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PA PQC Learning Session - Shared screen with speaker view
lgost01
01:18:41
Leslie Gostic, Nurse Manager,Washington Health System
Luz Marte
01:18:47
Luz Marte, Counselor at New Directions Treatment Services.
Michele Neff-Bulger
01:19:01
Michele Neff-Bulger, DO, Nursery Director, Geisinger Medical Center
hitekc
01:19:13
Kimberly Ketchel, Director Clinical Programs, Maternity and Pediatric Care Management, UPMC Health Plan
Cheryl Bergamaschi
01:19:20
Good Morning. Cheryl Bergamaschi MSN, RNC-OB, C-EFM UPMC Harrisburg. Unit Director of Maternity
debfogarty
01:19:24
Deb Fogarty, RN, Mount Nittany Medical Center, women's and children's unit
Nicholas DeGregorio, MD - UPMC for You
01:19:41
Nick DeGregorio, Senior Medical Director, UPMC for You
Brittney Bogar
01:19:43
Brittney Bogar, Quality Improvement Advisor, Penn State Health Milton S. Hershey Medical Center
SWC
01:20:07
Good morning from Sue Wehry-Crowell, Clinical Supervisor Tower Health OBGYN Wyomissing Pa.
nathan
01:20:07
Wendi Manning DNP, RN, NPD-BC Penn Medicine- Lancaster General Health
Bob Cicco
01:20:11
Hi, Everyone! Bob Cicco, neonatologist from Pittsburgh
Sadie Jordan
01:20:21
Sadie Jordan, Medical Advocacy Coordinator, The Women's Center, Inc. of Columbia & Montour Counties
margie gardner
01:20:22
Marjorie Gardner Thomas Jefferson Hospital
Jim Cook
01:20:37
Greetings from Geisinger! Jim Cook MD, Director of Newborn Services
mike
01:20:49
good morning. mike goodstein, wellspan health
Emily Goyne
01:21:21
Good morning! Emily Goyne, Quality Data Analyst at Main Line Health System (Philly suburbs)
Shawndel Laughner
01:21:31
Good morning!Shawndel LaughnerJess FortePatricia SterrettSt. Clair Hospital
Catherine Edwards
01:21:36
Catherine Edwards, Nurse-Family Partnership
Elizabeth Imboden
01:21:53
Hello! Liz Imboden MD Pediatric Hospitalist Wellspan Health
mabradle
01:21:56
Good morning! Maria Bradley, Comemaugh MARC
Susan Payne
01:22:13
Good morning everyone!
prober23
01:22:42
Good morning. Paula Roberts from UHC
MaryNissi Lemon
01:23:01
Morning from MCFH :)
mlewis
01:23:57
Hello! Mary Lewis from Penn State Hershey
Sarah horvath
01:23:59
Good morning! Sarah Horvath, MD, MSHP penn state ob-gyn
CoraKoller
01:24:07
Good morning all! Cora Koller Crisis Center NOrth
Beverly Cameline
01:24:24
Good morning all from Beverly Cameline. St. Luke’s University Health Network. Bethlehem
Sara Jann, Maternity Care Coalition
01:24:35
Morning-- Sara Jann, Maternity Care Coalition
Heather Stephens
01:24:38
Good morning, Heather Stephens from Penn State Health Hershey!
Krista Flaherty
01:24:45
Good morning! Krista Flaherty Allegheny Health Network
Traci
01:24:53
Good morning!
Traci
01:25:09
Traci Jennings from Penn State Health - NICU
Becky Ludwick
01:25:37
Becky Ludwick, PA Partnerships for Children
Johanna Vidal Phelan
01:26:06
Good morning from UPMC. Johanna Vidal-Phelan- Senior Medical Director Pediatrics
Amy Noaker
01:26:26
Amy Noaker, Evangelical Community Hospital
Jen Sullivan
01:26:41
Jen Sullivan, Evangelical Community Hospital
Sabrina Hannon
01:27:04
Sabrina Hannon, Medical Advocacy Program Coordinator, Women's Resource Center
Stacey Gustin
01:29:19
Stacey Gustin, Division of Newborn Screening and Genetics, DOH
Benny Alouf
01:31:58
Benny Alouf MD, CMO Aetna Better Health PA
Amy Lembeck
01:41:03
Good morning, Part of the difficulty we're experiencing in our county is spreading the word outside the immediate hospitalization/birth. How are you notifying pediatricians/family med providers about plan of safe care?
