Mother/Infant Opioid Substance Use Treatment and Recovery Effort

The Mother/Infant Opioid and Substance use Treatment and Recovery Effort (MOSTaRE) purpose is to work with providers, hospitals, and other stakeholders to improve identification, clinical care, and coordinated treatment/support for pregnant and parenting individuals with opioid use disorder and their infants through a family-centered care approach. 

The MOSTaRE Initiative will emphasize family-centered care that maintains the dyad and will address treatment and prevention of substance exposure during and after pregnancy for both mother and infant.

These are a variety of resources provided by MPO/MNPQC and other organizations for healthcare providers and the public. Many links are provided by other organizations and are subject to change without notice.


Charter

The Mother/Infant Opioid and Substance use Treatment and Recovery Effort (MOSTaRE) purpose is to work with providers, hospitals, and other stakeholders to improve identification, clinical care, and coordinated treatment/support for pregnant and parenting individuals with opioid use disorder and their infants through a family-centered care approach. 

The MOSTaRE Initiative will emphasize family-centered care that maintains the dyad and will address treatment and prevention of substance exposure during and after pregnancy for both mother and infant.

Team Membership (includes both infant/perinatal arms)

  1. Infant Team Members include:  NICU, general pediatric or family practice provider, community treatment and support partners, women with lived experience 
  2. Perinatal Team Members include:  prenatal, delivery, and postpartum providers; treatment and community support members, women with lived experience 

AIM

Perinatal

To increase the recognition, diagnosis, and treatment of Substance Use Disorders (SUDs) in the perinatal population in order to improve perinatal and postpartum outcomes. Use education, trauma-informed care, medication-assisted treatment (MAT), where appropriate, collaboration across healthcare providers, and encourage engagement in additional support services.

Infant

Through increased identification and treatment of substance-exposed infants through improved screening, increased adoption of nonpharmacologic methods, and Eat-Sleep-Console practices that promote the maintenance of dyad, i.e., the mom and babe bond – the length of stay for infants diagnosed with Neonatal Abstinence Syndrome (NAS) will be reduced by 1 day among participating sites within 12 months.

Objectives

Perinatal
  1. Educate patients, the community, clinicians, and staff about Substance and Opioid Use Disorders (SUD/OUD) and reduce the stigma associated.
    • Screen for use disorders with a validated screening tool
    • 4Ps Plus © (https://www.ntiupstream.com/4psabout) Copyrighted and fee required
    • 5Ps (currently undergoing validation)
    • SURP-Pz
    • Promote trauma-informed care model
    • Ask permission before screening
    • Screen universally
    • Urine toxicology is not recommended as a screening test
    • Follow screening with brief intervention and referral to treatment (SBIRT)
    • Educate on mandating reporting; maintaining transparency for patients and supplying them with available resources
  2. Partner with patients by referring those identified as having a SUD/OUD to treatment, including the collaboration of care and coordination across all care systems for the patient. 
    • Utilize medication-assisted therapy where appropriate. MAT is the standard of care for OUD
    • Early referral and collaboration with social services, focusing on creating a care team rather than strictly reporting patients. 
    • Provide equitable and culturally competent care. Acknowledge and address the impact of social determinants of health (transportation/food security/housing/safety/environment)
  3. Standardize in hospital caregiver/infant-focused care as well as comprehensive discharge planning measures. Plan for, anticipate, and ensure appropriate postpartum care and treatment, emphasizing the importance of the “4th Trimester.”
    • Create pain management protocols minimizing the use of opioid pain medications
    • Establish early postpartum follow-up with OB provider and treatment, family planning measures, and naloxone distribution.
    • Coordinate with infant outpatient providers, where possible.
    • Consider early outpatient follow-up for patients with SUDs, within 2 days of hospital discharge.
    • Proactively plan for pain management during the postpartum period, specifically around surgical deliveries. 
    • Discuss and establish family planning goals.
    • Educate and screen for postpartum depression
    • Establish, where possible, peer recovery and/or other public health support for new caregivers.
    • Foster the breastfeeding relationship, where appropriate, offering support post-discharge.
    • Acknowledge the risk for lapse and relapse- create a safety plan 
Infant
  1. Improve identification and assessment of substance-exposed infants
    • Standardized assessment of substance-exposed neonates postpartum 
    • Universally screen all infants for symptoms that could be related to substance exposure and test when appropriate
  2. Promote the integration of Eat-Sleep-Console treatment methods with a focus on non-pharmacologic care for substance-exposed infants and reduced separation of dyad during hospitalization
    • Reduce the length of hospitalization and NICU admissions of substance-exposed infants 
    • Reduce infant admission to NICU and provide NAS treatment in a regular inpatient setting or at home
    • Optimize the hospital environment to maintain the dyad for NAS treatment including reducing lighting, noise, and stimulation through waking and handling
    • Reduce medication exposure 
  1. Provide safe, coordinated discharge that maintains dyad when possible 
    • Education for staff and families on the family-centered care protocol emphasizes keeping caregiver(s) and infants together. This includes promoting non-pharmacologic strategies to care for the infant. This includes encouraging and promoting breastfeeding when appropriate. Encourage Eat, Sleep, Console practices for neonatal withdrawal.
    • Understand Child Protective Services’ role and their current protocols as a means to minimize the punitive approach.
    • Provide training to staff in family-centered care, stigma and bias recognition and education, and trauma-informed care
    • Coordinate with perinatal healthcare providers (outpatient, SUD treatment, peer recovery support, social work, etc.)
    • Make referrals to family home visiting prior to discharge 

