Overview with Pregnancy-specific Considerations

This section provides an overview of things to consider when training jail staff regarding MOUD (also referred to as MAT) for pregnant patients in custody. It outlines the basics of MOUD, the fundamental components of a jail-based MOUD program, and includes items you should incorporate in training like patient counseling and non-judgmental care.

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Key Points

HOW 

  • Assess your staff training needs related to MOUD in custody and MOUD for pregnant individuals in custody. If you are just starting a MOUD program, your staff would benefit from all trainings. If you already have an established MOUD program in your facility, you may want to focus on trainings specific to pregnant individuals including things like counseling and stigma. For assistance, view the checklists in the resources and consider seeking technical assistance (see MOMCARE Technical Assistance).
  • Determine the logistics for training staff including who will be the trainer, who will participate, how it will be delivered (in-person or virtual), the timing of delivery, how often it will be delivered, and how you will assess for knowledge and skill retention.
  • Administrators must develop a plan to provide supervision and support to staff throughout the process. This includes providing a space for open dialogue without fear of consequences to address misconceptions and false beliefs regarding addiction, MOUD in general, and in pregnancy.
  • Regularly monitor your MOUD program processes (e.g. screening, dosing, linkage to care at release) to determine if training refreshers are needed. Soliciting feedback from staff who deliver and patients who receive this care can also inform training.

WHY 

  • MOUD has been the long-established evidence-based treatment for individuals who use opioids, including in pregnancy.
  • A prepared workforce produces standardized care and better outcomes for both the facility and patients.

KEEP IN MIND

  • Some staff may have very limited knowledge of what MOUD is including benefits for people who use opioids. Starting with basic fundamental education on addiction and opioid use is necessary.
  • Jail leadership should provide ongoing staff supervision and support to make sure staff needs and concerns are addressed regarding MOUD implementation. This could take many forms including regular one-on-one or group check-ins, anonymous question/feedback submissions, etc.
  • If you partner with an OTP or outside provider to provide MOUD in custody, they should receive training on custody MOUD protocols and procedures specific to your setting (see training checklist for community organizations)
  • You can reach out to your local health department to find out if they offer in-person training on MOUD and MOUD in pregnancy.
  • Training materials should include facility-specific information that references your protocol for pregnant patients in custody and those with OUD

🤰PREGNANCY-SPECIFIC CONSIDERATIONS

Staff should be trained on care and situations specific to pregnant patients like:

  • Urgent maternal warning signs
  • When to transport a pregnant patient to the hospital for labor/birth or a higher level of care
  • Abortion access
  • Postpartum care
  • Restraint use
  • Stigma and language
  • MOUD counseling

Deeper Dive

HOW 

Action Items

  1. Assess your staff training needs related to MOUD in custody and MOUD for pregnant individuals in custody. If you are just starting a MOUD program, your staff would benefit from all trainings. If you already have an established MOUD program in your facility, you may want to focus on trainings specific to pregnant individuals including things like counseling and stigma. For assistance, view the checklists in the resources and consider seeking technical assistance (see MOMCARE Technical Assistance).
  2. Determine the logistics for training staff including who will be the trainer, who will participate, how it will be delivered (in-person or virtual), the timing of delivery, how often it will be delivered, and how you will assess for knowledge and skill retention.
  3. Administrators must develop a plan to provide supervision and support to staff throughout the process. This includes providing a space for open dialogue without fear of consequences to address misconceptions and false beliefs regarding addiction, MOUD in general, and in pregnancy.
  4. Regularly monitor your MOUD program processes (e.g. screening, dosing, linkage to care at release) to determine if training refreshers are needed. Soliciting feedback from staff who deliver and patients who receive this care can also inform training.

Training needs will differ by facility but we encourage everyone to complete trainings on the basics of MOUD in pregnancy, MOUD in a carceral setting, and stigma and language (see subsequent sections for details). All staff should be aware of their facility’s MOUD program model, staffing design, and organizational needs. Medical and security staff who are directly involved in the provision of MOUD in their facility should receive additional training.  Although some topics only pertain to medical staff and others to custody officers, both groups must understand each other’s roles and expectations. We highly recommend that these core staff, if not all staff, engage in training related to values, behaviors, trauma-informed care, and stigma.

