Health care delivery for maternal-child populations represents a key opportunity for improvement in Missouri.
Addressing the complex health considerations relating to maternal and child health is important because it provides an opportunity to end preventable deaths among all women, infants, children and adolescents, while greatly improving their health and well-being. The tools and programs that MHA provides seek to improve the health care experience and outcomes for moms and babies in Missouri.
Maternal and Child Learning Action Network
The Maternal and Child Learning Action Network provides guidance, knowledge-sharing and peer support in developing strategic quality initiatives based on the Triple Aim principles. The committee partners with the communities they serve to achieve better communication, and educate and impact the public on quality and safety initiatives of the health care community. Additional information about the MC LAN is available.
Alliance for Innovation on Maternal Health
Soon after launching the Missouri Maternal-Child Learning and Action Network in 2018, the Missouri Department of Health and Senior Services and MHA partnered to join the American College of Obstetricians and Gynecologists, as funded by the Health Resources and Services Administration, to join the Alliance for Innovation on Maternal Health — AIM. AIM is a national data-driven maternal safety and quality improvement initiative. Missouri was designated as an AIM state in 2018, and MHA serves as the designated organization responsible for ensuring completion of AIM activities, achievements and outcomes.
Severe Hypertension in Pregnancy AIM
- Cardiac Disease in Pregnancy — PowerPoint | Recording
- EleVATE Women Collaborative IHN — PowerPoint | Recording
- Severe Hypertension in Pregnancy Case Studies and Lessons Learned — PowerPoint | Recording
- Simulation in Obstetrics — PowerPoint | Recording
- TeamSTEPPS Tools for Patient Safety Communication — PowerPoint | Recording
Care for Pregnant and Postpartum Persons with SUD
Missouri Neonatal Abstinence Syndrome Collaborative
The growing increase of neonatal abstinence syndrome is an escalating problem throughout the U.S. and Missouri. The American Academy of Pediatrics states NAS is a multifactorial public health crisis. In the U.S., NAS incidence increased more than fivefold in a decade, rising from 2.8 per 1,000 births in 2004 to 14.4 per 1,000 births in 2014. In Missouri, the reported NAS rate climbed year over year from 2012 to 2015. Recent research suggests that ESC is an evidence-based functional assessment tool that integrates multiple novel approaches to the care of the substance-exposed newborn.
Missouri NAS Collaborative Goals
- Increase capacity and capability of Missouri nursery locations to provide nonpharmacologic support of infants with in-utero exposure to substance abuse.
- Use evidence-based, nonpharmacologic treatment to support the infant, ideally through the Eat, Sleep, Console model, to foster an environment that promotes mother-infant attachment and health outcomes.
- Collaborate to develop Safe Plans of Care for both the infant and the mother.
- Identify psychosocial and addiction recovery services locally and ensure transitions of care occur.
- Monitor and report identified data metrics toward performance improvement.
Throughout the next two years, participating organizations will focus on developing improvements in care related to the care of substance-exposed newborns, including keeping the mother-infant dyad intact; incorporating the functional assessment model Eat, Sleep, Console into practice; and establishing Safe Plans of Care of the mother and the infant. Teams will utilize an evidence-based implementation guide as the framework for their work.
Missouri NAS Collaborative participants will receive technical support from MHA staff; bi-monthly collaborative education through the Missouri Telehealth Network’s SHOW-ME ECHO — Mothers, Infants and NAS; shared learning opportunities; and the chance to connect with peers nationally and statewide. Organizations will be able to track their bundle and data progress, as well as share implementation stories with organizations throughout the state.
Registration to the Show-Me ECHO Mothers, Infants and NAS is open is available to all.
Participants of the NAS Collaborative will focus on developing improvements in care related to the care of substance-exposed newborns, including keeping the mother-infant dyad intact; incorporating the Eat, Sleep, Console functional assessment model into practice; and establishing safe plans of care for the mother and infant. Teams will utilize an evidence-based implementation guide as the framework for their work.
University of Missouri’s telehealth network and MHA have created a Mothers, Infants & NAS ECHO. The ECHO will support providers to improve outcomes for the mother-infant dyad affected by substance use disorder, especially opioids. During the interactive Zoom sessions, participants will learn about evidence-based practices, collaboration, innovation and enhanced support systems.
Initiatives to Improve Maternal Health
- Reduce the maternal mortality rate by 50% in five years.
- Reduce the low-risk cesarean delivery rate by 25% in five years.
- Achieve blood pressure control in 80% of women of reproductive age with hypertension in five years.
Specifically, to achieve these goals, the Action Plan and Call to Action calls for work on improving prevention and treatment of cardiovascular disease, and development on reporting quality measures related to maternal mortality and morbidity, including a structural measure for participation in a perinatal quality improvement collaborative program, as well as a cesarean delivery quality reporting measure. Further, goals include improving the quality of and access to postpartum care, especially mental health services and substance use services, including promoting the development of strong parent-child relationships. Additionally, the Action Plan notes there will be additional funding and expansion of AIM bundles on cardiovascular disease and maternal sepsis, and expansion of these bundles to outpatient and community settings.
According to the 2017 Annual Missouri Pregnancy-Associated Mortality Review Annual Report, 80% of pregnancy-related deaths were determined to be preventable, and cardiomyopathy was the leading underlying cause of pregnancy-related deaths (26%). The leading recommendation from the PAMR report is to implement standardized practices and procedures across health care systems through evidence-based practices, such as AIM bundles. As Missouri’s designated AIM facilitating organization, MHA will continue to offer AIM collaboratives, as well as other evidence-based initiatives, toolkits and resources to help our partner organizations meet these ambitious goals.
MHA, in partnership with the Mid-America Addiction Technology Transfer Center, Region 7, released a new guidance document and professional development opportunity, “Optimizing Care of the Mother-Baby Dyad Affected by SUD: A Guide for Health Care and Social Service Professionals Serving Pregnant and Parenting Persons.” The guide includes links to on-demand webinars and materials for use to increase awareness and understanding of addiction as a chronic disease, care delivery changes required to better serve this population, and how to become a stigma-free provider.
Organizations are encouraged to use the guide and training webinars for staff professional development and to encourage ongoing conversations on how to reduce stigma and implicit bias for perinatal patients diagnosed with SUD and co-morbid mental health conditions.
- What We Know About Covid-19 in Pregnancy & Vaccine Safety: Update For Missouri (Sept. 21, 2021) — Recording | Infographic | PowerPoint
- Embracing Pregnant & Parenting Families Challenged with Substance Use Disorder
- The Brain, Substance Use Disorders and Parenting: A Health Care Professional’s Guide Universal Screening Practices (May 26, 2021) — Recording | Slides
- Pregnant and Parenting Families with SUD: Evidence-Based Treatment, Neonatal Opioid Withdrawal and Supporting the Infant-Parent Relationship (June 2, 2021) — Recording | Slides
- Stigma, Language & Implicit Bias: Moving Toward Becoming a Stigma-Free Provider (June 9, 2021) — Recording | Slides