1 00:00:00,710 --> 00:00:01,950 - And also the Chittenden County 2 00:00:01,950 --> 00:00:04,830 Child Protection and Family Support Team. 3 00:00:04,830 --> 00:00:07,140 She co-chairs Vermont's Federally Mandated 4 00:00:07,140 --> 00:00:10,720 Vermont Citizens Advisory Board to the Vermont DCF, 5 00:00:10,720 --> 00:00:12,310 Department of Children and Families, 6 00:00:12,310 --> 00:00:15,840 and serves on the Vermont Child Fatality Review Team. 7 00:00:15,840 --> 00:00:17,800 She has extensive professional experience 8 00:00:17,800 --> 00:00:20,270 in the field of domestic violence, child abuse services, 9 00:00:20,270 --> 00:00:23,460 and victims and witness assistance. 10 00:00:23,460 --> 00:00:25,230 And she has been recognized 11 00:00:25,230 --> 00:00:28,610 with the US Health and Human Services Administration 12 00:00:28,610 --> 00:00:31,410 for Children and Families Commissioners Award, 13 00:00:31,410 --> 00:00:34,090 and also the Vermont Agency of Human Services 14 00:00:34,090 --> 00:00:37,940 Community Award and the Queen City Police Foundation 15 00:00:37,940 --> 00:00:41,070 Antonio B. Pomerleau Medal of Honor, 16 00:00:41,070 --> 00:00:44,136 which was presented by Senator Patrick Leahy. 17 00:00:44,136 --> 00:00:47,573 Well deserved of all of this for her amazing work. 18 00:00:48,710 --> 00:00:51,640 And she graduated from University of California Davis 19 00:00:51,640 --> 00:00:54,830 and has a Master's in Education from Cambridge College. 20 00:00:54,830 --> 00:00:56,470 So thank you very much, Sally. 21 00:00:56,470 --> 00:00:58,333 Your work is invaluable. 22 00:01:00,040 --> 00:01:00,873 - Thank you, Molly. 23 00:01:00,873 --> 00:01:02,380 I certainly should have shortened that up. 24 00:01:02,380 --> 00:01:04,960 I didn't know you're gonna do the whole thing. 25 00:01:04,960 --> 00:01:06,460 Much more importantly, 26 00:01:06,460 --> 00:01:08,660 my kids went to preschool with Molly's kids 27 00:01:08,660 --> 00:01:12,310 and that was really all the introduction that we need. 28 00:01:12,310 --> 00:01:14,460 So thank you. 29 00:01:14,460 --> 00:01:16,920 So I think we have our panelists here, 30 00:01:16,920 --> 00:01:21,360 and I'm delighted to be here and it's a little intimidating 31 00:01:21,360 --> 00:01:23,950 to follow Andre Jones, 32 00:01:23,950 --> 00:01:27,160 but we are eager to share with you all 33 00:01:27,160 --> 00:01:31,570 a little bit about the collaborative work of the CHARM Team. 34 00:01:33,230 --> 00:01:38,230 So I'm going to do my best to share my screen. 35 00:01:40,230 --> 00:01:43,033 All right, is that showing up there? 36 00:01:43,970 --> 00:01:45,140 It's showing on my screen, 37 00:01:45,140 --> 00:01:48,130 but I don't know if it's showing on your screen, is it? 38 00:01:48,130 --> 00:01:51,900 - It is, but if you put it in slideshow mode, it'll be full. 39 00:01:51,900 --> 00:01:52,733 - Oh, yay. 40 00:01:52,733 --> 00:01:54,353 Thank you for that little hot tip. 41 00:01:56,760 --> 00:02:00,730 Okay, slide show from the beginning. 42 00:02:00,730 --> 00:02:02,913 Okay, how's that? 43 00:02:09,601 --> 00:02:12,820 We seem to have a very blank screen now. 44 00:02:12,820 --> 00:02:13,653 Whoops. 45 00:02:13,653 --> 00:02:16,540 - Now it jumped out of it. - Okay, sorry. 46 00:02:16,540 --> 00:02:17,900 I'm so sorry. 47 00:02:17,900 --> 00:02:19,567 I'm gonna try this one more time, 48 00:02:19,567 --> 00:02:22,720 and if not, I'm, you know, just gonna wing it. 49 00:02:22,720 --> 00:02:25,300 - And we could still see it the other way 50 00:02:25,300 --> 00:02:26,250 if it doesn't work. 51 00:02:27,370 --> 00:02:28,550 - Yeah. 52 00:02:28,550 --> 00:02:32,470 I don't know why that suddenly, you know, 53 00:02:32,470 --> 00:02:36,263 I even tested it ahead of time, of course, but. 54 00:02:39,720 --> 00:02:42,690 Okay, now I can't see any of you, so. 55 00:02:42,690 --> 00:02:44,550 You can hear me, right? 56 00:02:44,550 --> 00:02:46,590 - Yep, we can hear you and we can see the slides. 57 00:02:46,590 --> 00:02:49,550 It's not in slideshow view, but we can see them all. 58 00:02:49,550 --> 00:02:51,640 - Well, that's awesome, but I can't see you. 59 00:02:51,640 --> 00:02:52,910 No, I'll go ahead anyway. 60 00:02:52,910 --> 00:02:54,210 I think I can. 61 00:02:54,210 --> 00:02:59,130 For some reason my screen just went totally blank, 62 00:02:59,130 --> 00:03:03,070 but I will just say it's my pleasure 63 00:03:03,070 --> 00:03:06,660 to introduce a few of the CHARM partners 64 00:03:06,660 --> 00:03:08,806 who are here with me today. 65 00:03:08,806 --> 00:03:13,806 We are going to hear from Shara Tarule who is a nurse, 66 00:03:15,870 --> 00:03:18,530 clinician at the Chittenden Clinic. 67 00:03:18,530 --> 00:03:20,980 And we'll talk about the importance of MAT 68 00:03:22,140 --> 00:03:25,820 and support services within a treatment environment 69 00:03:25,820 --> 00:03:29,201 for pregnant and postpartum women. 70 00:03:29,201 --> 00:03:31,320 We'll hear from Skyler Bryant, 71 00:03:31,320 --> 00:03:34,050 who is one of our DCF partners. 72 00:03:34,050 --> 00:03:38,410 And she will talk about the role of child welfare 73 00:03:38,410 --> 00:03:43,260 in working with pregnant and postpartum women 74 00:03:43,260 --> 00:03:44,640 and their infants. 