healthcare providers. Treating for Two also conducts ongoing research and surveillance of medications commonly used to manage health conditions during pregnancy and associated adverse outcomes including structural birth defects.
  • Unfunded
  • Ongoing
FDA (move to next FDA)
  • Class labeling for immediate-release opioid analgesics.
  • Funded
  • Ongoing
  • Participated in ongoing communications about abuse-deterrent formulations of opioids during all stages of the drug development process. There are currently eight approved opioid analgesic products with abuse-deterrent properties described in the product labeling.
  • Funded
  • Funded
HRSA (move to next HRSA)
  • Achieves this recommendation through health centers and other primary care settings. Examples include:
    • The AIMS and SUD-MH supplemental funding for health centers.
    • RHOP
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Collaborates with external partners such as ACOG and the CONACH for development and implantation of guidelines for SUD and NOWS.
  • Funded
  • Ongoing
  • Publishes best practices guidelines and recommendations on the Pain Management and IHS Opioid Dependence Management/Maternal Child Health websites; distributes information updates and resources through internal listserv domains.
  • Funded
  • Ongoing
OASH (move to next OASH)
OWH (move to next OWH)
  • The OASH/OWH and HRSA Office of Women's Health initiative to produce a care coordination model for women impacted by opioids who receive healthcare services via HRSA-administered programs may address this recommendation by implementing and disseminating models and resources, including pain management and opioid alternatives.
  • Funded via IAA in FY18, FY19 funding TBD
  • FY18-FY20
SAMHSA (move to next SAMHSA)
  • AAP participated in the Technical Expert Panel addressing the Developmental Impacts on Children of Opioid Use in Pregnancy and will continue to partner to develop approaches to treatment for mothers and children affected by opioids.
  • Funded, future initiatives funding TBD
  • April 2018
Recommendation Agency Action Funding Milestones/Status
10. Promote non-pharmacologic interventions, such as rooming in, for managing mild to moderate NAS/NOWS. (Programs & Services, Child) ACF (move to next ACF)
Children's Bureau (move to next CB)
  • NCSACW is an HHS initiative jointly funded by SAMHSA CSAT and the ACF ACYF and OCAN. The mission of NCSACW is to improve family recovery, safety, and stability by advancing practices and collaboration among agencies, organizations and courts working with families affected by substance use and co-occurring mental health disorders and child abuse or neglect. NCSACW provide various forms of TA, including working with states to expand screening to identify women in need of brief intervention, and referral to treatment. Examples of the related TA they are providing include:
    • Launched in September 2014, the SEI IDTA, which provides in depth TA to advance the capacity of tribes, states, and community agencies to improve the safety, health, permanency, and well-being of substance-exposed infants and the recovery of PPW and their families. The program is designed to strengthen collaboration among child welfare, substance use disorder treatment, and the courts, as well as medical communities, early care and education systems, home visiting, and other key partners. Six states were selected to participate in Round I (2014-2016) -- CT, KY MN, NJ, VA, and WV. Four of the states, CT, KY, NJ, and VA-- receive time-limited TA to develop policy and protocol on the prenatal substance exposure provisions in CAPTA. Currently, two states were selected to participate in Round II, including DE and NY and three additional states were selected to participate in Round III, including FL, MD and NC.
    • ACF/ACYF/Children's Bureau and SAMHSA conducted a Policy Academy entitled "Improving Outcomes for Pregnant and Postpartum Women with Opioid Use Disorders, and their Infants and Families" on February 7-8, 2017, in Baltimore, MD. Ten states were selected to participate in the Policy Academy to develop action plans on the complex needs of pregnant and parenting women. The states included FL, GA, MD, MA, NY, MI, NC, PA, VT, and DE. NCSACW is providing support to the states to implement the action plans, many of which focus on the development and implementation of the CAPTA provisions.
