Substance Abuse and Mental Health Services Administration
January 17, 2019
Printer Friendly Version in PDF Format (109 PDF pages)
ABSTRACT
The Protecting Our Infants Act of 2015 (POIA) became law on November 25, 2015. The Act (Public Law 114-91) addressed problems related to prenatal opioid exposure called for HHS to review planning and coordination of HHS activities related to prenatal opioid exposure and neonatal abstinence syndrome (NAS), and to study and develop recommendations for the prevention, identification, and treatment of NAS as well as the treatment of opioid use disorder (OUD) in pregnant women. In May of 2017 HHS released a POIA strategy to address gaps in research, overlap of federal programs and coordination of federal efforts to address NAS and NOWS. Section 7062 of the SUPPORT for Patients and Communities Act (P.L. 115-271, enacted October 24, 2018) requires a report about the implementation of the recommendations in the POIA strategy, to be submitted to specified congressional committees and made available to the public on the Department's website. HHS developed an implementation plan focusing on preventing prenatal opioid exposure, providing evidence-based treatment for both mother and infant, increasing the accessibility of family-friendly services for pregnant and parenting women with OUD, supporting continuing education for healthcare providers, and determining optimal family and developmental support services for children who have experienced prenatal opioid exposure. [101 PDF pages]
For additional information about this subject, you can visit the HHS/ASPE/Office of Disability, Aging and Long-Term Care Policy home page at http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officer, Kristina West, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201, Kristina.West@hhs.gov.
"ABBREVIATIONS
AAP | American Academy of Pediatrics |
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ACF | Administration for Children and Families |
ACT NOW | Advancing Clinical Trials for Neonatal Opioid Withdrawal |
ACYF | Administration on Children, Youth and Families |
ACOG | American College of Obstetrics and Gynecology |
AFCARS | Adoption and Foster Care Analysis and Reporting System |
AHRQ | Agency for Healthcare Research and Quality |
AIM | Alliance for Innovation on Maternal Health |
AIMS | Access Increases in Mental Health and Substance Abuse Services |
AI/AN | American Indian/Alaskan Native |
ASHTO | Association of State and Territorial Health Officials |
ASPE | Office of the Assistant Secretary for Planning and Evaluation |
BHCC | Behavioral Health Coordinating Council |
BRFSS | Behavioral Risk Factor Surveillance System |
CAHPG | Children and Adults Health Programs Group |
CARA | Comprehensive Addiction and Recovery Act of 2016 |
CAPTA | Child Abuse Prevention and Treatment Act |
CDC | Centers for Disease Control and Prevention |
CEU | Continuing Education Units |
CME | Continuing Medical Education |
CMCS | Center for Medicaid and CHIP Services |
CMMI | Center for Medicare and Medicaid Innovation |
CMS | Centers for Medicare & Medicaid Services |
CONACH | Committee on Native American Child Health |
CSAT | Center for Substance Abuse Treatment |
CSTE | Council of State and Territorial Epidemiologists |
DAST | Drug Abuse Screening Test |
DBP | Developmental-Behavioral Pediatrics |
DEHPG | Disabled and Elderly Health Programs Group |
ECHO | Extension for Community Care Outcomes |
EPSDT | Early and Periodic Screening, Diagnostic and Treatment |
ESC | Eat, Sleep, Console |
FASD | Fetal Alcohol Spectrum Disorders |
FOA | Funding Opportunity Announcement |
GAO | Government Accountability Office |
GPRA | Government Performance and Results Act |
HCUP | Healthcare Cost and Utilization Project |
HEDIS | Healthcare Effectiveness Data and Information Set |
HHS | Health and Human Services |
HIV/AIDS | Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome |
HOPE | Heroin, Opioids, and Pain Efforts |
HRSA | Health Resources and Services Administration |
IAA | Institutional Review Board Authorization Agreements |
IAP | MedicaidInnovation Accelerator Program |
ICD | International Statistical Classification of Diseases |
IDeA | Institutional Development Awards |
IMD | Institutions for Mental Diseases |
IHS | Indian Health Services |
ISPCTN | IDeA States Pediatric Clinical Trials Network |
IUD | Intrauterine Device |
LARCs | Long-acting reversible contraceptives |
LAUNCH | Linking Actions for Unmet Needs in Children's Health |
MAT | Medication-Assisted Treatment |
MAT-PDOA | Medication-Assisted Treatment--Prescription Drug and Opioid Addiction |
MCH | Maternal and Child Health |
MCHB | Maternal and Child Health Bureau |
MIECHV | Maternal, Infant, and Early Childhood Home Visiting |
MMRC | Maternal Mortality Review Committees |
MOU | Memorandum of Understanding |
NAS | Neonatal Abstinence Syndrome |
