Albany Medical Center Pediatric Group – General Pediatrics
Albany Medical Center Pediatric Group – General Pediatrics (AMCGenPeds) is part of a large academic medical center affiliated with Albany Medical College (AMC) in Albany, New York. AMCGenPeds welcomes the opportunity to provide care for infants identified at birth with neonatal opioid withdrawal syndrome (NOWS) or neonatal abstinence syndrome (NAS).
Referrals and Care Coordination
The diagnosis and related information are communicated to AMCGenPeds from the delivery hospital, through shared medical records. Also included with the shared records is the birth parent’s status on receiving medication treatment for opioid use disorder (OUD), if applicable. When infants with NOWS/NAS are referred to the AMCGenPeds, clinical staff work as a team in emphasizing positive parenting and supporting the parent, infant, and the entire family. In the first few weeks of life infants with NOWS/NAS are seen frequently in the AMCGenPeds office. The team provides anticipatory guidance to families about identifying and managing withdrawal symptoms. Additionally, birth parents receive comprehensive information about non-pharmacological care, such as eat, sleep, console (ESC) approaches.
All infants exposed to opioids prenatally receive developmental screening starting at 2 months of age. AMCGenPeds is currently working on standardizing a referral process to AMC developmental pediatrics for all infants with NOWS/NAS at 9 months of age. Infants with NOWS/NAS are routinely referred to early intervention services and other appropriate therapies. The office secretary at AMCGenPeds coordinates all care, referrals, and tracks follow-up reports from external services. The office secretary also ensures inclusion of that information in patient records.
Dyadic Care and Support for Families
The AMCGenPeds staff offer empathetic, supportive, and non-judgmental care through a medical home framework. During the first visit, the clinical team at AMCGenPeds aims to establish themselves as a source of support for the family. The team prioritizes patient engagement and asks parents for their perspectives, recovery goals, and priorities.
The AMCGenPeds practice includes a mental health clinician that is available to provide mental health services. Birth parents are screened for postpartum depression at every visit. Through the county’s home visiting program, families have access to a maternal-child home visiting nurse. Additionally, AMCGenPeds connects families with peer support recovery groups. While these group meetings have been limited due to the pandemic, the practice hopes to resume the groups soon. The practice is working toward regular meetings and collaborative transitions and referrals with the obstetrics department.
Health Equity Team
In addition to the care services listed above, AMCGenPeds also administers a social drivers of health screening to families at every health supervision visit. The screening is offered by the Health Equity Team embedded in the practice and staffed through a partnership with the local school of public health. The Health Equity Team reviews the screening results and calls each parent who identified a need, eg, food and/or housing insecurity, diapers, infant supplies, transportation, and connects families with services for their individualized needs. The Health Equity Team also follows up with families at 1 month and 3 months after the initial screen to determine additional needs and to connect families with applicable community resources. In 2020, the AMCGenPeds practice found a 200% increase in additional needs identified through the social determinants of health screens, making the Health Equity Team an invaluable asset to families.
Building a Therapeutic Alliance with Inclusive and Accessible Environments
The AMCGenPeds clinical staff uses trauma-informed care approaches when working with families affected by substance use and are engaging families as active partners in the decision process for their own health care. The staff use positive and non-stigmatizing language. The staff believe that an inclusive and accessible environment fosters feelings of being welcomed and respected which in turn, encourages honest, trusting relationships. As an example, the practice offers early and late office hours on certain days each week; the office is open 6 days per week, and a clinician is always on call. The office itself is staffed by individuals reflecting diverse backgrounds. The office artwork and décor reflect not only racial diversity in its imagery, but the imagery and language are inclusive of LGBTQ+ individuals and of family constellations. AMCGenPeds aims to normalize the practice of seeking and receiving help, without stigma or shame. In turn, all the information regarding food pantries, free local and community support services, is readily available in the office or through the Health Equity Team.
COVID-19 and Infants with NOWS/NAS
During the COVID-19 pandemic, when in-person appointments were a challenge, the AMCGenPeds staff found that the shift to virtual visits has negatively affected the continuity of care for their families and patients with NOWS/NAS. AMCGenPeds clinicians do not feel that virtual visits can be as comprehensive as an in-person visit. Additionally, many families did not have access to reliable internet connections for attending telehealth visits. When compared with virtual visits, AMCGenPeds staff felt that for families affected by opioid use, in-person visits were more beneficial to the overall care and well-being of such patients.
Financial Aspects
Being part of a large academic center, AMCGenPeds sees all pediatric patients, not exclusively infants with NOWS/NAS and their birth parents. Therefore, all the staff contributes to the care needed by this population. No staff member within AMCGenPeds is compensated exclusively for, nor tasked solely with, caring for infants with NOWS/NAS.
In the near future, AMCGenPeds hopes to secure a grant to fund a case manager position who can provide home visits. Infants with NOWS/NAS and exposed to substances prenatally will be prioritized to receive home visits. The AMCGenPeds staff postulate that the case manager position could be sustained if a billing code for value-based or incentive payments were available for the contributory work done by the case manager.
The AMCGenPeds clinicians currently code for administering a maternal depression screen at every visit, but additional payment based on the results of that screen is not billable. Recently, a large health insurance plan based in Albany is providing a modest incentive when a provider addresses a positive maternal depression screen. The details of what “addressing” entails is now vague but will presumably become more structured in the coming year.
Evaluation
AMCGenPeds routinely surveys all patients and takes any concerns of their patients seriously. The surveys are mailed to all patients and are not specific to families affected by prenatal substance use. If additional funding for evaluation would be available, the staff would like to gather feedback from parents and caregivers about the care infants with NOWS/NAS received from birth to 6 months of age at AMCGenPeds.
Patient and Family Education Resources
The AMCGenPeds staff regularly distributes information to families from the American Academy of Pediatrics Pediatric Care Online™ (login required) and Connected Kids: Safe, Strong, Secure™ resources, as well as handouts from ZERO to THREE.