Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration

Reducing Neonatal Abstinence Syndrome in Tennessee

Rising prescription painkiller abuse and the simultaneous increase in heroin dependence have led to an alarming growth in the number of infants born with neonatal abstinence syndrome (NAS) since 2000.1 These infants can suffer intense withdrawal symptoms, including vomiting, weight loss, hypersensitivity to light and sound, and seizures, and are often admitted to neonatal intensive care units (NICUs). Average hospital charges for infants born with NAS are five times higher than those for non-NAS hospital births, and the total hospital charges associated with caring for these babies has nearly doubled from $732 million in 2009 to $1.5 billion in 2012, with 80 percent of charges paid by Medicaid (Figure 1).2

There is significant geographic variation in the incidence of NAS, with the highest rates concentrated in the East South Central region of the country.3 In Tennessee (TN) incidence of NAS has increased sixteen-fold since 2000,4 far exceeding the five-fold national increase.5 In 2014, there were 973 reported cases of NAS in TN, with 60 percent of the cases concentrated in East Tennessee.6 BlueCross BlueShield of Tennessee Health Foundation (THF), recognizing the increasing incidence of NAS and its associated cost, committed to improve access to substance abuse services for pregnant women and new mothers struggling with opiate addiction and access to treatment for NAS babies. This fact sheet highlights several of THF’s partnerships to address the NAS epidemic.

Mothers and Infants Sober Together

The town of Jellico in East Tennessee has the highest rate of NAS births in the state. It has very few health care providers and only one prenatal provider. This sole provider of prenatal care illustrates the region’s NAS epidemic and its ties to opiate addiction: out of the 2,034 female patients that he saw with opioid prescriptions in 2013, nearly 50 percent were women of childbearing age.

To address this problem and increase access to substance abuse services for pregnant women, THF provided a two-year grant in 2013 for an expansion of the Mothers and Infants Sober Together (MIST) at Jellico Community Hospital, in conjunction with Ridgeview Behavioral Health Center, Dayspring Family Health Center and the local health department.

MIST is designed to assist mothers with substance abuse problems and ensure a drug-free and safe home for their newborns. Mothers qualify for the MIST program through a referral from a prenatal care provider and are assigned a program team consisting of a case manager, counselor and program coordinator. Women can participate in the six-month long program anytime during their pregnancy through one-year postpartum.

At the end of the THF grant in 2015, MIST staff reflected that the program had been well received in the community and had allowed for the creation of strong partnerships with other community programs and referring agencies. While it was difficult to engage pregnant women in the program, the women who did participate reported they gained support for their recovery process through the weekly support group and the interaction with providers. THF shared that one of the barriers encountered was a lack of access to inpatient detoxification (detox) treatment services for those women in need of support beyond what was offered through the MIST program. THF is now supporting a new program focused on inpatient treatment options for women of childbearing age battling opiate addiction and research on the effectiveness of these treatment options.

Services Provided Through MIST Include:

  • Home visits
  • Mental health counseling
  • Weekly support groups
  • Individual therapy
  • Substance abuse treatment
  • Relapse prevention
  • Parenting education
  • Supervised visits for mothers without custody of their children
  • Case Management

Source: MIST: Mothers and Infants Sober Together (2015). Rural Assistance Center. Retrieved from

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