NCANDS | National Child Abuse and Neglect Data System |
NCSACW | National Center on Substance Abuse and Child Welfare |
NICHD | The Eunice Kennedy Shriver National Institute of Child Health and Human Development |
NICU | Neonatal Intensive Care Unit |
NIDA | National Institute on Drug Abuse |
NOWS | Neonatal Opioid Withdrawal Syndrome |
NRN | Neonatal Research Network |
NSDUH | National Survey on Drug Use and Health |
OASH | Office of the Assistant Secretary for Health |
OAT | Opioid Addiction Treatment |
OCA | Office of Community Awareness |
OCAN | Office on Child Abuse and Neglect |
OMB | Office of Management and Budget |
OTC | Over-The-Counter |
OUD | Opioid Use Disorder |
OWH | Office on Women's Health |
OWHPA | Office on Women's Health Prevention Award |
PCSS-O | Providers' Clinical Support System--Opioid Therapies |
PICs | Practice and Implementation Centers |
POIA | Protecting Our Infants Act |
PPW | Pregnant and Postpartum Women |
PQC | Perinatal Quality Collaboratives |
PRAMS | Pregnancy Risk Assessment Monitoring System |
RCT | Randomized Controlled Trial |
RFA | Request For Application |
RHOP | Rural Health Opioid Program |
SAMHSA | Substance Abuse and Mental Health Services Administration |
SABG | Substance Abuse Prevention and Treatment Block Grant |
SBIRT | Screening, Brief Intervention, and Referral to Treatment |
SEI IDTA | Substance Exposed Infant In-Depth Technical Assistance Program |
SGM | Special General Memorandums |
SNOMED | Systematized Nomenclature of Medicine |
SUD | Substance Use Disorder |
TA | Technical Assistance |
UDS | Uniform Data System |
BACKGROUND
A new study revealed that from 2004 to 2014, the rate of US infants diagnosed with opioid withdrawal symptoms increased 433%, from 1.5 to 8.0 per 1000 hospital births. This translates to one infant being born every 15 minutes with withdrawal symptoms due to prenatal opioid exposure. [1], [2]
The Protecting Our Infants Act of 2015 (POIA) became law on November 25, 2015. The Act (Public Law 114-91) addressed problems related to prenatal opioid exposure and included several mandates for the U.S. Department of Health and Human Services (HHS). The law called for HHS to review planning and coordination of HHS activities related to prenatal opioid exposure and neonatal abstinence syndrome (NAS), which includes neonatal opioid withdrawal syndrome (NOWS), and to study and develop recommendations for the prevention, identification, and treatment of NAS as well as the treatment of opioid use disorder (OUD) in pregnant women. In May of 2017 HHS released a POIA strategy to address gaps in research, overlap of federal programs and coordination of federal efforts to address NAS and NOWS.
In addition, the Comprehensive Addiction and Recovery Act of 2016 (CARA) included a provision for the Government Accountability Office (GAO) to examine NAS in the United States and related treatment services for the condition. The GAO study was published in October, 2017 and found limited physical capacity to care for infants with NAS; limited coordination of care for mothers and infants with NAS; and gaps in research and data on NAS.
Finally, Section 7062 of the SUPPORT for Patients and Communities Act (P.L. 115-271, enacted October 24, 2018) requires a report about the implementation of the recommendations in the POIA strategy, to be submitted to specified congressional committees and made available to the public on the Department's website within 60 days of enactment.
In response to POIA, the GAO study, and the SUPPORT for Patients and Communities Act, HHS developed an implementation plan to inform planning and policy across the Department. Recommendations range from aspirational to practical and include preventing prenatal opioid exposure, providing evidence-based treatment for both mother and infant, increasing the accessibility of family-friendly services for pregnant and parenting women with OUD, supporting continuing education for healthcare providers, and determining optimal family and developmental support services for children who have experienced prenatal opioid exposure.
IMPLEMENTATION PLAN PURPOSE AND DEVELOPMENT PROCESS
In recognition of the need for an organizing framework to guide and track implementation of recommendations in the POIA Strategy, the HHS Behavioral Health Coordinating Council (BHCC) Opioid and Controlled Substances Subcommittee, NAS Workgroup developed this implementation work plan. This plan provides an update on the POIA implementation plan activities that are completed, in process, and planned by HHS agencies, targeting activities for research and evaluation, programs and services, data and surveillance, and education.
The development of the plan represents an iterative process with the first draft completed on March 30, 2018 and the final plan to be completed by September 1, 2018. HHS agencies updated their NAS-related activities in March, April, and August 2018.
