The USF College of Public Health is saying farewell to one of its esteemed faculty members, Dr. William Sappenfield, a USF Distinguished Professor and director of the Florida Perinatal Quality Collaborative (FPQC) and the Chiles Center, both housed within the college and dedicated to cutting-edge research and education promoting the health and well-being of women, children and families.

Sappenfield, a pediatrician and epidemiologist who focuses on maternal and child health, retires after serving the college for 12 years. “That’s the longest I’ve been anywhere in my career,” he noted.

Sappenfield says what he’ll miss most about his time at the COPH is the people—the students, faculty, staff and leaders. “I have had the chance to work with outstanding people,” he noted.

And they will undoubtedly miss him as well.

“It was both an honor and a privilege to work with Bill,” said Bobbi Rose, an alum of the college who also served as conference coordinator for USF Health. “He is, WITHOUT FAIL, supportive, super smart, available, ethical and caring—for his colleagues, staff, students and the community at large. We need more Bill Sappenfields in this world!”

Amy Phillips, doctoral student and alum of the college, echoes those sentiments.

“As a new master’s student in 2013, I remember meeting one-on-one with Dr. Sappenfield and he insisted I call him Bill—never Dr. Sappenfield (to this day, I still don’t know that I ever have, lol),” Phillips, currently a COPH doctoral student, recalled. “He also shared his journey to leadership with my Maternal and Child Health Leadership Scholar cohort. I am grateful for the opportunity to know and learn from him!”

Natalie Preston, director of the college’s Office of Engagement and Constituent Relations, also values the knowledge she gleaned from Sappenfield.

“I appreciate that Bill always made me feel like we were equals,” Preston said. “He was very approachable and personal. My son was quite sickly as a toddler and elementary school kid. I reached out to Bill on many occasions for his medical insight as a pediatrician. He always received me warmly and explained options in a manner that was easily understood by a non-medical professional. His demeanor is as warm and bright as his smile! Without question, I will miss him. Hopefully his best life is coming in retirement!”

Sappenfield said some of the highlights of his time at the college have been becoming a faculty member, impacting lives and careers via teaching and mentoring, leading, promoting and revitalizing the Chiles Center and fully developing the FPQC, a group that significantly impacts the health and health care of mothers and infants in Florida.

What’s next for Sappenfield as he heads off into retirement?

“Deciding what I want to do when I grow up,” he said. “That’s going to take me some time to figure out! The college has paid me to do what I so much enjoy doing.”

Here, a pictorial look back at Sappenfield’s 12 years with the college:

Story by Donna Campisano, USF College of Public Health

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The Florida Perinatal Quality Collaborative (FPQC), housed within USF’s College of Public Health (COPH), has one mission: to give Florida’s mothers, infants and families the best health outcomes possible via perinatal care that’s respectful, equitable, high quality and evidence based.

The FPQC partners with perinatal-related organizations, individuals, health professionals, advocates, policymakers, hospitals and payers (FPQC stakeholders) from around the state. The collaborative aims to develop health care quality improvement initiatives and data-driven best practices that ultimately promote the health and health care of mothers, infants and families.

A collaborative takes off

The FPQC was born in 2010.

“The need to focus on maternal and infant quality improvement issues was identified as a major issue in Florida when I worked for the Florida Department of Health (FDOH) as the state maternal and child health epidemiologist,” explained Dr. William Sappenfield, the FPQC’s current executive director. “As part of the multi-state envisioning and implementation process, we had to put together our Florida leadership team. I recruited Dr. John Curran [a now-retired neonatologist and former associate vice president for USF Health] to lead the Florida group of state partners.  As a group, we quickly recognized the need to create the Florida Perinatal Quality Collaborative, and the FPQC was established at the USF Chiles Center in 2010.”

The Chiles Center, also part of the COPH, is a multidisciplinary, community-engaged collective that promotes optimal health and health care for mothers and babies around the time of birth.

Curran was named the founding director while Sappenfield lent a supportive leadership role from his position with the FDOH. Upon arrival at USF as a COPH professor, Sappenfield became co-director. When Curran retired in 2017, Sappenfield took over at the helm of the FPQC.

“It takes more than a leader, it takes a team”

Over the last 13 years, the FPQC has developed a number of initiatives, resources and training modules to help ensure moms and their babies have the best shot at a healthy life. Some of them include:

• Postpartum Access & Continuity of Care (PACC) Initiative. Noting that as many as 40 percent of moms do not see a health care provider for postpartum care, the PACC Initiative works with women, health care providers and hospitals to provide a continuum of after-delivery care to prevent pregnancy-related deaths.

• PAIRED. This initiative works to better how families with babies in the neonatal intensive care unit (NICU) engage and communicate with staff about the care of their infant.

• Levels of Maternal Care. This program is designed to promote Florida maternity hospitals’ participation in a verification program that aims to ensure mothers are cared for at hospitals that have the expertise, equipment and resources to appropriately treat their maternal needs, thereby reducing maternal morbidity and mortality.

