It Takes a Village: A New Approach to Opioid Abuse Helps Mothers and Babies

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Tom Haederle

nts Substance Help, opened in: 2016

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Tom Haederle

Stay with us to learn more about how the WISH Center is making a difference.

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Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. For pregnant or postpartum women who are struggling with opioid substance disorder, reaching and maintaining sobriety is a continuous process that may take years. The WISH Center helps make this brave and difficult journey easier by leveraging many community resources that offer support. Truly, it takes a village.

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Tom Haederle

In this podcast, Dr. Chris DeRienzo, AHA’s chief physician executive, speaks with three WISH Center experts on how its approach is helping to protect the health of new mothers and their babies. Donna Spears is director of the maternal service line for the WISH Center. Dr. Niraj Chavan is medical director and Dr. Karen Fowler directs its women and neonatal clinical program.

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Tom Haederle

Let's join them.

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Chris DeRienzo, M.D.

Welcome everyone to this week's podcast. We are so excited to celebrate CHI week and get to highlight the incredible work of the SSM WISH Center and how they engage with their community. We have three outstanding guests joining us today from SSM and I know we have a relatively short period of time that we get to spend with them.

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Chris DeRienzo, M.D.

So we're going to jump right in. And I'm going to ask the team to begin sharing with us at some of the conditions in their community that led to the creation of the WISH Center. And perhaps, you can start with sharing a little bit about your community in general, because I don't know that every one of our listeners has a good feel for who is SSM and what is the kind of community that you serve?

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Chris DeRienzo, M.D.

But then really specifically, you know, get into get into the details and share with us more about how this incredible center works.

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Donna Spears, RN

Well, my name is Donna Spears, and I'm the director for the Saint Louis region for SSM Health, Women's Health Services. And I was the founding director for the WISH Center based out of Saint Louis, Missouri. Several years ago, we noticed an increase in our pregnant population delivering babies that had the effects of what was recognized of opioids.

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Donna Spears, RN

Opioid use disorder, neonatal abstinence syndrome, and noticed an increase of patients that were using opioids while pregnant when there was no type of services around that could support their needs. And, basically try to give them an opportunity for a prenatal care episode as well as delivery and sobriety. So that was the whole genesis for the why behind it, to create something basically for better outcomes for mom and moms and babies.

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Donna Spears, RN

But there of course were many other nuances to that. There was a lot of research that had to go into it, a great deal of work, but ultimately it was decided that we should develop the WISH Center to provide that space, normalize the care for women and try again to, you know, move moms and babies to healthy outcomes.

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Chris DeRienzo, M.D.

Donna, thank you so much for sharing that background. I'm a neonatologist and I remember practicing ten years ago in western North Carolina, and there were days where only 10 or 12% of our NICU census would be babies who were experiencing withdrawal symptoms from opiates. And, you know, our follow up clinics, sometimes it was as high as 25 or 30% of the kiddos who were visiting us that day.

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Chris DeRienzo, M.D.

And so, it means a lot that the folks like you are trying to engage so far upstream in the process. And I'm wondering, perhaps this question goes to Dr. Chavan and Dr. Fowler, talked about some of the ways that you've had to leverage those community strings in order to be able to bring your center the success that you've seen.

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Niraj Chavan, MD

le of last decade, right from: 2014

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Niraj Chavan, MD

where we're in right now and a lot has changed over the period of time. COVID just being one of the big, big, big things that hit all of us, certainly in the most unexpected of ways. But, you know, when we look at leveraging our community, I think one of the most recent additions and most welcome additions that we've been looking forward to over several years is our doula program. And this is really in response to understanding the need from our community for having something like that, specifically in the perinatal, substance use disorder space, which, has been certainly a benchmark for anybody working in this space, but also setting a precedent at a

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Niraj Chavan, MD

national level. So we have a doula program where our patients are able to connect with their doulas. And these are folks from the community coming from where our patients are coming from. So they're able to literally understand and quite literally meet the patient where they are. And when I say that, quite literally, I actually mean that quite literally, because they don't always meet here physically at WISH. They might meet at a Starbucks, for example.

