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[Michelle] Pretty good
time to get rolling.

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So good morning everyone again

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and welcome to the Perinatal Quality

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of Collaborative Vermont
Annual Improving Care

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for Opioid Exposed Newborns Conference.

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I know that this is the
eighth conference I've been to

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and this has been going
for quite some time.

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So about 21 years now I believe

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since the onset of ICON founded

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by our friend Dr. Ann Johnson.

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So welcome everyone today.

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See the weather is starting to turn,

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so excited to be here.

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Just some really quick housekeeping.

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As usual for a Zoom conference, we have

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a very active chat box monitor

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so please feel free to put any questions

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or comments in the chat box
throughout the talks today.

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Also, we have live captioning available

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and that link is already in the chat box.

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We will have everybody muted when you join

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but there will be times where
we can allow people to unmute

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for question and answer portions.

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And of course to help us
continually improve, we appreciate

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if you could complete the evaluation

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at the end of the webinars today.

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If you have any questions or concerns,

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please send an email directly

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to us or reach out through the chat box.

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So I'm gonna do some brief
welcome and updates here today

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so we can get right into
the heart of the matter.

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I just want of course, no disclosures,

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I just wanted everyone
to be on the same page

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and know where we are and
where we're going as far

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as our project here, the Improving Care

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for Opioid Exposed
Newborns or ICON Project.

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And just a reminder we are

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a Vermont Child Health Improvement
Program project or VCHIP.

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We focus on quality improvement

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and are part of the Perinatal
Quality Collaborative Vermont.

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Our main focus is really
to improve the care

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for opioid dependent pregnant

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and parenting people and families

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and opioid exposed newborns
throughout our state.

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And then we are quite
a collaborative team.

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We have partners from all over the state

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from the Department of Health,
the Department for Children

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and Families, the Children's Hospitals,

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the community hospitals

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and of course our
wonderful advisors, people

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with lived experience.

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Some of our initiatives here

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and we'll quickly zoom
through these, but we partner

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with other VCHIP projects
to really expand the reach

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of our quality improvement initiatives

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through the PQC Vermont.

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We also support our hospitals,

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both the medical center
and our community hospitals

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around technical assistance
and implementation

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for the Vermont Plan of Safe Care

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and CAPTA notifications system.

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We collect some hospital data

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for quality improvement initiatives

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which we try to share here each year.

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And really we focus on
providing education as well

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to both the hospitals but
also the families affected

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by substance use and opioid use disorders.

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So partnering is the first thing we do

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and just I wanna give a
shout out to Julie Peren

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who many of you know is
the project director here

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for the ICON Project,
but also extremely active

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in the Perinatal Quality Collaborative.

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And a few of these slides I
borrowed from her recent talk.

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So the PQC Vermont it's goal overall is

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to optimize health outcomes
in pregnancy and infancy.

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And again, this is a quality
improvement initiative

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throughout the state and looking

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to really support
perinatal health outcomes

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in many different domains as well

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as quality improvement efforts.

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You can see that there's been many efforts

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over the years 20 years and going

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at VCHIP around perinatal
health and infancy.

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So these are some of the ongoing projects

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and different things that we
do to help support the state

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around caring for mothers and infants.

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Supporting the Vermont Plan of
Safe Care is kind of my baby

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and something that
we've worked really hard

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out here in the state.

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And really our goal is to
really remove these silos

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and improve the care and communication

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for families from pre-pregnancy,
throughout pregnancy,

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after the birth of the infant and beyond.

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And really thinking about
how we can best connect

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through that hospital stay
out to the community support.

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So just I wanted everyone to have language

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all the same here.

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So the plan of Safe Care
in Vermont is a part

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of a federal legislation package,

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but the way we have approached that here

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in Vermont is really to
make this a living document

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that's completed with
the pregnant individual

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and other caregivers.

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The goal is to start pre-pregnancy,
but must be completed

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by the birth hospital
discharge and it really,

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the role is to list any
current supports as well

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as additional areas of needed supports

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and referrals at the time
of hospital discharge.

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And again, focusing heavily
on things like partnering

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with our nurse home visiting
partners, as well as thinking

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about referrals to children's
integrated services

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for those infants moving forward.

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This is shared with the parent as well

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as the infant's primary
care provider really

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to allow follow up of all
of these new referrals

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and make sure people are connected.

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Really importantly, and I think
important with our language

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to families is that this is
not something that's sent

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to or shared with the Department
of Children and Families

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unless they're already involved

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for other child safety concerns.

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In our state, we set up
two separate pathways

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and the Vermont Plan of
Safe Care is required

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along with a de-identified
CAPTA notification

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for pregnant people that
are receiving medications

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for opioid use disorder
using prescribed opioids

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or benzodiazepines and/or using cannabis

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after the first trimester of pregnancy.

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This is what it looks like.

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It's a one page back

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and forth and it can be downloaded online.

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The CAPTA notification,
again this is something

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that's required by federal law

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but a lot of leeway was given

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to the states and what to put
in this CAPTA notifications.

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We use a different system
than many other states rather

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than reporting to our
Department of Children

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and Families, we use this for families

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that don't have any other safety concerns

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and are again using medications

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as prescribed such as that for treatment

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of opioid use disorder, for
chronic pain, for anxiety

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or in this case in the use of
cannabis throughout pregnancy.

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This really allows us to
complete what we need to do

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for federal legislation

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which is to really send a
aggregate overall number

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of infants affected by substance
abuses during pregnancy.