“The FPQC has created a strong collaborative organization that works with all major state agencies and organizations,” Sappenfield noted. “Other organizations and individuals want to work with us because of our success. In 13 years, the FPQC has gone from working with six hospitals to all 105 Florida maternity hospitals. It takes more than a leader,” he added, “it takes a great team to do this quality of work, and the FPQC has been blessed with a highly capable one. Moreover, the FPQC has provided a great learning experience for many students as graduate assistants and volunteers who have helped develop data measures, reporting systems and quality initiatives, conduct surveys, evaluate initiatives and more.”

What’s next?

While Sappenfield will be retiring later this year, the FPQC will continue to trailblaze on behalf of moms and their babies.

“It is the improvement in maternal and infant health outcomes that I am most proud of,” Sappenfield said. “The FPQC is well positioned, resourced, led and staffed to continue to make a measurable difference in the health and health care of moms and babies for years to come.”

Story by Donna Campisano, USF College of Public Health

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A new herd of Bulls entered the USF College of Public Health (COPH) on Monday, Aug. 22. Whether you’re a student, faculty member or employee on campus, we are ready to be together for a year planned with more in-person events and celebrations.

New faces at the COPH

The COPH is welcomed 810 new students enrolled for the fall 2022 semester, with 492 undergraduate, 292 master’s and 26 doctoral students.

Students also saw some new faces among the college staff.

Cassandra Garza

Cassandra Garza supports the COPH’s Florida Covering Kids and Families team initiatives as a program planner analyst.

Garza’s journey at USF began through earning her BS in biomedical sciences. She has worked at USF since 2015, contributing to varying departments. Determined to advance her skills in serving diverse populations, she started the MPH program concentrating in maternal and child health. She is thrilled for the opportunity to continue to contribute to USF and the surrounding Tampa Bay community.

Sirly Castro, MBA

Sirly Castro is a fiscal and business specialist for the COPH Office of Research. As a detail and solution-oriented accountant with a strong work ethic, she provides technical assistance and financial management strategies.

Castro had been working at the USF College of Behavioral and Community Science for the past 10 years, assisting with fiscal responsibilities while supporting and guiding clients to achieve their goals and teaching them skills to be successful.

Holding an MBA in accounting, Castro has an exceptional breadth of community outreach experience and is bilingual in English and Spanish.

Rory Noonan, MPH

Rory Noonan is one of the newest members of the Florida Covering Kids and Families team, joining as a program planner analyst.

Noonan recently graduated from the COPH, earning an MPH with a concentration in health policies and programs. After earning his BS in both economics and finance, he realized that he wanted to go in a different direction with his career and chose public health. He’s happy to be making the transition to a field where he can make a positive impact as a public health professional. 

Miriam Esocabar, MA, MSPH

Miriam Escobar joined the college as a consultant for USF SafetyFlorida.

Escobar is an Air Force veteran who grew up in Chicago. She holds a BA in geography and economics from Northeastern Illinois University. After 10 years of active-duty service in the Air Force, she completed an MA in Latin American, Caribbean and Latino Studies and an MSPH in occupational exposure science from USF. She has worked in COVID-19 response for the Florida Department of Health and as an industrial hygienist and military contractor.

Ciarrah Silva

Ciarrah Silva joined the Florida Covering Kids & Families team as a program planner analyst.

Silva began her USF journey in 2016 as an undergraduate in the BSHS program, graduating in December 2019. During her time as a student, she began her career at USF at the RightPath Research and Innovation Center working on a research project.  She’s excited to use the skills she’s developed in her new position.

Natalie Erasme, MPH, CPH

Natalie Erasme is continuing to practice her passion as a program planner analyst for the Florida Prevention Research Center.

Erasme began her public health career as a consultant for the NYC Department of Health and Mental Hygiene after graduating from Fordham University in 2018. She then went on to obtain an MPH from the COPH in 2021.

She currently coordinates and evaluates culturally appropriate research studies that help underrepresented communities reach improved health outcomes. Erasme will be working on projects with the National COVID-19 Resiliency Network and Morehouse School of Medicine and is serving as the chair of the Southwest Florida Cancer Control Collaborative.

Silvia Moreno

Silvia Moreno is looking forward to working as the project manager for the COPH Lifelong Learning Academy. In this role, she will expand public health professional and workforce development.

In 2007, Moreno obtained her bachelor’s degree from USF in elementary education. She has served as an educator and facilitator for Hillsborough County Public Schools for the last 15 years.

Moreno is looking forward to graduating with her master’s degree in learning design and technology and with a graduate certificate in e-learning design and development from USF this fall. She is eager to coalesce her teaching and instructional design skills to develop and deliver programs of outstanding value to the community.

Ashley Tower

Ashley Tower joined the COPH as a fiscal and business specialist.

Originally from Bristol, R.I., Tower moved to Tampa in 2014 with her partner, Jesse, where they later adopted two dogs, a Siberian husky and a German shepherd. Previously working at the USF College of Arts and Sciences and the USF Operations and Facilities Management, Tower has a background in banking as well as administrative support and is excited to use her skills in this new role.

James Kakoullis, MS

James Kakoullis is happy to be joining the COPH team as a teaching laboratory manager.

Kakoullis earned his MS in chemistry from the University of California, Riverside, and has worked in private industry at an environmental testing lab in the Tampa Bay Area. He also has experience in education, teaching chemistry at St. Petersburg and Hillsborough Community Colleges.

