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2023 State Pilot Grant Program for Treatment for Pregnant and Postpartum Women (PPW-PLT) Strengthening Families Initiative - Montana In partnership with a broad and diverse set of community partners, The Montana Department of Public Health and Human Services (DPHHS) is submitting this proposal to receive funding that will allow us to build upon existing efforts supported by the 2020 PPW State Pilot Grant. The 2020 PPW grant has greatly enhanced substance use disorder (SUD) treatment and family strengthening services for pregnant and postpartum people experiencing SUD through the Strengthening Families Initiative (SFI) throughout Montana. As the 2020 grant comes to an end, DPHHS recognized that additional financial support is required to preserve the progress Montana has made in expanding the continuum of care for pregnant and postpartum people and families SFI is seeking to achieve the following goals and objectives which were developed in partnership with community leaders: 1. Equitable Access. Pregnant and postpartum individuals with SUDs and their families equitably receive services and supports to meet their needs across the continuum of care. 2. Coordination. Programs and services are coordinated to provide seamless services, support quality improvement, and avoid duplication. 3. Workforce. Montana has a confident and effective behavioral health workforce that supports the needs of pregnant and postpartum individuals with SUDs and their families. 4. Engagement. Families are partners in creating safe, stable, and nurturing relationships, and environments. 5. Sustainability. Our policies and funding demonstrate our sustained commitment to supporting pregnant and postpartum individuals with SUDs and their families.

The CT Department of Mental Health and Addiction Services (DMHAS), is looking to build upon the existing infrastructure established in the first PPW program, Parents Recovering from Opioid Use Disorder (PROUD). The next round of PROUD funding will allow continuation of existing services as well as support expansion to the Greater New Haven and Bridgeport areas. Population data from these communities reveal high rates of opioid use, as well as disproportionate racial, social, and economic disparities as compared to other areas of CT. Pregnant and Parenting Women/Birthing Persons (PPW) in these communities experience adverse health consequences, trauma, and stigma, leading to additional barriers accessing behavioral health, peer recovery, and medical services. 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 PROUD service model will utilize evidence-based practices including recovery coaching, prenatal health, parenting education, and trauma support. Substance use, physical and mental health assessments, education and referrals will be provided to all participants, including children and families of the PPW. Primary features of the initiative will include easy accessibility through office-based, telehealth, and/or in-home support and individualization of services based on the assessed needs and preferences of each family. We will engage 500 PPW (i.e., 130 in year 1; 185 in each of years 2 and 3), including their children, partners, and other family members, into this team-based community model. The three PROUD site teams will include a combination of clinical, case management, and peer staff. PROUD teams will also engage in expansive community outreach to educate medical, behavioral health, and other social service partners on the PROUD model and develop a pathway for streamlined referrals into the program. The community will be engaged through public health campaigns aimed at reducing stigma, increasing knowledge around addiction best practices and outlining resources and support services. In partnership with the CT Hospital Association and the CT Women's Consortium, healthcare professionals will be offered access to diverse educational opportunities with the goal of increasing knowledge of SUD, the impact of stigma, screening best practices, and reducing healthcare disparities. Connecticut has considerable momentum to continue and expand 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 Family Care Plans with all pregnant participants. An existing needs assessment and statewide strategic plan from the Substance Exposed Pregnancy Initiative CT project will be modified and enhanced specifically for the PROUD Initiative.