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So again, this is completely de-identified

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with no family names.

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You can see what this looks like.

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There's nowhere on here
and specifically says

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on the top, please do not put
any identifying information.

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We have developed these
pathways which can be downloaded

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and this is really a what
to do during pregnancy and

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after pregnancy and when
a DCF report would be made

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versus using this
de-identified notification

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and support pathway.

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This is what should be done
after the birth of an infant.

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And again, newborn reports and
prenatal reports are accepted

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after the 30 days prior to delivery

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and that really allows
us to engage families

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in the support they need

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so that they can feel
comfortable, confident

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and safe in parenting their
child without involvement

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from Department of Children and Families.

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Here's the website for all of
the information I've shown.

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So the Vermont Plans of Safe
Care, CAPTA notification forms,

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there are frequently asked questions.

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There's a handout I'll
show you for families

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and I really think it's
important that we have an area

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that we can hop back to
if we have any questions.

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There's also an email here that comes

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to a small group of us
to answer any questions

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or concerns related to CAPTA
or the Plan of Safe Care.

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So the third thing we do here

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at VCHIP is look at a lot of data.

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And so I just wanted to briefly
show the same data I know

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if people have been here before
you've seen this every year,

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but really wanted to see annually

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how many infants are being cared

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for at the UVM Medical Center

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with opioid exposure during pregnancy.

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And really the trend continues to go down.

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We really started to see a down trend

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in 2020 and that's continued
to go down in 2022.

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You can see when we
started data back in 2002,

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there were 12 people with a peak really

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in the 2010 to 2015 zone
and really has started

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to come down.

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At the community
hospitals, thank you to all

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of you who complete the
perinatal statistics forms

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and send those in.

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We are seeing, again, also a decline

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in the number of infants
that are being cared

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for with prenatal exposure to opioids.

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But over the course of 2022

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there were 91 infants cared
for at community hospitals.

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And then looking at that as the proportion

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of opioid exposed newborns
in all live births,

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so really we again, are seeing a decline.

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It's not just a decline in birth overall

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but really a decline in the number

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of opioid exposed newborns
that are being cared for.

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This is just from the UVM Medical Center.

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I know that many of the
hospitals are doing just

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as needed morphine for signs and symptoms

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of opioid withdrawal.

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But here at the medical center
and you know it fluctuates

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between 10 and 20, we
had about 25% of infants

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over the last year that
required any medication therapy.

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And again, that can be a
one dose methadone here

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at the medical center

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or that may include a
prolonged ween from methadone.

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But it was about 14 babies
this year and about 25%

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of the overall population that
required some medications.

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This is looking at another
sample of data we collect

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which is the CAPTA notifications.

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So again, as hospitals send
a de-identified form over,

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we then collect and monitor
how many we're receiving.

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And that decline is mirroring

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to some extent the decline we're seeing

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in opioid exposed newborns
throughout the state.

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So the other thing we wanna do
is really improve education.

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So materials to prepare
families for birth,

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for hospital stay, for
their transition home.

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So preparing families.

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We have a totally updated
Our Care Notebook.

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Many of you may have
seen this in the past.

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It is now available for
download on our website.

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So you can download it,
you can browse through it,

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you can reach out to us

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if you would like printed copies of this.

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It really is a wonderful resource.

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It has been updated to include resources

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throughout the state and not
just here in Chittenden County.

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So please have a look at this.

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We also did a preparation video really

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to help families be ready for the amount

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of time they'll be here in
the hospital and what kind

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of things to expect during
the 96 hours of monitoring

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that generally we have for infants exposed

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to the long-acting
opioid agonist treatments

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for opioid use disorder.

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We also have the Plan of
Safe Care Family handout.

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Again, this is a piece
of paper you can give

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the families to help
explain when you're talking

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to them about why we do
this and where it goes.

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And then I do like to point people

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to the One More Conversation Campaign.

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This is something we worked

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with the Department of Health on

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and this has patient education materials

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as well as provider toolkit resources

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to really help have this
ongoing conversation

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and to destigmatize the way we talk

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about substance abuse in pregnancy.

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This is an example of one of the handouts,

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this is opioid use during pregnancy.

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And then I just wanted
to take a second again

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to identify our team.

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And this really takes a team.

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We have many collaborators here

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and thankfully later today I'm
so excited you'll get to hear

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from our current advisors
who have been integral

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to us really moving forward
and making sure the priorities

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for the state meet the priorities

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of the population that we
are trying to work with here.

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So I am going to pop out of my share

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which is nice 'cause
then I can see everyone.

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I'm happy to take quick questions

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but I wanna keep us on time.

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So I also want to make sure to go ahead

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and do the introduction
here for Dr. Turpin.

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Any quick questions from the group?

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[Participant] Hey Michelle,
there was one question

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in the chat if you can see
the chat about the data.

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[Michelle] Oh, that's a
great question, Debra.

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So we do have that information.

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We do know where the
infants are coming from.

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Generally when we're looking

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at some of those numbers and
proportions, we're looking

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at Vermont Hospital data

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and those that are born
at UVM Medical Center.

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We're not filtering out

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whether the state of maternal
residence is New York.

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But we are looking at the
difference between transfers,

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so infants that are
transferred from say CBPH

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in Plattsburgh, we're
unfortunately not able

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to have Dartmouth information on here too.

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So we do know there's a lot

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of Vermont residents that
deliver at Dartmouth.

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But again, these were
Vermont born infants.