Benjamin Gessner, MPH

Benjamin Gessner is excited to continue practicing his passion at the COPH as a statistical data analyst for the Florida Perinatal Quality Collaborative within the Chiles Center.

After graduating with his BS in health sciences, Gessner went on to pursue an MPH with a concentration in epidemiology from the COPH. During his time earning his MPH, he served as a teaching assistant for a population assessment course while also interning at the Dry Eye and Cornea Treatment Center as a data analyst.

Earlette Thompkins

Earlette Thompkins is looking forward to working with her new team within the COPH’s OSHA Training Institute Education Center. She will be a training support specialist.

Thompkins is joining the COPH from a career in the court system. She has also been employed at various school districts, working within the classroom and administration. She most recently worked within the state’s Guardian Ad Litem Office, where she held a senior administrative assistant position. She hopes that her knowledge and skill set will be an asset to the team.

Social justice + public health = a more diverse workforce

The COPH also introduces a new undergraduate-to-graduate pathway program, Maternal and Child Health (MCH) Scholar for Social Justice.

Originally known as the Maternal and Child Health Pipeline Training Program or MCH Train-A-Bull, the newly redesigned program aims to ensure a competent and diverse workforce passionate about improving health and reducing health disparities. The program provides students with a foundation in anti-racism and social justice through an exploration of systemic racism as a precursor to the social determinants of health disparities and outcomes.

Thirty undergraduate students were selected into this competitive program. They will complete a specially designed, intensive one-year curriculum that includes a community-engaged service project and two virtual, five-week summer trainings with online meetings that provide an MCH career and research foundation and guide students in applying for graduate school.

Students will work closely with MCH graduate student mentors, faculty mentors and community leaders during the program.

“I am excited to engage with students about social justice and MCH. Social justice is something I have worked in and have had a passion for since a very young age, even prior to my work in public health. It allows me to tie my interests together! I love workforce development, mentoring students and watching them grow into their own paths,” said Dr. Anna Armstrong, program director and associate professor. “We are laying the foundation for real social change at an MCH system level by empowering students with this knowledge and these skills. They will be reflective and intentional in their work, their decisions and their careers.”

Read more here.

Story by Caitlin Keough, USF College of Public Health

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After Randi McCallian graduated college with a degree in psychology and a minor in biology, she married her love of science with service and began working with young children on the autism spectrum, providing in-home and community-based behavioral therapy. 

It was work that ultimately drove her to study maternal child health.

“I often heard parents talk about their pregnancy and birth and postpartum experiences and comment how challenging the ‘systems’ had made their situations,” said McCallian, who graduated from the USF College of Public Health (COPH) with an MPH in maternal and child health in 2013. “They had ultrasounds that led to invasive tests, and tests that led to fear about possible problems with the pregnancy. In nearly every case, a healthy baby was born, but often with significant birth interventions, such as inductions and cesarean sections that the parents felt were unnecessary.”

McCallian grew increasingly more interested in maternal care and began training to be a labor doula. “I learned that just providing a comforting presence alone was enough to improve outcomes and make the birth experience better for the family,” said McCallian, who has been a doula now for the past 10 years.

McCallian said having a bird’s-eye view of health care led her to see problems with it. 

“I worked with a new mom who felt her negative birth experience was because she was a teen mom who needed a cesarean,” McCallian noted. “I saw the number of appointments—from seeing the pediatrician to getting breastfeeding support—she was required to attend, using public transportation with a newborn, in order to keep her WIC food stamps and other social services. She had to put in so much effort to stay afloat instead of resting and connecting with her baby. I felt frustrated right along with her.”

That frustration led McCallian to pursue her MPH at the COPH, in part because of its strong focus on maternal and child health. While a student, she racked up a long list of accomplishments, serving as president of the Maternal and Child Health Student Organization, being inducted into the Delta Omega Honorary Society in Public Health, receiving a Maternal and Child Health Leadership Trainee Scholarship and working with the Florida Perinatal Quality Collaborative (FPQC).

It was her work with the FPQC that led McCallian to become an International Board Certified Lactation Consultant, after which she took a position providing birth, postpartum and breastfeeding education to community health workers with MHP Salud. MHP Salud is a nonprofit dedicated to strengthening underserved Hispanic and Latino communities by improving access to health care and social services.

“I loved creating access to more downstream providers who work within their own communities,” McCallian said. “My favorite part of the job was organizing and co-teaching peer counselor training for members of the farm-working communities the program served.”

McCallian, now a mom of two and living in rural Missouri, says it’s the advocacy portion of public health she’s leaning heavily on these days as she campaigns for a seat in the U.S. Congress (the election is coming up in November).

“I learned in my public health classes that advocacy is an important component of the work public health professionals do,” McCallian, who lost a state senate election in 2020, said. “We work in a field that encompasses so many who cannot advocate for themselves. It’s our role to speak up for them at every level of policy.”

McCallian said she’s focusing her campaign on what she knows best—the issues of mothers, children and families, raising awareness about infant mortality, childhood hunger and equitable access to health care, among other things.

“It’s important that people with experience and background in public health get engaged in our government at all levels,” she emphasized. “I hope I can help more people see a path for themselves in government.”