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Niraj Chavan, MD

They might meet at a grocery store, for example. But being able to understand where our patients are coming from, and meeting them, understanding what their needs are and responding to that sort of in a community-centric approach. I think that's been one key aspect of leveraging those community partnerships. And I think the other solid example, really, I would say, is our postpartum program, where we're able to continue caring for these patients not just through pregnancy, but all the way through two years postpartum.

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Niraj Chavan, MD

And this is way before anything along the lines of Medicaid expansion and expansion was even on the horizon. And so when we're doing that, we're really doing that in response to what the community has been telling us. Understand what their needs are. And while we're doing that, we're able to partner with so many different agencies, whether it's the diaper bank, for example, whether it's, some of the behavioral health facilities where we work at, to make sure that we're able to understand and respond to those community needs.

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Chris DeRienzo, M.D.

And, Dr. Fowler, I'm wondering if you might want to jump into the conversation here as well, because, those community needs are absolutely always evolving. And I love the fact that you have that emphasis, not just in the in the pre partum period, but we know that the risks involved in that postpartum period are incredibly high, both for moms and babies alike.

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Karen Fowler, MD

There's a couple of key points that both Donna and Niraj are making, and one of them is normalizing the experience of these women who are in this clinic. And I think when you normalize it for these women, what they understand is that they can access areas of the community and ways to live a healthy, sober life, long term and help them interact with the community in a way that they haven't before.

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Karen Fowler, MD

Or maybe they have, but it's been a long time. I also think one of the key thoughts in this whole concept is that sobriety is an ongoing...it doesn't end when she delivers, or that 6 to 12 week postpartum mark. This is something that these families will manage for years. And you know, staying healthy, it requires them to have long term support so that two years is really short, in the long scheme of things.

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Karen Fowler, MD

But I think it really increases the level of success that these families have.

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Chris DeRienzo, M.D.

It must. I mean, you're right, it's a short two years, but gosh, the level of impact over those two years. I'm a neonatologist but I'm also a father of three kids, and I remember going through, you know, ages birth to two with all three of them. And, you know, we weren't trying to do that and manage of what we know is a chronic condition in terms of substance use disorder.

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Chris DeRienzo, M.D.

So, I'm just blown away by the work that you're doing. Talk to us a little bit about tactical lessons that you've learned in building this program. And for anyone who hasn't, would strongly recommend that you go out to YouTube and you watch the video. it's only about seven minutes long that that gives you some visuals on the way this program works and the communities they serve because, gosh, it is incredibly impactful.

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Chris DeRienzo, M.D.

But, for those who are listening, this could be to any of the three of you, Donna, Niraj or Karen. Share with us a key tactical lesson, that if I'm a team in a hospital, somewhere else in the country and I see this need in my community, that I could benefit from hearing through your experience as I embark on that journey to help build it.

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Niraj Chavan, MD

You know, I think one of the key tactical lessons I would say, when you are working in this space is to understand that it's not a one man show. It really takes a team. And the big part of that journey is who is in your team. So when you're looking at caring for patients, whether they're pregnant or postpartum with substance use disorder, and the most important thing to understand is that it takes a village.

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Niraj Chavan, MD

Right. And so when we talk about it takes a village, it really then kind of hinges upon understanding who all is in that village. So for example, when you look at our team, physicians are physician providers, for example, just one piece of that puzzle. The other pieces are, I would actually argue, as important or more important perhaps, than that one physician provider. For example, our social workers - we have a handful of prenatal social workers, and then that dedicated postpartum social workers. Behavioral health counselors, a therapist, our peer support specialists, a psychiatrist who dedicatedly is now focusing on perinatal or reproductive psychiatry, a clinical pharmacist.

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Niraj Chavan, MD

Our nurse practitioners, our prenatal nurses. And again, our doulas, like I talked about a little while ago. So, you know, understanding who all is in that team. And more importantly, perhaps assembling that team is really a key tactical strategy that I would say all our listeners would benefit from. Because unless you get the right players, you're not going to have a successful team.

