Explore existing and emerging policies to support your family-centered pregnant and postpartum women behavioral health treatment program.

  • Improving care for neonatal abstinence syndrome.
    Abstract BACKGROUND AND OBJECTIVE: Care for neonatal abstinence syndrome (NAS), a postnatal drug withdrawal syndrome, remains variable. We designed and implemented a multicenter quality improvement collaborative for infants with NAS. Our objective was to determine if the collaborative was effective in standardizing hospital policies and improving patient outcomes. METHODS: From 2012 to 2014, data were collected through serial cross-sectional audits of participating centers. Hospitals assessed institutional policies and patient-level data for infants with NAS requiring pharmacotherapy, including length of pharmacologic treatment and length of hospital stay (LOS). Models were fit, clustered according to hospital, to evaluate changes in patient outcomes over time. RESULTS: Among 199 participating centers, the mean number of NAS-focused guidelines increased from 3.7 to 5.1 of a possible 6 (P < .001), with improvements noted in all measured domains. Among infants cared for at participating centers, decreases occurred in median (interquartile range) length of pharmacologic treatment, from 16 days (10 to 27 days) to 15 days (10 to 24 days; P = .02), and LOS from 21 days (14 to 33 days) to 19 days (15 to 28 days; P = .002). In addition, there was a statistically significant decrease in the proportion of infants discharged on medication for NAS, from 39.7% to 26.5% (P = .02). After adjusting for potential confounders, standardized NAS scoring process was associated with shorter LOS (-3.3 days,95% confidence interval, -4.9 to -1.4). CONCLUSIONS: Involvement in a multicenter, multistate quality improvement collaborative focused on infants requiring pharmacologic treatment for NAS was associated with increases in standardizing hospital patient care policies and decreases in health care utilization.
  • Policy Statement from AAP: A Public Health Response to Opioid Use in Pregnancy
    Abstract The use of opioids during pregnancy has grown rapidly in the past decade. As opioid use during pregnancy increased, so did complications from their use, including neonatal abstinence syndrome. Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs. A public health response, rather than a punitive approach to the opioid epidemic and substance use during pregnancy, is critical, including the following: a focus on preventing unintended pregnancies and improving access to contraception; universal screening for alcohol and other drug use in women of childbearing age; knowledge and informed consent of maternal drug testing and reporting practices; improved access to comprehensive obstetric care, including opioid-replacement therapy; gender-specific substance use treatment programs; and improved funding for social services and child welfare systems. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool (December 2016). DOI: 10.1542/peds.2016-4070
  • Alcohol abuse and other substance use disorders: Ethical issues in Obstetric and Gynecologic Practic
    Alcohol abuse and other substance use disorders are major, often underdiagnosed health problems for women, regardless of age, race, ethnicity, and socioeconomic status, and have resulting high costs for individuals and society. In order to optimize care of patients with substance use disorder, obstetrician-gynecologists are encouraged to learn and appropriately use routine screening techniques, clinical laboratory tests, brief interventions, and treatment referrals. The purpose of this Committee Opinion is to propose an ethical framework for incorporating such care into obstetric and gynecologic practice and for resolving common ethical dilemmas related to substance use disorder.
  • Designing Medicaid Health Homes for Individuals with Opioid Dependency: Considerations for States
    Although individuals with opioid dependency represent a small percentage of all Medicaid enrollees, they often have significant physical and behavioral health needs that result in high costs of care. States are looking for innovative, cost-effective ways to integrate and coordinate care for this high-need population. Through the Affordable Care Act, states can implement health homes to provide enhanced integration and care coordination for people with opioid dependency. This brief, made possible by the Centers for Medicare & Medicaid Services Health Home Information Resource Center, highlights key features of approved health home models from Maryland, Rhode Island, and Vermont that are tailored to individuals with opioid dependency. It identifies important considerations in developing opioid dependence-focused health homes, including: (1) leveraging opioid treatment program requirements; (2) promoting collaboration across multiple state agencies; (3) supporting providers in transforming into health homes; and (4) encouraging information sharing.
