The Meadowlark Initiative brings a new standard of pregnancy care to Montana by offering routine screening and treatment for substance use disorders and mental illness as a part of prenatal and postpartum care. The initiative supports recovery while keeping families together and children out of foster care. In partnership with the State of Montana, we developed the initiative to respond to the high rates of foster care placement reported by the Child and Family Services Division and the research which showed a lack of treatment available for pregnant women with substance use disorders. This update provides an overview of the initiative, details about the model of care, and an early look at how the initiative helps women and families.
The Problem: Lack of Treatment Options & High Rates of Foster Care Removals
Substance use disorders and mental illnesses, like depression and anxiety, impact thousands of pregnant women and their babies each year. These illnesses are common and cross all demographic groups in Montana, yet they often go undiagnosed and untreated. In 2017, we looked into perinatal behavioral health issues and their impact on pregnancy outcomes and families. We found a domino effect beginning with a lack of screening and few treatment options and ending with increasing foster care removals. In Montana in 2017:
- Screening and treatment for prevalent mental illnesses and substance use disorders were not routine in prenatal and postpartum care.
- Only 6% of Montana’s state-licensed substance use disorder treatment programs served pregnant women.
- Many delivering hospitals reported increasing numbers of drug and alcohol-exposed newborns.
- Between 2011 and 2016, the number of Montana children in foster care more than doubled, and 64% of children in foster care were removed from their homes because of parental substance abuse.
To tell the stories behind the numbers, the Missoulian published a series of articles on pregnancy and addiction. “Addicted and expecting: How Montana’s lack of resources impacts mothers and their children” is a thoughtful look at the challenges mothers and families were facing in 2017.
Fortunately, our research also revealed promising solutions to this devastating problem: in a series of promising programs in other states, a team-based approach offering prenatal care hand-in-hand with behavioral health services, along with care coordination between health care providers and social service agencies, improves clinical outcomes for women and newborns and reduces the need for foster care placement.
The Meadowlark Initiative: Providing the Right Care at the Right Time
We launched the initiative (first called the Perinatal Behavioral Health Initiative) in 2017, with the ambitious goal of improving maternal health outcomes, reducing newborn drug exposure and neonatal abstinence syndrome, and keeping families together and children out of foster care. In the first year, we supported a cohort of prenatal care practices located in Butte, Kalispell, Great Falls, and Missoula. The following year, the Montana Department of Public Health and Human Services (DPHHS) joined us as a partner. Together, we committed more than $5 million in private and federal funds to support this work. By 2019, 11 sites around Montana had joined the initiative, which we branded and renamed the Meadowlark Initiative. There are currently 15 sites participating, and we aim to add at least 10 more in the next two years.
Meadowlark providers offer an innovative model that aims to provide the right care at the right time for pregnant and postpartum women. They bring together a clinical team that includes prenatal care providers, behavioral health providers, and care coordinators. And they coordinate a “community team” of other agencies that can help with needs such as food, safe housing, domestic violence, employment, and transportation.
Meadowlark sites routinely screen every patient for common illnesses, including depression, anxiety, and substance use disorders. Whenever needed, the behavioral health provider sees women right away, usually as part of the same appointment.
“The Meadowlark Initiative is transforming pregnancy care for women around Montana. At participating hospitals and clinics, women affected by depression, anxiety, or drug and alcohol addiction can now receive supportive, team-based care that is proven to help.” – Dr. Aaron Wernham, MCHF CEO
“The initiative continues to address a complex problem in our state, but through strong collaborations and expansion of the program to more communities, much progress is being made. This is very encouraging, and I appreciate all our community partners whose efforts are truly making a difference in Montana.” – Sheila Hogan, DPHHS Director
Early Success: A New Standard of Care
As more providers join the Meadowlark Initiative each year, we are now starting to receive data on how it is changing both clinical practice and outcomes for patients and families.
Screening and Access to Care for Mental Illness and Substance Use Disorders
A first and critically important change is that prenatal providers are becoming more comfortable screening their patients for behavioral health issues. Of our first cohort of five grantees, four are screening at least 99% of pregnant women for substance use, and three are screening at least 97% for depression. By making this screening a routine expected part of care, Meadowlark providers help remove the stigma that may keep people from seeking help. And with behavioral health providers on staff, they can now offer prompt, effective treatment options and empower their patients to get the care they need.
“Screening for anxiety, depression, substance use, and social determinants of health has now been integrated into the standard of care for pregnant women. This allows caregivers the ability to offer support and intervene early in pregnancy. This holistic approach helps to improve the outcomes for mothers and their families.” – Tracey Hartzell, Providence St. Patrick Hospital Clinical Nurse Manager
One of our first grantees, St. James Healthcare, created a short video showing just how much difference this approach care can make for patients and their families.
Reducing the Need for Foster Care Placement
A second outcome is a new collaboration between medical providers and the child protective service workers from the DPHHS Child and Family Services Division (CFSD). Meadowlark Initiative sites now work with CFSD and patients proactively throughout the pregnancy. The Meadowlark Initiative works with CFSD to create a “Plan of Safe Care” for each patient, with the goal of enabling families to remain together safely. Meadowlark care coordinators include CFSD early in the pregnancy with their patients’ permission. This inclusion allows CFSD case managers to understand each patient better and stay updated on recovery efforts. By coordinating everyone involved in the women’s care, the entire team can find more effective solutions that benefit the mother and infant.
Meadowlark providers have reported many cases in which this collaboration has helped CFSD keep children safe and families together. We are now starting to see data that suggest the initiative contributes to lower foster care placement rates: most counties with the first Meadowlark Initiative sites now show a reduction averaging 40% in infant (0-30 days old) removal rates.
“The Meadowlark Initiative has helped foster teamwork and collaboration between CFSD and our local hospital. While many women are afraid of CFSD involvement, we are trying to help them understand how helpful CFSD can be. If we know there is an issue and can bring CFSD into the process early, it can help empower women to become active participants in their care and recovery plan.” – Joslin Hubbard, St. James Healthcare Meadowlark Care Coordinator
“With the Meadowlark Initiative, I can see the positive changes in our cases. Before being a part of this initiative, there weren’t many things we could do before a baby was born. Now, we can be involved earlier in the process. We can talk with moms about the different options they have and what to expect, and we work with them to develop a plan for after birth.” – Shaunda Hall, CFSD Intake Supervisor, Butte
“While there are many factors that impact whether an infant is removed from the home, I believe that the Meadowlark Initiative is helping reduce the need to remove infants. The efforts that everyone is making to support families being safe and healthy is making a difference.” – Nikki Grossberg, CFSD Deputy Administrator
Clinical Outcomes for Pregnant Women and Infants
The Meadowlark Initiative also seeks to reduce perinatal drug exposure and improve maternal and infant clinical outcomes. These outcomes are challenging for practices to measure, and we work with each Meadowlark site to support data collection and evaluate these outcomes. While the numbers are preliminary, three of the first five Meadowlark sites have already seen a decrease in infants born with a positive drug screen. Over the coming year, we will be working with all Meadowlark sites to collect and analyze clinical data on maternal and infant clinical outcomes.
To keep Montana families together and children out of foster care, the Meadowlark Initiative is successfully forging new partnerships among health care providers, state agencies, and community organizations. While many large hospitals in the state are now participating in the initiative, our work is not done. Our goal is to support at least one prenatal practice in each Montana community with a hospital that delivers babies. Grant funding and technical assistance are currently available for practices in those communities that would like to participate in the initiative. Prenatal care providers that see Medicaid patients (including family practitioners, obstetricians, midwives, and rural hospitals) are encouraged to apply. For more information, please visit our website.