Please see below for a variety of resources recently shared by CHoSEN partners:
Nationwide Study Shows Continued Rise in Opioid Affected Births, January 2021
Postpartum Behavioral Health in Colorado, February 2021
Mothering and Opioids Toolkit: Addressing Stigma- Acting Collaboratively
Knowledge to Action: Care Equity for Black Moms: AWHONN - The Association of Women's Health, Obstetric and Neonatal Nurses is committed to bringing the truth about racial disparity in maternal care into the light. This video shares the journeys of two Black women whose lives were changed forever as they experienced bias, disrespectful care, and neglect during their hospital stay. The video also highlights the perspectives of a nurse and a nurse midwife who emphasize the need for change. Our hope is that this video will serve as a catalyst to challenge healthcare providers’ mindsets around racial disparity, and to transform knowledge into actions that will pave a pathway to equitable treatment for Black women and women of color.
Virtual Support Groups for Pregnant and Parenting Individuals:
Please see below for upcoming events and opportunities to engage recently shared by CHoSEN partners:
Don’t miss the spring CHoSEN Forum! CHoSEN Collaborative will host its spring Forum virtually from 9 am-1:30 pm on April 15, 2021. The virtual forum will include a focus on prenatal engagement and safe discharge of families and two keynote presentations. Visit this page to learn more, see the agenda, and register for the event!
Join a SEN Work/Advisory Group today! The Colorado SEN Steering Committee is recruiting participants for the work/advisory groups that will convene to advance its 2021-2022 priority areas. Visit this page to learn more about the Committee and its 2021-2022 priority areas and to sign up to join a work or advisory group.
Virtual Screening of "Community Voices": A Black Maternal Health Week in Colorado Event; Friday, April 16, 12 pm MT- In honor of Black Maternal Health Week 2021 (#BMHW21) occurring April 11-17, CPCQC invites you to attend a virtual documentary screening of "Community Voices." The infant mortality rate in Colorado is one of the lowest in the nation, so why is the death rate for Black babies over twice that of white babies? This short documentary depicts the experiences of the healthcare system by Black women in our community. The Addressing Infant and Maternal Mortality (AIMM) Medical Student Group at the CU School of Medicine will screen the film and facilitate a post-screening discussion about racism in the healthcare system. Register here.
Stigma, Equity and Trauma-Informed Care: Rebuilding Hospital Culture- Modeled on the CA Bridge implementation Blueprint, this “Boot Camp” series will provide specialized training and networking opportunities for hospital champions. Sessions will focus on changing the standard of care for substance use disorders, including clinical guidance for medication for addiction treatment (MAT), and health equity for underrepresented populations. You can join the webinars at any part in the series.
Colorado AIM: Substance Use Disorder Learning Collaborative Learning Opportunities- The Colorado AIM: Substance Use Disorder (CO AIM: SUD) Learning Collaborative, convened by CPCQC, focuses on establishing hospital guidelines and protocols for screening, brief intervention, and referral to treatment (SBIRT) for substance use disorder and perinatal mood and anxiety disorders at the time of admission for birth. Labor and Delivery units across the state are participating in the Collaborative, and CPCQC invites all who are interested to participate in related learning opportunities, even if their hospital is not participating in the Collaborative. For more information about the Collaborative and upcoming learning opportunities, visit CPCQC's project page or email email@example.com.
**Please note: While the learning opportunities are open to anyone who is interested, the last 30 minutes of each Monthly Coaching Call will be dedicated to sharing challenges, successes, and questions of participating hospital teams only. Additionally, portions of each quarterly Learning Session will be dedicated to group work for participating hospital teams only. Those who are not members of a participating hospital team can leave the call when this portion of each learning opportunity begins.**
Stigma of Addiction Summit: June 10, 2021 | 12 pm- 6pm ET: Join the National Academy of Medicine, Dell Medical School at The University of Texas at Austin, and Shatterproof on June 10, 2021 for the Stigma of Addiction Summit - a half-day, virtual, action-oriented summit entirely dedicated to understanding, addressing, and eliminating the harmful impacts of stigma on people who use drugs.
The Summit will endeavor to elevate current efforts at reducing stigma, identify successes and gaps in the evidence base, and prioritize and identify areas for future research and funding with an explicit focus on stigma, which is often touched upon only marginally in broader conversations about addiction.
The Summit is free to attend and will be recorded for viewing after the event concludes. Register to attend and/or submit an innovation abstract.
