First 1000 Days Interagency Forum Meeting Minutes

Woodrow Wilson Keeble Memorial Health Care Center Main Conference Room

August 15, 2019

“Leadership . . . will be selected January of each year” Facilitator: Sara DeCoteau Co-Facilitator: Winona Nicolar Recorder: Open Timekeeper: Audrey German Monitor: Melissa Fries Website Administrator: Gypsy Wanna

Visit our website: http://swofirst1000days.com/

Person’s Present:

Name Title Agency / Program Phone E-Mail Parent of a child 0-8

Alana Cimburek Parent Partner SWO LAUNCH 605/237.9868 adumarce88@gmail.com Yes

April Eastman Project Director SWO Indigenous LAUNCH 698-4520 AprilE@swo-nsn.gov No

Audrey German Program Manager SWO Community Health

Education 698-4204 Audrey.German@ihs.gov No

Bridgette Neilan Project Manager/Data

Specialist

SWO Health Administration /

Tribal Opioid Response 605/742-3653 Bridgette.Neilan@ihs.gov Yes

Brooke Wegener OMC-CC RN IHS - Office of Managed Care 742-3839 Brooke.Wegener@ihs.gov Yes

Charnelle Gill Director SWO Early Childhood

Intervention Program 698-8322 cgill@swo-nsn.gov Yes

Christy Hacker** MCH Director Great Plains Tribal Chairmen's

Health Board 605/721-1922 christy.hacker@gptchb.org Yes

Cindy Block Public Health Nurse IHS Public Health Nursing 605/742-3769 cindy.block@ihs.gov No

Dallas Owen SWO Behavioral Health

Office Manager SWO Behavioral Health 605/698.2106 dallaso@swo-nsn.gov Yes

Greg Boris Leadership / Policy Specialist USD Sanford School of Medicine

Center for Disabilities 605/321-5514 Greg.Boris@usd.edu No

Halie Williams LAUNCH Assistant SWO LAUNCH Project 605/520-9560 haliew@swo-nsn.gov No

Jennifer Bissonette Site Manager/ SWO EHS SWO EHS 605/698-3103 jenniferw@swo-nsn.gov Yes

Josie Deutsch Nurse Care Connector SWO Tribal Opioid Response

Project 605/742-3605 Josie.Deutsch@ihs.gov Yes

Kathi Murray Nutrition Services Director,

RD IHS 605/742-3680 Kathi.Murray@ihs.gov No

Kayla Paszek Dietetic Intern IHS 605/265-0240 Kayla.Paszek@ihs.gov No

Lise Erdrich Grant Writer Consultant SWO Health Plan Initiative #11 701/640-0093 shine79@me.com

Mary Warhol Locke Community Coordinator SWO ILAUNCH 698-4522 MaryL@swo-nsn.gov Yes

Meghan Adams** External Evaluator ACET Inc. (Consultant for GP-

MIECHV Project) 952-922-1811 meghan@acetinc.com

Melissa Fries Case Manager Coteau des Prairies Healthcare

System 605/698-6429 Melissaf@cdphospital.com No

Mickey Divine Director SWO Child Protection Program 605/698-8311 deborahd@swo-nsn.gov No

First 1000 Days Interagency Team Meeting Minutes - Page 2 of 11

Name Title Agency / Program Phone E-Mail Parent of a child 0-8

Montana Warhol Foster Care/Adoption Worker SWO Child Protection Program 605/698-8310 mwarhol@swo-nsn.gov No

Patsey Seaboy Community Health Worker Healthy Start, Great Plains Tribal

Chairmen's Health Board 698-8434 / 467-3220 patsey.seaboy@gptchb.org No

Ralph Erdrich Red Team IHS Case Manager IHS 605/742-3855 Ralph.Erdrich@ihs.gov No

Sara DeCoteau Health Coordinator Sisseton-Wahpeton Oyate Health

Administration 742-3697 sara.decoteau@ihs.gov No

Sarah Pistorius** DOH - RN Roberts County Community

Health 605/698-4183 Sarah.Pistorius@state.sd.us

Shobi Zetina Project Director SWO Behavioral Health / Youth

& Family TREE Project 605/698/2106 Shobiz@swo-nsn.gov Yes

Terri Rattler** Program Manager

Tribal MIECHV Project, Great

Plains Tribal Chairmen's Health

Board

605/721-7627 Terri.Rattler@gptchb.org

** Participated via Unlimited Conferencing

Topic Discussion Follow-up

OPENING

REMARKS &

INTRODUCTIONS

Sara D. opened the meeting at 10:00am and welcomed attendees. Those present, including those on

the phone, introduced themselves.

