R01HD105348

Project Nurture Expansion Study - Project Summary

In the past 20 years, the United States (US) has seen a fourfold increase in the prevalence of maternal substance use disorders during pregnancy. Substance use during pregnancy is associated with adverse maternal and infant health outcomes. Numerous barriers impede the delivery of well-coordinated and high-quality pregnancy and postpartum care for women with substance use disorder. These barriers include a lack of access to obstetrics providers who are comfortable with providing medical care to women with substance use disorders, competing demands from child welfare and necessary medical services, and limited availability of substance use disorder treatment programs that allow children and provide parenting support resources.

A coalition of maternity care providers, substance use treatment agencies, state social service agencies, and Medicaid funding partners in Oregon tested a care model called Project Nurture in three clinics in the Portland area in 2015. Project Nurture combines maternity care, substance use disorder treatment, peer/doula support, and case management in a single setting. Access to these services in a single care setting reduces barriers to care and facilitates increased collaboration among providers, creating a more supportive environment with realistic expectations for mothers. Care is delivered in a non-judgmental and trauma-informed manner, which is important given the high prevalence of stressful life events experienced by women with substance use disorder.

A peer-reviewed study found Project Nurture to be associated with reductions in child maltreatment and placement of children in foster care, as well as increases in prenatal visits. Preliminary data from an independent evaluator also suggest that Project Nurture may reduce preterm births, reduce intensive neonatal care, and increase engagement in substance use disorder treatment. Oregon's governor is expanding Project Nurture to five rural and underserved counties.

The objective of this study is to establish the empirical evidence needed to replicate Project Nurture in other states. While preliminary findings suggest that Project Nurture improves short- and longer-term maternal-infant outcomes, we propose further investigation to answer three critical questions: (1) What are the key elements of Project Nurture associated with improved outcomes? (2) How can these elements be implemented in rural and underserved settings? And (3) What is the effectiveness of Project Nurture in rural regions and when mothers are engaged in methamphetamine and polysubstance use?

Thus, this study is designed to accomplish the following four aims: (1) Assess the effects of Project Nurture on pregnancy, birth, neonatal, and child welfare outcomes; (2) Assess the effect of Project Nurture on healthcare expenditures; (3) Describe implementation of Project Nurture; and (4) Identify critical elements of Project Nurture and support replication and dissemination.

This study will provide state, regional, and organizational leaders the information needed to replicate Project Nurture and create a safe and de-stigmatized care environment for pregnant women living with substance use disorder.

Oregon Health & Science University

TO CONDUCT AND SUPPORT LABORATORY RESEARCH, CLINICAL TRIALS, AND STUDIES WITH PEOPLE THAT EXPLORE HEALTH PROCESSES. NICHD RESEARCHERS EXAMINE GROWTH AND DEVELOPMENT, BIOLOGIC AND REPRODUCTIVE FUNCTIONS, BEHAVIOR PATTERNS, AND POPULATION DYNAMICS TO PROTECT AND MAINTAIN THE HEALTH OF ALL PEOPLE. TO EXAMINE THE IMPACT OF DISABILITIES, DISEASES, AND DEFECTS ON THE LIVES OF INDIVIDUALS. WITH THIS INFORMATION, THE NICHD HOPES TO RESTORE, INCREASE, AND MAXIMIZE THE CAPABILITIES OF PEOPLE AFFECTED BY DISEASE AND INJURY. TO SPONSOR TRAINING PROGRAMS FOR SCIENTISTS, DOCTORS, AND RESEARCHERS TO ENSURE THAT NICHD RESEARCH CAN CONTINUE. BY TRAINING THESE PROFESSIONALS IN THE LATEST RESEARCH METHODS AND TECHNOLOGIES, THE NICHD WILL BE ABLE TO CONDUCT ITS RESEARCH AND MAKE HEALTH RESEARCH PROGRESS UNTIL ALL CHILDREN, ADULTS, FAMILIES, AND POPULATIONS ENJOY GOOD HEALTH. THE MISSION OF THE NICHD IS TO ENSURE THAT EVERY PERSON IS BORN HEALTHY AND WANTED, THAT WOMEN SUFFER NO HARMFUL EFFECTS FROM REPRODUCTIVE PROCESSES, AND THAT ALL CHILDREN HAVE THE CHANCE TO ACHIEVE THEIR FULL POTENTIAL FOR HEALTHY AND PRODUCTIVE LIVES, FREE FROM DISEASE OR DISABILITY, AND TO ENSURE THE HEALTH, PRODUCTIVITY, INDEPENDENCE, AND WELL-BEING OF ALL PEOPLE THROUGH OPTIMAL REHABILITATION.

93.865 - Child Health and Human Development Extramural Research

National Institute of Child Health and Human Development (NICHD) [HHS - NIH]

Portland, Oregon 972393011 United States

Single Zip Code

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)

Amendment Since initial award the total obligations have increased 391% from $673,376 to $3,304,098.