To further strengthen families impacted by perinatal substance use in Colorado, the Prenatal Substance Use and Improving Family Health study examined data at the intersection of health, public assistance, and child welfare. This research offers unique insights into how these systems can coordinate efforts to strengthen families, prevent family separation, and decrease foster care placement. Findings show several factors associated with an increased risk of infant removal from their family by child welfare due to prenatal substance use, including:
For infants removed from the home, the rate of placement with relatives while in foster care decreased by 15% (2016-2019). This is a concern as placing children with relatives has been shown to promote healthy child development.
Study findings inform prenatal opportunities for wrapping services around families impacted by prenatal substance use, beginning in pregnancy and using Plans of Safe Care, with the long-term goal of proactively preventing child welfare involvement and setting families who are involved in child welfare on a trajectory of safety and well-being.
The statewide perinatal substance use data linkage study was made possible by SB19-228 and the Linked Information Network of Colorado (LINC), which securely connects data across multiple systems. The study was designed in partnership with the Center for Prescription Drug Abuse Prevention, Illuminate Colorado, the Substance Exposed Newborns Steering Committee, and experts from state agencies, hospitals, non-profits, and the research community. Learn more about the project and access the report here.
For more information, contact Dr. Elysia Clemens at Elysia@ColoradoLab.org
The Challenge: Engaging Families during the Birth Hospitalization
Implementation of the Eat Sleep Console (ESC) tool and decreased use of pharmacologic therapy has contributed to great progress in reduction of the average length of stay for substance exposed infants within the CHoSEN Collaborative. While this care model has led to exciting outcomes, it requires significant support and time investment from both hospital providers and families, and we don’t yet fully understand how parents and caregivers are impacted by this new approach.
The Solution: Learning Directly from Families
To fill this gap, CHoSEN QIC has begun to engage birthing individuals in semi-structured qualitative interviews to better understand their birth hospitalization experience. By engaging directly with those involved, we aim to better understand the barriers and facilitators to implementing ESC and non-pharmacologic care during this time. These interviews focus on the following key areas:
Engaging in this process will allow us as a Collaborative to learn directly from those receiving this care with the goal of tailoring our interventions and approach to hospital care to best serve families.
While this work is ongoing, so far, three key areas have emerged as important for families during this time:
One participant emphasized the importance of education throughout this process by saying, “One thing has been consistent through both of my experiences, I was very surprised at how every staff member, specifically the RNs knew a significant amount about withdrawal, the adverse effects of medication vs. no medication. They were very non-biased and very informative, and they all were consistent on what they knew, you can tell the information was accurate.”
Looking to Understand the Experiences of Families at Your Hospital?
If your hospital is interested in having families who receive care at your site share their experiences, CHoSEN QIC is currently conducting interviews with birthing individuals affected by substance use. This allows us to learn directly from individuals and families who have experienced caring for an infant prenatally exposed to substances and how we can best care for them during their birth hospitalization. To learn more about this opportunity, contact Dr. Stephanie Bourque.
Dr. Bourque is a member of the CHoSEN QIC Steering Committee and is on faculty at the University of Colorado School of Medicine. Her clinical work as a neonatologist is primarily at Children’s Hospital Colorado and University Hospital. Within the CHoSEN Collaborative, Dr. Bourque’s focus is on optimizing family engagement, specifically during the birth hospitalization.
With the coronavirus (COVID-19) pandemic ongoing, multidisciplinary professionals from across the Rocky Mountain region who support families impacted by prenatal substance exposure convened virtually on October 13th to share updates and learn from each other’s successes and challenges in implementing related quality improvement efforts.
Missed the event or looking to refresh your memory of the day? Find the materials, recordings, and related upcoming opportunities to engage linked below.
Materials and Recordings:
The work continues! While our world continues to look different, the CHoSEN Collaborative team is still here to support your efforts and connect you to related initiatives.
Opportunities to Engage:
Quality improvement efforts often use the phrase “share seamlessly, steal shameless” to describe the importance of learning from one another and building from each others’ strengths and past efforts.
With that sharing philosophy in mind, we’re happy to share that our first CHoSEN article will be published in Hospital Pediatrics (Volume 10, Issue 9, September 2020). The article is titled “The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative: Standardization of Care for Opioid-Exposed Newborns Shortens Length of Stay and Reduces Number of Infants Requiring Opiate Therapy” and includes aggregated CHoSEN QIC data from April 2017 to December 2019 demonstrating our statewide collaborative’s reductions in average LOS, the percentage of OENs requiring opiate therapy, and average LOS for OENs requiring opiate therapy.