REVIEW AND

APPROVAL OF

JULY MEETING

MINUTES

Sara D. provided highlights from the last meeting. Follow-up items were as follows:

1. Sandra Melstad and Katelyn Strasser will send the draft, transcribed input gathered at the July meeting for the South Dakota Department of Health Infant and Early Childhood Statewide Needs Assessment for review and comment. SD DOH been conducting the Community Survey since the middle of June. They would like to hear from people of childbearing age who use their services. That survey is open until the end of August. They want to hear from people who are underserved and asked for help from Forum participants to have people fill out the survey. They also invited people to come to Chamberlain for the Partner Meeting in October that will be held to identify priorities for the strategic plan.

2. Community Health Dept. will send the Delta Dental Smile Mobile flyer

3. Josie and Terra will connect to discuss a possible opioid presentation at ECIP Parent Meeting in August.

A motion was made, voted on and carried to approve the July meeting minutes.

Draft Forum input

was routed to Forum

for response by 8/9.

Results are

incorporated into the

July minutes.

Smile Mobile Flyer

was in the packets.

ECIP Parent

Meeting flyer for

8/28 was in the

packets

First 1000 Days Interagency Team Meeting Minutes - Page 3 of 11

1 Epi Aid Stakeholders’ Meeting Report (8/9/2018) may be accessed at the following link: https://files.acrobat.com/a/preview/585909bc-e522-4166-9f55-

6cfef402e97e 2 Link to the film about the 4 Ps Plus: https://www.ntiupstream.com/4psabout/ 3 Link to Epi-Aid PowerPoint Presentation: https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3A666c96f0-c324-4ff8-852f-

e951adbe7c98

7 USPSTF recommends all adult patients be screened for illicit drug use: The New York Times (8/13, Hoffman) reports the U.S. Preventive Services Task

Force (USPSTF) issued draft recommendations Tuesday that all adult patients be screened “for illicit drug use, including improper use of prescription

medications.” The USPSTF did not extend this recommendation to teens, citing lack of research on adolescent screening benefits. Though USPSTF “guidelines are

not binding...a provision in the Affordable Care Act says that services recommended by the task force must be covered by insurance with minimal or no co-

payment.” The Los Angeles Times (8/13, Healy) reports the guideline “recommends that all U.S. adults be screened for illicit drug use as long as their doctors

can do so accurately and, when abuse is detected, offer their patients effective treatment or refer them to someone who can.” Moreover, “an acknowledgment of

drug use should prompt a physician to warn a patient about the dangers he or she is courting, offer medication-assisted therapy for addiction if appropriate, and

refer the patient to counseling and further treatment.” STAT (8/13, Flaherty) reports the independent panel “has determined, for the first time, that there is enough

evidence to state with ‘moderate certainty’ that screening adults for illicit substance use is overall beneficial.” The draft recommendations will be open for public

comment until September 9.

ONE YEAR

FOLLOW-UP TO

THE EPI AID ON

SUBSTANCE USE

DURING

PREGNANCY

STAKEHOLDERS’

MEETING1 HELD

AT SISSETON

WAHPETON

COLLEGE 8/9/2018

One year ago, SWO held a stakeholders meeting to follow-up on the Epi-Aid on Substance

Use During Pregnancy conducted in 2016, which was a huge, 3-year undertaking with many

partners and complex logistics. Stakeholders identified and committed to implementing six

follow-up strategies. Stakeholders agreed that progress would be reported to this Forum.

