Ve r monts CHARM (Childr e n and Re c ove r ing Mothe r s) T e - PowerPoint PPT Presentation

Ve r mont’s CHARM (Childr e n and Re c ove r ing Mothe r s) T e am: A c o llab o rative appro ac h to suppo rting pre g nant and pare nting wo me n with o pio id use diso rde rs and the ir infants Sa lly Borde n , M . E d . , E xe c utive Dire c to r K idSa fe Co lla b o ra tive Kimbe rly- Ann Coe , Se nio r Pro g ra m Asso c ia te Natio nal Ce nte r o n Sub stanc e Ab use and Child We lfare Ce nte r fo r Childre n a nd F a mily F uture s, I nc . July 11 & 12, 2018 ♦ QIC All Site s Me e ting Ne wpo rt Be a c h, Ca lifo rnia 1

What is CHARM?  Childre n a nd Re c ove ring Mothe rs is a n inte r- disc iplina ry a nd c ross- a g e nc y te a m whic h c oordina te s c a re fo r pre g na nt a nd po stpa rtum mo the rs with a histo ry o f o pio id use diso rde r, a nd the ir b a b ie s.  Mo de l c o lla b o ra tive a ppro a c h (US De pt. o f He a lth a nd Huma n Se rvic e s, SAMHSA 2016) 2

CHARM Goal : to impro ve the he alth and safe ty o utc o me s o f b a b ie s b o rn to wo me n with a histo ry o f o pio id use diso rde r b y c oor dinating me dic a l c a re , sub sta nc e a b use tre a tme nt, c hild we lfa re , a nd so c ia l se rvic e suppo rts. 3

CHARM T e am – Par tne r Or ganizations e n's Hospital – Ne onatal UVM Me dic al Ce nte r OBGYN - UVM Childr (COGS ) me dic a l, so c ia l wo rk, MAT me dic a l a nd so c ia l wo rk MAT (Me tha do ne & e – VT DCF Child We lfar Bupre no rphine ) - F a mily Se rvic e s Ho wa rd Ce nte r CHARM T e a m Chitte nde n Clinic fa c ilita to r – VT De pt. o f He a lthc a re Ac c e ss - Mo ms Pro g ra m K idSa fe He alth De pt. ADAP : VT (Me dic a id ) Co lla b o ra tive Hub a nd Spo ke s VT De pt. o f Co rre c tio ns He alth De pt. – VT he a lthc a re se rvic e s Mate r nal Child He alth (WI C) Re side ntia l & Outpa tie nt T x - Childre n's I nte g ra te d Se rvic e s: mo ms & b a b ie s ( L und ) Ho me Visiting ; Child De vpmt Svc s 4

̶ ̶ CHARM - Be ginnings  1998 ̶ No MAT a va ila b le in VT fo r pre g na nt wo ma n with o pio id use diso rde r. Physic ia n re q ue st: individua l wa ive r fro m Opia te T re a tme nt Autho rity  2002 Sub sta nc e Ab use physic ia n, OB a nd Ne o na to lo g ist me e t, c o o rdinate c are fo r pre g na nt wo me n ne e ding tre a tme nt  F irst me tha do ne c linic o pe ns  2003 Additio na l c o mmunity-b a se d he a lth and so c ia l se rvic e s jo in c o o rdina tio n: sta rt o f multi-disc iplinary appro ac h - the se e ffo rts le a d to the CHARM T e a m  2004-2006 − K idSa fe jo ins to fa c ilita te . E mpa ne lme nt a s VT Multi-disc iplina ry Child Pro te c tio n T e a m; − De ve lo pme nt o f MOU, Re le a se o f I nfo rma tio n; o pe ra ting pro c e dure s 5

