Meeting Packet - Professions & Public Health Subcommittee (October 13, 2021)
Summary
A meeting packet for the Professions & Public Health Subcommittee, Chair Will Robinson, for Wednesday, October 13, 2021, 11:00 AM to 12:30 PM at Webster Hall. The meeting notice announces presentations on infant mortality prevention efforts: Fetal and Infant Mortality Review projects, by Cathy Timuta of the Florida Association of Healthy Start Coalitions, Inc. and Faye Johnson of the Northeast Florida Healthy Start Coalition, and the Maternal Opioid Recovery Effort (MORE) Project, by William Sappenfield of the Florida Perinatal Quality Collaborative, University of South Florida. The packet includes biographies of Timuta and Johnson and presentation slides, including one on coordinating care for opioid exposed mothers.
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Professions and Public Health
Subcommittee
Wednesday, October 13, 2021
11:00 AM - 12:30 PM
Webster Hall (212 Knott)
Meeting Packet
Chris Sprowls Will Robinson
Speaker Chair
Committee Meeting Notice
HOUSE OF REPRESENTATIVES
Professions & Public Health Subcommittee
Start Date and Time: Wednesday, October 13, 2021 11:00 am
End Date and Time: Wednesday, October 13, 2021 12:30 pm
Location: Webster Hall (212 Knott)
Duration: 1.50 hrs
Presentations on Infant Mortality Prevention Efforts
- Fetal and Infant Mortality Review Projects - Cathy Timuta, Chief Executive Officer, Florida Association of
Healthy Start Coalitions, Inc. and Faye Johnson, Chief Executive Officer, Northeast Florida Healthy Start
Coalition
- Maternal Opioid Recovery Effort (MORE) Project - William Sappenfield, MD, MPH, CPH, Director, Florida
Perinatal Quality Collaborative, University of South Florida
For information about attending or testifying at a committee meeting, please see the “Visiting the House”
tab at www.myfloridahouse.gov.
NOTICE FINALIZED on 10/06/2021 4:05PM by Osborne.Erin
10/06/2021 04:05:56PM Leagis ® Page 1 of 1
FAHSC
Bio: Cathy Timuta, MBA
(rev. 2-1-21)
Cathy Timuta is the Chief Executive Officer for the Florida Association of Healthy
Start Coalitions (FAHSC) and the Healthy Start MomCare Network, Inc. which is the
administrative services organization for FAHSC. She has been in these roles since
October 2018. Prior to working at the state level, Cathy was the Executive Director
for the Healthy Start Coalition of Southwest Florida for 19 years. She was a former
Board President for FAHSC as well as former co-chairs for several committees
including Legislative, Data, Contracts, and Managed Care Organizations
committees. Cathy started her career in Minnesota where she received her MBA in
health care administration. She was the Project Manager for the Minnesota Health Partnership, which
was a collaboration of the state of Minnesota, the Buyer’s Healthcare Action Group (Minnesota’s largest
employers), hospital systems, and health plans. Her passion is to ensure that families have access to
needed healthcare and services to empower parents to give their every baby a healthy start in life.
Faye Johnson
Chief Executive Officer
Northeast Florida Healthy Start Coalition, Inc.
FAHSC Board Immediate Past President
Faye Johnson received her Bachelor’s degree in Social Science and minor in Sociology from
Jacksonville University. Faye has an extensive background that ensures a level of competency in
Preconception Care, Maternal and Child Health, Life Course Model, the Social Determinant of
Health, Adverse Childhood Experiences, Healthy Equity and Equality, Administration and Quality
Assurance.
Faye has 25 years’ experience working with low-income populations and 23 years’ experience in
program administration and management. Prior to becoming the Chief Executive Officer, Faye
served as the Project Director of the Magnolia Project, an initiative of the Coalition located in
Jacksonville. The Magnolia Project is a special federally-funded Healthy Start preconception
initiative to improve the health and well-being of women during their childbearing years (15–44
years old) living in underserved zip codes with the highest rate of infant mortality. Faye
oversees multiple programs within the organization such as but not limited to Northeast Florida
State Healthy Start, Fetal and Infant Mortality Review program, Fatherhood PRIDE and two
evidence-based models, the MIECHV Nurse-Family Partnership and Healthy Families
Jacksonville. She is also the past President of the Florida Association of Healthy Start Coalitions.
