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Illinois Families in Recovery Pilot is an enhanced outpatient family-based program focused on addressing the needs of pregnant and postpartum women with substance use disorders including opioid use and her identified family. The Illinois Department of Human Services, Division of Substance Use Prevention and Recovery (IDHS/SUPR), submits this application in response to SAMHSA/CSAT announcement #TI-20-010, FY2020 State Pilot Grant Program for Treatment for Pregnant and Postpartum Women (PPW-PLT). The requested SAMHSA/CSAT PPW-PLT funding will support the development of expanded outpatient family-based services enhanced with home visiting, parenting, childcare and recovery support services using cognitive behavioral therapy and motivational interviewing with the focus of increasing family engagement and moving the family towards recovery. A multidisciplinary team including a Doula/Recovery Coach, Certified Peer Recovery Specialist (CPRS), Case Mangers and Family Educator will work together to address the needs of the family unit by creating individualized Family Support Plans. Human Service Center of Peoria (HSC), a licensed substance use disorder (SUD) treatment provider, will be targeted to implement the Illinois Families in Recovery Pilot in central Illinois focusing on the following counties: 1) Peoria, 2) Tazewell, and 3) Woodford. It is projected that at least 150 unduplicated pregnant and postpartum women will be admitted to outpatient family-based services over the three years of SAMHSA/CSAT funding (Yr.1 – 45, Yr. 2 – 55, Yr. 3 – 50). Infrastructure activities will be built around current work being done within the state. Illinois’ Opioid Use Disorder, Maternal Outcomes, Neonatal Abstinence Syndrome (OMNI) Initiative’s Learning Collaborative Year 2 Action Plan and the Perinatal Advisory Committee’s (PAC) Maternal Mortality Review of Violent Death Committee (MMRC-V)’s recommendations from the 2018 Illinois Maternal Morbidity and Mortality Report will be enhanced to address the need for short-and long-term strategies to support family-based treatment services along the continuum of care for pregnant and postpartum women. An enhancement of current needs assessment being done will drill down to gaps in services for pregnant and postpartum women. Advocates for Human Potential (AHP) will be responsible for providing the required data collection and reporting activities associated with the project. AHP will also be responsible for the infrastructure development activities including the needs assessment and strategic plan specific to the targeted population. A performance measurement plan will be implemented that consists of both process and outcome components. The organizational experience, resources, and qualifications of IDHS/SUPR, the participating treatment and infrastructure partners are described within this application. IDHS/SUPR will retain legal, administrative, and fiscal responsibility for this PPW-PLT project. Biographical sketches and job descriptions are provided for key staff. A total of $900,000 is requested in each of the three years of this SAMHSA/CSAT-funded award.

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) in partnership with CREOKS Health Services, the Center for Therapeutic Interventions, Green Country Behavioral Health Services, and Grand Lake Mental Health will create the Oklahoma Families First Project (OFFP) to expand treatment, prevention, and recovery support services for women, their children, and involved family members. The OFFP will work with the identified outpatient treatment providers to achieve the following goals: (1) develop and expand the menu of outpatient services consisting of evidenced-based practices designed to address the needs of pregnant and postpartum women with substance use issues, their infants, and families; (2) implement a family-focused treatment approach utilizing programming to support family strengthening, reunification, and a reduction in the impact of substance use on infants and children; (3) utilize a wraparound recovery support approach designed to address the continuum of care and improve access and retention in services by addressing barriers to treatment for pregnant and postpartum women with substance use issues, their infants, and families; and (4) create a cohesive state-level continuum of care for pregnant and postpartum women, their infants and families that includes a process of: early identification, referral, individualized assessment, and care coordination across systems. The providers deliver outpatient treatment opportunities for women to receive substance abuse services. CREOKS Health Services and the Center for Therapeutic Interventions deliver services in Tulsa County, the second-most populous county in the state. CREOKS Health Services also serves the rural counties with the highest number of women who gave birth to substance-exposed infants along with Green Country Behavioral Health Services and Grand Lake Mental Health. The identified providers currently serve the population of focus and are poised to enhance their family programs to improve treatment outcomes for the women, children, and additional family members served. All provider partners employ a diverse team of professionals with experience, expertise, and a unified philosophy necessary to meet the complex needs of the families. The OFFP target population includes women who are pregnant or postpartum, their minor children, and other involved family members receiving treatment outpatient settings. The proposed evidenced-based intervention includes: Circle of Security, Seeking Safety, the Celebrating Families Program and the Community Reinforcement Approach. This comprehensive and approach will improve outcomes in the areas of individual and family functioning. Anticipated outcomes include improved child/parent relationship/attachment, improved family functioning, and well-being, and increased number of family members served in tandem with mother and child(ren). The OFFP will serve 120 women and their children in the first year and increase the number served by 15% each year of the grant.

