Strengthening the Pro-Life Safety Net: Federal Response to Perinatal Substance Use

This is Issue 32 of the American Reports Series.
By Brenda Destro, Ph.D. & Christopher C. Hull, Ph.D.
Executive Summary
- The prevalence of perinatal substance use among pregnant women is a critical public health challenge, affecting one in 20 pregnancies in the U.S. and leading to adverse maternal and fetal outcomes.
- This study assesses the available data on substance use during pregnancy, examines the impact on maternal and neonatal health, and evaluates existing federal programs that offer support and treatment for pregnant women with substance use disorders (SUDs).
- Through a review of programs under the U.S. Department of Health and Human Services (HHS), including the Substance Abuse and Mental Health Services Administration SAMHSA in particular, this report identifies pathways for policy enhancement to improve access to integrated addiction care for pregnant and parenting women in need.
- Recommendations include expanding support for integrated treatment models, fostering faith-based and community-centered interventions, and addressing barriers to care, such as social stigma and service accessibility, particularly in rural and underserved regions, for pregnant and parenting women in need.
- Implementing such recommendations would help leverage existing federal programs and resources to strengthen the country’s addiction care pro-life safety net.
I. Introduction
Substance use during pregnancy presents significant health risks, affecting both maternal and fetal health outcomes and often leading to complications that require substantial medical and social intervention. Although federal programs address substance use disorders (SUD) in the general population, unique challenges accompany the treatment of pregnant and parenting women in need, who often lack adequate resources, face societal stigma, and experience legal and regulatory barriers to getting treatment. The prevalence of substance use during pregnancy is particularly concerning given that recent data indicates a rise in opioid-related diagnoses at delivery,[1] underscoring the urgent need for policy interventions to strengthen the addiction care pro-life safety net.
This study provides a comprehensive review of federal policies affecting pregnant and parenting women in need with SUDs, detailing both existing initiatives and areas where improvements can be made. It examines key federal programs, including those administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) under the U.S. Department of Health and Human Services (HHS), and explores the potential of various models for supporting pregnant and parenting women in need. The study finds particular potential in effective treatment models like faith-based interventions, the “Hub and Spoke” approach, and maternal opioid misuse programs, which have shown promise in addressing the complex needs of this population.
By analyzing the impact and reach of current programs and identifying gaps in access to quality addiction treatment, this study aims to inform policymakers and stakeholders on actionable steps to strengthen the federal addiction care framework for pregnant and parenting women. The findings and recommendations underscore the importance of a multi-faceted approach that integrates medical, social, and community resources to create a comprehensive, pro-life safety net for pregnant and parenting women in need.
II. Background
Perinatal substance use is a serious public health issue for many women. Although exact data on rates of this substance abuse are scarce, the available research provides a glimpse into the problem. By some estimates, nearly 5% of pregnant women use one or more addictive substances.[2] According to a 2019 Survey on Drug Use and Health, 5.8% of pregnant women used illicit drugs, 9.5% drank alcohol, and 9.6% smoked cigarettes or used other tobacco products in the past month.[3] Moreover, other research shows that as many as 50% of pregnant women who used at least one addictive substance engaged in combined use of these substances.[4] Data collected from 2010 to 2017 found that the number of women with opioid-related diagnoses at delivery hospitalization grew by 131%.[5] What this data does not report is the variance in the use of addictive substances by pregnant women that would determine the degree of their addiction. Such data could be used to help route women into treatment or screen them as non-addicts.