  • Using Medicaid to Finance and Deliver Services in Supportive Housing: Challenges and Opportunities
    Behavioral health authorities and community behavioral health organizations are increasingly examining ways to meet the needs of individuals with mental illnesses (MI) and/or substance use disorders (SUD). Permanent Supportive Housing (PSH) is a cost-effective, evidence-based intervention that addresses the need among many individuals, providing permanent affordable housing and community-based, person centered services. As states increase their PSH capacity, they are also seeking to leverage Medicaid as a cost-effective source to finance and deliver the services component of PSH. This paper discusses the policy context driving the inclusion of more integrated PSH options within state and local behavioral health authorities, and builds on recent federal guidance regarding Medicaid reimbursement for housing-related services. State behavioral health authorities, Medicaid agencies and organizations serving people with MI and/or SUD each play a critical role working together to identify, pay for, and implement these types of services.
  • Family Strengthening at the Tipping Point: Emerging Transformation in the Human Services Field
    Describes advances at national and community levels in human services organizations to integrate place-based, family-strengthening approaches into policies, programs, and practices.
  • Neonatal Abstinence Syndrome Project Level I Webinar Legalities and Practicalities
    Describes strategies to identify neonatal abstinence syndrome. Discusses practice based implications in screening and testing for prenatal substance exposure.
  • How Minnesota Uses Medicaid Levers to Address Maternal Depression and Improve Healthy Child Dev.
    Despite evidence that maternal depression is quite common and can negatively impact young children’s development, it is often undiagnosed and untreated. Since the rate of maternal depression is disproportionately higher in low-income women, Medicaid can play a leading role in identifying at-risk mothers and connecting them to treatment. With support from the David and Lucile Packard Foundation, a new NASHP case study explores how Minnesota uses various policy levers in administering a Quality Improvement Project focused on addressing postpartum depression.
  • Substance-Exposed Infants: State Responses to the Problem
    Existing policies, strategies, and activities that compose the national response to the problem of prenatal substance exposure are considerably stronger than they were in the late 1980s and early 1990s. However, the substance-exposed infant (SEI) problem requires close ties across the boundaries of public and private systems serving children and their families, robust information systems and a willingness to use those systems to support accountability in achieving interagency missions, and greater attention to the gaps between policy as it is stated and policy as it is actually carried out at State and local levels. The 10 States reviewed in this report have shown that SEI policy can be made effective, and that it can be taken to scale. The report describes the findings from a review and analysis of States' policies regarding prenatal exposure to alcohol and other drugs, in order to help State, local, and tribal governments. The framework around which the report is organized asserts that there are five major timeframes when intervention in the life of the SEI can reduce potential harm of prenatal substance exposure: pre-pregnancy, prenatal, birth, neonatal, and throughout childhood and adolescence. This framework formed the basis for the review of State practices with SEIs. When the needs of substance-exposed children are addressed, it is apparent that the connections across these five points discussed are as important as the actual interventions. The handoffs from one point to the next and the linkages needed to coordinate services become a comprehensive services framework. Recommended action steps are outlined to provide the proper foundation for this framework resulting in better outcomes.
  • The triple aim for neonatal abstinence syndrome
    For decades, the diagnosis of neonatal abstinence syndrome (NAS) was relatively rare in the US; however, the recent epidemic of prescription and nonprescription opioid use across the country has made this once novel diagnosis common.1 The number of infants diagnosed with NAS in the US has grown nearly 5-fold since 2000. Today, one infant with NAS is born every 25 minutes, accounting for an estimated $1.5 billion in hospital charges.2 The rapid rise of NAS in our nurseries and neonatal intensive care units demands that improvements in research and care delivery systems keep pace.
  • Drug Testing in Child Welfare: Practice and Policy Considerations
    Guides child welfare agency policymakers in developing practice and policy protocols regarding the use of drug testing in child welfare practice. Covers issues to consider when using drug testing and how to incorporate drug testing into child welfare casework.
  • Substance-Exposed Infants: State Responses to the Problem
    In 2005–2006, the National Center on Substance Abuse and Child Welfare (NCSACW) undertook a review and analysis of States’ policies regarding prenatal exposure to alcohol and other drugs, in order to help local, State, and Tribal governments: 1. Gain a better understanding of current policy and practice in place at the State level that address substance-exposed infants (SEIs); and 2. Identify opportunities for strengthening interagency efforts in this area.
