VUMC Expands Programming in Effort to Help Pregnant and Postpartum Women, Infants in Opioid Crisis

The opioid crisis — now one of the leading causes of maternal mortality — continues to rage in Tennessee.

Vanderbilt University Medical Center has long recognized the increasing toll the crisis has on pregnant and postpartum women and their infants.

“There is a critical need to address access to care and provide comprehensive public health solutions for pregnant women and infants affected by the opioid crisis,” said Stephen Patrick, MD, MPH, MS, executive director of Firefly and a neonatologist at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“The stakes are high. For years we have been in the middle of an opioid overdose epidemic, but there are still far too many barriers to get treatment. Women are dying or losing their children to foster care as a result,” he said.

For many years VUMC has had clinical programs dedicated to pregnant women with opioid use disorder and their infants, including the Vanderbilt Maternal Addiction Recovery Program (VMARP) and Team Hope, a VUMC program to optimize care for opioid-exposed newborns. Now, funding from the Centers for Medicare and Medicaid Innovation, in conjunction with TennCare, will help to unite and expand these programs and provide additional resources to optimize care for women with opioid use disorder beginning in pregnancy through the baby’s first year of life. 

This new expanded program is called Firefly – lighting a path for moms in recovery and their infants.

Firefly is one of nine state programs funded by the Centers for Medicare and Medicaid Innovation to test optimal models of care for mothers and their babies. This $5.3 million grant provides funding over a five-year period to combat the nation’s opioid crisis and address fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder. 

Each program is structured differently, with an aim to innovate and improve how care is administered to women and infants impacted by the opioid crisis, said Patrick. Vanderbilt’s model has been developed in collaboration with the departments of obstetrics, pediatrics and psychiatry.

“We have to work to push through the system, break down barriers, enhance services and create resources to connect women,” said Patrick. “The ultimate goal for this new program is to support families and optimize care for pregnant women with opioid use disorder and for opioid-exposed infants.”

Patrick said that families’ challenges have likely worsened during the COVID-19 pandemic. The program’s recent launch is very timely, he said.

Firefly’s new model will coordinate clinical care and integrate services for health, well-being and recovery for women covered by Medicaid throughout 26 counties in Middle Tennessee. Initial enrollment is expected to top 300 with plans to expand to rural communities.

The program will be based in the Center for Women’s Health at One Hundred Oaks, where existing programs will continue to care for uninsured and privately insured pregnant and postpartum women with substance use disorders.

“Often care for pregnant women with opioid use disorder is fragmented by silos within health care systems.  With the new Firefly model, we have a unique opportunity to create transformative partnerships across specialties,” said Jessica Young, MD MPH, founder of VMARP and medical director for Firefly.

“As an OB-GYN and addiction medicine specialist, I see daily how difficult it is for our patients to navigate complicated health systems. It can be a struggle to obtain basic needs like food, shelter and housing, making recovery even more challenging. The new model will support women and their families in their recovery journey, and I believe this kind of support can be transformational,” she said.

“We want to be the ultimate connector of resources for families, and enhance traditional addiction treatment by optimizing the coordination of care and services, including through peer support,” said Kim Lovell, MBA, MPH, director of operations for Firefly.

Women in the new Firefly program will each be paired with a peer recovery specialist, a trained patient navigator and advocate with lived experience.

“Our peer recovery specialists have each expressed how much they wish this program had been available to them during their own pregnancy and recovery journey,” said Lovell. “This kind of coordinated support simply wasn’t there.”

Angela Easterling, one of five peer recovery specialists, said Firefly is an important resource because women have different barriers to recovery, treatment and services. She hopes to use her experience to encourage others throughout their recovery journey.

Pregnant with her fourth child, Easterling began her recovery in 1989 after an intervention by her OB-GYN and a group of ladies.

“I was a young mother of three children under the age of 4,” she said. “They had been removed from my custody during this time.

The program I enrolled in and the recovery community became my family and main support system. I want to assist women in Firefly achieve their goals and access all the wonderful resources available to them.

“One of the best things is – it’s all in one place, which is priceless for women struggling to make ends meet, attend appointments and care for their children.”

In addition to five peer recovery specialists, the new Firefly program will also include social workers, an outpatient lactation consultant, obstetric, pediatric and psychiatric professionals and a clinical program manager to help provide wraparound services that are responsive to the needs of this patient population.

For additional information about Firefly or to make an appointment go to www.fireflytn.org or call 615-421-8000.