Lane County Medical Workgroup Minutes

Lane County Workgroup - Meeting Minutes

May 15th, 2008

Participants: Kelli Augustadt, Nancy Bischofs, Jill Burge, Kelli Burns, Kristin Funk, Paula Michaud, Michelle Maloney, Sandy Moses, Kathy Moxley, Terra Ralph, Heather Richardson, Brianna Robins, Pam Stuver, Liz Twombly, Paula Wright

Announcements and Updates

Update on AIA Teleconference : Prenatal Methamphetamine Exposure & Child Outcome: What Do We Know
Sandy Moses gave an update on Lane County Prevention's Second Annual Healthy Brain Conference, which will take place on October 22-24, 2008 in Eugene . Conference and registration information can be found at lanecounty.org/prevention/brain development
Nancy Bischofs gave an update on Healthy Start. Healthy Start plans to expand its services to begin working with women in the 3 rd trimester of pregnancy. They will be holding meetings in June to further define these changes and will be training staff in July. Healthy Start has recently hired four Americorps volunteers which will allow them to provide these services. Nancy is not yet sure where prenatal referrals will from. The following possibilities were raised:

FEAT Family Advocate, Heather Richardson, can refer women she encounters
Prenatal providers are another source of referrals, particularly in conjunction with FEAT's prenatal screening, brief intervention and referral pilot
Paula Michaud of DHS suggested that pregnant women referred to DHS might be able to be referred to Healthy Start. Logistics of this type of referral would need to be worked out between DHS and Healthy Start.

Pam Stuver talked briefly about potential cuts to Public Health funding. She said that there is a possibility that funding be restored either for WIC or for Maternal Child Health nurses.
Liz informed the group about a new website: asqoregon.com Caregivers can complete a screening tool and receive results and activities for their children ages 3 months to 5 ½ years.

Family Advocate Report

Heather Richardson gave a brief update on recent Family Advocate activities:

She and Nicole are currently seeing many moms with older children in foster care.
Last month was particularly good. Seven families were closed and all were hooked up with services. Many still keep in touch with Heather.
Between Heather and Nicole, 14 families are active. 9 are in residential treatment, 1 is awaiting residential, and 3 are in outpatient treatment. They are also working with another very young mother (age 17) who has serious domestic violence issues.
Obstacles have arisen related to methadone maintenance and one client's attempts to transfer her maintenance to another county.
The question was raised about treatment for marijuana use alone. A woman with marijuana use only can be eligible to receive services from Willamette Family Services, depending other life issues and how the drug use impacts her life.
Kelli mentioned that marijuana smokers involved in DHS are now mandated to attend a class with Eric Martin called ‘Up In Smoke' that addresses marijuana use.

Small Workgroup Reports

The Hospital Policy pilot is on hold until after Sacred Heart has moved to its new location. Sacred Heart employees have been asked not to take on any new projects until after the move.
Kris reported on the Prenatal Workgroup. Things are moving forward with the prenatal screening pilot, though implementation at OMG has been delayed due to a medical issue on staff. Bob Nickel recently met with Jim Shames and Lillian Koppelman in Southern Oregon to talk about their work with Dr. Chasnoff. Dr. Chasnoff is working on a prenatal screening, brief intervention, referral and treatment project with Jackson , Douglas and Josephine Counties . Dr. Shames (Public Health Officer in Jackson County) has been emailing back and forth with Kris and suggested that we include separate screening questions for both marijuana and prescription drugs on the tools we're developing. Southern Oregon has included both of these questions on their screening protocol to meet the needs of their population. FEAT workgroup participants agreed that it would be important to include these questions.

Discussion of Communication and Discharge Planning

Liz briefly discussed an upcoming meeting to discuss potential changes to hospital discharge planning for SEN, along with the possibility of creating portable medical records for families and caregivers. The meeting will held on June 5 th and those attending include: Paula Wright (Sacred Heart Nurse Care Manager), Brianna Robbins (DHS), Michelle Maloney/Nancy St. George (Sacred Heart Social Workers), Sharay Baker and (DHS Nurse who does newborn assessments). If you have input or would like to be included in these initial discussions, please contact Liz.
FEAT staff also met recently with Dr. Randy Phelps (CDRC) to talk about portable, electronic medical records. Randy and Bob Nickel had some ideas that Kris and Liz will follow up on.
Pam Stuver also mentioned a model of electronic used for pregnant women in Contracosta, CA. Patients carry a card with their medical information. Public Health applied for a grant to replicate this model, but was not funded. Pam will send the RFP to FEAT Staff to use in seeking future funding.