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Niraj Chavan, MD

And when we talk about the team-based approach to care, it's just as important to make sure that they have the right attitude and the right people in the mix as what they're going to be doing actually.

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Donna Spears, RN

Another key component would be the need for perinatal behavioral health support and ongoing behavioral health support, because that is fundamental to this program. And so we have co-located substance use counselors. We have psychiatry. You know, we have, again, the social workers, we have other resources for patients, within the community that they can access for services for ongoing management as well.

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Donna Spears, RN

It's very important that that's a component of anyone's care model, because you have to consider the majority of these women are dual diagnosis. There's been some sort of past trauma or some sort of mental health situation that must be addressed to help address the SUD/OUD issues as well.

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Karen Fowler, MD

It really does take a village, and paying for that village is really tricky. Paying for that village and paying for this model of care, quite honestly, would not happen without operational wizards like Donna. Like people in the health system that understand that when you have these 12 people on the care team, billable services and actually getting paid to do this work is not straightforward.

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Karen Fowler, MD

These are not procedures. These are not - yes, we're doing MFM ultrasounds, etc. - but one of my ongoing lessons right now is the art of creating these relationships with payers. We're talking about models of care that actually make sense that we can sustain this. I think WISH is very sus - have we talked about what WISH stands for, by the way? Did I miss that?

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Chris DeRienzo, M.D.

We haven't yet. If you would, please share.

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Karen Fowler, MD

Donna Niraj, you say it so much more eloquently.

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Donna Spears, RN

It's an acronym for Women and Infants Substance Help. When we came up the name, we wanted something that gave hope to the patients that joined us without it being something that was scary. So, as we talk about normalizing, I think it's important to put out that we put ours in a medical building on campus at SSM Saint Mary's in St. Louis.

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Donna Spears, RN

And if you walk in it looks like any other physician offices nestled amongst other physician offices. It's important that patients not feel like they're walking into something that has a flashing neon sign that says Substance Use Disorder and Pregnancy Center. So let's give it a positive name. Let's give it something that provides some hope, but also normalizes and put them in a setting with the special nuances built into the center that can provide the support and care that they need to be successful.

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Chris DeRienzo, M.D.

These are the times where sometimes I wish that instead of recording a podcast, we were recording a podcast of some kind. Because for your listeners, if you could see the heads nodding in agreement with all of the things that are being shared again, we're here today with the outstanding team from SSM and their WISH center. And we've talked about operational sustainability.

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Chris DeRienzo, M.D.

We've talked about how you build the program. And we only have a few minutes left. And I'm curious, you know, you all have gotten to such an outstanding place, but when you were starting this work, what was the approach that you took to really understand both the needs of the patients and the community that you're serving, but also the assets that you could lead on?

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Chris DeRienzo, M.D.

I mean, you've spoken to the way that which that we're treating the whole person. It's a multi-year commitment. But if I'm, you know, in western North Carolina and I'm looking at you all as this ideal that I want to emulate, how do I know, you know, where in my community I've got some strengths already and where we might need to be building?

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Chris DeRienzo, M.D.

How did you start that process?

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Donna Spears, RN

That's more through, sort of an asset inventory when you do that, as well as gap analysis to see what you have, what you don't have. And then, after you do an assessment of your internal resources, then you look at your external. Who wants to be a partner, who wants to be at the table, who will support the service?

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Donna Spears, RN

So then you can do that through that type of work as well. We're very lucky that we're a mission-based organization. And so because of that, when we take, you know, business proposals forward for a new center like this that is expensive to run, that needs support from AHA and state legislatures and legislators and others to be able to create sustainable, reimbursement models...

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Donna Spears, RN

When you think about the work that goes into that, you really need to, you know, also consider what all assets are needed, what resources are needed, and what is the benefit? So when you, as Dr. Fowler mentioned, when you think about the benefit, you know, it benefits society in general to have productive moms, to have people that, you know, live in sobriety that could live, you know, productive lives with jobs and, have healthier moms and babies.

