As drug overdoses and deaths have risen to alarming rates in Spokane County, researchers from Washington State University’s Health Sciences Spokane have been gathering data to evaluate the health outcomes of mothers and babies receiving treatment at Maddie’s Place, a neonatal transitional facility on Spokane’s South Hill. 

Celestina Barbosa-Leiker, executive vice chancellor for research at WSU Health Sciences, says the takeaway from almost a year of research indicates  that Maddie's Place is a beneficial resource to mothers and infants withdrawing from exposure to drugs.

“Post-discharge from the Neonatal Intensive Care Unit … (Maddie’s Place) is filling a need here in Spokane County, a huge need that is unable to be met with any other facility,” Barbosa-Leiker says. “We’re hearing from moms served there that without Maddie’s Place, they would potentially still be using drugs, and they would not have their baby.”

Barbosa-Leiker leads a six-person team of experts in substance use with a focus on neonatal abstinence syndrome, commonly referred to as NAS, from WSU’s College of Nursing and the Elson S. Floyd College of Medicine who are tasked with providing an overall assessment of Maddie’s Place. The team has shared its results with the Washington state Health Care Authority and will submit a full report in August. 

Shaun Cross, president and CEO of Maddie’s Place, says the outcome of the research will help make a case for the necessity of funding the services that the facility provides to mothers and infants in withdrawal. Currently, Medicaid funding for these types of services ends when the mother and baby are discharged from the hospital. Barbosa-Leiker, who has been collaborating informally with Maddie’s Place for about six years, says her research provides objective feedback to the Health Care Authority, which will create its own final report of the findings in December. 

“As researchers, we had to make sure this was an independent evaluation," Barbosa-Leiker says. 

As earlier reported by the Journal of Business, Maddie’s Place, a neonatal transitional care facility that provides 24/7 care to mothers and infants withdrawing from drug exposure, was awarded $5.5 million from Washington state’s opioid abatement settlement account.  

The funds are for the implementation of a pilot program—Maddie’s Place—that studies and evaluates the efficacy, outcomes, and impact of providing these services to infants with NAS to avoid more costly medical interventions, Cross says. 

Of these funds, $190,000 is provided solely for Maddie’s Place to contract with Spokane-based Washington State University Health Sciences and provide an assessment of those services. 

According to data from the Washington state Department of Health, the hospitalization statewide rate of infants with neonatal abstinence syndrome is about 10 out of every 1,000 births as of 2020. In Spokane County, which sees about 6,000 births annually, that figure translates to about 60 babies born with neonatal abstinence syndrome annually. Nationally, there are six babies born with NAS out of every 1,000. 

The research had three aims that were approved by the Health Care Authority, says Barbosa-Leiker.

The first aim was to look at the prevalence of babies born with NAS in Spokane. However, the researchers were unable to access the data as planned and instead focused on Spokane-specific practices and potential barriers, Barbosa-Leiker says.  

Ekaterina Burduli led that effort and spoke with health care providers in Spokane County and found that practices for babies born with neonatal abstinence syndrome are consistent and that health care providers have a streamlined NAS coding process. However, the research team also found that neonatal treatment is complicated by fentanyl and polysubstance use, says Burduli. Polysubstance use refers to the use of multiple substances indiscriminately.

“Due to increase in polysubstance-fentanyl use, standard treatment for infants seems to be less effective possibly due to both increased symptoms in newborns and less availability of mothers-caregivers to engage in care,” Burduli says via email. 

“When we look at prevalence from her part of the study ... this whole process is a moving target, and that’s what health care providers are struggling with,” Barbosa-Leiker says. “This opioid epidemic is changing and evolving every six months. … We have practices that were put in place just a few years ago to help moms who had an opioid use disorder. The drugs look very different and are more detrimental to mom and baby, so in order to qualify for these great practices that were put in place, they’re seeing that a lot of moms can’t even function.”

The second aim of the study looked at the health outcomes of mothers and babies at Maddie’s Place, using data from 71 babies that had been served at the facility, Barbosa-Leiker says.

On average, researchers found that hospital tests of umbilical cord blood showed the infants had been exposed to about four different substances. The most common exposure was methamphetamine, followed by fentanyl. The infants exposed to these drugs came to Maddie’s Place with an average of six medical conditions including feeding problems, respiratory distress, and tongue ties, Barbosa-Leiker says. 

To assess a baby’s daily progress, caregivers at Maddie’s Place use the Hopkins Assessment/Intervention Tool that evaluates four areas: the baby’s nervous system, motor and muscle tone, state control and attention, and sensory reactivity, she says. Researchers analyzed the data from when the babies were admitted compared to the data at the baby’s midpoint stay at the facility. The average stay for a baby at Maddie’s Place is 56 days, Barbosa-Leiker says. 

“We were able to look at those trends over time,” Barbosa-Leiker says. “Across all those domains, they saw statistically significant improvement there while at Maddie’s Place. I think what we’re finding here is that Maddie’s Place is doing what it’s funded to do. That’s a great thing.” 

The last component of the study is made up of interviews with 15 participants who were asked questions about their pregnancy, their expectations for having a baby with NAS, and their experiences at Maddie’s Place. 

What researchers found was that most moms didn’t fully understand what the babies would experience going through withdrawal, they didn't feel prepared, and potential complications might not have been fully explained to them by health care providers. Many reported feeling misunderstood and stigmatized at their pregnancy appointments, while others felt they were treated with compassion and care, Barbosa-Leiker says. 

When asked about their experience at Maddie’s Place, almost all participants said their baby most likely would be in foster care were it not for such a facility. Many expressed that they would still be using drugs or contemplating getting high. One participant said, “Without Maddie’s Place, I wouldn’t be a functional human being,” Barbosa-Leiker says. 

“Absolutely, there is a need for the foster care system, but I also know that we want mom and baby together if that’s the best outcome for mom and baby,” Barbosa-Leiker says. “If we want to know if there’s an alternative to foster care, it seems like Maddie’s Place is the way to go.”

When asked about areas of improvement, one participant said there needs to be more facilities like Maddie's Place. Across the country, Maddie’s Place is one of four facilities that care for babies with NAS. 

One note for improvement that Barbosa-Leiker had not expected came from a mom who expressed her sense of vulnerability handing her baby off to five different volunteers throughout the day. 

“"They’re saying, it’s great that there are people here to help me with my baby, but having to hand off my baby and tell my story over and over again to new people is really hard,” Barbosa-Leiker says. “To me in my mind, that’s what a funding model would change. You’d have consistent staff there and potentially still volunteers.” 

The current model for Maddie’s Place has over 40 volunteers who are there to hold the babies while the mother is resting or absent, she says.

"If I had to give a takeaway on the research side of things, I think that Maddie's Place is helping moms and babies be as healthy as possible," Barbosa-Leiker says. "I think unfortunately there is going to be more and more demand. ... If they are unable to grow to meet that need, they're just going to have to turn moms away, and that's going to be detrimental to our county, our state, our nation."