IMPLEMENTATION PLAN PROGRESS
All POIA recommendations are being addressed by HHS, with the majority of recommendations being addressed through dedicated cross-agency collaboration. Of the 39 recommendations, the Administration for Children and Families (ACF) is addressing 15, the Agency for Healthcare Research and Quality (AHRQ) is addressing two, the Centers for Disease Control and Prevention (CDC) is addressing 26, the Centers for Medicare & Medicaid Services (CMS) is addressing 21, the Food and Drug Administration is addressing seven, the Health Resources and Services Administration (HRSA) is addressing 29, Indian Health Services (IHS) is addressing 29, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) is addressing 14, the National Institute on Drug Abuse (NIDA) is addressing 18, HHS's Office of the Assistant Secretary for Health (OASH) is addressing 14, and the Substance Abuse and Mental Health Services Administration (SAMHSA) is addressing 25.
All agency activities are listed in the tables below. Updates are listed by recommendations, which in turn are organized into functional categories (Systemic, Clinical, Data and Surveillance, and Research and Evaluation).
Examples of Cross-Agency Collaboration
As highlighted above, the majority of recommendations are addressed through cross-agency collaboration with dedicated cross-agency activities for 36 of the 39 recommendations. For instance, ACF and SAMHSA jointly fund the National Center on Substance Abuse and Child Welfare (NCSACW) -- a technical assistance and training resource -- to improve family recovery, safety, and stability by advancing practices and collaboration among agencies, organizations, and courts working with families affected by substance use and co-occurring mental disorders and child abuse or neglect. ACF/Administration on Children, Youth and Families (ACYF) and SAMHSA also conducted a Policy Academy entitled "Improving Outcomes for Pregnant and Postpartum Women with Opioid Use Disorders, and their Infants and Families" on February 7-8, 2017, in Baltimore, MD to develop action plans on the complex needs of pregnant and parenting women. CMS and HRSA jointly issued guidance regarding Coverage of Maternal, Infant, and Early Childhood Home Visiting Services. NICHD (Office of the Director, Institutional Development Awards [IDeA] States Pediatric Clinical Trial Network) and NIDA partner on multiple research projects, including the "ACT NOW: Advancing Clinical Trials in NOWs" Initiative to evaluate treatment options and improve clinical care of infants with NAS. SAMHSA leads several joint efforts, including a work group entitled "Children and Families Impacted by the Opioid Crisis," a cross-agency collaboration with the Maternal and Child Health Bureau/HRSA, OASH/OWH, NIDA, and ACF in collaboration with CDC. OASH/OWH and IHS partnered to address opioid misuse among women of reproductive age in the American Indian/Alaskan Native (AI/AN) communities. OASH/OWH is also partnering with the HRSA Office of Women's Health on an initiative to produce a care coordination model for women impacted by opioids who receive healthcare services via HRSA-administered programs.
SUSTAINING HHS POIA IMPLEMENTATION PLAN EFFORTS
After the final implementation plan is approved, the BHCC Opioid and Controlled Substances Subcommittee will assume responsibility for the ongoing implementation and coordination of NAS and prenatal opioid exposure related activities to assess progress, evaluate effectiveness, and publicize NAS-specific programs and tools, contingent on funding.
IMPLEMENTATION STATUS OVERVIEW
The table below provides an overview of the recommendations by category, federal actions to address the recommendations, and funding and status for each action. The details of the implementation status for each recommendation is detailed in the following pages.
Recommendation Category | Number of Recommendations | Number of actions | Funding (Number of Actions | Percent of Actions) |
Status (Number of Actions | Percent of Actions) |
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39 | 423 | Funded | Proposed/Contingent on Funding | Completed | Ongoing | |||||
Systemic Changes | 16 | 198 | 164 | 82.82% | 34 | 17.17% | 8 | 4.04% | 190 | 95.95% |
Clinical Changes | 7 | 90 | 79 | 87.77% | 11 | 12.22% | 9 | 10% | 81 | 90% |
Data and Surveillance Changes | 5 | 55 | 36 | 65.45% | 19 | 34.55% | 0 | 0% | 55 | 100% |
Research and Evaluation Changes | 11 | 80 | 57 | 71.25% | 23 | 28.75% | 9 | 11.25% | 71 | 88.75% |
IMPLEMENTATION STATUS BY RECOMMENDATION
Recommendations Addressing Systemic Changes
Recommendations addressed by the following agencies:
1. Increase access to the broad range of contraceptive options for women at risk of experiencing a substance-exposed pregnancy, including barrier free access to long-acting reversible contraception. (Programs & Services, Maternal)
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CDC, CMS, HRSA, IHS
2. Provide ready access to effective SUD treatment, including tobacco cessation counseling/treatment, prior to conception and during pregnancy. (Programs & Services, Maternal)
- CMS, FDA, HRSA, IHS, NIDA, OASH/OWH, SAMHSA
3. Make available family-friendly relapse prevention and recovery support for parents in recovery. (Programs & Services, Maternal)
- ACF/Children's Bureau, CMS, HRSA, IHS
4. Provide ready access to family-friendly SUD treatment for parents. (Programs & Services, Maternal)
- ACF/Children's Bureau, CMS, HRSA, IHS, SAMHSA
5. Provide ready access to parental support and early intervention services. (Programs & Services, Child)
- ACF/Children's Bureau, CDC, CMS, HRSA, IHS, SAMHSA
6. Provide access to effective and alternative treatment options for pain prior to conception and during pregnancy and breastfeeding (Programs & Services, Maternal)