Other research describes the multiple drug-related adverse outcomes for mothers and their unborn children.[6] Pregnant women who abuse alcohol, for example, can suffer from alcohol-associated liver disease (ALD) which may lead to cirrhosis.[7] This can in turn result in ‘high‐risk’ pregnancies and adverse maternal and fetal outcomes. Such adverse outcomes may include the premature birth or death of the newborn, pregnancy‐induced hypertension, post‐partum hemorrhage, or even the death of the mother.[8] Misuse of opioids in particular can lead to preterm birth, stillbirth, and maternal mortality.[9] There can be comorbidity with mental health issues like depression and anxiety.[10] Some mothers also face stigma and fear of losing their child as they try to sort out their life and that of their child, often with little support and few resources.[11],[12],[13]
In utero exposure to addictive substances taken by the mother puts the developing baby at risk of serious health consequences. Addictive substances taken by the mother can pass through the placenta, exposing the child directly to that substance, often with devastating results.[14] For instance, alcohol abuse during pregnancy can cause unborn children to suffer bone, heart, kidney, and other organ problems, as well as impaired growth, low birth weight, brain damage, stillbirth, miscarriage, prematurity, or sudden infant death syndrome (SIDS).[15],[16],[17],[18] Such damage can lead to lifelong physical, intellectual, and behavioral disabilities in the child,[19] collectively known as fetal alcohol spectrum disorders (FASDs).[20] These challenges can include learning disabilities, low IQ, hyperactivity, difficulty with attention, poor social communication skills, and poor reasoning and judgment skills, which in turn can result in lifelong issues with school, mental health, substance abuse, living independently, keeping a job, and even legal trouble.[21]
Similarly, using certain drugs regularly during pregnancy can result in neonatal abstinence syndrome (NAS), in which the baby becomes dependent and goes through withdrawal at birth.[22] The effects of opioids has been the focus of the majority of research on NAS,[23] but some research has found that a mother using alcohol, barbiturates, benzodiazepines, and even caffeine during pregnancy may also result in the baby showing withdrawal symptoms at birth.[24],[25]
III. Treatment Options
Treatment for the mother and the child can be complicated and costly. The best scenario is when a pregnant mother can stop any prior use of addictive substances and remain abstinent for the rest of her pregnancy, demonstrating a low level of addiction to those substances. These women would need prenatal care, but not necessarily addiction treatment. Mothers at the other end of the continuum who are addicted and have limited personal, social, and financial resources have more complex needs. They often have suffered trauma and will need more integrated services to manage or overcome their problems while also protecting their children.[26]
The American Society of Addiction Medicine (ASAM) provides a comprehensive look at the recommended services available to treat opioid-related SUD. Clinical care includes early intervention, outpatient services, intensive outpatient services, partial hospitalization, residential and inpatient treatment at varying intensities, and medications.[27] For postpartum women suffering from SUD, data suggests intensive outpatient treatment (IOP) has higher completion rates than traditional outpatient services.[28] Recovery support services address the psychological and social factors of addiction and provide support to help the mother manage her behavioral issues.[29] Finally, case management provides a collaborative process under the guidance of medical and social professionals that “assesses, plans, implements, coordinates, monitors, and evaluates [services] to improve outcomes.”[30],[31],[32]
Infants with prenatal substance exposure including fetal alcohol spectrum disorder (FASD) and mothers suffering from SUD both need care for them to receive the maximum benefit.[33],[34] Prevention of drug use by the mother is the first line of defense, and family interventions to address the addiction can occur pre-pregnancy, during pregnancy, at birth, in the neonatal/infancy/postpartum period, and in childhood and adolescence.[35] If the child is born with NAS, then medical care is indicated and can range from admission to neonatal intensive care, a prolonged stay in the hospital, and the need for medication.[36],[37]
Several important SUD treatments that also should be considered when designing an integrated federal approach to helping pregnant and parenting women in need include:
- Faith-Based Treatment – Leveraging faith for addiction recovery is a unique and promising approach. It draws on the power of spirituality and religiosity to promote abstinence and recovery. Faith-based principles and practices can provide a holistic approach that can be very effective in addressing the diversity of problems and issues faced by these mothers. In a systematic review of 43 studies examining faith and involving empirical research on adolescent health, more than 84% of those studies show a positive correlation with improved outcomes in addiction prevention or recovery.[38],[39]
- Hub and Spoke (H&S) Addiction Treatment – Hub and spoke systems of medication-assisted treatment (MAT) provide a structured approach that combines the strengths of primary care, specialty addiction services, and community resources. Specifically, this method uses centralized addiction treatment programs that provide MAT as “hubs,” with primary care, office-based practitioners, and other health care settings that provide more localized services as “spokes.” The H&S system has shown a substantial increase in substance abuse treatment capacity, allowing more physicians to prescribe key medications, more patients served per physician, and an interchange of patients between hubs and spokes based upon clinical need.[40] By reaching more people with SUD, as well as improving access to MAT, the H&S approach also holds the promise of decreasing overdose deaths.[41] Both California and Vermont currently employ the H&S system.