Julia Och (she/her)
01:44:15
Is it just 1 healthcare provider who makes the determination or does the multidisciplinary team come to consensus on this? Wondering if there is any protocol to prevent implicit bias.
mike
01:49:04
our social worker is frustrated that the decisions being made through child line are not consistent and there are times that she feels services are indicated, but child line declines to make a referral. she then feels her hands are tied for discussing further directly with CYS. are there options to pursue services further if child line declines to make a GPS referral?
Kerry Heppen
01:50:16
What training or guidance are the Childline workers receiving re plans of safe care?
Lakshmi Reddy
01:50:22
Good morning, Lakshmi Reddy with Gateway Health
Tina Willier
01:51:58
We have infants affected by SSRIs, do these infants qualify for a notification and a plan of safe care? There mothers are certainly at risk, as well as infants can show signs of withdrawal.
Janice Mayer
01:53:50
I usually calls referrals in at birth, before baby may have signs of withdrawal - if the baby does develop NAS after referral is made - does Childline receive this change from OCYS worker and does that enter into your statistics?
Norma
01:55:51
are we to be notifying childline for those infant's born to mother's who are using prescribed substances such as Methadone and Subutex, etc?
Ellen Taylor
01:56:33
If we know a expecting mother is on MAT why can't the notification process be started prenatally so education can occur earlier versus the scramble after delivery?
Celina Migone
01:56:38
To add to what Norma asked- what about those mothers using marijuana and can present their medical card? (ie. legal use)
mlewis
01:56:48
We hear of variability in reporting..., reporting all infants with perinatal exposure, all infants with symptoms of NAS, or only if pharmacological treatment if needed? What is the correct process?
Celina Migone
01:58:18
Yes- again to add to mlewis- which symptoms of NAS withdraw are we referring to? Ones listed in Finnegan scoring or only Eat, sleep, console? And, now that more places are moving towards ESC and prn dosing, this will really change who "counts"
Norma
02:00:04
so it is not necessary to notify immediately after birth?
CoraKoller
02:00:13
what if its the Father who uses substances
Robert Ferguson
02:01:34
For more information: https://www.dhs.pa.gov/KeepKidsSafe/Resources/Pages/Plans-of-Safe-Care.aspx
Elizabeth Imboden
02:01:46
This is my understanding-If infant has any symptoms consistent with withdrawal, even if not requiring pharmacologic treatment, they should be reported.
Robert Ferguson
02:01:52
Plans of Safe Care FAQ: https://www.dhs.pa.gov/KeepKidsSafe/Resources/Documents/POSC_FAQ.pdf
Kerin Kohler
02:02:05
ChildLine has been not accepting notifications if a child has not received pharmacologic treatment. Especially as more birthing centers move toward the Eat, Sleep, Console, fewer infants will receive such mediation treatment; however, experience withdrawal symptoms. Both healthcare providers and CYS in our county as not pleased with the ChildLine assessment of this process. Additionally, ChildLine has requested that newborns are tested for substances. From a medical standpoint, if a mom is on MAT and testing + for that substance throughout pregnancy,, there is no need medically to test the child. It seems that some real, on the ground, information on how things really work should be taken into consideration when determining how the state is processing these notifications.
Vivian Petticord
02:02:09
Not every baby shows signs of being affected by. THC is one such drug and should be notified as a substance.
Michele Walsh
02:03:39
Good morning, Part of the difficulty we're experiencing in our county is spreading the word outside the immediate hospitalization/birth. How are you notifying pediatricians/family med providers about plan of safe care?
Michele Walsh
02:04:38
The Department of Health has sent information to hospital organizations regarding Plans of Safe Care. We are aware there is more work to be done.
Michele Walsh
02:06:46
Is it just 1 healthcare provider who makes the determination or does the multidisciplinary team come to consensus on this? Wondering if there is any protocol to prevent implicit bias.The health care provider is the one who makes the determination based on standard medical practice. At this time there is no explicit protocol related to prevention f implicit bias. MDWISE is working to address this.
