Form to Request Trainings on a PA PQC Maternal Substance Use or Substance Exposed Newborn Key Intervention

Directions:

PA PQC healthcare teams participating in either the Maternal Substance Use or Substance Exposed Newborn initiative are eligible to request trainings that the PA PQC will help to organize. Please use this form to request a training. The PA PQC will then be in touch with you to learn more about the training that is needed, logistics, and next steps.

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* 1. PA PQC Hospital

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* 2. Name, title, and organization of the person completing this form.

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* 3. Please select the training topic that your PA PQC healthcare team has identified as a need for providers and staff in your organization.

Reducing substance misuse stigma among providers

Patient and family education about substance misuse

Plans of Safe Care overview and key messages for provider and patient/family education

Assessing substance-exposed newborns with validated screening tools

Standardizing non-pharmacological interventions for substance exposed newborns

Implementing trauma-informed approaches to perinatal care

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use

Motivational Interviewing

Working with patient, family, and community advisors to develop and improve programs

Speaking up against racism and structural inequities

Connecting patients and families to community and outpatient services and supports

Recruiting, training, and embedding peer specialists on maternity care teams

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* 4. Would you prefer this training to be in-person or virtual?

In-person

Virtual

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* 5. Please identify an ideal, targeted timeframe for the requested training.

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* 6. Please describe any previous training or work on this topic at your organization. Also describe any specific learning objectives and needs for the training(s) you selected.