- CDC, CMS, HRSA, IHS, NIDA
7. Promote general public awareness of the effectiveness of SUD treatment, to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal)
- ACF/Children's Bureau, CDC, CMS, FDA, HRSA, IHS, SAMHSA, OASH/OWH
8. Promote shift in public perceptions of SUD so that it is regarded as a disease rather than as a criminal or moral problem to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal)
- ACF/Children's Bureau, CMS, HRSA, IHS, NIDA, OASH/OWH, SAMHSA
9. Develop effective strategies to support informed decision making around pain management or SUD treatment when these conditions are identified prenatally. (Programs & Services, Maternal)
- CDC, FDA, HRSA, IHS, OASH/OWH, SAMHSA
10. Promote non-pharmacologic interventions, such as rooming in, for managing mild to moderate NAS/NOWS. (Programs & Services, Child)
- ACF/Children's Bureau, CDC, CMS, HRSA, IHS, NICHD, NIDA, SAMHSA
11. Promote breastfeeding for women who receive opioids for pain or the treatment of OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal)
- ACF/Children's Bureau, CDC, CMS, HRSA, IHS, OASH/OWH, SAMHSA
12. Promote breastfeeding of infants of women who receive opioids for pain or OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal)
- CDC, CMS, HRSA, IHS, NICHD, OASH/OWH, SAMHSA
13. Provide continuing medical education to the provider for managing pain in the pregnant woman with OUD. (Education, Maternal)
- CDC, CMS, HRSA, IHS, SAMHSA
14. Provide continuing medical education to the provider for managing the infant with NAS symptoms. (Education, Maternal)
- CDC, HRSA, IHS, OASH/OWH
15. Identify a history of prenatal substance exposure and NAS/NOWS when children receive developmental assessment, early intervention services or enter child welfare. (Data & Surveillance, Child)
- ACF/Children's Bureau, CDC, CMS, HRSA, IHS
16. Promote public and health professional awareness of ongoing parental treatment engagement, recovery support, and early-intervention services in family function and mitigation of consequences of prenatal substance exposure and NAS/NOWS. (Education, Maternal)
- ACF/Children's Bureau, CMS, FDA, HRSA, IHS, SAMHSA
Examples of agency activities to address recommendations:
*The hyperlinks allow readers to move to the next recommendation the specific agency addresses. For example, the first hyperlink for CDC takes the reader to recommendation #5, which is the next recommendation CDC addresses. The hyperlink for CDC in recommendation #5 then takes the reader to recommendation #6, the next recommendation CDC addresses; etc.
Recommendation | Agency | Action | Funding | Milestones/Status |
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1. Increase access to the broad range of contraceptive options for women at risk of experiencing a substance-exposed pregnancy, including barrier free access to long-acting reversible contraception. (Programs & Services, Maternal) | CDC (move to next CDC) |
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2. Provide ready access to effective SUD treatment, including tobacco cessation counseling/treatment, prior to conception and during pregnancy. (Programs & Services, Maternal) | CMS move to next CMS) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
3. Make available family-friendly relapse prevention and recovery support for parents in recovery. (Programs & Services, Maternal) | ACF (move to next ACF) Office of Head Start (move to next OHS) |
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4. Provide ready access to family-friendly SUD treatment for parents. (Programs & Services, Maternal) | ACF move to next ACF) Children's Bureau move to next CB) |
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5. Provide ready access to parental support and early intervention services. (Programs & Services, Child) | ACF move to next ACF) Office of Head Start move to next CDC) |
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6. Provide access to effective and alternative treatment options for pain prior to conception and during pregnancy and breastfeeding. (Programs & Services, Maternal) | CDC (move to next CDC) |
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7. Promote general public awareness of the effectiveness of SUD treatment, to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal) | ACF (move to next ACF) Children's Bureau move to next CB) |
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8. Promote shift in public perceptions of SUD so that it is regarded as a disease rather than as a criminal or moral problem to reduce barriers to seeking treatment prior to conception and in early pregnancy. (Education, Maternal) | ACF (move to next ACF) Children's Bureau move to next CB) |
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9. Develop effective strategies to support informed decision making around pain management or SUD treatment when these conditions are identified prenatally. (Programs & Services, Maternal) | CDC (move to next CDC) |
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10. Promote non-pharmacologic interventions, such as rooming in, for managing mild to moderate NAS/NOWS. (Programs & Services, Child) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
11. Promote breastfeeding for women who receive opioids for pain or the treatment of OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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HRSA (move to next HRSA) | Several HRSA activities help address this recommendation, including:
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Recommendation | Agency | Action | Funding | Milestones/Status |