Robert Ferguson
02:07:12
The PA PQC's definition for NAS in the PA PQC NAS quality measurement specifications is also based on this CSTE definition for alignment purposes.
Michele Walsh
02:08:49
our social worker is frustrated that the decisions being made through child line are not consistent and there are times that she feels services are indicated, but child line declines to make a referral. she then feels her hands are tied for discussing further directly with CYS. are there options to pursue services further if child line declines to make a GPS referral?Childline alone doesn't make the determination re: GPS it is make in conjunction with the county child welfare agency. The only recourse is to continue to report concerns.
Michele Walsh
02:10:31
so it is not necessary to notify immediately after birth? what if its the Father who uses substancesA SAI notification can be made anytime up to the infant's first birthday. If the child show affects of substance exposure and a POSC is accepted by the family the father may also receive services
Michele Walsh
02:10:55
This is my understanding-If infant has any symptoms consistent with withdrawal, even if not requiring pharmacologic treatment, they should be reported.This is correct
Michele Walsh
02:12:43
ChildLine has requested that newborns are tested for substances. From a medical standpoint, if a mom is on MAT and testing + for that substance throughout pregnancy,, there is no need medically to test the child. It seems that some real, on the ground, information on how things really work should be taken into consideration when determining how the state is processing these notifications.Kerin, thank you for this information. I will follow up with the Childline supervisor
Michele Walsh
02:14:11
Not every baby shows signs of being affected by. THC is one such drug and should be notified as a substance.There has been a great deal of concern related to THC exposure. By all means if it is known or suspected that an infant has been exposed to THC make a report to Childline. It just won't be a SAI notification unless the infant shows affects of the exposure.
mike
02:19:51
agree with Kerin- we are being asked to waste resources to test babies when the mother readily admits to her drug use
Arielle Narva
02:25:29
- it's also a waste of resources when we know the birthing person is prescribed opioids
Arielle Narva
02:25:37
for treatment
Robert Ferguson
02:28:12
The referenced agreements and exhibits are available here (currently from 2020) https://www.dhs.pa.gov/providers/Providers/Pages/Managed-Care-Information.aspx
Vivian Petticord
02:37:57
Appreciate the comment - what is recommended when FOB is the substance abuse user! This also makes the home environment very high risk for the infant and i would imagine is often overlooked during the birth encounter.
Janice Mayer
02:38:40
are these the home visits that are offered by our local health bureaus? or something else?
Ann Giazzoni
02:41:03
Michelle- did you say that the Exhibit will be updated and to check the website?
John
02:41:16
So these programs are outside of the 2 home care nursing visits that are covered by the MCO
Nazanin Silver
02:41:24
As a physician who use to be an Ob.Gyn and now a women's behavioral health psychiatrist, reporting a pregnant or postpartum woman on SSRIs makes absolutely zero sense to me. It is frustrating to know that this mandate even exists. This only further stigmatizes our patients and prevents them from getting care when we are actively trying very hard to encourage women who are pregnant or postpartum to get treated for any mental health disorder.
Robert Ferguson
02:41:31
https://www.dhs.pa.gov/providers/Providers/Pages/Managed-Care-Information.aspx
Janice Mayer
02:52:09
our mothers who are on opiods for pain mgmt. and do not have dx of SUD - are also upset by need to report them
Robert Ferguson
02:56:34
The FAQ about SSRIs and Plans of Safe Care from https://www.dhs.pa.gov/KeepKidsSafe/Resources/Documents/POSC_FAQ.pdf is copied below. "What if a mother is taking a medication as prescribed by her doctor that may or may not affect the newborn at birth, but it is a legal medication and not an opioid, such as an SSRI or medication to prevent seizures? Must I make a notification if I detect an effect on the newborn?Yes. Legal and prescribed medications may also affect an infant exposed prenatally. A Plan of Safe Care is required for any infant born affected by substance use, withdrawal symptoms or FASD to ensure the ongoing health and safety of the infant and ongoing health and treatment needs of the parent."
Nazanin Silver
03:00:15
Janice - I can completely understand. When legislatures makes laws, they don't seem to seek physician input and that is what is most frustrating. Then when the law is implemented, it it's negative impacts are shown in our populations. At that point it is a bit late. I was recently confirmed by the PA Senate to sit on the PA Medical Board and we are made acutely aware of any laws that may be introduced that can impact health care and make sure we give feedback.
