The “Practicing Safety Mindfulness Project for Mothers in Drug Treatment” provides integrated services to improve the parenting of pregnant women and mothers who are in medically assisted treatment for opioid dependence. The multi-faceted intervention recruits women from the Maternal Addiction Treatment Education and Research (MATER) Program at Thomas Jefferson University through its outpatient (Family Center) and short and long term medically monitored residential (My Sisters Place) facilities. The project includes: 1) an innovative trauma-informed Mindfulness Based Parenting intervention to enhance resilience, 2) enhanced case management between Jefferson/Nemours Pediatrics and Family Center, and 3) a quality improvement intervention, “Practicing Safety”, at Jefferson/Nemours Pediatrics Philadelphia Clinic focusing on preventing abuse and neglect of children ages 0-3.
Case management works directly to improve behavioral health access. The caseworker and social worker for the program lead this segment, and work directly with the mothers, MBP teachers, MATER clinicians, and contacts at outside agencies to ensure mothers are being put into contact with the services they need. For the caseworker, this involves sitting with the women weekly to discuss what services they are in need of.
At the practice, the social worker identifies new, previously unknown community resources and as a result builds stronger ties to community service agencies/organizations known to the practice in an effort to build and strengthen the medical home for the family. The social worker follows up with parents, solicits feedback to determine the success or barriers to assessing referral services, and works to reduce identified barriers and support mothers to follow through with referrals.
This innovative program works to improve behavioral health quality in two ways: through enhanced case management, and through the quality improvement initiative. Enhanced case management between the case manager and social worker ensures that families are being put into contact with the services they need in a timely manner, following up with mothers and agencies on the mother’s behalf. Close attention to the mother’s behavioral health is also important, as the caseworker is closely attuned to signs of mental health issues such as depression to ensure there is no threat to her or her child’s safety. The intervention at the practice uses quality improvement science methods, including a defined measurement plan, a toolkit consisting of the four bundles mentioned above of assessment tools, anticipatory guidance, and resources, and a set of suggested strategies to test changes and implement practice-level improvements.
The program works to address behavioral health costs by screening for depression and referring all positive screens to a clinician. Identifying depression early on and treating it reduces the negative effects of an untreated condition on both the mother and her child (emotionally and financially). Further, mindfulness has been shown in other studies to reduce stress and depression symptoms which may impact downstream treatment and quality of life related costs.
The entire intervention is trauma informed, and preliminary results show that for some measures women with the highest exposure to childhood trauma are able to make the largest improvements from pre-intervention to post-intervention. There is great potential for cost savings in disseminating an intervention in a population with an ACE burden, to improve parenting which is related to childhood behavioral and health issues as well as downstream issues when the children become adults themselves.
This is a novel intervention to increase parental resources and enhance parental resilience, and the ability to meet the emotional needs of children, which may improve child outcomes. This has potential to move science closer to reducing the burden of child abuse and neglect, and enhance the likelihood of family unity that supports lifelong child development. Additionally innovative is instituting active referral processes in the pediatric practice to intervene and support at-risk families for prevention of child abuse and neglect to community agencies designed to protect children and families. This program has fostered a sustainable collaboration between a pediatrics clinic, a women’s drug treatment facility, a mindfulness based stress reduction program, and the community of services and programs that support and enable parents to enhance the psychosocial development of children 0-3 years of age while maintaining family unity.
The program has worked to become a leader in the community in a variety of ways. To further integrate enhanced case management and develop stronger ties between community agencies mothers in our program interact with, we organized a Community Networking Summit. The purpose was to connect service organizations in the area with each other to increase utilization of available services for parenting women in Philadelphia. Further, we have disseminated results from this research at various settings including Grand Rounds at local hospitals, workshops and posters at national conferences, and national webinars with the AIA Resource Center. By sharing results we hope others can learn about the integration of a research program into a clinical setting and the novel testing of MBP in a population of mothers in medically assisted treatment for opioid dependence.
The Director of MATER has integrated mindfulness throughout MATER, offering staff to take MBSR so they can practice mindfulness with clients. It is also being woven into the cultural landscape of MATER. There are plans to establish a peer led mindfulness group and mindful yoga. A partnership has also been developed between MATER and a Jefferson University Integrative Medicine Institute for participants’ scholarship to an eight week MBSR course. Further there have been two trainings at the pediatric practice in mindfulness. Work to the EHR at the pediatric practice formally integrates QI efforts into the practice’s workflow for the long-term. Additionally, the QI team and QI agenda item on the monthly practice meeting are now core elements of the practice. Both the pediatric site and MATER sites have also held trauma trainings to improve the skill set of clinicians.
The innovative program has kept meticulous notes over the course of the past four years, detailing how the curriculum was developed and implemented. Additionally, a RE-AIM evaluation has been performed looking at barriers and assets to implementation, adoption, and maintenance of the intervention at the clinical site. This data will inform generalizability of the intervention to other sites as well as recommendations for others wishing to adopt a similar approach. The intervention was first applied only at the outpatient setting of MATER, and after two years we spread it to the short and long term medically assisted residential treatment setting with great success. This provided experience in both the outpatient and residential setting to share with others.
Preliminary results from the project show a high frequency of childhood adversity, significantly higher than the general population. Regarding stress, following MBP, perceived stress scores significantly decreased after women completed the intervention and mindfulness scores have increased after the intervention. Quality of parenting behavior scores significantly improved following MBP, and this change was significantly moderated by ACE scores.