Sara D presented a video shared by Jodi that frames most of the Epi-Aid recommendations

in a different way and is presented by a physician. The link to the 25-minute video is provided

below.2 It promotes use of a screening instrument (in this case 4 Ps Plus) rather than relying on

biophysical measures, and illustrates flow from screening to assessment to intervention and

intervention / referral to treatment. The presentation is from a physician who models what to say

and how to have conversations with mothers on this sensitive topic. After asking general health

history questions, he proposes framing the question about substance use as: “In the month before

you knew you were pregnant how much [substance] have you used?” He does not recommend

saying, “in the month before you were pregnant,” to get a more reliable answer. His approach is

consistent with the follow-up recommendations in the Epi-Aid report.

Greg reported that the U.S. Preventive Services Task Force (USPSTF) recently came out

with recommendations that all adult patients be screened for illicit drug use, including improper

use of prescription drugs.

Sara D then presented a PowerPoint3 that explained the Epi Aid, CDC recommendations, and

follow-up strategies agreed to at a stakeholders meeting held a year ago. The aim is to improve

Greg will send

information on

the new USPSTF

recommendations7 , which are that

all adult patients

be screened for

illicit drug use,

and Sara D will

disseminate to

Forum members.

First 1000 Days Interagency Team Meeting Minutes - Page 4 of 11

coordination and processes in order to prevent drug-exposed infants. A summary of the

strategies and work groups set up last year is as follows:

Action Plan (Items most

important and do-able) Team Members

1. Make screening for alcohol and

drugs a standard of care for pregnant

women.

For IHS: Lead -

Jackie Birney, Jodi

Lutjens and Shobi

Zetina

For CDP: Lead -

Brenda Bostrom, Melissa Freese, and

Shobi Zetina

2. Strengthen the referral process to get

mothers the help they need to avoid

incarceration and separation of

families.

Lead: Lori Sampson, Kristi Richards, Jodi

Lutjens, and Myrna Thompson

3. Preconception care and birth control Lead: Audrey German, Shelly Freese and

Charnelle Gill

4. Interagency care coordination for

pregnant women and drug exposed

infants

Lead: Melissa Fries, April Hieb, Lori Sampson,

Jackie Birney, Charnelle Gill, and Brenda

Bostrom

5. Education of providers about

treatment resources and best

practices

Lead: Kristi Richards, Myrna Thompson, April

Hieb and Melissa Fries

6. Trauma Informed education and

understanding of addiction

Lead: Linda Obago-Nicolar, Kristi Richards,

Jackie Birney, Audrey German, Myrna

Thompson, and Winona Nicolar

Stakeholders who did not volunteer to serve on one of these teams may do so later.

Team Leads may recruit other stakeholders to their teams.

Teams should look at other, related "Next Steps" that did not rank in the Top 5 to see if they may be

integrated.

Legal Issues / concerns, Mandatory Reporting: Tribal vs. State was deferred from the "Parking Lot"

to Work Group 2

All teams should look for and use success stories

Accountability going forward:

Team Leads will report progress at First 1,000

Days Interagency Forum meetings, beginning in

September 2018. As needed (recommended by

the teams), a follow-up meeting or teleconference

may be scheduled.

First 1000 Days Interagency Team Meeting Minutes - Page 5 of 11

4 Sisseton-Wahpeton Oyate Codes of Law, Chapter 38—Juvenile Code provides processes for reporting child abuse in §38-29-01 and in §38-30-01 lists who is a Mandatory

Reporter, “. . . mandated to report any instance where he or she has reasonable cause to suspect that a child under the age of 18 has been abused or neglected . . . “, including

social workers; physicians, nurses, and other health care workers; counselors, therapists, and other mental health professionals, and states the penalty for failure to report suspected

child abuse as a mandatory reporter shall be a Class One Misdemeanor, conviction for which may result in a sentence of up to one (1) year incarceration, $5,000 fine or both.

