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
SMART_READER_LITE
LIVE PREVIEW

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

Apr 07, 2024 480 likes •773 views

Ve r monts 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

slide-1
SLIDE 1

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

  • pio id use diso rde rs and the ir infants

July 11 & 12, 2018 ♦ QIC All Site s Me e ting

Ne wpo rt Be a c h, Ca lifo rnia 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 .

1

slide-2
SLIDE 2

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

  • 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

slide-3
SLIDE 3

3

CHARM Goal:

to impro ve the he alth and safe ty

  • 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.

slide-4
SLIDE 4

4

VT De pt. o f He a lthc a re Ac c e ss - Mo ms Pro g ra m (Me dic a id )

VT De pt. o f Co rre c tio ns he a lthc a re se rvic e s

UVM Me dic al Ce nte r OBGYN - (COGS) me dic a l, so c ia l wo rk, MAT UVM Childr e n's Hospital – Ne onatal

me dic a l a nd so c ia l wo rk

MAT(Me tha do ne &

Bupre no rphine ) - Ho wa rd Ce nte r

Chitte nde n Clinic

Re side ntia l & Outpa tie nt T x - mo ms & b a b ie s (L

und) VT He alth De pt. ADAP:

Hub a nd Spo ke s

VT He alth De pt. – Mate r nal Child He alth (WI

C)

Childre n's I nte g ra te d Se rvic e s:

Ho me Visiting ; Child De vpmt Svc s

CHARM T e a m fa c ilita to r – K idSa fe Co lla b o ra tive Child We lfar e – VT

DCF F a mily Se rvic e s

CHARM T e am – Par tne r Or ganizations

slide-5
SLIDE 5

5

  • 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

CHARM - Be ginnings

slide-6
SLIDE 6

6

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

CHARM - Be ginnings

  • 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

slide-7
SLIDE 7

7

  • A Sha re d Philosophy: I

mpro ving c ar

e and suppo r ts fo r mo the r s is the mo st impo rta nt fa c to 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.

  • Ve rmont L

aw: “E

mpa ne lle d” a s a multi-disc iplina ry “c hild pro te c tio n” te a m unde r VSA T itle 33 §4917

Ke y E le me nts of CHARM Colla bora tion

slide-8
SLIDE 8

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

slide-9
SLIDE 9

CHARM T e am Me e tings: How it Works

  • 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

slide-10
SLIDE 10

UVM Children’s Hospital:

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

slide-11
SLIDE 11

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

  • 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

11

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.

VDH, Vermont Uniform Ho spita l Discharge dataset; uschildhealthdata.org

slide-12
SLIDE 12

12

slide-13
SLIDE 13

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

  • 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

slide-14
SLIDE 14

14

Ve r mont CHARM T e am Data - Ca le nda r Ye a r 2017

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

  • tal numbe r
  • f individuals se r

ve d 228 # of Case Re vie ws

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)

283

slide-15
SLIDE 15
  • 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

isk pr e natal pa tie nts

  • 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

isk post- par tum patie nts a nd the ir b a b ie s F

  • c us: Ho w ar

e the y do ing? What do the y ne e d?

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

slide-16
SLIDE 16

16

 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.

  • Gift c ards, transpo rtatio n passe s, b ab y ite ms

How Doe s CHARM Work?

Information Sharing at CHARM Meetings and Followup

slide-17
SLIDE 17

17

 Post-par

tum and Ne onatal Me dic al F

  • llowup
  • 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:

 Mo the r-b a b y ro o m-in; invo lve mo the rs/ pa re nts  Ma ximize no n-pha rma c o lo g ic c a re

  • U

VM Chi l dr e n’s H

  • spi

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

  • llow-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
  • 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

“Addicted newborns”

slide-18
SLIDE 18

CHARM and Child Welfare (DCF Family Services)

  • Pr

e natal/ 30 days pr ior to due date :

Are the re c o nc e rns o f o ng o ing sub stanc e use ? c hild safe ty risks? Re po rt to DCF : Asse ssme nt fo r suppo rts and se rvic e s. Ve rmo nt: o nly state that c o nduc ts c hild we lfare asse ssme nt prio r to the b irth o f b ab y. F

  • c us: safe e nviro nme nt fo r infant. No t Child

Ab use I nve stig atio n. (Ke y CHARM Outc o me )

  • At bir

th:

 Plan o f Safe Car

e (fe de ral re q uire me nt):

I f no o the r c hild safe ty risks: No n-I de ntifie d No tific atio n to DCF and Plan o f Safe Care (ho spital)

 I

f c hild safe ty risks: DCF

Re po r t; DCF

  • F

S do e s Plan o f Safe Care

18

slide-19
SLIDE 19

19

slide-20
SLIDE 20

UVM CHI L DRE N’ S HOSPI T AL

BAYL E Y I I I : ME AN PE RCE NT I L E RANK (N=277) 7-14 MONT HS OF AGE

10 20 30 40 50 60 70 80 90 100 2008 2009 2010 2011 2012 2013 2014 2015

Me a n

Co g nitive L a ng ua g e Mo to r

  • Dr. Anne Jo hnsto n,

Ne o na to lo g ist, Unive rsity o f Ve rmo nt Child re n’ s Ho spita l

slide-21
SLIDE 21

21

CARA Amendment And Pla ns o f Sa fe Ca re

slide-22
SLIDE 22

22

CARA Amendment And Pla ns o f Sa fe Ca re

slide-23
SLIDE 23

Ke y E le me nts of Pa tie nt Suc c e ss

(what indic ato rs do we me asure ? )