75 00:03:44,640 --> 00:03:48,340 And we'll talk a little bit about the very unique approach 76 00:03:48,340 --> 00:03:52,680 that Vermont has with this population 77 00:03:52,680 --> 00:03:54,810 and the importance of that. 78 00:03:54,810 --> 00:03:58,800 And then we will hear from home health from Melissa Kahold 79 00:03:58,800 --> 00:04:02,320 who has been a long time home health 80 00:04:02,320 --> 00:04:05,830 nurse home visiting provider, 81 00:04:05,830 --> 00:04:08,370 and the importance of that piece. 82 00:04:08,370 --> 00:04:12,977 There are a lot of partners in our work, and I, 83 00:04:16,490 --> 00:04:19,980 so I'm still not able to see my screen. 84 00:04:19,980 --> 00:04:24,980 So I am going to take a moment, 85 00:04:25,640 --> 00:04:27,920 and all right, one sec. 86 00:04:27,920 --> 00:04:29,080 - Sally, this is Melissa. 87 00:04:29,080 --> 00:04:32,110 That's happened to me four times during this meeting, 88 00:04:32,110 --> 00:04:34,270 and I've had to rejoin each time. 89 00:04:34,270 --> 00:04:37,460 So just a warning that that might be what you need to do. 90 00:04:37,460 --> 00:04:39,970 Sorry. - Okay. 91 00:04:39,970 --> 00:04:41,850 So let me just double check. 92 00:04:41,850 --> 00:04:45,770 You guys can see the screen, the slides, but not see me. 93 00:04:45,770 --> 00:04:47,431 Is that the deal? 94 00:04:47,431 --> 00:04:49,930 - We can see you as well as the slides. 95 00:04:49,930 --> 00:04:52,455 - Yep, everything looks normal from our end. 96 00:04:52,455 --> 00:04:54,680 - Yay, well, okay then. 97 00:04:54,680 --> 00:04:56,540 Well, let me just go right ahead. 98 00:04:56,540 --> 00:04:58,860 I have another copy of my slides here. 99 00:04:58,860 --> 00:05:00,994 Here, we can go ahead. 100 00:05:00,994 --> 00:05:03,920 So obviously in Molly's introduction, 101 00:05:03,920 --> 00:05:05,830 she mentioned what CHARM is. 102 00:05:05,830 --> 00:05:09,230 And many of you already know we're a collaborative approach 103 00:05:09,230 --> 00:05:11,290 that our goal is to improve the health 104 00:05:11,290 --> 00:05:14,100 and safety outcomes of babies. 105 00:05:14,100 --> 00:05:18,190 And we do that by coordinating medical care, 106 00:05:18,190 --> 00:05:21,050 substance abuse treatment, child welfare, 107 00:05:21,050 --> 00:05:23,970 and social service supports. 108 00:05:23,970 --> 00:05:25,040 We'll just talk for a minute 109 00:05:25,040 --> 00:05:26,760 about our collaborative partners. 110 00:05:26,760 --> 00:05:29,780 Again, you will hear from a few of them today, 111 00:05:29,780 --> 00:05:32,780 and our collaborative partners include 112 00:05:32,780 --> 00:05:35,470 all of these disciplines. 113 00:05:35,470 --> 00:05:40,470 And sorry to have to advance with this screen in this way, 114 00:05:43,250 --> 00:05:45,350 but we'll just make it work. 115 00:05:45,350 --> 00:05:49,800 So thank you for indulging me with this process. 116 00:05:49,800 --> 00:05:54,800 So key partners, obviously prenatal care 117 00:05:55,500 --> 00:05:58,400 and the importance of OBGYN care. 118 00:06:01,008 --> 00:06:05,150 And we work closely with the COGS clinic 119 00:06:05,150 --> 00:06:06,840 at UVM Medical Center, 120 00:06:06,840 --> 00:06:11,790 which is Comprehensive Obstetric and Gynecological Services. 121 00:06:11,790 --> 00:06:15,840 And at COGS, COGS includes what many of you 122 00:06:15,840 --> 00:06:18,756 are familiar with the term a spoke program. 123 00:06:18,756 --> 00:06:23,145 So while Chittenden Clinic is a hub, 124 00:06:23,145 --> 00:06:26,788 the clinic at COGS is a spoke, 125 00:06:26,788 --> 00:06:30,267 and both of those work closely together 126 00:06:30,267 --> 00:06:33,370 to serve those who are identified 127 00:06:33,370 --> 00:06:35,653 as CHARM patients or clients. 128 00:06:36,850 --> 00:06:38,170 UVM Children's Hospital. 129 00:06:38,170 --> 00:06:42,820 Obviously the baby end of the collaborative. 130 00:06:42,820 --> 00:06:44,090 Child welfare. 131 00:06:44,090 --> 00:06:46,560 Again, so happy to have a Sky here with us. 132 00:06:46,560 --> 00:06:50,564 We'll talk about the unique role of DCF Family Services 133 00:06:50,564 --> 00:06:53,610 and how that plays out here in Vermont. 134 00:06:53,610 --> 00:06:55,320 Economic services. 135 00:06:55,320 --> 00:06:59,562 ReachUp is an instrumental partner to our work. 136 00:06:59,562 --> 00:07:03,560 Maternal child health through the health department. 137 00:07:03,560 --> 00:07:06,766 And that includes, importantly, WIC. 138 00:07:06,766 --> 00:07:08,130 Home health. 139 00:07:08,130 --> 00:07:10,473 As I said, Melissa is here to share that. 140 00:07:11,712 --> 00:07:14,481 The Lund has been part of that, 141 00:07:14,481 --> 00:07:18,320 Lund being a residential and outpatient treatment program 142 00:07:18,320 --> 00:07:19,740 for women and their children 143 00:07:19,740 --> 00:07:23,200 or those who are women identified and their children. 144 00:07:23,200 --> 00:07:26,040 And of course, ADAP is a partner 145 00:07:26,040 --> 00:07:29,957 in all things related to SUD, 146 00:07:32,359 --> 00:07:36,493 the SUD clients and patients that we serve. 147 00:07:37,480 --> 00:07:41,230 Most important for CHARM, I think, 148 00:07:41,230 --> 00:07:44,170 and Dr. Jones alluded to this. 149 00:07:44,170 --> 00:07:47,810 And I think, I guess the one thing that I really wanna say 150 00:07:47,810 --> 00:07:52,240 is that having a shared goal and a shared framework 151 00:07:52,240 --> 00:07:54,460 for the work is key, 152 00:07:54,460 --> 00:07:58,190 and I also wanna say that that didn't happen overnight. 