1. 1 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Substance Abuse among Perinatal Women Rebecca Hebner Roppolo, MPH Substance Abuse Prevention Systems Coordinator Violence and Injury Prevention-Mental Health Promotion Branch

2. 2 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Welcome and Introductions Warm Up Share Name, Agency and Role What makes you interested in substance abuse prevention among pregnant and breastfeeding women? What is your comfort level working on this topic? (“Not at All,” “Kind Of,” or “Really”)

3. 3 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Overview of Today’s Presentation Background on Substance Abuse Priority: Marijuana and Prescription Drug Misuse Data on substance abuse among pregnant/postpartum women and women of reproductive age (18-44) State-level Strategies: Logic Model + Action Plan Local-level Strategies: Logic Model + Action Plan Future Opportunities Discussion: Questions, Feedback, Ideas Next Steps

4. 4 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Background Bad for Mom Addiction, mental health disorders, organ damage, overdose and death Bad for Baby Preterm birth, stillbirth, fetal and childhood developmental problems

5. 5 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Marijuana & Prescription Drugs Prenatal Marijuana Exposure Executive functioning, impacts attention, flexible problem solving, and working memory abilities- may interfere with intellectual development and academic achievement Prescription Drugs Few studies have examined the impact of prescription drug abuse on fetal development, Neonatal Abstinence Syndrome (NAS) is complication from opioids Risks for pregnancies include an elevated risk for obstetric complications, such as premature birth, stroke, and drug withdrawal

6. 6 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Data National Survey on Drug Use and Health (NSDUH) Colorado Pregnancy Risk Assessment Service (PRAMS) Behavioral Risk Factor Surveillance System (BRFSS)

7. 7 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. National Survey on Drug Use & Health illicit drug use Pregnant women use any illicit drugs (including marijuana and misuse of prescription drugs) less often in past 30 days than women of reproductive age (ages 15-44). Marijuana is the most commonly used illicit drug among pregnant women (2002-2007 data). Prescription drugs are second most commonly used illicit drug. Use declines as pregnancy progresses. http://archive.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/NationalFindings/NSDUHresults2013.pdf Past 30 day illicit drug use PregnantNot Pregnant 2011 data 4.4%10.9% 2012-2013 data 5.4%11.4%

8. 8 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. National Survey on Drug Use & Health demographics Use of any illicit drugs (including marijuana and misuse of prescription drugs) during pregnancy is more common among younger women. Use of any illicit drugs by pregnant women varies by race/ethnicity (2002-2010 data). http://www.samhsa.gov/data/sites/default/files/Spot062PregnantRaceEthnicity2012/Spot062PregnantRaceEthnicity2012.pdf BlackWhiteHispanic Use during pregnancy 7.7%4.4%3.1%

9. 9 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Concerning Issue, Scarce CO Data Colorado Pregnancy Risk Assessment Monitoring Service (PRAMS): 1998- 2011 (most recent year) = no questions on marijuana or prescription drug misuse, only tobacco and alcohol.  PRAMS data on marijuana forthcoming Behavioral Risk Factor Surveillance Survey (BRFSS): Only one year of data on marijuana use among women of reproductive age, no data on prescription drugs.  BRFSS data on prescription drugs forthcoming

10. 10 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. BRFSS women of reproductive age (15-44) Current use (past 30 day) data reflects overall Colorado trends for age, education, income, and race. Highest among younger and lower income adults. Whites more likely than other races. n/a Special data request: 2013 BRFSS.

11. 11 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State-Level Strategies OVERVIEW

12. 12 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Processes Used New Priority!  Examined existing activities for synergy, opportunities Violence and Injury Prevention – Mental Health Promotion branch Environmental Health Substance Exposed Newborns commission, Colorado Alliance for Drug Endangered Children

13. 13 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Strategies 1.Mass-reach health education campaigns to women of reproductive age 2.Access to safe disposal for prescription drugs 3.Health care provider education on risks from substance misuse while pregnant or breastfeeding 4.Promote prescription drug monitoring program (PDMP) use 5.Expand data and surveillance efforts to better understand scope of issue

14. 14 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Logic Model

15. 15 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Action Plan 1.Health education campaigns Develop and implement marijuana education campaign targeting pregnant and post partum women, including consultation and/or focus groups with indicated populations Coordinate messaging and outreach efforts with state-wide partner organizations to promote mass reach health education campaign materials with substance abuse (marijuana and non-medical use of prescription drugs) messaging

16. 16 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Action Plan 2.Safe disposal Partner with Environmental Health to recruit law enforcement, pharmacies or hospitals to host permanent prescription drug take-back receptacles

17. 17 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Action Plan 3. Health care provider education Provide trainings, clinical guidance documents, and webinars to healthcare providers on risks of marijuana use for pregnant or postpartum women Promote resources for both marijuana and prescription drug misuse prevention Develop evaluation tool to measure capacity of health care providers who participate in CDPHE trainings, webinars