 Sta rt p re na ta l c a re e a rly in p re g na nc y  Initia te p ha rma c o lo g ic a l tre a tme nt fo r o p io id

d e p e nd e nc e e a rly in p re g na nc y

 Eng a g e in sub sta nc e a b use tre a tme nt, c o unse ling  Atte nd p re na ta l c a re a p p o intme nts  Atte nd Ne o me d Clinic a p p o intme nts  Fa mily a nd so c ia l sup p o rts, sta b le ho using  Pla n o f sa fe c a re

23

Babyleavase.com

slide-24
SLIDE 24

Ke y E le me nts of Pa tie nt Suc c e ss

 Anything tha t d rive s p re g na nt wo me n with

  • p io id use d iso rd e r fro m se e king tre a tme nt

re sults in mo re p re ma turity, hig he r infa nt mo rta lity, le ss p ro b a b ility o f suc c e ssful p a re nting

 He a lth of Ba by de pe nds on the mothe r’s

he a lth, the fa mily’s he a lth!

  • Dr. Anne Jo hnsto n

24

slide-25
SLIDE 25

CHARM OUT COME S

25

  • E

a rly pre na ta l c a re a nd MAT = he a lthie r b a b ie s

  • Re duc e sha me a nd stig ma
  • Sta b le in sub sta nc e a b use tre a tme nt, a c c e ss to

suppo rt se rvic e s = b e tte r a b le to pa re nt sa fe ly

  • Allo ws time fo r fa mily e ng a g e me nt prio r to b irth,

suppo rt se rvic e s, pla n sa fe e nviro nme nt fo r infa nt

  • I

nfa nts mo re like ly to b e disc ha rg e d in the c a re o f the ir mo the r/ pa re nt(s)

  • Child ma ltre a tme nt pre ve ntio n: e a rlie r indic a tio n o f

risk/ pa re nt is no t a b le to pa re nt sa fe ly

  • Avo id unne c e ssa ry e me rg e nc y c hild c usto dy a t b irth
slide-26
SLIDE 26

COL L ABORAT I VE PROCE SS OUT COME S

26

  • T

ime -sa ve r = mo ne y sa ve r

  • I

mpro ve d unde rsta nding o f pa tie nts/ c lie nts, o pio id use diso rde r; minimize misunde rsta nding s

  • I

mpro ve d unde rsta nding o f e a c h o the r’ s ro le s a nd pe rspe c tive s

  • De ve lo pme nt o f e xpe rtise a mo ng pro je c t pa rtne rs a b o ut

he a lth a nd tre a tme nt o f o pio id-e xpo se d ne wb o rns

  • Child pro te c tio n de c isio ns ma de b a se d o n b e tte r info rma tio n

fro m pro je c t pa rtne rs a b o ut sa fe ty a nd risks

  • Ha ve a “Go -to ” c o nta c t fo r q ue stio ns

Impr

  • ve d c ollabor

ation = safe r babie s

slide-27
SLIDE 27

27

 T

he Childr e n and Re c ove r ing Mothe r s (CHARM) Collabor ative in Bur lington, VT : A Case Study

Natio nal Ce nte r o n S ubstanc e Abuse and Child We lfare

https:/ / nc sa c w.sa mhsa .g o v/ file s/ Co lla b o ra tive _Appro a c h_508.pdf

 Ve rmo nt He a lth De pa rtme nt - Alc o ho l a nd Drug

Ab use Pro g ra ms:

Car e Allianc e for Opioid Addic tion

http:/ / he a lthve rmo nt.g o v/ a da p/ tre a tme nt/

 Unive rsity o f VT

  • VCHI

P: Impr

  • ving Car

e for Opioid- e xpose d Ne wbor ns (ICON)

http:/ / www.uvm.e du/ me dic ine / vc hip/ ? Pa g e =I CON.html

slide-28
SLIDE 28

Sally Borden, Executive Director KidSafe Collaborative 45 Kilburn Street, Burlington VT 05401 802.863.9626 sallyb@kidsafevt.org

www.kidsafevt.org

Kimberly-Ann Coe, Senior Program Associate Center for Children and Family Futures, Inc. 25371 Commercentre Drive, Suite 250 Lake Forest, CA 92630 Office: (714) 505-3525 ext. 8954

Vermont’s CHARM (Children and Recovering Mothers) Team: A collaborative approach to supporting pregnant and parenting women with opioid use disorders and their infants

Note: images in this presentation are used with permission; stock photos are licensed for use by KidSafe Collaborative 28

Additional contacts:

  • Dr. Anne M. Johnston, Neonatologist

Associate Professor, University of Vermont College of Medicine University of Vermont Children’s Hospital Smith 575, 111 Colchester Ave., Burlington, VT 05401 802.847.3993 Anne.johnston@uvmhealth.org www.uvmhealth.org

  • Dr. Marjorie C. Meyer, Obstetrician & Maternal Fetal Medicine Physician

Associate Professor, University of Vermont College of Medicine University of Vermont Medical Center 111 Colchester Avenue, Burlington, Vermont 05401 802-847-1400 Marjorie.meyer@uvmhealth.org www.uvmhealth.org

Key Contacts: