Bridging Patient Care, Polling, and Policy

In the 1950s, Stephen Patrick’s grandfather worked on the railroad in Bluefield, West Virginia. The railroad served a booming coal industry. But when the industry began declining, things changed. The town’s population is now half of what it was 60 years ago. Jobs are hard to find. And the county’s overdose death rate is three times the national average.

The growing prevalence of substance use disorders in his hometown did not personally affect Patrick’s life—or those of his loved ones—during his youth. It was years later, when he was finishing his medical training in the neonatal intensive care unit at the University of Michigan in 2010, when he came face to face with the dire effects of the country’s opioid epidemic.

“We started seeing more babies having opioid withdrawal, and those infants really stood out because in a sea of infants who were critically ill, these were kind of big, fussy, irritable infants. And people weren't really talking about it. So, it really led us to ask, ‘What’s going on?’”

In these situations, many people initially blame the mothers. But, if you let go of assumptions and ask the right questions, he says, you’ll quickly learn that the issue runs much deeper. “You learn about barriers to treatment. You learn about people's trauma, lack of economic opportunity, the layers of things that fall into place.”

Patrick, MD, was riveted. And deeply disturbed. As the father of a young daughter (and another soon to follow), he couldn’t bear to see the infants and mothers suffer. He dove into research on pregnant people’s access to opioid treatment. His research quickly gained prominence through publications in top medical journals like JAMA.

After finishing his training, Patrick took his work to the national level, becoming a policy adviser at the White House. Over the next few years, he testified multiple times before Congress on neonatal abstinence syndrome (when babies withdraw from drugs they are exposed to before birth), reviewed policy on medication-assisted treatment (MAT), and led the development of the Biden-Harris Administration’s action plan to support pregnant people battling substance use disorders.

Finding Access to Care

In West Virginia, 1 in 25 infants are in foster care, many due to parental substance use. In Patrick’s home county, up to 5% of infants are born experiencing drug withdrawal. Meanwhile, health care—both for substance use treatment and delivery—is harder to find than ever.

“The hospital where I was born doesn't even exist anymore,” he says. The shortage is emblematic—and a driving factor—of the state’s struggles with poverty, health problems, and substance use disorders.

As a result, the remaining health care centers in the state have been overwhelmed, making it even harder to find treatment.

To find out more about the intersecting crises, Patrick developed an innovative study to examine opioid treatment barriers from the patient perspective. He carried out a “secret shopper” study encompassing 10 states in which women called MAT providers listed on government websites. Half the time, participants weren’t even able to get someone on the phone after at least five attempts. Of the participants who were able to get in contact with treatment programs, the “pregnant” people were 17% less likely to be accepted for treatment. Many participants also reported that the person who answered their call was unkind or judgmental.

Some states have enacted policies that prohibit such discrimination against pregnant people in treatment program admissions. Patrick examined those in a separate study. “We found them to be largely ineffective,” he says.

“We're seeing record levels of pregnant women dying from an overdose,” he adds. “We have to be able to do this better.”

So, he did.

From Polling to Policy

In 2020, Patrick became executive director of Firefly, a Vanderbilt program that cares for pregnant people with addiction. Its specially designed infrastructure integrates obstetrics, psychiatry, MAT, peer support, and connections to food banks and other resources.

Over the past two and a half years, about 350 mothers have gone through the program. Patrick was especially touched by one patient, who was getting her first ultrasound when the sonographer asked if she had found a home [meaning, adoption placement] for the baby yet.

“Because people who use drugs never end up with their baby, it’s almost a foregone conclusion [that they will have to give the baby up for adoption],” Patrick explains, becoming emotional. “I have two girls, and I can't imagine that feeling. It's supposed to be a happy moment, but that's what you're faced with. So, she found her way to our program, got into treatment, and here she was [telling her story to a radio audience] holding her 15-month-old baby, both thriving and doing well.

“I'm a pediatrician, so I'm an optimist. I think these things are changing. I know they are because I've seen them incrementally get better,” he says. “In the time that we've been here at Vanderbilt, the care that we deliver to newborns that are opioid-exposed is completely different. It is more parent-family centric. Meanwhile, Firefly is making a tangible difference on clinical outcomes.”

Those outcomes are bolstered by qualitative research that shows patients feel connected and supported.

“It gives us this ability to say, ‘Hey, this doesn't have to be this way,’” Patrick concludes. “And we can think about how to transform not just one person at a time, but systems and communities. And that's what public health is all about.”

A Spectrum of Perspective

Patrick’s ability to bridge clinical work, research, and public health made him stand out to recruiters at Rollins. “We were thrilled by Dr. Patrick's deep research expertise, his work engaging in health policy discourse, his experience building new research initiatives, his strong focus on mentorship throughout his career, and his core principles that align well with our school,” says Don Operario, PhD, who led the search committee for the Department of Health Policy and Management chair.

“He's actually the doctor caring for those babies, so he really has a perspective of the whole family,” explains Dani Fallin, PhD, dean of the Rollins School of Public Health. Furthermore, Patrick’s expertise in polling helps researchers match what communities want with the policies that can meet those needs. Fallin admires how his passions span from “individual patient care to population health and how policies affect that population. It's a wonderful spectrum of perspectives.”

“He is just an incredible health services researcher in an area that's really important to the school and for the public's health,” she says, referring to Rollins researchers with similar interests, such as Hannah Cooper, ScD, Rollins Chair of Substance Use Disorders Research; Janet Cummings, PhD, professor of health policy and management; and Ben Druss, MD, Rosalynn Carter Chair in Mental Health; as well as colleagues in the School of Medicine. “It’s a wonderful fit in terms of the research that we do, the values that we have as a school, and where we're moving forward.”

“The Department of Health Policy and Management is critical to a thriving school of public health,” Fallin adds, because so much of the work in other departments depends on the translation of research to policy.

These policies become even more impactful when medicine, nursing, and public health join forces. And as a neonatologist, researcher, and policy expert, Patrick is poised to facilitate those relationships.

A team effort

And for Patrick, everything is about collaboration. When pressed to talk about his achievements, he always circles back to the power of teamwork, repeating, “But none of this has just been me. It's really been about the team.”

As he prepares to join the Rollins team on June 1, he has been meeting with staff and students to learn more about the department and their visions for it. According to Fallin, Patrick regularly asks people questions like, “How can I do what's best for the faculty, staff, and students in the department? How should I use my time to effectively promote them and see them thrive?’”

“I, and many who met him, were very impressed with his ability to listen, his ability to be very thoughtful and reflective, and his ideas for how to create community and nurture community,” says Fallin.

Operario, chair of the Department of Behavioral, Social, and Health Education Sciences, concurs. “He comes to Rollins with excitement to co-create collaboration and boundless energy to make things happen.”

Patrick wants to build a community where people are genuinely excited to come to work every day, where they feel supported by their colleagues, and where they have access to the tools they need to pursue their passions. He looks forward to expanding access to career-advancing tools such as mentorship, coaching, and skill-building opportunities.

Meanwhile, he’s excited to move to Atlanta with his two daughters, who are now 18 and 13, and his wife, Kelly. “And we have our dogs,” he adds, three rescues “who like to bark.”

“He and his wife are both really engaging people who want to talk not only about whether Schitt’s Creek was the best show ever made,” says Fallin, “but also about what policies are going to be most important for the opioid crisis and beyond.”