- Maternal Opioid Misuse (MOM) Model – The MOM Model works to strengthen and coordinate the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD), in particular by transforming the delivery system at the state level. The Centers for Medicare and Medicaid Services (CMS) Innovation Center supports programs that improve the integration of maternity care with SUD and mental health treatment. Since coordination of clinical care and the integration of other services are critical for helping mothers suffering from SUD, the MOM Model aims to improve quality of care and reduce costs for mothers and infants. Currently, Colorado, Indiana, Maine, New Hampshire, Tennessee, Texas, and West Virginia are using this model.[42]
- Integrated Care for Kids (InCK) – This model is a local and child-centered approach. It uses a state payment model designed to improve child health through prevention, early diagnosis, and treatment of priority health concerns such as behavioral health challenges and physical health needs.[43],[44] InCK serves children under the age of 21 covered by Medicaid and in some cases the Children’s Health Insurance Program (CHIP). Some programs also serve pregnant women over age 21 who are covered by Medicaid. Currently, facilities in Connecticut, Illinois, New Jersey, New York, North Carolina, and Ohio are being tested with this model but are not yet being used.[45]
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) – The SBIRT program, according to SAMHSA, integrates three basic components: Screening, to promptly assesses the severity of substance use and identify the appropriate treatment level; brief intervention, focusing on insight about substance use and behavioral change motivation; and referral to treatment, for those needing more extensive specialty care.[46] This model has shown effectiveness in reducing alcohol and tobacco use but needs further studies of its impact on other substances.[47] Primary care centers, trauma facilities, emergency rooms, and other community settings can employ SBIRT with addictive substance users to prevent more severe consequences.[48]
Regardless of the options for treatment, however, some factors exist that threaten access to quality SUD care, as discussed below.
IV. Factors Affecting Treatment Access
Several factors affect SUD treatment access that might be addressed by leveraging existing federal programs to aid pregnant and parenting women in need. For instance:
- Race, Ethnicity, and Culture. SUD has racial, ethnic, and cultural components. For instance, SUD rates among American Indians and Alaska Natives (AIAN) are some of the highest among all racial and ethnic groups.[49] Abuse of alcohol in particular among AIANs is very high, and has led to higher rates of death than White and Latino groups.[50]
- Rural Areas. For many in the U.S., gaining accessing SUD care is challenging simply because of the distances involved. Rural areas, including Indian reservations, have issues not seen in urban areas. Although lack of funding is apparent in both urban and rural communities, other problems like limited transportation, lack of services and providers, and lack of service coordination disproportionally affect access to treatment in rural areas.[51]
- Stigma/Confidentiality and Cost. Other barriers include stigma associated with SUD, which dramatically increases the importance of preserving confidentiality, especially if there is a need or requirement to report perinatal substance abuse to law enforcement and child welfare services; as well as cost, which for some pregnant and parenting women in need can rule out treatment altogether without outside resources and support.[52]
With this foundation of research in mind to guide policy changes, this study now considers the specific federal programs that might be leveraged to benefit pregnant and parenting women in need.
