SENI - LaunchSubstance-Exposed Newborns Initiative

SENI Agenda Review of Priority Ranking from 2019 PQC Summit

Data Update on Substance-Exposed Newborns (SENs)

Current State

On the Front Lines

PQC Neonatal Project

BREAK

Small Group Breakouts

Plenary Report-out & Action Planning

2:35

2:45

2:55

3:05

3:15

3:30

3:45

4:10

Priority Rankings – PQC 2019

Evelyn Rider

NEONATAL PROJECT LAUNCHJANUARY 25, 2020

SECTION OF WOMEN’S, CHILDREN’S, AND FAMILY HEALTH

AK PQC Launch 2019 – Healthcare Priorities Survey

NEONATAL HEALTH SURVEY1. LARGEST HEALTH PROBLEM◦ --Safe Sleep◦ --NAS◦ --Breastfeeding◦ --Children with special health care needs

2. MOST SERIOUS HEALTH PROBLEM◦ --NAS◦ --Children with special health care needs

3. MOST EFFECTIVE INTERVENTIONS◦ --Breastfeeding◦ --NAS

MATERNAL HEALTH SURVEY1. LARGEST HEALTH PROBLEM◦ --Maternal Mental Health◦ --Substance Use in Pregnancy◦ --Hemorrhage management, Access, Hypertension

2. MOST SERIOUS HEALTH PROBLEM◦ --Substance Use in Pregnancy◦ --Hypertension

3. MOST EFFECTIVE INTERVENTIONS◦ --Hypertension in Pregnancy◦ --Hemorrhage, Mental Health, Access◦ --Substance Use in Pregnancy

ALASKA MATERNAL CHILD HEALTH EPIDEMIOLOGY 5

Which Neonatal Topic for most buy-in at your site and **would result in improved process/outcomes

1. Focus on mothers because postpartum opioids affect ability to care for the baby and impacts usage later

2. Eat, Sleep, Console Protocol3. Need comprehensive guide for managing babies with NAS and the

mothers4. Coordination with rural facilities – what to do when babies/moms return

home5. Need for MAT waivered providers in rural areas6. **Need to include out of hospital providers for QI projects7. **NAS scoring and breastfeeding QI would be easiest to track/report8. **NAS/maternal substance use – need standardized terminology and

coding

ALASKA MATERNAL CHILD HEALTH EPIDEMIOLOGY 6

Incidence is Increasing

ALASKA MATERNAL CHILD HEALTH EPIDEMIOLOGY 8

2014-NAS 1 baby every 9-15 minutesWinkelman et al – Pediatrics 2018

Data Update on SENs

Margaret Young

Current State

Sherrell Holtshouser

Current Status of SENI Program

2018: first full 12 months of data available

1049/9244 (11%) of all births screened—not representative of whole state

Screening Rate average for all sites combined=41%

2019:UAA IRB approval—surveillance

2019 data now being collected and processed

Current Status of SENI Program

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2017 2018 2019

Number of Pregnant Women Screened with 4Ps by YearSubstance Exposed Newborns Initiative

(N=2,298)2017 & 2019 are 6 months of data

Current Status of SENI Program

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Number screened Number positive assess Number offered BI Number accepting BI

SENI: Initial 24 Months Data by Year

2017 (6 mo) 2018 (12 mo) 2019 (6 mo)

Investigating data management possibilities

Working on a program toolkit

Becoming Medicaid billable SBIRT

Useful for new Plans of Safe Care Initiative

Current Status of SENI Program

SENI will continue to screen for:• Tobacco• Alcohol• Marijuana• Opioids• Other harmful substances• Mother’s desired timing for subsequent

pregnancy• Depression• Violence

Current Status of SENI Program

On the Front Lines

Bill Trawick

PQC Neonatal Project

Lily Lou

Ideal Project Characteristics

“Low-hanging fruit,” simple & do-able

Relevant to newborns of all gestations, in all birth settings

Measurable

Meaningful

Aligned with priorities of other agencies

Selected NAS

Most votes in priority rankings

Most meaningful to PQC members

Measurable

Builds on previous work from the AK Prenatal Screening Project

Aligned with the work to implement ”Plans of Safe Care”

However…

NAS is very complicated

Components: Finnegan ESC Non-pharmacologic interventions Universal screening Case management SBIRT

✘ More than scoring ✘ NICU

✘ Too big ✘ Limited budgets✓ Aligned with OCS & POSC✓ Good idea…maybe later?

✓ Perinatal training ~ in development

Terminology

NAS – “Neonatal Abstinence Syndrome”

NOWS – “Neonatal Opioid Withdrawal Syndrome”

SEN – “Substance Exposed Newborn”

New concept of “Prenatal Neglect”

Screening Strategy

Some states are considering mandatory drug testing

Evidence supports verbal screening

Alaska Prenatal Screening Program: 4Ps Plus Proprietary product Data reports from NTI q 6 months Uses verbal screening tool

Screening Strategy

ACOG:

“Screening is a public health-oriented approach that relies on evidence and has been documented to support the health of mothers and their babies”

“…urine testing…is best done as an adjunct to confirm suspected drug use and only with the patient’s consent.”

Screening Strategy AAP & ACOG agree:

Screening for substance use should be a part of routine prenatal care

Universal verbal screening with a validated tool is the preferred method for initial screening

Screening based only on factors such as poor adherence to prenatal care or adverse pregnancy outcomes will result in missed cases

Urine toxicology testing does not rule out sporadic substance use and does not detect many substances

Screening Strategy

Evidence supports the best validity of the 4Ps Plus Tool (5Ps Plus considered)

Alaska will review the data forms prior to submission

NTI will provide more frequent data reports

We will need to develop our own data management system (will take resources and FTEs)

This can then be used for future PQC work

4Ps Validation DataCorrect classification….……..1,514/1884…80%Sensitivity…………………………310/375…83%Specificity…………………...…1,204/1509...80%Positive predictive validity…..…. 310/615…50%Negative predictive validity…...1204/1269…95%

Timeline January 2020 SENI Launch

Initial 4 hospitals continue screening

Jan-Dec 2020 Educate new sites, begin SENI screening Develop SBIRT protocol Develop SEN guidelines (ESC, non-pharm) Establish standard tox testing criteria Coordinate with POSC Steering Comm. Refine Medicaid coverage planMonitor SENI data; report to PQC members

What you can do now Current 4 hospitals:

• Continue screening using 4Ps Plus –SENI forms• Continue to submit data, but will pass through DHSS first

Birth facilities interested in SENI:• Sign up for orientation/onboarding training on SENI tool• Learn how to submit data

Outpatient providers• Sign up for orientation/onboarding• Data collection will follow when capacity is expanded to include

outpatients

Breakout Groups

SBIRT - Sherrell Holtshouser

Optimal toxicology testing - Bill Trawick

Management of SENs - Evelyn Rider

Plans of Safe Care - Kim Guay

--- Please join a group by 3:45 ---

Breakout Groups

Small group discussions 20 minutes1. Ideal state2. Metrics3. Support needed

Plenary report out [3-4 min per group] 20 minutes

Wrap-Up – AIM Statement 10 minutes

SENI Summary

Breakout group reports

Discussion

Overall SMART Aim

SENI SMART Aim

Alaska will increase the percent of pregnancies screened from 11% to ____% by ______________.

SENI Summary

Breakout group reports

Discussion

Overall SMART Aim

Next Steps

Contacts

Sherrell Holtshouser (SENI)sherrell.holtshouser@alaska.gov(907) 269-3426

Natalie Norberg (POSC)natalie.norberg@alaska.gov(907) 465-3636

Thank you!