New England has the second highest rate of prenatal opioid exposure in the country. This population of women and children is particularly vulnerable and requires a comprehensive, multidisciplinary approach in order to overcome barriers to care and support good outcomes. This webinar will describe how one rural community collaborated to create a screening, referral and support program called EMPOWER (Engaging Mothers for Positive Outcomes with Early Referrals). Learn how this innovative approach helps support women and improve outcomes by identifying and addressing barriers to care for patients, health care providers and their community.
Learning Objectives
Participants will:   Recognize how prenatal opioid exposure affects the health and wellness of women and their newborns. Identify effective strategies to address barriers to care for women and newborns affected by Perinatal Substance Use Disorder and Neonatal Abstinence Syndrome. Understand the benefits of utilizing a comprehensive, community-based approach to improve outcomes

Halpin, Susan Marie

Jablonski, Linda

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS National Network of Libraries of Medicine New England Region (NNLM NER) Repository National Network of Libraries of Medicine New England Region 2018-5 EMPOWER: A Community-Based Approach to Improve Care for Women and Newborns Affected by Perinatal Substance Use Disorder Linda Jablonski Baystate Health Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/ner  Part of the Clinical and Medical Social Work Commons, Library and Information Science Commons, Maternal, Child Health and Neonatal Nursing Commons, Psychiatric and Mental Health Commons, Psychiatric and Mental Health Nursing Commons, Public Health Commons, Public Health and Community Nursing Commons, and the Substance Abuse and Addiction Commons Repository Citation Jablonski L, Halpin SM. (2018). EMPOWER: A Community-Based Approach to Improve Care for Women and Newborns Affected by Perinatal Substance Use Disorder. National Network of Libraries of Medicine New England Region (NNLM NER) Repository. https://doi.org/10.13028/m97e-s422. Retrieved from https://escholarship.umassmed.edu/ner/56 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in National Network of Libraries of Medicine New England Region (NNLM NER) Repository by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Welcome to the Webinar EMPOWER: A Community-Based Approach to Improve Care for Women and Newborns Affected by Perinatal Substance Use DisorderTo Connect to Webinar Audio1. To receive a call back, provide your phone number when you join the event, or call the number below and enter the access code2. Call-in toll number (US/Canada) 1-650-479-3208To view the captions for this event click on the URL in the chat box.http://livewrite-ncc.appspot.com/attend?event=cit001Susan Halpinsusan.halpin@umassmed.eduNNLM NER, Education & Outreach CoordinatorUniversity of Massachusetts Medical School Worcester, MassachusettsYour Webinar HostMissionAdvance the progress of medicine and improve public health by making biomedical information accessible to everyone.Physical library is Bethesda, MD part of the NIH campus. Largest biomedical library in the worldOne of the federal government’s largest providers of digital contentThe library is open to everyoneAbout the National Library of Medicine• Nationwide network of health sciences libraries, public libraries & information centers • Each region has a partnership with a regional medical library• Outreach provided through Free access to online health & medical resourcesFree Training & Professional DevelopmentGrant funding opportunities available for your communityNLM Carries Out its Mission ThroughThe National Network of Libraries of Medicinehttps://nnlm.gov/Substance Use Disorder Resources from the National Library of Medicine (Updated 5.3.18)• Opiate Addiction and Treatment Information Guide https://sis.nlm.nih.gov/enviro/addiction.html• Disaster Lit® search of opioid guidelines, reports, factsheets, etc., including:- Fentanyl Safety Recommendations