18. 18 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Action Plan 4. Prescription Drug Monitoring Program (PDMP) Conduct public health surveillance with PDMP for women age 18-44 and/or prescribers that provide care to pregnant or postpartum women Publically disseminate findings to raise awareness among prescribers of the risks of misuse among women of reproductive age Promote use of PDMP for women age 18-44 among prescribers

19. 19 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. State Action Plan 5. Data and surveillance Identify data sources, explore non-traditional data sources, and collaborate with existing groups (PDMP workgroup, Maternal Mortality Review, Birth Defect Registry, Substance Exposed Newborn Commission) to understand scope of prescription drug use by pregnant and post-partum women and suggest recommendations for improvements to data collection and surveillance at CDPHE, specifically for Neonatal Abstinence Syndrome: emerging issue Maternal Mortality: Rx is second leading cause

20. 20 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Local-Level Strategies OVERVIEW

21. 21 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Process Used New Priority!  Thank you, December LPHA Summit Participants! GOALS 1.Align local and state efforts 2.Feasibility 3.Sustainability

22. 22 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Pardon our appearance… 1.New MCH priority  no established local activities, no expectation of expertise 2.New LPHA priority  currently limited to no funding from CDPHE for local public health activities 3.New CDPHE priority  only since July 2014 has there been any funding, efforts for marijuana; limited prescription drug work

23. 23 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Local Strategies REQUIRED 1.Identify key partners, stakeholders, responsible parties and resources in community 2.Expand local use of substance abuse data for women of reproductive age, pregnant or postpartum OPTIONAL 3. Leverage and support community-level strategies that impact women of reproductive age 4. Disseminate mass reach substance abuse prevention social norming campaigns from state agencies

24. 24 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Local Logic Model

25. 25 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Notez Bien! Local action plans are customizable.

26. 26 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Required Strategy 1. Identify Key Partners to Leverage Resources Tracking: Community Substance Abuse Resource Environmental Scan Identify potential or existing partners, organizations and businesses, community substance abuse prevention coalitions Consolidate in written substance abuse community resource environmental scan Share the community resource directory among stakeholders and MCH Assist existing coalitions to identify new coalition members identified in environmental scan to represent MCH concerns

27. 27 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Required Strategy 2. Expand Use of Local Data Tracking: Community Substance Abuse Data Profile & Presentation Collect data from CDPHE on local BRFSS results: marijuana use (2013-2015), prescription drug misuse (2015) among WRA optional: Birth Defects Registry for NAS; hospitalization/ED data from CHA; PDMP prescribing patterns; other local sources Create and share Community Substance Abuse Data Profile & Presentation with coalitions, stakeholders and CDPHE Partner with existing coalitions to identify SMART objectives based on community data and needs that will impact pregnant/postpartum women.

28. 28 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Optional Strategy 3. Partner with Local Communities that Care (CTC) Substance Abuse Coalitions to Represent MCH populations Tracking: Action plan w/ SMART objectives to reduce substance misuse among local pregnant and breastfeeding women Join local CTC substance abuse prevention coalition and help identify ways to leverage resources to achieve shared goals among coalition members. Select community-level strategies from CTC menu that impact pregnant/postpartum women Complete a written community-specific action plan to prevent substance use among pregnant and breastfeeding women in collaboration with CTC

29. 29 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Optional Strategy 4. Disseminate Mass-Reach Substance Abuse Prevention Social Norming Campaigns from State Agencies Tracking: # of local outlets disseminating materials Social norming: Speak Now, Good to Know/Marihuana en Colorado, Take Meds Seriously, other materials developed and provided by CDPHE disseminated Health care provider resources: promote trainings on substance abuse prevention- SBIRT/PDO/MJ – to partners

30. 30 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Future Opportunities In addition to current local-level prevention efforts…

31. 31 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Potential Substance Abuse Funding Opportunities for LPHAs Prescription Drug Abuse Prevention: CDC funding to… 1.Enhance and maximize PDMP 2.Implement community interventions for high-burden communities Youth Substance Abuse Prevention: Communities that Care model includes… 1.Coalition for youth substance abuse prevention 2.Community-level environmental strategies

32. 32 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Discussion

33. 33 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Questions: 1.What community and agency-level strengths need to be in place or obtainable? (feasible as is, need training, unrealistic) 2.Who are the key partners & coalitions needed to champion and implement the priority? (identified in community resource directory) 3.What resources are needed in order to effectively achieve the stated outcomes? (disseminate campaign materials + community resource directory + data presentation) 4.What skills are needed to lead implementation of the action plan? (request campaign materials + i.d. partners + data request + objectives)

34. 34 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Next Steps

35. 35 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. FY16 Planning Process (March- May) Generalist Consultants (Julie and Isabel) will work with each of their agencies to schedule planning meetings. Rebecca Roppolo (rebecca.roppolo@state.co.us) is available to consult with LPHA staff to draft customized local action plans.rebecca.roppolo@state.co.us  Ongoing Technical Assistance is Available! Depending on the number of LPHAs that select this priority, I will be reaching out via conference calls, webinars, or in-person technical assistance.

36. 36 This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number B04MC28087, Maternal and Child Health Services. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. Thank you!