Title and Population to be Served: Iowa's Choices for Women is the title for our project for the State Pilot Program for Treatment for Pregnant and Postpartum Women (PPW-PLT). The Iowa's Choices for Women project will serve PPW in outpatient settings with a primary diagnosis of substance use disorder (SUD), as well as their families, including minor children under 17, fathers/parents and family members including adult children. Women presenting to SUD treatment in Iowa for state fiscal year (SFY) 2022 most frequently report the use of alcohol (56.9%), methamphetamines (43.2%), marijuana (48.3%) and opioids (11.4%). The most frequently reported substance use by pregnant women in Iowa in SFY22 included alcohol (34.8%), methamphetamines (66.0%), marijuana (52.8%) and opioids (13.5%). The most frequently reported substances used by postpartum women in Iowa in SFY22 included alcohol (37.1%), methamphetamines (60.3%), marijuana (60%) and opioids (11.4%). Please note that percentages may add up to more than 100% due to more than one substance being reported at admission. Clients to be Served: A total of 250 pregnant and postpartum women will be served through this grant each year, for a total of 750 in three years. In addition, 325 children under 17 will be served and fathers/parents as well as family members will be included in this grant. The purpose of the proposed project is to (1) support family-based services for pregnant and postpartum women with a primary diagnosis of SUD, emphasizing the treatment of opioid use disorder (OUD); (2) expand and improve the continuum of care for pregnant and postpartum women with SUD at four SUD treatment programs, with an emphasis on helping individuals with OUD; and (30 promote a coordinated, effective and efficient state system managed by the Iowa Department of Health and Human Services (Iowa HHS) by identifying and developing new approaches and models of service delivery for PPW with SUD, their children, fathers/parenting partners and family members. Iowa HHS as the Single State Agency for substance use services will build upon the experiences and knowledge of current contracted providers who deliver SUD treatment services under the Iowa Substance Use Prevention, Treatment and Recovery Services (SUPTRS) Block Grant set-aside for pregnant and women with children. The project will accomplish the purposes outlined by expanding, broadening and improving prevention, early intervention, treatment and recovery support services to pregnant and postpartum women as well as their children, fathers/parenting partners and family members. Iowa HHS will expand care coordination (with an emphasis on education regarding overdose prevention, naloxone and medications for SUD treatment), add additional evidence-based practices (EBPs) and improve existing EBPs through fidelity monitoring. Additionally, Iowa HHS will strengthen partnerships across systems through the program steering committee, the development of a needs assessment and a statewide strategic plan.

Empowering Nevada is a program focused on improving care coordination and the continuum of care for pregnant and postpartum women with a primary diagnosis of substance use disorder in Nevada. The program aims to decrease gaps in the continuum of care by developing resource sharing and contracting mechanisms that enhance bidirectional linkages among providers, community-based organizations, and other support services. Additionally, the program seeks to increase the adoption of universal screening and SBIRT, as well as expand the EMPOWERED program to address critical gaps in NAS mitigation/prevention, SUD and/or OUD treatments, and support services for pregnant and postpartum women and their families in Washoe County, Carson City, Storey County, and Churchill County. EMPOWERED is a recovery-oriented program that combines medications for opioid use disorder (MOUD) with educational, counseling, and peer support services and aims to manage the social determinants of health (SDOH) of program participants and their families longitudinally. We operationalize this vision through seven goals. These goals and objectives include: (1) wrap-around care, coordination and navigation services (2) educational and counseling services to increase participation and offer peer recovery support sessions for better outcomes (3) social determinants of health management, coordination, navigation and referrals to improve the overall health of the targeted population (4) sustainability in rural, health professional shortages areas and underserved areas by accelerating arrangements between key partners in Medicaid and other programs. Based on initial projections, this project will serve: Year 1 -- 115 mothers, 115 babies Year 2 -- 115 mothers, 115 babies Year 3 -- 115 mothers, 115 babies Cumulative Total: 690 program participants throughout the course of the three-year Pilot Project