V. Federal Addiction Care Programs
Federal involvement in substance use care operates mainly within the U.S Department of Health and Human Services (HHS). SAMHSA leads public health efforts to advance the behavioral health of the nation. Title V, Part A of the Public Health Service Act describes the establishment of the agency, its leadership, and programs for both mental health issues and addiction.[53] The Director of the Center for Substance Abuse Treatment (CSAT),[54] in collaboration with the Center for Substance Abuse Prevention (CSAP) at SAMHSA,[55] is specifically tasked to collaborate to address the needs of pregnant women who use and are addicted to drugs, and cooperates with key stakeholders and through public and private partnerships to encourage education about SUD.[56]
SAMHSA has many programs, offices, and services that can meet the needs of pregnant and postpartum women. In particular, SAMHSA offers discretionary grant opportunities for funding through a competitive process. Recipients are selected based on the quality of their application, and funding decisions are made by SAMHSA.[57]
- Substance Use Prevention, Treatment, and Recovery Services – The Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG) is a program for which funding amounts are determined by a legislative formula.[58] SUBG supports states and territories in developing and delivering comprehensive and evidence-based SUD prevention, treatment, and recovery services. It provides flexibility to states to develop a plan to fund services that meet local needs, including the needs of pregnant women, and provides for training of providers. The SUBG program’s objective is “to help plan, implement, and evaluate activities that prevent and treat substance use.”[59] It was funded at $2,008,079,000 in the President’s FY2025 Budget.[60]
- Certified Community Behavioral Health Clinics (CCBHCs) – CCBHCs are designed “to ensure access to coordinated comprehensive behavioral health care” for those who request mental health or substance use-related care.[61] This care is offered independent of a person’s place of residence, age, or ability to pay. Developmentally appropriate care for children and youth[62] and treatment for pregnant and postpartum women can also be included.[63] Furthermore, the CCBHC National Training and Technical Assistance Center at SAMHSA provides these clinics with training and technical assistance on certification, as well as help with implementing evidence-based practices and processes that support access to care.[64]
- Community-Based Maternal Behavioral Health Services Program –The goal of this program is to “improve access to evidence-based, timely, and culturally relevant maternal mental health and substance use (behavioral health) intervention and treatment by strengthening community referral pathways.”[65] Grant recipients work with pregnancy and postpartum healthcare groups, provide short-term mental health and SUD services to those who otherwise could not get access to care, and refer those needing behavioral health care to relevant services.[66]
- Residential Treatment for Pregnant and Postpartum Women – The purpose of this grant program is to provide comprehensive services for pregnant and postpartum women with substance use disorders across the continuum of residential and outpatient settings that support and sustain recovery.[67] Services extend to family members and children who reside with the women in program facilities.[68] Eligible applicants include States, Territories, local governments, Indian tribal organizations, and other non-profit entities.[69]
Outside of SAMHSA, other components within HHS are involved in supporting pregnant and postpartum women and their children. This includes:
- Health Resources and Services Administration (HRSA), which provides health care to high-need communities. Some of HRSA’s efforts already serve the needs of pregnant and parenting women and their born and unborn children, for instance:
-
- Maternal and Child Health (MCH) Services – States apply for funding from the MCH block grant program to reduce infant deaths, help women get pregnancy and postnatal care, and help children with special health care needs. Care is delivered in a family-centered and community-based manner.[70] A specific program funded by the MCH is Healthy Start, which funds local programs to “improve health outcomes before, during, and after pregnancy.”[71] MCH includes two programs that have a specific emphasis on substance abuse:
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- Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) – The MMHSUD program provides grants aimed at expanding health care providers’ ability to help mothers deal with mental health and SUD challenges during or after pregnancy.[72] Specifically, grants go to give front-line and maternal health care professionals virtual and in-person psychiatric consultation; trainings on SUD and mental health screening, assessment, and treatment; and care coordination services, including treatment referrals, peer support groups, housing support, and education.[73] The program requires that its supported training and services are grounded in the best science, respond to trauma’s impact on patients, and match patients’ language and cultural background.[74] Grantees include statewide programs in Kansas, Kentucky, West Virginia, Louisiana, Colorado, Missouri, North Carolina, Montana, Mississippi, Texas, Vermont, and Tennessee, as well as a regional program in Los Angeles County, California.[75]
-
-
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- Maternal, Infant, and Early Childhood Home Visiting (MIECHV) – This program helps pregnant women and parents of young children through home visitation to improve their health, get children ready for school, and meet other needs.[76] To address substance abuse and the opioid crisis in particular, grantees “[u]se evidence-based approaches to screen, intervene, and refer perinatal women and parents of young children, to treatment and recovery support services.”[77] MIECHV grant recipients also help educate and guide parents about caring for infants with NAS.[78]