    In 2016, The Tennessee Association for Alcohol, Drug & other Addiction Services (TAADAS), a membership organization for the prevention and treatment community has drafted this white paper to assist policy makers and the public in understanding the issues surrounding Pregnancy, Drug Use, and the Law. TAADAS hopes this effort will assist policy makers as they discuss whether to wind down the temporary fetal assault law which is set to expire in 2016.
  • State Medicaid Payment Approaches to Improve Access to Long-Acting Reversible Contraception
    In July 2014, the Center for Medicaid and CHIP Services (CMCS) launched the Maternal and Infant Health Initiative to improve maternal and infant health outcomes. The initiative has two primary goals: 1) increasing the rate and improving the content of postpartum visits; and 2) increasing access and use of effective methods of contraception. Medicaid provides coverage for more than 70 percent of family planning services for low-income Americans. Given this important role, CMCS sought to identify approaches to Medicaid reimbursement that promote the availability of effective contraception.1 This Informational Bulletin describes emerging payment approaches several state Medicaid agencies have used to optimize access and use of long-acting reversible contraception (LARC).
  • Snuggle ME Webinar Series
    In Maine, the number of infants treated for prenatal drug exposure has risen dramatically from 165 to over 927 infants a year from 2005 to 2013. In response to this growing crisis affecting our state's youngest children and families, the Family Health Division of the Maine CDC and the Maine Chapter of the AAP identified this as a priority area in the spring of 2010 and partnered to create the “Snuggle ME” project. This is an effort to improve care coordination for affected families with the goal of providing appropriate counseling and care prenatally, in the hospital setting, and post-discharge through early intervention services. The Snuggle ME project is an integrated effort of the Maine Chapter of the AAP and Maine CDC, maternity care providers including high risk maternal fetal medicine, OB/GYN, family medicine, nurse midwives, nurse practitioners, pediatricians and neonatologists with representatives from EMMC, MMC, and CMMC, MaineGeneral, Penobscot Bay Medical Center, Franklin Memorial, Mayo Regional, ACOG, Office of Substance Abuse, WIC and lactation consultants that came together to create recommendations for care. Click here to view the Snuggle ME guidelines now posted on the Maine CDC website.
  • Protecting our Infants Act: Report to Congress
    In response to the Protecting Our Infants Act (Public Law 114-91), enacted on November 25, 2015, this report provides background information on prenatal opioid exposure and NAS, summarizes HHS activities related to prenatal opioid exposure and NAS, presents clinical and programmatic evidence and recommendations for preventing and treating NAS, and presents a strategy to address the identified gaps, challenges, and recommendations.
  • Systematic Development of an Evidence-Based Website on Preconception Care.
    INTRODUCTION: In February 2015, the Flemish Minister of Welfare, Public Health and Family launched a website on preconception care: 'gezondzwangerworden.be'. The website was developed in response to the lack of comprehensive communication on preconception care and the inadequate intake of folic acid among Flemish women. Despite the international recommendation to take 400?µg folic acid on a daily basis one month before conception until 12 weeks of pregnancy, studies show a lack of compliance in women wanting to become pregnant. PROCEDURE: A compilation of evidence was made through reviewing well-established guidelines on preconception and prenatal care. The quality of guidelines was assessed by means of AGREE II. The topics included in the website were selected by an internal committee of 5 experts and an external committee of 16 experts. Content validation was carried out by 40 experts in preconception care or related topics. RESULTS: The above-described procedure resulted in an evidence-based website with a selection of relevant, validated information for both women and men who plan a pregnancy and professionals who are consulted by these people. Evaluation and recommendation: The website is currently attracting a constant number of 100 to 200 visitors a day. The information on folic acid is among the most requested, which is an important finding with regard to the policy objectives on preconception care. More research is needed in order to evaluate the use and effect of the website more thoroughly.
