One Health Recovery Doulas

Description

One Health is a consortium of Federally Qualified Health Centers (FQHCs) serving several counties in rural Montana. Since 2017, One Health has implemented a variety of program models to expand services for pregnant women with substance use disorder: a home-visiting nurse, the development of a peer support team, and the creation of peer support drop-in centers. These initial programs were supported by grants from the Rural Health Opioid Program (RHOP) and the Rural Communities Opioid Response Program (RCORP) and partnerships with the Montana Department of Health and Human Services and the Montana Healthcare Foundation.

During the COVID-19 pandemic, program organizers observed that doulas were being permitted to accompany pregnant women to appointments and births, but peer support specialists were not. Additionally, program organizers observed that their clients were at higher risk for relapse and suicide in the hours and days immediately following birth. These concerns led to the idea to create a team of “recovery doulas” — individuals who are dual-certified as doulas and peer-support specialists. The One Health recovery doula program is supported by RCORP Implementation and Planning grant funding.

Recovery doulas are trained in delivery positioning skills and all other skills for traditional doula practice, in addition to:

• Labor supports
• Calming babies
• Feeding babies
• Neonatal abstinence syndrome
• Social determinants of health
• Motivational interviewing
• Intimate partner violence
• Sexual abuse
• Financial management
• Medications for opioid use disorder (MOUD) during pregnancy
• Family plan of safe care
• Screening, brief intervention, and referral to treatment (SBIRT)
• Perinatal mood and anxiety disorders (PMADs)
• Trauma informed care
• Indigenous traditions of perinatal care
• Cultural safety

Services offered

A team of trained recovery doulas provide services to pregnant and parenting women and families in 13 rural Montana counties. The Crow Indian Reservation and the Fort Belknap Indian Reservation are located within this service area.

Individuals are usually referred to the program by emergency departments, clinics, and Child Protective Services (CPS). Individuals may also self-enroll at drop-in centers.

Group services include:

• Classes on parenthood, including classes designed specifically for Native populations
• Perinatal groups
• Trauma-based groups for women and men
• Mental and physical wellness groups
• Fitness groups, including a stroller fitness group for moms
• Art-therapy groups
• Educational sessions at a local laundromat; costs for laundry are covered in exchange for participation in the session

Individual services include:

• Weekly one-on-one visits with a peer support specialist
• Individualized doula services (including assistance with household chores, preparing the baby's room, safety planning, birth support, and postpartum support)
• “Daddy doula” services, offering education and support to fathers

Individuals are eligible for services until three years after the baby is born.

Results

Program staff have supported survivors of sex trafficking, women with incarcerated partners, unhoused individuals, and individuals facing other complex challenges throughout pregnancy, birth, and the first years of parenthood.

Organizations from across Montana and other states have expressed interest in starting their own recovery doula programs using the One Health program model and training curriculum. One Health is currently training 22 recovery doulas, including trainees from other states.

More information about the One Health Recovery Doula program, including personal stories of the program's impact, can be found in the following article and podcast:

• How 'Recovery Doulas' Are Helping Montanans Navigate Addiction and Parenthood, The Montana Free Press
• A Mother Struggling With Substance Use Finds the Help She Needs, The One In Five Podcast

Challenges

Program staff initially encountered some skepticism and lack of knowledge regarding peer support from medical providers. However, this reaction became less common after staff received dual certification and were referred to as “recovery doulas” – and as stories of the impact of their work became more widely known.

Replication

It is important to select a doula certification program that is appropriate for individuals in recovery from substance abuse. For example, a curriculum which involves extensive independent reading assignments may be difficult for individuals with lower levels of formal educational attainment – leading to higher drop-out rates.

Program coordinators are in the process of designing an online curriculum for a recovery doula training that will make the training more accessible to peer support specialists from other states.

Contact Information

Pamela Ponich, MS, LCPC, Perinatal Program Manager
One Health
406.465.6895
pam.ponich@onechc.org