Alumni Fast Five

What did you dream of becoming when you were young?

Someone who makes people’s lives better.

Where can we find you on the weekends?

With my family, campaigning, or reading a book with a cat in my lap.

What is the last book you read?

“Dirt Road Revival,” by Chloe Maxmin and Canyon Woodward

What superpower would you like to have?

The ability to heal.

What’s your all-time favorite movie?

“Practical Magic.”

Story by Donna Campisano, USF College of Public Health

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Dr. William Sappenfield, FPQC Director, opened the meetings with a special thank you for hospital teams’ efforts during these challenging times of COVID-19 pandemic and continued staffing issues. He recognized how hospitals remained engaged with FPQC as they learned how to work through several surges of the pandemic and gave one “final push” for PROVIDE and MORE. Dr. Estefania Rubio, FPQC Data Manager, presented overwhelmingly positive outcome data, sharing progress made in many areas. PROVIDE successes included improved completion of induction and pre-cesarean checklists, and improved staff education on pain management, labor support, latent labor management, labor progress, and active labor management. MORE successes included improved rates of Hepatitis C screening; as well as improved screening for other infectious disease/mental health comorbidities, education on Narcan use, and referrals to a postpartum visit. For both initiatives, Dr. Rubio also encouraged the ongoing work of sustaining and even improving on initiative gains, as well as continuing to give attention to areas where teams may have struggled.

Kelly Rogers from the Florida Department of Health was a featured guest during the PROVIDE webinar. She thanked the teams and encouraged a continued focus to meet the Healthy People 2030 goal of 23.6% for NTSV cesareans. Dr. Chris Cogle, Florida Medicaid Chief Medical Officer, was a featured guest during the MORE event and thanked the teams for their efforts to better support mothers with substance use disorder/opioid use disorder (SUD/OUD).  

Dr. Maya Balakrishnan, FPQC Associate Director of Quality, summarized the importance of sustainability with quality improvement initiatives. She emphasized as initiatives end, progress can backslide. However, improvement can be sustained through standardization of tasks, accountability, visual management (seeing the data), problem solving, and escalation of concerns. Hospital teams learned they can tailor their strategies depending on their goals and desired improvements.

Drs. Karen Bruder and Julie DeCesare, PROVIDE Physician Leads, stressed key sustainability components including labor support, pre-cesarean huddles with a checklist, and using the “What Can Florida Do to have California’s Rates?” checklist. Dr. Jan Lanouette, MORE Physician Lead, emphasized the importance of screening for SUD/OUD, referring to treatment and continuing to work on Naloxone (NARCAN) distribution for all women with diagnosed SUD/OUD discharged from the hospital.

At the MORE event, FPQC was honored to hear from Helena Girouard, who is in recovery and is now a community liaison for women affected by OUD/SUD. Her personal story is an inspiration for all clinicians working to help affected women and families. Afterward, Jennifer Williams from the Department of Children and Families discussed how hospitals can provide Naloxone kits at discharge for women with SUD.

PROVIDE Nurse/Physician dyads also reported on their hospital groups: Nancy Travis and Chadwick Leo, Kim Huber and Cole Greves, Jane James and Karen Harris, Carol Lawrence and Julie DeCesare, and Leah Williams-Jones and Karen Bruder. Summaries of each team’s successes and plans for sustainability were shared. MORE nurse/physician coaches reported on the progress of their hospital groups: Jan Lanouette and Lindsay Greenfield, Pam Carbiener, Tracy Blue, and Amanda Snyder all gave summaries of each group’s successes and plans for sustainability.

A highlight at each celebration was the “Star Hospital Awards.” Hospitals that met criteria on participation on coaching calls, data submission, improvement on structure measures, and improved outcome measures were recognized. Each hospital received a certificate from FPQC listing their stars.

Dr. Sappenfield thanked all the hospitals again for their commitment to improving health care quality and working with FPQC. He especially thanked them for making a difference for all mothers, babies, and families across the state of Florida.

More information about PROVIDE and MORE is available at http://www.fpqc.org

Hospital teams should stay tuned for FPQC’s next maternal health QI Initiatives set to launch in October and March: 1) Postpartum Access and Continuity of Care (PACC). PACC is in development with hospital leaders, federally qualified health centers, inpatient and outpatient clinicians, community members, birth workers, and other perinatal health advocates from across Florida, and 2) a new focus on social determinants of health.

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Overdoses are now the leading cause of pregnancy-associated death in Fla. According to the Florida Pregnancy-Associated Mortality Review, more deaths occur related to drugs than due to complications related to pregnancy, accounting for one in four of these deaths.

To combat this crisis, the USF College of Public Health’s Chiles Center faculty and students in partnership with the Florida Perinatal Quality Collaborative (FPQC) started the Maternal Opioid Recovery Effort (MORE) initiative to promote strategies that improve health care quality for these vulnerable women. Since 2020, they have worked with 33 hospitals across the state, Medicaid and other state partners to prevent these deaths.

