Molinalogo

MCC of AZ Provider Guidance

Clinical Guidance and References

SAMHSA Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Opioid Use and Opioid Use Disorder in Pregnancy. Committee Opinion No. 711. The American College of Obstetricians and Gynecologists (ACOG). August 2017

Society of Maternal Fetal Medicine Special Report – Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine;  2019

Council on Patient Safety in Women’s Health

Obstetric Care for Women with Opioid Use Disorder – Patient Safety Bundle developed by the Alliance for Innovation in Maternal Health (AIM) – a cooperative agreement between the American College of Obstetricians and Gynecologists (ACOG) and the Health and Resources Services Administration Maternal-Child Health Bureau (HRSA-MCHB) – endorsed and disseminated by the Council on Patient Safety in Women’s Health.

Arizona Guidelines and Resources

Arizona OAR Line (Opioid Assistance and Referral) for provider consultation – (888) 688-4222

Certified nurses, pharmacists, and physicians with expertise in medical toxicology, pharmacology, and substance use disorder are available anytime you need a free, confidential consultation about complex patient care involving opioids and chronic pain.

Arizona Department of Health Services and Arizona Statewide task Force on preventing Prenatal Exposure to Alcohol and other Drugs

Provider Guidance for Assessment and Management of Pregnant Women and Infants Healthy Outcomes for Mom and Baby Neonatal Abstinence Syndrome (NAS)

Arizona Department of Health Services

Arizona Department of Child Safety Opioid Epidemic

To prevent child abuse and neglect by supporting the needs of children and strengthening families.

Mandatory Reporting of Substance Exposed Newborns (SEN)

AZ Controlled Substance Prescription Monitoring Program (CSPMP) –Register and check the database if substance use is suspected but not verified by the pregnant woman.

Arizona Opioid Treatment Program providers prioritize pregnant women.

SAMHSA Opioid Treatment Program Directory 

Arizona Opioid Treatment Centers of Excellence
Open 24/7 – provides immediate access to opioid treatment to connect you to ongoing services. They serve AHCCCS members, individuals with no insurance, and individuals with insurance that may not cover some services like Medication Assisted Treatment or peer support services.

Community Bridges, East Valley Addiction Recovery Center
560 S. Bellview
Mesa, AZ 85204
(480) 461-1711

Community Medical Services
2301 W. Northern Avenue
Phoenix, AZ 85021
(602) 866-9378

Intensive Treatment Systems, West Clinic
4136 N. 75th Ave #116
Phoenix, AZ 85033
(623) 247-1234

CODAC Health, Recovery and Wellness
380 E. Ft. Lowell Road
Tucson, AZ 85705
(520) 202-1786

Office-Based Opioid Treatment (OBOT) Providers
SAMHSA Treatment Provider Locator

Arizona OAR Line (Opioid Assistance and Referral) for Provider Consultation
Certified nurses, pharmacists, and physicians with expertise in medical toxicology, pharmacology, and substance use disorder are available anytime you need a free, confidential consultation about complex patient care involving opioids and chronic pain.

(888) 688-4222

Arizona OAR Line

National Clinician Consultation Line (NCCL): Substance use warmline peer-to-peer consultation and decision support
Free and confidential consultation for clinicians with national experts from the Clinician Consultation Center at San Francisco General Hospital focusing on substance use in primary care

NCCC Clinician Consultation 

Overview:
Office Based Opioid Treatment (OBOT) removes barriers to MAT for pregnant women. OBOT programs have proven to be effective, confidential, accessible, and safe when used with engaged and motivated pregnant women. OBOT allows qualified practitioners with a Drug Addiction Treatment Act of 2000 (DATA) waiver to dispense or prescribe Buprenorphine. Qualified providers include physicians, Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs).

Medication:
Buprenorphine can be prescribed as take home prescriptions or administered on-site. Referrals should still be made to wrap around substance-use disorder counseling and other behavioral health services. Pregnant women who are candidates for buprenorphine treatment, should be inducted and maintained on the buprenorphine monoproduct. The efficacy of buprenorphine/naloxone combination product is unknown.

Certification:
Office Based Opioid Therapy (OBOT): ASAM/ACOG certification for OB’s interested in providing office based opioid therapy (OBOT). This course, with an Ob-Gyn focus, covers all medications and treatments for opioid use disorder, and provides the required education needed to obtain the waiver to prescribe buprenorphine. The curriculum for this course has been specifically designed for women’s healthcare providers and is offered in collaboration with ACOG.

