First published on June 4, 2015 in observance of the COPH’s 30^th anniversary celebration.

It was January 1998, and the Florida Board of Regents had just promoted one of USF’s fledgling entities to major status with sublimely understated efficiency.

Following authorizations for a BS in dance education, a degree of undetermined level in occupational therapy and an MS in physical therapy, it was the last of four single-sentence items in the typically dry language of officialdom, replete with redundancy and excessive capitalization, on a State University System memo to Dr. Thomas Tighe, then USF provost: “Established the Type I Lawton and Rhea Chiles Center for Healthy Mothers and Babies as a Type I Center (sic).”

The rationale for the Center’s status elevation cited the state’s “tremendous progress in improving the health status of pregnant women and infants, largely through the leadership of Gov. and Mrs. Chiles and Charles Mahan,” who was then USF College of Public Health dean.  Marked improvement in the state’s infant mortality rate was among the leading factors, along with the Center’s performance the previous two years as a Type IV center.

Mahan had envisioned a research, program and policy institute for maternal and infant health as early as 1988, according to the Center’s official timeline.  The Center’s originally intended location was the University of Florida, Mahan said, but that was before the state had established its first college of public health at USF.  By the time the Center was created a few years later, USF, with the only COPH in the state, had become the obvious location, and Mahan had been named COPH dean.

Charles Mahan, MD, former USF College of Public Health dean

“Gov. and Mrs. Chiles had a lot of allegiance to the University of Florida, where they met and where he got his law degree,” Mahan said.  “I was state health officer on loan from the medical school at Florida, and I was supposed to go back there, and the Chiles Center was supposed to be there.”

But having served in the same administration, Mahan was friends with Betty Castor, who had been state secretary of education under Chiles and had since become president of USF.  Mahan said she called him and personally asked him to be the dean of COPH.  He accepted, and the first “steal” from the University of Florida only naturally led to the second.

USF was the better location for the Chiles Center, Castor told the governor, as it had the only college of public health and was headed by a dean who had served him as state health officer.  It also had a Healthy Beginnings program in place that arguably was already doing some of the work the Chiles Center would do.

Dr. Betty Castor, former USF president and Florida secretary of education.  To her left is her husband, former Florida state Rep. Samuel P. Bell III.

The Florida Healthy Start Program had been created by the legislature in 1991, under the urging of Chiles, and from its inception, had included a Healthy Beginnings Program at USF.  So when Mahan was appointed COPH dean in February 1995, he was at the right place at the right time to begin realization of his vision.  A year later, the Board of Regents established the Center, and Mahan served as its founding director in addition to his duties as COPH dean.

A $2-million federal grant followed in 1997 that was specifically aimed at reducing infant mortality in Hillsborough County.  In December of that year, a gala event at Busch Gardens honored the governor and his wife and formally launched the Center.  Additional state funding came in 1998 for construction of a building and a $600,000 annual operating budget.

Former Florida first lady Rhea Chiles (third from right) and her and the late governor’s daughter, also named Rhea (fourth from right), and son Ed (center) at the Chiles Center’s groundbreaking ceremony.

“President Castor invited Gov. and Mrs. Chiles down to USF, and we toured the campus and got them to put their names on the Chiles Center,” Mahan recalled.  “And then, Gov. Chiles was great about taking me to Washington and meeting all the senators who were his friends and raising money for the building.”

That journey for federal support brought home another $800,000 for the building.  The governor and first lady then spearheaded a series of fundraisers in Daytona Beach, Lakeland, Pensacola, Tallahassee and West Palm Beach.

“The Center was originally housed in office space near Tampa International Airport on Mariner Drive,” recalled Dr. Linda A. Detman, research associate for the Center.  “I believe that was from 1996 to 1998.  The Center’s first on-campus location was in FMHI, what is now labeled on maps as the College of Behavioral & Community Sciences building.  We also had a pair of temporary trailers for added office space between FMHI and the Westside Conference Center.”