Small Workgroup Meetings

The group met in small workgroups for the duration of the meeting.

Important Dates

May 15, 2008, 7:30-9:00 am, FEAT Meeting , Banquet Room, Griffeth Hall, NWCC
May 19, 12:00-1:30 p.m., Resource and Referral Brown Bag , Michael Rogers Room , Lane County Mental Health 2411 Martin Luther King Blvd. , Eugene . Gloria Griffith from Benton House in Springfield will be talking about Family Resource Centers.

June

June 5, 2008, 8:30-10:00 am , HBHC Perinatal Health Team , Lane Co. Mental Health
June 19, 2008, 7:30-9:00 am, FEAT Meeting , Banquet Room, Griffeth Hall, NWCC

February 28th, 2008

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Participants: Kellie Augustadt (DHS ART Team), Jill Burge (Peacehealth MCM), Kris Funk (FEAT), Kathy Moxley (Relief Nursery), Sandy Moses (HBHC), Bob Nickel, Heather Richardson and Nicole, FEAT Family Advocates, Brianna Robbins (DHS Foster Care), Pam Stuver (Lane County Public Health), Jane Squires (FEAT), Liz Twombly (FEAT), Deanne Unruh (FEAT), Rose Wilde (DHS), Kay Yannit (McKenzie Willamette SW).

Welcome
Announcements and Updates

Kris Funk reported that the first joint HBHC/FEAT Joint Community Meeting was held on January 31 st . The meeting was well-received, and provided a helpful opportunity to highlight the collaboration between FEAT and HB/HC. Most participants at today's meeting had also attended the joint meeting. The next joint community meeting will be May 2 nd (see Important Dates below for details).
Liz Twombly and Kris Funk reported on the February 26 th State FEAT workgroup meeting. Since advocating for legislation is one of proposed activities of the state workgroup, there was some discussion about the legislative timeline, and the fact that any legislation intended for the 2009 session will need to be in place by November of 2008. The next legislative session will be in 2011.
Other agency updates.

Rose Wilde reported that the OHP reservation list is closing tomorrow (February 29 th ). So far, 76,000 people are on the waiting list, with 5,000 of those waiting who may actually be able to receive OHP in this round.
Heather Richardson reported that the Relief Nursery Courthouse childcare project is up and running. This center (located in the courthouse building) provides childcare for children whose parents are going to court. It is currently operating on Monday mornings.
Pam Stuver reported that the county is currently considering 4 different budgets for the next year, one of which cuts home visiting services by 50%. Public Health may be asking for advocates to go to the county commissioners and speak for the importance of these services.

Sandy Moses reported briefly on the Community Education workgroup, an HBHC project in which FEAT is collaborating. This workgroup is focused on creating and disseminating educational materials that focus on HBHCs 4 priority areas: parental substance use; safe sleep/accident prevention; perinatal mood disorders; and preconception and reproductive health.

Small Workgroup Reports

Prenatal Screening : FEAT is collaborating with HBHC to pilot revised health screening not only during the prenatal period, but across the span of women's reproductive history. Members of the Prenatal Screening workgroup have met twice with staff from OMG and hope to pilot screening, brief intervention and referral procedures at both OMG clinics this spring.
Hospital Policy : Bob Nickel reported that the Hospital Policy workgroup hopes to begin implementing a pilot at Sacred Heart in April, 2008. The pilot will implement a Maternal and Newborn Risk Assessment and the standardized protocol for drug testing for mother and baby. The next goal for this group will be to focus on creating Standardized Discharge Plans for SEN and their families so that each family has a safe care plan and so that relevant medical information is communicated to future providers, caretakers etc.
SEN Team: A new, monthly SEN Team Review process (first meeting in April 2008) will be put in place to look at how the process is going and make changes to the process as necessary. This review will include social workers from both hospitals, DHS Addiction and Recovery Team members, FEAT Family Advocates and treatment staff. Other involved agency personnel are welcome to attend if they would like to discuss a specific case in which they were involved. The intent of this review is to keep communication channels open between these different agencies, and make changes as needed to policies and procedures.

