John McConnell K, Kaufman Menolly R, Grunditz Jenny I, Bellanca Helen, Risser Amanda, Rodriguez Maria I, Renfro Stephanie
K. John McConnell ( mcconnjo@ohsu. edu ) is director of the Center for Health Systems Effectiveness and a professor in the Department of Emergency Medicine, both at Oregon Health & Science University, in Portland.
Menolly R. Kaufman is a research associate in the Center for Health Systems Effectiveness, Oregon Health & Science University.
Health Aff (Millwood). 2020 Apr;39(4):595-602. doi: 10.1377/hlthaff.2019.01574.
Children born to women with substance use disorders are at high risk for early foster care placement, which is associated with long-term adverse outcomes for children and places additional pressure on state budgets. Poor outcomes for drug-dependent mothers and their children may be further exacerbated by a lack of coordination between the health care and human services sectors. Project Nurture is an innovative model in Portland, Oregon, that integrates maternity care, substance use treatment, and social service coordination for Medicaid beneficiaries. This study assessed the impact of Project Nurture on a range of patient and child welfare outcomes. Among the "treatment" population of opioid-dependent women enrolled in Medicaid, Project Nurture was associated with reductions in child maltreatment, placement of children in foster care, and increases in both prenatal visits and maternal lengths-of-stay in the hospital, compared to opioid-dependent women enrolled in Medicaid in Oregon counties not served by the project. These results suggest that models based in a clinical setting that engage the human services sector may improve overall outcomes, even though the difficulty in sharing savings across sectors presents challenges to sustainability.
患有物质使用障碍的女性所生子女被早期安置到寄养家庭的风险很高，这与儿童的长期不良后果相关，并且给州预算带来了额外压力。医疗保健和公共服务部门之间缺乏协调，可能会进一步加剧药物依赖母亲及其子女的不良后果。“关爱计划”是俄勒冈州波特兰市的一个创新模式，为医疗补助受益人群整合了孕产妇护理、物质使用治疗和社会服务协调。本研究评估了“关爱计划”对一系列患者和儿童福利结果的影响。在参加医疗补助的阿片类药物依赖女性“治疗”人群中，与俄勒冈州未实施该计划的县中参加医疗补助的阿片类药物依赖女性相比，“关爱计划”与儿童虐待减少、儿童被安置到寄养家庭的情况减少以及产前检查次数增加和产妇住院时间延长有关。这些结果表明，基于临床环境并让公共服务部门参与其中的模式可能会改善总体结果，尽管跨部门分享节省资金存在困难，给可持续性带来了挑战。