  • Funded
  • Ongoing
  • NCSACW created the publication, "A Collaborative Approach to the Treatment of Pregnant Women With Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating With Medical, and Service Providers". The document was downloaded from the NCSACW website 347 times during the first quarter. It was the most downloaded resource from the NCSACW website. Since its release in 2016, it has been downloaded 2,148 times.
  • Funded
  • Completed
CDC (move to next CDC)
  • Funds the PQC which are networks of perinatal care providers and public health professionals working to improve pregnancy outcomes for women and newborns in states and nationally. Efforts include: improve identification of and care for infants with NAS.
  • Funded
  • Ongoing-2022
CMS (move to next CMS)
  • Developed guidance regarding the critical role of Medicaid in the care of infants with NAS through an Informational Bulletin, "Neonatal Abstinence Syndrome: A Critical Role for Medicaid in the Care of Infants," at https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf. This guidance includes a discussion of the professional recommendations for non-pharmacologic interventions as a first line treatment for mild to moderate NAS.
  • Funded
  • 1-3 months
  • Through the Medicaid IAP, CMS is supporting a cohort of states to assess the size and characteristics of NAS and opioid-related maternity care within the state's Medicaid program, including conducting data analytics on key population, utilization and expenditure patterns associated with NAS treatment.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to promote non-pharmacologic interventions, such as rooming in, for managing mild to moderate NAS/NOWS.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 month
IHS (move to next IHS)
  • Ensures all IHS delivery facilities are Baby-Friendly certified. Baby-Friendly status includes high-level support for rooming-in, maternal-newborn bonding, and breastfeeding, all of which are helpful in the management of mild to moderate NOWS.
  • Funded
  • Ongoing
  • Develops IHS initiatives on best practices guidelines on NOWS.
  • Funded
  • 12 months
NICHD (move to next NICHD)
  • Through NICHD and ECHO/ISPCTN programs, develops ACT NOW. The Second Act proposal includes research on non-pharmacologic interventions such as rooming-in and ESC comprehensive care strategies for treatment of NOWS versus usual care.
  • Funding
  • Under development
NIDA (move to next NIDA)
NICHD (move to next NICHD)
  • Published a notice of interest in February 2018 informing researchers of high programmatic priority to fund research on studies of non-pharmacologic interventions of NOWS.
  • Funding TBD
  • Ongoing
  • Encourages and works with applicants in the development of research proposals addressing this high-priority area.
  • Funding TBD
  • TBD
SAMHSA (move to next SAMHSA)
  • Initiates SAMHSA cross-agency collaboration with the Maternal and Child Health Bureau/HRSA, OASH/OWH, NIDA, and ACF.
  • Funded
  • Ongoing
  • Engages with the NIDAMED and CDC and leverages SABG to pay for services in SUD facilities.
  • Funded
  • Ongoing
  • Project LAUNCH: Education and trainings for medical professions and other child serving systems (such as child welfare or substance abuse treatment providers) related to management of NAS. Project LAUNCH grantees have the opportunity to educate all of these providers about best practices related to NAS, both in the hospital and post-discharge.
    • Maine developed an innovative model (Bridging) for helping families before birth, shaping NICU practices, and reducing re-hospitalizations through post-discharge support to families related to NAS care and attachment.
    • PA is developing training for home visitors, early intervention, and child welfare systems regarding best practices to managing NAS/NOWS and supporting of families experiencing the impacts of SUD.
  • Grant funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
11. Promote breastfeeding for women who receive opioids for pain or the treatment of OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal) ACF (move to next ACF)
Children's Bureau (move to next CB)
  • Funded
  • Ongoing
CDC (move to next CDC)
  • Has contracted with the ACOG to survey members about screening, referral, and treatment of maternal opioid use (including support of breastfeeding postpartum) and will produce a research report on survey results.
  • Funded
  • 1 year
  • Planning to collect information on hospital practices related to NAS infant (including breastfeeding) s with the mPINC survey (currently under OMB review). CDC will analyze data.