Family Advocate Report

Heather Richardson reported on the FEAT Family Advocate activity in the last month. 6 referrals were made, 2 of which were self-referrals from women who picked up brochures some place in the community. There were more referrals from Peacehealth this month than in past months. Heather reported that because of the number of women, the Family Advocates have had to prioritize women for whom FA services will be most beneficial. If a woman has successfully entered treatment, the FA likely will no longer provide services.

FEAT Project Years 4 and 5

FEAT staff reported on potential objectives targeted for Years 4 and 5 of the FEAT project. Input was solicited from participants. Additional input is welcome as we move into the next phase of this project. The following were discussed as potential steps to take in the next two years. Additional input into these steps is welcomed.

Year 4 (October 2008-September 2009)

Strengthen SEN Team approach in Lane County
Strengthen Discharge Planning Process for SEN in Lane County
Strengthen safe care planning with DHS and foster care
Disseminate Model throughout Lane County in prenatal practices, hospitals and community agencies

Year 5 (October 2009-September 2010)

Focus on legislative issues at state level
Transition FEAT collaboration to local and state entities
Disseminate model across state

FEAT Meeting Structure.

FEAT staff presented the idea of having theme-related meetings. In a theme-related meeting, specific FEAT participants would be invited to come to that meeting (who may not have been attending regularly) to discuss a particular issue. In addition, an expert, or other community members with useful information/perspectives may be invited to speak for a period of time. One topic that continues to need focus in the issue of communication channels between medical personnel (particularly between MD's) .
FEAT participants were open to this type of structure change to the meeting. FEAT Staff welcome suggestions for specific speakers or discussion topics.

Small Workgroup Meetings
Important Dates

March 6, 2008, 8:30-10:00 am , HBHC Perinatal Health Team, Lane Co. Mental Health
(CANCELLED) March 27 2008, 7:30-9:00 am, FEAT Meeting , Banquet Room, Griffeth Hall, NWCC
(CANCELLED) April 3, 2008, 8:30-10:00 , HBHC Perinatal Health Team, Lane Co. Mental Health
April 8, 2008, 11 am -12:30 pm, AIA Teleconference: Methamphetamine: Latest Knowledge, Latest Treatments , Clinical Services Building , U of O
April 15, 2008, 7:30-9:00 am, FEAT Meeting , Banquet Room, Griffeth Hall, NWCC
April 16, 2008, 9:00-10:30 am , HBHC Community Education Workgroup Meeting, location TBA
April 24, 2008, 11 am -12:30 pm, AIA Teleconference: Prenatal Methamphetamine Exposure & Child Outcome: What Do We Know , Clinical Services Building , UO
May 2, 2008, 8-10 am, HBHC/FEAT Community Meeting , Lane County Mental Health
May 15, 2008, 7:30-9:00 am, FEAT Meeting , Banquet Room, Griffeth Hall, NWCC
June 5, 2008, 8:30-10:00 am , HBHC Perinatal Health Team, Lane Co. Mental Health
June 19, 2008, 7:30-9:00 am, FEAT Meeting , Banquet Room, Griffeth Hall, NWCC

