This page references Implementation Resources for AIM. To visit Wave 1 or 2 Team pages, Quality Improvement Resources and the Onboarding Process Steps, please visit the appropriate pages by clicking the links below. 

AIM Implementation Resources

Readiness


Every patient/family

  • Provide education to promote understanding of opioid use disorder (OUD) as a chronic disease

    • Emphasize that substance use disorders (SUDs) are chronic medical conditions, treatment is available, family and peer support is necessary and recovery is possible.

    • Emphasize that opioid pharmacotherapy (i.e. methadone, buprenorphine) and behavioral therapy are effective treatments for OUD.

  • Provide education regarding neonatal abstinence syndrome (NAS) and newborn care.

    • Awareness of the signs and symptoms of NAS

    • Interventions to decrease NAS severity (e.g. breastfeeding, smoking cessation)

  • Engage appropriate partners (i.e. social workers, case managers) to assist patients and families in the development of a “plan of safe care” for mom and baby.

Every clinical setting/health system
  • Provide staff-wide (clinical and non-clinical staff) education on SUDs.

    • Emphasize that SUDs are chronic medical conditions that can be treated.

    • Emphasize that stigma, bias and discrimination negatively impact pregnant women with OUD and their ability to receive high quality care.

    • Provide training regarding trauma-informed care.

  • Know federal (Child Abuse Prevention Treatment Act – CAPTA), state and county reporting guidelines for substance-exposed infants.

    • Understand “Plan of Safe Care” requirements.

  • Identify local SUD treatment facilities that provide women-centered care.

    • Ensure that OUD treatment programs meet patient and family resource needs (i.e. wrap-around services such as housing, child care, transportation and home visitation).

    • Ensure that drug and alcohol counseling and/or behavioral health services are provided.

  • Establish specific prenatal, intrapartum and postpartum clinical pathways for women with OUD that incorporate care coordination among multiple providers.
  • Develop pain control protocols that account for increased pain sensitivity and avoidance of mixed agonist-antagonist opioid analgesics.
  • Know state reporting guidelines regarding the use of opioid pharmacotherapy and identification of illicit substance use during pregnancy.
    • Know state, legal and regulatory requirements for SUD care.
  • Investigate partnerships with other providers (i.e. social work, addiction treatment, behavioral health) and state public health agencies to assist in bundle implementation.
Readiness Links HERE




Recognition and Prevention


Every provider/clinical setting

  • Assess all pregnant women for SUDs

    • Utilize validated screening tools to identify drug and alcohol use

    • Incorporate a screening, brief intervention and referral to treatment (SBIRT) approach in the maternity care setting.

    • Ensure screening for polysubstance use among women with OUD.

  • Screen and evaluate all pregnant women with OUD for commonly occurring co-morbidities.
    • Ensure the ability to screen for infectious disease (e.g. HIV, Hepatitis and sexually transmitted infections (STIs)).
    • Ensure the ability to screen for psychiatric disorders, physical and sexual violence.
    • Provide resources and interventions for smoking cessation.
  • Match treatment response to each woman’s stage of recovery and/or readiness to change.




Response


Every provider/clinical setting/health system

  • Ensure that all patients with OUD are enrolled in a woman-centered OUD treatment program.

  • Establish communication with OUD treatment providers and obtain consents for sharing patient information.
  • Assist in linking to local resources (e.g. peer navigator programs, narcotics anonymous (NA), support groups) that support recovery.
  • Incorporate family planning, breastfeeding, pain management and infant care counseling, education and resources into prenatal, intrapartum and postpartum clinical pathways.

  • Provide breastfeeding and lactation support for all postpartum women on pharmacotherapy.
  • Provide immediate postpartum contraceptive options (e.g. long acting reversible contraception (LARC)) prior to hospital discharge.
  • Ensure coordination among providers during pregnancy, postpartum and the inter-conception period.

  • Provide referrals to providers (e.g. social workers, psychiatry, and infectious disease) for identified co-morbid conditions.
  • Identify a lead provider responsible for care coordination, specify the duration of coordination and assure a “warm handoff” with any change in the lead provider.
  • Develop a communication strategy to facilitate coordination among the obstetric provider, OUD treatment provider, health system clinical staff (i.e. inpatient maternity staff, social services) and child welfare services.
  • Engage child welfare services in developing safe care protocols tailored to the patient and family’s OUD treatment and resource needs.

  • Ensure priority access to quality home visiting services for families affected by SUDs.




Reporting and Systems Learning


Every clinical setting/health system

  • Develop mechanisms to collect data and monitor process and outcome metrics to ensure high quality healthcare delivery for women with SUDs.

  • Develop a data dashboard to monitor process and outcome measures (i.e. number of pregnant women in OUD treatment at specified intervals).
  • Create multidisciplinary case review teams to evaluate patient, provider and system-level issues.
  • Develop continuing education and learning opportunities for providers and staff regarding SUDs.
  • Identify ways to connect non-medical local and community stakeholders with clinical providers and health systems to share outcomes and identify ways to improve systems of care.

  • Engage child welfare services, public health agencies, court systems and law enforcement to assist with data collection, identify existing problems and help drive initiatives.





A cooperative voluntary program involving Massachusetts maternity facilities and key perinatal stakeholders, designed to promote the sharing of best practices of care.