  • Funded
  • Ongoing; currently under OMB review
CMS (move to next CMS)
  • Issued guidance regarding the critical role of Medicaid in the care of infants with NAS through an Informational Bulletin, "Neonatal Abstinence Syndrome: A Critical Role for Medicaid in the Care of Infants," at https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf. This guidance includes a discussion of the recommendations for breastfeeding of infants with NAS by women if the women are enrolled in substance abuse treatment and no contraindications to breastfeeding are observed.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to promote breastfeeding for women who receive opioids for pain or the treatment of OUD when not otherwise contraindicated and consistent with appropriate guidelines.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
HRSA (move to next HRSA) Several HRSA activities help address this recommendation, including:
  • The evidence-based Home Visiting program.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Through the AAP CONACH Guideline, has extensive recommendations on breastfeeding opioid-exposed infants.
  • Funded
  • Ongoing
  • Has IHS Delivery Hospitals designated as Baby-Friendly institutions.
  • Funded
  • Ongoing
  • Through GPRA measure, addresses total breastfeeding rates.
  • Funded
  • Ongoing
  • Evaluates/leverages the Baby-Friendly initiative to increase breastfeeding rates where appropriate.
  • Funded
  • Ongoing
OASH (move to next OASH)
OWH (move to next OWH)
  • In March 2017, initiated a 1-year partnership with IHS to support work to address the problem of opioid misuse among women of reproductive age in the AI/AN communities, including PPW. Specifically, the IAA supports national training, education, and guidance through development of written recommendations on the screening, diagnosis, and management of opioid dependence among AI/AN women of reproductive age and AI/AN newborns. These documents are being developed with ACOG and the AAP.
  • Funded via IAA and contract in FY17.
  • Written recommendations will be released later in 2018 and will then be disseminated throughout the IHS system.
SAMHSA (move to next SAMHSA)
  • SAMHSA's Office of the Chief Medical Officer is collaborating with ACOG, AAP, and other HHS partners. Participated in Workshop addressing SUDs in Pregnancy to develop guidance/publications for treating pregnant women with SUD/OUD. Will publish in American Journal of Obstetrics and Pediatrics.
  • Funded
  • January-February 2018
  • Under the Project LAUNCH Grant: Education and trainings for medical professions and other child serving professionals (such as early intervention and child welfare agencies) related to best practices and research related to treatment of lactating women with OUD: Project LAUNCH grantees have the opportunity to educate all of these providers about best practices related to breastfeeding and OUD, NAS, etc. both in the hospital and post-discharge. SAMHSA Clinical Guidelines has been disseminated. Examples:
    • Maine developed an innovative model (Bridging) for helping families before birth, shaping NICU practices, and reducing re-hospitalizations through post-discharge support to families related to NAS care and attachment.
    • PA is developing training for home visitors, early intervention, and child welfare systems that will include guidance on breastfeeding and LAUNCH grantee is involved in the PA opioid efforts at the state level.
  • Grant funded
  • Ongoing; first cohort awarded in FY08; new cohort targeting AIAN communities will be awarded in FY18, date TBD
  • Included SAMHSA official talking points in the spotlight segment in March and June 2018 Road to Recovery show.
  • Funded
  • March 2018
Recommendation Agency Action Funding Milestones/Status
12. Promote breastfeeding of infants of women who receive opioids for pain or OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal) CDC (move to next CDC)
  • Has contracted with ACOG to survey members about screening, referral, and treatment of maternal opioid use (including support of breast-feeding postpartum) and will produce a research report on survey results.
