Geisinger Clinic is applying to the PPW grant program for its Free2BMom(F2BM) program. Geisinger's F2BM is a care delivery model that helps mothers and babies affected by opioid use disorder/substance use disorder physically, psychologically, and socially. The program was designed to bring current services offered in obstetrics, addiction medicine, pediatrics, behavioral health and community-based services into one interdisciplinary care team.
The F2BM program began in 2019 with a pilot in Luzerne County, Pennsylvania and has expanded to an additional five counties (Columbia, Montour, Northumberland, Snyder, and Union) since its inception. Any pregnant woman seeking addiction treatment in these counties, along with her entire household, is eligible to participate. This proposal aims to expand program offerings in these counties and expand rural central Pennsylvania after a new Community Health Needs Assessment is completed. Geisinger anticipates serving the following number of unduplicated patients (and their household members) in each year of the grant:
Year 1: 75 (206), Year 2: 55 (151), Year 3: 67 (184), Year 4: 88 (242), Year 5: 108 (297), Total: 393 (1,080)
The goals of F2BM are to increase the activation of eligible pregnant mothers in treatment and health care, increases the initiation, access, and adherence for pregnant moms with MAT, and increase mom's long-term health status by implementing evidence based practices around social and behavioral health case management support. Goals and objectives include:
1) 1) Identify potential program participants as early as possible in their pregnancy to improve the birth and health outcomes of babies born to moms with OUD/SUD.
- By March 1, 2023, the team will complete 25 outreach connections to providers and potential referral partners to educate them on F2BM.
- Within 90 days of employment, all F2BM staff will receive Mental Health First Aid training, training on Neighborly, and education on the outcomes and evaluation plan.
2) Increase the connection of pregnant women to comprehensive health, treatment and recovery services to achieve and maintain sobriety.
- Within 90 days of the start of the project, F2BM will execute agreements with 100% of providers and community organizations to address each of the areas of the workplan.
- At least 80% of program participants with a documented initial assessment by the F2BM team will receive a follow up connection/assessment within 90 days.
- By the end of the project period, at least 35% of the active participants will have engaged in the formal evaluation interviews/process.
3) Increase the number of household members referred to supportive services.
- Within 120 days of enrollment, at least 75% of the participant's household members will have met with a case manager and been referred to appropriate services.
4) Increase the initiation and adherence for pregnant moms in treatment.
- Enroll 100% of mothers in a coordinated treatment plan and increase program adherence by 10% in Year 1, 15% in Year 2 and 20% in Years 3-5.
5) Increase mom's long-term health status by implementing evidence-based practices around social, recovery and case management support.
- By one year of enrollment, provide each woman a minimum of three service referrals.
- Through year 5, attainment of zero new criminal justice encounters for each woman enrolled.