12. Promote breastfeeding of infants of women who receive opioids for pain or OUD when not otherwise contraindicated and consistent with appropriate guidelines. (Education, Maternal) | CDC (move to next CDC) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
13. Provide continuing medical education to the provider for managing pain in the pregnant woman with OUD. (Education, Maternal) | CDC (move to next CDC) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
14. Provide continuing medical education to the provider for managing the infant with NAS symptoms. (Education, Maternal) | CDC (move to next CDC) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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OASH (move to next OASH) OWH (move to next OWH) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
15. Identify a history of prenatal substance exposure and NAS/NOWS when children receive developmental assessment, early intervention services or enter child welfare. (Data & Surveillance, Child) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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CMS (move to next CMS) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
16. Promote public and health professional awareness of ongoing parental treatment engagement, recovery support, and early-intervention services in family function and mitigation of consequences of prenatal substance exposure and NAS/NOWS. (Education, Maternal) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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CMS (move to next CMS) |
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FDA (move to next FDA) |
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HRSA (move to next HRSA) | HRSA addresses this recommendation through:
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IHS (move to next IHS) |
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Recommendations Addressing Clinical Changes
Recommendations addressed by the following agencies:
17. Improve and expand screening to identify women in need of brief intervention, and referral to treatment.(Data & Surveillance, Maternal)
- ACF/Children's Bureau, AHRQ, CDC, CMS, HRSA, IHS, NIDA, OASH/OWH, SAMHSA
18. Define and understand the elements of an effective risk-benefit assessment in order to counsel pregnant women with pain regarding their management.(Data & Surveillance, Maternal)
- CDC, IHS, NICHD, NIDA, OASH/OWH, SAMHSA
19. Expand the use of SBIRT to identify hazardous and harmful substance use and intervene to change behavior prior to conception. (Programs & Services, Maternal)
- CDC, CMS, FDA, HRSA, IHS, OASH/OWH, SAMHSA
20. Support continuation of treatment for SUD from preconception through pregnancy and one year postpartum and tailor MAT according to parental need.(Programs & Services, Maternal)
- CDC, CMSHRSA, OASH/OWH, SAMHSA
21. Provide easily accessible, family-friendly, SUD treatment for pregnant and parenting women.(Programs & Services, Maternal)
- ACF/Children's Bureau, CMS, HRSA, IHS, NIDA
22. Provide developmental assessment and early intervention services for substance-exposed children with or without a history of NAS/NOWS.(Programs & Services, Child)
- ACF/Children's Bureau, CDC, CMS, HRSA, IHS, SAMHSA
23. Promote training and resources for child welfare workers to effectively address SUD and prenatal substance exposure, facilitate linkages to treatment, and promote recovery for mothers with SUD.(Education, Child)
- ACF/Children's Bureau, CDC, CMS, HRSA, IHS
Examples of Agency activities to address recommendations:
Recommendation | Agency | Action | Funding | Milestones/Status |
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17. Improve and expand screening to identify women in need of brief intervention, and referral to treatment.(Data & Surveillance, Maternal) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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AHRQ (move to next AHRQ) |
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CDC (move to next CDC) |
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CMS (move to next CMS) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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NIDA (move to next NIDA) |
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OASH (move to next OASH) OWH (move to next OWH) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
18. Define and understand the elements of an effective risk-benefit assessment in order to counsel pregnant women with pain regarding their management. (Data & Surveillance, Maternal) | CDC (move to next CDC) |
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IHS (move to next IHS) |
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NIDA (move to next NIDA) NICHD (move to next NICHD) |
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OASH (move to next OASH) OWH (move to next OWH) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
19. Expand the use of SBIRT to identify hazardous and harmful substance use and intervene to change behavior prior to conception.(Programs & Services, Maternal) | CDC (move to next CDC) |
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CMS (move to next CMS) |
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HRSA (move to next HRSA) | Achieves this recommendation through health centers and other primary care settings. Examples include:
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IHS (move to next IHS) |
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OASH (move to next OASH) OWH (move to next OWH) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
20. Support continuation of treatment for SUD from preconception through pregnancy and one year postpartum and tailor MAT according to parental need.(Programs & Services, Maternal) | CDC (move to next CDC) |
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CMS (move to next CMS) |