Faye has exhibited at numerous federal and state Conferences throughout the country and
coauthored Integrating the Life Course into Maternal and Child Health (MCH) Service Delivery:
From Theory to Practice, Maternal and Child Health Journal. Faye received several awards such
as a finalist of the 2017 Florida Times Union Eve Award, the 2019 Faye Jacksonville Business
Journal 2019 Women of Influence Award and the Child Florida Department of Children and
Families Child Welfare Excellence Award. Faye is President of the statewide Florida Association
of Health Start Coalitions.
Faye views her service opportunities as an experience that she values and is humbled everyday
by the opportunity to serve others!
FETAL AND INFANT MORTALITY
REVIEW (FIMR)
Cathy Timuta, CEO, Florida Association of Healthy Start Coalitions, Inc.
Faye Johnson, CEO, Northeast Florida Healthy Start Coalition, Inc.
1
HEALTHY START COALITIONS ARE DEDICATED TO
REDUCING FLORIDA’S INFANT MORTALITY RATE
Infant mortality rate is often used as an indicator
to measure the health and well-being of a
community.
Infant mortality is the death of
an infant during the first year of
life and is calculated as the
number of infant deaths per
1,000 live births.
Fetal mortality is a stillbirth that
is at least 20 weeks gestation
but dies beforeit is born.
2
WHAT IS FIMR?
Fetal and Infant Mortality Review (FIMR)
Brings together key members of the community to review
information from individual cases of fetal and infant deaths to identify ways to
improve community resources and service delivery systems available to
families.
Community Members include
• Case Review Team ⎼ obstetricians, pediatricians, social workers, nurse-
midwifes, hospital and community nurses, coroners or medical examiners,
interviewers, abstractors, community outreach workers, mental health
counselors, public health nutritionists, home visiting programs.
• Community Action Group ⎼ community leaders representing
government, consumers, key institutions, and health & human service
organizations.
The Florida FIMR Toolkit serves as a resource that can be accessed in
the development, evaluation and execution of FIMR throughout Florida.
3
INFANT MORTALITY RATES
& FIMR PROJECTS
4
FIMR PROGRAMS
Healthy Start Coalitions are leads
for FIMR in Florida
There are 11 state funded FIMR programs.
19 Coalition areas do NOT have a FIMR
program.
1 Coalition has other funding, but it does
not cover their costs.
1 Coalition is fully funded with local dollars.
5
FIMR BENEFITS
• Provides a systematic approach to
identify what is driving infant and fetal
deaths in a community.
• Is an evidence-based model endorsed by
American College of Obstetricians and
Gynecologists which facilitates medical
community participation.
• Includes the family’s perspective.
• Identifies issues unique to a community.
• Allows for targeted initiatives.
• Engages community leaders to identify
and implement solutions.
6
FIMR DEATHS OCCUR
PROCESS DATA ANALYZED
CASES SELECTED
RECORDS ABSTRACTED
MOTHERS INTERVIEWED
CASE REVIEW TEAM: REVIEWS & RECOMMENDS
COMMUNITY ACTION TEAM: PROPOSES ACTION
IMPROVED HEALTH
7
A Johns Hopkins Women’s and Children’s Health Policy Center study
shows that FIMR programs contribute significantly to improvements in
systems of health care for pregnant women and infants through
enhanced public health activities in communities.
FIMR IMPACT
BEREAVEMENT SUPPORT
BLACK INFANT HEALTH PRACTICE INITIATIVE
COMMUNITY EDUCATION
EDUCATION OF INCARCERATED PREGNANT WOMEN
INTERCONCEPTIONAL CARE SERVICES
MEMORY BOXES AND WALKS
SAFE BABY AND OTHER SAFETY INITIATIVES
DOULA PROGRAM
8
From Data to
Action:
Improving
Birth Outcomes
in Northeast Florida
Northeast Florida
Healthy Start Coalition
9
Infant Deaths/1000 Live Births
9
8.5
7.9
8
FL & NEF 7.5
7.1
7.4
7.2
7.3
Infant Mortality 7
6.5
2015-2019 6
6.2
6.1 6.1
6 6
5.5
5
2015 2016 2017 2018 2019
FL NEF
10
Infant Deaths/1000 Live Births
18
15.6
16
14 13.2
12.5 13.5
NEF 12
12.8
Infant 10
7.9
8 7.4 7.3
Mortality 6
7.1
7.2
by Race 4
4.8
4.9 5.2
4.3
4.9
2015-2019 2
0
2015 2016 2017 2018 2019
Total White Black
11
32046
NEFL 32208
Zip codes with 32209
Highest Infant
32277
Mortality Rates
32059
2015-2019 32210
32033
12
NEFL
Disparities 2.7x 2.4x 3.6x 2.8x
2015-2019
13
• Project IMPACT is a fetal
and infant mortality
review (FIMR) project
for Baker, Clay, Duval,
Nassau and St. Johns
counties.
