VDH and Neonatal Abstinence Syndrome. May 12, 2017 Vanessa Walker Harris, MD Director, Office of Family Health Services Virginia Department of Health

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1 VDH and Neonatal Abstinence Syndrome May 12, 2017 Vanessa Walker Harris, MD Director, Office of Family Health Services Virginia Department of Health

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5 Neonatal Abstinence Syndrome Discharges per 1,000 Live Births, by Locality: Virginia, 2015

6 Neonatal Abstinence Syndrome Discharges per 1,000 Live Births: Virginia, Rate per 1,000 Live Births

7 VDH: NAS Data and Surveillance HB 1467, SB 1323 Act to require the Board of Health to adopt regulations to include neonatal abstinence syndrome on the list of reportable diseases Tennessee Online reporting Maternal history Clinical signs in infant of NAS Infant screening/confirmatory testing of Infants

8 VDH: Response to Opioid Crisis Prevention Provider Education Support PDMP Enhancement Establish policy focused coalition Screening and Treatment Provide ADM Training Increase access to substance use d/o services Harm Reduction Test and treat infectious disease (HIV, HCV, STI) Safe syringe services Increase access to naloxone PQC focused on pregnant women with substance use d/o and infants with NAS

9 VDH: Prevention Provider education Addiction prevention in at-risk populations Safe drug storage PDMP Enhancements Providers manage delegates Reports: Prescriber Reports, PMP Risk Indicator Surveillance and Notification Module Morphine milligram equivalent calculator EHR integration

10 VDH: Treatment Addiction Disease Management Training providers trained across the state Project ECHO Hub: academic specialty center to provide telehealth CME forums on ADM Spokes: community providers interested in integrating ADM into their practice

11 VDH: Harm Reduction NAS DSS Substance Exposed Infant Workgroup HB2162 Analyze current policies Identify barriers to treatment (inclusive of infant, mother, and family support system) Make specific recommendations to the GA: policy, Code/regulatory change, financing 400% increase in SEI reports to CPS over the last 4 years Over 1,300 valid reports related to SEI

12 VDH: NAS DBHDS Handle with C.A.R.E. 3 focus areas Plan of Safe Care: Develop a Guideline for Developing PSC; coordinated system of care (ob/gyn, home visitor, behavioral health, etc) to ensure PSC are created PSC required by CAPTA Ideally identify women prenatally to begin plan development PSC should identify needs of the mother, needs of the entity, needs of the family support system

13 VDH: NAS DBHDS Handle with C.A.R.E. Opiate Treatment Program Guidelines for Services for Pregnant Women Wrap around service needs of pregnant women on methadone from OTP Referral guidelines for CSBs to facilitate access to substance abuse services for pregnant and post partum women

14 VDH: NAS PQC 2017 General Assembly, Budget Item 294 Appropriated General Funds and nongeneral funds (Medicaid match) to Perinatal Quality Collaborative Focus on pregnant women with substance use disorder and infants with NAS CDC PQC Grant 4 focus areas NAS Data surveillance, education/training, quality improvement through Vermont Oxford Network

15 VDH: NAS and Care Coordination Resources Children and Youth with Special Health Care Needs Care Connection for Children 6 regional centers Southwest Virginia, Roanoke, Blue Ridge, Northern Virginia, Central Virginia, Hampton Roads Care coordination, medical insurance evaluation, family-to-family support and related services Child Development Centers 5 regional centers Gate City, Harrisonburg, Norfolk, Richmond, Roanoke Diagnostic assessment, care planning, follow-up care coordination and referral to children and youth with developmental or social/emotional disorders

16 VDH: NAS and Care Coordination Resources Home Visiting Program Resource Mothers Healthy Start/Loving Steps Nurse Family Partnership, Parents as Teachers, Healthy Families America BabyCare Case management program for high risk pregnant women and their infants up to age 2 (Medicaid FFS, FAMIS Plus, FAMIS, FAMIS MOMS) Prenatal education, nutritional services, substance abuse treatment services

17 VDH: NAS and Injury Prevention Safe sleep Back to sleep Safe sleep environment Modify risk factors Tobacco use (in utero, postnatal exposure) Substance use (in utero, postnatal exposure to alcohol, drugs) Promote protective factors Breastfeeding High quality prenatal care

18 VDH: NAS Reproductive Health LARC access Title X Family Planning Clinics in 34 health districts Counseling on most effective contraceptive methods Provider training on LARC insertion Provide LARC at no cost to health districts LARC Workgroup DMAS policy change to address cost barrier to post-partum LARC insertion

19 VDH: Response to Opioid Crisis Prevention Provider Education Support PDMP Enhancement Establish policy focused coalition Screening and Treatment Provide ADM Training Increase access to substance use d/o services Harm Reduction Test and treat infectious disease (HIV, HCV, STI) Safe syringe services Increase access to naloxone PQC focused on pregnant women with substance use d/o and infants with NAS

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21 Thank you! Vanessa Walker Harris, MD Director, Office of Family Health Services Virginia Department of Health

22 AIM 1: Healthy, Connected Communities Goal 1: Virginia s Families Maintain Economic Stability Goal 2: Virginia s Communities Collaborate to Improve the Population s Health

23 AIM 2: Strong Start for Children Goal 1: Virginians Plan Their Pregnancies Goal 2: Virginia s Children are Prepared to Succeed in Kindergarten Goal 3: The Racial Disparity in Virginia s Infant Mortality Rate is Eliminated

24 AIM 3: Preventive Actions Goal 1: Virginians Follow a Healthy Diet and Live Actively Goal 2: Virginia Prevents Nicotine Dependency Goal 3: Virginians are Protected Against Vaccine Preventable Diseases Goal 4: In Virginia, Cancers Are Prevented or Diagnosed at the Earliest Stage Possible Goal 5: Virginians Have Lifelong Wellness

25 AIM 4: System of Health Care Goal 1: Virginia Has a Strong Primary Care System Linked to Behavioral Health Care, Oral Health Care, and Community Support Systems Goal 2: Virginia s Health IT System Connects People, Services and Information to Support Optimal Health Outcomes Goal 3: Health Care-Associated Infections in Virginia are Prevented and Controlled