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FDA (move to next FDA) |
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HRSA (move to next HRSA) | Achieves this recommendation through health centers and other primary care settings. Examples include:
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OASH (move to next OASH) OWH (move to next OWH) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
21. Provide easily accessible, family-friendly, SUD treatment for pregnant and parenting women.(Programs & Services, Maternal) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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CMS (move to next CMS) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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NIDA (move to next NIDA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
22. Provide developmental assessment and early intervention services for substance-exposed children with or without a history of NAS/NOWS. (Programs & Services, Child) | ACF (move to next ACF) Officeof Head Start |
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CDC (move to next CDC) |
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CMS (move to next CMS) |
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HRSA (move to next HRSA) ACF (move to next ACF) |
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HRSA (move to next HRSA) ACF (move to next ACF) |
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HRSA (move to next HRSA) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
23. Promote training and resources for child welfare workers to effectively address SUD and prenatal substance exposure, facilitate linkages to treatment, and promote recovery for mothers with SUD. (Education, Child) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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CDC (move to next CDC) |
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CMS (move to next CMS) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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Recommendations Addressing Data and Surveillance Changes
Recommendations addressed by the following agencies:
24. Standardize terminology and promote a unified approach to data collection and reporting in order to accurately quantify prenatal substance exposure and identify risk and protective factors amenable to preventive efforts.(Data & Surveillance, Child)
- AHRQ, CDC, HRSA, IHS, SAMHSA
25. Collect substance- and diagnosis-specific data about prenatal substance use in order to develop adequate treatment capacity.(Data & Surveillance, Maternal)
- CDC, CMS, HRSA, IHS, NIDA, OASH/OWH, SAMHSA
26. Establish clear definitions of NAS vs. NOWS and standardize the use of ICD codes in order to collect more meaningful and actionable data on the impact of prenatal substance exposure on infants and children.(Data & Surveillance, Child)
- CDC, HRSA, IHS
27. Collect substance and diagnosis specific data about prenatal substance use in order to identify unmet service and care-coordination needs and any disparities in access.(Data & Surveillance, Maternal)
- CMS, HRSA, SAMHSA
28. Collect data on the outcomes of substance exposed children who are removed from their families versus those remaining with a mother receiving supportive interventions.(Data & Surveillance, Child)
- ACF/Children's Bureau, CDC, HRSA, NICHD, NIDA
Examples of Agency activities to address recommendations:
Recommendation | Agency | Action | Funding | Milestones/Status |
---|---|---|---|---|
24. Standardize terminology and promote a unified approach to data collection and reporting in order to accurately quantify prenatal substance exposure and identify risk and protective factors amenable to preventive efforts.(Data & Surveillance, Child) | AHRQ |
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CDC (move to next CDC) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
25. Collect substance- and diagnosis-specific data about prenatal substance use in order to develop adequate treatment capacity.(Data & Surveillance, Maternal) | CDC (move to next CDC) |
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CMS (move to next CMS) |
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HRSA(move to next HRSA) |
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IHS (move to next IHS) |
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NIDA (move to next NIDA) |
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OASH (move to next OASH) OWH (move to next OWH) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
26. Establish clear definitions of NAS vs. NOWS and standardize the use of ICD codes in order to collect more meaningful and actionable data on the impact of prenatal substance exposure on infants and children. (Data & Surveillance, Child) | CDC (move to next CDC) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
27. Collect substance and diagnosis specific data about prenatal substance use in order to identify unmet service and care-coordination needs and any disparities in access.(Data & Surveillance, Maternal) | CMS (move to next CMS) |
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HRSA (move to next HRSA) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
28. Collect data on the outcomes of substance exposed children who are removed from their families versus those remaining with a mother receiving supportive interventions. (Data & Surveillance, Child) | ACF (move to next ACF) Children's Bureau (move to next CB) |
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CDC (move to next CDC) |
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HRSA (move to next HRSA) |