Section 38-29-01 states “Reports may be made to the Tribal Court Prosecutor, a Police Officer, Social Worker, or the Child Protection Program. Anyone participating in good

faith in the making of a report pursuant to the Sisseton-Wahpeton Juvenile Code provisions shall have immunity from any liability, civil or criminal, that might otherwise be

incurred or imposed and shall have the same immunity with respect to participation in any court proceeding resulting from such report. Reports shall be reduced to writing and

contain the following:

a) Name, age, and address of the child(ren) alleged to be abused;

b) Name and address of person or caretaker in charge of child(ren) who is the subject of the report;

c) Name and address of alleged perpetrator;

d) Nature and extent of the abuse;

e) Date(s) and location(s) of when and where the alleged abuse occurred;

f) Any other pertinent information known to the person making the report.”

5 In the United States, use of alcohol around the time of conception is common, with more than half of non-pregnant women self-reporting alcohol use according to information on

the Centers for Disease Control and Prevention (CDC) website https://www.cdc.gov/ncbddd/fasd/data.html. Up to 50% of pregnancies within the United States are unplanned,

making it very likely that the developing fetus will be exposed to alcohol before pregnancy is recognized. The reason why the three months prior to conception is used as a proxy

for drinking in early pregnancy is that so many women do not realize they have conceived until several weeks into the pregnancy.

It was noted SWO Chapter 38 - Juvenile Code provides that Cruelty to or Abuse of a

Child, Including an Unborn Child, or Minor is any person who causes or permits a child to be . . .

h) Placed at risk for birth defects by using alcohol and/or other substances during pregnancy.

Chapter 38 establishes mandatory reporting4 requirements. The Sisseton Indian Health Service

has not been in compliance with Tribal Law for several years. One issue is IHS’s reliance on

urine drug screens, which (as emphasized in the 4 Ps Plus film) are unreliable, not recommended

by the American College of Obstetricians and Gynecologists, and (when informed consent is not

obtained from the mother and employed for prosecutor purposes) deemed by the Supreme Court

to be illegal search and seizure.

Mickey stated that the Child Protection Program wants referrals of alcohol/drug use during

pregnancy from all mandatory reporter and community members, which is needed to prevent

drug exposed infants. Child Protection Program will investigate and, if they substantiate

substance use during pregnancy, will offer preventive services to the pregnant woman, including

a case service plan. They can file for custody in order to place the pregnant woman in treatment,

although this is difficult and would be a last resort scenario.

There was discussion regarding the difficulties of diagnosing Fetal Alcohol Spectrum

Disorder, which takes an interdisciplinary team of professionals and specialists, as well as proof

of alcohol use in pregnancy. According to recent articles, people are more often diagnosed with

Attention Deficit Hyperactivity Disorder5, which is a co-occurring disorder to FASD.

Behavioral issues usually do not show up until the child is older.

First 1000 Days Interagency Team Meeting Minutes - Page 6 of 11

In response to a question from Sara D, Mickey said Child Protection will put regular

attendance of prenatal visits into a pregnant woman’s case service plan.

In response to a question, Charnelle said that Early Childhood Intervention Program only

gets referrals of Neonatal Withdrawal Syndrome for infants who have been born or hospitalized

at Fargo, ND and Sioux Falls, SD. They have not seen any such referrals in the last year and a

half.

TEAM UPDATES:

Team 1 - Make screening for alcohol and drugs a standard of care for pregnant women.

Shobi Z stated that when this work group met Jackie delegated Kayla Hawkins to take the

lead. However, Kayla is no longer working in the Red Team. Shobi described the substance use

disorder screening and assessment instruments used by the Youth and Family TREE Project. It

was noted that the Epi-Aid recommended the following:

• Screening for alcohol and drug use should be a routine, universal standard of care • Biologic samples as a form of screening should be discouraged • Recommend questionnaires before and during the entire pregnancy using validated screening

tools • If biologic testing is clinically required, informed consent should be obtained • When UDS are positive, they should be confirmed by a reference laboratory before treatment

approaches are altered • First priority should be maintaining and building therapeutic, compassionate, and non-

threatening relationships with the patient

There was discussion on whether the electronic health record prompts screening every

trimester, as recommended by ACOG. This may be a question to bring up to IT in order to flag

more often for pregnant woman. Since WWKMCC is short-staffed, possibly a nurse could

complete the screening, assessment, and intervention interviews.

