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.

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 

Faculty

Working Group

Adrienne Richardson

Health Partners

MD, Ob/GYN | MOSTaRE Co-Chair

Alina Kraynak

MDH

No bio at this time.

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.

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.

Heather Bell

Corporate Medical Director for MEnD Correctional Care and MEnD Recovery Services

Heather has been in full-spectrum family medicine with obstetrics since the start of her career in a rural critical access hospital. She has also been caring for patients with opioid use disorder, with MAT, for 4 years and became dual boarded in addiction medicine in early 2020. She has co-facilitated ProjectECHO and has provided technical assistance for mentorship of communities throughout MN through MDH for nearly 3 years as well.

Jane Taylor

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

Lila Page

MPO/MNPQC Program Coordinator

Lila is a marketing professional with a Bachelor’s degree focused in Communications and Public Health from the University of Minnesota-Twin Cities. She has 3+ years of marketing & communications experience with a demonstrated history of working in the healthcare, software, and technology industry.

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.

Alison Newton

DNP Student, University of Minnesota 

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 H

No information provided

Daniela White

Women’s Recovery Services initiative at DHS

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

Hennepin Health

No bio at this time.

Jenny 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.

Kurt Devine

CHI St. Gabriel’s Health

Dr. Kurt Devine has been a full-spectrum family medicine physician for more than 26 years. He is also a boarded Addiction Medicine physician. As a practicing physician in rural Minnesota, he has faced many unique challenges caring for patients in the primary care setting amid evolving care delivery models demanding forward-thinking and creative strategies for change.  As opioid use and its attributing issues became increasingly apparent, he became more engaged and involved with the local community task force assembled to address concerns of opioid use and dependency within the county. His leadership has enabled grant funding to be put to practical use, demonstrating positive outcomes both financially and from a patient care perspective. During this time, Dr. DeVine added buprenorphine to his primary care practice, to improve rural access to treatment for opioid use disorder. Through legislative funding and grant procurement, Dr. DeVine and his colleague Dr. Heather Bell initiated Minnesota’s first ECHO to reduce and monitor opioid prescribing in a rural clinic setting.

Laura Newton

Minneapolis American Indian Center

No bio at this time.

Megan Warfield-Kimball

Benefit Policy Specialist at Minnesota Department of Human Services 

Phillip Rauk

MNPQC Executive Branch

Dr Rauk lead quality for Fairview System in OB for 10 years and serves at MHA as lead of their Perinatal Committee. He is the Vice Chair of Quality and Safety Department and an OB GYN at University of Minnesota.

Rachel Cooper

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. 

Ruth Richardson

Wayside Recovery Center

No bio at this time.

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 26 years. They live on a farm with beef cattle and pigs, and have 3 children- Daniel is 22, Megan is 17, and Abby is 15. Sarah has worked at TCHC for 26 years, first as a CNA, then LPN, then RN, BSN, IBCLC, and finally OB Supervisor.

Samantha Sommerness

University of Minnesota School of Nursing

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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