NORTON MATERNAL OPIATE AND SUBSTANCE TREATMENT (MOST) PROGRAM Norton Healthcare | Louisville, Ky. MATERNAL HEALTH CASE STUDY Overview Norton Healthcare serves the Louisville and South- ern Indiana market. Its 373-bed Norton Women's & Children's Hospital includes a maternal-fetal medicine program and Level III neonatal intensive care unit. Recognizing that the country was in the grips of an opioid epidemic, the health system launched the Norton Maternal Opiate and Substance Treatment (MOST) Program in 2015. The program aims to pro- vide specially designed treatment to pregnant woman with substance use disorder (SUD). At the time, these patients often felt neglected by health care systems and obstetricians (OBs), and other specialists were reluctant to treat a pregnant woman with SUD. "The patient was stuck in a vicious cycle," said Jona- than W. Weeks, M.D., maternal-fetal medicine special- ist and medical director of the Norton MOST Program. "And these patients have decreased capacity to endure frustration." The Norton MOST Program employs a single point of care approach so patients can easily access addiction and OB services simultaneously. Patients are first as- sessed in the office or emergency department to see if Dr. Jonathan W. Weeks, maternal-fetal medicine specialist and they meet the program's criteria (e.g., pregnant, willing medical director of the Norton MOST Program. to enter treatment and will experience/is experiencing withdrawal symptoms) and determine if a hospital admission is needed. Norton Healthcare worked to destigmatize SUD by integrating MOST Program patients into a regular OB Eligible patients are admitted to the hospital for an practice. Norton Healthcare also trained obstetrics average of two to three days. The admission enables teams in the treatment of SUD, ensuring patients are patients to receive care from an addiction medi- treated with respect and dignity. cine specialist at a single location and removes the hassle to travel to alternate sites of care. This single "Our intense education of care providers enabled point-of-care approach improved Norton Healthcare's them to understand the disease and change the way ability to screen patients, stabilize them with med- they care for patients," said Charlotte Ipsan, DNP, chief ication-assisted treatment and perform obstetrical administrative officer of Norton Women's & Children's evaluations. Hospital. ©2021 American Hospital Association | April 2021 Page 1 | www.aha.org Physicians, nurses and others who may have been Caregivers note that having a small baby while trying skeptical became more open to accepting patients with to get housing, go to meetings and come to grips with SUD. Several surrounding hospitals, hearing about the medical and psychiatric issues related to SUD is much Norton MOST Program's success in reducing neonatal more difficult. Therefore, the Norton MOST Program abstinence syndrome (NAS), reached out to ask for counsels women to avoid a future pregnancy while training so they could initiate similar programs. working toward recovery. Providers learned to empha- size contraception early on when the patient was in The Norton MOST Program plugged in to community the hospital for the baby's delivery, rather than later in resources to address issues often associated with ad- outpatient visits. diction, such as homelessness. Initially, a licensed social worker provided individual counseling to clients, but due Future goals to COVID-19, the program began offering group counsel- ing both in person and via Zoom. These interactions have "Even though patients have substance use disorders, enhanced the recovery journey of these patients. they really do have strong maternal instincts. If you give them some sort of a lifeline, they'll grab on. What Impact we've learned is that moms have significant others whom we don't have a program for," Weeks said. Since its launch, the Norton MOST Program has admitted around 100 women annually for sub- Norton Healthcare would like to expand its SUD treat- stance use treatment. In that population, Nor- ment and support programs to include fathers/partners, ton Healthcare experienced a 41% decrease so that both parents can be treated during the preg- in the number of babies admitted to the NICU nancy and one to two years in tandem after pregnancy. for NAS. "That's a huge win," Ipsan said. Newborns also would be included in this setting, where neonatal specialists can monitor childhood develop- Norton Healthcare also has experienced cultural chang- ment and provide proper interventions. es around how care providers interact with pregnant women with SUD. The Norton MOST Program demon- strated that caregivers with expertise in obstetrics also can provide high-quality treatment to pregnant women Contact with SUD. Jonathan W. Weeks, M.D. Lessons learned Maternal-Fetal Medicine Specialist Norton Healthcare has seen first-hand the importance Medical Director, Norton MOST Program of early counseling. When initiated soon after the Norton Healthcare patient arrives, it tends to quickly improve her frame of jonathan.weeks@nortonhealthcare.org mind, making her less anxious and more open to treat- ment. Norton Healthcare now employs licensed clinical Charlotte Ipsan, DNP, RNC, NNP-BC, FACHE social workers who concentrate on homelessness, psy- Chief Administrative Officer chological or psychiatric scarring and related problems Norton Women's & Children's Hospital that often accompany SUD. It has started on-site group charlotte.ipsan@nortonhealthcare.org counseling (now supplemented by Zoom meetings), which have enhanced patients' progress in recovery. ©2021 American Hospital Association | April 2021 Page 2 | www.aha.org