  • Funded
  • 1 year
CMS (move to next CMS)
  • Developed guidance regarding the critical role of Medicaid in the care of infants with NAS, through an Informational Bulletin, "Neonatal Abstinence Syndrome: A Critical Role for Medicaid in the Care of Infants," at: https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf. This guidance includes a discussion of the recommendations for breastfeeding of infants with NAS if the women are enrolled in substance abuse treatment and no contraindications to breastfeeding are observed.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to promote breastfeeding of infants of women who receive opioids for pain or OUD when not otherwise contraindicated and consistent with appropriate guidelines.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
HRSA (move to next HRSA)
  • Several HRSA activities help achieve this goal, including: The evidence-based Home Visiting program.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Collaborates with the AAP CONACH to develop standardized screening guidelines based on the IHS Best Practice Guidelines: NOWS.
  • Funded
  • Ongoing
NICHD (move to next NICHD)
  • Led an opioid use in pregnancy, NAS, and childhood outcomes workshop that was co-sponsored by ACOG, AAP, the Society for Maternal-Fetal Medicine, CDC, and the March of Dimes Foundation. The executive summary was published in Obstetrics and Gynecology June 2017 and reviewed the benefits of breastfeeding and the research agenda for breastfeeding.
  • Funded
  • Completed; summary/research agenda published June 2017
OASH (move to next OASH)
OWH (move to next OWH)
  • In March 2017, initiated a 1-year partnership with IHS to support work to address the problem of opioid misuse among women of reproductive age in the AI/AN communities, including PPW. Specifically, the IAA supports national training, education, and guidance through development of written recommendations on the screening, diagnosis, and management of opioid dependence among AI/AN women of reproductive age and AI/AN newborns. These documents are being developed with ACOG and the AAP.
  • Funded via IAA and contract in FY17
  • Written recommendations will be released later in 2018 and will then be disseminated throughout the IHS system.
SAMHSA (move to next SAMHSA)
  • Project LAUNCH grantees have a wide reach into maternal and infant health serving systems and there are efforts and opportunities to provide information, awareness, and education around breastfeeding and other best clinical practices as they relate to breastfeeding, babies with NAS, and women with OUD.
  • Grant Funded
  • Ongoing; first cohort awarded in FY08; new cohort targeting AIAN communities will be awarded in FY18, date TBD
Recommendation Agency Action Funding Milestones/Status
13. Provide continuing medical education to the provider for managing pain in the pregnant woman with OUD. (Education, Maternal) CDC (move to next CDC)
  • On August 16, 2016, hosted a Public Health Grand Round on "Primary Prevention and Public Health Strategies to Prevent Neonatal Abstinence Syndrome." (Ko JY, Wolicki S, Barfield WD, et al. CDC Grand Rounds: Public Health Strategies to Prevent Neonatal Abstinence Syndrome. MMWR Morb Mortal Wkly Rep 2017;66:242-245. DOI: dx.doi.org/10.15585/mmwr.mm6609a2)
  • Funded
  • August 2016
  • CDC also has information and resources on the Treating for Two website that discuss the safety of medications used to treat pain during pregnancy and disseminates key findings on updated research through professional organizations for healthcare providers (e.g., ACOG, AAP).
  • Unfunded
  • Ongoing
  • Has developed an online training for healthcare providers on opioids and pregnancy.
  • Funded
  • Ongoing
  • Developing a module specific to pregnancy from the CDC Guideline for Prescribing Opioids for Chronic Pain to be released summer/fall 2018.
  • Funded
  • Ongoing
  • Funded
  • September 2018
HRSA (move to next HRSA)
  • Health Center Program supplemental funding through AIMS and SUD-MH may support continuing education for providers on SUD and mental health topics.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Mandates 5-hour, web-based course on safe opioid prescribing and addiction treatment training for controlled substance prescribers spending greater than 50% of time in the federal government. The training module started in 2015 with refresher training required every 3 years.
  • Funded
  • Ongoing
SAMHSA (move to next SAMHSA)
  • Collaborating with ACOG, AAP and other HHS partners and is working with CDC as lead using Providers Clinical Support System (PCSS)-MAT.