  • Brief – State-Level Policy Advocacy for Children Affected by Parental Substance Use
    More than 8.3 million children, or 11 percent of all children in the United States, live in homes where at least one parent or caretaker has a substance use disorder involving alcohol and other drugs. Parental substance abuse places the family at an increased risk of child abuse, neglect, and trauma. Most of these children are not identified by child-serving agencies. This SPARC brief, authored by Sid Gardner from Children and Family Futures, provides compelling data to demonstrate that alcohol and drug use is a key factor in a high percentage of child welfare involved families, outlines eight barriers to taking substance abuse seriously in the child welfare system, summarizes five levers for advocates aiming at going beyond pilot projects to systems change and highlights policy and practice innovations that advocates can promote.
  • State-Level Policy Advocacy for Children Affected by Parental Substance Use
    More than 8.3 million children, or 11 percent of all children in the United States, live in homes where at least one parent or caretaker has a substance use disorder involving alcohol and other drugs. Parental substance abuse places the family at an increased risk of child abuse, neglect, and trauma. Most of these children are not identified by child-serving agencies. This SPARC brief, authored by Sid Gardner from Children and Family Futures, provides compelling data to demonstrate that alcohol and drug use is a key factor in a high percentage of child welfare involved families, outlines eight barriers to taking substance abuse seriously in the child welfare system, summarizes five levers for advocates aiming at going beyond pilot projects to systems change and highlights policy and practice innovations that advocates can promote.
  • Caring for pregnant opioid abusers in Vermont: A potential model for non-urban areas.
    Opioid addiction is no longer a primarily urban problem. As dependence on heroin and prescription pain relievers has become a significant issue in rural areas, the need for effective treatment of opioid-dependent pregnant women and their neonates has grown accordingly. In addition to the adverse perinatal outcomes associated with opioid addiction in pregnant women, the high costs of caring for these mothers and their babies motivate efforts to develop appropriate treatment models. We found that integration and coordination of services that promote maternal recovery and ability to parent are key requirements for treatment of opioid dependence during pregnancy. Unfortunately, lack of experience and resources makes such coordination a real challenge in rural areas. In this review, we discuss how we managed the challenges of developing a comprehensive program for treatment of opioid dependence during pregnancy. In addition, we outline our approach for facilitating the development of community-based programs to help these patients and families in rural regions of Vermont. Close relationships between our tertiary care center, local hospitals, community health care infrastructure, and legislators bolstered our efforts. In particular, appreciation for the severity and importance of the opioid-dependence problem in Vermont among health care providers and state legislators was paramount for our success in developing a state-wide treatment program. This approach can inform similar efforts in other rural regions of the United States, and has great potential to improve both access and quality of care for women struggling with opioid dependence.
  • Substance Abuse and Mental Health Services Administration: Federal Guidelines for Opioid Treatment P
    Provides updated guidelines for the operation of opioid treatment programs (OTPs). Covers patient assessment, treatment planning, medication-assisted treatment (methadone and buprenorphine), overdose and relapse prevention, and recovery care.
  • Facilitating Cross-System Collaboration: A Primer on Child Welfare, Alcohol and Other Drug Services
    Reviews characteristics of child welfare, substance abuse services, and courts to support cross-system coordination within State, county, and tribal jurisdictions. Considers the framework, population, legislation and funding sources, and services for each system.
  • Substance Abuse During Pregnancy: State Laws and Policies as of April 1, 2016
    Since the late 1980s, policymakers have debated the question of how society should deal with the problem of women’s substance abuse during pregnancy. In 2014, Tennessee became the only state to specifically criminalize drug use during pregnancy. However, prosecutors have attempted to rely on a host of criminal laws already on the books to attack prenatal substance abuse. The Supreme Courts in Alabama and South have upheld convictions ruling that a woman’s substance abuse in pregnancy constitutes criminal child abuse. Meanwhile, several states have expanded their civil child-welfare requirements to include prenatal substance abuse, so that prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. Further, some states, under the rubric of protecting the fetus, authorize civil commitment (such as forced admission to an inpatient treatment program) of pregnant women who use drugs; these policies sometimes also apply to alcohol use or other behaviors. A number of states require health care professionals to report or test for prenatal drug exposure, which can be used as evidence in child-welfare proceedings. And in order to receive federal child abuse prevention funds, states must require health care providers to notify child protective services when the provider cares for an infant affected by illegal substance abuse. Finally, a number of states have placed a priority on making drug treatment more readily available to pregnant women, which is bolstered by federal funds that require pregnant women receive priority access to programs.