ASAM Treatment of Opioid Use Disorder Course – OB/GYN Focus

Reference:
Kraus, M. L., Alford, D. P., Kotz, M. M., Levounis, P., Mandel, T. W., Meyer, M., … Wyatt, S. A. (2011, December). Statement of the American Society of Addiction Medicine Consensus Panel on the use of buprenorphine in office-based treatment of opioid addiction. Journal of Addiction Medicine, 5(4), 254–263.

Community Resources

Home Visitation Programs
• Strong Families AZ – Search by ZIP code
• High Risk Perinatal Program (HRPP) – for NICU and substance exposed newborns.

Pregnant & Postpartum Housing
• Arizona Friends of Homeless

Peer Support
• Peer and Family Support Resources and Contacts
• CHEEERS – Peer Doulas
Credentialed Peer/ Recovery Supports who currently or plan to work with pregnant women with substance use disorders specialized training to become a certified Doula.

Community Supports
• Molina Complete Care Local and Online Resources

Professional Online Trainings and Videos

Universal Screening
• Indiana University SBIRT@IUSM
Course 1: Understanding SBIRT (OBGYN Version) (Introductory)
• ACOG District II Podcast
Opioid Use Disorder in Pregnancy
• SBIRT Training with CME Credit
SBIRT Training

Pregnant and Parenting Women with Opioid Use Disorder OUD
• American College of Obstetricians Webinar
Caring for pregnant and breastfeeding women with OUD
• ACOG District II Postcast
Opioid Use Disorder in Pregnancy On the Front Line
Part 1: Readiness, Recognition, and Prevention

Part 2: Response & Reporting

Part 3: Essentials of Screening

Office Based Opioid Therapy (OBOT)
• ASAM/ACOG Certification for OB practitioners interested in providing office based opioid therapy (OBOT).
ASAM/ACOG Certification

Trauma Informed Care
• Center for Health Care Strategies (CHCS)
What is Trauma-Informed Care? (Introductory)
• Center for Health Care Strategies (CHCS)
Implementing Trauma-Informed Care in Pediatric and Adult Primary Care Settings
• Relias: Be Attentive: All Language Matters!
Using Trauma Sensitive Language

Health Equity Training
• March of Dimes Implicit Bias Training for healthcare professionals – CNE/CME available
“Breaking Through Bias in Maternity Care”

Motivational Interviewing
SBIRT Training with CME Credit available

Stigma and Opioid Use
• Council on Patient Safety in Women’s Health – National Collaborative on Maternal OUD
Presentation on Opiate Use Disorder in Pregnancy: Addressing Stigma

Professional Resources

Pregnant and Parenting Women with Opioid Use Disorder (OUD)
• American College of Obstetricians
• Substance Abuse and Mental Health Services Administration (SAMHSA)

Trauma Informed Care
• National Council for Behavioral Health Fostering Resilience and Recovery: A Change Package for Advancing Trauma-Informed Primary Care
• Center for Health Care Strategies (CHCS) Trauma Informed Care

Health Equity
• March of Dimes consensus statement: BIRTH EQUITY FOR MOMS AND BABIES: Advancing social determinants pathways for research

Stigma
• March of Dimes – Beyond Stigma: Do your part to reduce stigma (so moms and babies get the support they need)

Evidence Based Practice
The ESC method’s sole principle is that the treatment of the infant (both non-pharm and pharmacologic treatment) should be based on infant function and comfort, rather than reducing signs and symptoms of withdrawal. The ESC Care Tool only documents items key to the functioning of the infant – specifically, the infant’s ability to eat effectively, sleep, and be consoled within a reasonable amount of time.

Recent studies show that the ESC method:

• Supports infants and mothers rooming-in together during infant hospitalization
• Focuses on non-pharmacologic treatments
• Increases breastfeeding rates
• Decreases pharmacologic treatment and duration of treatment
• Decreases the average length of stay (LOS)

Developed by a collaborative effort between faculty at Yale, Children’s Hospital at Dartmouth-Hitchcock, and Boston Medical Center

Webinars/Videos

• American Academy of Pediatrics Webinar
Novel Tools for Caring for Infants with NAS: The Eat

• Evidence Based Practice Brief – Eat, Sleep, Console
Banner University Medical Center Tucson – Banner Children’s Diamond Children’s Medical Center