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- Telehealth Services – HRSA defines telehealth as “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health.”[79] HRSA’s Office for the Advancement of Telehealth (OAT) specifically provides over $38 million to communities per year in grants to improve access to quality health care through integrated telehealth services, including telehealth funding and programs focused on research, direct services, and technical assistance.[80] In particular, OAT oversees the Substance Abuse Treatment Telehealth Network Grant Program (SAT TNGP), which awards up to $250,000/year to projects that demonstrate how telehealth can improve access to substance abuse treatment services in rural, frontier, and underserved communities.[81]
-
- Community Health Centers (CHC) – HRSA’s Bureau of Primary Health Care (BPHC) funds approximately 1,400 community health centers (CHCs) that operate in every state, U.S. territory, and the District of Columbia, which provide care to all patients, regardless of ability to pay.[82] Health centers offer promising opportunities to link pregnant and parenting women in need to SUD treatment, given that they serve disproportionately low-income, black, and Hispanic patients, who generally have less access to substance abuse services.[83]
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- Rural Maternity and Obstetrics Management Strategies (RMOMS) – Since rural mothers have more trouble getting health care, RMOMS helps them by building networks that help coordinate a continuum of care, collecting data on obstetric services at rural hospitals, and building financial support. According to HRSA, “As of June 2024, there [were] 11 active RMOMS participants with a total of 14 RMOMS awardees funded since fiscal year (FY) 2019 in 11 states to test programs that address unmet needs for their target populations.”[84] RMOMS grantees already focus on leveraging telehealth and specialty care,[85] so the program holds out the promise of adding into grantmaking guidance explicit eligibility or preference for substance abuse treatment services akin to the SAT TNGP program highlighted above.
- National Institutes for Health, which has two institutes that address research on alcohol and drug abuse:
-
- National Institute on Alcohol Abuse and Alcoholism (NIAAA) does research on the use and abuse of alcohol,[86] including during pregnancy and the impact on the mother and child, covering fetal alcohol syndrome, prevention of risk drinking, and combining alcohol with other drugs during pregnancy.[87] Accordingly, the HHS Secretary or NIH Director might realistically task NIAAA with increasing research into the most effective treatments of alcoholism in pregnant mothers, as well as programs with the highest adoption rates among such mothers.
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- National Institute on Drug Abuse (NIDA) underwrites and publicizes the latest research on drug use during pregnancy and its effect on the mother and her child.[88],[89],[90],[91],[92] For instance, currently NIDA is contributing to the HEALthy Brain and Child Development Study on how drug use during pregnancy affects a child’s mental health.[93] Such efforts might be expanded into additional research into the most effective and accessible treatment of drug abuse in pregnant mothers, which the HHS Secretary or NIH Director should be able to initiate without additional legislative, regulatory, or even sub-regulatory guidance.
- Centers for Medicare and Medicaid Services (CMS) – Numerous Medicaid programs, including the state plan, waivers, and other demonstration programs, can be used to provide treatment and recovery support services to pregnant and postpartum (PPP) women with SUD as well as specialized services for infants with NAS.[94]
VI. Recommended Federal Addiction Care Policy Changes
Based on the review above, below are recommended changes to federal addiction care policy to better provide addiction services to pregnant and parenting women in need. Those recommendations include, first, an overarching Departmental directive by the Secretary of Health and Human Services directing all subcomponents to make pregnant and parenting women in need of substance use care a priority; and second, specific changes that might be made at the regulatory and sub-regulatory levels to individual HHS addiction care programs to enhance SUD treatment among pregnant and parenting women in need.
The first overarching recommendation would be to leverage the October 26, 2017, declaration that an opioid public health emergency (PHE) exists nationwide, pursuant to the authority vested in the Secretary of Health and Human Services under section 319 of the Public Health Service Act, 42 U.S.C. § 247d, which was recently renewed.[95] Specifically, the new Secretary could reference that PHE to make it a national policy priority to provide substance use treatment services to pregnant and parenting women in need, and accordingly direct divisions of HHS—such as SAMHSA, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), HRSA, and CMS—to increase resources to pregnant and parenting women in need. Resources could be increased in:
- Certified Community Behavioral Health Clinics (CCBHCs);
- The Screening, Brief Intervention, and Referral to Treatment (SBIRT) program;
- Substance Use Prevention, Treatment, and Recovery Services (SUPTRS);
- Community-Based Maternal Behavioral Health Services;
- Residential Treatment for Pregnant and Postpartum Women;
- Maternal and Child Health (MCH) Services;
- Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD);
- Maternal, Infant, and Early Childhood Home Visiting (MIECHV);
- Telehealth Programs;
- Community Health Centers (CHC);
- Rural Maternity and Obstetrics Management Strategies (RMOMS); and
- Medicaid.
