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Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider’ s Roles and Responsibilities

Abstract

Peripartum individuals with substance misuse are a high-risk population that challenge clinicians and child welfare specialists alike. Federal legislation was updated in 2016 with the Comprehensive Addiction Recovery Act (CARA) to improve care via expanded screening and treatment referrals for peripartum women with substance misuse. The implementation of CARA requires providers to update their policies and procedures in order to meet the requirements outlined by this legislation. As this is a new process, this paper reviews the new administrative reporting and safety planning requirements relevant to obstetrical care providers and provides examples of best practice for different clinical scenarios. Given the variable state laws, confidentiality concerns, influence of stigma and health inequities on substance use treatment, and the fragmented healthcare system, implementation of CARA will challenge obstetric, pediatric, and mental health care providers along with child welfare services. All entities involved must work together to create effective and efficient protocols to address the CARA requirements. Health systems must also evaluate and update methods and interventions to assure that policies improve family stability and well-being.

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  1. This project was approved by the Albert Einstein College of Medicine Institutional Review Board. The manuscript is not based upon patient data. The authors confirm that this research was conducted in accord with prevailing ethical principles.

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Acknowledgements & Funding Information

Funding for this project was provided by the Administration for Children Youth and Families – Children’s Bureau under the Regional Partnership Grant to Improve Child Welfare Outcomes Among Substance Abusers 90CU0102-01.

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Correspondence to Marlee Madora MD.

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There are no competing interests.

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Given that no human subjects data was used, this manuscript did not require formal Institutional Review Board review. However, the authors confirm that this research was conducted in accord with prevailing ethical principles. This is also indicated in the manuscript under Footnote 1.

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Significance

This article describes the obstetrical care provider’s role in reporting and managing substance use in line with recent policy changes to promote family stability and wellbeing.

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Madora, M., Wetzler, S., Jose, A. et al. Pregnant and Postpartum People with Substance Use Disorders: Understanding the Obstetrical Care Provider’ s Roles and Responsibilities. Matern Child Health J 26, 1409–1414 (2022). https://doi.org/10.1007/s10995-022-03446-x

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  • DOI: https://doi.org/10.1007/s10995-022-03446-x

Keywords

  • Maternal substance use
  • Obstetrics
  • Child welfare
  • Comprehensive Addiction Recovery Act
  • Plan of Safe Care