What does someone with a substance use disorder look like?
For years, that question created a barrier to care for pregnant women and frustrated healthcare providers in Humboldt County, where the number of pregnant women with substance use disorders was three times higher than other counties in California.
Then, in 2017, the Humboldt RISE (Resilience and Inclusion through Support and Empowerment) Project brought together community partners to try to solve the problem. Representatives from Providence St. Joseph Hospital in Eurka, the county Public Health Department, North Coast Health Improvement and Information Network and the California Center for Rural Policy at Humboldt State University agreed that the key was to destigmatize the issue by asking the right questions and empowering people to articulate what they need.
“Before, it was a lot of assumptions,” says Hannah Lippe, a social worker and patient advocate, called a Navigator, on St. Joseph Hospital’s CARE Network team. (CARE stands for Care Management, Advocacy, Resource and Referral, Education) and a member of the Humboldt RISE project team.
“One of our clinical champions drew the comparison to HIV screening. Twenty years ago, there was so much stigma. No one wanted to talk about it. It was so hidden and there was so much shame around it,” says Joy Victorine, Area Manager for CARE Network’s Transitional and Community programs.
The first step – before RISE could help connect women with the care and services they need – was to take the guesswork out of identifying who needs help. The project team chose a universal screening process for all pregnant women called the four Ps – parents, partner, past and pregnancy. Clinical staff ask every patient the same four questions:
- Do your parents have a history of substance use disorder?
- Does your partner use?
- Have you used in the past?
- Do you currently use during your pregnancy?
For those people identified through the screening process as needing substance use services, patients face the next, and often greater challenge of how to connect with the right services and stay engaged. Clinicians aren’t equipped with time or training to help these patients through a complex addiction treatment system, so, to prevent these patients from falling through the cracks, a new position needed to be created.
With the help of a 2018 Wellbeing Trust grant, Hannah was brought on to do just that. As a patient Navigator, Hannah becomes the patient’s trusted advisor, helping with anything from transportation to appointments, shepherding the patient through their care plans and being a willing ear when the patient is having a difficult time, depending on what each individual might need.
“I meet people where they are at,” Hannah says. “Sometimes that means getting people into treatment and other times it could be just attending appointments with them or helping to coordinate with another service provider.”
The program starts with the awareness that being pregnant is already a vulnerable time, Joy says. “On top of that, add battling substance use disorder and the stress of not having anyone in your life you can go to. Hannah is that person.”
Since the program began, CARE coordinators have been working to train and educate perinatal care providers. Over the past two years, more and more providers are using the four Ps to screen patients. In 2019, the screening program empowered 30 women to seek help through referrals. Since December 1, 2019, one provider, St. Joseph Health – Heritage Medical Group OBGYN in Eureka, reported screening 95 patients, of whom 13 have been referred for services.
Beyond the numbers, Hannah says the best measure of success is in the benefits to the lives of the individual women she helps.
In one instance, Hannah helped a woman navigate the system to attempt to reunite with her child. The woman had given birth after using methamphetamine earlier that day. Child Welfare Services took her child into protective custody. The woman had no home and no source of income. She injected heroin daily. Because of her history, Dependency Court wasn’t required to give her a chance. But with Hannah’s help, the woman started attending medical appointments and entered a residential treatment program. She credits having Hannah as her Navigator with getting another chance in Dependency Court and in her life.
“Try to imagine the pressure of being homeless, attempting to carve out a new system of functioning while having Child Welfare Services in your life and knowing the court may decide not to give you another chance to parent your child,” Hannah says. “When I asked her if I could share parts of her story, she said, ‘Absolutely. Every woman should have access to this amazing program.’”
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