Maricopa Safe, Healthy Infants and Families Thrive (SHIFT)

At a glance

  • The Maricopa County Public Health Department in Phoenix, Arizona, is one of 40 agencies funded by CDC's Overdose Data to Action: LOCAL cooperative agreement to respond to the drug overdose crisis.
  • SHIFT brings family support and substance use disorder (SUD) professionals together to reduce the stigma of expectant mothers with an SUD and improve outcomes for newborns and families.
  • SHIFT emphasizes the importance of the parent-infant relationship, and that improving the quality of life for parents results in healthier, safer babies.
Adult hands gently holding a baby's tiny feet

Substance use, pregnancy, and stigma

When pregnant women struggle with SUD, they can feel isolated, afraid, and overwhelmed. Pregnant women may feel stigma or shame and avoid seeking the critical care they need. Families may also fear mandated reporting requirements—from law enforcement or child welfare officials—that could lead to the loss of parental custody rights when seeking care. Nonjudgmental, compassionate support, and evidence-based best practices support the best possible outcomes for babies and their mothers.

The Maricopa County SHIFT collaborative supports a multidisciplinary network of programs that serve pregnant and postpartum women and families affected by SUD. The program's goal is to ensure these individuals and families receive person-centered, high-quality, compassionate care including prenatal care and SUD treatment during pregnancy. Maricopa SHIFT recruits, trains, and engages an extensive network of partners that collaborate to deliver services and reduce the stigma associated with SUD during pregnancy.

The key to Maricopa SHIFT is engaging with families during pregnancy. Early engagement helps identify prenatal substance exposure; reduces the time it takes for parents and infants to get services; increases cross-system coordination; and keeps families safely together—ultimately leading to better health outcomes for parents, children, families, and communities. Developing a plan of safe care before giving birth greatly improves the likelihood that the newborn will go home with their parent(s).

I've been touched by the issue of substance use personally, and I felt helpless at that time. I didn't know who to turn to or where to go for help. I never want another family to feel that way. If families suffer, so do we. If one family heals, so do we.

- SHIFT team member

Stepping up to support families

The Maricopa SHIFT collaborative is modeled after Vermont's CHARM (Children and Recovering Mothers), which was established in 2003 to improve cross-system collaboration and outcomes for newborns and families affected by SUD.

Partners include:

The Maricopa SHIFT team also includes peer mentors with lived and living experience with substance use and recovery during pregnancy. The Collaborative began with 10 stakeholders but has since grown to 123 members from 57 organizations.

SHIFT creates connections and fosters community

SHIFT educates everyone who comes into contact with families impacted by SUD to treat moms with dignity, provide compassionate care, and take action for integrated case management.

Creating a system of care like SHIFT requires courageous optimism on the part of multiple leaders and support from their respective organizations. According to SHIFT leadership, "This is within our grasp today. Our communities are waiting for us. Our families are calling us. Our babies are asking to be raised by their healthy parents. To achieve this will require all of our systems, policies, procedures, and people to recognize that SUD is not a character flaw; is not a criminal justice issue; but rather is a treatable condition that millions of parents recover from. This is our task at hand. Our communities deserve the best we have to offer of ourselves."

The future of SHIFT in Arizona

Four of Arizona's 15 counties currently have a SHIFT collaborative, moving towards the goal of one in every county statewide. Each county SHIFT collaborative in Arizona has different strengths and expertise. Innovative practices are encouraged, and successes are shared with the SHIFT Statewide Leadership team with the aim of achieving consolidated, broad systems change. Maricopa County has the largest population in the state, so five regional Maricopa SHIFT Partnership teams are in development to cover each region of the county.

The impact

Since 2019, Maricopa County has trained 3,800 professionals on the SHIFT approach; the complexities of myths and facts regarding SUD during pregnancy; best practices to improve outcomes; and reducing stigmatizing attitudes, behaviors, and practices.

Once fully implemented, the Maricopa SHIFT approach is expected to achieve significant cost reductions to systems of care (including Medicaid). For example, the average cost of treatment for a newborn exposed to opioids or other substances is over $30,000 per child, with an average hospital stay of 20 days. Under the SHIFT collaborative model, the average stay in specialized care is six days at a cost of $3,000 per newborn. The approach also reduces trauma experienced by families, and compassion fatigue and burnout among social workers.

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