Second, an array of specific policy options exists for expanding addiction care services for pregnant and parenting women in need, which might be enacted either at the secretarial or subagency level, including potentially:
- Ensuring houses of worship and faith-based organizations sensitive to the needs of pregnant and parenting women in need have equal opportunity to apply for and be awarded grants or contracts.
- Expanding use of SBIRT and leveraging other federal programs to provide addiction care access to pregnant and parenting women in need, particularly at maternal and child health clinics, in home visiting services, and other programs.
- Training maternal care professionals to provide options counseling to pregnant and parenting women in need using a tested model that is client centered, offers information on options including adoption, and is respectful of the value of the client and her children, including those children who are still unborn.
- Expanding the use of the Hub and Spoke Model to support SUD programs for pregnant and parenting women in need in rural areas via rural maternity and obstetrics management strategies and support from Office for the Advancement of Telehealth.
- Encouraging CHCs to include or partner with programs for pregnant and parenting women in need and their children using the MOM and InCK models, and for National Training and Technical Assistance Partner (NTTAPs) to help CHCs deliver services.
- Appointing representatives of faith-based organizations focused on the needs of pregnant and parenting women in need to serve on:
- The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Advisory Board;
- The NIAAA Extramural Advisory Board; and/or
- The National Advisory Council on Drug Abuse (NACDA) at the National Institute on Drug Abuse (NIDA).
These prioritizations of serving pregnant and women in grant awards offers substantial opportunities to increase addiction care services to pregnant and parenting women in need, and in doing so leveraging existing federal resources to strengthen the pro-life safety net.
VII. Conclusion
The intersection of pregnancy and substance use disorder represents a critical area for federal intervention, with profound implications for maternal and neonatal health outcomes. The findings of this study emphasize that while several federal programs—such as SAMHSA’s Title V initiatives and Medicaid-based support models—offer resources for treating perinatal substance use, gaps remain, particularly in the accessibility and integration of services for pregnant and parenting women in need.
Based on that review, this study makes recommendations intended to help fill those gaps. Specifically, those recommendations include, first, that the HHS Secretary leverage the national opioid crisis public health emergency to provide addiction care services to pregnant and parenting women in need, and thus, direct components of HHS—such as SAMHSA, HRSA, NIH, and CMS—to identify and implement ways of doing so in each’s orbit.
Second, the recommendations include more specific policy options, such as maximizing and prioritizing use of available federal funding for pregnant and parenting women; ensuring the Department offers opportunities for faith-based organizations sensitive to the needs of pregnant and parenting women on the ground to have the opportunity to apply for, receive, and use Federal funding; providing technical assistance, options counseling, and other resources to community health centers; expanding utilization of hub-and-spoke, MOM, SBIRT and InCK models to address needs in rural America and tribal areas; and appointing representatives of faith-based organizations focused on the needs of pregnant and parenting women in need to serve on key substance use treatment and research boards and advisory councils.
These changes offer substantial opportunities to increase addiction care services to pregnant and parenting women in need, and in doing so leveraging existing federal resources to strengthen the pro-life safety net.
Dr. Brenda Destro, Ph.D., is the former U.S. Department of Health and Human Services (HHS) Acting Assistant Secretary for Planning and Evaluation (ASPE). As a social worker and then public official for over 40 years, Dr. Destro has worked with many clients and organizations on a host of social and family issues. Her career began with providing direct services to clients, including as an Addiction Counselor at DePaul Rehabilitation Hospital in Milwaukee. She also served as a Medical Social Worker at the Ohio State University Hospital, a Probation Officer in Cuyahoga County (Ohio), and the Director of Social Services for the Teamsters Union in Ohio, dealing with problems often related to addiction and childcare, in particular. After completing a master’s degree and a Ph.D. in Social Work, she became an analyst and administrator working on policy development, training, and research with a special focus on mental health and adolescent pregnancy. Childcare and addiction were key factors in that work. Today, Dr. Destro serves as a private consultant, offering services as an accomplished public health and human services analyst with over four decades of experience in direct service, education and training, advocacy, evaluative research, and federal legislative and administrative management.