  • Lifting the Burden of Addiction: Philanthropic Opportunities to Address Substance Use Disorders
    Substance use disorders (SUDs), also known as substance abuse or addiction, affect an estimated 20 million or more adolescents and adults in the U.S. This guidance provides philanthropic funders with the tools & information to reduce immediate harm from substance use disorders and reduce the burden of the disorder over the long term. This includes reducing the damage the disorder causes to people with SUDs and their loved ones, reducing the overall incidence of SUDs, and reducing SUD-related costs to society. We present four strategies for philanthropic funders who want to help: - Save lives and reduce SUD-related illness and homelessness - Improve access to evidence-based treatment - Improve SUD care by changing systems and policies - Fund innovation to improve prevention and treatment.
  • Medication Assisted Treatment (MAT) Series, Part I of II: Understanding MAT for Families Affected by
    The convergence of various factors highlight the need to understand the efficacy, use and implications of medication assisted treatment (MAT) for families receiving child welfare services. Individuals may be undergoing MAT for a variety of issues –mental health disorders, pain management and substance use. MAT for mental health issues can include use of psychotropic medications. MAT can be used to assist in pain management for both short and long-term conditions. Medical marijuana legislation further compounds the issue as individuals can be prescribed marijuana for pain management and other disorders. The advent of new medications highlight the need to understand MAT for substance use disorders. In the first of this two-part series, presenters will provide an overview of medication assisted treatment for various issues and explore currently available medications. Practice and policy examples addressing the use of MAT in child welfare and dependency court jurisdictions will be presented and discussed.
  • Opioid addiction: Laws, regulations & other factors can affect medication-assisted treatment access
    The Department of Health and Human Services (HHS) has stated that addressing opioid abuse is a high priority and is promoting access to medication-assisted treatment (MAT)—an approach that combines behavioral therapy and the use of medications—to combat the problem. Three medications are currently approved for use in MAT for opioid addiction—methadone, buprenorphine, and naltrexone. Methadone and buprenorphine are regulated like other controlled substances under the Controlled Substances Act (CSA) when used to treat pain and have additional requirements that apply when used to treat opioid addiction. The third medication—naltrexone—is not a controlled substance and is therefore not subject to the CSA. Methadone is a Schedule II controlled substance, which indicates a higher risk of abuse. Buprenorphine is a Schedule III controlled substance, with lower risk, and so generally has fewer requirements. For example, when used to treat pain, methadone generally may not be dispensed without a written or electronic prescription. In contrast, buprenorphine may be dispensed based on a written, electronic, or oral (phone) prescription. When used for opioid addiction treatment, the CSA and implementing regulations impose additional requirements for methadone and buprenorphine: · Methadone may generally only be administered or dispensed within an opioid treatment program (OTP), as prescriptions for methadone cannot be issued when used for opioid addiction treatment. · Buprenorphine may be administered or dispensed within an OTP and may also be prescribed by a qualifying practitioner who has received a waiver from the Substance Abuse and Mental Health Services Administration. Practitioners who received this waiver are limited in the number of patients they may treat for opioid addiction. In addition to laws and regulations, several key factors can affect patients’ access to MAT for opioid addiction, according to articles from peer-reviewed and scholarly journals, documents GAO reviewed, and interviews with agency officials and experts. Specifically, through these sources GAO identified the following key factors: · The availability of qualified practitioners and their capacity to meet patient demand for MAT. For example, there were approximately 1,400 OTPs in 2016. However, sources GAO reviewed stated that they are lacking in certain locations. Furthermore, some MAT practitioners may be operating at full capacity, leading to wait lists that can affect patients’ access to MAT. · The perceptions of MAT and its value among patients, practitioners, and institutions. Some practitioners do not believe that MAT is more effective than abstinence-based treatment—when patients are treated without medication—despite science-based evidence, and there are concerns that the medications will be misused. · The availability and limits of insurance coverage for MAT. Patients with no insurance coverage for MAT may face prohibitive out-of-pocket costs that may limit their access to it, and coverage for MAT varies for those individuals with insurance. In some cases, state Medicaid programs limit the length of time that patients can use MAT medications.
