© Sisters of Charity of Leavenworth Health System, Inc. All rights reserved. Comprehensive Prenatal Care with Integrated Substance Abuse Treatment for American Indian Women Vicki Birkeland, RN, Women’s & Children’s Director

Partnership St. Vincent Healthcare –Midwives, MFM, Culture Liaison Tribal health leaders from Northern Cheyenne and Crow –Program directors for Chemical Dependency, Behavioral Health, Social Services, Health Promotion, Public Health Nursing, Law Enforcement, Tribal Council members Indian Health Service (HIS) providers 2

Goal of the Grant: Planning Year St. Vincent Healthcare and Tribal health partners seek to improve maternal-child health outcomes for American Indian women and their newborns by validating current barriers encountered in accessing prenatal and substance abuse treatment. Develop a tribally-led pilot program to address drug use during pregnancy. The program seeks to increase early entry into prenatal care by refining a trusted model of care for prenatal care and integrating supportive services and substance abuse treatment. Create process for care coordination between multiple facilities and multiple providers on and off the reservation. The development of the curriculum / screening protocol / treatment model will be defined.

Planning: Coordination of Tribal Programs Current Process Program directors for Chemical Dependency Behavioral Health Social Services Health Promotion Public Health Nursing Law Enforcement Tribal Council members Identify Gaps Coordination Communication Education Opportunities Integration Case Management

Examples of Current Integrated Prenatal Care Models Toronto (Canada) T-CUP Red Lake Nation (Minnesota) Helping Hands Sanford Health (Minnesota) First Steps to Health Babies Albuquerque, NM –Young Women United

Planning: Prenatal Care Model Gaps/Barriers: –Negative stigma, fear of judgment –Access to prenatal care –Access to treatment programs/providers –Inconsistent screening, practitioner bias and attitudes Model design: –Integrated prenatal care (midwifery model) Same visit access to addiction counseling Case Manager –Warm hand-off between programs and providers –Early entry to prenatal care and early referrals from all points –Universal, standardized, structured screening 6

Planning: Professional Development Education Curriculum Interdisciplinary Education –Motivational Interviewing –SBIRT: Screening, Brief Intervention, and Referral to Treatment –Historical Trauma Theory –Trauma Informed Care Development of health policy by Tribal Health and Tribal Government Addiction Education for all disciplines / programs Substance use/abuse and impact on pregnancy, fetus, newborn 7

Planning: Educational Materials Gaps / needs –American Indian specific –Voice of the mother –Plea to the men (fathers, husbands, brothers, significant others) –Culturally sensitive –Stories of wellness and positive outcomes

Critical to Our Future Partnering together, alongside these women who are pregnant and using at the same time, we can provide expertise, support, education, services, and insight critical to building a future that our communities desperately need. 9

“We Are More Than Addiction”