̶ ̶ ̶ CHARM - Be ginnings Issue s and Co nflic ts :  Who a tte nds mo nthly me e ting  Ho w muc h info rma tio n c a n b e sha re d  No g uiding do c ume nts fo r inte ra g e nc y pro c e ss  Ro le o f c hild we lfa re a g e nc y a nd te a m me mb e rs re po rting suspe c te d c hild a b use / ne g le c t  Cur r e nt CHARM ha s o pe ra te d c o ntinuo usly; MOU a nd ROI upda te d. VT “Hub & Spo ke ” SUD T re a tme nt/ MAT syste m: e xpa nde d a c c e ss to c a re , tre a tme nt suppo rt, c a se ma na g e me nt SAMHSA re c o g nitio n: mo de l c o lla b o ra tio n 6

Ke y E le me nts of CHARM Colla bora tion • A Sha re d Philosophy: I mpro ving c ar e and s is the mo st impo rta nt fa c to r suppo r ts fo r mo the r in he lping to e nsure he a lthy a nd sa fe infa nts • Share d Information a c ro ss a g e nc ie s impro ve s c hild sa fe ty a nd he a lthy o utc o me s • Me morandum of Unde rstanding: pro vide s a n impo rta nt fra me wo rk fo r sha ring info rma tio n a nd c o o rdina ting se rvic e s. • aw: “E mpa ne lle d” a s a multi-disc iplina ry Ve rmont L “c hild pro te c tio n” te a m unde r VSA T itle 33 §4917 7

How Doe s CHARM Work? F r ame wo r k fo r Co llabo r atio n • Crite ria : lo w thre sho ld – pre g na nt; o pio id use diso rde r • Multiple po ints o f re fe rra l • Me mo ra ndum o f Unde rsta nding • Sig ne d b y le a de rship o f a ll ke y o rg a niza tio ns • Co nse nt to Re le a se I nfo rma tio n • Sig ne d b y pa tie nts/ c lie nts • Sta te la w a nd po lic y • Suppo rts info rma tio n sha ring ; c hild we lfa re ro le • Ope ra ting a g re e me nts: fo rma l a nd info rma l • Re g ula r (mo nthly) T e a m Me e ting s • 11 Ag e nc ie s/ De pa rtme nts; Case Re vie ws ; Syste ms I ssue s • I nfra struc ture a nd fa c ilita tio n 8

e am Me e tings: How it Works CHARM T  T e am me mbe r s: • Ave ra g e o f 11 a g e nc ie s/ de pa rtme nts re pre se nte d a t e a c h CHARM te a m me e ting  Me e t Monthly • 12- 13 pa rtic ipa nts pe r mo nth  Syste ms Issue s • F irst 10-15 minute s o f e a c h me e ting   Case Re vie ws  • Ave ra g e 15-20 c a se re vie ws pe r me e ting 9

UVM Children’s Hospital: Infants born (at UVM) to opioid dependent women with substance use disorder on methadone or buprenorphine at delivery (N = 1119)

Opioid-Exposed Newborns • Ve rmo nt ha s a hig he r ra te o f o pio id-e xpo se d ne wb o rns tha n U.S. a ve ra g e 2015: 34/ 1000 live b irths VDH, Vermont Uniform Ho spita l Discharge dataset; uschildhealthdata.org • Ve rmo nt: hig he st a nnua l ra te o f NAS (Ne o na ta l Ab stine nc e Syndro me ) I nc ide nc e – o ut o f 28 sta te s surve ye d 2012-13 Ko JY, Patrick SW, Tong VT, Patel R, Lind JN, Barfield WD. Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013. MMWR Morb Mortal Wkly Rep 2016;65:799–802  I n additio n to inc re ase in o pio id use diso rde r, this may re fle c t Ve rmo nt’ s suc c e ss in impro ving ac c e ss to tre atme nt fo r pre g nant wo me n, and re duc ing b arrie rs to pre natal c are . Ve rmo nt has a hig h rate o f wo me n o n MAT at the time o f de live ry. 11

