Please work with your team to complete this birth site-level survey for the designated quarter, starting with January through March 2022.

Question Title

* 1. What is your PA PQC Hospital or Affiliation?

Question Title

* 2. What is your name?

Question Title

* 3. What is your title/role?

Question Title

* 4. Has your hospital developed trauma-informed protocols in the context of substance use? (e.g., please see Key Ingredients for Successful Trauma-Informed Care Implementation)

Question Title

* 5. Does your hospital provide anti-racist training for providers, staff, and leadership?

Description: Anti-racist training is defined as a training that focuses on the "active process of identifying and eliminating racism by changing systems, organizational structures, policies and practices and attitudes, so that power is redistributed and shared equitably." The trainings also use this lens to address topics that are included in Diversity, Equity, and Inclusion trainings, such as unconscious and implicit bias, the meaning of diversity, equity and inclusion, stereotyping, reducing prejudice, cultural awareness and belonging, addressing microaggressions, and anti-harassment.

Question Title

* 6. Does your hospital provide training for clinical and non-clinical staff on substance use among pregnant and postpartum individuals that also express and address health care team members' biases and stigma related to substance use?

Description: Clinical and Non-Clinical Staff education and training should emphasize SUDs are chronic medical conditions that can be treated, stigma, bias and discrimination negatively impact pregnant people with SUD and their ability to receive high quality care, providers should match treatment response to each person’s stage of recovery and/or readiness to change, and federal, state, and local notification guidelines for infants with in-utero substance exposure and comprehensive family care plan requirements. This training should include trauma-informed care, naloxone and harm reduction strategies, regional and local data on SUDs, and regional and local support services, programs, and resources. Obstetric providers should consider receiving training on outpatient treatment of SUD, including MOUD (buprenorphine) to improve access to care.

Question Title

* 7. Does your hospital have evidence-based patient education materials focused on substance use in pregnancy and the caregiver's role in Substance Exposed Newborn care?

Question Title

* 8. If you responded "Yes (in place)" in Question 7, please check which substances your education materials address: (select all that apply)

Question Title

* 9. Does your hospital provide education to pregnant and postpartum people related to naloxone use?

Question Title

* 10. Does your hospital have a system in place to provide naloxone to patients prior to discharge?

Question Title

* 11. Does your site use a validated, self-report screening tool for substance use in pregnancy?

Question Title

* 12. If you responded "Yes (in place)" in Question 11, please check the validated screening tool that is being used: (select all that apply)

Question Title

* 13. For pregnant/postpartum individuals who screen positive for substance use, does your site have protocols and team roles in place to provide brief interventions that offer feedback to patients, explore readiness for behavior changes, initiate goal-setting, and refer to treatment?

Question Title

* 14. Does your site provide Medications for Opioid Use Disorders (MOUD) for pregnant individuals with OUD? (e.g., buprenorphine)

Question Title

* 15. Has your hospital developed referral relationships with any SUD treatment services in your area/county?

Question Title

* 16. If you responded "Yes (in place)" to Question 15, please indicate which recovery treatment services (check all that apply)

Question Title

* 17. Has your site established specific prenatal, intrapartum, and postpartum care pathways (algorithms) for substance use that facilitate coordination among multiple providers during pregnancy and the year that follows?

Question Title

* 18. Has your hospital implemented post-delivery and discharge pain management prescribing guidelines for all vaginal and cesarean births focused on limiting opioid prescriptions?

Question Title

* 19. Has your hospital implemented specific pain management and opioid prescribing guidelines for vaginal and cesarean births for patients with OUD?

T