A new state health program announced Tuesday encourages physicians to identify and seek treatment for pregnant women dealing with substance abuse, depression or domestic violence.
The goal of the Screening, Brief Intervention and Referral to Treatment program is to spend public health dollars up front to improve the health of newborns, thus keeping those babies out of expensive hospital neonatal units. The program isn’t designed to punish mothers who refuse treatment for their problems, but health officials recognize they must overcome that concern to make the program work.
Doctors and health plan coordinators will be asked to use a standard, one-page questionnaire designed to determine if a woman is using harmful substances, suffers from depression or is a victim of domestic violence. The program sets up direct links to experts at the state mental health and alcohol and drug abuse agencies as well as non-profits such as the S.C. Coalition Against Domestic Violence and Sexual Assault.
Physicians enrolled in Medicaid coordinated care plans will receive an enhanced payment if they use the screening program. The S.C. Department of Health and Human Services, which administers Medicaid, estimates the program will cost about $1.6 million per year.
The state investment “is small compared to the huge improvements we can make in the lives of families throughout the state and the overall savings we expect by reducing the need for expensive neonatal intensive care,” said Tony Keck, director of HHS.
The average hospital charge for one infant in a neonatal intensive care unit in South Carolina is $100,000, according to HHS.
The new program was announced Tuesday at a meeting in Columbia of the S.C. Birth Outcomes Initiative. That effort already has prompted each hospital in the state to pledge to reduce induced births prior to the 39th week of pregnancy.
Very low birth weight babies, usually born prematurely, account for 2 percent of all births but about 50 percent of all the newborn healthcare costs. And mothers with substance abuse problems often have low birth weight babies.
Nationally, about 4.5 percent of all pregnant women need treatment for illicit drug use, 11.9 percent need treatment for binge drinking and 15.3 percent need treatment for tobacco use, according to HHS.
If a pregnant mother has a blood problem or an odd-looking mole, a doctor will send her to a specialist. But that hasn’t happened with substance abuse, depression or domestic violence, Keck said. Oftentimes, he added, physicians were frustrated trying to find the proper treatment options. The SBIRT program is designed to solve that.
“I hope we are swamped with referrals,” Bob Toomey, director of the Department of Alcohol and Other Drug Abuse Service, said at the kickoff of the program. “These women will move to the top of our list.”
Dr. Tom Gailey, an obstetrician-gynecologist in Greenville, said the SBIRT questionnaire does a good job of expanding on questions physicians already ask of pregnant patients. More importantly, the program sets defined lines of communication with agencies that can provide counseling.
The idea that mothers could be punished for not seeking help “is a perception that needs to be worked through,” Gailey said.
That hasn’t yet been a problem in the Upstate, Gailey said, but drug-abusing mothers have been arrested and/or prosecuted in well-publicized cases in Charleston and Myrtle Beach. An early 1990s policy, long ago discontinued, at the Medical University of South Carolina led to the arrest of more than 40 women and began to shape court precedent on such cases, which is still evolving.
State health officials say the new program is designed for one goal — improving the health of the state’s moms and babies.
“Problems caused by alcohol, tobacco and other drugs are the only completely preventable type of birth defects,” Toomey said. “It is crucial that we identify pregnant women using these harmful substances as early as possible and provide the help they need to stop.”
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