Online Program

Birth hospitals' role in access to early intervention services among drug-exposed infants

Monday, November 4, 2013 : 11:10 a.m. - 11:30 a.m.

Taletha Derrington, PhD, Center for Education and Human Services, Education Division, SRI International, Menlo Park, CA
Milton Kotelchuck, MPH, PhD, MGH Center for Child & Adolescent Health Policy and Research, Harvard Medical School, Boston, MA
BACKGROUND: Birth hospitals could support secondary prevention efforts for drug-exposed infants (DEI) through referral to Part C Early Intervention (EI), but data on hospital referrals and EI service access predictors are lacking. METHODS: A population-based analysis of 1998-2005 Massachusetts maternity hospital births identified 6,302 DEI who survived the neonatal period. Linkages to EI program data measured access from 1998-2008. Generalized estimating equations measured associations between EI access and neonatal abstinence syndrome (NAS) diagnosis, toxicology screen results, maternal race/ethnicity, insurance, and hospital maternity level of care. Interactions between NAS diagnosis/toxicology results and race/ethnicity, insurance and hospital maternity level were examined. RESULTS: While 59% of DEI were referred overall, hospitals referred only 12.8%. Referral probabilities were higher for NAS vs. no NAS (adjusted odds ratio [aOR] 2.5, 95% confidence interval 2.1-3.0), positive vs. negative toxicology screens (aOR 1.5, 1.2-1.9); and no or public vs. private insurance (aOR 1.9, 1.1-3.4 and 2.3, 1.9-2.9, respectively). Referral probabilities were lower for well-baby vs. neonatal intensive care nursery births (aOR 0.7, 0.6-1.0) and Asian/Pacific Islanders vs. Non-Hispanic Whites (aOR 0.5, 0.3-0.8). Interactions revealed lower referral rates associated with NAS diagnosis and positive toxicology results for privately insured infants. Similarly, interactions revealed lower referral rates associated with NAS diagnosis and positive toxicology screens for children born in well-baby nurseries. CONCLUSIONS: Hospital referral rates were low and referral response to NAS diagnosis and positive toxicology screens was inconsistent. Policies promoting hospital referral could improve DEI access to EI, and differential referral for privately insured infants warrants further investigation.

Learning Areas:

Administration, management, leadership
Other professions or practice related to public health
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Compare the rate of referral of drug-exposed infants to Part C Early Intervention (EI) overall to referrals made by hospitals. Describe EI service access among drug-exposed infants by infant, maternal & hospital characteristics: neonatal abstinence syndrome diagnosis, birth toxicology screen results, maternal race/ethnicity, insurance type, and level of hospital maternity care. Identify potential reasons for differential access based on insurance and hospital maternity level for infants with neonatal abstinence syndrome and positive toxicology screens.

Keyword(s): Access and Services, High Risk Infants

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator or co-investigator for multiple federally and privately funded grants/projects examining substance use disorders among women of child-bearing age; prenatally drug-exposed infants; Part C Early Intervention (EI) service access and engagement; coordination between hospitals, medical personnel, and EI programs; and EI systems development.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.