153 00:07:58,190 --> 00:08:02,020 So if some of you are just starting out 154 00:08:02,020 --> 00:08:04,317 with a collaborative partnership, 155 00:08:04,317 --> 00:08:07,040 it's not always smooth and easy. 156 00:08:07,040 --> 00:08:09,020 There's a lot of bumps in the road. 157 00:08:09,020 --> 00:08:12,510 And really, a lot of those bumps in the road come down to 158 00:08:12,510 --> 00:08:16,573 do we sort of have a shared approach to this work? 159 00:08:18,370 --> 00:08:20,830 And so starting with the point 160 00:08:20,830 --> 00:08:25,040 that we know that we all want, a healthy and safe infant, 161 00:08:25,040 --> 00:08:26,720 then we come back up and look at 162 00:08:26,720 --> 00:08:30,020 what is our shared philosophy about reaching that? 163 00:08:30,020 --> 00:08:33,075 Improving care and supports for mothers 164 00:08:33,075 --> 00:08:37,360 is the most important factor in helping to ensure 165 00:08:37,360 --> 00:08:39,040 healthy and safe infants. 166 00:08:39,040 --> 00:08:40,600 And that's a lesson that 167 00:08:42,010 --> 00:08:44,100 we don't always come to this work with, 168 00:08:44,100 --> 00:08:46,060 but it's something that many of us have learned 169 00:08:46,060 --> 00:08:49,180 over the years, and a shout out to Dr. Johnson, 170 00:08:49,180 --> 00:08:50,830 because I certainly learned that from her 171 00:08:50,830 --> 00:08:52,783 many, many years ago. 172 00:08:53,970 --> 00:08:56,070 And then the other thing is just have a framework 173 00:08:56,070 --> 00:08:58,980 for operation of the collaboration. 174 00:08:58,980 --> 00:09:01,740 That shared information across agencies 175 00:09:01,740 --> 00:09:06,290 improves child safety and healthy outcomes. 176 00:09:06,290 --> 00:09:08,998 For us, we have a framework for that. 177 00:09:08,998 --> 00:09:12,320 We have a memorandum of understanding 178 00:09:12,320 --> 00:09:15,970 and a release of information that's shared 179 00:09:15,970 --> 00:09:18,590 by all of the agencies and organizations 180 00:09:18,590 --> 00:09:22,600 and departments that are part of our collaborative approach. 181 00:09:22,600 --> 00:09:27,600 We're empaneled as a multidisciplinary child protection team 182 00:09:28,720 --> 00:09:31,020 under the Vermont laws that guide those teams 183 00:09:31,020 --> 00:09:32,850 around the state. 184 00:09:32,850 --> 00:09:35,590 We have that infrastructure and facilitation. 185 00:09:35,590 --> 00:09:36,470 That's my job. 186 00:09:36,470 --> 00:09:39,920 I facilitate it, make sure we can all come together 187 00:09:39,920 --> 00:09:42,940 and we have the infrastructure to do that. 188 00:09:42,940 --> 00:09:45,820 And then just having regular team meetings 189 00:09:45,820 --> 00:09:48,990 where we have a structure for sharing that information 190 00:09:48,990 --> 00:09:50,290 and we get together. 191 00:09:50,290 --> 00:09:55,050 And it's obviously changed since COVID 192 00:09:55,050 --> 00:09:56,360 and we're all online now 193 00:09:56,360 --> 00:09:59,741 and we're not all gathered in a room and sharing chocolates, 194 00:09:59,741 --> 00:10:02,820 thanks to Heather Simpsons who is here, I see, 195 00:10:02,820 --> 00:10:05,250 and Heather always brought chocolate to our meetings, 196 00:10:05,250 --> 00:10:10,250 and now we just have imaginary chocolate as we're on Zoom. 197 00:10:11,570 --> 00:10:15,750 So a couple of things about the prenatal care, 198 00:10:15,750 --> 00:10:20,750 and then they're very similar to what Dr. Jones shared. 199 00:10:21,727 --> 00:10:23,830 And so in the interest of time, 200 00:10:23,830 --> 00:10:26,470 I'm going to just move on and share with you 201 00:10:26,470 --> 00:10:28,210 how the CHARM team works. 202 00:10:28,210 --> 00:10:30,800 We have about 11 different agencies and departments 203 00:10:30,800 --> 00:10:32,293 that come to each meeting. 204 00:10:33,265 --> 00:10:37,330 We meet monthly and there are sometimes 205 00:10:37,330 --> 00:10:40,433 multiple participants from different departments. 206 00:10:41,380 --> 00:10:45,180 We spend about 10 or 15 minutes sharing systems issues, 207 00:10:45,180 --> 00:10:46,490 and that is one of the ways 208 00:10:46,490 --> 00:10:48,650 that we really interface with CHARM. 209 00:10:48,650 --> 00:10:50,650 I mean, with Icon, sorry, 210 00:10:50,650 --> 00:10:54,790 and making sure that we share information back and forth 211 00:10:54,790 --> 00:10:59,790 where we're working on improving channels of communication 212 00:11:00,530 --> 00:11:04,060 around the issues that we see sort of on the ground at CHARM 213 00:11:04,060 --> 00:11:06,132 and with Icon. 214 00:11:06,132 --> 00:11:10,670 And at each meeting, we go through who's due this month, 215 00:11:10,670 --> 00:11:14,300 you know, who are the high risk prenatal patients, 216 00:11:14,300 --> 00:11:16,020 who are new pregnant patients, 217 00:11:16,020 --> 00:11:19,060 and then you of course go over all the babies 218 00:11:19,060 --> 00:11:20,890 that were born in the past month, 219 00:11:20,890 --> 00:11:22,780 and those that are prioritized 220 00:11:22,780 --> 00:11:26,233 by any of our members for discussion. 