• In 2019 the Coalition
FIMR Project received
funding from local
partners to review and
complete an analysis of
all 147 babies that did
not live to see their first
birthday in Northeast
Florida in 2018.
14
Too many babies born too soon and too
small (90% of “excess deaths”)
•Social determinants of health
Findings
10% due to medical/health care
•Access, service delivery, quality improvement
opportunities
15
Cause Number Percent
Prematurity/Low 29 21
Leading Birthweight
Causes of Other Perinatal Conditions 44 32
Infant Death Congenital Anomalies 18 13
Sudden Unexpected Infant 23 17
Deaths
More than half:
prematurity/LBW & Infections 6 4
other perinatal Injuries 4 3
conditions Other Causes 12 9
TOTAL 147 100
16
Social determinants of health
•61% unmarried (single, divorced, separated)
•12% < 18 years old at first pregnancy
•77% high school or less education
•55% low income
•41% employed
Key issues: •Dads had similar profiles (although lots of missing info)
Pre-pregnancy •Lack of insurance prior to pregnancy
•Disproportionate impact on black moms
Prior poor outcome
•27% previous pre-term of LBW birth
•More likely among black moms
17
Lack of family planning
• 40% had < 18 months between pregnancies
• About 30% not using birth control
• 50% of these moms report pregnancy as unintended or mis-timed
Substance use (prescription & illegal)
• 43% self-report
Key issues: • 20% used tobacco during pregnancy (white moms at higher rates)
Pre-pregnancy • 10% documented MAT
Poor pre-pregnancy health
• 59% overweight or obese
• Chronic hypertension, diabetes
• One-third with STIs
18
Prenatal care
• 82% received some prenatal care
• One third entered care late or not at all
• 50% covered by Medicaid
• 45% received < 5 visits prior to delivery
• Access or compliance issues were documented in nearly half of
the cases
Key issues: • Transportation
• Medicaid, other insurance problems
Prenatal
Pregnancy complications
• Most common: gestational hypertension, diabetes, pre-
eclampsia
• Multiple births in 11 cases
19
Stressors during pregnancy
•One-third of cases with documented stressors
•Financial problems, IPV, depression
Use of services, support
Key issues: •Most cases (72%) documented receipt of social services
Prenatal •About half received referral to case management
•Lack of follow-up by mom
•Lack of engagement, follow-up by provider
•40% of cases had documented home visit, BUT
•Low intensity, short duration of services across programs
20
Medical complications
•One-third documented pre-term labor
Key issues: •One in five cases experienced PROM,
PPROM
Delivery •Chorioamnionitis, placental abruption
•Cord problems
•UTI, HELLP syndrome
21
Prematurity & very low birthweight
• 36% of babies lived < 1 day
• 59% of babies born VLBW lived < 1 day
• 52% of babies lived < 1 week
• Disproportionate impact on Black babies
Nursery & NICU
• 40% with documented morbidity during nursery stay
Key issues: • RDS, neonatal sepsis, jaundice, other - most common
• 40% with NICU stay > 1 day
Baby,
Postpartum Substance use
• 11% documented with substance exposure
Preventable post-discharge deaths
• Sleep-related, accidents
Postpartum visit
• Only 23 of 147 cases included some documentation of a postpartum visit by mom
22
Pre-pregnancy health Lack of family Social determinants of Siloed, fragmented
of mother is a key planning health care
What we factor contributing to
poor outcomes
learned Lack of insurance coverage Non-use Poverty, lack of education, Disconnect between
clinical/medical/ hospital
(before & after pregnancy) Birth intervals <18 months transportation, violence =
STRESS and community support
Chronic health conditions, Postpartum visit? services
especially among black Screening, documentation
moms by providers? Lack of follow-through,
engagement, retention in
Severe co-morbidities, but Culturally sensitive/trauma home visiting, other care
not in care informed care? coordination
Lack of awareness among
policymakers, at-risk
families
23
Increase Provider Screening Rates
Develop Medical Home Model
Medical and Social Needs Model
From Data to
Action Centering Pregnancy Group Care Models -Chronic Disease
and Stress Model
Universal Home Visitation
Improve Quality of Care
24
• Integrate at least three specific
policies into local government to
Examples of the address social determinants of health that
impact infant mortality and other health
Benefits of FIMR disparities. Infant Mortality Prevention
Leadership Council
• Develop and implement a social
marketing campaign to increase
public awareness about infant
Northeast mortality and disparities at birth.