for First Responders https://disasterlit.nlm.nih.gov/record/16121- How HIPAA Allows Doctors to Respond to the Opioid Crisis https://disasterlit.nlm.nih.gov/record/16093- Preventing Opioid Misuse in the States and Territories: A Public Health Framework for Cross-Sector - -Leadership https://disasterlit.nlm.nih.gov/record/15995• MedlinePlus Opioid Abuse and Addiction https://medlineplus.gov/opioidabuseandaddiction.htmlAbuso y adicción de opioids https://medlineplus.gov/spanish/opioidabuseandaddiction.html• HealthReach low-literacy patient materials about opioids, opioid addiction, and opioid treatment (includes documents, videos, and audio)PHPartners Information Access for the Public Health Workforce https://phpartners.org/PHP Partners aggregates a lot of public health news, some of it involving substance misuse from a public health point of view,http://www.pewtrusts.org/en/multimedia/audio/2017/treating-the-opioid-epidemic. Partnership for Drug-Free KidsHeroin, Fentanyl & Other Opioids – A Comprehensive Resource for Families with a Teen or Young Adult Struggling with Opioid Use - https://bit.ly/2vb6OnmLactMedhttps://www.toxnet.nlm.nih.gov/newtoxnet/lactmed.htmOffering programming on addiction and recovery? Consider borrowing one of our Graphic Medicine Book Club Kits featuring Sobriety: A Graphic Novel! From the publisher… “Through rich illustration and narrative, Sobriety: A Graphic Novel offers an inside look into recovery from the perspectives of five Twelve Step group members, each with a unique set of addictions, philosophies, struggles, and successes while working the Steps.”To Request a Kit: www.nnlm.gov/ner/kitsFor Questions or Further Information, Contact Sarah Levin-Lederer at Sarah.LevinLederer@umassmed.eduLinda Jablonski, RNC, MSNAssistant Nurse Manager, The Birthplace, Baystate Medical CenterCo-Chair Franklin County Perinatal Support CoalitionYour Webinar PresenterEMPOWER A Community-Based Approach to Improve Care for Women and Newborns Affected by Perinatal Substance Use DisorderLinda Jablonski RNC, MSN Assistant Nurse Manager, The Birthplace; Co-Chair Franklin County Perinatal Support Coalition DisclosuresI have no actual or potential conflict of interest in relation to this program/ presentationObjectivesParticipants will:• Recognize how prenatal opioid exposure affects the health and wellness of women and their newborns.• Identify effective strategies to address barriers to care for women and newborns affected by Perinatal Substance Use Disorder and Neonatal Abstinence Syndrome• Understand the benefits of utilizing a comprehensive, community based approach to improve outcomes.TerminologySUD – Substance Use DisorderSEN – Substance Exposed NewbornNAS – Neonatal Abstinence Syndrome  MAT – Medication Assisted TreatmentPerinatal Substance UseSource: HPC analysis of Center for Health Information and Analysis, Inpatient Discharge Database 2011-2015Notes: NAS discharges were identified using ICD-9-CM diagnosis code 779.5 (drug withdrawal syndrome in a newborn). Perinatal Substance UseRisks to Mother:- Miscarriage- Limited Prenatal Care- Preterm birth- Placental abruptionRisks to Baby- Growth Restriction- Low birth weight- NAS- Potential long term effectsF1000 Research 2016 5(F1000FacultyReview):887 LastUpdated 13 May 2016Medication Assisted Treatment ACOG Recommendation Stabilizes serum opioid levels  Reducing harm to fetus Reduction in illicit drug use Reduces risk of infectious disease Relapse prevention Adherence to prenatal care Improved neonatal outcomes In combination with behavioral therapy Substance Abuse and Mental Health Administration. Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants.  HHS Publication No. (SMA) 18-5054.  Rockville JD: SAMHSA, 2018Neonatal Abstinence Syndrome• SEN vs NAS• Symptoms• Diagnosis• Treatment• NAS Ø AddictionPrior, J. et.al 2015, “The Opioid Epidemic and Neonatal Abstinence SyndromeA review of the Continuum of care”  ArchDis Child Fetal Neonatal ED Doi:10.1136/archdischild-2015-310045Neonatal Abstinence Syndrome• Breastfeeding• Non-pharmacologic treatment• Long TermOutcomesLogan, B, Brown, M, Hayes, M. 2013 “Neonatal Abstinence Syndrome: Treatment and Pediatric Outcomes.  