[Michelle] Pretty good time to get rolling.
So good morning everyone again
and welcome to the Perinatal Quality
of Collaborative Vermont Annual Improving Care
for Opioid Exposed Newborns Conference.
I know that this is the eighth conference I've been to
and this has been going for quite some time.
So about 21 years now I believe
since the onset of ICON founded
by our friend Dr. Ann Johnson.
So welcome everyone today.
See the weather is starting to turn,
so excited to be here.
Just some really quick housekeeping.
As usual for a Zoom conference, we have
a very active chat box monitor
so please feel free to put any questions
or comments in the chat box throughout the talks today.
Also, we have live captioning available
and that link is already in the chat box.
We will have everybody muted when you join
but there will be times where we can allow people to unmute
for question and answer portions.
And of course to help us continually improve, we appreciate
if you could complete the evaluation
at the end of the webinars today.
If you have any questions or concerns,
please send an email directly
to us or reach out through the chat box.
So I'm gonna do some brief welcome and updates here today
so we can get right into the heart of the matter.
I just want of course, no disclosures,
I just wanted everyone to be on the same page
and know where we are and where we're going as far
as our project here, the Improving Care
for Opioid Exposed Newborns or ICON Project.
And just a reminder we are
a Vermont Child Health Improvement Program project or VCHIP.
We focus on quality improvement
and are part of the Perinatal Quality Collaborative Vermont.
Our main focus is really to improve the care
for opioid dependent pregnant
and parenting people and families
and opioid exposed newborns throughout our state.
And then we are quite a collaborative team.
We have partners from all over the state
from the Department of Health, the Department for Children
and Families, the Children's Hospitals,
the community hospitals
and of course our wonderful advisors, people
with lived experience.
Some of our initiatives here
and we'll quickly zoom through these, but we partner
with other VCHIP projects to really expand the reach
of our quality improvement initiatives
through the PQC Vermont.
We also support our hospitals,
both the medical center and our community hospitals
around technical assistance and implementation
for the Vermont Plan of Safe Care
and CAPTA notifications system.
We collect some hospital data
for quality improvement initiatives
which we try to share here each year.
And really we focus on providing education as well
to both the hospitals but also the families affected
by substance use and opioid use disorders.
So partnering is the first thing we do
and just I wanna give a shout out to Julie Peren
who many of you know is the project director here
for the ICON Project, but also extremely active
in the Perinatal Quality Collaborative.
And a few of these slides I borrowed from her recent talk.
So the PQC Vermont it's goal overall is
to optimize health outcomes in pregnancy and infancy.
And again, this is a quality improvement initiative
throughout the state and looking
to really support perinatal health outcomes
in many different domains as well
as quality improvement efforts.
You can see that there's been many efforts
over the years 20 years and going
at VCHIP around perinatal health and infancy.
So these are some of the ongoing projects
and different things that we do to help support the state
around caring for mothers and infants.
Supporting the Vermont Plan of Safe Care is kind of my baby
and something that we've worked really hard
out here in the state.
And really our goal is to really remove these silos
and improve the care and communication
for families from pre-pregnancy, throughout pregnancy,
after the birth of the infant and beyond.
And really thinking about how we can best connect
through that hospital stay out to the community support.
So just I wanted everyone to have language
all the same here.
So the plan of Safe Care in Vermont is a part
of a federal legislation package,
but the way we have approached that here
in Vermont is really to make this a living document
that's completed with the pregnant individual
and other caregivers.
The goal is to start pre-pregnancy, but must be completed
by the birth hospital discharge and it really,
the role is to list any current supports as well
as additional areas of needed supports
and referrals at the time of hospital discharge.
And again, focusing heavily on things like partnering
with our nurse home visiting partners, as well as thinking
about referrals to children's integrated services
for those infants moving forward.
This is shared with the parent as well
as the infant's primary care provider really
to allow follow up of all of these new referrals
and make sure people are connected.
Really importantly, and I think important with our language
to families is that this is not something that's sent
to or shared with the Department of Children and Families
unless they're already involved
for other child safety concerns.
In our state, we set up two separate pathways
and the Vermont Plan of Safe Care is required
along with a de-identified CAPTA notification
for pregnant people that are receiving medications
for opioid use disorder using prescribed opioids
or benzodiazepines and/or using cannabis
after the first trimester of pregnancy.
This is what it looks like.
It's a one page back
and forth and it can be downloaded online.
The CAPTA notification, again this is something
that's required by federal law
but a lot of leeway was given
to the states and what to put in this CAPTA notifications.
We use a different system than many other states rather
than reporting to our Department of Children
and Families, we use this for families
that don't have any other safety concerns
and are again using medications
as prescribed such as that for treatment
of opioid use disorder, for chronic pain, for anxiety
or in this case in the use of cannabis throughout pregnancy.
This really allows us to complete what we need to do
for federal legislation
which is to really send a aggregate overall number
of infants affected by substance abuses during pregnancy.