221 00:11:28,010 --> 00:11:30,340 There are a lot of services that aren't 222 00:11:30,340 --> 00:11:34,130 part of our team meeting, but we make sure to connect with. 223 00:11:34,130 --> 00:11:37,000 And so the peer support that we heard so much about 224 00:11:37,000 --> 00:11:41,750 earlier this morning is something that we really 225 00:11:41,750 --> 00:11:44,497 try and refer people to. 226 00:11:44,497 --> 00:11:48,800 CIS and making sure that we have developmental screens 227 00:11:48,800 --> 00:11:52,973 and so on is key. 228 00:11:53,900 --> 00:11:55,883 And sorry. 229 00:11:57,520 --> 00:11:59,163 Nope, sorry about that. 230 00:12:00,580 --> 00:12:03,640 Okay, all of a sudden, my little, 231 00:12:03,640 --> 00:12:04,870 I'm so sorry. 232 00:12:04,870 --> 00:12:08,760 My little cursor switched, 233 00:12:08,760 --> 00:12:13,760 so I think we can go here and just skip right down to here. 234 00:12:14,002 --> 00:12:17,770 Sky's gonna talk a little bit more about DCF policy 235 00:12:19,170 --> 00:12:20,550 and how that works, 236 00:12:20,550 --> 00:12:22,770 and I'm not gonna go into plans of safe care 237 00:12:22,770 --> 00:12:24,350 'cause Michelle covered that. 238 00:12:24,350 --> 00:12:27,210 And so, again, in the interest of time, 239 00:12:27,210 --> 00:12:31,610 just quickly, what's the value of a collaboration? 240 00:12:31,610 --> 00:12:36,610 Starting prenatal care in starting early in pregnancy. 241 00:12:39,120 --> 00:12:43,500 These are the things that we look at in each meeting. 242 00:12:43,500 --> 00:12:47,220 And then I guess the bottom line for us 243 00:12:47,220 --> 00:12:51,410 is that improving our collaboration means safe for babies. 244 00:12:51,410 --> 00:12:55,560 And quoting one of my esteemed mentors 245 00:12:58,581 --> 00:13:00,850 who sadly is no longer with her, 246 00:13:00,850 --> 00:13:04,130 but I carry her with me all the time. 247 00:13:04,130 --> 00:13:06,640 And she said anything that drives pregnant women 248 00:13:06,640 --> 00:13:09,560 with opioid use disorder from seeking treatment 249 00:13:09,560 --> 00:13:13,410 results in more prematurity, higher infant mortality, 250 00:13:13,410 --> 00:13:16,230 less probability of successful parenting. 251 00:13:16,230 --> 00:13:18,680 And I give her an extra shoutout because she said that 252 00:13:18,680 --> 00:13:20,580 to a legislative committee. 253 00:13:20,580 --> 00:13:23,480 And it wasn't the most popular thing to say at the time, 254 00:13:23,480 --> 00:13:24,853 but it was so important. 255 00:13:25,815 --> 00:13:28,560 There's a lot of benefits to collaboration, 256 00:13:28,560 --> 00:13:32,630 but really the improved understanding, 257 00:13:32,630 --> 00:13:36,107 minimizing misunderstandings and misinformation 258 00:13:36,107 --> 00:13:40,933 is I would say the most important part of our collaboration. 259 00:13:42,350 --> 00:13:46,210 CHARM was written up as a model collaborative approach 260 00:13:46,210 --> 00:13:49,300 a few years back, and I've included a link here. 261 00:13:49,300 --> 00:13:53,810 And of course, we'll share the slides afterwards. 262 00:13:53,810 --> 00:13:57,030 And just listing our contact information 263 00:13:57,030 --> 00:14:00,633 if there are questions after today. 264 00:14:02,510 --> 00:14:05,932 So with that, I'm gonna turn it over to Shara 265 00:14:05,932 --> 00:14:06,953 and go right ahead. 266 00:14:08,978 --> 00:14:09,811 Thank you. 267 00:14:10,750 --> 00:14:12,150 - Yeah, thank you. 268 00:14:12,150 --> 00:14:14,850 And wanting to make sure that we have a chance for Sky 269 00:14:14,850 --> 00:14:18,790 and Melissa to join in as well. 270 00:14:18,790 --> 00:14:22,190 I wanted to emphasize the part of the conversation, 271 00:14:22,190 --> 00:14:24,057 part of our collaboration. 272 00:14:24,057 --> 00:14:26,660 I'm just gonna jump right into 273 00:14:26,660 --> 00:14:28,960 the differences of the philosophies 274 00:14:28,960 --> 00:14:31,190 and the approaches that we have. 275 00:14:31,190 --> 00:14:33,130 I am with the Chittenden Clinic. 276 00:14:33,130 --> 00:14:35,970 That's Vermont's largest methadone clinic. 277 00:14:35,970 --> 00:14:39,430 We are nationally known as an OTP 278 00:14:39,430 --> 00:14:41,940 and opiate treatment program. 279 00:14:41,940 --> 00:14:43,932 In Vermont, we are called hub. 280 00:14:43,932 --> 00:14:47,840 Spokes being the primary care and other providers 281 00:14:47,840 --> 00:14:51,610 that can prescribe Suboxone for opioid use disorder. 282 00:14:51,610 --> 00:14:54,890 Nationally, methadone can only be prescribed 283 00:14:54,890 --> 00:14:58,515 for opioid use disorder out of a hub like ours. 284 00:14:58,515 --> 00:15:02,219 Our philosophy, our approach is harm reduction. 285 00:15:02,219 --> 00:15:03,720 As you can imagine, 286 00:15:03,720 --> 00:15:06,740 that means that I am in a different position 287 00:15:06,740 --> 00:15:08,680 than the philosophy and approaches 288 00:15:08,680 --> 00:15:10,824 of other members at the table. 289 00:15:10,824 --> 00:15:15,750 Skyler DCF, you can't be harm reduction in child protection. 290 00:15:15,750 --> 00:15:18,380 Oh, just a little bit less abuse than neglect? 291 00:15:18,380 --> 00:15:19,400 No, no, no. 292 00:15:19,400 --> 00:15:20,670 That doesn't work in that. 293 00:15:20,670 --> 00:15:24,273 And yet we have to figure out how to work together. 294 00:15:24,273 --> 00:15:27,870 I think there's a lot of things that support us in this. 295 00:15:27,870 --> 00:15:29,710 I think recognizing, first of all, 296 00:15:29,710 --> 00:15:34,710 that we are all humans who are working for the same outcome. 