Resources

Webinars

Wayside Recovery Center
Perinatal Substance Use & Reporting Laws
Presented by Dr. Cresta Jones, MD, FACOG
March 2022

MNPQC Townhall
Response to changes in reporting of Prenatal Exposure to Controlled Substances
CPS Panel featuring Hennepin, Ramsey, Anoka,
and Beltrami County
May 11, 2022

Faculty

Working Group

Adrienne Richardson

MOSTaRE Chair

MD, Ob/GYN | HealthPartners

Rachel Cooper

MOSTaRE Vice Chair
Sanford Health

Rachel is an Mpls native who went to South High School. Undergrad at New York University, Master’s in Bioethics at Columbia University, Medical School at the U of MN, Pediatrics Residency at the University of WI in Madison. Currently working as a Peds Hospitalist, covering Newborn Nursery, Special Care Nursery, Peds Floors, and Peds Consults in Bemidji, MN at Sanford Bemidji Medical Center. Special interests include health equity, pediatric and adult bioethics/conflict resolution/decisionmaking, pediatric hospice, and palliative care. Previous work as an EMT, Spanish, and French medical interpreter. 

Cresta Jones

MHealth Fairview

Dr. Jones is a maternal-fetal medicine and addiction, medicine physician. She obtained her degree from the Medical College of Wisconsin and completed both her residency in obstetrics and gynecology and her fellowship in maternal-fetal medicine at the University of Vermont College of Medicine.

Anne Walaszek

MNPQC Executive Branch

Anne Walaszek, MPH (Anishinaabe) is the Maternal and Child Health Quality Improvement Specialist in the Women and Infant Health Unit at the Minnesota Department of Health. In her role, she leads two quality improvement grants, the Perinatal Quality Collaborative and the Communities Collaborating to Prevent Girls Opioid Abuse. Ms. Walaszek has experience working at a national non-profit addressing cancer inequities within American Indian and Alaska Native communities. In this role, she provided leadership for a clinic and community health approach to develop and implement culturally tailored evidence-based interventions to effectively build capacity in health systems across Indian Country. Her public health experience reflects grant writing, program development, research and data management throughout her experiences at the Minnesota Department of Health Diabetes Program, Institute of Child Development at the University of Minnesota, and SAMHSA for their Child, Adolescent and Family Branch. She is a 2017 recipient of the Lou Fuller Award for Distinguished Service in Eliminating Health Disparities.

Jane Taylor

Ed.D., Hospital & Health Care Consultant, Contractor, and Advisor to Improvers and Learners.

Susan Boehm

MPO Executive Director/Treasurer, MNPQC Co-Director


Susan has been a Clinical Nurse Specialist in Women’s Health for over 30 years. She has a long history with MPO as a volunteer, conference presenter, planning committee member, and has served on the Board of Directors. She is currently the MPO Executive Director and Co-Director of the Minnesota Perinatal Quality Collaborative (MNPQC).

She enjoys the outdoors, hiking and kayaking, and loves the solitude of their cabin in the Boundary Waters.

Todd Stanhope
North Memorial, MNPQC Executive Branch

Dr. Stanhope is a full-time OB/Gyn hospitalist and medical director of Women’s and Children’s services at North Memorial Health Hospital. His clinical interests include hypertension, complex deliveries, and postoperative opioid prescribing. Prior to his current position, he provided contracted OB coverage at a number of facilities, high and low volume, in several states and completed two missions to South Sudan with Doctors Without Borders from which he gained invaluable experience learning the myriad needs and challenges of different facilities and systems face.

Alina Kraynak

Minnesota Department of Health

Alison Newton

DNP Student at the University of Minnesota

Amy Bea Bowles

Sanford

Bea is a masters prepared nurse, with an emphasis in Leadership and has been working in healthcare since she was a teenager. In addition to LTC, she has worked in ortho/neuro, surgical, public health, home care, obstetrics, pediatrics, teaching (NDSCS and NDSU –go Bison!), and most recently learning the special care nursery world. She is blessed with an amazing leadership team and a wonderful team of staff to serve. After 22 years of living in Fargo, she relocated to Bemidji; she loves her new location and looks forward to serving the patients in their hospital as well as her community. She has been married for 21 years and has three children, 1 dog, and one snake.

Brian Grahan

Hennepin Health

No bio at this time.

Courtney Higginbotham

U of M Institute on Community Integration

Chris Derauf

MD | he/him/his
Professor | Mayo Clinic Alix School of Medicine
Consultant | Mayo Clinic | Department of Pediatric and Adolescent Medicine | Division of Child Abuse Pediatrics | Mayo Clinic Center for Safe and Healthy Children and Adolescents

Daniela White

MA, LPC, LADC- Women Services Programs at the Department of Human Services, Behavioral Health Division.