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NICHD (move to next NICHD) NIDA move to next NIDA) ECHO (move to next ECHO) |
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Recommendations Addressing Research and Evaluation Changes
Recommendations addressed by the following agencies:
29. Determine the safety and effectiveness of naltrexone and naloxone when combined with buprenorphine use during pregnancy and breastfeeding.(Research & Evaluation, Maternal)
- NICHD, NIDA, SAMHSA
30. Research consequences of unrelieved pain on women and their pregnancies.(Research & Evaluation, Maternal)
- NICHD
31. Conduct research to support effective and safe non-opioid pharmacotherapy and non-pharmacologic pain relief strategies during pregnancy and breastfeeding.(Research & Evaluation, Child)
- NICHD, NIDA
32. Develop easy to implement and valid screening instruments for SUD in pregnancy.(Data & Surveillance, Maternal)
- CDC, HRSA, IHS, NIDA, OASH/OWH, SAMHSA
33. Research the modifiable maternal risk and protective factors and most effective interventions to minimize the impact of prenatal substance exposure on the fetus and child.(Research & Evaluation, Maternal)
- CDC, NICHD, NIDA, SAMHSA
34. Study prenatal opioid treatment for pain and develop an objective risk-benefit analysis for providers and patients to use in making pain management decisions.(Research & Evaluation, Maternal)
- CDC, FDA, IHS, NICHD
35. Research effective non-pharmacologic and non-opioid pharmacotherapies for pain management during pregnancy, labor and delivery, the postpartum care, and breastfeeding for women with chronic pain or OUD.(Research & Evaluation, Maternal)
- NICHD, NIDA
36. Establish evidence-based protocols for identifying and managing NAS and NOWS.(Research & Evaluation, Child)
- CDC, FDA, IHS, NICHD, NIDA, OASH/OWH, SAMHSA
37. Determine optimal toxicology screening of the opioid-exposed infant to support effective management with or without NAS/NOWS. (Research & Evaluation, Child)
- IHS, NICHD, NIDA
38. Assess and determine optimal family and development support services for the child who experienced prenatal substance exposure or NAS/NOWS.(Research & Evaluation, Child)
- ACF/Children's Bureau, CMS, HRSA, NICHD, NIDA, SAMHSA
39. Research the long-term developmental effects of prenatal substance exposure so that services can be developed to mitigate any effects. (Research & Evaluation, Child)
- CDC, NICHD, NIDA, SAMHSA
Examples of Agency activities to address recommendations:
Recommendation | Agency | Action | Funding | Milestones/Status |
---|---|---|---|---|
29. Determine the safety and effectiveness of naltrexone and naloxone when combined with buprenorphine use during pregnancy and breastfeeding. (Research & Evaluation, Maternal) | NICHD (move to next NICHD) |
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NIDA (move to next NIDA) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
30. Research consequences of unrelieved pain on women and their pregnancies. (Research & Evaluation, Maternal) | NICHD (move to next NICHD) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
31. Conduct research to support effective and safe non-opioid pharmacotherapy and non-pharmacologic pain relief strategies during pregnancy and breastfeeding. (Research & Evaluation, Child) | NICHD (move to next NICHD) NIDA (move to next NIDA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
32. Develop easy to implement and valid screening instruments for SUD in pregnancy. (Data & Surveillance, Maternal) | CDC (move to next CDC) |
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HRSA (move to next HRSA) |
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IHS (move to next IHS) |
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NIDA (move to next NIDA) |
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OASH (move to next OASH) OWH (move to next OWH) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
33. Research the modifiable maternal risk and protective factors and most effective interventions to minimize the impact of prenatal substance exposure on the fetus and child. (Research & Evaluation, Maternal) | CDC (move to next CDC) |
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NICHD (move to next NICHD) |
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NIDA (move to next NIDA) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
34. Study prenatal opioid treatment for pain and develop an objective risk-benefit analysis for providers and patients to use in making pain management decisions. (Research & Evaluation, Maternal) | CDC (move to next CDC) |
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FDA (move to next FDA) |
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IHS (move to next IHS) |
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NICHD (move to next NICHD) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
35. Research effective non-pharmacologic and non-opioid pharmacotherapies for pain management during pregnancy, labor and delivery, the postpartum care, and breastfeeding for women with chronic pain or OUD. (Research & Evaluation, Maternal) | NICHD (move to next NICHD) |
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NIDA (move to next NIDA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
36. Establish evidence-based protocols for identifying and managing NAS and NOWS. (Research & Evaluation, Child) | CDC (move to next CDC) |
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FDA |
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IHS (move to next IHS) |
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NICHD (move to next NICHD) |
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NICHD (move to next NICHD) NIDA move to next NIDA) ECHO (move to next ECHO) |
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NIDA (move to next NIDA) NICHD (move to next NICHD) |
