Document text
Principal Investigator: Deborah Jill Cohen
Organization: OREGON HEALTH & SCIENCE UNIVERSITY
Fiscal Year: 2024
Award: $653,028
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
PROJECT SUMMARY
In the past 20 years, the United States (US) has seen a fourfold increase in the prevalence of maternal
substance use disorders during pregnancy. Substance use during pregnancy is associated with adverse
maternal and infant health outcomes. Numerous barriers impede the delivery of well-coordinated and high-
quality pregnancy and postpartum care for women with substance use disorder: lack of access to obstetrics
providers who are comfortable with providing medical care to women with substance use disorders; competing
demands from child welfare and necessary medical services; and limited availability of substance use disorder
treatment programs that allow children and provide parenting support resources. A coalition of maternity care
providers, substance use treatment agencies, state social service agencies, and Medicaid funding partners in
Oregon tested a care model called Project Nurture in three clinics in the Portland area in 2015. Project
Nurture combines maternity care, substance use disorder treatment, peer/doula support, and case
management in a single setting. Access to these services in a single care setting reduces barriers to care and
facilitates increased collaboration among providers, which creates a more supportive environment with realistic
expectations for mothers. Care is delivered in a non-judgmental and trauma-informed manner, which is
important given the high prevalence of stressful life events experienced by women with substance use
disorder. A peer-reviewed study found Project Nurture to be associated with reductions in child maltreatment
and placement of children in foster care, and increases in prenatal visits. Preliminary data from an independent
evaluator also suggest that Project Nurture may reduce preterm births, reduce intensive neonatal care, and
increase engagement in substance use disorder treatment. Oregon's Governor is expanding Project Nurture to
five rural and underserved counties. The objective of this study is to establish the empirical evidence needed to
replicate Project Nurture in other states. While preliminary findings suggest that Project Nurture improves
short- and longer-term maternal-infant outcomes, we propose further investigation to answer three critical
questions: (1) What are the key elements of Project Nurture associated with improved outcomes; (2) how can
these elements be implemented in rural and underserved settings; and (3) what is the effectiveness of Project
Nurture in rural regions and when mothers are engaged in methamphetamine and polysubstance use? Thus,
this study is designed to accomplish the following four aims: (1) Assess the effects of Project Nurture on
pregnancy, birth, neonatal, and child welfare outcomes; (2) Assess the effect of Project Nurture on health care
expenditures; (3) Describe implementation of Project Nurture; and (4) Identify critical elements of Project
Nurture and support replication and dissemination. This study will provide state, regional and organizational
leaders the information needed to replicate Project Nurture and create a safe and de-stigmatized care
environment for pregnant women living with substance use disorder.
Terms: <0-11 years old><0-4 weeks old><Abruptio Placentae><Access to Care><Area><Birth><COVID-19><CV-19><Caring><Case Management><Child><Child Abuse and Neglect><Child Rearing><Child Welfare><Child Youth><Childhood maltreatment><Children (0-21)><Clinic><Clinical><Collaborations><Coronavirus Infectious Disease 2019><Cot Death><County><Crib Death><Data><Data Bases><Databases><Discipline of obstetrics><Disease><Disorder><EPH Gestosis><Effectiveness><Elements><Environment><Equity><Expenditure><Fostering><Funding><Gestation><Goals><Health><Health Expenditures><Health Services Accessibility><High Prevalence><Hospitals><Human><Infant><Infant Health><Investigation><Length of Stay><Link><Low Birth Weight Infant><METH use><Maternal Health><Measures><Medicaid><Medical><Methamphetamine use disorder><Modeling><Modern Man><Mothers><Neonatal><Neonatal Intensive Care><Newborn Infant><Newborn Infant Intensive Care><Newborns><Number of Days in Hospital><Obstetrics><Oregon><Outcome><Parenting><Parenting behavior><Parturition><Peer Review><Personal Satisfaction><Pilot Projects><Pre-Eclampsia><Preeclampsia><Pregnancy><Pregnancy Toxemias><Pregnant Women><Premature Birth><Premature Labor><Premature Obstetric Labor><Premature Separation of Placenta><Prematurely delivering><Prenatal care><Preterm Birth><Preterm Labor><Prevalence><Proteinuria-Edema-Hypertension Gestosis><Provider><Recommendation><Research Resources><Resources><Risk><Rural><SIDS><Services><Social Service><Social Work><Stigmatization><Stressful Event><Substance Use Disorder><Sudden Infant Death><Sudden Unexpected Infant Death><Sudden infant death syndrome><Testing><Trauma><United States><Vital Statistics><Withdrawal><Woman><access to health services><access to services><access to treatment><accessibility to health services><adolescent welfare><assess effectiveness><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><care access><care providers><care services><care systems><child maltreatment><child well being><child wellbeing><childrearing><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><data base><design><designing><determine effectiveness><effectiveness assessment><effectiveness evaluation><enthusiastic atmosphere><enthusiastic environment><evaluate effectiveness><examine effectiveness><expectant mother><expectation><expecting mother><experience><female outcomes><foster care><frontier><health care expenditure><health service access><health services availability><healthcare expenditure><hospital days><hospital length of stay><hospital stay><improved><improved outcome><infant outcome><integrated care><integrated model of care><kids><low birth weight><low birthweight><medical expenditure><medically necessary><medically necessary care><meth use disorder><methamphetamine use><model design><multiple substance use><multisubstance use><newborn child><newborn children><novel><obstacle to care><obstacle to healthcare><opiate consumption><opiate drug use><opiate intake><opiate use><opioid consumption><opioid drug use><opioid intake><opioid use><outcomes among females><outcomes among women><outcomes in females><outcomes in women><peer><pilot study><placental abruption><poly substance use><polysubstance use><post-partum care><postpartum care><pre-eclamptic><pregnancy care><pregnancy toxemia/hypertension><pregnant><pregnant mothers><premature childbirth><premature delivery><prenatal appointment><prenatal checkup><prenatal visit><preterm delivery><programs><rural area><rural locality><rural location><rural place><rural region><rural setting><service availability><stressful experience><stressful life event><stressful life experience><substance use><substance use and disorder><substance use treatment><substance using><supportive atmosphere><supportive environment><treatment access><treatment program><well-being><wellbeing><women's outcomes><youngster>