Gov. Lawton Chiles (right) and daughter Rhea with Dr. Harold Varmus, then director of the National Institutes of Health, at the dedication of Lawton Chiles House (not related to the Chiles Center).

The Center’s impressive home since 2001 puts plenty of inspiration on display for visitors and staff alike:  A photo gallery of Gov. and Mrs. Chiles, including framed moments with presidents Clinton, Carter and Bush the first; a replica of the governor’s Tallahassee conference room for his use whenever he visited; even a bronzed pair of “Walkin’ Lawton’s” famous shoes.

After all, inspiration is what it’s all about.  Over the years, the Chiles Center’s health care initiatives have racked up impressive victories, to say the least.

“At the Chiles Center, Florida Covering Kids and Families and its collaborators across the state exceeded the federal goal for Florida in enrolling people for health care coverage in the federal health insurance marketplaces,” said Dr. William M. Sappenfield, Chiles Center director and Department of Community and Family Health chair and professor.  “During the first open enrollment, about 500,000 more individuals enrolled over the initial target and reached more than 1.6 million after the second enrollment period.  Moreover, because of the success of projects like this, Florida now enrolls more people through this important health insurance program than any other state.”

William M. Sappenfield, MD, MPH, director of the Chiles Center

Sappenfield also points to one of the Center’s most recent projects, the Florida Perinatal Quality Collaborative, which has radically reduced elective early deliveries (before 39 weeks of gestation).

“Babies electively delivered before 39 weeks are at higher risk of poor outcomes, including respiratory troubles and difficulties feeding, and are at higher risk of learning, behavioral and school-related problems in childhood,” explained Detman, who oversees the project.

“It continues to make a measurable difference in the quality of health care that mothers and babies are receiving,” Sappenfield said, “through improving newborn health care at birth and reducing death and morbidity to obstetric hemorrhage.”

Another recent Chiles Center project is the Obstetric Hemorrhage Initiative begun in October 2013 with 31 Florida and four North Carolina hospitals.  The participating Florida hospitals represent more than one-forth of the state’s delivery hospitals and nearly two-thirds of all births statewide, Detman said, adding that maternal deaths from postpartum hemorrhage are the leading cause of maternal mortality in the state.

Linda Detman, PhD, program manager for the Chiles Center’s Florida Perinatal Quality Collaborative

“We are fortunate to have the enthusiasm and dedication of perinatal professionals across the state who want to be engaged in improving outcomes for mothers and infants, and we plan to grow in the number of hospitals actively engaged in one or more of our projects,” she said.

Though funding issues put an end to the Center’s branch office in Tallahassee years ago, the original main office – now an imposing office building – on the USF Tampa campus continues to thrive and achieve.

“As was initially dreamed, the Chiles Center continues to improve the health and health care of women, children and families in Florida,” Sappenfield said.  “We will continue to build upon and expand these successful collaborations to succeed in our mission of improving their health and health care.”

Gov. Chiles visits COPH and its dean, Dr. Charles Mahan, in 1995.

“We worked with Gov. and Mrs. Chiles for many years to devise and implement programs and ideas to improve the pregnancy outcomes for women and babies,” Mahan said.  “The LRCC is designed to carry out these efforts and continue to design and improve new ones for future generations.”

Story by David Brothers, College of Public Health.

The post Chiles Center promotes health for all women and babies appeared first on College of Public Health News.

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

The post For over 40 years, Dr. William Sappenfield has served the public—now he heads into retirement appeared first on College of Public Health News.

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

The post FPQC: 13 years of championing the health of moms and babies appeared first on College of Public Health News.

USF College of Public Health’s (COPH) Dr. William Sappenfield, director of the USF Chiles Center, was recently named a USF Distinguished University Professor.

The Distinguished University Professor award recognizes senior faculty members who have distinguished themselves among their peers both within and outside USF. The title is awarded through a process of nomination and external peer review. Those who hold the award are identified as outstanding members of their profession.

Becoming part of this elite group of professors means Sappenfield’s responsibilities will include serving in an advisory group for the provost and president of USF, providing counsel on issues affecting the overall academic and scholarly activities of the university and giving a university-wide address during the academic year.