So again, this is completely de-identified
with no family names.
You can see what this looks like.
There's nowhere on here and specifically says
on the top, please do not put any identifying information.
We have developed these pathways which can be downloaded
and this is really a what to do during pregnancy and
after pregnancy and when a DCF report would be made
versus using this de-identified notification
and support pathway.
This is what should be done after the birth of an infant.
And again, newborn reports and prenatal reports are accepted
after the 30 days prior to delivery
and that really allows us to engage families
in the support they need
so that they can feel comfortable, confident
and safe in parenting their child without involvement
from Department of Children and Families.
Here's the website for all of the information I've shown.
So the Vermont Plans of Safe Care, CAPTA notification forms,
there are frequently asked questions.
There's a handout I'll show you for families
and I really think it's important that we have an area
that we can hop back to if we have any questions.
There's also an email here that comes
to a small group of us to answer any questions
or concerns related to CAPTA or the Plan of Safe Care.
So the third thing we do here
at VCHIP is look at a lot of data.
And so I just wanted to briefly show the same data I know
if people have been here before you've seen this every year,
but really wanted to see annually
how many infants are being cared
for at the UVM Medical Center
with opioid exposure during pregnancy.
And really the trend continues to go down.
We really started to see a down trend
in 2020 and that's continued to go down in 2022.
You can see when we started data back in 2002,
there were 12 people with a peak really
in the 2010 to 2015 zone and really has started
to come down.
At the community hospitals, thank you to all
of you who complete the perinatal statistics forms
and send those in.
We are seeing, again, also a decline
in the number of infants that are being cared
for with prenatal exposure to opioids.
But over the course of 2022
there were 91 infants cared for at community hospitals.
And then looking at that as the proportion
of opioid exposed newborns in all live births,
so really we again, are seeing a decline.
It's not just a decline in birth overall
but really a decline in the number
of opioid exposed newborns that are being cared for.
This is just from the UVM Medical Center.
I know that many of the hospitals are doing just
as needed morphine for signs and symptoms
of opioid withdrawal.
But here at the medical center and you know it fluctuates
between 10 and 20, we had about 25% of infants
over the last year that required any medication therapy.
And again, that can be a one dose methadone here
at the medical center
or that may include a prolonged ween from methadone.
But it was about 14 babies this year and about 25%
of the overall population that required some medications.
This is looking at another sample of data we collect
which is the CAPTA notifications.
So again, as hospitals send a de-identified form over,
we then collect and monitor how many we're receiving.
And that decline is mirroring
to some extent the decline we're seeing
in opioid exposed newborns throughout the state.
So the other thing we wanna do is really improve education.
So materials to prepare families for birth,
for hospital stay, for their transition home.
So preparing families.
We have a totally updated Our Care Notebook.
Many of you may have seen this in the past.
It is now available for download on our website.
So you can download it, you can browse through it,
you can reach out to us
if you would like printed copies of this.
It really is a wonderful resource.
It has been updated to include resources
throughout the state and not just here in Chittenden County.
So please have a look at this.
We also did a preparation video really
to help families be ready for the amount
of time they'll be here in the hospital and what kind
of things to expect during the 96 hours of monitoring
that generally we have for infants exposed
to the long-acting opioid agonist treatments
for opioid use disorder.
We also have the Plan of Safe Care Family handout.
Again, this is a piece of paper you can give
the families to help explain when you're talking
to them about why we do this and where it goes.
And then I do like to point people
to the One More Conversation Campaign.
This is something we worked
with the Department of Health on
and this has patient education materials
as well as provider toolkit resources
to really help have this ongoing conversation
and to destigmatize the way we talk
about substance abuse in pregnancy.
This is an example of one of the handouts,
this is opioid use during pregnancy.
And then I just wanted to take a second again
to identify our team.
And this really takes a team.
We have many collaborators here
and thankfully later today I'm so excited you'll get to hear
from our current advisors who have been integral
to us really moving forward and making sure the priorities
for the state meet the priorities
of the population that we are trying to work with here.
So I am going to pop out of my share
which is nice 'cause then I can see everyone.
I'm happy to take quick questions
but I wanna keep us on time.
So I also want to make sure to go ahead
and do the introduction here for Dr. Turpin.
Any quick questions from the group?
[Participant] Hey Michelle, there was one question
in the chat if you can see the chat about the data.
[Michelle] Oh, that's a great question, Debra.
So we do have that information.
We do know where the infants are coming from.
Generally when we're looking
at some of those numbers and proportions, we're looking
at Vermont Hospital data
and those that are born at UVM Medical Center.
We're not filtering out
whether the state of maternal residence is New York.
But we are looking at the difference between transfers,
so infants that are transferred from say CBPH
in Plattsburgh, we're unfortunately not able
to have Dartmouth information on here too.
So we do know there's a lot
of Vermont residents that deliver at Dartmouth.
But again, these were Vermont born infants.