Establishes funding for a pilot clinic to provide comprehensive prenatal, delivery, and postpartum care and social services on the island of Oahu to women who have a history of methamphetamine and other substance use. Makes an appropriation. (SD1)

A BILL FOR AN ACT

SECTION 1. Since mid-1980, Hawaii has been gripped by an epidemic of methamphetamine use. Females in Hawaii, in particular, have been adversely impacted. In the year 2000, Child Welfare Services (CWS) received reports of two hundred eight drug-exposed infants on the island of Oahu, 78.8 per cent of which (one hundred sixty-four infants) were reportedly exposed to methamphetamine. In 2002, the criminal justice system reported that one-half of adult female arrestees in Honolulu tested positive for methamphetamine. In 2004, CWS reported that methamphetamine use was involved in over eighty per cent of its active cases.

While methamphetamine receives a great deal of attention, little is known about its adverse effects during pregnancy. More is known about the harmful nature of legal drugs such as tobacco and alcohol, which are much more widely used before and during pregnancy. Approximately sixty-five per cent of reproductive-aged women use alcohol and unfortunately, despite strong warnings about harmful effects, not enough women stop using alcohol during pregnancy. One University of Hawaii study showed that twenty per cent of women used alcohol during pregnancy. Fetal alcohol syndrome is the number one cause of preventable birth defects. In addition, nineteen per cent of pregnant women in Hawaii smoke. Smoking during pregnancy is associated with preterm labor, small for gestational age, abruption and other serious pregnancy complications. Studies have shown that treating smoking addiction during pregnancy works, and offering treatment for nicotine addiction provides a great avenue through which women who would otherwise be too afraid to seek care can be enrolled into methamphetamine addiction treatment programs.

In 2004, the state legislature enacted a law requiring health providers involved in the delivery or care of a drug-affected infant to notify child protective services. The law also requires the department of human to implement and operate a statewide program, including:

(1) A plan of safe care for the infant; and

A cornerstone of programs that address perinatal drug use has been the prevention of infant abandonment or placement into out-of-home care. Many studies have shown better outcomes when children are raised by their biological parents. This has led to interventions designed to maintain the family structure while preventing or treating substance use during pregnancy and providing prenatal care.

However, women who suffer from substance use have difficulty using traditional systems of care. Services are not accessed for a number of reasons:

(1) Fear of losing custody of children;

(2) Fear of forced treatment;

(3) Lack of transportation to treatment sites;

(4) Stigmatization of substance use; and

(5) Fear of criminal prosecution.

Fear of losing custody is the number one reason why women do not seek prenatal care. In addition, rather than being a deterrent to drug use during pregnancy, policies such as criminal prosecution serve as a deterrent to obtaining prenatal care. In South Carolina, Cornelia Whitner was tested without her knowledge or consent for the use of crack cocaine during her pregnancy and was prosecuted. Subsequently, the Supreme Court upheld the ruling that made it mandatory in South Carolina to report pregnant women for even suspected drug abuse. After implementation of the mandatory reporting laws and the prosecution of Cornelia Whitner, there was a precipitous drop in admissions to drug treatment programs for pregnant women and a subsequent increase in infant mortality as well as a twenty per cent increase in the number of abandoned babies.

In addition to the fear of detection and criminal prosecution, treatment services may not be accessed for reasons such as unreadiness for treatment or a coexisting mental illness. Other system-related barriers to prenatal care are the stigmatization of substance use and negative attitudes of health care providers.

Further, the importance of comprehensive, coordinated, and individualized service provided by an interdisciplinary team of professionals who are supportive, nonjudgmental, and nurturing has been widely acknowledged. However, separate service delivery systems have traditionally been provided for prenatal care and substance abuse treatment.

Women with high-risk pregnancies, such as drug-exposed pregnancies, have been shown to adapt to pregnancy and motherhood differently and less easily than women with low-risk pregnancies, and require specialized services to create a nurturing and caring environment. Health care workers in a traditional, separate service delivery system might lack not only the knowledge and skill to identify substance abuse, but also familiarity with available resources and therapeutic management. Workers in a separate substance use treatment delivery system are unlikely to have the capacity to adequately address needs specific to pregnant women.

However, Hawaii lacks facilities equipped to provide specialized, coordinated care for high-risk pregnancies. Oahu has the only residential drug-treatment facility designed to treat pregnant and parenting women, but due to funding cutbacks, the program does not offer a high level of outpatient care. It has no internal capacity to provide medical care, and pregnant women are referred out to medical providers, many of whom lack training in the care of women with substance use issues.

The purpose of this Act is to establish a pilot clinic to provide comprehensive prenatal, delivery, and postpartum care to women who have a history of methamphetamine and other substance use, including alcohol and tobacco. The pilot clinic will provide this care at one location, and the care will include non-judgmental substance use counseling, parenting classes, social service resources, and legal services. The goal of the comprehensive care and services provided by the clinic will be to facilitate the patient's transition from a troubled, pregnant woman to a coping, capable parent, assess the safety of the home environment for the child, and prevent outplacement and keep families together whenever possible.

SECTION 2. There is established within the John A. Burns school of medicine university clinical educational and research associates program at the University of Hawaii department of obstetrics, gynecology, and women's health, a pilot perinatal clinic, which in collaboration with the departments of pediatrics and psychiatry will provide:

2. (2) Substance use counseling;

To supplement state funding of the pilot perinatal clinic, funding for perinatal and pediatric services of the clinic shall be pursued through health plans, insurers, and the state medicaid program.

SECTION 3. For purposes of medicaid reimbursement only, prenatal, delivery, and postpartum care shall be provided by a licensed physician or for delivery, an advanced practice registered nurse. The clinic and staff providing services shall be medicaid participating providers.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $400,000 or so much thereof as may be necessary for fiscal year 2006-2007 and $200,000 or so much thereof as may be necessary for fiscal year 2007-2008 to establish a pilot perinatal clinic and provide case management services.

The sums appropriated shall be expended by the John A. Burns school of medicine university clinical educational and research associates program at the University of Hawaii

department of obstetrics, gynecology, and women's health for the purposes of this Act.

SECTION 5. This Act shall take effect on July 1, 2006.