Building Capacity and Dedicating Field Staff to Address Substance Use Disorders During COVID-19

October 14, 2021 | Sanaa Akbarali, Ramya Dronamraju

In 2020, the COVID-19 pandemic exacerbated barriers to care and treatment for individuals experiencing opioid use disorder (OUD). Experts estimate a record-setting 90,000 people died of a drug overdose in 2020. Additionally, as the pandemic continues, it has understandably diverted attention, funds, and personnel usually focused on the opioid crisis. State and local public health departments are experiencing an all-time low in staffing, especially among Maternal and Child Health (MCH) programs.

Origin of the OMNI Learning Community

ASTHO’s Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI), is a learning community funded through CDC’s Division of Reproductive Health (DRH), the National Center on Birth Defects and Developmental Disabilities (NCBDDD), and HRSA’s Bureau of Primary Health Care. The learning community’s purpose is to identify and disseminate strategies and best practices for implementing systems-level changes in state health departments to improve the lives of pregnant and postpartum women with OUD and infants prenatally exposed to substances.

In 2019, ASTHO and CDC launched the Local Enhancement project as an element of the OMNI Learning Community, which provided up to one year of funding (in the form of locally based field placements) to five participating OMNI states. The objectives of the Local Enhancement project were to bridge connections between state and local public health entities, provide community-based support to jurisdictions heavily impacted by the opioid crisis, and identify opportunities to inform programmatic and policy change. During the COVID-19 pandemic, field placements were invaluable to supporting continuous and sustained state opioid-related activities focused on provider awareness and training, stakeholder engagement, and access to and coordination of quality services.

Raising Provider Awareness and Conducting Training in NV, WA, and FL

State teams focused programmatic and policy activities on provider awareness and training to improve quality of care in their jurisdictions. Guidance, training, and education for providers on treatment protocols are critical steps to improving health outcomes and standardizing care. Despite limitations caused by the pandemic, OMNI Local Enhancement states created innovative and comprehensive awareness and training opportunities for providers who serve MCH populations. For example:

• Nevada successfully used the local enhancement opportunity to increase provider training and disseminate state and local resources on medical care for pregnant and postpartum people with substance use disorders (SUD). The field placement contributed to training materials including a provider reference guide on SUD during pregnancy and a family-focused informational brochure on Plans of Safe Care.
• Washington State also focused on provider training to support the state’s child welfare agency. The field placement collaborated with the Washington State Department of Children, Youth, and Families to implement trainings with continuing education credit for medical healthcare and service providers across the state. Training focused on addressing stigma, medication-assisted treatment (MAT), and substance use disorder as a risk factor.
• Florida used the local enhancement opportunity to increase provider awareness and training on MAT and Plans of Safe Care. Through stakeholder meetings with 19 counties, the field placement identified best practices to support the implementation of Plans of Safe Care for pregnant and parenting women with OUD and infants with neonatal abstinence syndrome (NAS). The Florida OMNI team formed a workgroup with the Department of Children and Families (DCF) to develop messaging and a framework for non-DCF entities to facilitate the development and implementation of Plans of Safe Care statewide.

Engaging Stakeholders in KY

Establishing connections between state and local health departments and systems can be difficult when there are conflicting priorities. Field Placements helped to facilitate connections across state and local health departments and other systems, although some efforts were hampered due to pandemic-related challenges, and many activities that were in person were moved to a virtual setting.

The Kentucky OMNI Team used the local enhancement opportunity to cultivate partnerships through the Kentucky Perinatal Quality Collaborative (KyPQC). The field placement updated partners quarterly and supported the development of provider education and training programs focused on MAT and stigma reduction. Kentucky has successfully sustained the progress KyPQC has made since its 2019 launch and continues to work full-time as the program manager of the KyPQC.

Improving Access to and Coordination of Quality Services in OH

Ohio used the local enhancement opportunity to improve coordination between state and county-level stakeholders, which was critical to improving access to care and treatment for infants diagnosed with NAS. Through virtual focus groups and interviews, the Ohio field placement identified best practices to support development and standardization of Plans of Safe Care in four Appalachian counties. Participants included social workers, nurse navigators, WIC coordinators, medical directors from the state and local health departments, county hospitals and medical centers, and Child Protective Services (CPS) to discuss barriers and best practices.

Summary

Investing in the public health workforce helps address critical public health issues affecting MCH populations including the current opioid crisis. Capacity building solutions (e.g., dedicated field support) ensure ongoing advancement and sustainability of activities. The OMNI Local Enhancement project was successful because state teams had skilled public health field staff working to improve access to care and treatment for MCH populations despite the ongoing pandemic and diversion of other resources. This approach can be replicated in future efforts to improve systems coordination, build relationships, and create sustainable solutions at the state and local level.