On October 22, 2020, more than 85 participants, representing hospitals, Healthy Start Coalitions, managed care organizations and other stakeholders, gathered for the Maternal Opioid Recovery Effort (MORE) virtual mid-project meeting to assess progress and brainstorm future strategies for supporting mothers.

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.