  • PCSS-MAT -- Funded; new initiatives as a result of collaboration; funding TBD
  • Ongoing
  • Determines and hosts in one repository a CME courses on topics organized by content area (e.g., treating pain in pregnancy and special populations; treating OUD in pregnancy; treating substance-exposed infants).
  • Funded
  • Ongoing
Recommendation Agency Action Funding Milestones/Status
14. Provide continuing medical education to the provider for managing the infant with NAS symptoms. (Education, Maternal) CDC (move to next CDC)
  • Supports Grand Rounds and collaborations through the Treating for Two initiative.
  • Funded
  • Ongoing
HRSA (move to next HRSA)
  • Health Center Program supplemental funding through AIMS and SUD-MH may support continuing education for providers on SUD and mental health topics.
  • Funded
  • Ongoing
  • Supports the Children's Hospitals Graduate Medical Education Payment Program.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Supports IHS Best Practices Guidelines: NOWS and other initiatives.
  • Funded
  • Ongoing
  • Revising NOWS training curriculum to expand provider capacity.
  • Funding TBD
  • 12 months
  • Expand capacity for NOWS care at HIS Labor and Delivery hospitals to minimize the need for NICU transfer for cases of lower acuity.
  • Funding TBD
  • 2 years
OASH (move to next OASH)
OWH (move to next OWH)
  • In March 2017, initiated a 1-year partnership with IHS to support work to address the problem of opioid misuse among women of reproductive age in the AI/AN communities, including PPW. Specifically, the IAA supports national training, education, and guidance through development of written recommendations on the screening, diagnosis, and management of opioid dependence among AI/AN women of reproductive age and AI/AN newborns. These documents are being developed with ACOG and the AAP.
  • Funded via IAA and contract in FY17
  • Written recommendations will be released later in 2018 and will then be disseminated throughout the IHS system.
Recommendation Agency Action Funding Milestones/Status
15. Identify a history of prenatal substance exposure and NAS/NOWS when children receive developmental assessment, early intervention services or enter child welfare. (Data & Surveillance, Child) ACF (move to next ACF)
Children's Bureau (move to next CB)
  • To support CAPTA and strengthen the implementation of Plans of Safe Care the Children's Bureau issued guidance on the administration of the CARA provisions relevant to the CAPTA State Grant though Information Memoranda ACYF-CB-IM-16-05 [https://www.acf.hhs.gov/cb/resource/im1605], Program Instruction ACYF-CB-PI-16-03 [https://www.acf.hhs.gov/cb/resource/pi1603] and Program Instruction ACYF-CB-PI-17-05 [https://www.acf.hhs.gov/sites/default/files/cb/pi1705.pdf]. States were required to provide an update on their activities to implement the provision, as amended by CARA, by June 30, 2017 as part of their submission of the Annual Progress and Services Report that addresses several grant programs funding child protection and child welfare services:
    • SEI IDTA: NCSACW continues to provide IDTA focused on SEI in their new contract. The NCSACW will continue their work with states to help them respond to growing concerns about opioid use during pregnancy, the increasing number of infants with prenatal exposure, particularly those with NAS, and the lack of coordinated and ongoing services needed to support infants, families, and caregivers during the critical postpartum and infancy period. The initiative is focused on strengthening collaboration and linkages among child welfare, mental health and substance use treatment, public health and medical communities, home visiting and early intervention systems, and other key stakeholders to improve outcomes for infants with prenatal exposure, their mothers and families.
    • TA Support to assist in the implementation of CARA: The NCSACW is tasked with providing two kinds of TA to directly support state implementation of the CAPTA requirements as it relates to the passage of CARA. The first task is to provide TA on an on-going basis to states and state organizations designated to implement the CAPTA requirements, including programmatic TA related to the development and implementation of Plans of Safe Care. TA will be tailored to specific state needs, as well as address the needs of all states when appropriate. TA may include responding to requests for information; disseminating written materials and resources, and conducting webinars/conference calls. The second task, to further assist in the successful implementation of CARA is CAPTA time-limited IDTA. This IDTA will be similar to other IDTA provided by the NCSACW, but on a time-limited basis. It will include the involvement of a Change Leader and may include a site visit. In addition, as necessary, TA tools may be developed and used to provide IDTA, as well as respond to other TA requests that come into NCSACW. These may include use of protocols, training plans, strategic plans, MOUs, etc.