The initiative, which runs through June 2022, goal is to work with providers, hospitals and other stakeholders to improve identification, clinical care and coordinated treatment/support for pregnant women with opioid use disorder and their infants. Obstetric providers, nurses and hospitals are the first health care contact for most mothers with opioid use disorder (OUD) and need to lead the effort to screen, assess and refer these mothers for OUD treatment.

The two most effective ways to prevent the deaths of mothers suffering from OUD is to get them into medication-assisted behavioral health treatment and make sure they have access to naloxone.

“Screening and referring mothers on opioids for medication assisted treatment and making Naloxone available are essential strategies to preventing maternal deaths,” said Dr. William Sappenfield, professor and director of the Chiles Center.

According to the National Institute of Drug Abuse, naloxone is a medicine that rapidly reverses an opioid overdose. The medication attaches to opioid receptors, reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose.

As the MORE initiative is coming to a close this summer, multiple efforts are underway or have been concluded at the Chiles Center to address this public health issue in partnership with and funding support from the Florida Department of Health (FDOH):

• Drs. Russell Kirby, USF distinguished professor and Marrell endowed chair, and Jason Salemi, associate professor, and their team have worked with FDOH investigators to assess the accuracy of neonatal opioid withdrawal syndrome and maternal OUD claims on hospital inpatient data, as this is the primary data source for the state’s surveillance of this issue. 

• Pregnant women with OUD have difficulty accessing Medication Assisted Treatment. Dr. Jennifer Marshall, associate professor, Dr. Kimberly Fryer, obstetrician-gynecologist with the USF Morsani College of Medicine, and collaborators examined access to treatment and access to prenatal care in Florida for pregnant women with Medicaid using secret shopper methods. Results confirmed many barriers to access, with few callers successful in obtaining an appointment.

• To improve physician providing practices, the FPQC held a waiver training in conjunction with the American College of Obstetricians and Gynecologists, American Society of Addiction Medicine and the Association of Women’s Health, Obstetric and Neonatal Nurses. The FPQC also collaborated with the Tennessee Initiative for Perinatal Quality Care to provide virtual buprenorphine training modules to providers.

• Continue to promote naloxone distribution to patients with opioid use disorder prior to discharge and have worked with the Florida Department of Children and Families’ opioid prevention program to distribute free Narcan to hospitals throughout the state.

• In conjunction with the COPH, they released a video entitled “Naloxone Saves Mothers’ Lives: Angel’s Story”. The video details how Angel, a mother in recovery, had her life saved multiple times by Narcan and how she in turn was able to save another person’s life by carrying a naloxone kit.

• Dr. Cheryl Vamos, associate professor and director of the Center of Excellence in Maternal and Child Health Education, Science and Practice, and colleagues examined promising practices in provider education as a key implementation strategy in perinatal healthcare initiatives, particularly as it pertains to delivering care to women with opioid use disorder.

• The FPQC developed both a prenatal and hospital checklist, as well as educational materials for mother and providers. With the help of Healthy Start Coalitions throughout the state, this information will be disseminated to assist obstetrical providers to recognize, treat and support pregnant women with OUD during prenatal care and at their delivery.

• In an effort to decrease stigma against pregnant women with OUD, FPQC offered a virtual naloxone training to Association of Women’s Health, Obstetric and Neonatal Nurses. Free kits from FDOH were sent to those who completed the workshop.

“We know that a smoker needs to quit 8 to 11 times to be successful. With opioids, regretfully, restarting can be fatal,” Sappenfield said.  “As our new video shows, Naloxone is needed to keep these mothers alive until they make it successfully into recovery.”

Sappenfield also commented that none of FPQC’s work on this initiative is possible without their community partners.

Related articles:

PROVIDE and MORE Virtual Mid-Point Meetings Celebrate Successes and Look to the Future

Hospitals vow to do MORE: FPQC’s new Maternal Opioid Recovery Effort

The Maternal Opioid Recovery Effort Mid-Project Meeting Connects Diverse Stakeholders

Story by Caitlin Keough, USF College of Public Health

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On September 23, over 130 attendees from 45 hospital teams, Healthy Start Coalitions, Medicaid Managed Care Organizations, and state agencies and organizations gathered virtually to learn how the PROVIDE initiative is progressing, hear tips from state and national experts on reducing Nulliparous Term Singleton Vertex (NTSV) cesarean births, and gain inspiration for making the “final push” in this initiative. Mary Mayhew, Executive Director of the Florida Hospital Association and former Secretary of the Agency for Healthcare Administration, congratulated the PROVIDE teams on their leadership, consistent commitment to best practices and on their progress in improving birth outcomes for women across the state. Dr. Bill Sappenfield, Director of FPQC and Kristina Svatos, PROVIDE Data Analyst, summarized the progress made since the beginning of the initiative, emphasizing that Florida’s NTSV cesarean rates have decreased 7.4% while the total US rate has only decreased by 1.5%. Dr. Cheryl Vamos, USF College of Public Health, shared her research findings regarding effective ways to educate busy obstetric staff and providers with tips about techniques perceived to be most effective and recommendations for successful training strategies.