State Pilot Program for Treatment for Pregnant and Postpartum Women (Short Title: PPW-PLT) The Maryland Department of Health, Behavioral Health Administration (MDH-BHA) is the lead applicant for a five-site targeted pilot intervention to support pregnant and parenting women in recovery from substance and/or opioid use disorders successfully transition to community life. The proposed project, Strengthening Families in Recovery will enroll 750 women over three years (250 per year, unduplicated) and provide wrap-around supports to deepen protective factors for families, while removing barriers to encourage lasting recovery for women. Participants will remain in the program for up to 12-months and follow up post discharge will be conducted every three months for one year. Strengthening Families in Recovery is designed as a holistic, community-based intervention that will leverage existing efforts in Baltimore City, Anne Arundel County, Prince George's County, Washington County, and Worcester County as led by Local Behavioral Health Authorities. With additional funding, MDH-BHA will implement the Evidence-based Program (EBP), Strengthening Families, and fund (number) Recovery Support Coordinators (RSC), Pregnant Parenting Women (PPW) Navigators, and Family Support Coaches (FSC) focused on addressing administrative barriers such as criminal histories, access to financial services, transportation, childcare, safety net programs, and job readiness. Through this pilot initiative, MDH-BHA seeks to demonstrate how combining an evidence-based family strengthening program with support to address administrative barriers to recovery and community life can help PPW succeed. Strengthening Families in Recovery will focus its efforts in rural, suburban, and urban communities, each struggling with the rise of opioid addiction and the resulting family dysfunction. According to 2022 estimates from NSDUH, there are nearly 30,000 women with SUD/OUD with children, across the state. U.S. Census data demonstrates the challenges of these communities, with high rates of poverty, disability, and women outside of the labor force. Drug use, along with the burden of criminal records related to women's drug addiction, histories of trauma and domestic violence compound personal shame and perceived stigma. MDH-BHA's Strengthening Families in Recovery initiative recognizes that a comprehensive model must be inclusive of clinical and community support, while also providing opportunities for family strengthening work and removal of administrative barriers that can easily derail clinical progress. With these factors in mind, the proposed projects has identified three goal and aligned objectives. First, engage and enroll families in the Strengthening Families program where they can identify and build on evidence-based factors that support the whole family. Second, remove administrative barriers such as criminal records through the expungement process. Third, help women navigator and resolve issues such as negative credit histories, outstanding financial debt, access to benefits like food stamp, and getting job ready by accessing resources in the workforce system from the Workforce Investment System to local nonprofit like Dress for Success.

The overarching goal of the South Carolina (SC) State Pilot Program for Treatment for Pregnant and Postpartum Women (PPW-PLT) is the reduce maternal morbidity and morality associated with Perinatal Mental Health (PMH) and Perinatal Substance Use Disorder (PSUD), including Perinatal Opioid Use Disorder (POUD) by addressing gaps in the continuum of care throughout pregnancy and the postpartum year for the mother-infant dyad and family unit. The pilot program will build upon an existing statewide initiative, Moms IMPACTT (Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring), which provides immediate access to treatment and care coordination via phone and telehealth modalities for POUD and PSUD/PMH concerns. The proposed project will allow our team to leverage and expand the IMPACTT program to include: 1) access to POUD treatment for PPW 7 days a week, including Medications for Opioid Use Disorder (MOUD); 2) addition for Doula-Certified Peer Support Specialists (DCPSS) to enhance treatment engagement and family-based service delivery and recovery support during pregnancy and the postpartum year; 3) intensive case management for families with minor children to facilitate immediate access to mental health assessment and treatment via telehealth; 4) strategic collaboration with community and public agencies (i.e., community mental health, family recovery support, healthy start, schools, child protection and foster care service systems); and 5) expanded outreach to obstetric and pediatric clinics, FQHCs, detention centers, family shelters, harm reduction services and community-based organizations in SC counties with the highest rates of NAS and opioid overdose. Mom's IMPACTT also provides frontline provider training and provider-to-provider consultations, which will be increased to 7 days a week, with expanded outreach as described above, and include hospitals, emergency departments and law enforcement in counties with the highest rates of NAS and opioid overdose. The geographic catchment area where services will be delivered are counties in SC with highest rates of Neonatal Abstinence Syndrome (NAS) and opioid overdose (Charleston, Horry and Lexington), and those designated as fully rural, fully Medically Underserved Areas, fully Mental Health and Health Professional Shortage Areas, and high proportion of women living below poverty: Chesterfield (33% African American [AA]; 21% Below Poverty [BP], Darlington (42% AA; 24% BP), Dillon (47% AA; 32% BP), Jasper (37.8% Black; 16.1% BP), Lancaster (20.8%; 11.8% BP) and Orangeburg (61.8% Black; 25.6% BP). Outcomes include improved treatment attendance, engagement and retention, depression symptoms and maternal functioning, birth outcomes, Social Determinants of Health, child/parent attachment, and increased number of Plans of Safe Care among perinatal women accessing the program. MOMs IMPACTT will serve a minimum of 50 women with PSUD/PMH concerns in the first year and increase the number served by 15% each year of the award. Additionally, it is projected that 112 unduplicated women will be provided access to a DCPSS throughout the project period: year 1 (18), year 2 (38), and year 3 (56). Infrastructure activities will leverage current work being done across SC, including an enhanced current needs assessment and statewide strategic plan to pinpoint gaps in the continuum of care for PPW and their families.