A simpler assessment tool for newborns exposed to opioids means more mom time and fewer medications

Cailyn Morreale continued using buprenorphine during her pregnancy. Once her baby was born, the two were never separated. (Photo by Taylor Sisk, KFF Health News)

A new approach is helping mothers recovering from opioid addiction and newborns with opioid exposure stay together after birth. Historically, babies born with opioid exposure have been separated from their mothers and received heavy medications in neuro-intensive units, but "research has since indicated that in many, if not most, cases, those extreme measures are unnecessary," reports Taylor Sisk of KFF Health News. "A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced."

Over the past decade, how pregnancy pairs with addiction treatment has changed, meaning most women can continue to take addiction-recovery medication throughout pregnancy. For Cailyn Morreale, a West Virginian from rural Mars Hill, the new methods helped her continue her recovery medicine, buprenorphine, and her care team assured her "that her baby would be assessed and monitored using the Eat, Sleep, Console approach," Sisk explains. "Morreale was never separated from her son. She was able to begin breastfeeding immediately. She was told, the trace of buprenorphine in her breast milk would help her son withdraw from it."

The Eat, Sleep, Console method is slowly replacing the older Finnegan Neonatal Abstinence Scoring System, which involved 21 evaluative questions. Sisk writes, "David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine, suggests this protocol could simply be called 'parenting.' Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade. . . .The results are persuading more health professionals to adopt the method."

A 2023 study found "babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care," Sisk reports. "Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, found a non-pharmacological-first approach works best. He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks."

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, "found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020," Sisk adds. "The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home."

A small town in Georgia answers a call to service and saves its volunteer fire department

Asst. Fire Chief Michael Moravek with mascot,
Fire Pup. (Photo by Jennifer King via the Echo)

Across the country, rural fire departments are struggling to attract, train and retain volunteer firefighters. In Oglethorpe County, Georgia, the small unincorporated town of Vesta had a fire department facing closure until they put a call out to the community for help, reports Makenzy Wolford of The Oglethorpe Echo. "Down to three volunteers and battling new state regulations, the station faced the possibility of extinction." That was four years ago. Now the Vesta Volunteer Fire Department is staffed with volunteers thanks to its residents' "overwhelming response."

Vesta Fire Chief Wayne King "wasn't even a volunteer firefighter four years ago," Wolford writes. "He, among the majority of the station’s current volunteers, were unaware the station needed help until Douglas Spencer spoke to the congregation of Vesta Baptist Church. . . . Douglas, along with his wife Nicole Spencer, were two of the remaining firefighters at the Vesta station. When the situation became dire, Douglas went to the church. . . . A dozen members, including King and now assistant chief Michael Moravek, chose public service that night."

Moravek told Wolford, “I’ve always wanted to do this. I’ve been living here for 25 years, and no one’s ever asked. I thought they didn’t need anyone else extra.” Wolford adds, "The once-grim station blossomed in the 3½ years since Spencer’s call to action. Handshakes, hugs and kind words flowed freely Saturday as the VFD hosted its annual barbecue fundraiser on the first day of deer gun season."

Firefighting requires physical stamina, extensive knowledge of fire and bravery, which is part of the reason why getting and keeping volunteers is difficult. Moravek told Wolford, "I was very surprised by the amount of training that we had to go through. Twelve weeks of training at night time. . . . And then it’s a continuous training experience.” Wolford reports, "Training and certification requirements are more involved and strenuous than many anticipated."

Like most rural communities, all of Oglethorpe County's fire departments are staffed by volunteers. Wolford adds, "The issue of staffing, like that Vesta faced, is not only a local problem. . . Nationally, fire departments are struggling to come up with a staff equipped to act as the community’s first line of defense against everyday emergencies."

Opinion: Growing up in Appalachia made navigating college tough. 'I felt compelled to abandon my background.'

Piper Slinka-Petka

An Appalachian student from West Virginia heads off to college at the University of Pennsylvania, dubbed "Penn" by most students, and encounters a community where she doesn't know how or when she will ever fit in and keep up with her urban counterparts. A lightly edited version of Piper Slinka-Petka's story from The Daily Pennsylvanian is shared below.

"During the same conversation, all first-year students find themselves in, state follows directly after name. Penn’s student body, while diverse, leaves many geographical regions underrepresented in their class. . . . When I reveal I am from West Virginia, home to Penn students few and far between, I get one of a few responses:

I haven’t heard that one yet. Are you the only one? (No, I am not.)

Like from the song? (Yes, the very state described by John Denver’s 1971 song, “Take Me Home, Country Roads.”)

I have family from Virginia, same thing, right? (Two different states, separated in 1863.)

"Growing up in Appalachia is an identity I spent my adolescence running away from. Portrayal in the media, such as by vice presidential candidate JD Vance’s "Hillbilly Elegy," paints Appalachia as a place for the uneducated, poverty-stricken, and lazy. The misinterpretation of rural America creates a narrative that all people inside of it are 'white, conservative, and dumb.' In conversations with other Penn students, I would explain my rural upbringing, and end with 'but at least I made it out.' I felt compelled to abandon my background to find my new place at Penn.

