In the 1990s, Sylvia Kirkland was coping with a substance use disorder as a young mother. “I remember how mothers who were using alcohol or drugs were being arrested or giving birth to babies who were addicted,” she explained. “There wasn’t any kind of program or support to help these women improve their health or the health of their unborn children.”
Why was there such a lack of support? “In the past, no one wanted to treat a pregnant woman who was taking street drugs,” revealed Russell Suda, MD, medical director of Cabarrus Health Alliance. “They feared a bad medical outcome as well as legal problems. Plus, they didn’t have the right training or resources in place to manage these complex patients. Delaying care until after delivery puts the health of both the mother and child in serious danger.”
According to experts from Atrium Health Behavioral Health Services, it’s important for both patients and providers to remember that addiction is a disease. Applying a chronic disease model to addiction treatment is effective and proven. Pregnant women, like many others, can recover from addiction and uncover their true lives.
In 2015, things began to change when Dr. Suda started working on a project that would address the complex social, mental and physical challenges facing women with substance use disorders in order to provide the needed care and support throughout pregnancy and the postpartum period. By connecting these women with the state-of-the-art prenatal care, behavioral health services and social support services they need, the Substance Use Network (SUN) Project is helping pregnant women suffering from substance use disorders achieve optimal health outcomes and overall well-being.
Collaborative, compassionate care
As the first program of its kind in North Carolina, the SUN Project is a partnership between Atrium Health Behavioral Health Services, Cabarrus Health Alliance and Cabarrus Partnership for Children (CPC). It provides a cross-sector collaborative system of compassionate care that uses best practices to support the health, safety, well-being and recovery of pregnant women using substances and protect their families.
“What really makes our project different is how we bring all these sectors together, including legal experts, doctors, providers, members of public health departments, agency representatives, etc.,” explained Gina Hofert, MA, program manager of the SUN Project with CPC. “We take resources and services from the community and connect them together rather than creating a new standalone system.”
Various agencies across the county coordinate services in order to decrease duplication and prioritize the mother's goals and needs while preventing the patient from becoming overwhelmed. The project facilitates the collaboration between partners for care coordination at no cost to the patient.
Peer support services
To help support SUN Project patients, Atrium Health Behavioral Health Services offers peer support services through specialists with lived experiences of recovery from psychiatric, traumatic and/or substance use challenges. These specialists work with patients to help them achieve the following goals before giving birth:
- Find housing and learn critical life skills, like reading.
- Keep their appointments at the SUN Clinic.
- Make sure they take care of themselves, including eating, bathing and staying away from their drug of choice.
Peer support specialists also work side by side with patients to provide crisis support. If patients are in crisis and feel like they can only cope by using drugs or alcohol, they can reach out to a specialist for immediate help. Patients often feel more comfortable talking with peer support specialists because of their ability to sympathize with them and be personable.
Clinical services
Clinical services are provided for mothers at the SUN Clinic, which is located within Cabarrus Health Alliance. Services include:
- Prenatal care by an OB physician or provider with specialized training in addiction
- Ultrasound, lab and fetal monitoring
- Medication-assisted treatment in the form of buprenorphine
- Mental health and substance use therapy services by licensed providers
- Nutritional counseling
- Case management services
- Recovery support
- Peer support specialist services
- Women, Infants and Children (WIC) nutrition program
- Dental care
- Newborn care
Consistent communication and training
The SUN Project maintains a continuum of communication to ensure that all providers are aligned and trained to care for pregnant women with substance use disorders. Consider this sample case:
- Challenge: A patient receives care at an OB physician or provider. When delivery time comes, she checks into the hospital. However, if the staff aren’t trained to handle pregnant women with substance use disorders, there could be trauma that causes the patient to relapse.
- Solution: The SUN Project notifies the hospital several weeks before the patient is expected to deliver. Project coordinators help find a nurse at the hospital who has experience working with mothers with addiction to ensure the patient will have compassionate support during delivery.
Program model and funding
The SUN Project uses the “SAMHSA Guide on How to Develop a Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders” to implement best practices and to promote collaboration and cooperation across sectors.
“The guide outlines 20 best practices that can be used system wide by hospitals, community service providers, etc.,” Hofert said. “We use it as our evaluation tool to help determine to what degree the providers are implementing these best practices each year and how working together is impacting the health of mothers and their babies.”
Funding partners for the SUN Project include:
- Cabarrus Partnership Smart Start
- Cabarrus Health Alliance
- Robert Wood Johnson Foundation: Cross-Sector Innovation Initiative
- Duke Endowment Grant: Atrium Health
Collaboration with behavioral health experts
“From the beginning of the SUN Project, Atrium Health Behavioral Health Services has been in lockstep with us,” said Dr. Suda. “In fact, Cheryl Dodds, MD, medical director of Atrium Health Behavioral Health Davidson, has taken the lead in connecting psychiatric health with our patients and promoting the project. She has showed us through collaboration that we can manage the most difficult patients and provide the resources needed to help them have healthy full-term babies.”
“Dr. Dodds and her staff, including Lacy Esposito, director of Addiction Services with Atrium Health Behavioral Health Services, are always willing to weigh in on very complex behavioral health problems influencing these women,” added Dr. Suda.
Keeping families together
Now, nearly 31 years sober, Kirkland has been working for the past 2 years as a peer support specialist with Atrium Health Behavioral Health Services, helping pregnant women with addiction. “The first thing I do is work with the patient to help them understand we’re not the enemy,” she said. “When you’re using, you think everyone’s the enemy out there. These women often fear that everyone’s trying to take their kids away from them. I help them understand that one of our main goals is to keep families together.
“This program is so close to my heart,” added Kirkland. “I really understand the route they’re taking and the challenges they’ll face. Helping women benefit from this program is really worthwhile and rewarding.”
Impact of maternal motivation
Since launching in 2019, the SUN Project has worked with about 40 patients. “By leveraging their pregnancy positively in their lives, despite using heroin in the first 10 weeks of pregnancy, we’ve helped many women get on a drug that helps them get their babies to full term,” revealed Dr. Suda. “Most of these women delivered healthy babies at 35 weeks or beyond. And many have been able to recover from addiction.”
According to Dr. Suda, motherhood is a motivator that’s unequaled by anything else. “After giving up illicit drug use, one patient in the program pointed to her baby and said ‘That’s my drug right there,’” he said. “That’s exactly what pregnancy should be. Motherhood is so intimate. It gives mom a reason to live and the motivation to give her baby a chance to live in a safe environment with her – instead of a custodian.”
Through her work with the project, Hofert has realized the importance of how patients feel throughout the experience. “We’ve realized that it’s not what services you provide but how you treat patients when they’re here,” she said. “Having a well-educated staff helps mothers feel safe enough to get the care they need – and to keep coming back for support and treatment.”
For help
To learn more about the SUN Project, call the SUN Clinic at 704-920-1289 or email gina@cabarruspartnership.org.
For 24/7 mental health crisis support, call Atrium Health’s Behavioral Health Help Line at 704-444-2400. If you or someone you know is in immediate danger, please call 911.