Two speakers discussed California’s successes and challenges in reducing NTSV cesarean rates. Christa Sakowski, nurse lead from the California Maternal Quality Care Collaborative, emphasized there is no single successful strategy for supporting vaginal births; a culture change is needed for sustained change. She also stressed the importance of celebrating successes in this long journey. Dr. Ramy Eskandar from the Harbor UCLA Medical Center provided an honest description of the difficulty of culture change: it takes time and involves many steps. He emphasized the importance of involving the entire care team, including the patient, and aligning all levels of stakeholders, including executive management in a shared, unified vision

Both speakers acknowledged the powerful role of the bedside nurse in the labor process, both as a patient educator and as a patient advocate.

The final push for PROVIDE includes offering smaller, monthly coaching call groups led by a physician and nurse coach mentor and using a “What Can Florida Do” checklist with strategies used by California to reduce its rates.

Comments from attendees included:

“[I liked] Having a physician champion share frontline information and encouragement.”

“[I plan to] Improve education to our mothers, to impower them to become active participants in their delivery by asking the right questions.”

Teams also viewed snippets from several PROVIDE hospital teams (South Miami Hospital [pictured], AdventHealth Wesley Chapel, Mt. Sinai, and Lee Health Cape Coral) who shared tips about how their teams were able to successfully reduce cesarean rates. Strategies included hosting FPQC labor support trainings or similar trainings to support vaginal birth, reference cards for positioning, labor walking paths, a labor corner with posted initiative successes, cesarean rates, and tools (e.g. labor balls, peanut balls), hosting Grand Rounds, and support from administration and providers.

Further strategies included creating badge buddies for physicians who meet benchmark which read “ask me about my low c-section rates”, and a Wall of Stars recognizing physicians, midwives, and nurses who have contributed to a successful NTSV delivery. 

Likewise, the virtual mid-point meeting for the MORE initiative was held October 28 with participation from over 120 attendees representing 26 hospital teams, managed care organizations, Healthy Start Coalitions, and state partners. The MORE initiative will also be coming to a close in June 2022, so the teams were eager to learn tips about best practices regarding screening, community resources, referral strategies and ways to get Narcan, an overdose reversal medication, into the hands of pregnant and new moms with OUD and their families.

The meeting began with a compelling video telling the story of Angel (pictured), a mother in recovery, who has overdosed and been revived with Narcan several times. She emphasized the impact of a physician and  nurse who “believed in me until I could believe in myself” as well as her gratitude for having Narcan available so she could survive the overdoses, sustain her recovery and raise her daughters. Dr. Estefania Rubio, FPQC Data Manager, presented an update on progress with MORE.  Successes included a substantial increase in SUD screening as well as recommended secondary screening.

Dr. Pamela Carbiener, FPQC MORE Physician Coach, discussed the barriers to screening and referral for medication assisted treatment (MAT), debunked myths related to prescribing MAT, and reviewed recent federal and state changes supporting MAT prescribing by prenatal care providers. This was followed by a panel representing three Medicaid managed care plans describing the services available for Medicaid recipients in each plan. A brief description of behind-the-scenes work supporting pregnant women and new mothers with OUD by statewide agencies and organizations ended this segment of the agenda.

Dr. Cheryl Vamos, USF College of Public Health, also presented her work at this meeting. She emphasized that training should be ongoing, not just “one and done” and include system level training, interpersonal training using snippets, huddles and informal influencers, and intrapersonal – encouraging each individual to understand the impact of bias and stigma on the care and treatment of patients.

Elena Jensen, Executive Coach at eilumin Corporation, wrapped up the meeting with a presentation entitled “Of Course You Feel This Way: Compassion for Your Brain in the Midst of Chaos”. She emphasized personal resiliency and small things to lessen stress, or at least not compound stress, in day-to-day situations. She took attendees through a guided exercise around a stressful memory and offered techniques to self-calm. Given the challenges faced by medical professionals during the COVID-19 pandemic, these techniques and practices were much appreciated by attendees.

Comments from attendees included:

“[I enjoyed the] number of people showing their faces, speaking up, asking questions.”

“It was all very informative and needed, but I really enjoyed the self-care speaker.”

“The video enhanced my knowledge of Naloxone.”

FPQC looks forward to a strong finish for the current maternal initiatives and will soon be planning the next round of initiatives. Hospital teams are encouraged to stay tuned for more information in 2022.

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Monica Babich didn’t feel like a mother when she was separated from her daughter Elara following her birth. Skin-to-skin care in the neonatal intensive care unit changed that. By holding Elara skin-to-skin, Monica could feel like a mother and knew she was providing just what Elara needed.

Monica, was one of three mothers and fathers who spoke on the experience of parents of infants in the neonatal intensive care unit at the Florida Perinatal Quality Collaborative’s PAIRED Initiative Kick Off meeting held on March 19, 2021.

FPQC’s new infant health quality improvement initiative PAIRED is focused on improving family-centered care in participating Florida NICUs. The acronym PAIRED comes from the core domains of family-centered care put forth by the Institute for Patient- and Family-Centered Care: (1) PArticipation in care and decision-making; (2) dignity and respect in identifying every infant and family as Individuals; (3) Respectful collaboration with families; and (4) information sharing regarding EDucation for families about medical care.  Due to the complexity of family-centered care, PAIRED will be focused specifically on improving skin-to-skin care (SSC) with infants.

