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Understanding the Parental and Caregiver Experience: Hospital Care of Substance Exposed Newborns

11/6/2020

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:

The prenatal experience, including receipt of prenatal counseling
The birth hospitalization itself, including interactions with the healthcare team and benefits and challenges of using ESC
The transition from hospital to home, including follow-up care and anticipated challenges.

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:

Setting clear and upfront expectations for how families can be successful during the birth hospitalization with their infant
Engaging in shared-decision making when pharmacologic treatment or transfer to the NICU may be needed
Preparing families for what to expect upon discharge and referring them to relevant community resources.

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.

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Fall CHoSEN Forum Hosted Virtually on October 13th

11/4/2020

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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.

Dr. Susan Hwang shared updates on the CHoSEN Collaborative’s hospital-level efforts, including the most recent data on average lengths of inpatient stays for opioid-exposed newborns, percentages of opioid-exposed newborns who received pharmacologic therapy, and impacts that the COVID-19 pandemic may have had on these indicators most recently. During her update, Dr. Hwang also reflected on the data published in the Maternal Mortality Review Committee Report earlier this year, which indicates that suicide and drug overdose were the leading causes of pregnancy-associated maternal deaths in Colorado between 2014-2016. Lastly, Dr. Hwang shared the exciting news of CHoSEN’s first publication of a paper in Hospital Pediatrics regarding how the collaborative’s quality improvement efforts have led to shortened lengths of stay and a reduction in the use of pharmacological treatments to care for substance-exposed newborns.
CPCQC’s Jaime Cabrera shared updates on new funding streams that will make it possible to place more of a focus on care for the birthing individual, and Illuminate Colorado’s Jade Woodard shared policy and systems level updates, including:
- Information on the recent revision to the Children’s Code that modifies the definition of abuse and neglect as the result of prenatal substance exposure
- New efforts to increase access to child care for parents and caregivers navigating complex life situations, like mental health concerns, substance use disorders, or employment challenges, and
- The Toxicology Resource Guide, which provides guidance on toxicology implications as they relate to child welfare.

The keynote presentations focused on a variety of challenges and opportunities related to the improvement of care for substance-exposed newborns. Dr. Hafastou Diop presented on the opportunities related to early intervention enrollment of infants with NAS, such as improving post-discharge care, supporting the parent-child relationship, and connecting parents with OUD to other support services. She also reflected on the variety of parental, hospital, and provider factors that present challenges to early intervention enrollment and shared ideas on approaches to addressing them. Dr. Munish Gupta presented on the many improvements that perinatal quality collaboratives have helped to make to care of substance-exposed newborns and reflected on the opportunities they have to contribute to even more improvements, such as increasing treatment for pregnant individuals with OUD, improving post-discharge care of both the birthing individual and newborn, and identifying and working to address barriers for families of color.

Participating CHoSEN hospitals shared updates on their work on each of CHoSEN Collaborative’s key drivers, and Presbyterian St. Luke’s Medical Center shared their experience participating in the Colorado pilot for the Alliance for Innovations on Maternal Health (AIM) Opioid Use Disorder Bundle.
Attendees learned how they can improve their care of families straight from the experts, as individuals with lived experience related to substance use and pregnancy shared their overall experiences and their specific experiences related to bias and stigma, ways they were encouraged and discouraged from accessing care, and ways in which they did or did not receive patient-centered care. Due to the sensitivity of the topics and in order to respect the privacy of the speakers, this session was not recorded.
At the end of the day, attendees participated in small group breakout discussions on the implementation of the AIM Opioid Use Disorder Bundle, Family Engagement, Non-Pharmacological Approaches, and Working with Child Welfare and Plans of Safe Care and shared their takeaways with the full group.

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:

Slides from the day can be found here.
Recordings of the main sessions can be found here.
For more information on maternal deaths in Colorado from 2014-2016, see the Maternal Mortality Review Committee Report and find CHoSEN’s first published paper here.

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:

If you are looking for support with your hospital's quality improvement efforts, including virtual site visits, please reach out to Susan Hwang.
To learn more about the upcoming implementation of the AIM Opioid Use Disorder Bundle in Colorado, reach out to Katie Breen or Valerie Garrison.
To get involved in policy advocacy and other systems-level work that impacts substance- exposed newborns and their families, please contact Jillian Adams Fabricius.

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Understanding the Parental and Caregiver Experience: Hospital Care of Substance Exposed Newborns

Fall CHoSEN Forum Hosted Virtually on October 13th

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