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Donna Spears, RN

You know, we've reduced NICU days significantly from when we first started. When you think about just the cost, you know, to society, for this type of care for these babies, not just during, you know, post-birth, but also long term, then you have to think about, you know, that's a huge impact. So there's a lot to this, a lot to consider

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Donna Spears, RN

and what needs to be part of it to make a comprehensive care model and meet all the facets for a very complex service.

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Chris DeRienzo, M.D.

It is absolutely, as you've pointed out, Donna, the right thing to be doing. You know, when you make that heavy investment early on, you are bending the curve of an entire family's life outcome from that point onward. And so, again, it speaks to my heart, because you're talking about my NICU babies and I just love it.

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Chris DeRienzo, M.D.

I know we're short on time. And so I would love to invite the group to just share, whatever closing thoughts you'd like and again, specifically focusing in on, wondering what you have found to be the best ways to do that as you serve your community through the WISH Center. And again, thank you all so much for being willing to share your stories today.

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Niraj Chavan, MD

I think one of the biggest things when it comes to, approaching partners in the community and really finding partners that you want to work with or that you want to sort of partner with is it's all about finding the right fit. So, you know, I think to a little bit about, the mission and, you know, it's the mission.

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Niraj Chavan, MD

It's the vision and it's kind of what sort of shared goals do you have? And, you know, having that shared mental model in terms of growth, in terms of serving the community that you're looking at in terms of understanding what their needs are and in terms of respecting what each partner is bringing to the table. So, you know, when we look at sort of partnership, it really is a two way stream.

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Niraj Chavan, MD

And that, symbiosis, if you will, or that mutual sort of benefit will only flourish if we have all of these in alignment. So I think finding that right fit, I would say, would be sort of the one day home thing that I would encourage all our listeners to sort of look out for.

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Chris DeRienzo, M.D.

Very well said, Niraj. And Donna or Karen, anything else you'd like to share in closing?

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Donna Spears, RN

I think it's also important to call out that, part of meeting patients where they are is to understand their needs. And Dr. Fowler has led a very extensive project related to social determinants of health screening across our organization, and a pilot program that's now further into embedded in not just, a pilot anymore.

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Karen Fowler, MD

What we have learned through this SDOH work in doing it in a standardized process, etc. And two piece of advice I would give to anybody starting this work in other areas of the country or other health systems is the sooner you can create data that shows benefit, the more sustainable you are. And I think one of the lessons that we've had in this work is our SDOH data is not good.

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Karen Fowler, MD

We're not good at coding on Z codes. We in obstetrics and maternal health, we're just not good at that area. And so the better we can be when we start...again, sustainability, the way we pay for this work. You can't look away from data. So the earlier the benefit the better. And that's what I would tell anybody that's starting this work.

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Karen Fowler, MD

The other piece is the sooner you can create relationships in awareness with payers, with your state Medicaid, with other policymakers, the earlier, you can get traction in really making change that makes sense for this work to sustain. Again, I'm all about sustainability. WISH Center has deep roots. They have figured out that. But I also know that scaling this is hard and we as a health system need to figure that out.

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Karen Fowler, MD

So those are the two pieces that I think are really important.

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Chris DeRienzo, M.D.

We are out of time today. It has been a true privilege Donna, Niraj and Karen, to get to visit with you. We heard about how to engage the community, how to figure out where the assets are to build from, to meet your community where they are, and these closing words about making sure that you grow those deep roots from the outset.

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Chris DeRienzo, M.D.

Oh, gosh. this has been a gem. Again thank you to everyone for listening in during this CHI week special presentation. And if you want to learn more about the WISH Center again, there's a really terrific video. All you got to do is look up SSM Health WISH center. You'll find that on YouTube. And I hope you enjoy.

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Chris DeRienzo, M.D.

Take care everyone.

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Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.