“I am absolutely thrilled to share with you that Dr. Bill Sappenfield has just been named a Distinguished University Professor!” said COPH Dean Donna Petersen. “These honors are highly coveted and highly competitive. Many are nominated, with only a few selected. The selection process is an arduous one involving an intensive internal and external review of the candidate’s credentials.”

After a 22-year career as a Centers for Disease Control and Prevention (CDC) epidemiologist, Sappenfield came to Florida in 2005 to serve as the Florida Department of Health’s (DOH) state maternal and child health (MCH) epidemiologist and unit director for the MCH practice and analysis unit leading research, epidemiology, evaluation and health data efforts to guide policies and programs for Florida mothers and children.

At the DOH, he joined the pregnancy-associated mortality review team, bringing his epidemiological expertise to the table and leading deeper analyses of the mortality data. He led the development of perinatal periods of risk profiles for each county and each Healthy Start coalition area in the state, giving local MCH advocates understandable data to guide policy development. He also led efforts to monitor and study Florida’s high maternal and infant mortality rates.

Sappenfield then joined the faculty at the COPH in 2011, teaching maternal and child health, epidemiology and public health practice.

“From Dean Petersen, to the faculty, staff and students, I chose the COPH because public health is our passion and translation of research into practice is valued,” Sappenfield said. “Collaborating with others is a key component of the COPH’s DNA.”

Publishing extensively on maternal and infant mortality, morbidity and related health issues, he has also focused on mentoring and teaching young professionals to serve as MCH epidemiologists in governmental public health agencies at a local, state and national level. He also trains  multidisciplinary teams of public health practitioners and community members to effectively use data to improve maternal and child health.

Sappenfield was also instrumental in developing the Florida Perinatal Quality Collaborative (FPQC) in 2011, serving first as a co-director with Dr. John Curran, and the director since 2016. 

As director of the FPQC, Sappenfield champions its mission to advance health care quality and patient safety for all of Florida’s mothers and babies through collective quality improvement efforts with state and hospital partners.  

One of Sappenfield’s most rewarding experiences at the COPH was the FPQC earning the Sapphire Award.

“The FPQC as an organization receiving the Sapphire Award recognizing leadership, excellence and innovation in nonprofit community health leadership and programming improving maternal and infant health in Florida,” Sappenfield said.

Sappenfield’s 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.

“A recognition like this from your peers is always very special. It recognizes you and the value of the work that you do with others,” Sappenfield said. “You can only be effective in public health through working collaboratively with others.”

Sappenfield said that he will continue to strive to improve the health of Florida’s mothers and infants.

“This is not only a personal achievement for Dr. Sappenfield but an honor we can all share in as it contributes to the growing positive reputation of the COPH and ultimately in the larger community,” Petersen said. “We also know that none of us succeeds on our own—it takes teams of dedicated colleagues and the commitment of our highly skilled staff to complement and amplify the perseverance of a senior scholar devoted to his passion to make the world a better place, in this case, for women and children.”

Story by Caitlin Keough, USF College of Public Health

The post Dr. William Sappenfield named 2022 Distinguished University Professor appeared first on College of Public Health News.

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.

The post Wrapping Up Maternal QI Initiatives: PROVIDE & MORE Focus on Sustainability appeared first on College of Public Health News.

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

The post FPQC takes action to prevent deaths of new mothers suffering opioid addiction appeared first on College of Public Health News.

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.

The post PROVIDE and MORE Virtual Mid-Point Meetings Celebrate Successes and Look to the Future appeared first on College of Public Health News.

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

The post New neonatal initiative aims to better involve families appeared first on College of Public Health News.

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.

The post Continuing to PROVIDE during the pandemic: Florida hospitals meet to promote primary vaginal deliveries appeared first on College of Public Health News.

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.

The post The Maternal Opioid Recovery Effort Mid-Project Meeting Connects Diverse Stakeholders appeared first on College of Public Health News.