The CT Department of Mental Health & Addiction Services (DMHAS), in partnership with two treatment providers in two urban Connecticut communities (Hartford/East Hartford and New Britain/Bristol) where opioid use is at epidemic levels, proposes to launch the PROUD Initiative: Parents Recovering from Opioid Use Disorders. Population data from these communities reveal disproportionate racial, social and economic disparities as compared to other areas of CT. This results in adverse health effects for pregnant and postpartum women (PPW) and PPW with substance use disorders (especially opioids), who are at higher risk for experiencing treatment barriers. Participation in the PROUD initiative is expected to lead to reduced health disparities, including decreased substance use, criminal justice involvement, and HIV risk behaviors. Improved housing, employment outcomes, family functioning and involvement in social networks are anticipated to support the recovery journey of PPW and participating family members. The community will be engaged through a public health campaign aimed at reducing stigma and increasing knowledge around addiction. Healthcare professionals will be offered educational opportunities to better understand and screen for SUD and provide treatment referrals to PPW. The PROUD service model will utilize evidence-based practices, recovery coaching, prenatal health and parenting education, support and modeling, and offer additional social services as indicated. Substance use, physical and mental health assessments, education and referrals will be provided to all participants, including children and family of the PPW. Primary features of the initiative will include easy accessibility through telehealth and in-home support and individualization of services based on the assessed needs and preferences of each family. We will engage 480 PPW (i.e., 120 in year 1; 180 in each of years 2 and 3), including their children, partners, and other family members, into this team-based and community/mobile service model. The two PROUD site teams will include a combination of clinical, medical, case management and peer staff. The specific team makeups will vary by site which is anticipated to allow for comparative analysis of client outcomes associated with team arrangement. Connecticut has considerable momentum to implement this project given the many collaborating partners and synchronous initiatives. CT's Department of Children and Families (DCF) will be a key partner, especially as it relates to the planned media campaign on PPW and substance-exposed infants. The PROUD Initiative will also support DCF with the full implementation of the Child Abuse Prevention and Treatment Act (CAPTA) including the development of Plans of Safe Care with all pregnant participants. The CT Department of Public Health (DPH) will partner on needed data analyses to inform this work. DMHAS will embark on information systems infrastructure changes in order to allow for ongoing data collection specific to PPW with substance use disorders. An existing needs assessment and statewide strategic plan from the SEI/NASD project will be modified and enhanced specifically for the PROUD Initiative.

2020 State Pilot Grant Program: Treatment for Pregnant and Postpartum Women Montana Project Abstract The MT Department of Public Health and Human Services (DPHHS) proposes to enhance substance use disorder (SUD) and family strengthening services for pregnant and postpartum mothers experiencing SUD through the proposed Strengthening Families Initiative (SFI). SFI increases support for mothers and families in the postpartum period through age two. SFI will implement a trauma-sensitive, team-based, community-focused intensive outpatient care model for early family care, promoting safe, stable and nurturing relationships and environments. SFI incorporates a range of evidence-based programs to treat women with SUD and their families and environments. SFI incorporates a range of EBPs to treat women with SUD and their families, including clinical therapy and psychological approaches through outpatient and intensive outpatient services, in addition to case management, tobacco cessation, HIV /Hepatitis testing and care, and a family recovery home pilot. SFI will serve approximately 150 women and their families annually, a total of 450 over the project term. SFI extends successful steps MT Medicaid has already taken to enhance the continuum of care for pregnant and postpartum women with a diagnosis of SUD and their families. Montana Medicaid currently supports a bundled intensive outpatient (IOP) service, which includes individual, group, and family SUD therapy, educational groups, psychosocial rehabilitation, co-occurring mental health treatment, crisis service, and care coordination. Montana Medicaid also pays for Medication Assisted Treatment (MAT), high intensity residential ASAM 3.5 level of care, HIV/Hepatitis testing and treatment, and tobacco cessation. SFI builds a specialized IOP bundle with a targeted focus on pregnant / postpartum women with SUD and their families. The proposed project strengthens higher level specialty SUD service delivery for pregnant and postpartum mothers, continues care coordination across extended higher level services, expands the focus to include families, and increases recovery housing supports. The project fills gaps in provider capacity through increased workforce development to expand the number of licensed addiction counselors, dually-licensed behavioral health providers, and peer support specialists with specialized training to support this population. SFI supports continued infrastructure development to improve communication, coordination, and collaboration. SFI will help the state to achieve its goal such that: 1. Women with SUD and their families receive services and supports to meet their needs across the continuum of care; 2. Montana has a confident and effective behavioral health workforce committed to serving this population; 3. Programs and services are coordinated to provide seamless services, support quality improvement, and avoid duplication; 4. Families are partners in creating safe, stable, and nurturing relationships and environments.

The overarching goal of the Arizona State Pilot Program for Treatment for Pregnant and Postpartum Women (PPW-PLT) is to build and pilot a family-based systems of enchantments to increase engagement, integrated treatment and wrap around services for pregnant and postpartum women with Substance Use Disorders (SUDs), including Opioid Use Disorder (OUD), their substance exposed newborns and their family members in the Pima and Pinal counties of Arizona. This includes the provision of services for pregnant and parenting women, their minor children, and other family members of the women and children. The Arizona State Pilot Program for Treatment for Pregnant and Postpartum Women project will meet the required activities of the grant by meeting the following proposed goals and objectives: Goal 1: Increase outreach, engagement, screening and assessment of PPW with a SUD, including OUD. Goal 2: Expand infrastructure and build capacity through a multi-sector PPW Learning Collaborative among public and behavioral health providers, government and tribal agencies, managed care organizations, law enforcement, corrections and community. Goal 3: Increase accessibility and retention to treatment services for pregnant population with a SUD, including OUD to produce best outcomes for the family unit. Goal 4: Ensure provision of ongoing family-based services for mother-infant Dyad and family unit. Some objectives include, but are not limited to: 1: Serving total of 96 unduplicated women: year 1 (30), year 2 (36), and year 3 (30). 2: Developing and implementing a state strategic plan with partnerships across public health and other systems that will result in short- and long-term strategies to support family based treatment services. The plan will at minimum include identifying geographic and population specific areas of high need, service gaps, resources, goals, strategies and activities including policy change, infrastructure development, and program/service development. 3: Referral to trauma informed services as part of the psychosocial service delivery for pregnant and post-partum population, as appropriate as measured by referral log. 4: Increase the number of participants referred to family based services by 90% as part of the service delivery for pregnant and post-partum population as measured by referral log.