An out-patient medical home model in Boston provides individualized, multi-disciplinary treatment for pregnant and post-partum women with substance use disorder
In 2006, the Obstetrics Department at the Boston Medical Center initiated Project RESPECT (Recovery, Empowerment, Social Services, Prenatal care, Education, Community and Treatment), offering comprehensive substance use disorder treatment and obstetric care to pregnant and post-partum women. A patient's obstetrician serves as her provider of medications for opioid use disorder (MOUD), such as methadone, buprenorphine, or naltrexone, while the RESPECT clinical team coordinates care with pediatric, psychiatric, and social work services, and connects patients with community-based recovery resources. Key elements of the program include:
- admission to high-risk obstetrics service
- safe management of acute withdrawal
- initiation of MOUD by supervising obstetrician
- development of individualized treatment plan
- referral to methadone clinics, residential treatment, peer support, and family services as appropriate
- post-partum coordination of care for up to two years
A more detailed overview of the program can be found in the presentation here and a historical perspective of the program can be found in the paper here. Project RESPECT has made available its guidelines for substance use disorder treatment of pregnant and parenting patients, and has successfully transitioned to a hybrid tele-medicine/in-person model of care in response to the Covid-19 epidemic
The program has successfully helped women establish sobriety while on medication treatment for their opioid use disorder.