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Prenatal Care and MAT in Pregnancy UVM Me dic a l Ce nte r : 2017 COGS (Co mpre he nsive Ob ste tric a nd Gyne c o lo g ic a l Se rvic e s) MAT “Hub a nd Spo ke ” pro g ra m • 52 Pre g na nt Wo me n • Do e s no t inc lude wo me n who re c e ive d MAT e lse whe re , with o nly pre na ta l c a re a t COGS • 23 o f the 52: ne w tre a tme nt / induc tio n fo r b upre no rphine a t COGS • T re nd: fe we r initia tio ns o f tre a tme nt a t COGS, mo re tra nsfe rs a nd/ o r MAT c a re a t o the r Spo ke s • Hub / Spo ke : On-site COGS So c ia l Wo rke rs pro vide re fe rra ls to ho using , WI C, c o mmunity b a se d se rvic e s fo r COGS MAT pa tie nts 13

Ve r mont e am Data - Ca le nda r Ye a r 2017 CHARM T Numb e r o f Adult Pa tie nts “sta ffe d” b y CHARM T e a m 125 Numb e r o f b a b ie s 103 T otal numbe r of individuals se r ve d 228 # of Case Re vie ws 283 Of 113 infants se rve d b y Ne o Me d Clinic , 33 re c e ive d tre atme nt with me dic atio n fo r sympto ms o f withdrawal (NAS) 14

How Doe s CHARM Work? Information Sharing at CHARM Meetings and Followup • At e a c h mo nthly me e ting the CHARM te a m re vie ws a list o f c urre nt c a se s, a nd prio ritize s c a se s fo r disc ussio n:  All pr e gnant pa tie nts due in upc o ming mo nth  Prio ritize d high r e natal pa tie nts isk pr  All ne w pr e gnant pa tie nts  All ne w babie s / po st-pa rtum pa tie nts within pa st mo nth  Prio ritize d high r tum patie nts a nd the ir b a b ie s isk post- par oc us: Ho w ar e the y do ing? What do the y ne e d? F Are the re b a rrie rs? Who a nd ho w c a n we he lp a ddre ss the se ? 15

How Doe s CHARM Work? Information Sharing at CHARM Meetings and Followup  Pr e natal Car e Initial: Co nfirm pr e g na nc y, a sse ss fo r o pio id de pe nde nc e ; Ongo ing: c o mplia nc e with pr e na ta l visits a nd mo nito ring ; re fe rra ls fo r spe c ia lty o r c o mmunity se rvic e s  Me dic ation Assiste d T re atme nt: c o nsiste nc y; urine drug te sts; do se a djustme nt; sub sta nc e a b use c o unse ling fo llo wup: po st-pa rtum MAT pro vide r pla n  Re side ntial pro g ra m o ptio n fo r mo ms a nd b a b ie s  Case Manage me nt, Re fe rrals and Support :  WI C, b re a stfe e ding , Ho me Visiting , so c ia l suppo rt se rvic e s.  G ift c ards, transpo rtatio n passe s, b ab y ite ms 16

 Post-par tum and Ne onatal Me dic al F ollowup Pr e natal Ne oMe d visit: •  E sta b lish trust, a ddre ss myths, de c re a se sha me , pro vide info rma tio n NAS Sc r e e ning: • “Addicted  Mo the r-b a b y ro o m-in; invo lve mo the rs/ pa re nts newborns”  Ma ximize no n-pha rma c o lo g ic c a re  U VM Chi l dr e n’s H ospi tal : ~20% o pio id-e xpo se d infa nts re q uire tre a tme nt T r e atme nt and F ollow-Up •  T re a tme nt with me tha do ne : in ho spita l, the n a fte r sta b le 72 ho urs, disc ha rg e ho me with sa fe ty suppo rts. Pla n o f Sa fe Ca re . • Ca re -g ive r e duc a tio n re g a rding me tha do ne ; • Ne o na ta l Me dic a l F o llo w-up 24/ 7 a va ila b ility  Ne o Me d Clinic visits within 1 we e k, the n e ve ry 2 we e ks: me tha do ne we a n, mo nito r g ro wth and de ve lo pme nt, mo nito r pa re nt(s) re c o ve ry 17