Description

Babies born whose mothers used opioids during pregnancy, or were receiving buprenorphine due to medication assisted treatment, are born exposed to the drugs and experience withdrawals once born. Children born drug positive have special needs. With East Tennessee's high number of neonatal abstinence syndrome (NAS), it is important to secure these women in treatment early on in their pregnancy.

In order to help mothers access substance abuse treatment and properly care for their children, the Mothers and Infants Sober Together (MIST) program was formed in 2006 through the Ridgeview Behavioral Health Center. The program's mission was to improve the quality of life and daily functioning of drug-exposed infants and families.

The program, which started small, eventually expanded to include Anderson, Roane, and Campbell counties in Tennessee. The program provides case management, group, and individual therapy to pregnant women and mothers with drug-exposed infants.

Many clients come from referral sources such as:

• Department of Children Services
• Obstetrics and gynaecology (OB/GYN) doctors
• Anderson, Roane, and Campbell County Juvenile Court
• Health departments
• Community probation services
• Treatment providers
• Self-referral from clients

This program received support from a 2006-2009 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.

Dayspring Family Health Center is one of MIST's medical partners. Staff and clients share about the impact of the program in this video:

Services offered

The program team consists of case managers, a therapist, and a program coordinator. Together, the team works with mothers to create a stable, drug-free environment for their infants and the families. To be eligible for services, mothers must test positive for substances during pregnancy or at time of birth and/or admitted to using drugs during the pregnancy. The majority of the women that MIST serves use opiates, Suboxone, tetrahydrocannabinol (THC), and methamphetamine.

MIST provides Same-Day Access for initial appointments. Next Day Medication Management is initiated following the assessment where a psychiatrist evaluates the patient and can prescribe medication-assisted treatment (oral or injections) or referrals to additional MAT treatment using Suboxone or Subutex. Providers use a methodology called Just-in-Time to prescribe dosages to help mothers with medication management.

Additional services include:

• Home visits
• Mental health counseling
• Substance abuse treatment
• Relapse prevention
• Parenting education
• Supervised visits for mothers without custody of their children
• Case management
• Weekly support groups
• Individualized treatment plans
• Individual therapy

Results

From August 2009 to June 2016:

• 942 referrals were received by the MIST Program from various agencies
• The average age of a MIST client was 24, with the youngest client being 13 years old and the oldest client being 41.
• The program has had an increase of pregnant women join
• Many women successfully detox before giving birth, with the assistance of their OB and Subutex doctors.
• Drug-free, healthy babies have been born to women who were previously addicted to drugs during pregnancy

MIST has caught the attention of local and national media outlets:

• NPR's All Things Considered radio show and website, November 18^th, 2015
• "Mothers' Helper," Better Tennessee
• "Reducing Neonatal Abstinence Syndrome in Tennessee," Fact Sheet by the National Institute for Health Care Management, November, 2015
• "Ridgeview Pioneers Program for Drug-Addicted Mothers," Oak Ridge Today in September, 2015

Barriers

MIST has continuously faced barriers to reaching pregnant women for substance treatment and detox. The enactment of the Tennessee Fetal Assault Law of 2014 led to a greater number of women who avoided discussing their substance use for fear that they would be arrested. This law expired on July 1, 2016.

The program continues to work towards substance use prevention in communities, providing medical resources to spread the word about available treatment. A preeminent goal is to establish the reputation of being a welcoming place of assistance, making women feel comfortable and empowered.

Replication

Organizations wishing to bring something like this to their area should find a clear plan for sustainability. They should also work closely with area law enforcement, judges, healthcare workers, and mental health centers in order to be the most effective.

Contact Information

Anna Reddick, MIST Therapist and Program Coordinator
Ridgeview Behavioral Health Services
Mothers and Infants Sober Together
865.481.6170 ext. 1298
reddickar@ridgeview.com