Florida PSEP Status UpdateOctober 2012

Scope of Problem in Florida1200% increase in production of Oxycodone

from 8.7 tons in 1997 to 105 tons in 2010.(St. Pete Times 10/30/11)

More Oxycodone is dispensed in Fl. than in the rest of the nation. 4.1 million prescriptions in Fl. compared to 5 million in the 49 states combined.

98 of the top 100 doctors dispensing Oxycodone nationally are in Fl.

1355 infants classified as Neonatal Withdrawal Syndrome in 2010 but many more exposed and not diagnosed- a 433% increase from 2005.

2005 2006 2007 2008 2009 20100

250

500

750

1000

1250

1500

254347

472

648

953

1355

Trends in Newborn Withdrawal di-agnoses

2005 - 2010N

umbe

r of

Dia

gnos

es

+433%

Source: Florida Agency for Health Care Administration Emergency Department and Inpatient Hospital Datasets

3

4

FY 01-02 FY 02-03 FY 03-04 FY 04-05 FY 05-06 FY 06-07 FY 07-08 FY 08-09 FY 09-10 FY 10-110.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

Ten Year Trend Analysis of Drug of Abuse

AlcoholMarijuanaCrack/CocaineHeroinOther OpiatesMethamphetaminePrescription Other Drugs

Fiscal Year

% o

f To

tal A

dmis

sion

s

Team Members

Judi Vitucci, Christine Gibson, Rhonda Brown, Jane Murphy, Patti Kodish, Jane Bambace, Mari Detres, Kay Doughty, Diane Clark, Dixie Morgese, Patricia

Armstrong, Brooke Baker, Carol Scoggins, Kris-Tena Albers,Lynn Marie Firehammer, Jennifer Highland

Biggest challenge: Team member turn-over at the state level

Our Vision

Florida will be a state where every child is

born substance free and lives in a family that

promotes healthy growth and

development

Florida PSEP Method of WorkAction Plan developed at first meeting in October 2011

and revised based on input from CityMatch in May 2012Leadership responsibilities divided between two co-leads

(facilitate/communicate with team & minutes)

The team has met monthly to work on the established strategies in the plan.

We collaborate with 190 colleagues statewide in 9 MOD workgroups to work on various aspects related to the effects of substance exposure during pregnancy

Multiple Florida communities have local SEN workgroupsPSEP resources are shared statewide

PSEP Team & Systems Map for the Prevention of Risky Behavior

1=Danielle/Rhonda, 2=Chris, 3=Lori/Patti, 4=Jane, 5=Kay,6=Judi; 7-Dixie,, 9-Mari,10=Jane B,, 11=Jennifer Highland Travelers= RED; Non travel team = green

DOH

DEC

CHD

Family Planning

19

10

Healthy Start

6

DCF

FASD Cent

er

Crisis Center

s

Universities

March of

Dimes

Drug Rx

Centers

CSCs

Attorney

General

FQHCC

Legislature

School

System

FOGS

Fed. HS

LawEnforcem

ent

SAMH

FADAA

CPI

CBCCommunity Drug Coalition

s

75

9

4 39

Strategy 1: Work with physicians and providers serving on MOD workgroups to develop at least one clinical guideline or protocol for screening and brief interventions for pregnant women and infants.

Strategy 1 Action Steps 1.Literature review of effective screening

tools and brief interventions

2. Obtain buy-in from PAMR

3. Pilot screening tools in Pinellas, Alaucha Hillsborough Counties, etc

4 . Engage Healthy Start to implement screening and brief intervention statewide

Strategy 1 AccomplishmentsAfter literature review, 5Ps selected for piloting in FloridaDixie and Kay offered 5P’s Behavioral Risk

Screening trainingJane shared with PAMR and they support our efforts Dr. Karen Harris (Alachua Co), Dr. Kay Roussos-

Ross at UF clinic (Hillsborough Co.) and Bayfront High Risk Clinic (Pinellas Co. )are piloting the 5Ps screening tool

Florida OBGYN(FOGS) survey completed re: screening

Not ready to implement screening and brief intervention statewide yet

Strategy 1: Work with physicians and providers serving on MOD workgroups to develop at least one clinical guideline or protocol for screening and brief interventions for pregnant women and infants by October 20, 2012

Pilot of Screening & Brief Intervention

Baseline data collected using standard screening.Pilot protocol for screening pregnant women, using

the 5 Ps tool, initiated in June at Dr. Karen Harris’s OB practice with 8 physicians and 4 midwives. The practice serves 1500-2000 women annually.

