PROJECT: MySafePlan mobile app
GOAL: Engage women in developing a digital technology to provide easily accessible resources needed for self care, recovery, and parenting and to support compliance with the federal mandate for a plan of safe care for babies born exposed to opiates during pregnancy.
COMMUNITY PARTNERS: Habit OPCO, a national network of substance use treatment centers that provide methadone and buprenorphine treatment to individuals with opioid use disorder; Groups (formerly Recover Together), a locally-started and nationally growing network of centers that provide medication-assisted treatment and group psychosocial support to individuals with opioid use disorder.
RESEARCH TEAM: Sarah Lord, PhD; Daisy Goodman, CNM, DNP, MPH; Jennifer Williams, LPN; Mary Kay Jankowski PhD
FUNDING: Dartmouth SYNERGY
New England has higher rates of newborn babies who suffer withdrawal from opioids than most of the United States(1). In a study conducted in 2014, 6% of newborns at Dartmouth-Hitchcock Medical Center had confirmed exposure to opioids during pregnancy(2).
The Comprehensive Addiction and Recovery Act enacted in 2016 requires babies with exposure to substances during pregnancy, including opioids, other illicit drugs and alcohol, to have a plan for safe care before leaving the hospital after birth. Although most babies are not exposed to substances during pregnancy, hundreds of babies are expected to be born in New Hampshire and Vermont affected by substances each year and require a plan for safe care that is approved by child protective services.
(1) Patrick SW1, Davis MM2, Lehmann CU3, Cooper WO4. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015 Aug;35(8):650-5. doi: 10.1038/jp.2015.36. Epub 2015 Apr 30.
(2) Holmes AV, Atwood EC, Whalen B, et al. Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics. 2016;137(6):e20152929
The level of complexity needed to fulfill the requirements of a plan for safe care is often overwhelming for women, especially women with opioid used disorder who are also commonly struggling with depression and anxiety.
Daisy Goodman, nurse midwife and co-creator of MySafePlan
MySafePlan – a Mobile App
Daisy Goodman, a nurse midwife specializing in addiction treatment for pregnant women, and Sarah Lord, a researcher at the Center for Technology in Behavioral Health, are collaborating with other researchers, clinicians, child welfare professionals, community organizations and families to create MySafePlan, a mobile app that supports families while they navigate what can be an overwhelming and confusing system.
MySafePlan is the first step in a research program investigating how technology can improve infant care and parenting outcomes. The app will be adapted from a previous project to fit this population. Sarah and Daisy are collaborating with local organizations to develop this app. The app will include digital recovery supports, links to medically valid resources about prenatal, well woman, and infant care, assistance with scheduling rides, reminders, ways to share specific information with family and more. It will also allow a woman to create a report with the details required to fulfill the federal mandate for a plan of safe care.
This population tends to be very vulnerable with so much happening in their lives. Participating in the study will allow women to access a platform that will help keep them organized, provide resources, and reduce barriers to care ultimately benefiting the community as a whole.
Heather Prebish, Clinical Director of Groups
This initiative connects with regional public health priorities for substance misuse. This is a top priority in community health needs assessments (CHIPs) conducted throughout the region.
The figure above shows the neonatal abstinence syndrome rate in Vermont increasing from less than 1 baby per 1000 hospital births in 2001 to 33 babies per 1000 hospital birth in 2013, the last year reported (3). A similar trend occurred for the Medicaid population in New Hampshire between 2000 and 2011 in data reported in this 2015 Neonatal Abstinence Syndrome data brief.
(3) Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of neonatal abstinence syndrome – 28 States, 1999-2013. MMWR Morb Mortal Wkly Rep (2016) 65(31):799–802. doi: 10.15585/mmwr.mm6531a210.15585/mmwr.mm6531a2 https://www.cdc.gov/mmwr/volumes/65/wr/pdfs/mm6531a2.pdf
Developing an app that will be most helpful and relevant to women with substance use disorders requires participation from new moms and community organizations. Women with substance use disorders have traditionally feared engagement with the child welfare system. This project allows mothers to participate fully in developing a plan for safe care proactively, and has the potential to transform approaches to this issue nationally.
This fall, Goodman and Lord are working with families and other community partners to guide the development of this app. Anyone interested in learning more about this project can contact them via email or phone.
More Information / Contact
Daisy J. Goodman
Sarah E. Lord