WSN Responses (18) to Nevada’s Request Regarding How States Publicize Treatment and Admission Priority for Pregnant and Parenting Women

Compiled by NASADAD staff by/on February 16, 2010

Request from Betsy Fedor (NV), 1/04/10

I am trying to put together information for Nevada on how other states publicize treatment and admission priority for pregnant women and women with children. Do any of you have a document or procedures on how your state complies with this requirement?

Summary:

States that receive Block Grant funds are required to: give preference to pregnant women and women with children in admissions to treatment facilities; to publicize the availability of treatment for this priority population; to have a capacity tracking system that tracks treatment availability for pregnant women and women with children. This requirement is most commonly addressed through provider contracts and performance contractsthat outline SAPT Block Grant requirements. In addition, States identify pregnant women and women with children as priority populations through legislation and regulations, as well as in contracts with providers. SSAs also require providers who receive State funding to maintain a formal written policy that includes their procedures regarding pregnant women, and their action plan for interim services when the agency is at full capacity. Compliance with the admission priority requirement is monitored through: on-site contract monitoring reviews; provider reports and telephone screenings; a question about protocol in annual plan and budget applications. Providersadvertisetheir services for pregnant and parenting women in brochures, directories, outreach programs, and on the internet. Other State efforts include educational mailings to providers, developing gender-specific assessment tools, and statewide programs that maintain linkages with other social services that provide aid to pregnant and parenting women.

AR, Christine Reid:

Arkansas addresses priority admission in the Rules of Practice and Procedure.

SECTION III

POLICIES AFFECTING TREATMENT

9 OADAP shall require that funded treatment programs provide priority admission in the following order: (1) Pregnant Injecting Drug Users (IDU), (2) Pregnant Substance Abusers, (3) Injecting Drug Users, (4) Clients with the greatest clinical need, (5) Clients from the Catchment area as specified by OADAP, (6) Clients from the State of Arkansas, and (7) Clients from other states.

Also:

SECTION III

Treatment Service Capacity

3.06 TREATMENT PROGRAMS SHALL PROVIDE TREATMENT SERVICEs, if OADAP funding is available…. for pregnant women within 48 hours of the request, until the time of admission to treatment….”

And lastly

GENERAL REQUIREMENTS 4.01.5 Treatment Service Capacity: treatment programs shall provide for preference in admission utilizing the following hierarchy:

  1. Pregnant women who are injecting drug users;
  2. Pregnant women……”

This document can be found at

To my knowledge no other publication documents this information in our state.

CT, Terry Nowakowski:

In Connecticut, weinclude language in our SA contracts that outlines SAPT Block Grant requirements; as it relates toPriority Access and Interim Services, for pregnant and parenting women.We monitor for compliancein this area, and in addition, we send out periodic mailings to educate providers on this topic. Our Administrative Services Organization (ASO), assiststo ensure thatwomen who are pregnant or parenting can access care/services in a timely fashion. We recently sent out a new brochure (see attached) as part of our on-going educationaleffort to inform all providers of their responsibility in this area.This is on ourDMHAS website under Statewide Services/Women's Services/Women's Specialty Programs Brochure.

In addition, we have had a six (6) year Women's Service Practice Improvement Collaborative (WSPIC) that has developedGender Responsive Guidelines, an Assessment Tool thatmonitors outcomes in the Women & Children's programs.As part of this six (6) year Initiative, weholdquarterly meetingson various informational topics andPriority Access and Interim Servicesguidelines are always included in all educational materials.

FL, Atrica Warr

Substance Abuse Prevention and Treatment Block Grant Providers receiving set-aside funds for pregnant women and women with dependent children are contractually required to comply with all of the women's services program requirements including "Publicized the availability of treatment for pregnant women and the priority preference in admissions." The contract doesn't separately list this or any other of the block grant requirements. It just includes a requirement to comply with the federal law and rule applicable to the block grant. Compliance with this requirement, as well as others, is monitored through on-site contract monitoring reviews. Annually, providers report to the state how they accomplished this. The state does not stipulate how they must advertise but would take issue during the monitoring review if there was an opinion that the publication of services was insufficient. In the prior year reports, most indicate that services are advertised on the internet, through outreach activities and speaking engagements, and in program brochures. Some providers also indicate that they advertise through television ads, radio ads, and the local newspaper. Florida also has a statewide Healthy Start Program that has coverage for most of the counties in the state and where strong linkages are maintained with the pregnant/post partum treatment programs.

The larger providers all have websites that describe all their services, locations, contact information.