Thank you to all the participating CHoSEN hospital teams who have made this opportunity to share our work with the broader pediatric community possible!
The CHoSEN QIC team is developing additional manuscripts to continue to share our lessons and successes, including a draft manuscript analyzing demographic disparities. If your hospital team is interested in disseminating your hospital’s work--whether to your C-suite, for a conference, or for publication, support is available. Please contact Dr. Susan Hwang to get the ball rolling to seamlessly share.
Lutheran Medical Center is one of the founding hospitals of the CHoSEN Quality Improvement Collaborative. Jillian Adams, director of strategic initiatives for Illuminate Colorado sat down with Dr. Erica Wymore to discuss how she and the team at Lutheran Medical Center are utilizing their electronic health record (EHR) system to support their hospital’s CHoSEN practice changes, particularly related to breastfeeding practices.
Dr. Wymore is the Medical Director of the Newborn ICU at Lutheran Medical Center, a faculty member at the University of Colorado School of Medicine, and a member of the Steering Committee for CHoSEN QIC has been part of this effort from the beginning, continuing to innovate around supporting opioid-exposed newborns and their families.
The Challenge: Communication Across Mother and Infant Provider Teams
Examination of data across CHoSEN hospitals revealed variability among breastfeeding rates for substance-exposed newborns, leading to a desire to improve these rates among mother-infant dyads affected by a substance use disorder.
To begin addressing this need, Lutheran Medical Center worked to create a process map to help them understand, reflect on, and identify room for improvement in their policies and procedures for determining a dyad’s breastfeeding eligibility and effectively and consistently communicating it between providers and to families.
Engaging in this process led to the identification of a challenge with ensuring that important information from the mother’s medical record and provider team is reflected in the infant’s medical record and shared with the infant’s provider team.
The Solution: Ask What Your EHR System Can Do for You
With this challenge identified, the team at Lutheran began collaborating with their electronic health record provider to develop improved and automated workflows within their EHR system to ensure that important information related to a mother-infant dyad’s breastfeeding eligibility is available in all of the necessary places. Watch the interview with Dr. Wymore to learn more about how Lutheran Medical Center developed their process map and is working with their EHR provider to create new workflows.
Looking for Solutions for your Hospital?
If your site is interested in implementing similar innovations, Dr. Wymore advises developing a process map to identify your hospital’s key players and then working to provide clear and consistent education that will ensure families affected by prenatal substance exposure receive the best and most consistent care. CHoSEN QIC is able to support hospitals through these innovations by conducting a virtual site visit and helping teams with steps like developing a process map. To request and schedule a virtual site visit, contact Jessica Scott.
Addressing the Shortage of Providers in Colorado able to Prescribe Treatment for Patients with Opioid Use Disorder
For the last decade, overdose has been a leading cause of pregnancy-associated death in Colorado. Colorado providers have a unique opportunity to aid persons struggling with opioid use disorder (OUD) during the vulnerable perinatal period.
Buprenorphine can be prescribed during routine clinical care, including primary care, family practice, psychiatry, and the emergency department, to treat individuals with prescription opioid or heroin addiction, including during pregnancy and postpartum. With the increasing prevalence of maternal OUD and overdose deaths in the state, it is imperative that treatment resources for these patients increase.
However, there is a shortage of providers in Colorado who are able to prescribe buprenorphine treatment for patients with OUD, and even fewer trained to care for the perinatal population.
To address this need, the Practice Innovations in Opioid Management at the CU Department of Family Medicine is offering a stipend for Colorado providers who invest the time to take the waiver training to get their DEA X waiver. Those who complete a waiver training course and receive their waivers from DEA by September 30 will be eligible to receive up to $1000 in compensation.
Amidst the Coronavirus (COVID-19) pandemic, multidisciplinary professionals who support families with newborns prenatally exposed to substances from across the state of Colorado convened virtually on May 12th for the Spring CHoSEN Forum to share updates and learn from each other’s successes and challenges in implementing related quality improvement efforts.
Dr. Susan Hwang shared updates on the CHoSEN Collaborative’s hospital-level efforts, including the network’s growth to over 30 hospitals across three states and 2017-2020 data from hospitals within the CHoSEN cohort, including average lengths of inpatient stays for opioid-exposed newborns, percentages of opioid-exposed newborns who received pharmacologic therapy, and the racial and ethnic disparities that exist within those statistics.