Hawaii-2011-HB129-Amended

SECTION 1. The legislature established a perinatal clinic, the Path Clinic, as a three-year pilot project in 2006 in response to the high rate of methamphetamine use by pregnant women. The clinic provides comprehensive prenatal, delivery, and postpartum care and social services to women who have a history of substance use. Since it was established, the clinic has been successful in engaging this difficult-to-reach population of women. It supports them in decreasing their substance use and helps them deliver healthy infants that they are capable of parenting. Despite the high average cost of medical care for a single very low weight infant in its first year of life -- over $200,000 -- the clinic is cost-effective. However, this highly successful clinic is not sustainable without funding from the State.

The Path Clinic provides its patients with prenatal care that addresses their addictions in a small, dedicated, and nonjudgmental setting. Patients are also provided with social service support, parenting education, and transportation. Since its creation, the Path Clinic has cared for over one hundred eighty women, and it is expected to provide services to over sixty women with addictions in 2011.

The legislature initially appropriated $400,000 for this pilot project. Because of funding delays, only half of the funds were expended. Act 147, Session Laws of Hawaii 2007, authorized an appropriation of the remaining $200,000 for fiscal year 2007-2008. In March 2009, the Path Clinic was awarded a grant from the department of health to provide perinatal support services and triage, but due to budget restrictions, the grant was not funded. The clinic has continued to provide services through individual donations and small grants made to its tax-exempt charitable social service agency.

While the Path Clinic is not a substance abuse treatment program, its unique integration of prenatal, clinical, and social services results in a cessation of substance use in most women. It also assists some women to recognize that they require residential substance abuse treatment and facilitates their admission into an appropriate program.

Since its creation, the Path Clinic pilot project has achieved the following results:

(1) The effects of substance use and the associated risk factors (i.e., poverty, homelessness, interpersonal violence, tobacco and alcohol use, and co-occurring medical and behavioral health illness) on birth outcomes were largely ameliorated by the prenatal care at the Path Clinic;

(2) Patients in the program were overwhelmingly likely to stop using drugs, deliver healthy infants, maintain custody of their infants, choose a long-term birth control method, and choose to work on or develop skills six months after delivery;

(3) While infants born to women who received services at the Path Clinic were four to five times more likely to suffer preterm birth and low birth weight, the birth outcomes at the Path Clinic were consistent with state and national averages for all births;

(4) Eighty per cent of women treated at the Path Clinic abstained from drug usage and over ninety per cent significantly decreased substance use within eight weeks of using Path Clinic services;

(5) Ninety-four per cent of women treated were tested to be substance-free at the time of birth;

(6) Of the women who had positive drug tests at the time of birth, over half chose to enter a residential substance abuse treatment program, often noting that their experience at the Path Clinic contributed to their readiness to accept treatment;

(7) Ninety-six per cent of women treated maintained custody of their infants eight weeks after delivery (fifty-seven per cent had previously lost custody of at least one child); and

(8) The nine-month repeat pregnancy rate for women who maintained custody of their infants was lower than state and national averages while fifty per cent of the women who lost custody of their infants were pregnant again within nine months of having given birth.

The Path Clinic is a comprehensive perinatal addiction clinic that integrates prenatal and postpartum obstetric clinical services, addiction medicine services, and social services. The state medicaid program is billed for allowable clinical services. Although funding sources are available for medical services, essential social services that are provided by the clinic remain unfunded. State moneys are needed to fund these services.

The purpose of this Act is to appropriate funds to continue the Path Clinic pilot program.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2011-2012 and the same sum or so much thereof as may be necessary for fiscal year 2012-2013 as a grant pursuant to chapter 42F, Hawaii Revised Statutes, to the Path Clinic for case management and other social services that it provides.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 3. The moneys appropriated by this Act shall be used for:

(1) Case management for pregnant women and women who recently delivered (up to six months) who are struggling with substance abuse, including alcohol, to be provided by a master's degree level social worker or nurse experienced in the area of substance abuse treatment;

(2) Addiction medicine services that may not be funded by medicaid;

(3) Therapeutic childcare during clinic appointments and classes or activity groups;

(4) Transportation assistance to and from clinic appointments and classes or activity groups;

(5) Group classes and activities to support women in achieving their goals of giving birth to healthy infants that they are capable of parenting; and

(6) Administrative support to provide a dedicated space, integration of services, and support of education and research in the area of effective treatment of perinatal addiction.

SECTION 4. This Act shall take effect on July 1, 2117.

HOUSE OF REPRESENTATIVES	H.B. NO.	129
TWENTY-SIXTH LEGISLATURE, 2011		H.D. 2
STATE OF HAWAII		S.D. 2


S.D. 1S.D. 2