January 31st, 2008

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Participants (46)
Grant Beardsley, Oregon Medical Laboratories
Iris Bicksler , Doulas Supporting Teens
Nancy Bischofs , Department of Children & Families
Karen Buntman , Lane County Public Health Advisory Committee
Jill Burge , Peace Health, RN Case Manager, OB
Kelli Burns , Willamette Family Treatment
Jill Burrell , Sacred Heart Medical Center Pediatrics
Nicole Cotto , Relief Nursery
Deena Crandall , Circle of Gold, Int'l.
Lois Day , Child Welfare Program, Dept. of Human Services
Susie Dey , Willamette Family Treatment Services
Carol Freitas , Birth to Three/Healthy Start
Kris Funk , University of Oregon FEAT Project
Mary Gent , Lane County Mental Health
Karen Gillette , Lane County Public Health
Laura Hammond , Lane County Public Health
Shea Hardy , Doulas Supporting Teens
Sarah Hendrickson , Lane County Public Health
Tamara Hughes , Sacred Heart Medical Center Social Work
Brain Johnson , Lane County Public Health
Karen Lawrence , U of O Early Intervention Program
Natalie Marshall , Family Relief Nursery
Sandy Moses , Lane County Health & Human Services
Kathy Moxley , Relief Nursery
Jorge Navarro , Centro Latino Americano
Desiree Nelson, Peace Health Medical Group, OB
Kelly Oatman , EC CARES
Erin Owen , Health Policy Research NW
Randy Phelps , CDRC/OHSU
LaWanda Potter , EC Cares
John Radich, Oregon Department of Human Services, District 5
Terra Ralph , Department of Human Services
Heather Richardson , Relief Nursery/FEAT Project
Charlotte Riersgard , OSU/Lane County Extension
Brianna Robbins , Child Welfare Program, Dept. of Human Services
Dawn Sly, Dawn Sly, LCSW, Inc.
Sally Snyder , Options Counseling
Jane Squires , U of O Early Intervention Program
Anna Stern , Health Policy Research NW
Pam Stuver , Lane County Public Health
Liz Twombly , University of Oregon FEAT Project
Stacie Vandewisse , Doulas Supporting Teens
Danene Wanner, Willamette Family
Jessica White-Kiehle , Sacred Heart Medical Center, Labor & Delivery
Rose Wilde, Oregon Department of Health Services
Kay Yanit , McKenzie-Willamette Medical Center

Welcome/Introductions
- Karen Gillette, Lane County Public Health, welcomed everyone, explaining that this was the first joint meeting of Healthy Babies, Healthy Communities and the Family Early Advocacy & Treatment (FEAT) projects.
Healthy Babies, Healthy Communities Overview/Update

Pam Stuver , Lane County Public Health, provided an overview of the Healthy Babies, Healthy Communities (HBHC) initiative, providing a brief history of how HBHC developed, beginning with the Perinatal Periods of Risk (PPOR) process. The PPOR approach was used to begin looking at our high rate of fetal-infant mortality. As a result of data collection, some surprises arose: Lane County's rate of fetal-infant mortality was higher than the state rate; rates were high across all population groups, and the highest excess deaths occurred in infants from one month through the first year of life.
With the new name, HBHC has reorganized into three primary teams:

Case Review Team (CRT)-multidisciplinary team, reviews summarized, de-identified case findings via the Fetal-Infant Mortality Review (FIMR) process. CRT meets monthly. The CRT in turn shares case finding information & recommendations with Community Action Team & Perinatal Health Team
Perinatal Health Team (PHT) - composed of service providers, meets monthly as needed, and provides input on recommendations. Formerly known as the joint maternal-infant health team.
Community Action Team (CAT)-larger community group, meeting quarterly, plans and implements systems-wide changes to reduce fetal-infant mortality.

Pam described the four primary periods of impact and intervention which both HBHC and FEAT focus on: pre & inter-conception, prenatal, hospital/at birth, and postpartum.
FIMR Update. Pam provided an overview of progress to date:

Of the 22 Lane County resident fetal and infant deaths from July 1 thru December 31, 2007:

--Six were < 20 weeks gestation &/or < 500 grams (thus not included for case finding)
--Medical files of 10 of the remaining 16 have been reviewed, summarized, de-identified

Sixteen families have been sent letters inviting their participation in a FIMR interview
Maternal interviews to begin second half of February
First Case Review Team review of actual cases to be held second half of March

SOCO-single, Overriding Communication Objective . The importance of creating a SOCO (pronounced sock-o) was mentioned at the September HBHC meeting. As a result, the PHT proposed the following SOCO for HBHC: Why Are So Many Lane County Babies Dying?

After discussion, the group agreed to keep this statement as our SOCO. Key communication points include:

Fetal-infant mortality is a reflection of the overall health and well-being of the community.
Infant mortality is the "tip of the iceberg" of infants born too early & too little with potential developmental delays & long-term (difficult and costly) health issues.
There are ways to make babies safe. These include safe sleep, breastfeeding, and immunization.

