Frequently Asked Questions

CARE Plus is an innovative, evidence-based pilot program aimed at providing tools for mother-infant pairs who suffer from opioid dependence so these women can best care for their babies and seek treatment for themselves. It builds on an existing IU School of Medicine program called WeCare that is designed to decrease infant mortality in Indiana by addressing common risk factors such as smoking, mental health, obesity/access to healthy food, and failure to use safe sleep practices. CARE stands for Community-based Addiction Reduction Program.

Opioid abuse by pregnant and new mothers is a growing problem. In 2014, 657 infants were born across the state with neonatal abstinence syndrome, which results from a mother’s use of opioids. When these mothers are discharged without support, they face many obstacles to treatment and their babies are put at further risk—both short term and long term. Since WeCare first launched in 2016, experts involved found that 12 to 15 percent of participating women were screening positive for substance abuse. CARE Plus seeks to address this population with even more customized services.

All opioid-dependent mothers who deliver babies at IU Health Methodist Hospital will be offered the opportunity to participate in CARE Plus. The goal is to use this pilot to create a model for serving postpartum mothers with opioid dependency and their babies across the state. IU School of Medicine will develop a toolkit to be shared with other health systems and nonprofits so that the program can be replicated.

Neonatal abstinence syndrome occurs when the fetus was exposed to opioids in utero and they have developed a tolerance for the opioids. Once the babies are born, there is a cycle of withdrawal with symptoms of mostly agitation, crying and irritability, but sometimes also diarrhea, difficulty feeding or even seizures. To treat the babies, they are given a score to assess their level of symptoms and withdrawal, and then doctors adjust the amount of opioids given to them and slowly ween them off the medication. The amount of time the baby is in the neonatal intensive care unit varies, but typically, this process takes two to four weeks.

In 2014, over 500 babies were born with neonatal abstinence syndrome in Indiana. Neonatologists are seeing an increase in babies born with NAS every year.

Providing support to new moms after they leave the hospital with a new baby who has had neonatal abstinence syndrome is very challenging. They usually have to find new caregivers depending on their health needs, and many treatment programs for substance addictions do not accommodate a mother and baby pair. It can also be difficult for mothers to focus on their own recovery process while learning to care for a newborn with neonatal abstinence syndrome. The CARE Plus program community health worker will work to build relationships with mothers and caregivers in hopes of helping them navigate some of these challenges and provide them with the resources they need, whether it’s health care, housing, food, or other social services, as well as helping new mothers find treatment and therapy for opioid dependence.

There is very limited data on the developmental outcomes of babies who have been exposed to opioids. One of the goals of CARE Plus is to follow these babies and do sophisticated, developmental testing to begin to answer those questions.

The women will be provided a connection to services such as medication-assisted treatment, mental health services, vital social services that provide access to food, housing and transportation, personalized coaching and supportive text messaging, and therapy designed to develop strong emotional bonds with their children.

CARE Plus aspires to bring services and support to women, rather than require women to travel to receive assistance. A significant part of the program relies on well-trained community health workers who will make personal visits and have frequent communication with the mothers. These community health workers will meet mothers in convenient locations – whether at their home, a nearby laundromat, or other familiar location in their own community. The community health workers are not medical professionals, but instead are lay staff who often have similar socioeconomic backgrounds and life experiences, making it easier for them to connect and relate to mothers in the program. They are trained to identify and understand challenges these mothers are facing and to connect them with resources such as food, housing, and transportation, and provide information about topics such as safe sleep practices. The community health workers will have added training as addiction recovery coaches. A trained therapist will also provide training in parenting techniques that help the mothers develop strong emotional bonds with their children and provide a sense of security. This includes teaching the importance of skin-to-skin contact, rooming in with an infant, cuddling the baby and soothing him or her. Research shows that enhancing the sense of attachment between the baby and mother can decrease the length of hospitalization for an infant. Children who feel secure also benefit throughout their lives by having greater self-esteem, school readiness, and ability to manage their emotions.

While many elements of the program are being deployed across the country, CARE Plus is innovative in that it brings all of the components together and packages them as part of a single, comprehensive program. Specifically, it couples attachment therapy—to help mothers bond with their infants—with the use of community health workers. This is a novel combination, both in Indiana and nationally. In addition, the program is unique in Indiana due to the involvement of the global design firm IDEO. For nearly 40 years, IDEO has taken a human-centered approach to helping organizations in the public and private sectors innovate and grow through design. Together with their clients, IDEO designs the products, services, systems, and organizations that people interact with every day—from consumer goods to health care, education, food, government, new ventures and more. For example, IDEO designed the first manufacturable mouse for Apple and the first notebook-style computer, pioneered systems to combat food waste, and helped develop the blueprint for a network of schools for Peru’s middle class. IDEO will use human-centered design to help CARE Plus effectively serve mother-infant pairs who suffer from opioid dependence—a difficult to reach population. Human-centered design incorporates feedback from the population being served to inform improvements and adjustments, increasing both the reach and effectiveness of the program. Finally, because CARE Plus is being developed as a pilot project by IU School of Medicine, there will be a rigorous evaluation and review of outcomes. This research will be used to help develop a model that can be shared with health systems and other partners across the state.

For more information about CARE Plus, contact Kathleen Sobiech, PhD at ksobiech@regenstrief.org.