    • As well as other TA efforts by NCSACW outlined in response to recommendation #10.
  • Funded
  • Ongoing
CDC (move to next CDC)
  • Provided funds to the March of Dimes to conduct a pilot project in Tennessee to link a cohort of infants identified with NAS through Medicaid claims data to Department of Education data to increase understanding of long-term neurodevelopmental outcomes potentially associated with NAS.
  • Funded co-agreement
  • Co-agreement to end June 2018
  • Working with AAP on efforts to integrate assessment of prenatal alcohol exposure as routine primary pediatric practice.
  • Funded co-agreement
  • 2014-2018
  • Both surveillance of NAS and the Mother/Infant surveillance of sustained prenatal opioid exposure will prioritize the timely referral of families to needed services. We are still learning about possible long-term outcomes associated with prenatal opioid exposure during pregnancy. Limited research suggests that children with a history of NAS may be significantly more likely to have a disability, developmental delay, and speech or language impairment. Longer-term monitoring of these infants allows for appropriate referral to services to improve outcomes. Early intervention services can have a significant impact on a child's ability to learn new skills, overcome challenges and can increase success in school and life.
  • Funding TBD
  • Proposed/Contingent on funding
CMS (move to next CMS)
  • Under the EPSDT benefit, Medicaid covers regular screening services for children under age 21 in order to identify health and developmental issues as early as possible. States must provide or arrange for screening services both at established times and on an as-needed basis. Covered screening services are medical, mental health, vision, hearing and dental. The medical screenings include, among other things, a comprehensive health and developmental history that assesses for both physical and mental health, as well as for substance use disorders.
  • Funded
  • Ongoing
  • Provide TA to states as requested in implementing this requirement.
  • Funded
  • Ongoing
HRSA (move to next HRSA)
  • Provided funds for Developmental-Behavioral Pediatrics Training Programs that provide training in developmental behavioral pediatrics and may include follow-up clinics for NICU patients and high-risk infants, which may include those with prenatal exposure to opioids.
  • Funded
  • Ongoing
  • Provides Title V funds to all states. Funds may be used to implement screening for substance use among pregnant women, provider training, and care coordination.
  • Funded
  • Ongoing
  • Achieves this recommendation through health centers and other primary care settings. Examples include:
    • Behavioral Health Integration grant program awarded to community health centers, AIMS, and SUD-MH all support expansion of services and access, which include appropriate screening.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Provides standard of care for IHS Pediatric departments.
  • Funded
  • Ongoing
  • Operates early childhood intervention programs in tribal programs.
  • Funded (additional funding needed)
  • Ongoing
  • Plans to work with Federal partners and professional organizations to develop formal recommendations surrounding early childhood interventions.
  • Funding TBD
  • 2 years
Recommendation Agency Action Funding Milestones/Status
16. Promote public and health professional awareness of ongoing parental treatment engagement, recovery support, and early-intervention services in family function and mitigation of consequences of prenatal substance exposure and NAS/NOWS. (Education, Maternal) ACF (move to next ACF)
Children's Bureau (move to next CB)
  • Funded
  • Ongoing
CMS (move to next CMS)
  • Developed guidance to states regarding the critical role of Medicaid in the care of infants with NAS, and issued an Informational Bulletin, "Neonatal Abstinence Syndrome: A Critical Role for Medicaid in the Care of Infants," at https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf. This guidance includes a discussion of the important role mothers can play in treatment of the infants, as well as early intervention services available to Medicaid eligible infants after discharge from NAS treatment.