Elissa Concini- Geisinger
03:02:25
That statement "who we associate with the drug problem is how we view it" that is SO very true.
Nazanin Silver
03:05:15
As far as infants are concerned when a pregnant patient is placed on SSRIs, the infant may be irritable, have feeding difficulties, or sleep problems for the1st two weeks. This is the extent of it. Reporting this is absolutely ridiculous. SSRIs are safe in pregnancy and postpartum. However, the long term impact of not having the mother treated is far worse including the child having learning disorders, ADHD, and/or anxiety, poor bonding, not to mention poor family dynamics.
Vivian Petticord
03:06:23
When women are prescribed opiates for medical indications prenatally they need to be counseled that this can affect the baby and the baby may need to stay for monitoring. We created a fact sheet for pts who are prescribed opiates so that they are informed. If they understand this prenatally - they are more likely to be understanding.
Nazanin Silver
03:08:26
Babies born to moms on SSRIs generally don't require monitoring. Almost all go home with mom unless there are other medical complications. Again, this will only stigmatize our patients and defeat the purpose of our efforts to get moms to come in for care
amanda mulenga Foundations Pregnancy Support Services
03:31:56
thank you for that comment! empathy is very important and very meaningful to our patients.
Celina Migone
03:32:25
Yes. When you read this language about who to report- Legal and prescribed medications may also affect an infant exposed prenatally. A Plan of Safe Care is required for any infant born affected by substance use, withdrawal symptoms or FASD to ensure the ongoing health and safety of the infant and ongoing health and treatment needs of the parent."
Celina Migone
03:33:10
Oops- hit send. I meant to say that when you read those words, I can't help but point out that this now includes NICOTINE and CAFFEINE.
Sam Merkt
03:33:58
THANK YOU SO MUCH MISHKA! This presentation was so affirming and informative.
Celina Migone
03:34:22
We have several "jittery" "irritable" babies. Nurses want to evaluate them for NAS even though there is no history of that whatsoever. These kids can certainly experience withdrawal symptoms. But it seems crazy to me that we would consider reporting/establishing a plan of safe care for them.
Arielle Narva
03:34:24
Thank you so so much!!!! This was an absolutely incredible presentation
Kelley Clark
03:34:37
Dr. Terplan, How do we communicate and “teach” the importance of listening and addressing this issue without imposing fear and guilt?
Akilah Evans
03:34:48
phenomenal presentation!
SWC
03:34:56
Excellent presentation Dr. Terplan. Thank you!
RLCUNNIFFE
03:35:19
This was an excellent presentation! Thank you Dr. Terplan!
mike
03:35:20
fantastic presentation! thank you so much!
Vivian Petticord
03:35:30
excellent presentation!
Tina Willier
03:35:31
Wonderful presentation. Thank you!!
Lauren J
03:36:40
Amazing, thanks so much! Does the AIM guideline provide a sample guidleline for Urine Drug Testing on Labor and Delivery.
krichc02
03:37:23
Thank you so much for this presentation! This was Amazing and very much needed in this area!
Michele Walsh
03:37:32
Regarding the notification of infants that show signs of affects from all drugs. The key word is notification - this is not a report of child abuse. It will not be treated as a report of child abuse.
Michele Walsh
03:39:08
Thank you, Dr. Terplan for pointing out the positive possibilities of Plans of Safe Care. The Plans are voluntary.
Susan Adeniyi-Jones
03:42:11
So much to be learned from our European colleagues where services are generalized. All newborns and moms need a little bit of extra support with the goals of optimizing outcomes whether it be for jaundice, breast feeding, weight gain or dysregulation, general infant care. I believe this is what Plans of Safe Care are ultimately striving to do.
Elizabeth Imboden
03:42:16
The Notification is a way of identifying families who will benefit from additional resources. Because it is CHILDLINE which is associated with intrusiveness/possible removal of child, it creates a fear. When I perform prenatal NAS consults I discuss this with the families to prepare them for the notification and explain the purpose of the "report" It is to be supportive not punitive.
Janice Mayer
03:42:59
agree the way this is explained to the parent is critical
Michele Walsh
03:44:20
NAS reporting is in the Department of Health in Pennsylvania
mike
03:44:28
this will continue to be a problem until we help destigmatize CYS to the public.