  • A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders
    The overarching message of this guide is that a coordinated, multi-system approach best serves the needs of pregnant women with opioid use disorders and their infants. Collaborative planning and implementation of services that reflect best practices for treating opioid use disorders during pregnancy are yielding promising results in communities across the country. Advance planning for the treatment of pregnant women with opioid use disorders that addresses safe care for mothers and their newborns can help prevent unexpected crises at the time of delivery. This guidance document provides background information on the treatment of pregnant women with opioid use disorders, summarizes key aspects of guidelines that have been adopted by professional organizations across many of the disciplines, presents a comprehensive framework to organize these efforts in communities, and provides a collaborative practice guide for community planning to improve outcomes for these families.
  • Supporting the Development of Young Children in American Indian and Alaska Native Communities
    The purpose of this U.S. Department of Health and Human Services (HHS) policy statement is to support early childhood programs and tribal communities by providing recommendations that promote the early development of American Indian and Alaska Native (AI/AN) children, prenatal to age eight, who have been exposed to alcohol or substances during pregnancy, or who are affected by parent or caregiver substance misuse during early childhood.
  • Developing a Collaborative Approach to Addressing the Opioid Crisis: 2-Part Webinar Series
    The Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment and the Administration on Children, Youth and Families, Children’s Bureau, Office on Child Abuse and Neglect, in partnership with the National Center on Substance Abuse and Child Welfare hosted a 2-part webinar series to learn strategies grounded in collaborative practice and policy in supporting families affected by opioid use disorders. The first webinar in the series provided an overview of the newly released publication A Collaborative Approach to the Treatment of Pregnant Women With Opioid Use Disorders: Practice and Policy Considerations for Child Welfare, Collaborating Medical & Service Providers. The publication provides: • An overview of the extent of opioid use by pregnant women and the effects on the infant • Evidence-based recommendations for treatment approaches • An in-depth case study • A guide for collaborative planning • Tools to conduct a needs and gap analysis and to develop a collaborative action plan
  • Literature Review on Effective Sex- and Gender-Based Systems/Models of Care
    The U.S. Department of Health and Human Services, Office on Women’s Health (OWH), commissioned this literature review to provide an up-to-date review of effective sex- and gender-based systems/models of healthcare.
  • The Treatment of Opioid Dependence in Pregnancy: Vermont Guidelines
    These best practice guidelines were written as a collaborative effort between the division of Alcohol and Drug Abuse Programming at the Vermont Department of Health, the Maternal Fetal Medicine Department at Fletcher Allen Health Care and the Neomedical Follow-up Department at Fletcher Allen Health Care. The obstetrical and pediatric guidelines were written for use in Vermont after a decade of work with the population of substance dependent pregnant women and their children. They are intended for clinical providers to review and use as a template, if desired.
  • Funding Family-Centered Treatment for Women with Substance Use Disorders
    This 2008 resource paper is a companion to the Family-Centered Treatment monograph and assists treatment providers and state substance abuse agencies to identify and access potential sources of funding for comprehensive family-centered treatment.
  • Perinatal Substance Abuse: At the Clinical Crossroads of Policy and Practice
    This clinical case conference provides a case study, as well as information on legal and policy implications of perinatal substance use from the perspective of health care providers.
  • Guidelines for Testing and Reporting Drug Exposed Newborns in Washington State, 2014.
    This document provides guidance to hospitals, health care providers and affiliated professionals about maternal drug screening, laboratory testing and reporting of drug-exposed newborns delivered in Washington State.
  • Protecting our Infants Act: Final Strategy
    This report includes background information on prenatal opioid exposure and NAS. It also includes strategies for preventing prenatal opioid exposure – treating both the mother and the infant, and providing services for pregnant and parenting women with OUD and their infants.
  • U.S. Medical Eligibility Criteria for Contraceptive Use, 2016
    This report includes recommendations for using specific contraceptive methods by women and men who have certain characteristics or medical conditions. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice.
  • Washington Department of Health — Substance Abuse During Pregnancy: Guidelines for Screening and Man
    This resource offers guidelines and sample tools for screening pregnant women for substance use and provides recommendations on drug testing protocols for pregnant women and newborns.

Federal and State Legislation

The Guttmacher Institute website maintains a list of state policies on substance use during pregnancy.