Clinical Obstetrics and Gynecology Volume 56, Number 1, 186-192.Our Community450 deliveries a year91% White  5% Hispanic50% Mass HealthCommunity InvolvementOur Mission“To create a comprehensive safety net for all mothersduring the perinatal period in order to support optimal perinatal emotional health.”“To systematically evaluate and implement measures to improve the quality, safety and effectiveness of nursing practice for women and newborns.”Community Based Support ModelMA hospitals with highest rate of NAS in 201512 CHART hospitals8 non-CHART hospitalsSource: HPC analysis of Center for Health Information and Analysis, Inpatient Discharge Database 2015Notes: NAS discharges were identified using ICD-9-CM diagnosis code 779.5 (drug withdrawal syndrome in a newborn).  Only includes hospitals with 12 or more NAS discharges. Intrauterine Substance ExposureIllicit Drug UseCocaine – 6/24Heroin  8/24Prescription Opioids1/24Abuse of PrescriptionOpioids   3/24MATMethadone 11/24Buprenorphine 12/24SubstanceExposed NewbornsBenzodiazepines5/24TOBACCO23/24 THC14/24Collaborative ApproachBest Practice Coordinated,Multisystem approach Collaborative planning Service implementation Advance planning for safe care Comprehensive FrameworkSAMHSA  A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders.  HHS Publication No. (SMA) XX-XXX.  Rockville, MD:Substance Abuse and Mental Health Services administration, 2016.  Available at: http://samhsa.govOur ApproachAddress barriers to care:• Individual barriers Decrease Stigma Improve access to care  Recovery Support• Provider Barriers Training Screening and Referral Standardized protocols • System Barriers Care Coordination CommunicationByatt, N. et.al 2013 General Hospital Psychiatry, Volume 35, Issue 6, Pages 598-604, Patient’s views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals?Individual Barriers  Addiction Co-Existing Mental Health Diagnosis• AnxietyDepression• ADHD Fear and Stigma Guilt and Shame Family History PTSD Economic InsecurityNREPP  Learning Center Evidence Summary.  Substance Use Treatment for Pregnant women.  2017Pregnancy as MotivationMotivation:Seek TreatmentIntensify Treatment- 80% decrease in use from 1st trimester to 3rd trimesterSAMHSA TEDS 2014Provider Barriers Training Needs• SUD, Addiction• Trauma Informed Care• SBIRT Screening Tool Referral Process Protocols Work Flow EMR ReimbursementSystems Barriers to Care Silos Competition Lack of Referral System Collaboration Coordination Communication Release of InformationOur Coalition PartnersEARLY CHILDHOOD MENTAL HEALTH ROUNDTABLE OF FRANKLIN AND HAMPSHIRE COUNTIESOur Solution: EMPOWEREngagingMothers forPositive OutcomesWithEarly ReferralsOvercoming Provider Barriers:IHR 5 P’s Screening ToolOvercoming Provider Barriers:Overcoming Provider Barriers:Training SU & PSU Motivational Interviewing SBIRT Trauma Informed Care Buprenorphine CertificationOvercoming System Barriers Community Conversation Collaboration Monthly Meetings Case Studies Trainings RelationshipsOvercoming System BarriersRecovery CoachScreening Timeline2012 Circular Letter 13-5-586  Commonwealth of Massachusetts Department of Public Health “Guidelines for Community Standard for Maternal/Newborn Screening for Alcohol/ Substance Use2012 ACOG Committee Opinion # 524  “Opioid Abuse, Dependence and Addiction in Pregnancy”36 weeks Follow Up ConsultPregnancy PlanPeer MentorPostpartum28 WeeksFirst Office VisitOvercoming Patient BarriersPregnancy Plan Visits Fear and Stigma Stories Education DCF Information ReferralsOvercoming Patient Barriers Rooming in Non Pharmacologic Care Infant Care Cuddler Program EmpowermentOvercoming Patient BarriersPregnancy PlanPilot Study Retrospective Chart Review Quasi-experimental Design N=38 38 medical records women with SUD 19 cases: participated in EMPOWER (6/1/15-1/31/16) 19 randomly selected historical controls prior to EMPOWER (6/1/12 – 5/31/15) (Paterno, Jablonski, Klepacki, & Friedmann 2018)Pilot StudyMaternal Outcomes