Christopher C. Hull, Ph.D., is the President of Issue Management Inc., a full-service public affairs firm focused on achieving policy results. Dr. Hull holds a Ph.D. with distinction in American Government from Georgetown University, and an undergraduate degree magna cum laude in Comparative Government from Harvard University. He has served as Chief of Staff in the U.S. House of Representatives; the Majority Caucus Staff Director of a State Senate; Executive Vice President of a major national think tank; and Legislative Assistant/Legislative Correspondent in the U.S. Senate. He is the author of Grassroots Rules (Stanford Press, 2007), as well as more than 100 book chapters, peer-reviewed articles, conference papers, and op-eds.
[1] https://www.cdc.gov/maternal-infant-health/pregnancy-substance-abuse/index.html; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804920/
[2] https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding; https://pubmed.ncbi.nlm.nih.gov/23314721/
[3]https://www.drugsandalcohol.ie/32995/1/National%20Survey%20on%20Drug%20Use%20and%20Health%20(NSDUH).pdf
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671272/; https://pubmed.ncbi.nlm.nih.gov/12576263; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387084/
[5] https://www.cdc.gov/maternal-infant-health/pregnancy-substance-abuse/index.html; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804920/
[6] https://www.ncbi.nlm.nih.gov/books/NBK542330/
[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC10745229/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259114/pdf/UEG2-9-110.pdf
[9] https://www.cdc.gov/maternal-infant-health/pregnancy-substance-abuse/index.html
[10] https://www.healthywomen.org/condition/substance-abuse
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447112/
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251798/
[13] https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6455-4
[14] https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding
[15] https://www.cdc.gov/vitalsigns/pdf/2016-02-vitalsigns.pdf
[16] https://pubmed.ncbi.nlm.nih.gov/1405419/
[17] https://pmc.ncbi.nlm.nih.gov/articles/PMC7061927/
[18] https://pmc.ncbi.nlm.nih.gov/articles/PMC5901082/
[19] https://www.cdc.gov/alcohol-pregnancy/about/index.html
[20] https://www.cdc.gov/fasd/about/index.html
[21] https://www.cdc.gov/vitalsigns/pdf/2016-02-vitalsigns.pdf
[22] https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding
[23] https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-and-pregnancy.html
[24] https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding
[25] https://www.nejm.org/doi/full/10.1056/NEJMra1600879
[26] https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6455-4
[27] https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy
[28] https://www.ncbi.nlm.nih.gov/sites/books/NBK83238/
[29] https://www.macpac.gov/publication/recovery-support-services-for-medicaid-beneficiaries-with-a-substance-use-disorder/
[30] https://www.hfma.org/wp-content/uploads/2023/02/5_Basics-of-Case-Management-HRMA.pdf
[31] https://www.ncbi.nlm.nih.gov/books/NBK571736/
[32] https://ccmcertification.org/about-ccmc/about-case-management/definition-and-philosophy-case-management#
[33] https://ncsacw.acf.hhs.gov/files/five-points-family-intervention.pdf
[34] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847954/
[35] https://ncsacw.acf.hhs.gov/files/five-points-family-intervention.pdf
[36] https://www.nejm.org/doi/full/10.1056/NEJMra1600879
[37] https://medlineplus.gov/ency/article/007238.htm
[38] https://www.sciencedirect.com/science/article/pii/S1054139X05000789?via%3Dihub; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759672/
[39] See also https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8827378/
[40] https://pubmed.ncbi.nlm.nih.gov/28379862/
[41] https://www.jsatjournal.com/article/S0740-5472(19)30118-7/fulltext