Strong Start grant written and includes 5 Ps screening in four county area (Pinellas, Hillsborough, Polk, and Lake)-pending funding decision. If awarded, 2748 women will receive SBIRT in year one and 8502 by year

Strategy 2: Identify and implement guidelines/ protocols for treatment of pregnant women and newborns by clinicians. Raise awareness/train clinicians.

Strategy 2 Action Steps1. Conduct literature review of effective opioid

treatment

2. Reviewed protocols and identified best/promising practices-

a. Identify evidence based protocols

3. Create protocols where gaps exist

4. Obtain buy-in from clinical groups to implement the protocols

5. Develop logic model related to clinical protocols

Strategy 2 AccomplishmentsDr. Mark Hudak provided leadership for the American

Academy of Pediatrics Committee on Drugs and the Committee on Fetus and Newborn. He was lead author on their guidance for treatment of neonatal drug withdrawal that was published in Pediatrics on January 31, 2012

Dr. Hudak presented at the Perinatal Quality Conference in April 2012 in Tampa with several hundred health care providers in attendance.

March of Dimes funding obtained for conference on December 14th with multiple sessions to train clinicians planned.

CityMatch offered an educational Webinar for physician leaders with national expert (Dr. Ted Parran) on 4/25/12.

Strategy 3: Design and implement at least two health provider education programs.

Strategy 3 Action Steps1. Develop logic model pertaining to education 2. Develop and offer educational program for non clinical staff

including home visitors and child welfare staff.

3. Develop and offer educational program for clinical staff (nurses/OB offices, treatment, etc)

  4. Develop educational program for non clinical staff 5. Find funding for educational programs. a. Apply for MOD funding to support educational component b. Find out what other agencies can provide to support

education  Develop educational program for CPIs.

Strategy 3 AccomplishmentsLogic model developed

Conducted two substance abuse oriented training for 120 home visiting staff entitled, "Motivational Interviewing: Releasing the Power of Change" and "Women and Substance Abuse." Topics included "Current Trends in Pharmaceutical Drug Diversion" and "Substance Abuse Services in Pinellas County

Generation RX Conference held on September 7, 2012 in Tampa with 171 attendees.

Strategy Accomplishments (cont)1948 individuals were trained statewide by Dixie Morgese

850 child welfare staff at Dept Children & Families Dependency Summit

430 child welfare workers125 home visitors & direct care providers at Fl. Association of

Infant Mental Health Conference on 7/11/1223 nurses and social workers at Daytona State College on

5/3/12 200 North Central Healthy Start Community workers on

3/1/12160 community based care workers on 1/20/12 at Community

Partnership for Children.160 medical providers and direct care providers on 10/28/11

at Bayfront Medical Center

Strategy 3 Accomplishments(cont)Addicted At Birth” Webinar offered on March 29 with Kay

Doughty as one of the panelists.

“An educational program for 45 school system employees & early childhood educators was provided in March 2012.Prescription Drug Misuse and Effects on Young Children

presented to 160 childcare providers in March 2012.Information about webinars & conferences sponsored by

other agencies disseminated to Florida PSEP participants.Drug Abuse Awareness Webcast presented by Fl. DOH and

Fl. Medical Association on 3/21/12.Grant written and awarded for March of Dimes support of Statewide Conference/Summit on December 14, 2012

Other AccomplishmentsAdvocated with legislators to add two PSEP

team members (representatives of Healthy Start Coalitions & March of Dimes) to a Statewide Prescription Drug Task Force led by the State Attorney General

Home Visiting Program for substance misusing womenand their infants initiated in Pinellas Co. (MIECHV funded)