297 00:15:35,210 --> 00:15:37,990 Just because the philosophy of our approaches are different, 298 00:15:37,990 --> 00:15:42,953 all of us want what's best for babies, mothers, families, 299 00:15:42,953 --> 00:15:46,240 and yet, how do we navigate these things? 300 00:15:46,240 --> 00:15:48,920 Means that I do work with a number of women, 301 00:15:48,920 --> 00:15:51,180 people who are pregnant here, sorry, 302 00:15:51,180 --> 00:15:53,670 working on that languaging still, 303 00:15:53,670 --> 00:15:58,670 who has declined to sign the term agreement. 304 00:15:58,770 --> 00:16:00,080 That is our easiest, 305 00:16:00,080 --> 00:16:02,530 if somebody agrees to sign the term agreement, 306 00:16:02,530 --> 00:16:04,370 then we've got that blanket coverage 307 00:16:04,370 --> 00:16:07,680 for all of the coordination that is so valuable 308 00:16:07,680 --> 00:16:10,300 out of that term team. 309 00:16:10,300 --> 00:16:12,210 So what do I do if I'm with somebody 310 00:16:12,210 --> 00:16:14,330 who won't sign the term agreement? 311 00:16:14,330 --> 00:16:17,300 We do have a requirement that they sign an agreement 312 00:16:17,300 --> 00:16:19,920 for us to be in touch with the OB. 313 00:16:19,920 --> 00:16:22,270 When I'm navigating people through pregnancy, 314 00:16:22,270 --> 00:16:24,570 what are things that are most important to me 315 00:16:24,570 --> 00:16:27,010 that the medication that we are managing, 316 00:16:27,010 --> 00:16:29,350 methadone or Suboxone or buprenorphine, 317 00:16:29,350 --> 00:16:31,870 that that is adequate and is where it needs to be 318 00:16:31,870 --> 00:16:34,790 throughout the pregnancy and that they are at least 319 00:16:34,790 --> 00:16:38,420 following up with their OB care and getting regular OB care. 320 00:16:38,420 --> 00:16:40,830 Part of the reason I can hold the philosophy 321 00:16:40,830 --> 00:16:43,690 of harm reduction is that here, we do not, 322 00:16:43,690 --> 00:16:46,570 I do not treat the unborn child. 323 00:16:46,570 --> 00:16:49,560 That, again, is part of the philosophy of our approach. 324 00:16:49,560 --> 00:16:52,552 I am treating the pregnant person. 325 00:16:52,552 --> 00:16:55,180 I am treating the child bearing person. 326 00:16:55,180 --> 00:16:58,230 So I that's where I focus it, 327 00:16:58,230 --> 00:17:00,990 but I also obviously prioritize the care 328 00:17:00,990 --> 00:17:02,020 of the unborn child. 329 00:17:02,020 --> 00:17:05,050 Need to be sure that the person that I'm working with 330 00:17:05,050 --> 00:17:07,304 is having their regular OB care. 331 00:17:07,304 --> 00:17:08,950 And then if they're not, 332 00:17:08,950 --> 00:17:12,190 that's where incredible coordination of care can come in 333 00:17:12,190 --> 00:17:14,010 so that I can work with the OBs. 334 00:17:14,010 --> 00:17:16,410 I can flag reminders here. 335 00:17:16,410 --> 00:17:18,480 There are times where a person's so out of touch 336 00:17:18,480 --> 00:17:21,620 with their OB that I'm able to say, 337 00:17:21,620 --> 00:17:24,550 well, just schedule them appointment because I see them. 338 00:17:24,550 --> 00:17:26,960 We see them here at the clinic every day 339 00:17:26,960 --> 00:17:28,460 or quite frequently, 340 00:17:28,460 --> 00:17:30,870 then we can give those reminders of the appointments, 341 00:17:30,870 --> 00:17:32,280 we can ask do you need a ride? 342 00:17:32,280 --> 00:17:33,880 Do you need a ride from the clinic? 343 00:17:33,880 --> 00:17:37,463 How can we help you get to those appointments? 344 00:17:39,760 --> 00:17:44,010 So the other place that we do 345 00:17:44,010 --> 00:17:47,400 is really an opt out, we're evolving this, 346 00:17:47,400 --> 00:17:50,340 but an opt out of working with Melissa Cofield 347 00:17:50,340 --> 00:17:53,770 and the VNA and the Home Health Maternal Child Programming. 348 00:17:53,770 --> 00:17:56,680 So that at the minimum, you sign a CHARM consent. 349 00:17:56,680 --> 00:17:58,100 Great, everything's covered. 350 00:17:58,100 --> 00:18:00,300 If not, you'll sign a consent for us 351 00:18:00,300 --> 00:18:04,330 to be in touch with your OBs and for the VNA Home Health. 352 00:18:04,330 --> 00:18:06,900 That VNA Home Health referral to us 353 00:18:06,900 --> 00:18:11,670 will mean also another way of variables to make referrals 354 00:18:11,670 --> 00:18:13,680 if we're having trouble getting all of those 355 00:18:13,680 --> 00:18:15,770 releases of information signed. 356 00:18:15,770 --> 00:18:17,690 So like I said, I wanted to go really quickly 357 00:18:17,690 --> 00:18:20,160 and sort of pick one part to focus on 358 00:18:20,160 --> 00:18:24,382 of how I represent and how I come to the team. 359 00:18:24,382 --> 00:18:26,630 I can get back into some of the other things 360 00:18:26,630 --> 00:18:29,330 when we come back, but I'll turn it back to Sally now. 361 00:18:30,950 --> 00:18:32,471 - Thank you, Shara. 362 00:18:32,471 --> 00:18:37,471 That was a great overview of the services that you provide. 363 00:18:38,294 --> 00:18:42,530 Sky, we'd love to hear about DCF Family Services 364 00:18:42,530 --> 00:18:44,370 and your role on CHARM. 365 00:18:44,370 --> 00:18:45,220 - Yes. 366 00:18:45,220 --> 00:18:46,273 Hi, everybody. 367 00:18:47,260 --> 00:18:49,440 Yeah, I think the, 368 00:18:49,440 --> 00:18:52,220 I really enjoy sitting on CHARM. 