Act Act Plan Plan 6/2013 6/2013 1/2011 1/2011 Study Study - PDF document

10/7/2014 We have no known or Families Affected perceived financial or professional conflict by Addiction: A of interest regarding Family Centered this presentation Approach All images, throughout of persons, place or animal are either purchased stock images or personally K. Dawn Forbes, MD, MS, FAAP photographed images Founder & Medical Director HARPS Program and have no known affiliation with drug Christine Cooper, MSN, NNP-BC, APRN Director use/abuse, addiction, HARPS Program NAS or illicit activity. o Defined the global problem o Standardize Program o Defined the local problem o Expand Program o Defined the existingsystem o Continuous growth & o Defined Current supports Improvement o Assessed Current situation o Developed A solution Act Act Plan Plan 6/2013 6/2013 1/2011 1/2011 Study Study Do Do Developing A Comprehensive 1/2013 1/2013 6/2011 6/2011 o Evaluate Success o Began Implementing Solution in Care Program o LOS phases o Cost of Care o PNC o NAS Data Base o Nurse Education o Maternal Survey o Community Education o Developmental Follow UP o Research Addiction Addiction What We Found… Treatment Treatment Centers Centers Pregnant Pregnant women women Social Social Plan • Adult Addiction treatment with drug with drug Work Work use use programs history history • Some family resources Newborn Newborn Understanding Understanding Nursery Nursery Child Child What We Did NOT Find… NAS within our NAS within our & & Protective Protective system and our system and our Services Services NICU NICU community community Nurses Nurses Programs for substance exposed infants and at-risk pregnancies Nursing Nursing Pediatricians Pediatricians admin admin Obstetricians Obstetricians 1

10/7/2014 Many misconceptions… Pregnant What We Learned… women with  “Babies rarely have problems if your in drug use history treatment” • 4 Treatment Centers  “My first child did not withdraw so none of my • Several pain clinics/prescribing pain babies will withdraw” management MDs  “I am on a low dose so my baby will be fine”  “I was told I can not breast feed if on methadone”  “I don’t know what NAS is, but I don’t think my – Inconsistent, inaccurate or NO information about NAS baby can catch it” – 2 treatment options When asked how they feel about delivering at a • Detoxification • Maintenance hospital.. – Structured counseling/therapy during treatment  “The hospital just wants to take away my baby” – Deferred Payment during pregnancy  “The staff is mean and treats me bad” • Rapid weaning for failure to pay after pregnancy  “I've been clean and in treatment for X years but • Changing clinics • Unstable treatment everybody still treats me like I want to hurt my baby” In general these moms where: Paradigm Shift in NICU Care Nursing Pregnant  Misinformed women with  Carried extreme guilt drug use history  Increased NAS  Defensive  Change in focus of care  Stigmatized  Did not know  Limited staffing in the Nursery & NICU  Their infant was at a significant risk for  Limited or over burdened resources NAS  Social Work  That NAS  could require prolonged  CPS hospitalization  WIC  interfere with bonding  symptoms could last 6-9 months  In-utero drug exposure, regardless of NAS, carried a risk of developmental issues Define Problem/Etiologies… Nursing  Paucity of evidence based best-practice guidelines  Significant addiction related stigma and misconceptions Plan  Dealing with momsaddiction limiting help seeking  Falling asleep while holding or providing  Inconsistent Scoring care  Inconsistent, ineffective and insufficient maternal education  Dealing with momswithdrawal about NAS/in-utero drug exposure  Maternal rapiddetox due to failure to pay  Insufficient long term developmental follow up  Return to illicit use  Limited funding  Breast feeding while mom is on medication/in  Poor Communication between all providers: treatment  Obstetricians, Addiction Treatment Centers, Social  Maternal Post Partum Depression (PPD) Work/Child Protective Services, Pediatricians,  Risk factors for child abuse Neonatologist  Limited parentingskills  No Transparency between “the system” and families  Concernsof developmental outcomesof these  No perceived Accessibility to the families infants which may be worsened by the home  Increasing cost environment  Increasing length of stay  Increasing nursing frustration 2

10/7/2014 HARPS Program Helping At-Risk Pregnancies Succeed Founder/Medical Director: Dawn Forbes, MD Director: Chris Cooper, APRN Evidence Home Pre-Natal Based Developmental Nursing Community Research/Dat Annual Methadone Consultation NICU/NBN Follow Up Education Outreach a Collection Conference Treatment Do Helping At-Risk Pregnancies Succeed Program Care Standardized NAS Data Strict Finnegan scoring BayleyII *Regional Base EvidenceBased 1 st Trimester qualifications Scoring/  Offered by Kosair Children’s Hospital Neonatal Specialist 0-3yrs old Hospital Best Practices Monthly f/u FNAST conferences calls Standardized National Treatment  A group of 15 neonatologist, 3 pediatricians and 6 *DCBS Survey 1 st 10/19/2011 protocol Dialoguing Training (manuscript 2 nd 9/27/2012 neonatal nurse practioners *OB/Peds pending) 3 rd 3/2013 Parent * NAS Core support/reso Contract SITC Group Competency urce  Covering NICUs in Louisville, Frankfort, Henderson SRSP student Counseling *SITC pre- research Bed Side conception Nursing NAS and Southern Indiana areas Family Folder counseling Updates MPH Intern *Court Research  One of the few programs in the Nation OB/Peds/Rx Comfort Care Referral Centers Program Referrals *Treatment  Comprehensive care for infants at risk of NAS from 1 st Environment/ Protocol NAS Unit *Middle/Hig trimester to 3 year developmental follow up offer at no h School education *RADARS cost Phase 3 Phase 1 Phase 4 Phase 2 Comprehensive Care Comprehensive Care 1. Preconception 2. Pregnancy Preconception 3. At birth  Universal screening at all primary care visits (GP, 4. Postpartum care and care for neonate/infant GYN)  Referral to an effective treatment program if substance abuse noted  Encourage delayed fertility till stable in treatment  Educate regarding the risks of substance abuse in pregnancy and to the fetus Comprehensive Care Comprehensive Care Pregnancy Pregnancy  Referral of pregnantwomen to substanceabuse  Pre-natal consultation regarding effects of services drug abuse and MAT to fetus/newborn  Services to ensuregood pre-natal care and nutrition  In Office  Coordinatingcare, ensuringmoms physical and  On-Site at Addiction Treatment Centers psychological diagnosis are treated  In-Hospital  Universal screening  Upon admission to NBN and/or NICU  OB  TreatmentCenters  Primary Care 3