Deb Peters

Essentia Health

Lead Neonatal Nurse Practitioner in Duluth, MN for the past 25 years.

Erin Plummer

Children’s

Erin is a neonatologist at Children’s Minnesota. She completed her pediatric residency and neonatology fellowship at the University of Minnesota. Dr Plummer specializes in neonatal critical care at Children’s Minnesota. She is originally from Ohio and attended medical school at Wright State University Boonshoft School of Medicine in Dayton, OH. She completed her residency and fellowship at the University of Minnesota Medical Center. Her clinical interests include nutrition, growth, and neurodevelopmental outcomes in premature and critically ill infants. She is passionate about caring for infants hospitalized in the NICU and building relationships with their families. Dr Plummer is involved in the education of neonatal fellows, pediatrics residents, family practice residents and medical students. She lives in Minneapolis with her husband and two children.

Erin Morris

University of Minnesota

Erin Morris is a Neonatal-Perinatal medicine fellow at the University of Minnesota. Her research interests include nutrition and neurodevelopment of infants in the NICU and specifically of those with prenatal drug exposures. She is currently involved in a QI project through the University of Minnesota involving the implementation of the Eat, Sleep, Console treatment for infants with prenatal opioid exposures.

Frances Prekker

Frances Prekker, MD is a Pediatric Hospitalist with Hennepin Healthcare. She is the Medical Director of both the Newborn Nursery and Pediatric Inpatient Unit at Hennepin County Medical Center. She has a special interest in the care of substance-exposed newborns, perinatal substance use, and providing care that preserves the mother-infant dyad. She has led many QI projects at HCMC improving care for infants experiencing withdrawal, keeping moms and babies rooming in together, and reducing bias in newborn drug testing.

Jennifer Hall-Lande

Ph.D, MN-ADDM

Kari Rabie

Native American Community Clinic

As a physician serving the Native American Community in Minneapolis, Dr Rabie is passionate about addressing the significant health disparities that impact Native Americans in Minnesota. To address these disparities she became buprenorphine waivered, and pursued specialty in Addiction Medicine. She is also passionate about educating the next generation of physicians to provide care to the Native Community in the context of community medicine. She provides care using the lens of harm reduction.

Kelcee Kociemba

Kelcee currently works in a private practice setting with special training in maternal mental health specifically perinatal mood and anxiety disorders. 

She also works in Adult Mental Health as a county case manager, previously working in child protection as well. She has a variety of experiences within rural communities.

Laura Newton

Minneapolis American Indian Center

No bio at this time.

Liz Corey

Minneapolis Department of Health

Megan Warfield-Kimball

Benefit Policy Specialist at Minnesota Department of Human Services 

Meagan Thompson

Meagan Thompson, DNP, APRN, CNM, has a BA in Sociology from the University of Wisconsin Madison in Sociology, with minors in American Indian Studies and Women’s Studies. She worked as a reproductive health educator before returning for her Masters of Nursing (MN) at the University of Minnesota-Twin Cities. In her role as a reproductive health educator, she created educational content to engage young people in their social, emotional, and reproductive health in a variety of settings. After receiving her MN degree, Meagan worked as an RN in a high-acuity tertiary care labor and delivery unit. While working as a bedside nurse, Meagan pursued her Doctorate of Nursing Practice (DNP) degree in the Nurse-Midwifery specialty. During her DNP program, Meagan participated in the Leadership Education in Adolescent Health (LEAH) Fellowship. She worked as part of an interdisciplinary cohort to learn the basics of research, grant writing, and interprofessional collaboration. Her fellowship project examined reproductive outcomes for incarcerated adolescents. Meagan is currently enrolled in a Psychiatric Mental Health Nurse Practitioner (PMHNP) certificate program through the University of Iowa. Upon graduation, she will be a dual-certified CNM/PMHNP provider uniquely qualified to care for perinatal substance use disorders. After graduation from the DNP program, Meagan worked at the University of Iowa where she received funding to implement universal SBIRT and create a maternal substance use disorder (MSUD) clinic. She worked as the primary provider in the MSUD clinic before returning to MN.

Ruth Richardson

Wayside Recovery Center

No bio at this time.

Samantha Sommerness

University of Minnesota School of Nursing

Sarah Riedel

Tri-County Health Care

RN, BSN, IBCLC, CPST

Sarah is the OB Supervisor of a critical access hospital in Midwestern Minnesota. She has been married to her husband Nathan for 28 years. They live on a farm with beef cattle and pigs, and have 3 children- Daniel is 23, Megan is 18, and Abby is 16. Sarah has worked at TCHC for 28 years, first as a CNA, then LPN, then RN, BSN, IBCLC, and finally OB Supervisor.

Shelly Mahowald

Shelly recently celebrated her 30 year anniversary in nursing, most of those years focusing on moms and infants. Recently, finishing a nurse practitioner program and started in the Medication Assisted Therapy clinic working with clients working through substance use disorders. She will lend experiential expertise to the MNPQC in the areas of perinatal safety around the education of staff and providers through simulation.

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