ProgenyHealth’s team of neonatologists, pediatric nurses, and social workers have managed over 60,000 NICU cases to-date as part of our neonatal medical management service offering. Infants born with neonatal abstinence syndrome (NAS) – symptoms related to opioid exposure in the womb – represent a complex and growing segment of this population. Tackling their unique challenges requires a specialized approach that supports the needs of both the mother and the baby.
The success stories presented below demonstrate the realities of the opioid crisis that we take-on every day in our mission to improve health outcomes for NICU infants. Names have been changed to protect the privacy of these program members.
Managing the toughest social determinants of health
David was born at 36 weeks and treated for NAS. He spent 24 days in the NICU. David’s mother, Lizzie, who tested positive for THC, opiates, and methadone, did not receive any prenatal care. During his time in the NICU, ProgenyHealth’s utilization management (UM) nurse kept in close contact with the case manager at the hospital to help ensure David received appropriate care for his condition, as well as to receive updates on the status of a state custody determination for discharge. ProgenyHealth’s case manager (CM) also followed up with the discharge planner to determine his status to ensure authorization for outreach to the caregiver was obtained from the State custody office, as was required.
The state Department of Children and Families allowed Lizzie to take David home with a safety plan in place where she was supervised for the first few weeks. Our CM and social worker then took up the challenge of helping Lizzie get the support she needed for the first year of David’s life.
Consistent with the safety plan, our CM continually confirmed that Lizzie was participating in her prescribed Medication-Assisted Treatment (MAT) program for methadone to prevent relapse. Given the nature of her pre-delivery drug use, Lizzie was counseled about breastfeeding options to discuss with her doctor. ProgenyHealth’s CM assisted Lizzie with obtaining vital resources, such as a breast pump, car seat, and crib. Additionally, as part of the care plan goals, our CM helped with obtaining lactation support and making transportation arrangements so that Lizzie could receive postpartum care and remain connected to her methadone treatment program. The CM also helped Lizzie complete the important task of selecting a PCP for David, scheduling an appointment, and arranging for transportation to the first scheduled office visits.
Initially, Lizzie was living in a hotel and characterized herself and David as homeless. The ProgenyHealth Social Worker (SW) focused on discussing coping strategies and reframing negative thought patterns. Instead of identifying herself as homeless, the SW assisted Lizzie with realizing that she actually did have a home. Lizzie was able to see how thoughts are powerful and identify some positive aspects of her life. Coping strategies included taking time-outs and asking for help from the infant’s father, when needed, and focusing on positive thoughts.
Working to address social determinants of health, ProgenyHealth’s social worker provided Lizzie with specific resources to find solutions to her housing challenges. Lizzie shared with the SW that she had been having difficulty getting in touch with the Healthy Start community health worker (CHW). The CHW had not appeared for her first appointment and Lizzie was assigned another worker who had not returned her calls.
The SW reconnected Lizzie with Healthy Start and her new CHW assisted Lizzie with applying for housing assistance and discussed applying for benefits through Social Security Disability Income (SSDI) for the infant, as his father is disabled. While waiting for housing to become available, Lizzie was eventually able to rent a room from her step-mother, as she had demonstrated that she was seriously committed to working her MAT program and caring for her son.
As David reached his first birthday as a thriving baby boy – meeting important developmental milestones for health – Lizzie had many reasons to celebrate. With the help of ProgenyHealth’s team, she was able to complete the goals outlined for her in the safety plan, maintain David in her stepmother’s home and satisfy the requirements for caring for David independently. Upon transfer of case management services back to the health plan, Lizzie was actively engaged in her treatment and planning to move into a place of her own.
Critical support for at-risk moms and infants
Lorie was born at 40 weeks with a diagnosis of NAS and was treated with morphine for her withdrawal. She spent 26 days in the NICU. During pregnancy, her mother, Jill, was taking Subutex (buprenorphine) to manage her substance use disorder. She had been clean for a year, but three months prior to becoming pregnant, began taking Subutex for fear of relapsing. Like many mothers in this situation, she was unaware of NAS and insisted she would not have taken the medication had she known the risks to her baby. Jill was also interested in switching her current Medication-Assisted Treatment (MAT), quitting smoking, and cleaning up her life for the benefit of herself and her baby.
ProgenyHealth’s social worker researched available behavioral health resources, checked the health plan formulary, and shared the information with Jill. Likewise, our case manager connected Jill with the available smoking cessation resources offered by her health plan. To encourage Jill to take Lorie to all well-visit checkups, our CM also linked Jill with the health plan’s health and wellness rewards program, which provided incentives for these healthy behaviors.