Over 90 representatives from 17 pilot hospitals and other stakeholders attended the PAIRED Initiative Kick Off event. Each pilot hospital has assembled a quality improvement team including physician, nurse, and administrative champions. Although virtual, the group was enthusiastic and excited to kick off the project.

The virtual meeting began with a short video on re-imagining NICU care put out by the National Perinatal Association, followed by introductions of the 17 pilot hospital teams.  Dr. William M. Sappenfield, FPQC Director, featured a number of “firsts” occurring with this initiative:

1. It is FPQC’s first pilot initiative to test protocols and materials with a small group of hospitals, with plans to expand statewide later this year
2. It features a parent representative on the Project Advisor Committee, and also had a parent advisory board providing guidance on the development of materials
3. It will include obtaining family caregiver input on their experience of NICU care through an online survey.

It was exciting to have our PAIRED Initiative family representative, Lelis Vernon, introduce three members of the parent advisory board to tell their powerful stories of having a baby in the NICU. In addition to Monica Babich, Fabian Tejedor spoke of the special challenges for father involvement in the NICU when so much emphasis is placed on the mother. Shakeema Smiley spoke of the difficulty of skin-to-skin care while her daughter, Lori, was connected to so many tubes and wires.  All three parents presented powerful stories to support the need for the PAIRED initiative.

Following the parents was a presentation from the PAIRED Initiative clinical co-leads, Dr. Mark Hudak and Dr. Colby Day Richardson discussing the background and significance of FCC and its implications for infant development and family involvement in care in the NICU and when discharged home.  Also presented were clinical guidance on skin-to-skin care including benefits for the infant and family, barriers to SSC, and change ideas for pilot hospitals to implement.

Knowing skin-to-skin care is very important aspect of FCC, but not the only one, FPQC developed additional resources related to family-centered care called PAIRED Plus.  Hospitals can choose to add these additional components of FCC to enhance their efforts.

During the virtual kickoff three members of the PAIRED Advisory Group presented on three specific PAIRED Plus topic modules.  Elizabeth Simonton, president of ICUBaby, an advocacy group for NICU parents, presented on family inclusion in daily rounds.  Dr. Mitchell Stern, a Florida neonatologist presented on complex care conferences and early medical education for families, and Meredith Knapp a neonatal therapist, presented on identifying infants and families by preferred name. 

“You know you’re doing well if families feel involved in all aspects of the care of their infant.”

Mark Hudak, MD

Focusing on how to implement the PAIRED Initiative, an overview of the PAIRED toolkit and resources, and specific guidance on next steps for teams was highlighted by the PAIRED nurse consultant, Sue Bowles. Estefania Rubio, FPQC data manager, presented on the PAIRED key driver diagram and measures, and Dr. Maya Balakrishnan, FPQC Associate Director of Clinical and Quality Management wrapped up the day with a presentation on designing PDSA cycles to jump start hospital quality improvement efforts.

Over the course of the initiative, the FPQC will provide monthly quality improvement data reports for each hospital, a toolkit and an online toolbox with resources and tools, and technical assistance to assist hospitals in implementing process changes and improving documentation. The FPQC is available to provide on-site or remote technical assistance, Grand Rounds presentations, and coaching call learning sessions to further assist initiative hospitals with implementation.

For more information on the PAIRED Initiative, visit www.fpqc.org/paired

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The Mid-Project Meeting for the Florida Perinatal Quality Collaborative’s Promoting Primary Vaginal Deliveries (PROVIDE) Initiative looked a little different than meetings in the past. Held virtually on November 19, 2020, the meeting attracted more than 130 participants including hospital representatives, healthcare organizations, and other stakeholders.

The meeting was an opportunity to assess initiative-wide progress, brainstorm future strategies to reduce low-risk primary cesareans in the state, and reinvigorate participating hospitals teams’ quality improvement efforts.

The meeting highlighted the progress hospitals and providers are making towards decreasing nulliparous, term, singleton, vertex (NTSV) cesarean birth rates, as well as the status of quality improvement activities impacting their rates.   Keynote speakers shared information on efforts to promote vaginal births safely.

FPQC understands COVID-19 has impacted many of the teams’ level of participation.  FPQC Director, Bill Sappenfield, MD, MPH, CPH opened the meeting and reminded attendees that the FPQC is available to assist teams with tools, resources, and clinical experts to re-invigorate their PROVIDE initiative.

To focus on the patient impact of our work, guest Leah Swann told her story of having placenta accreta with her fourth cesarean section, with massive hemorrhaging and loss of her uterus. She emphasized how important avoiding a first cesarean is, and advocated for more VBACs. She noted that of the nine women in her accreta support group, she was the only one to survive their birth experience.

FPQC Data Manager Estefania Rubio, MD, MPH presented the data on how hospitals state-wide are doing with their quality improvement process changes and impact so far in the PROVIDE Initiative. Overall, many hospitals are showing progress towards meeting ACOG standards for labor induction and dystocia but more work needs to be done, especially for patients who never reach 6 centimeters dilation.

Two nationally recognized keynote speakers discussed timely topics around PROVIDE.

