Indiana Pilot Program Combatting Neonatal Abstinence Syndrome Shows Early Promise
February 19, 2020
|
| David Orlich, LEND Trainee |
Every 15 minutes a baby in the United States is born diagnoses with Neonatal Abstinence Syndrome (NAS). However, a new Indiana program targeted at improving outcomes for mothers struggling with Substance Use Disorder (SUD) and their newborns is showing strong, early results. The program, named CHOICES, which assists mothers and is attempting to combat (NAS) has been showing promise since its inception in 2016. In December of 2019 Indiana's effort was supported by a $5.2 million dollar grant from the U.S. Centers for Medicare and Medicaid Services (CMS) to the Indiana Family and Social Services Administration (FSSA). Rates of NAS have been skyrocketing across the country and have impacted Indiana particularly hard during the opioid crisis leading to what has become one of the most overwhelmed child welfare agencies in the nation with almost 30,000 children in care.
The symptoms an infant with NAS may display at birth can include tremors, irritability, excessive crying, and diarrhea. Occasionally, seizures also are present. Hyperirritability, one of the more prevalent symptoms, can lead to agitation, difficulty sleeping, and inconsolable crying. The high-pitched, uncontrollable and excessive crying is unmistakable and requires immediate attention. Some of the long-term affects may include hearing and vision problems as well as problems with learning and behavior that impact development.
The pilot program, located at Community Hospital East in Indianapolis, aims to provide a high level and continuity of care. The program which includes having an OGB-YN, Nurse Practitioner and mental health services in one location also boasts having the only neonatologist in Indiana prescribing buprenorphine, of the 3 established types of Medically Assisted Treatment. Recently published results from the program are inspiring. The program so far has shown a 39.9% decrease in neonate length of stay, that mother's taking buprenorphine has a 25% less chance of an NAS incident, and that those babies spent on average 15.5 less days in the hospital than babies born to mothers who were treated with methadone. The program also noted that mothers who used buprenorphine were 20% less likely to test positive for opiates at birth than those treated with methadone.
While the Indiana is encouraged and Governor Holcomb has expressed his desire to expand the program, the cost is of great concern to many. Expanded Medicaid to a scale large enough to institute programs like this state wide can be a financial and political hurdle. However, the CHOICES program has shown promise in this arena as well. While the cost to treat NAS in America increased by more than $472 million from 2004 to 2014. Before CHOICES took off at Community East Hospital the hospital was losing, on average, $12,000 per NAS diagnosis. Since the start of the program the hospital has seen $764 dollars in savings over about 2 years. Proactive, personalized care is showing to be not just medically effective, but financial effective as well.
While it is still early, it does look like positive change is on the horizon for Indiana's smallest Hoosiers. With the CMS grant and promise shown by the pilot program there is hope for real change in the care children born with NAS, and the mothers who carry them, will receive. Hoosiers are now in a position to wait and see what can be done to bring these successes to other regions of the state.
David Orlich
LEND Trainee
Riley Child Development Center
Indianapolis, IN