Nazanin Silver
03:49:27
Michelle Walsh - thank you for clarifying that it is a "notification" and not reporting. However, that still does not take away the stigma and fear associated with it as it is still made to child line. Unless this is changed to another avenue of "notification" it will continue to hurt us.
amanda mulenga Foundations Pregnancy Support Services
03:55:24
Thank you for that comment Dr. Terplan. Frequent trainings would be very helpful, removing stigmatizing language, and professionally making health care providers aware is important. Some people are very unaware of their stigmatization language.
Susan Adeniyi-Jones
03:59:12
Thank you Dr. Terplan!
Gina Wiser
03:59:19
Thank you very much! This was a great presentation. Thanks for taking my question
Veronika Lynch
04:01:36
Veronika Lynch, Outreach Awareness Specialist, Domestic Abuse Project of Delaware County. 24/7 hotline:610-565-4590
Sadie Jordan
04:02:14
Sadie Jordan, Medical Advocacy Coordinator, The Women's Center, Inc. of Columbia & Montour Counties. 24/7 Hotline: (570)-784-6631, my direct email- dvma@geisinger.edu
Robert Ferguson
04:02:18
Here's the link https://www.pcadv.org/find-help/find-your-local-domestic-violence-program/
CoraKoller
04:02:24
Cora Koller Medical Advocate Crisis Center North - domestic violence service provider Allegheny COunty ckoller@crisiscenternorth.org (412) 491-8177
Crystal Perry (She/Her) YWCA York
04:02:32
My agency does DV YWCA York but I am from the Human Trafficking side Hotline is 717-846-5400
Teia Crosby (she/her)
04:02:36
Teia Crosby-Medical Advocate-Crisis Shelter of Lawrence County-Dual Domestic Violence and Sexual Assault Agency
Bryn (they+he)
04:02:50
Hi I’m Bryn Diehl (they+he) and I’m a Medical Advocate with the BDVP at Lutheran Settlement House in Philly. I’m placed at Einstein Medical Center and can be reached at 267-250-5869 and bdiehl@lshphilly.org
Nicole Powell (she/her)
04:02:53
Nicole Powell with the Domestic Abuse Project of Delaware County
CoraKoller
04:04:32
Crisis Center NOrth website with text chatline is http://www.crisiscenternorth.org , 24-7 hotline is 412-364-5556
Akilah Evans
04:04:36
Akilah Evans (she/her), IPV Specialist, Lutheran Settlement House, working as a medical advocate at Jefferson Health (Frankford/Torresdale) in Philadelphia. I can be reached at 267-984-9304 or aevans@lshphilly.org
Vivian Petticord
04:14:48
I have heard that women should be screened for IPV at every prenatal visit. Is this routinely being done?
Elissa Concini- Geisinger
04:15:48
At Geisinger we do, however my perception is that the way in which the questions are asked may vary and could use enhancement.
Adriane Burgess
04:18:26
Does anyone have suggestions for online (or virtual) education options for office staff?
Elissa Concini- Geisinger
04:18:59
Great question, Adriane, I would be interested in that as well!
CoraKoller
04:20:27
Cora Koller Crisis Center NOrth I have many workshops and materials that can be shared electronically - please contact me for a course catalogue at ckoller@crisiscenternorth.org or 412-491-8177
Robert Ferguson
04:21:23
https://www.pcadv.org/find-help/find-your-local-domestic-violence-program/
Sadie Jordan
04:21:33
We offer trainings for Geisinger Bloomsburg Hospital and Geisinger Main Campus, I have a list of trainings we have available through our program, email me at dvma@geisinger.edu
CoraKoller
04:21:35
We can work with you about program length, content, platform etc.
Teia Crosby (she/her)
04:22:51
Crisis Shelter of Lawrence County 24 hour Hotline-724-652-9036
Adriane Burgess
04:22:57
Thank you we will be reaching out.
Ann Torregrossa
04:24:05
I love the concept of growing a circle of support. Thanks
Kerry Heppen
04:25:34
Agree w the red flag of overly-charming FOB's, that has also been my experience
Mae Reale (she/her), PCADV
04:26:34
Thank you EVERYONE!
Adriane Burgess
04:27:57
Thanks Mae!