Treating Addiction in Pregnant Women and New Mothers: A Promising Application for Social Impact Financing?

By Kate Greenwood

Cross-Posted at Health Reform Watch 

Last week, ran an interesting article by Laura Krantz on the difficulties pregnant women and new mothers who are addicted to drugs have accessing not just drug treatment but also all of the other services and supports they need. Krantz reported on a hearing before the Human Services Committee of the Vermont House of Representatives at which a new mother in recovery from addiction, “a neonatalogist, a substance abuse clinician, a Health Department employee and a representative from the Phoenix House, a residential treatment facility in Brattleboro … all said women need not only treatment, but housing, transportation and help finding jobs.”

Alice Larned, a substance abuse clinician at the Lund Family Center in Burlington, told Krantz that spaces in residential detoxification facilities are increasingly scarce. The demand for transitional housing for women who have completed inpatient detoxification also exceeds the supply. Add to this the sad fact that women can wait a year or more for an appointment with a physician who can treat them with methadone or buprenorphine. Larned told Krantz that many of the women who start treatment with her are taking buprenorphine they bought illegally, an “indication they want help ‘yet we don’t have the legitimate means for them to get this medication[.]’”

In another story that ran last week on NPR, Steve Zind spoke with Harry Chen, the Commissioner of the Vermont Department of Public Health, who emphasized the complexities inherent in treating addiction in pregnant women and new mothers. To do so successfully, Commissioner Chen explained, “requires so many different systems working together well: the social service system, the health care system, the substance abuse system and even to some extent the correctional system.”

I confess that one reason that these two articles caught my attention is that Alice Larned is my sister.  Another reason, though, is that the problem described in the articles seems like a promising application for social impact financing, something that has been in the news here in New Jersey in recent weeks.

On January 17th, the New Jersey Legislature passed legislation that would have authorized the New Jersey Economic Development Agency to guarantee up to $15 million in private loans to private organizations that provide government-funded healthcare services.  The loans would fund “preventive and early intervention health care” with the goal of reducing government expenditures on, for example, inappropriate emergency department use.  In addition to loan repayments, the private lenders would be eligible for payment “in an amount proportional to the amount of public sector savings generated” by their organizational partners.  Governor Chris Christie pocket vetoed the bill on January 24th, but its sponsors have not given up and have already reintroduced it.

As it turns out (not surprisingly), I am not the first person to have the idea that social impact financing could be used to help families in crisis due to addiction.  The Connecticut Department of Children and Families, for example, is working with the Social Impact Bond Technical Assistance Lab at Harvard’s Kennedy School of Government to explore the use of “a social impact bond model to assist in financing DFC’s substance abuse treatment for parents involved with our child welfare system.”  The potential for measurable financial gain from, for example, avoiding foster care placement is clear.  At the same time, innovative initiatives  can be stymied by an overall lack of funds as well as by the age-old problem of effort and expenditures by one system resulting in often-invisible savings to another.  Social impact financing could be a way to overcome such hurdles.

In an article in The Non Profit Times last week, Mark Hrwyna wrote that 2014:

“is shaping up to be the year of the Social Impact Bond (SIB). Two announcements this week on either coast highlighted the momentum behind SIBs, also called Pay For Success (PFS) initiatives. Massachusetts today launched the nation’s largest yet, a seven-year, $27-million effort, just weeks after New York state announced what was at the time the biggest, at $13.5 million. Meanwhile, with funding from The James Irvine Foundation, the Nonprofit Finance Fund (NFF) announced on Tuesday initial funding of $2.5 million to help incubate and develop potential efforts in California.”

Notably, neither the Massachusetts nor the New York initiatives involves state-guaranteed loans, something social impact financing advocates in New Jersey might want to consider.  In The Non Profit Times, John Grossman of funder Third Sector Partners said of the Massachusetts project: “All dollars are at risk, with no backstop. Everyone stands to lose or gain on this.”

The new documentary On Life’s Terms: Mothers in Recovery about this issue has launched an outreach campaign to do 50 free screenings around the country hosted by gender-specific residential treatment programs.  Please donate here