Jails should consider the following items to determine how they will train staff regarding MOUD for pregnant individuals in custody:

  • The best way to deliver content (e.g. in-person trainings, webinars, case examples/simulation activities, individual vs group training, etc.)
  • How often staff should be retrained/engage in training activities
  • Who should participate in training and who should deliver the training
  • The best way to foster buy-in and increase knowledge regarding MOUD for pregnant patients in jail

We suggest that staff be trained at the inception of their MOUD program or when there are changes to their MOUD program. New staff should be trained during onboarding. Staff directly involved in MOUD provision should receive more in-depth training and regular refreshers to ensure evidence-based care and prevent diversion.

While in-person training is best for engagement and knowledge retention, we know that it is not always feasible. We provide recommended virtual training as well as where you can go to request in-person training.  All recommended trainings are FREE.

 

🤰PREGNANCY-SPECIFIC CONSIDERATIONS

  • We recommend using this CDC and ACOG resource to train your staff on urgent maternal warning signs, including labor—it can be a brief 20-minute in-service so they know what things to take seriously.
    • The website has some details about why various symptoms are concerning, and this is helpful for training.
    • Print out the flyers—the website has them in English and many other languages—and post them in clinic and housing units where there are pregnant females. This helps the pregnant patients and staff remember what the urgent maternal warning signs are.
  • Use these short training videos to educate your staff on:
  • Train staff on when to transport a patient who might be in labor. Key training points:You cannot diagnose labor just by looking at someone. They need an exam of their cervix by a qualified perinatal clinician.
    • Have a low threshold to transport pregnant patients who might be in labor. Transports to the hospital are a hassle, but they are less of a hassle than a baby being born in jail and the lawsuit that is likely to follow.
    • The signs of preterm labor (< 37 weeks) are even more subtle than labor at term. Have a low threshold to transport a preterm patient who has any vaginal bleeding, leaking fluid, or recurrent cramps/contractions of more than 5 in one hour.
    • Purchase an emergency delivery kit to have at your jail, just in case someone gives birth in jail. They are not very expensive!
      • Have an in-service every year on what’s in the kit and how to use it. You are not training your staff to be midwives or obstetricians, just to know the basics until EMS help has arrived!
    • Abortion Access
      • Train medical staff to know what’s allowed in your state.
      • Train medical staff to ask pregnant patients who are early in their pregnancies (eligible in your state for an abortion) if they want to continue the pregnancy or seek abortion.
      • Use this MOMCARE 1-pager, Abortion in Custody: FAQs for Correctional Staff, to educate correctional staff on why someone might seek an abortion and what jail staff need to know if someone requests and obtains an abortion in custody. 
    • Postpartum Care
      • Identify a lactation consultant at the birthing hospital who can do telehealth visits if women are having problems. Have that person train a champion at your jail to be an onsite resource.
    • Restraint use
      • Train all staff (medical and custody) on the non-use of restraints in pregnancy and postpartum periods. Make sure you comply with your state’s law.
    • Train staff to address stigma and language around drug use and treatment in pregnancy
    • Train staff on topics and techniques for counseling pregnant and postpartum patients about MOUD

WHY

Medications for opioid use disorder (MOUD) have been the long-established evidence-based treatment for individuals who use opioids. This includes methadone and buprenorphine for pregnant patients. However, some jails are now just beginning to offer MOUD to pregnant individuals and others in custody. To optimize treatment retention and results, jails must build MOUD programs that are informed by data while adapting to the correctional environment.

Our goal is to guide jail staff in gaining the knowledge and tools to care for pregnant patients with OUD and execute MOUD in custody. A prepared workforce produces better outcomes for both the facility and patients. There are a lot of misconceptions and stigma around opioid use in general, but especially regarding pregnant individuals. We advise ALL staff (administrators, medical, and line staff) to engage in the training and education materials to increase their knowledge and know-how, as well as to create a jail environment of shared values and openness. Upon training completion, staff should understand how MOUD is compatible with the goals of their facility and understand what role they play.

Resources