IA, Cindy Kelly:

Iowa identifies priority populations through contract with the managed care provider who passes them through to the contracts they have with treatment programs.

We often see them noted in the agencies policies and procedures when we do inspections.

IN, Jennifer Fillmore:

Indiana makes admission of pregnant women and women and children into treatment a priority by detailing special conditions within provider contracts.I attached an example.

KS, Stacy Chamberlain:

The only thing Kansas has is policy in writing (which I have attached). This policy is posted on our web and disseminated to all licensed providers. Our managed care organization, our regional assessment centers, and other treatment providers all refer the priority women to the 8 designated women’s programs.

KY, Suzanne Carrier:

Below is the description of priority populations for Kentucky. Priority populations are part of the contract with the community mental health centers. Annual plan and budget applications include a question on protocol for working with the priority populations and is part of the monitoring process.

If you have further questions, please let me know.

PRIORITY POPULATIONS

The following list delineates the state-wide priorities as defined by the SAPT Block Grant:

  • Pregnant injecting drug users
  • Pregnant substance abusers
  • Injecting drug users

A plan for preferential admission should also be included to reflect the following on a state-wide rather than regional basis:

  • Department of Community Based Services (DCBS) clients, including guardianship clients
  • Persons infected with HIV, Hepatitis B, or Hepatitis C

Drug court clients are a state-wide priority population who may be considered for admission on a regional basis.

Therefore, the rank order of persons to receive preference for admission is as follows:

  1. Pregnant injecting drug users
  2. Pregnant substance abusers
  3. Injecting drug users
  4. DCBS clients
  5. Individuals with HIV, Hepatitis B, or Hepatitis C
  6. Drug Court clients
  7. ALL OTHERS

MA,Karen Pressman:

We are in the process of working on this very issue. We are going to be posting the Block Grant requirements on our website. We also have a pregnant women’s task force that is reviewing our current means of communication and is assisting us to develop a better way to communicate priority access information and the central number to reach our pregnant woman’s treatment coordinator. I’ll send the new policies and procedures to you and others, once they are finalized.

MD, Suzette Tucker

Here in Maryland we put that pregnant women must receive a service within 24 hours of the initial contact. This is written in our conditions of grant award as well as in any contracts that we have.

MS, Ginger Steadman:

Mississippi puts out an Alcohol and Drug Abuse Resource Directory that covers the state which entails all treatment services to include services for pregnant and parenting women.

NC, Starleen Scott Robbins:

NC includes the SAPTBG requirements regarding admission priority and publicizing treatment for pregnant and parenting women in the Performance Contracts with our Local Management Entities. These requirements are monitored through a Semi Annual SAPTBG Compliance Report and an on-site review of policies and programs annually. Additionally, pregnant women, women with dependent children and women seeking custody of child(ren) are also designated as one of NC's target populations for state and federal funds.

NH, Rosemary Shannon:

We have just released our RFP and have added significant language on pregnant women and interim services, see introduction and program description scope of services, etc. (See attached file: 2010-2011 Treatment Providers-RFP.pdf)

We do need to add 2 sentences about our electronic health record, the ASI and the NIDA blending product M.A.T.R.S. so an amended version of this RFP will be posted shortly (bidder's conference is tomorrow), but will not change the pregnant women's priority. We are also requesting the provider's submit their telephone screening "scripts/voice mail message/staff instructions, etc." as an attachment or appendix. It has certainly generated attention based on the calls we have gotten from our providers.

This priority language will then be imported to the final contract language. We plan to use a site review form that we have modified from Wisconsin and Arizona, which will be sent to providers prior to our onsite visit for their completion, along with using the tool for the site visit.

NJ, Christine Scalise:

The compliance section of each contract for treatment services supported by SAPT Block Grant funds includes a statement requiring preference in admissions for treatment to pregnant women and also requires contractees to publicize the availability of treatment. The compliance section further directs the contractee that when the facility is at full capacity and unable to accept new clients, such women must be referred to another facility or the contractee must make interim services available. Interim services will include referral for prenatal care and addiction and referrals to health care and social service agencies in the community as needed, including most importantly those providing nutrition and parenting programs. Referrals and provision of interim services must be documented by the facility, which will be monitored at least annually by Division of Addiction Services (DAS) staff to ensure that appropriate and timely treatment has been provided.

Additionally, if a treatment facility is at full capacity and not able to provide treatment to a pregnant woman and is unable to find another facility with available capacity, the facility will refer the woman to the New Jersey contracted State hotline and/or their County Drug and Alcohol Coordinator, who will assist in referring the woman to a treatment facility with the capacity to provide treatment services. If necessary, not later than 48 hours after she seeks the treatment services, assist in making available interim services to the woman, including a referral for prenatal care and/or referral to an outpatient program in her area of residence that will provide interim services until she is admitted to an appropriate level of care.