Make a Noise Make a Difference Social
Marketing Campaign
Florida FIMR • Engage and equip grassroots leaders
to address factors contributing to
2019 & 2020 high infant death rates and disparities
at birth. MANMAD Lay Health Advocates/
Recommended Community Health Workers
• Develop and operate a Maternal &
Strategies and Infant Medical Home pilot.
• Improve health provider quality of care.
Initiatives Provide cultural humility provider
training. Implement an effective
approach to addressing bias.
25
• Co-locate outreach staff in at
Examples of the least four prenatal care provider
offices or hospitals
Benefits of FIMR • Partner with Medicaid Managed
Care Plans to emphasize
preconception health
• Invest in medical provider
Northeast offices/hubs/clinics and
hospitals that offer a Medical
Florida FIMR One Stop Shop.
• Implement a community
2019 & 2020 outreach strategy to educate
women about the importance of
prenatal care. MANMAD Lay
Recommended Health Advocates/ Community
Health Workers
Strategies and • Develop an initiative to provide
recognition to Obstetric offices
Initiatives who exceed expectations in
prenatal screening and patient
satisfaction.
26
Keys to a Successful FIMR Program
• Community Partnership Commitments
• Physician Champions
• Adequate Funding
• No blame, only solutions
27
THANK YOU
Cathy Timuta, CEO, Florida Association of Healthy Start Coalitions, Inc.
Faye Johnson, CEO, Northeast Florida Healthy Start Coalition, Inc.
28
Dr. Sappenfield
USF
William Sappenfield, MD, MPH, CPH
Professor, Director of Chiles Center, University of South Florida
William M. Sappenfield, MD, MPH is professor and chair of the Department of Community and Family
Health and Director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies at the College
of Public Health, University of South Florida. He just started this new career opportunity at USF to teach
and develop new professionals in December 2011. His vision is to make the Chiles Center one of the
leading national centers in maternal and child health practice and research.
As both a pediatrician and an epidemiologist, Dr. Bill Sappenfield has more than 27 years of experience
in epidemiological teaching, research and practice in maternal and child health at a local, state and
national level. Dr. Sappenfield received his medical degree from Louisiana State University Health
Sciences Center in New Orleans in 1980 and his masters of public health with a concentration on
epidemiology from Harvard University in 1984. He completed his pediatric residency training at
Vanderbilt University Medical Center in 1983 and his preventive medicine residency training at the
Centers for Disease Control and Prevention (CDC) in 1987. He also received applied epidemiology
training through CDC’s Epidemic Intelligence Service (EIS) program from 1984 to 1986.
As a nationally recognized leader in the field of maternal and child health epidemiology, Dr. Sappenfield
spent the first 21 years of his career as a CDC epidemiologist working with state and local public health
agencies to enhance their capacity to use epidemiology to improve the health of the women and
children. This included being assigned to state public health agencies in Massachusetts, Mississippi and
South Carolina. He was also assigned to work at CityMatCH—a national public health organization
working with MCH Leaders in urban public health agencies, at the University of Nebraska Medical
Center. He completed his CDC career serving four years as Team Leader of their MCH Epidemiology
Program directly responsible for the national MCH EPI effort including mentoring senior MCH
epidemiologists assigned around the nation.
For the next six years, Dr. Sappenfield served at the Florida Department of Health as the State MCH
Epidemiologist and as Unit Director for the MCH Practice and Analysis Unit. His responsibilities include
leading the Department’s MCH epidemiology and evaluation efforts including directing a unit of six
epidemiologists; working with MCH programs in Family Health and other divisions; collaborating with
state agencies, organizations, and universities; and assisting County Health Departments and community
partners.
Dr. Sappenfield’s major contributions to the MCH field include early efforts to develop community-
based fetal and infant mortality reviews, to adapt the perinatal periods of risk approach to assess infant
mortality in U.S. communities, to propose state preconception health indicators and to shape best
practices in applied MCH epidemiology. His current research projects include: maternal and infant
mortality, chronic diseases during pregnancy, assistive reproductive technology, unintended pregnancy
and contraceptive use, non-medically indicated deliveries prior to 39 weeks, population-based perinatal
quality improvement efforts, access to childhood preventive dental care, and use of data file linkages in
maternal and child health. He continues to mentor both young and senior MCH epidemiologist in public
health practice around the nation.