Key statistics to emphasize are:

Lane County's fetal infant mortality is higher than the state & other large Oregon counties
Lane County's fetal infant mortality crosses all segment of the population (socio-economic, education, geographic, ethnic)
Most excess deaths occur in the 1 month to 1 year age range & > half of those are potentially preventable

Sandy Moses , Lane County Health & Human Services, updated the group on some priorities and activities the PHT has identified:

Home visiting , a best practice, is a priority. To begin with, the PHT, jointly with the Department of Children & Families, is conducting a survey to assess what home visiting services are currently being provided, including eligibility, length and type of services.
Safe Sleep - Dr. James McKenna presented information on this topic at a September, 2007 presentation. It is clear that more information needs to be disseminated throughout the community as there is still misinformation about the benefits and risks associated with different types of infant sleep situations.
Prenatal Alcohol & Drug Use -HBHC is currently working with the FEAT project to i ncrease/strengthen screening, intervention & referral practices.
Quarterly Resource & Referral Brown Bags , sponsored jointly by HBHC and FEAT, to increase awareness and understanding of the services provided in Lane County and identify gaps and needs.

Project FEAT - Project Coordinators Liz Twombly and Kristin Funk from the Early Intervention Program at the University of Oregon gave an introduction to Project FEAT, a project targeting systems change in Lane County and in Oregon in regard to the issue of Substance-Exposed Newborns (SEN). FEAT is funded by the Children's Bureau of Health and Human Services. FEAT's purpose is to facilitate the development of optimal, effective policies and procedures to implement the provisions of the Child Abuse Prevention and Treatment Act (CAPTA) which require state protocol for responding to problem of substance-exposed newborns (SEN) by creating systems for identification, referral and safe care of SEN.

Project FEAT Activities

A Lane County interagency collaborative workgroup that meets monthly and includes representatives from hospitals, medical practices, child welfare, treatment, public health, parents/families, early intervention, as well as post-natal service providers.
A Family Advocate , housed at the Relief Nursery, who provides support and service coordination during the prenatal as well as post natal time periods, to pregnant and parenting women who have substance abuse issues. The Family Advocates services include weekly home visits, along with assistance with issues related to parenting and living clean.

Heather Richardson , the current FEAT Family Advocate, gave a brief update on her services. Heather can be accessed at 485-0007 x204. Providers can call her to come and meet with patients immediately on site when necessary or can schedule follow-up visits with her.

A State level interagency collaborative workgroup which meets quarterly and seeks to address on a state level the SEN-related issues addressed by the Lane County workgroup. This work group is looking specifically at the need for better statewide data collection on SEN and hopes to advocate for SEN-related legislation in the future.

Lane County Workgroups - The Lane County FEAT Workgroup has organized its work into 4 major workgroup areas:

Prenatal Screening : This workgroup is focused on creating and piloting a substance use screening, brief intervention and referral process in local OB/GYN and midwifery practices in order to identify women at risk for use during their pregnancies and to provide them with needed education and support in stopping their use. The prenatal screening workgroup surveyed both prenatal providers and mothers in Lane County to find information on current screening practices. While most providers ask some questions about drug, tobacco and alcohol use, we hope to pilot a process of consistent, comprehensive and universal screening and to enhance brief intervention and referral processes. FEAT is collaborating with HBHC to pilot revised health screening not only during the prenatal period, but across the span of women's reproductive history.
Hospital Policy : This workgroup has created a standardized Maternal and Newborn Risk Assessment to be administered upon a woman's admission to the hospital at the time of birth and have also created a standardized protocol for drug testing for mother and baby so that providers are consistent in terms of the lab tests they order and the information they receive on a mother's substance use and a baby's exposure. This group will be focusing on creating Standardized Discharge Plans for SEN and their families so that each family has a safe care plan and so that relevant medical information is communicated to future providers, caretakers etc.
SEN Team: This workgroup meets at hospital when SEN identified at birth and consists of Hospital Social Workers, DHS Staff, Treatment Staff, Medical Staff, etc. The purpose of this group is to gather as much information as possible and makes decisions in SEN's best interest. A new, monthly SEN Team Review process is in place to look at how the process is going and make changes to the process as necessary.
Postnatal Supports: The postnatal support workgroup is looking at compiling information on the variety of postnatal supports that are currently in place for caregivers of SEN, and how to enhance/increase access to those supports.

