386 - Early Intervention Engagement Among Substance-Exposed Infants in Massachusetts

Publication Number: 386.4636

Katie Q. Gu, University of Massachusetts Medical School, Rohnert Park, CA, United States; Emma R. Miller, Baystate Children's Hospital, Holyoke, MA, United States; Sarah J. Palmer, University of Massachusetts Medical School, Shrewsbury, MA, United States; Meng-Shiou Shieh, Baystetehealth, Springfield, MA, United States; Briana L. Jurkowski, Baystate Children's Hospital, Springfield, MA, United States; Rachana Singh, Tufts University School of Medicine, Boston, MA, United States; Jonathan S. Litt, Stanford University School of Medicine, Palo Alto, CA, United States; JoAnna Leyenaar, Dartmouth Health Children's, Lebanon, NH, United States; Elizabeth Peacock-Chambers, Baystate Medical Center, Springfield, MA, United States

Background: The increasing number of newborns with in utero substance exposure over the past two decades represents a significant public health challenge. Substance-exposed newborns (SENs), particularly those exposed to opioids, have an increased, multi-factorial risk of developmental and behavioral challenges. Thus, neonatal abstinence syndrome (NAS), symptoms that can result from withdrawal of in utero substance exposure, is an automatically qualifying diagnosis for enrollment in Early Intervention (EI) home visiting in Massachusetts (MA). However, challenges with engagement and enrollment persist among this population, particularly for SENs without the NAS diagnosis. Little is known about the successful rate of referral and enrollment among SENs with and without a diagnosis of NAS at the population level.

Objective: To assess EI referral and enrollment rates among SENs with and without a diagnosis of NAS in MA, and to compare rates to infants without known substance exposure.

Design/Methods: We linked the Pregnancy to Early Life Longitudinal dataset, a cohort of all MA birth hospitalization records, with EI referral and enrollment data between 2013 to 2020. We identified SENs with and without a diagnosis of NAS using birth hospitalization ICD-9/10 codes. We conducted descriptive statistics and bivariate analysis to compare SENs with and without NAS diagnoses and to compare SENs to the unexposed population.

Results: This cohort captured 6,565 SENs, 4,843 with NAS diagnoses and 1,722 without, and 340,189 newborns without known substance exposure. For the total cohort of SENs, 85.3% were referred to EI, and of those, 49.5% enrolled. SENs with a NAS diagnosis were more likely to be referred to EI (87.6%) compared to SENs without a NAS diagnosis (79.0%, p< 0.001), and more likely to enroll (53.2% vs 38.2% of referred, p< 0.001). EI referral rates were lower among infants without any identified substance exposure (34.6%), but these referred infants had higher rates of enrollment (56.7%, p< 0.001).

Conclusion(s): This study is among the first to rigorously assess EI referral and enrollment of SENs at the population level. Our findings demonstrate that SENs in MA had relatively high rates of EI referral but lower rates of enrollment compared to the general population, particularly among SENs without a diagnosis of NAS. Our results point to a need for strategies to address the referral-to-enrollment gap in MA, which could inform programs nationwide.

EI Engagement Among SENs With and Without NAS Diagnosis
EI referral and enrollment rates were significantly higher amongst SENs with the NAS diagnosis compared to SENs without the NAS diagnosis (referral = 87.6% vs 79%, enrollment among referred = 53.2% vs 38.2%).

EI Engagement Among SENs and Infants Without Substance Exposure
SENs were more likely to be referred to EI (85.3%) compared to infants without substance exposure (34.6%). However, among those referred, infants without substance exposure were more likely to enroll in EI services (56.7%) compared to SENs (49.5%).

EI Engagement Among SENs With and Without NAS Diagnosis
EI referral and enrollment rates were significantly higher amongst SENs with the NAS diagnosis compared to SENs without the NAS diagnosis (referral = 87.6% vs 79%, enrollment among referred = 53.2% vs 38.2%).

EI Engagement Among SENs and Infants Without Substance Exposure
SENs were more likely to be referred to EI (85.3%) compared to infants without substance exposure (34.6%). However, among those referred, infants without substance exposure were more likely to enroll in EI services (56.7%) compared to SENs (49.5%).