369 00:18:52,220 --> 00:18:54,563 I think like Shara just represented, 370 00:18:55,490 --> 00:18:58,530 we all come with specific roles, philosophies, 371 00:18:58,530 --> 00:19:02,330 like programmatic policies or directives, 372 00:19:02,330 --> 00:19:05,140 but the collaboration and the relationships 373 00:19:05,140 --> 00:19:07,740 that we develop are really powerful, 374 00:19:07,740 --> 00:19:10,430 and I think help us better understand each other's roles 375 00:19:10,430 --> 00:19:13,663 and responsibilities within the larger system. 376 00:19:15,640 --> 00:19:19,750 A big piece of information that I think is sometimes 377 00:19:19,750 --> 00:19:22,623 a misconception or misunderstanding is that, 378 00:19:23,510 --> 00:19:25,280 Vermont is a very unique state. 379 00:19:25,280 --> 00:19:30,280 I think we are the only, if not one of the only states 380 00:19:30,700 --> 00:19:33,680 that allows for child protection intervention 381 00:19:33,680 --> 00:19:37,343 prior to the child being born. 382 00:19:37,343 --> 00:19:40,570 So we have a unique statute 383 00:19:42,042 --> 00:19:45,930 that allows for us to get involved 30 days prior 384 00:19:45,930 --> 00:19:50,930 to an estimated due date for various reasons. 385 00:19:52,437 --> 00:19:56,430 One being a potentially substance use disorder 386 00:19:56,430 --> 00:20:01,430 and positive screens during the third trimester. 387 00:20:04,130 --> 00:20:07,940 I like to distinguish those two things because, oftentimes, 388 00:20:07,940 --> 00:20:10,910 I think that there's a perception from parents 389 00:20:10,910 --> 00:20:13,530 and providers that when we get involved, 390 00:20:13,530 --> 00:20:15,770 we're investigating and we're trying 391 00:20:15,770 --> 00:20:17,990 to kind of find something. 392 00:20:17,990 --> 00:20:21,520 The model of these sort of early assessments 393 00:20:21,520 --> 00:20:25,577 is really intended to provide intervention 394 00:20:25,577 --> 00:20:30,577 that will allow for us to assess and screen 395 00:20:31,100 --> 00:20:33,860 and access resources and referrals 396 00:20:33,860 --> 00:20:38,660 to ensure that this baby that's on its way has a safe home, 397 00:20:38,660 --> 00:20:39,860 has a parent that's connected 398 00:20:39,860 --> 00:20:42,570 to the right level of treatment and care, 399 00:20:42,570 --> 00:20:47,570 and it allows us to be intentional and proactive, 400 00:20:48,747 --> 00:20:50,993 which I think, ultimately, 401 00:20:50,993 --> 00:20:53,980 it yields the outcomes that we all invested in, 402 00:20:53,980 --> 00:20:57,780 which is it prevents us from having court involvement, 403 00:20:57,780 --> 00:21:01,161 allows newborns to remain with our parents. 404 00:21:01,161 --> 00:21:05,661 Oftentimes, even if there are still some challenges, 405 00:21:05,661 --> 00:21:09,700 we will safety plan with a parent. 406 00:21:09,700 --> 00:21:12,050 We like to gather information about their family, 407 00:21:12,050 --> 00:21:14,660 their network, who do they have for supports 408 00:21:14,660 --> 00:21:17,240 in a way that allows for us to do 409 00:21:17,240 --> 00:21:19,040 some real preventative work with them 410 00:21:19,040 --> 00:21:21,293 and planning ahead of time. 411 00:21:22,340 --> 00:21:27,220 Unfortunately, there are times where there's babies 412 00:21:27,220 --> 00:21:30,320 that are delivered and we haven't received a report, 413 00:21:30,320 --> 00:21:33,920 and it often creates a much more, 414 00:21:33,920 --> 00:21:36,800 I guess I would say crisis type response, 415 00:21:36,800 --> 00:21:40,470 where we haven't had the opportunity to gather information 416 00:21:40,470 --> 00:21:44,013 about who they're connected to, 417 00:21:44,013 --> 00:21:47,150 if they have the resources that they need for the baby, 418 00:21:47,150 --> 00:21:48,450 if they have safe housing. 419 00:21:49,968 --> 00:21:54,649 And so that feels like it's often rushed work. 420 00:21:54,649 --> 00:21:57,310 It impacts our ability to, 421 00:21:57,310 --> 00:21:59,800 or the worker's ability that I supervise 422 00:21:59,800 --> 00:22:04,800 to really truly engage with a pregnant mom and a father 423 00:22:05,682 --> 00:22:08,600 in a way that builds trust and understanding 424 00:22:08,600 --> 00:22:09,750 in what our process is. 425 00:22:12,140 --> 00:22:15,900 So within these assessments, 426 00:22:15,900 --> 00:22:19,650 we also have a really great partnership with Lund 427 00:22:19,650 --> 00:22:22,130 where we have co-located screeners. 428 00:22:22,130 --> 00:22:24,890 And so there's sort of a teaming approach 429 00:22:24,890 --> 00:22:29,497 to working with pregnant or postnatal moms, 430 00:22:29,497 --> 00:22:33,290 in which DCF sort of, I don't wanna say steps back, 431 00:22:33,290 --> 00:22:35,090 'cause there's a release of information 432 00:22:35,090 --> 00:22:36,690 that's signed to share, 433 00:22:36,690 --> 00:22:41,370 but one really takes the lead in screening a parent, 434 00:22:41,370 --> 00:22:45,140 getting history from them regarding their substance use, 435 00:22:45,140 --> 00:22:47,320 finding out who they're connected to for resources, 436 00:22:47,320 --> 00:22:49,173 services, treatment providers, 437 00:22:50,520 --> 00:22:53,190 and then looping back to DCF to kind of explore 438 00:22:53,190 --> 00:22:56,420 any unmet needs or next steps. 