1. Maternal Opioids Supporting Moms
Jeanne Mahoney
ACOG Senior Director
AIM Program – Providers’ Partnership
National WIC -9/26/18
Cooperative Agreement with Maternal Child Health Bureau, HRSA

2. AIM STRATEGIES
BROAD PARTNERSHIP
TOOLS & TA
IMPLEMENTATION TRAINING
REAL TIME DATA
BUILD ON EXISTING INITIATIVES
INCREMENTAL BUNDLE ADOPTION
AIM GOAL Eliminate Preventable Maternal Mortality and Severe Morbidity in Every U.S. Birthing Facility

3. HRSA AIM Partners 2018 PCHHC WIC NICHQ Healthy Start ASAM City MatCH
American Hospital Assoc.
PCHHC
NICHQ
Healthy Start
WIC
ASAM
HRSA
City MatCH
Trinity Health Care
HealthStream

4. AIM Maternal Safety/Quality Improvement Bundles
Safety Bundles
Obstetric Hemorrhage
Severe Hypertension in Pregnancy
Maternal VTE Prevention
Patient, Family and Staff Support
Safe Reduction of Primary Cesarean Births
Maternal Early Warning Criteria
Reducing Disparities in Maternity Care
Safety Tools
For
Every
Birth
SMM Case Review Forms
Obstetric Care of Opioid Dependent Women
Postpartum Care Basics
Maternal Mental Health
Interconception Care
safehealthcareforeverywoman.org

6. Current AIM Initiatives
Bundle implementation guides and bundle commentaries on Postpartm Care, Transition to Well Woman Care and Maternal Opioid Use Disorder
Obstetric care of women with opioid use disorder
Reduction of peripartum Racial Disparities/ Clinical Community linkages
AHRQ initiated work: Building Team STEPPS into bundles
Data technical assistance
Engagement of emergency department clinicians
Refreshing and disseminating current e-learning modules
Hospital recognition program
Engagement of Indian Health Service

7. Why AIM and Opioids
Greatest cause of maternal mortality in many states
Addiction is a disease – withdrawal not a positive option
Difficult for pregnant women to get prenatal care
Clinical team not knowledgeable
Difficult for postpartum women to remain in treatment
Stigma
Fear

8. Opioid Bundle - Readiness
Every patient/family
Educate to promote understanding of opioid use disorder (OUD) as a chronic disease
Educate on NAS
Engage in development of safe plan of care for mom and baby
Every clinical setting
Staff-wide education on OUDs
Establish specific prenatal, intrapartum and postpartum pathways with care coordination
Develop pain control protocols
Know state reporting guidelines for moms and substance exposed infants and regulatory requirements for SUD care
Identify women-centered SUD facilities
Stigma/bias/discrimination
Chronic disease
Treatment
Education
Family/patient engagement
Care Coordination
Multidisciplinary care coordination
Antenatal, intrapartum, postpartum planning
Pain control
Know guidelines and statutes
Know best resources

9. Opioid Bundle - Recognition
Every provider & clinical setting
Assess ALL pregnant women for SUDs/ SBIRT approach
Identify polysubstance use
Evaluate for common co-morbidities
Provide resources for smoking cessation
Identify each woman’s stage of recovery or readiness to change
Assess ALL
SBIRT
Polysubstance use
Co-morbidities
Psychiatric disorders
IPV
Smoking
Readiness to change

10. Opioid Bundle - Response
Every provider/clinical setting
Ensure enrollment in OUD treatment program
Establish communication with treatment program
Assist in linking to local resources to support recovery
Incorporate family planning, breastfeeding, pain management and infant care education, counseling and resources
Ensure coordination among providers – pregnancy, postpartum and inter-conception period
Engage child welfare services in safe care protocols
Woman-centered treatment
Communication and coordination
Linkages
Postpartum contraception
Breastfeeding
Pain management
Infant care
Pregnancy, postpartum, inter-conception
“Warm handoff”
Child welfare
Safe care protocols
Home visiting

11. Opioid Bundle – Reporting and Systems Learning
Every clinical setting and health system
Collect data and monitor process and outcome metrics – data dashboard
Multidisciplinary case review teams to evaluate
Continuing education and learning opportunities for providers and staff.
Strategies to connect community stakeholders with clinicians to share outcomes and improve care
Engage public, welfare, court and legal systems for data collection, problem identification and to drive the initiative
Process and outcome metrics
Data dashboard
Case review teams
Continuing education
Connecting
Stakeholders
Child welfare
Public health
Courts
Law enforcement
Share outcomes

12. The Consequences of Stigma
Women with OUD carry a high burden of stigma.
Fear of judgment - less likely to seek help.
Fear of judgment -more likely to drop out of treatment.

13. Language Matters: Check Yourself
Protest any labels that turn people into things.
Words are important.
If you want to care for something, you call it a ‘flower;’ if you want to kill something, you call it a ‘weed.’

14. Language Matters: Check Yourself
Train staff on issues related to substance use and stigma
Focus on the inadvertent ways that staff may be perpetuating stigma in day-to-day conversation.
Ask them to think about the perceptions they hold of people with substance use disorders and the words and language they use in discussing individuals or cases.
How can they explore alternative language? How can they adopt this alternative language?

15. National Collaborative on Maternal Opioid Use Disorder
Started October 2018 with 14 state teams
To optimize the care of mothers with opioid use disorder (OUD) and their infants by providing screening and comprehensive care at the following levels:
Hospital (L&D, ED)
Outpatient settings (Clinics and offices)
State/Perinatal Quality Collaborative
Community

16. Pregnant and Postpartum Women with OUD & their Infants
DESIRED OUTCOMES
Pregnant and Postpartum Women with OUD & their Infants
Universal screening for pregnant women
Access to medical care and treatment
Increase number of women in treatment
Decrease number of women who overdose
Increased maternal participation in care of their newborns
Increase babies discharged home with mothers
Decreased length of stay for infants with NAS
Increase use of non-pharmacological care /decrease in pharmacologic care for babies

17. RESOURCES
AIM Opioid Collaborative Chart
A visual aid linking opioid collaborative goals to corresponding key drivers, interventions, resource links, and metrics.
AIM Opioid Implementation Guide
A step-by-step guide to implementing the recommendations of the AIM Opioid bundle.
AIM Opioid Screening Tool Chart
A comparison chart showing the various tools used for screening for substance use disorders.
AIM Neonatal Abstinence Syndrome Slides
A slide deck on NAS and maternal involvement in care of the infant.
AIM Screening Slides
A slide deck on screening for opioid use disorder during pregnancy and postpartum.
AIM “Questions for States to Consider”
Questions regarding partnerships and engagement outside of the hospital setting when implementing the AIM Opioid bundle.
AIM Opioid Use Disorder Chart Checklist
An example checklist for the clinical care of pregnant/postpartum women with OUD.
AIM Opioid Metrics
Metrics for the AIM Opioid bundle with notes and glossary.
Additional Resources

18. Thank You www.safehealthcareforeverywoman.org/AIM Jeanne Mahoney
CONTACT:
Thank You
Jeanne Mahoney