Dr. Sappenfield has received several national and state awards. In 2003, he received the National MCH
Epidemiology Award for Outstanding Leadership sponsored by 16 national health organizations.
Improving the Quality of Care for Mothers with Opioids:
The Florida Experience
Neonatal Opioid Withdrawal Syndrome (NOWS)
matters...
to infants w/prenatal substance exposures
2
Characteristics of
Male1 NOWS infants Low birth weight1
55-94% 50-80%
have NOWS have NOWS
signs2 requiring
meds3
1Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence & geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015;35(8):667 ; 2.
Devlin LA, Lau T, Radmacher PG. Decreasing Total Medication Exposure and Length of Stay While Completing Withdrawal for Neonatal Abstinence Syndrome during the Neonatal Hospital Stay.
Front Pediatr 2017;5:216; 3. Raffaeli G, Cavallaro G, Allegaert K, et al. Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies. Pharmacotherapy 2017;37:814-23 3
Characteristics of
Male1 NAS infants Low birth weight1
55-94% 50-80%
have NAS have NAS
symptoms2 requiring
meds3
COMMON DIAGNOSES1
Jaundice Respiratory Sepsis Feeding
~33% complications ~15% problems
~19% ~17%
1Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence & geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol. 2015;35(8):667 ; 2.
Devlin LA, Lau T, Radmacher PG. Decreasing Total Medication Exposure and Length of Stay While Completing Withdrawal for Neonatal Abstinence Syndrome during the Neonatal Hospital Stay.
Front Pediatr 2017;5:216; 3. Raffaeli G, Cavallaro G, Allegaert K, et al. Neonatal Abstinence Syndrome: Update on Diagnostic and Therapeutic Strategies. Pharmacotherapy 2017;37:814-23 4
Consequences of substance exposure
Drug misuse is a common
reason for child removal
More
More likely
likely to to experience
experience
• Abuse or neglect
• Sudden infant death, shaken baby syndrome
• Adverse neurodevelopmental outcomes
• Re-hospitalization after birth hospitalization
• Child removals
Patrick SW, Schiff DM, PREVENTION COSUA. A Public Health Response to Opioid Use in Pregnancy. Pediatrics 2017;139
5
Prevalence of NOWS/NAS, Florida, 1998-2019
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FPQC
Where is
the NOWS
problem in
2018?
https://www.hcup-us.ahrq.gov/faststats/NASMap 7
NOWS matters...
to pregnant women
8
Pregnancy-Associated Death Ratios for Select Causes,
Florida, 2009–2019
25
Deaths per 100,000 Live Births
20 Drug related
MVA
15
Suicide
10
Homicide
5
0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Source: PAMR Quarterly Demographic Data on Non-Selected Cases
9
Attention
Support
Services
Follow up
Compassion
The picture can't be displayed.
10
FL NAS Prevalence
2014-2019
The pi
21 + 12
MORE
Hospitals
11
Global aim: Improve identification, clinical care and coordinated treatment / support
for pregnant women with any opioid use and their infants
AIM Primary Drivers Secondary Drivers
Perform universal SUD screening for all pregnant women
Screening
Perform secondary screening1 for all pregnant women with any
opioid use
Documentation of family planning/contraceptive counseling
Prevention
By 3/2022, >50%
Increase breastfeeding initiation and rooming in rates
pregnant women with
Use SBIRT screening to obtain appropriate referrals for
any opioid use will mothers with any opioid use
receive screening, Treatment Referral/scheduled follow up to MAT/BH services for all
prevention, and pregnant women with any opioid use
treatment services Develop a map of local community resources (e.g., behavioral
Comprehensive health, and addiction/treatment services)
discharge Compliance with discharge checklist2
planning
Compliance with the hospital’s pain management prescribing
practices
Policies &
Provider education bundle
Procedures
Patient education bundle
1Secondary screening: 1) infectious diseases: HIV, HepA, HepB, HepC, GC, CT, syphilis and TB; 2) mental health including postpartum depression; 3) Intimate partner violence