Eat Sleep Console Instruction Manual
Eating, Sleeping, Consoling (ESC) Neonatal Abstinence Syndrome (NAS) Care Tool Instruction Manual 

Forms/Assessments/Checklists

Eat, Sleep, Console functional assessment, IRR Tool and Newborn Care Diary

Eating, Sleeping, Consoling (ESC) Neonatal Abstinence Syndrome (NAS) Care Tool

Instruction Manual

SAMHSA Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Eating, Sleeping, Consoling (ESC) Neonatal Abstinence Syndrome (NAS) Care Tool Instruction Manual

Arizona Department of Health Services – Neonatal Abstinence Syndrome in Arizona: Training

Adverse Childhood Experiences

Pregnancy, Opioid Use Disorder and Medication Assisted Treatment

AzEIP: Supporting Families Impacted by NAS

Caring for the NAS/SEN Baby

American Academy of Pediatrics AAP – Navigating NAS Webinars
Navigating NAS

American Academy of Pediatrics Webinar
Novel Tools for Caring for Infants with NAS: The Eat

Evidence Based Practice Brief-Eat, Sleep, Console

Banner University Medical Center Tucson – Banner Children’s Diamond Children’s Medical Center
Evidence Based Practice Brief - Eat

Community Resources

Home visitation

• Strong Families AZ – Strong Families AZ is a network of free home visiting programs that helps families raise healthy children ready to succeed in school and in life. Programs focus on pregnant women and families with children birth to age 5.

Find a program by zip code – includes Arizona Health Start, Early Head Start, Healthy Families, Nurse Family Partnership, Parents as Teachers, Family Spirit, Safecare

• High Risk Perinatal Program (HRPP) – For NICU and substance exposed newborns. Community Nursing Services facilitates the transition of the child and family from the Newborn Intensive Care Unit to their home and community. Periodic monitoring of the child’s medical and developmental needs identifies infants who would benefit from referral to other early intervention programs. Through these home visits, the family receives support and education as well as referral to appropriate community resources. In home visits for 0- 3 years old.

Peer & Family Support
• AHCCCS Peer and Family Support Resources and Contacts

Early Intervention Services
• AzEIP – Services and supports for birth to three years of age with disabilities or delays.

Housing
• Arizona Friends of Homeless – Pregnant and Postpartum Shelters, Housing, and Resources

Consultative Support
• MotherToBaby
A service of the non-profit Organization of Teratology Information Specialists, is dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding. Talk directly to the experts behind the most up-to-date research

Arizona Resources

Arizona Department of Health Services Neonatal Abstinence Syndrome
• Resource Materials NAS Provider Video Series and Course

Arizona Department of Child Safety Opioid Epidemic
• Arizona Department of Child Safety Opioid Epidemic – To prevent child abuse and neglect by supporting the needs of children and strengthening families.

Mandatory Reporting of Substance Exposed Newborns (SEN)
• Mandatory Reporting of Substance Exposed Newborns (SEN)

Clinical Guidelines & References – Opioid Prescribing Guidelines
• Arizona Opioid Prescribing Guidelines
• Register for the Arizona Controlled Substances Prescription Monitoring Program (CSPMP)

Arizona Substance Abuse Treatment Resources
• Substance Abuse Treatment Resources

Arizona Rx Misuse Information and Safe Disposal of Medications
• Rethink Rx Abuse
• Dump the Drugs AZ

Additional Resources

SAMHSA
• Substance Abuse and Mental Health Services Administration
Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants
HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.

Trauma Informed Care
• National Council for Behavioral Health Fostering Resilience and Recovery
A Change Package for Advancing Trauma-Informed Primary Care

Center for Health Care Strategies (CHCS)
• Trauma Informed Care

Health Equity
• March of Dimes Consensus Statement
BIRTH EQUITY FOR MOMS AND BABIES: Advancing social determinants pathways for research

Stigma and Opioid Use
• Council on Patient Safety in Women’s Health – National Collaborative on Maternal OUD
Presentation on Opiate Use Disorder in Pregnancy: Addressing Stigma

Stigma
• March of Dimes – Beyond Stigma
Do your part to reduce stigma (so moms and babies get the support they need)

SAMHSA Resources
• Treating Opioid Use Disorder During Pregnancy
• Treating Babies Who Were Exposed to Opioids Before Birth
• Good Care for You and Your Baby While Receiving Opioid Use Disorder Treatment