"It wasn’t the light pollution, lack of nature, or noise that made Penn so different — it was the culture. I found myself struggling to find an anchor with my urban peers. . . . I was always a step behind. My differences were possibly the most apparent at the dining hall. I grew up on simple, hearty foods like pepperoni rolls and baked mac & cheese — nothing like the diverse and unique food options my peers raved about. Penn’s food options felt like an entirely new language.

"The education I received, too, lacked greatly in comparison to my peers. In 2024, West Virginia was ranked the worst state for education. Approximately only 20% of West Virginians over 25 have a bachelor's degree or higher. While I’d been admitted to Penn, I was still the product of a struggling academic system. Even though I already knew my education put me at a disadvantage, I underestimated how much I would feel out of place at Penn. . . . Perhaps even more than educationally, I was lacking socially.

"Coming from a geographically underrepresented area meant I was at a disadvantage in navigating Penn. While my classmates seemed to effortlessly adjust to this new world, I felt lost grappling with new social dynamics, cuisine, and academics. The culture shock was not just locational; it was a reminder of how deeply our backgrounds influence our future. Although I felt the need to abandon my old life for Penn’s new offerings, I couldn't just put West Virginia behind me. I would have to actively work to bridge the gap between my unique upbringing and my new life at Penn. . ."

Free online class on rural mental health is available at eCornell. It's designed for vets and agribusiness partners.

A new online course, “Mental Health and Suicide Prevention in Rural America” aims to help veterinarians, agriculture partners and veterinary students learn about mental health issues in rural communities and how to help, reports The Daily Yonder. The class is supported by Cornell University’s College of Veterinary Medicine and NY FarmNet, in partnership with Rural Minds, a nonprofit organization dedicated to promoting mental health in rural America. People interested in taking the course can access it at eCornell. The course is offered at no charge to participants.

The online course provides "practical tips to help with mental health challenges, including recognizing and responding to warning signs, as well as providing key information on resources such as crisis hotline numbers and local supports," the Yonder staff reports. "Rural communities have disproportionately higher rates of suicide in their population compared to urban areas. Farmers are twice as likely than those in other occupations to die by suicide, according to Rural Minds, and veterinarians also face higher risks of suicide when compared to the general population."

Jeff Winton, founder and chairman of Rural Minds, told the Yonder. "As a dairy farmer, I know firsthand that veterinarians are an integral part of all rural communities. And they may be among the first to see warning signs that a client is experiencing a mental health challenge but may not recognize those same signs in themselves."

Sabato's Crystal Ball predicts the highest-profile issues on state ballots this year

Voters in 41 states will have at least one important item on the ballot this November in addition to all of the local and federal candidates running for office.

According to The Center for Politics – Sabato’s Crystal Ball, “The highest-profile issue on the ballot this year — as was the case in 2022 and 2023 — is abortion. . . .Voters will also be asked about a wide range of election-related issues, including ranked-choice voting, redistricting and non-citizen voting. Other common topics involve proposals on criminal justice, raising the minimum wage, recreational marijuana, and education policy.”

The Center for Politics, which is based at the University of Virginia, provides a guide to all of the ballot measures that can be found here.

The presidential race isn't top dog in Montana; both parties have eyes and ads fixed on the state's U.S. Senate race.

Tim Sheehy

Montana's heated senate race between incumbent Sen. Jon Tester (D-Montana) and first-time Republican candidate Tim Sheehy has put the presidential race in the rearview mirror. "The state is focused on a race that could determine control of the U.S. Senate, and the next president’s ability to get their agenda through Congress," report Rhonda Colvin, Ross Godwin and Whitney Shefte of The Washington Post. "On the ground, it is still a door-to-door, vote-to-vote fight to the finish, with historical levels of ad spending and an intense focus on Native American voters and potential ticket-splitters."

Native Americans comprise the sparsely populated state's largest minority voting block, but many are not registered voters. Ronnie Jo Horse, executive director of Western Native Voice, a statewide social welfare nonprofit, told the Post, "I think they are getting to know their power. We have 37,000 unregistered voters. Once people find that out and know that Montana wins elections on 3,000 votes, you can see their eyes get big and surprised.”

Jon Tester

Tester won the state's last three elections "partly because of support from Native voters and this year, the Montana Democratic Party announced a multimillion campaign focused on keeping their support," Colvin, Godwin and Shefte explain. "But Native turnout in the state has seen a downturn in recent elections" Republicans see Sheehy "as one of their best chances to unseat a Democrat and add to their numbers — and recent polls suggest they have some momentum."

Meanwhile, the intense campaigning has left some voters worn out from constant political chatter. "Montanans have been under a deluge of inescapable appeals for their vote. . . . The total ad spending from both sides in the race since January 2023 and planned until Election Day will come in at $275 million," the Post reports. Ad-weary Montana voter Machaela Goggins told the Post, “It feels like borderline psychological abuse. . . . I think people are just ready to have an answer one way or another."