FEAT Website : Information about FEAT, upcoming meetings and meeting notes, as well as resources relevant to medical practitioners, community members and SEN and their families can be accessed on the FEAT website; http://eip.uoregon.edu/projects/feat/

Issue to Action Discussion/Suggestions

An Issues to Action group exercise was conducted. This will be a similar process to the one we will use at subsequent meetings, using real FIMR case findings and CRT recommendations.
Pam first shared some Lane County population data and some fictitious case review findings and CRT recommendations. In small groups, the discussion question was "As the Community Action Team, what will you do to address the identified issues and recommendations?" Recommendations included:

Credentialing/licensing of maternal health providers. Require minimum number of hours in alcohol, tobacco and other drug (ATOD) screening
Develop uniform ATOD screening tool across all health settings (language and culturally appropriate)-hospital-, clinic-, community-based. Use Lane County as a pilot project
Pay OHP providers to conduct ATOD screening. Influence commercial health plans
Licensed day care providers-include information regarding safe sleep. provide incentives
Increase media blitz regarding safe sleep, breastfeeding
Add public awareness of ATOD-target specific audiences/periods, such as junior high, pre-conception
Increase safe sleep, decrease SIDS as a message
Target actions at high-risk populations, identify healthcare across the lifespan
Public touch points-1. Employers of low income workers, 2. Insurance companies 3. Prior to conception-family planning, 3. during pregnancy-healthcare
Follow Dr. McKenna 's lead! American Academy of Pediatrics and American College of Gynecologists and Obstetricians have published standards of care for healthcare systems.
Grant being written to target all pregnant Medicaid recipients-will include screening for risk factors/depression. Health Policy Research NW to collaborate with FEAT and Public Health, with emphasis on identifying at risk parents to maintain continuity of care
Policy recommendation to work with Oregon Health Plan on transition care for postpartum moms.
In addition to training healthcare providers on identifying ATOD, teach effective communication, encourage empowerment of parents to become health-educated. Provide opportunities for prenatal visits for education
Home visiting programs put emphasis on safe sleep/education/support for families beyond the postnatal (6 week) period
Use LTD for promotion/public awareness campaign/public announcements. Use PSAs, billboards, and include the SOCO.
Policy change regarding reimbursement for brief intervention
Safe sleep public awareness: across agencies at the same time (using newsletters, etc.)-e.g., every September-have Public Health and EC Cares coordinate; Provide specific guidelines (e.g., what is safe sleep?); provide materials to families for safe sleep
Home visits to support safe sleep, infant health (Healthy Start, Relief Nursery, TANF)
Hospital postpartum visit/clinic-include information on shaken baby syndrome, breastfeeding, safe sleep, etc.
Provider education about community resources
Political advocacy-tobacco, PSA, work place, public breastfeeding
211 or common website as a clearinghouse for information and resources
Change our culture!
Community handout included in DHS self-sufficiency paperwork, to include safe sleeping practices, treatment referrals, negative impacts of substance use while pregnant
avoid deficit model with clients
come together with other community collaborations to ensure consistent language
coordinate with Tobacco Free Coalition to increase knowledge about smoking and quitting resources
More prenatal focus on home visiting. Expanding Healthy Start to prenatal period
Home Visitor-check sleeping situation. Discuss what's happening in community and take to mom

Upcoming Meetings - A list of upcoming HBHC and FEAT meetings was distributed.

Upcoming FEAT Meetings

February 28 th , 7:30-9:00 am, Northwest Christian College, Banquet Room
March 27 th , 7:30-9:00 am, Northwest Christian College, Banquet Room

Next HBHC/FEAT meeting: Friday, May 2, 8 - 10 a.m., Lane County Mental Health.

Archive

October 19, 2006

Power Point Presentation Summary

September 14, 2006

July 20 , 2006

Baby Steps "Caring For Babies with Prenatal Substance Exposure"

June 22 , 2006

May 17 , 2006

April 20, 2006

Power Point Presentation

March 23, 2006

February 23, 2006

Powerpoint

January 26, 2006

Power Point presentation

December 15, 2005

Powerpoint Presentation

Project funded by: Children's Bureau, of Health and Human Services. Grant # 90-CB-0154
Disclaimer: Any views or opinions presented by this website are solely those of the project members do not necessarily represent those of the funding agency.