2 Discharge checklist: 1) Peer counselor visit 2) Postpartum depression screening, 3) Social work consult, 4) Pediatric consult, 5) Contraceptive plan, 6) Scheduled OB postpartum
visit, 7) Scheduled Behavioral Health and/or MAT visit or referral, 8) Healthy Start/Home visiting program referral, and 9) patient education bundle (MAT & SUD treatment,
infectious/mental health comorbidities, safe sleep, NAS including non-pharmacological management, family planning and Narcan ® (naloxone) use) v.11/7/2019 12
Project journey
Nov 2019 Jun 2021
Jan–Sep 2019
Jul–Oct 2019 Jan 2020- Jun 2021-
Apr 2021 Apr 2022
13
Project journey
Nov 2019 Jun 2022
Jan–Sep 2019
X
Jul–Oct 2019 Jan 2020-
Apr 2022
14
MORE Folder
Patient Ed Care Plan Provider Ed
15 15
MORE Video Series
From Judgment to Healing: The Impact
of Stigma
Getting Real: Taking the First Steps
Toward Recovery
Screening, Brief Intervention, and Referral
to Treatment
Mothers & Babies to Services: Plans
of Safe Care
Find these on FPQC.org/MORE
16
MORE Initiative Resources
Educational
Monthly Project-wide Monthly &
sessions,
Coaching Calls collaboration Quarterly QI
videos &
with hospitals meetings Data Reports
resources
state-wide
Custom, Personalized
Regular
E-mail Consultations & Grand
Technical Rounds Education
Assistance Updates
Webcam, Phone or On-site
From FPQC team, Online Toolbox
State Clinical Community
Advisors & Algorithms, Sample protocols, Engagement
National Experts Education tools, Competencies, Support
Slide sets, etc.
17
Maternal Screening in Hospital
MORE, 14 Hospitals Reporting
100
Substance Use Dis.
1) Screening
90
Mental Health
80 Int. Partner Violence
Percentage
Infectious Diseases
70
60
50
Q1 Q2 Q3 Q4 Q1 Q2
2020 2021
The picture can't be displayed.
| 18
18
% Mothers with Opioid Use with Contraception Counseling
& Plan Documented, MORE, 14 Hospitals Reporting
100%
Missing/No
25% 28%
80% 34% Declined
41%
2) Prevention
45% 48%
10% 7% Yes
60% 9%
4%
6% 4%
40%
65% 66%
55% 57%
50% 48%
20%
0%
Q1 Q2 Q3 Q4 Q1 Q2
2020 2021
The picture can't be displayed.
19
Behavioral Health / Medication-Assisted Treatment
MORE, Q2 of 2021, 14 Hospital Reporting
Not Started
3) Treatment
Pregnancy
Hospitalization
Unknown
20
The picture can't be displayed.
20
Comprehensive Discharge Planning
4) Comprehensive Discharge
MORE, 14 Reporting Hospitals
Q1 Q2 Q3 Q4 Q1 Q2
Narcan education 15% 1% 5% 10% 13% 16%
Social work consultation 97% 94% 95% 94% 96% 98%
Contraceptive plan 55% 59% 52% 66% 75% 72%
OB postpartum visit 14% 23% 21% 14% 22% 16%
Pediatric consult 72% 78% 72% 89% 99% 95%
Behavioral/MAT referral 66% 63% 50% 38% 49% 45%
Healthy Start referral 85% 77% 75% 76% 85% 84%
21
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21
Three Physician “Listening Sessions”
“What are your greatest barriers/challenges to screening or
treating pregnant women with OUD”
Reimbursement issues
These mothers are complex to care for
Not trained to care for these mothers
Need multiple referrals
Cannot find specialists / getting approvals
Too much time to coordinate care
Stigmatize their practice
22
Putting Pieces Together
for Opioid Exposed Mothers
Working Together—Coordinate enhancing system & problem solving
AHCA/Medicaid— DCF—
• Automatic approvals • Provide Naloxone free at discharge
• Training & reimburse for SBIRT • Case manager referrals for uninsured
• Direct Case Manager Referrals • Resource guide for uninsured
• Priority access to care
Department of Health— Florida Hospital Association—
• Data monitoring & reporting • Recruit participating hospitals
• Promoting education • Share materials with others
• Promoting Behavioral Health Impact
Florida Healthy Start—
FPQC— • Community resource directories
The picture can't be displayed.
Opioid training for OB & FP practitioners • Assist with referrals
23
Questions?
wsappenfield@usf.edu
fpqc@usf.edu
www.fpqc.org “To improve the health and
Florida Perinatal Quality Collaborative
health care of all Florida
Florida Perinatal Quality Collaborative mothers & babies”
@TheFPQC
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24
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