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OASH OWH |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
37. Determine optimal toxicology screening of the opioid-exposed infant to support effective management with or without NAS/NOWS. (Research & Evaluation, Child) | IHS |
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NICHD (move to next NICHD) NIDA move to next NIDA) ECHO (move to next ECHO) |
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NIDA (move to next NIDA) NICHD (move to next NICHD) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
38. Assess and determine optimal family and development support services for the child who experienced prenatal substance exposure or NAS/NOWS. (Research & Evaluation, Child) | ACF Children's Bureau |
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CMS |
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HRSA |
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NICHD (move to next NICHD) NIDA move to next NIDA) ECHO (move to next ECHO) |
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NIDA (move to next NIDA) NICHD (move to next NICHD) |
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SAMHSA (move to next SAMHSA) |
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Recommendation | Agency | Action | Funding | Milestones/Status |
39. Research the long-term developmental effects of prenatal substance exposure so that services can be developed to mitigate any effects. (Research & Evaluation, Child) | CDC |
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NICHD (move to next NICHD) NIDA move to next NIDA) ECHO |
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NIDA NICHD |
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SAMHSA |
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APPENDIX A. BHCC Opioid and Controlled Substances Subcommittee Members
Administration for Community Living
Keri Lipperini
Phantane Sprowls
Shannon Skowronski
Agency for Healthcare Research and Quality
Parivash Jourjah
Richard Ricciardi
Centers for Disease Control and Prevention
Farida Ahmad
Holly Hedegaard
LeShaundra Cordier
Margaret Warner
Rose Rudd
Sarah Bacon
Tamara Haegerich
Centers for Medicare & Medicaid Services
Adams Solola
Crystal High
Devon Trolley
Diane McNally
Elizabeth Goldstein
Joanne Hillborn
Joseph Fine
Kirsten Beronio
Laura Snyder
Mary Greene
Michael Forman
Pamela Schweitzer
Rena McClain
Rhepsie Christian
Shelby Kennedy
Victoria James
Wanda Pamphile
Yolanda Williams
Food and Drug Administration
Doug Throckmorton
Johanna McLatchy
Health Resources and Services Administration
Alexander Ross
Judith Steinberg
Karen Wade
Michelle Moses-Eisenstein
Shannon McDevitt
Immediate Office of the Secretary
Ben Shannon
Mona Siddiqui
Naweed Lamar
Shahla Jilani
Indian Health Service
Beverly Cotton
Cynthia Gunderson
Marcella Ronyak
Vanessa Thomas-Wilson
National Institute on Drug Abuse
Cheryl Boyce
David Thomas
Emily Einstein
Jack Stein
Jinhee Lee
Kelley Henry
Linda Porter
Maggie Stevenson
Nora Volkow -- Co-Chair
Wilson Compton
Office of the Assistant Secretary for Health
Alicia Richmond Scott
Anna Gribble
Clydette Powell
Corinna Dan
Cynthia Hansen
Dalton Paxman
Jessica Tytel (Office on Women's Health)
Joyce Yu
Juliet Bui
Michael Blodget
Nazleen Bharmal (Office of the Surgeon General)
Ndome Essoka
Rochelle Rollins
Ryan Moran
Office of the Assistant Secretary for Legislation
Alexandra Khalife
Sara Singleton
Office of the Assistant Secretary for Planning and Evaluation
Gavin Kennedy
Jessica (O'Hara) White
Laurel Fuller
Kristina West
Substance Abuse and Mental Health Services Administration
Audra Stock
Brandon Johnson
Christopher Jones -- Chair
Danielle Johnson
David deVoursney
Fran Harding
Greg Goldstein
Jeff Cody
Jennifer Fan
Jennifer Solomon
Jonaki Bose
Khadisha Johnson
Lisa Kaplowitz
Rebecca Flatow Zornick
Rob Lyerla
Sean Belouin
Shadia Garrison
Shahla Jilani
Steve Daviss
Tony Campbell
APPENDIX B. NAS Workgroup
Agency for Healthcare Research and Quality
Kamila Mistry
Administration for Children and Families
Elaine Stedt
Jean Blankenship
Centers for Disease Control and Prevention
Alex Ewling
Jean Ko
Jennifer Lind
Lisa Romero -- Subgroup Lead: Data and Surveillance
Meghan Frey
Centers for Medicare & Medicaid Services
Kirsten Beronio
Sandra Habit
Food and Drug Administration
Pamela Horn
Health Resources and Services Administration
Dawn Levinson -- Subgroup Lead: Programs and Services
Fraser Byrne
Sarah Sisaye
Judith Steinberg
Ashley Hirai
Indian Health Service
Cynthia Gunderson -- Lead: NAS Workgroup; Subgroup Lead: Education
Ted Hall -- Subgroup Lead: Education
Tyler Lannoye -- Subgroup Lead: Research and Evaluation
National Institute of Child Health and Human Development
Uma Reddy
Lisa Halvorson
National Institute on Drug Abuse
Emily Einstien
Karen Sirocco -- Subgroup Lead: Research and Evaluation
Office of the Assistant Secretary for Planning and Evaluation
Kristina West
Office of the Assistant Secretary for Health, Office on Women's Health
Jessica Tytel
Substance Abuse and Mental Health Services Administration
Audra Stock -- Lead: NAS Workgroup
Ekaterina Zoubak
Jennifer Oppenheim
Sharon Amatetti
Steve Daviss
NOTES
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Vanderbilt University Medical Center Reporter. Study tracks impact of NAS on state Medicaid programs. (2018, March 23). Retrieved March 29, 2018, from https://news.vanderbilt.edu/2018/03/23/study-tracks-impact-of-nas-on-state-medicaid-programs.
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Winkelman, T., N., A., Villapiano, N., Kozhimannil, K., B., Davis, M., & Patrick, S., W. (2018). Incidence and Costs of Neonatal Abstinence Syndrome Among Infants With Medicaid: 2004-2014. Pediatrics, 141(4):e20173520.