439 00:22:56,420 --> 00:23:00,370 And so that partnership has been hugely beneficial 440 00:23:00,370 --> 00:23:04,121 to gathering information quickly and getting parents 441 00:23:04,121 --> 00:23:06,600 connected to the right level of support 442 00:23:06,600 --> 00:23:08,023 in a preventative way. 443 00:23:10,440 --> 00:23:13,780 I think that one of the biggest things 444 00:23:13,780 --> 00:23:15,690 that I appreciate about CHARM 445 00:23:15,690 --> 00:23:19,910 is that we are often functioning in these silos, 446 00:23:19,910 --> 00:23:21,823 no matter how hard we try not to. 447 00:23:23,020 --> 00:23:27,020 And there's a sharing of information that goes on there 448 00:23:27,020 --> 00:23:29,880 that oftentimes truly actually benefits 449 00:23:29,880 --> 00:23:34,517 a lot of pregnant moms 'cause I'm receiving information 450 00:23:34,517 --> 00:23:38,431 from professionals and providers that indicates 451 00:23:38,431 --> 00:23:40,700 they're doing very well, 452 00:23:40,700 --> 00:23:43,070 and there are times where we're getting reports 453 00:23:43,070 --> 00:23:45,360 from perhaps a family member that might not have 454 00:23:45,360 --> 00:23:47,370 that same level of information. 455 00:23:47,370 --> 00:23:50,310 And so sometimes it really informs whether or not 456 00:23:50,310 --> 00:23:53,310 we will be getting involved or we won't be getting involved. 457 00:23:54,990 --> 00:23:57,580 When we're talking about a family or case 458 00:23:57,580 --> 00:23:59,330 that is already open, 459 00:23:59,330 --> 00:24:03,620 I have a system or practice where I'm looking at the notes, 460 00:24:03,620 --> 00:24:05,210 connecting with the workers ahead of time 461 00:24:05,210 --> 00:24:06,670 to get any updates, 462 00:24:06,670 --> 00:24:10,600 and then looping back to them about any updates I received 463 00:24:10,600 --> 00:24:13,830 or any particular provider that hasn't been able 464 00:24:13,830 --> 00:24:15,690 to get in touch with them and I'm saying, 465 00:24:15,690 --> 00:24:16,780 you gotta call Shara. 466 00:24:16,780 --> 00:24:18,873 She can help you navigate this. 467 00:24:20,120 --> 00:24:25,120 So yeah, I think that it allows for 468 00:24:25,570 --> 00:24:30,570 not only better outcomes for families and for newborns, 469 00:24:31,860 --> 00:24:35,230 but also allows for, I think strengthening 470 00:24:35,230 --> 00:24:38,054 community partner relationships, 471 00:24:38,054 --> 00:24:40,990 like unpacking and getting a better understanding 472 00:24:40,990 --> 00:24:42,780 or depth of what our roles are 473 00:24:42,780 --> 00:24:44,440 and why we do what we do and how. 474 00:24:44,440 --> 00:24:46,330 I know that Shara and I have had some really great 475 00:24:46,330 --> 00:24:49,025 philosophical conversations around that. 476 00:24:49,025 --> 00:24:51,980 And so the better that we, 477 00:24:51,980 --> 00:24:55,500 the more that we can understand why we are doing 478 00:24:55,500 --> 00:24:58,180 what we're doing and do it in a collaborative way, 479 00:24:58,180 --> 00:25:01,530 I really have seen a lot of success. 480 00:25:01,530 --> 00:25:03,570 So I'm not sure, Sally, 481 00:25:03,570 --> 00:25:04,860 if there's anything else that you wanted me 482 00:25:04,860 --> 00:25:06,293 to particularly touch on. 483 00:25:07,410 --> 00:25:09,380 - I think you've covered it, Sky. 484 00:25:09,380 --> 00:25:11,150 And given our the time, 485 00:25:11,150 --> 00:25:16,150 I'm gonna turn it right over to Melissa to go ahead. 486 00:25:16,920 --> 00:25:19,100 - Did anybody hear any of that? 487 00:25:19,100 --> 00:25:20,246 - No. 488 00:25:20,246 --> 00:25:23,120 And I think-- - Okay, I'm so sorry. 489 00:25:23,120 --> 00:25:25,910 - Somebody, did you share your screen? 490 00:25:25,910 --> 00:25:28,523 'Cause it's not slides. 491 00:25:29,730 --> 00:25:32,120 - I'm not sharing a screen, no. 492 00:25:32,120 --> 00:25:34,401 - Okay, then just go ahead. 493 00:25:34,401 --> 00:25:35,875 - Okay. 494 00:25:35,875 --> 00:25:37,439 - Okay. 495 00:25:37,439 --> 00:25:41,310 Much of which I planned to talk about this morning, 496 00:25:41,310 --> 00:25:44,410 we've already talked about in the storytelling section 497 00:25:44,410 --> 00:25:45,790 and some of the other places. 498 00:25:45,790 --> 00:25:49,740 So I think we can safely say that most of us have 499 00:25:49,740 --> 00:25:53,030 at least one thing over which we don't have control. 500 00:25:53,030 --> 00:25:55,080 Some of us are fortunate enough that that thing 501 00:25:55,080 --> 00:25:57,640 is more socially acceptable and leads 502 00:25:57,640 --> 00:26:01,310 to less dire repercussions and substance use disorder. 503 00:26:01,310 --> 00:26:04,150 And that also experience also helps us understand 504 00:26:04,150 --> 00:26:06,193 that relapse is part of recovery. 505 00:26:07,320 --> 00:26:08,430 My home health team, 506 00:26:08,430 --> 00:26:10,460 and I know that there's some other home health people 507 00:26:10,460 --> 00:26:14,450 on this call, we work through a primary relationship. 508 00:26:14,450 --> 00:26:17,080 The family has their person. 509 00:26:17,080 --> 00:26:20,020 We can develop a growing in intimate 510 00:26:20,020 --> 00:26:22,140 and individualized understanding 511 00:26:22,140 --> 00:26:24,270 of what will help that family be the strongest 512 00:26:24,270 --> 00:26:26,040 that they can be. 513 00:26:26,040 --> 00:26:28,720 Many families have multiple stressors. 514 00:26:28,720 --> 00:26:31,874 Opioid use disorder is often one of them, 515 00:26:31,874 --> 00:26:34,140 but there's often many, many others. 