[42] https://www.cms.gov/priorities/innovation/innovation-models/maternal-opioid-misuse-model
[43] https://www.cms.gov/priorities/innovation/innovation-models/integrated-care-for-kids-model
[44] https://www.cms.gov/newsroom/fact-sheets/integrated-care-kids-inck-model
[45] https://www.cms.gov/priorities/innovation/where-innovation-happening#model=integrated-care-for-kids-inck-model
[46] https://www.samhsa.gov/substance-use/treatment/sbirt
[47] https://www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf
[48] https://www.samhsa.gov/sbirt
[49] https://www.jsatjournal.com/article/S2949-8759(23)00146-7/abstract
[50] https://pmc.ncbi.nlm.nih.gov/articles/PMC8910676/
[51] https://pmc.ncbi.nlm.nih.gov/articles/PMC3995852/
[52] https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5
[53] https://www.govinfo.gov/content/pkg/COMPS-8776/pdf/COMPS-8776.pdf
[54] https://www.samhsa.gov/about-us/who-we-are/offices-centers/csat
[55] https://www.samhsa.gov/about-us/who-we-are/offices-centers/csap
[56] https://www.govinfo.gov/content/pkg/COMPS-8776/uslm/COMPS-8776.xml
[57] https://www.samhsa.gov/grants
[58] https://www.samhsa.gov/grants/block-grants/subg
[59] https://www.dhcs.ca.gov/provgovpart/Documents/SUBG-Policy-Manual-3.pdf
[60] https://www.samhsa.gov/sites/default/files/samhsa-fy-2025-cj.pdf
[61] https://www.samhsa.gov/communities/certified-community-behavioral-health-clinics
[62] https://www.samhsa.gov/certified-community-behavioral-health-clinics
[63] https://ccf.georgetown.edu/2024/01/23/state-medicaid-opportunities-to-support-mental-health-of-mothers-and-babies-during-the-12-month-postpartum-period/
[64] https://www.thenationalcouncil.org/program/ccbhce-training-technical-assistance-center/
[65] https://www.samhsa.gov/grants/grant-announcements/sm-24-013
[66] Ibid.
[67] https://www.samhsa.gov/grants/grant-announcements/ti-22-003
[68] https://www.samhsa.gov/sites/default/files/grants/pdf/fy-23-ppw-nofo.pdf
[69] https://www.samhsa.gov/grants/grant-announcements/ti-23-002
[70] https://mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-mch-services-block-grant
[71] https://mchb.hrsa.gov/programs-impact/healthy-start
[72] https://mchb.hrsa.gov/sites/default/files/mchb/programs-impact/mmhsud-fact-sheet.pdf
[73] https://mchb.hrsa.gov/programs-impact/programs/screening-treatment-maternal-mental-health-substance-use-disorders-mmhsud
[74] Ibid.
[75] Ibid.
[76] https://mchb.hrsa.gov/programs-impact/programs/home-visiting/maternal-infant-early-childhood-home-visiting-miechv-program
[77] https://mchb.hrsa.gov/sites/default/files/mchb/about-us/opioid-mch-factsheet.pdf
[78] Ibid.
[79] https://www.hrsa.gov/telehealth/what-is-telehealth
[80] https://www.hrsa.gov/telehealth
[81] https://nosorh.org/wp-content/uploads/2019/11/OAT-Division-Overview-SORH-Orientaiton.pdf
[82] https://bphc.hrsa.gov/about-health-center-program
[83] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871558/
[84] https://www.hrsa.gov/rural-health/grants/rural-community/rmoms
[85] Ibid.
[86] https://www.niaaa.nih.gov/
[87] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-and-your-pregnancy
[88] https://nida.nih.gov/news-events/news-releases/2023/11/overdose-deaths-increased-in-pregnant-and-postpartum-women-from-early-2018-to-late-2021
[89] https://nida.nih.gov/research-topics/pregnancy-early-childhood
[90] https://nida.nih.gov/sites/default/files/covid-sud_outcomesjul2022-508c.pdf
[91] https://onlinelibrary.wiley.com/doi/10.1002/adaw.33959
[92] https://www.researchgate.net/publication/339082393_Validation_of_the_NIDA-modified_ASSIST_as_a_Screening_Tool_for_Prenatal_Drug_Use_in_an_Urban_Setting_in_the_United_States
[93] https://nida.nih.gov/research-topics/pregnancy-early-childhood
[94] https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/substance-use-disorders/index.html
[95] https://aspr.hhs.gov/legal/PHE/Pages/Opioid-September2024-aspx.aspx