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In Case You Missed It Resources: April 2021

4/7/2021

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:

The Postpartum Wellness Center/Boulder is offering a new support group for pregnant and expectant individuals to connect with and navigate parenting through a pandemic. Groups are on Wednesdays, 4:30-5:30pm MST. Donations between $5-$15 are accepted. To learn more and to register, contact marley@pwcboulder.com. Additional support groups are available through Postpartum Support International.
The Apart But Not Alone well-being group for perinatal women will be continuing virtually yet again! This group is offered for FREE by the University of Colorado Department of Psychiatry with the aim of fostering connection for perinatal women during the COVID-19 Pandemic. As this is not designed as a treatment group, participants do not need to have a mental health diagnosis to benefit. If a mental health need is identified during the group, the facilitators will make appropriate referrals for treatment. The group does require advance registration. Details and registration link can be found on this flyer. Please feel free to circulate widely to other groups who might find this resource helpful!
Circle of Parents is a nationally recognized model that is evidence-informed. Circle of Parents provides parents and other caregivers free, weekly support group meetings that are friendly and supportive. It is a safe space that allows anyone in a parenting role to openly ask questions and discuss the successes and challenges of raising children. Circle of Parents increases the awareness of the five Protective Factors to promote healthy and safe families. Those five Protective Factors are: social connections, parental resilience, concrete support in times of need, knowledge of parenting and child development, and social-emotional competence of children.

Upcoming Events/Opportunities to Engage

4/7/2021

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 info@cpcqc.org.

**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.

Just Released! Prenatal Substance Use & Improving Family Health (Report No.19-08B)

3/29/2021

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:

less than adequate prenatal care,
lower household income,
low participation in WIC, and
greater medical fragility of the newborn.

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

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.

Fall CHoSEN Forum Hosted Virtually on October 13th

11/4/2020

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.

Seamlessly Sharing the Work: We’re Published!

9/2/2020

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!

Looking Ahead
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.

CHoSEN Hospital Spotlight: Lutheran Medical Center

7/30/2020

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.

Hospital Profile Interview - Erica Wymore from CHoSEN Collaborative on Vimeo.

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.

Additional Resources:

To learn more about all of CHoSEN’s key drivers, including breastfeeding, check out CHoSEN’s provider education videos here.
Breastfeeding guidelines from American Academy of Pediatrics can be found here and guidelines from the Academy of Breastfeeding Medicine can be found here.

Wyoming and Montana Hospitals Join CHoSEN QIC

5/27/2020

The CHoSEN Collaborative has been leading the effort to increase consistency in implementation of best practice approaches in the identification of and response to newborns prenatally exposed to substances in the Rocky Mountain region since 2017.

Over the course of the last several months the number of hospitals committed to the CHoSEN Collaborative Quality Improvement Collaborative (CHoSEN QIC) has grown from 17 birthing hospitals in Colorado in November 2019 to 31 hospitals today.

Addressing the Shortage of Providers in Colorado able to Prescribe Treatment for Patients with Opioid Use Disorder

5/27/2020

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.

The Work Goes On! Spring CHoSEN Forum Hosted Virtually on May 12, 2020

5/21/2020

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.

CHoSEN QIC Updates - May 2020 CHoSEN Forum from CHoSEN Collaborative on Vimeo.