Utilization of health and supportive services amongst children with prenatal opioid exposure: a mixed methods and community-initiated analysis

Research suggests long-term developmental implications of prenatal opioid exposure (POE) that may contribute to healthcare and educational service utilization patterns, such as lower utilization of preventative healthcare services, higher utilization of emergency department and inpatient services, and higher utilization of supportive educational services. However, research on how families navigate these services, including challenges and benefits, is limited. Parents and caregivers of children with POE worked with the study team to design, collect, and descriptively analyze mixed-method data. Data were collected through a survey (n = 148) and two focus groups (n = 15) from a convenience sample, 75% in West Virginia and Massachusetts. The vast majority of children in the sample received some type of supportive service, with Early Intervention (80%) and/or Individualized Education Plans (39%) being the most commonly reported. Additionally, children commonly received outpatient services such as occupational therapy (35%) or mental health counseling (31%), among others. Caregivers expressed navigating significant challenges in trying to access services for their children with POE, from a fractured and complex system to providers who do not see their child’s struggles or believe they are connected to POE. Utilization patterns did not vary between children with just POE and children with exposures to additional substances prenatally. Based on families’ reported experiences, investments in professional development for pediatricians and educators, a clinical understanding of the long-term implications of POE, best practices beyond the NICU, more integrated screening and services, and greater access to mental health services are top priorities. Prenatal opioid exposure is associated with long-term developmental implications and distinct healthcare and educational service utilization patterns. Existing research highlights contradictions: (1) These children are more likely to use hospital services but are not more likely to be diagnosed with chronic pediatric conditions, and (2) They may have less use of well-child visits but more use of school-based services. An investigation of health and education service utilization among children with prenatal opioid exposure, including their diagnoses, caregiver perspectives on the benefits and challenges of the services available, and perspectives on what services are still needed.