516 00:26:34,140 --> 00:26:39,140 So I would say that our care is always, 517 00:26:40,163 --> 00:26:41,970 we aim for it to be the same 518 00:26:41,970 --> 00:26:45,310 for no matter what is going on for families. 519 00:26:45,310 --> 00:26:47,470 That would include respectful advocacy, 520 00:26:47,470 --> 00:26:49,710 so care coordination with other providers, 521 00:26:49,710 --> 00:26:53,340 which sometimes includes helping care partners 522 00:26:53,340 --> 00:26:55,300 understand a little bit more 523 00:26:55,300 --> 00:26:57,710 about substance use disorder, 524 00:26:57,710 --> 00:27:01,980 seeing strengths, and also it would include 525 00:27:01,980 --> 00:27:04,830 sharing our concerns when they arise. 526 00:27:04,830 --> 00:27:08,720 Support resources, being a witness or companion 527 00:27:08,720 --> 00:27:12,120 with a historical understanding of how things are changing, 528 00:27:12,120 --> 00:27:13,280 how things are progressing, 529 00:27:13,280 --> 00:27:16,280 even if people feel overwhelmed by what's happening 530 00:27:16,280 --> 00:27:18,759 and can't see that. 531 00:27:18,759 --> 00:27:20,852 Our job is definitely, 532 00:27:20,852 --> 00:27:24,440 this is mutual delight is one of my favorite terms. 533 00:27:24,440 --> 00:27:27,920 So our job is definitely to help families 534 00:27:27,920 --> 00:27:30,880 find that mutual delight with their children. 535 00:27:30,880 --> 00:27:34,290 And in nursing, one of the biggest philosophies 536 00:27:34,290 --> 00:27:38,459 or tactics is anticipatory guidance. 537 00:27:38,459 --> 00:27:41,690 So we would much prefer hearing about referrals 538 00:27:41,690 --> 00:27:43,210 when people are pregnant. 539 00:27:43,210 --> 00:27:44,900 So we can develop that relationship 540 00:27:44,900 --> 00:27:49,053 before they're learning to relate with their babies. 541 00:27:50,107 --> 00:27:53,670 And two other things I think that are really important 542 00:27:53,670 --> 00:27:58,670 is that it's crucial for pregnant people see their dose 543 00:27:59,480 --> 00:28:01,750 as needing to be therapeutic. 544 00:28:01,750 --> 00:28:03,823 I think a lot of people feel like, 545 00:28:04,716 --> 00:28:07,300 sometimes out of guilt sometimes out of shame, 546 00:28:07,300 --> 00:28:10,670 sometimes out of all kinds of other factors, 547 00:28:10,670 --> 00:28:13,810 worrying that their baby's going to need to be dosed 548 00:28:13,810 --> 00:28:16,360 if they have too high a dose, 549 00:28:16,360 --> 00:28:19,660 which is not at all part of what research has found. 550 00:28:19,660 --> 00:28:23,390 So really encouraging people to find the therapeutic dose, 551 00:28:23,390 --> 00:28:26,490 'cause that's the most important thing. 552 00:28:26,490 --> 00:28:29,980 And I would also say that another thing that happens a lot 553 00:28:29,980 --> 00:28:34,980 for people is finding that they will over read 554 00:28:37,340 --> 00:28:42,340 what's happening for people, for their babies as withdrawal 555 00:28:42,500 --> 00:28:44,680 because they've experienced withdrawal themselves, 556 00:28:44,680 --> 00:28:47,110 but it's often just a newborn behavior. 557 00:28:47,110 --> 00:28:48,930 And I can't even tell if we're still, 558 00:28:48,930 --> 00:28:51,043 I think we're not even together, are we? 559 00:28:52,200 --> 00:28:53,300 - Yes we are. 560 00:28:53,300 --> 00:28:54,770 - Oh, we are. 561 00:28:54,770 --> 00:28:55,700 - You're doing great. 562 00:28:55,700 --> 00:28:57,380 - I'm sort of going, trying to speed through. 563 00:28:57,380 --> 00:28:58,520 So that's it. 564 00:28:58,520 --> 00:29:01,700 I just wanted to get out a few points. 565 00:29:01,700 --> 00:29:02,730 That's good. 566 00:29:02,730 --> 00:29:03,980 - That was great, Melissa. 567 00:29:03,980 --> 00:29:07,540 And I think so much of what you said and what you offer 568 00:29:07,540 --> 00:29:11,612 through Home Health echoes what Dr. Jones was talking about 569 00:29:11,612 --> 00:29:14,010 with the Horizons program, 570 00:29:14,010 --> 00:29:17,670 and also what you were just saying, 571 00:29:17,670 --> 00:29:22,580 I think addressing a lot of the myths and misconceptions 572 00:29:22,580 --> 00:29:27,024 around substance use disorder and around treatment 573 00:29:27,024 --> 00:29:31,242 is such a valuable part of what you do. 574 00:29:31,242 --> 00:29:36,242 Just helping address that stigma and the myths 575 00:29:36,310 --> 00:29:38,360 and misconceptions that are out there. 576 00:29:38,360 --> 00:29:40,523 So thank you for that. 577 00:29:41,430 --> 00:29:45,840 Molly, I'm not sure where we stand in terms of time. 578 00:29:45,840 --> 00:29:48,590 I know she said we were going back at 11:20, 579 00:29:48,590 --> 00:29:50,750 but I didn't see a prompt. 580 00:29:50,750 --> 00:29:52,820 So what's the plan here? 581 00:29:52,820 --> 00:29:55,800 We could take questions, we're happy to, or not. 582 00:29:55,800 --> 00:29:57,700 - Some of them are my wine glasses, 583 00:29:57,700 --> 00:29:59,513 but they say right on them. 584 00:30:00,351 --> 00:30:04,771 - I think we need to head back, 585 00:30:04,771 --> 00:30:08,140 but I think there's gonna be time in the larger group 586 00:30:08,140 --> 00:30:10,954 to debrief a bit. 587 00:30:10,954 --> 00:30:12,680 - Great. - And yeah, 588 00:30:12,680 --> 00:30:14,810 and I'm gonna thank you all, 589 00:30:14,810 --> 00:30:17,470 Sally, Skyler, Shara, and Melissa, 590 00:30:17,470 --> 00:30:20,163 that was really wonderful and really nice.