Breastfeeding support is a common focus of ProgenyHealth’s team. Our social worker counseled Jill on best practices, including how to breastfeed comfortably in public. Mom continued to successfully breastfeed and supplemented the breastfeeding, on occasion, with formula.
Jill lost her Medicaid coverage and was assisted by the SW to contact the County Assistance Office for evaluation for continued benefits. With the Social Worker’s help, Jill regained Medicaid coverage and was assisted with finding an alternate MAT clinic for ongoing support. With Jill’s social determinants of health managed, she was able to focus on Lorie’s care needs. Lorie was soon meeting her developmental milestones, consistently attending pediatric appointments, and receiving scheduled vaccinations.
Solving the unique challenges of NAS in rural populations
Hannah was born at 39 weeks with a diagnosis of NAS and was treated with clonidine and phenobarbital. She spent 13 days in the NICU and was discharged without the need for medications. Her mom, Kelly, was on medication to treat her bipolar and anxiety disorders and was being seen by a doula who provided her with rides to appointments for six weeks. After the doula services ended, Kelly was left without any transportation to appointments.
Complicating her situation, she lived in a rural area with the baby’s father, without a car or consistently reliable cell phone service, or any form of local social support. These factors are common in such areas, where the impact of the current opioid crisis and NAS has been disproportionate.
ProgenyHealth’s case management associates routinely call the infant’s PCP to introduce the program. Hannah’s PCP contacted our case manager the following day for transportation assistance for mom’s psychiatrist appointment after mom scored high on a depression screening assessment during one of Hannah’s appointments. Kelly has a history of bipolar disorder and post-traumatic stress disorder and her transportation benefit did not allow for her to bring Hannah along, unless it was for the infant’s appointment.
The ProgenyHealth case management team utilized their experience with these types of issues to help Kelly and Hannah achieve healthy outcomes. The team coordinated transportation services for Kelly, which included rides to her psychiatric appointments so that her condition could be managed consistently, and she could continue to get the support she needed to manage Hannah’s health care needs. ProgenyHealth’s social worker also assisted Kelly with adding the baby on to her health plan so that the transportation benefit could be used for pediatric appointments for Hannah. Kelly was also introduced to the ProgenyHealth Baby Trax® mobile app, which she then used to communicate securely with her case manager when she could get a signal.
Both Kelly and Hannah were doing well upon graduation from the ProgenyHealth program. Kelly continues to manage her own condition properly while Hannah achieved all of her growth and development milestones and received vaccinations on schedule.
Providing a lifeline in times of peril
Riley was born at 37 weeks with a diagnosis of NAS and was treated with morphine for her withdrawal. She spent 13 days in the NICU. At the time, her mother, Terry, was on methadone and receiving treatment in drug rehab. Upon discharge from the hospital, Riley joined her mom at the rehab facility and then they both moved in with Terry’s parents. But with a single mom dealing with substance use disorder, the risks for Riley did not end with her hospital stay and she needed continued oversight and management.
During the introductory call, ProgenyHealth’s case manager addressed Terry’s questions and located the County Assistance office nearest to the rehab facility to help Terry more conveniently secure WIC benefits and food stamps. They also discussed breastfeeding Riley, obtaining an Early Intervention referral, and ensured that the first PCP visit was scheduled. Terry continued to breast and bottle feed and was receiveing TANF, SNAP and WIC. Terry relocated with Riley and her parents to a new community after the first PCP visit and was successfully assisted with locating a new provider.
The PCP that provided services for Riley’s initial visit was not aware of the change to a new provider and called our CM after a missed appointment to ensure that the infant was receiving appropriate care. Our CM was able to provide the PCP with an update regarding the relocation. Riley stayed on schedule with all well visits and immunizations, was evaluated by the Early Intervention Program (EIP), and is now receiving weekly PT services.
To support Riley’s health, the CM reviewed her post-discharge medications and provided feeding tips to Terry related to the acid reflux that Riley was experiencing. The reflux improved, Zantac was discontinued, and Riley began better tolerating feeds and gaining weight. Our CM also continued outreach to Terry during the periods when she was not an inpatient in rehab. This support included educating Terry about the importance of ongoing postpartum care visits and continued screening for signs of depression. Terry continues to attend Narcotics Anonymous meetings and has a mentor who checks in with her frequently. She is coping well, has not reported feelings of depression, and stays home to care for her infant with support from her parents.
It takes a team to improve outcomes for at-risk infants
Stories like these demonstrate the many complexities of infants born to mothers struggling with substance use disorder. ProgenyHealth case managers and social workers provide a variety of crucial forms of support to moms, helping them obtain the resources they need to give themselves and their babies every opportunity to achieve healthy outcomes despite the challenges they face.