  • Funded
  • Ongoing
  • As a part of a multi-pronged strategy to combat the opioid crisis, some CMMI models being considered for potential development explore opportunities to promote public and health professional awareness of ongoing parental treatment engagement, recovery support, and early-intervention services in family function and mitigation of consequences of prenatal substance exposure and NAS/NOWS.
  • Potentially funded through Section 3021 (of the Affordable Care Act) Appropriation
  • 10-12 months
FDA (move to next FDA)
  • FDA has approved products for the treatment of opioid overdose with prescribing information for use in neonates.
  • Funded
  • Ongoing
HRSA (move to next HRSA) HRSA addresses this recommendation through:
  • Direct services programs such as Home Visiting
  • Several clinical guidelines such as Bright Futures Health Supervision Guidelines for pediatric practice and the AIM initiative.
  • Workforce development and training programs such as the National Health Service Corps, Public Health Training Centers, Teaching Health Center Graduate Medical Education, and Children's Hospitals Graduate Medical Education Payment Program.
  • HRSA's Title V Maternal and Child Health Services Block Grant Program, which allows states the flexibility to support activities such as addressing NAS. Recent state examples include provider training; addressing the needs of pregnant women and their babies, including care coordination; using screening tools for early detection of high-risk women; and standardizing care for infants with NAS.
  • Funded
  • Ongoing
IHS (move to next IHS)
  • Developed training on trauma-informed care and SUD in pregnancy.
  • Funded
  • Ongoing
  • Developed and enhanced ongoing strategies and efforts in these areas based on emerging information and current standards of practice.
  • Funded
  • Ongoing
  • Plans to increase number of trained peer recovery specialists.
  • Funding TBD
  • 12 months
  • Plans to advocate for increased access to intensive residential treatment and recovery housing (dependent on funding).
  • Funding TBD
  • Ongoing
  • Advocates for increased access to MAT and withdrawal support services for women of childbearing age.
  • Funding TBD
  • 12 months
SAMHSA (move to next SAMHSA)
  • Held an expert panel meeting titled 'The Developmental Impacts on Children of Opioid Use During Pregnancy: Pragmatic Approaches to Support Children and Families' to discuss the state of the evidence on the impact of in utero opioid exposure on child development and identify protective/mitigating factors that can reduce or eliminate negative long-term impacts. As an outcome of the meeting, SAMHSA will develop a product that summarizes the literature and strategies from the meeting.
  • Contract funding
  • April 2018
  • Create and improve linkages to early intervention services for families to mitigate impacts of prenatal exposure: Project LAUNCH grantees promote developmental and behavioral screening in childcare, pediatrics, and home visiting in order to promote early identification and intervention when developmental and behavioral issues emerge. In many communities, Project LAUNCH grantees provide developmental screening and assessment and have successfully increased and embedded behavioral screening and assessments in settings that do not specifically focus on young children such as child welfare. Grantees have also partnered with early intervention systems to build capacity around behavioral health. LAUNCH efforts also include parent engagement efforts across child serving systems and as part of system building.
  • Grant funded
  • Ongoing
  • Supports Center of Excellence for Infant and Early Childhood Mental Health Consultation.
  • Funded
  • Ongoing
  • Promotes awareness of early intervention services for families to mitigate impacts of prenatal exposure. The Center of Excellence will develop web materials and webinars in 2018 that prepare mental health consultants working in home visiting programs, childcare programs, and preschools to offer children, families, and caregivers strategies for effectively dealing with the consequences of prenatal exposure. These include behavioral strategies that promote healthy attachment, stable and nurturing caregiving, emotion regulation, and others.
  • Funded
  • Ongoing
  • SAMHSA and ACYF jointly support NCSACW to identify appropriate training materials available through the NCSAW that can be used by state welfare and substance abuse treatment systems to improve outcomes for families with SUD.
  • Contract funding
  • Currently available and ongoing