Assessing Sustainability of State-Led Action Plans for the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community, 2018-2021

Abstract

Objective(s): The opioid crisis affects the health and health care of pregnant and postpartum people and infants prenatally exposed to substances. A Learning Community (LC) among 15 states was implemented to improve services for these populations. States drafted action plans with goals, strategies, and activities. Materials and Methods: Qualitative data from action plans were analyzed to assess how reported activities aligned with focus areas each year. Year 2 focus areas were compared with year 1 to identify shifts or expansion of activities. States self-assessed progress at the LC closing meeting, reported goal completion, barriers and facilitators affecting goal completion, and sustainment strategies. Results: In year 2, many states included activities focused on access to and coordination of quality services (13 of 15 states) and provider awareness and training (11 of 15). Among 12 states participating in both years of the LC, 11 expanded activities to include at least one additional focus area, adding activities in financing and coverage of services (n = 6); consumer awareness and education (n = 5); or ethical, legal, and social considerations (n = 4). Of the 39 goals developed by states, 54% were completed, and of those not completed, 94% had ongoing activities. Barriers to goal completion included competing priorities and pandemic-related constraints, whereas facilitators involving use of the LC as a forum for information-sharing and leadership-supported goal completion. Sustainability strategies were continued provider training and partnership with Perinatal Quality Collaboratives. Conclusion: State LC participation supported sustainment of activities to improve health and health care for pregnant and postpartum people with opioid use disorder and infants prenatally exposed to substances.

Keywords: learning community; medication-assisted treatment; medications for opioid use disorder; opioid addiction; opioid crisis; opioid use disorder; postpartum; pregnancy.

FIG. 1.

Map of the 15 states participating in year 1 and 2 of the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community, 2018–2021. States participating in both year 1 and 2 of the Learning Community are indicated by black shading, and states participating in only year 2 of the Learning Community are indicated by dark grey shading. States not participating in the Learning Community are indicated by light grey shading.

FIG. 2.

Comparison of year 1 and 2 focus areas for state activities addressing opioid use disorder among pregnant and postpartum people and infant prenatally exposed to substances—12 states, Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community, 2018 and 2019. States working in each specific focus area during year 1 are colored in black. States working in each specific focus area during year 2 are colored in light grey. Consumer awareness was added as a state-identified focus area for year 2; therefore, no state was identified as working in consumer awareness during year 1. The states represented in Figure 1 are Alaska, Florida, Illinois, Kentucky, Nevada, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, Washington, West Virginia.