DENVER, CO (November 27, 2019) —  Nearly 50 percent of Colorado births occur in a hospital participating in a quality improvement collaborative, coordinated by a group known as the Colorado Hospital Substance Exposed Newborns Collaborative (CHoSEN Collaborative), to improve outcomes for newborns prenatally exposed to substances. Previous publicly reported cases of Neonatal Abstinence Syndrome (NAS) in Colorado had been found to increase by 120 percent from 2011 to 2016 based on hospital discharge coding data. NAS is a group of withdrawal symptoms resulting from the sudden discontinuation of fetal exposure to substances that were used by the woman during pregnancy. Among participating hospitals, the prevalence of prenatal opioid exposure in newborns has been found to be nearly double that of publicly reported estimates.
 
Dr. Susan Hwang, the physician champion of the CHoSEN Collaborative and neonatologist at Children’s Hospital Colorado and University Hospital, attributes the increase to a change in the way patients are identified as a result of practice changes. “We have the opportunity as providers not only to improve our practice while engaging families in the care team, but also to improve measurable outcomes for newborns and families impacted by substance use during pregnancy,” said Hwang.
 
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. Multidisciplinary hospital-based improvement teams track data and achieve measurable improvements for infants and families impacted by substance use.
 
Hwang shared CHoSEN Collaborative’s aggregate data at a quarterly forum organized by the CHoSEN Collaborative earlier this month, demonstrating a drastic decrease in length of stay for opioid-exposed newborns and an increase in prenatal counseling and service referrals for families. Over seventy clinicians from hospital newborn intensive care units and mom and baby units from Colorado and Wyoming gathered in Glenwood Springs, Colorado to share best practices around caring for women and newborns impacted by substance use, especially opioids.
 
“We have reduced the average length of stay for a newborn from more than two weeks to just six days, and the percent of opioid-exposed newborns being treated with opiate medications has declined from nearly 70 percent to less than 10 percent,” said Hwang.
 
Among the CHoSEN forum participants, Laurale Cross, the administrative director of the Women and Children Services Department at Valley View Hospital, located in Glenwood Springs. “When you are located in a small place, it is difficult to be aware of best practices and stay up to date on the latest research. That is one of the most important things the CHoSEN Collaborative does for hospitals,” shared Cross. 
 
Seventeen birthing hospitals are committed to the CHoSEN Collaborative Quality Improvement Collaborative. The best practice approaches include: training on behavioral techniques to sooth babies experiencing withdrawal symptoms, as an alternative to prescribing opiates; providing tools for creating safe discharge plans; and guidelines for safe breastfeeding for mothers impacted by substance use, especially opioids.    
 
The CHoSEN Collaborative is coordinated and led in partnership by the Colorado Substance Exposed Newborns Steering Committee, a subcommittee of the Colorado Attorney General’s Substance Abuse Trend and Response Task Force, chaired by Illuminate Colorado, and in collaboration with the Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and the Colorado Perinatal Care Quality Collaborative.
 
“We know from experience that collaborative action is most effective in achieving healthier outcomes for moms and babies,” shared Jaime Cabrera, executive director of the Colorado Perinatal Care Quality Collaborative (CPCQC), Colorado’s maternal and infant care quality network.
 
“We are continuing to drive a conversation around reducing barriers and stigma to accessing care for families impacted by substance use disorders in practice and policy during the upcoming legislative session in Colorado,” said Jade Woodard, executive director of Illuminate Colorado and co-chair of the Colorado Substance Exposed Newborns Steering Committee, a subcommittee of the Colorado Attorney General’s Substance Abuse Trend and Response Task Force. It will take all of us—clinicians, advocates, and most importantly families—to ensure our policies and practices are building systems to strengthen families,” said Woodard.

Hospitals participating in CHoSEN Quality Improvement Collaborative include:

• Denver Health Medical Center
• Lutheran Medical Center
• McKee Medical Center
• UCHealth Medical Center of the Rockies
• UCHealth Memorial Hospital
• North Colorado Medical Center
• North Suburban Medical Center
• Parker Adventist Hospital
• Parkview Medical Center
• Platte Valley Medical Center
• UCHealth Poudre Valley Hospital
• Rose Medical Center
• Saint Joseph Hospital
• San Luis Valley Regional Medical Center
• St. Mary’s Medical Center
• St Vincent Healthcare
• UCHealth University of Colorado Hospital

 
​Professionals not associated with a participating hospital are also encouraged to access resources available at www.chosencollaborative.org, including a New FREE tool gives Colorado perinatal providers access to hundreds of resources related to perinatal substance use paid for through a grant from the Colorado Department of Public Health and Environment.
 
Colorado Perinatal Care Quality Collaborative (CPCQC) is a statewide nonprofit network of hospitals, healthcare facilities, clinicians and public health professionals that improves the health of women and infants through continuous quality improvement. Visit cpcqc.org to learn more.
 
Illuminate Colorado is a statewide nonprofit organization building brighter childhoods through education, advocacy, and family support to prevent child maltreatment. Visit IlluminateColorado.org to learn more.

The CHoSEN Collaborative convenes a forum twice a year to foster idea-sharing and community collaboration for professionals working on improving outcomes for women and families affected by perinatal substance use and Neonatal Abstinence Syndrome (NAS). This year, the fall forum was held in Glennwood Springs, Colorado to better accommodate Western Slope attendees.  

More than seventy attendees began their day hearing CHoSEN QIC updates directly from subject matter experts Dr. Susan Hwang, Assistant Professor of Pediatrics, Neonatologist Children’s Hospital Colorado and University Hospital; CPCQC Executive Committee  Member, SEN Steering Committee Member Jaime Cabrera, MPH, Executive Director of CPCQC, SEN Steering Committee Member; and Jade Woodard, Executive Director of Illuminate Colorado and Co-Chair the SEN Steering Committee. 

The day also included two keynote addresses, first from Dr. Susanne Klawetter, Assistant Professor of Social Work, Portland State University, who highlighted the importance of using trauma-informed approaches given the prevalence of childhood trauma among mothers with a substance use disorder.    

After several presentations from hospitals participating in CHoSEN QIC and a discussion of barriers and facilitators to CHoSEN QIC implementation, clinicians received the final keynote address of the day from Dr. Ryan Jackman, St. Mary's Medical Center Faculty, Family Medicine Residency Medical Director, Integrated Addiction Medicine on treatment and recovery continuum on the West Slope. 

The next CHoSEN Forum is scheduled for May 12th in the Denver metro area.  ​

The Substance Exposed Newborns (SEN) Provider Education Work Group is excited to announce the creation of the Colorado Perinatal Substance Use Provider Toolkit, made possible with support from the Colorado Department of Public Health and Environment.

Evidence-based and inclusive resources provided include clinical guidelines and recommendations, data and epidemiology, and patient handouts and resources, bringing the latest from sources such as ACOG, AAP, and CDC.

Providers can find tools and resources related to:

• patient identification and communication,
• substance use disorder treatment,
• lactation, management of substance-specific impacts,
• community referrals,
• patient education and more!

​This searchable online toolkit provides hundreds of resources related to perinatal substance use.