All funded agencies are required to maintain a formal written policy that must include their procedures regarding pregnant women and the procedures surrounding the action plan for services when the agency is at full capacity. Their Program Management Officer will examine the written policy during annual site visits.

The General Treatment Directory will be maintained on the DAS website and will continue to be updated regularly to maximize its currency and utility. There is a separate clickable link specifying services offered by each provider, including specialized treatment services for PW/WDC.

OH, Jackie McCarey:

This is what’s shown in the board assurances related to your question.

Treatment facilities receiving SAPT Block Grant funds "will ensure that each pregnant woman in the state who seeks or is referred for and would benefit from treatment services is given preference in admission and will publicize the availability to such women of services from the facilities and the fact that women receive such preference [Section 1927(a)].

OR, Diane Lia:

Below is the language we include in our current rule. We are in the process of revising the rule to combine mental health and addiction services but the language will stay the same for all providers that receive Substance Abuse Prevention and Treatment Block Grant funds"
(a) Interim Referral and Information Services: Pregnant women or other individuals using substances intravenously, whose services are funded by the SAPT Block Grant, will receive interim referrals and information prior to entry,to reduce the adverse health effects of alcohol and other druguse, promote the health of the individual, and reduce the risk of transmission of disease. Ata minimum, interim referral and informational services will include:
(A) Counseling and education about blood borne pathogens including Hepatitis, HIV, STDs and Tuberculosis (TB); the risks of needle and paraphernalia sharing and the likelihood of transmission to sexual partners and infants;
(B) Counseling and education about steps that can decrease the likelihood of Hepatitis, HIV, STD, and TB transmission;
(C) Referral for Hepatitis, HIV, STD and TB testing, vaccine or care services if necessary; and
(D) For pregnant women, counseling on the likelihood of blood borne pathogen transmission as well as the effects of alcohol, tobacco and other drug use on the fetus and referral for prenatal care.

RI, Lori Dorsey:

Rhode Island includes the SAPTBG priority admission requirementsin all of our Provider Contracts , and our Department conducts on-sitemonitoring for SAPTBG compliance. Our agencies have strong linkages to Rite Care, Rhode Island's state-wide Medicaid managed care program for eligible uninsured pregnant women and parents with dependent children.

SC, Frankie Long:

The DAODAS contract states local providers have to advertise the availability of their treatment services for pregnant women and also they get priority for access to treatment services.

SD, Barbara Shoup Anderson:

South Dakota addresses priority admission for pregnant women in contract language and states:

FEDERAL TERMS AND CONDITIONS OF THE AGREEMENT

Pregnant Women

Providers must ensure that each pregnant woman in the state who seeks or is referred for and would benefit from such services is given preference in admissions to treatment facilities receiving block grant funds. The Provider shall publicize by public service announcement (radio/television), or street outreach programs the availability to such women of these treatment services designed for pregnant women and women with dependent children. Services for pregnant women/women with dependent children must comply with the provisions set for in CFR 45 Sec. 96.124.

The Provider shall develop and implement a program of outreach to ensure that such services are provided in the community to identify women who are engaging in substance abuse and to encourage women to undergo treatment for such abuse and to provide outreach services to identify individuals in need of treatment services, with emphasis on the provision of such services to pregnant and postpartum women and women with dependent children. Such outreach should welcome women who may have co-occurring mental health conditions, including those with severe and persistent mental illness. The Provider shall maintain in agency records all outreach services provided to pregnant women, and postpartum women and their infant.

The Provider shall develop, adopt, and implement policies and procedures to ensure that in the event the Provider has insufficient capacity to provide treatment services and if an admission cannot occur within 48 hours of the initial screening, a completed referral and interim services shall be provided. Referrals should be to accessible programs, preferably Specialized Women’s Services programs. Interim services are defined as services that are provided until an individual is admitted to a substance abuse treatment program. The purposes of the services are to reduce the adverse heath effects of such abuse, promote the health of the individual, and reduce the risk of transmission of disease. At a minimum, interim services may include counseling case management, or support groups and must include a referral for prenatal care and counseling on the effects of alcohol and drug use on the fetus. If these activities cannot be completed within 48 hours of the initial screening, the Provider is to contact the Division of Alcohol & Drug Abuse for assistance. The Provider shall maintain in agency records referrals to the state in the event that the Provider does not have the capacity to treat any pregnant or post-partum women and women with dependent children.