Sindhu Srinivas, MD, MSCE, Professor, University of Pennsylvania, presented “Continuing to Promote Primary Vaginal Delivery During the Pandemic: It Can Be Done!” She shared strategies to promote vaginal birth during the COVID-19 pandemic. She also introduced a labor induction calculator, developed at the University of Pennsylvania Perelman School of Medicine, that predicts the likelihood of a cesarean section for a certain subset of women with an unfavorable cervix.

Joyce Edmonds, PhD, RN, Professor, Boston College, shared her current research on nurse cesarean rates and emphasized the nurse’s performance variation and attributes that contribute to effective practices to promote vaginal birth.  

One of the highlights of the meeting was the breakout sessions, where attendees discussed timely topics with expert facilitators.  Topics included creative team education strategies during the pandemic; inductions, including scheduling, bishop scoring and cervical ripening; implementation of huddles/checklists; provider practice changes and intrapartum interventions to promote vaginal birth.  The conversations were robust and many ideas were generated.

“I like that we got to hear perspectives from other hospital systems and what was working and how they were implementing interventions and education.”

– Meeting attendee

FPQC announced plans to extend the initiative to make up for time when hospitals may not have been able to focus on PROVIDE, due to the COVID-19 pandemic. The FPQC team is thankful for all the team’s participation, especially this year!

“I feel reinvigorated to take this information back to my unit to share with my team.”

– Meeting attendee

More information on the initiative, project resources, and speaker presentations can be found at fpqc.org/provide. For more information, please e-mail FPQC@usf.edu.

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The meeting highlighted the impact of the latest data on maternal death rates, as well as the status of quality improvement activities among hospitals involved in the initiative. Keynote speakers shared information on efforts to build networks of care and deliver trauma-informed services to vulnerable women with OUD before and after pregnancy.

FPQC Director, Bill Sappenfield, MD, MPH opened the meeting with the FPQC-produced “Getting Real” video describing two women’s journey into recovery from opioid use disorder. 

New data show that both fatal and non-fatal drug overdoses among women of childbearing age are rising and are expected to continue to increase during the COVID-19 pandemic. Drug-related deaths are the leading cause of pregnancy-associated deaths in Florida, and the death rates are increasing with COVID-19.

Estefania Rubio, MD, MPH provided an overview of the MORE initiative data. Since the initiative started, half of participating hospitals have fully implemented universal screening protocols for substance use. For women who used opioids during pregnancy, hospitals provide additional screening, prevention and treatment services during their admission for delivery.

Hospitals have increased the number of women screened for intimate partner violence, mental health and infectious diseases, as well as providing education on most topics of the education bundle and most services of the safe discharge bundle. Areas of opportunity, such as initiation and referral to medication-assisted treatment and behavioral health services were discussed.

The two keynote speakers came from Massachusetts, which has been working on maternal OUD since 2014. Ron Iverson, MD, department vice chair of obstetrics and director of quality improvement at Boston Medical Center and co-director of the Perinatal-Neonatal Quality Improvement Network of Massachusetts (PNQIN) gave a brief overview of lessons learned from their quality improvement journey.

He emphasized that getting the hospital and community supports and services in place for women with OUD takes time. However, once they are in place as well as processes for timely referrals, women can be treated effectively and comprehensively, just as are women with diabetes and other chronic conditions.

Annie Lewis-O’Connor, PhD, NP, MPH, founder and director of the Coordinated Approach to Resilience and Empowerment (CARE) Clinic, co-chair of the Mass General Brigham Trauma-informed Care Initiative, and PNQIN collaborator, spoke about stigma, bias, and trauma-informed care.

She described a way of posing questions that focuses less on the past trauma and more on how past experiences impact the individual’s preferences for care.

The meeting also featured an update on how the Healthy Start Coalitions throughout the state are supporting the MORE initiative by Andrea Berry, CEO of the Indian River Healthy Start Coalition.

Margie Boyer, FPQC nurse consultant and Amanda Snyder, DNP, Perinatal Clinical Specialist for the Women and Children’s Pavilion at Lakeland Regional Health presented the MORE folders and checklist, a new resource to help ensure that all necessary services and referrals occur for women with OUD. Four hospitals are currently conducting a trial for the materials and they will soon be available for use by all the MORE teams.

The highlight of the meeting were the breakout sessions, where attendees discussed five topics with expert facilitators. The conversations were robust and many ideas were generated.

Comments from those who attended the meeting included:

• “I think the meeting really reinvigorated my interest in the program.”
• “[We need to] Keep it real, follow the process.”
• “[I] Realized the importance of complete community engaging and supporting these families.”

MORE clinical lead Jan Lanouette, MD and MORE advisor Washington Hill, MD closed out the meeting with several important takeaways. Most importantly, drug-related death rates are increasing during COVID-19 and should serve as a call to action for obstetrical providers.

Teams were also reminded to have hope, to collaborate, to continue to build your system of care, to treat SUD as a chronic disease; and that stigma, bias, and trauma-informed care training offers opportunity for improved engagement with patients, mitigates vicarious trauma for staff and providers, and provides a path toward health equity and social justice.

Speaker recordings can be found at the FPQC YouTube page, and slides and other project materials are available at fpqc.org/more. For more information, please e-mail FPQC@usf.edu.

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