To combat the rise of opioid use disorder (OUD), which has more than quadrupled in the past 20 years, the Centers for Disease Control and Prevention has partnered with the Association of State and Territorial Health Officials (ASTHO) to launch the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Initiative Learning Community (OMNI LC). The collaborative’s goal was to support systems change and capacity-building in 12 states and qualitative data from these states have been analyzed to identify strategies, barriers, and facilitators for capacity-building in state-defined focus areas.
The 12 states included in the first year of OMNI LC were: Alaska, Florida, Illinois, Kentucky, Nevada, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington and West Virginia. They were selected based on a high prevalence or incidence of opioid-related behaviors and outcomes.
As part of the learning collaborative framework, 12 state teams, composed of leaders from multidisciplinary agencies, participated in a 2-day meeting in Arlington, Virginia in November 2018 with support from ASTHO, CDC, and additional federal and academic partners. Five focus areas were identified in the meeting: 1) access to and coordination of quality services; 2) provider awareness and training; 3) data monitoring, and evaluation; 4) financing and coverage; and 5) ethical, legal, and social considerations. State teams developed plans of action within one or more focus areas and outlined activities to accomplish goals.
Access and coordination of quality services (10 state teams developed action plans): Existing barriers included geographic and logistical challenges, as well as a lack of coordinated clinical and social services. Strategies included coordination of OUD treatment; wraparound services, such as nutrition or mental health services; and trauma-informed, family-centered care. Telemedicine was identified as one way to improve access to care in rural areas or areas with limited services.
Provider awareness and training (nine state teams developed action plans): Existing barriers included lack of awareness and experience among providers in identifying women with OUD and prescribing medication-assisted treatment to pregnant and postpartum women. Strategies included implementing clinical protocols and standardized services; educating health care providers about evidence-based screening and treatment standards; and developing plans of safe-care requirements.
Data, monitoring, and evaluation (four state teams developed action plans): Reported barriers included inconsistent data collection and monitoring practices and limitations in data processing capacity. Strategies included plans to develop quality improvement protocols, data systems, and standard data elements to better identify pregnant women with OUD and infants with neonatal abstinence syndrome (NAS).
Financing and coverage (three state teams developed action plans): Identified barriers were variable coverage of OUD treatment for pregnant and postpartum women and care of infants with NAS, issues with service reimbursement, and limited funding for services. Strategies included better collaboration with insurers and other stakeholders to broaden coverage of services, implementing care bundles, limiting prior authorization requirements and providing full health insurance coverage up to 1 year postpartum.
Ethical, legal, and social considerations (two state teams developed action plans): Women with OUD and infants diagnosed with NAS may experience stigma, including discrimination and criminalization, and gaps in the provision of social services. Strategies included creating nonstigmatizing messages for health care and service providers, training providers on conscious bias and antidiscrimination practices for pregnant women with mental health conditions or OUD, and incorporating family-focused policies and practices into agencies and organizations.