Since its inception, the Colorado Hospitals Substance Exposed Newborns (CHoSEN) Collaborative has focused on and has made great strides in improvements to the birth hospitalization experience and outcomes of families impacted by perinatal substance use. With this ongoing work well underway, CHoSEN’s leadership decided to explore how they could begin proactively supporting families during the prenatal period and approached the Kempe Center to help develop a Perinatal Navigator Program that would take a collaborative approach to empowering and supporting families, beginning in the perinatal period.
We reached out to Jenny Koch-Zapfel, program manager at the Kempe Center, to learn more about the program and hear about successes and lessons learned so far:
What is the CHoSEN QIC Perinatal Navigator Program?
The Colorado Hospitals Substance Exposed Newborns Quality Improvement Collaborative (CHoSEN QIC) Perinatal Navigator Program is a program partnering the University of Colorado and Denver Health to improve the care and outcomes of families impacted by substance use. Believing that collaboration between systems serving affected infants and their families is best practice, the CHoSEN QIC Perinatal Navigator Program is focused on keeping families together by empowering them to identify and achieve personal goals, preparing them for the arrival of a new baby, and supporting them in accessing community resources. The Perinatal Navigator provides comprehensive and strength-based, client-centered navigation of goal setting, family education, and coordination of services. Learn more about each of the program’s elements here!
What have been some of the program’s greatest successes so far?
I think our greatest success has been the diversity and collaboration among our workgroup and other programs serving our target population. I think our program and our workflow represents the voices of each of our workgroup members. The collaboration has led to the creation of an informational flyer for providers and an implementation manual that is helping to track our workflow.
What have been some of the challenges you have experienced so far, and how have you approached them?
Identifying someone to fill the navigator role has been very challenging. At this time, the goal is for the navigator program to reside within the Nurse Family Wellness Program; however, staff availability is limited because the Nurse Educators are funded through the Denver Department of Human Services. We’ve been creative in thinking about how to staff this position given that the program is still in its pilot stage. Not knowing how it may grow and change, hiring staff is not feasible. In thinking about the scope of services we’d like to provide, as well as the experience we think would be most valuable, we’ve considered utilizing MSW students. However, due to the timing of the project and COVID restrictions on clinical time, student interest and availability has been limited. Currently, we’re piecing the navigator role together using one of the Nurse Educators within the Nurse Family Wellness Program, a social worker on the Mom/Baby unit at Denver Health, and the pilot’s Program Manager. Although each of these individuals has a wealth of knowledge and experience, they have other full-time clinical and administrative responsibilities, so we are continuing to brainstorm ideas for filling this role on a more permanent basis.
We have identified a process within the Denver Health electronic medical record system for notifying our temporary navigators of referrals. However, we anticipate that providers may forget to offer our program or may feel limited in discussing the program due to time constraints. We’ve approached this challenge by trying to anticipate what providers might consider barriers to the referral process and attempting to ease this burden. By creating an informational sheet with talking points for providers, we aim to educate them about the program, giving them confidence to discuss our program with patients and make referrals. Understanding that the time providers have in prenatal visits is limited, we are also working to educate the staff of Denver Health’s Integrated Behavioral Health program. This is a service which embeds mental health specialists within Denver Health’s clinics, providing additional support beyond the basic prenatal visits. We hope that knowledge of and familiarity with our navigator program amongst prenatal care providers, as well as the mental health specialists, will increase the chances that pregnant individuals may be offered a referral. I think we are heading in the right direction in terms of referrals. We haven’t had a chance to test out our method yet, but [we] hope to soon.”
What lessons would you share with others based on your experience?
Partnerships are key! We continue to reach out to other programs with similar aims in hopes of improving our processes and learning from what has and hasn’t worked for them. It’s also been invaluable to have a multi-disciplinary group working on the development of this program. Having perspectives of inpatient and outpatient pediatric providers, clinical and non-clinical social workers, non-profit program coordinators, nurse educators, and representatives from DDHS has fostered great relationships and rich discussions.
We are thrilled to see the work of CHoSEN expand beyond the birth hospitalization to begin supporting families prenatally! Please share information about this program with your colleagues, and if you have any questions or feedback about the program or ideas about filling the navigator role, please reach out to Jenny Koch-Zapfel at JENNIFER.KOCH-ZAPFEL@cuanschutz.edu.
Get news from the CHoSEN Collaborative on best practices and tools available to perinatal providers related to the care of SENs.