Initiation of breastfeeding Continuation of breast-feeding Initiation of contraception Prenatal and postpartum depression Number of referralsNeonatal Outcomes Pre-term birth Birth weight Length of Hospital stay Diagnosis of NAS(Paterno, Jablonski, Klepacki, & Friedmann 2018)Maternal OutcomesNot EMPOWERn = 19EMPOWERn = 19 Total nInitiated breastfeedingYesNo145181326Breastfeeding at dischargeYesNo145172317Not EMPOWERn = 14EMPOWERn = 17 Total nFull continuation of breastfeeding6 12 18Partial continuation of breastfeeding8 5 13Continuation of Breastfeeding at Hospital Discharge (among those who initiated breastfeeding)Breastfeeding Initiation (Paterno, Jablonski, Klepacki, & Friedmann 2018)Maternal Outcomes(Paterno, Jablonski, Klepacki, & Friedmann 2018)Not EMPOWERn = 19EMPOWERn = 19 Total nAny prenatal referral YesNo1181722810Recovery coachYesNo0191451424Residential treatment/detoxYesNo019316335Mental health providerYesNo118415533EI/REACHYesNo019316335Prenatal Community ReferralsNewborn OutcomesNot EMPOWERn = 19EMPOWERn = 19 Total nDiagnosed with NASYesNo6121181720Preterm birthYesNo217118325Newborn OutcomesNot EMPOWERn = 19Mean (SD)EMPOWERn = 19Mean(SD)Gestational age at birth (weeks)39.2 (1.5) 39.3 (1.6)Birthweight2963 (533) 3367 (605)Length of Hospital Stay7.0 (6.4) 11.4 (8.6)Newborn Outcomes(Paterno, Jablonski, Klepacki, & Friedmann 2018)Opportunities Postpartum Support• Early Intervention• Infant Massage Case Management  Individual Care Collaboration Support Groups Doula Program Prenatal classes Follow up for moms and babies Re-visit our scopeKeys to Success Focus on Patient Experience Lived Experience Expertise Community Based Model Grass Roots Leadership  Strategic Positions Addressing Barriers Questions Contact InformationLinda Jablonski RNC, MSNAssistant Nurse ManagerThe BirthplaceBaystate Franklin Medical CenterCo-Chair Franklin County PerinatalSupport CoalitionLinda.jablonski@baystatehealth.orgEVALUATION LINKhttps://www.surveygizmo.com/s3/3529624/93c2b5c34319Evaluation Code – subuse2Please follow the instructions below in order to complete an evaluation and claim an MLA Certificate of Credit for your participation.You have 30 days from the date you completed the course to complete an evaluation and claim credit. Here are the instructions to receive MLA Credit.1. Go to www.medlib-ed.org.2. Login. If you do not have a current MLANET login, please Register as an MLA guest. After you’ve set up your MLA account and you're logged in to MLANET, click MEDLIB-ED on the navigation bar to return to MEDLIB-ED.3. Click My Learning on the blue bar near the top of the MEDLIB-ED home page.4. Enter the [code] and complete the attestation and evaluation and claim credit.5. To learn more about MEDLIB-ED, please see the FAQ in the About menu.6. If you have questions or run into problems, please email MEDLIB-ED@mail.mlahq.org.Receiving MLA Continuing Education Credit?You must complete the webinar evaluation to receive MLA credit Upcoming WebinarJust Talk About It: Using Mental Health Education to Prevent & Treat Substance Use Disorder June 12, 2018 3PM-4PMCarl Antisell, Speaker/Director of Strategic Communications and Information Services for Minding Your Mind*Registration link http://bit.ly/2HCKCVpCarl Antisell from the Minding Your Mind (http://mindingyourmind.org) organization will share the story of his journey through addiction to recovery. Carl will discuss what to look for as warning signs of potential mental health issues such as stress, anxiety, depression and crisis. Learn to look beyond the stigma associated with mental health, and use strategies with students, friends and family to address signs of difficulty using vocabulary that invites engagement, empathy, care and respect. 

EMPOWER: A Community-Based Approach to Improve Care for Women and Newborns Affected by Perinatal Substance Use Disorder

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EMPOWER: A Community-Based Approach to Improve Care for Women and Newborns Affected by Perinatal Substance Use Disorder

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