Team 2 - Strengthen the referral process to get mothers the help they need to avoid

incarceration and separation of families:

Written updates were provided via a memorandum that was in the packets from Lori

Sampson, MSN, Supv. Case Management dated 8-14-19 :

Here is some follow up information about the Mandatory Reporting for drug use during pregnancy. Sorry I am not there to give a verbal report as I am very excited that this process improvement is almost complete and in its final stages.

Brooke agreed to

serve as the new

Lead for the

screening team.

After 8/21 when

the IHS

mandatory

reporting policy

First 1000 Days Interagency Team Meeting Minutes - Page 7 of 11

1. Policy has been approved and is in Policy Stat. Final review will be done August 21, 2019

with the Medical Providers.

2. The “referral” template has been developed and is currently being tested. Final approval

of this template will also occur on 8/21/2019, and then all providers once approved can use

it.

3. Business Rules have been identified and the note will be “hidden” just like the Mental

Health notes. Only certain users can see.

4. Post approvals on 8/21/2019. Training for providers and nursing staff will occur and

reporting will begin.

Team 3 - Preconception care and birth control:

Audrey described interest in working with the schools to educate youth on unintended

pregnancies preconception care. Sandi is being certified in Family Spirit and can use the lessons

from that curriculum for education.

Epi Aid Recommendations about Preconception Care and Birth Control: Postpartum period is associated with a high rate of relapse and even overdose

is approved, IHS

will begin

making reports to

the Child

Protection

Program, as

required by Law.

First 1000 Days Interagency Team Meeting Minutes - Page 8 of 11

6 Epi Aid Recommendation Slides regarding continuation of care for pregnant women using alcohol and drugs and drug exposed infants

Access to postpartum contraception requires patient education and shared decision-making prior to birth

Ongoing monitoring of the drug-exposed infant is needed due to increased risk of developmental and environmental issues

Team 4 - Interagency care coordination for pregnant women and drug exposed infants6:

First 1000 Days Interagency Team Meeting Minutes - Page 9 of 11

Written updates were provided from Lori Sampson, MSN, Supv. Case Management:

Coordination of Care Meeting with CDP has occurred quarterly so far this year (2019). Their nursing staff, social worker, DON and ER director are usual attendees. I will update Melissa (Case Manager of CDP) and the DON of the mandatory reporting process we have worked out. If there any questions, updates or comments, please do not hesitate to contact me for any questions at 605-742-3833.

It was noted that since the work groups were formed last year, the IHS Office of Managed

Care has hired Case Managers and Care Coordinators. Melissa communicates regularly with

them. At CDP Hospital, Melissa is the point of contact. A concern of all is that some patients do

not come back for prenatal are after they have a positive urine drug screen.

Team 5 - Education of providers about treatment resources and best practices:

Melissa stated that IHS and CDP providers meet twice a year. A plan is to present

resources to all providers during then.

Case Managers of

IHS, CDP, DPC,

CPP, Mayuteca,

TREE, and TOR

will work together

to improve

continued care

services for

mothers with

substance use

disorders and to

prevent drug

exposed infants,

following

recommendations

of the Epi Aid.

Team 5 will

organize a

presentation for

providers on

community

treatment and

recovery support

resources available

First 1000 Days Interagency Team Meeting Minutes - Page 10 of 11

Team 6 - Trauma Informed education and understanding of addiction:

Audrey described how the Community Health Education Program has been promoting

trauma informed practices and approaches to working with people who have addictions. Also,

she would like to coordinate efforts with the Tribal Secretary’s Office and Child Protection

program for a presentation through the Casey Family Program. Audrey met Daniel Press, CTER

Attorney, who made a presentation on building trauma informed communities at a National

TERO conference held at Idaho the beginning of August. He gave her copy of a handbook he

created titled A How-To Handbook on Creating Comprehensive, Integrated Trauma-Informed

Initiatives In Native American Communities. They talked about working together to bring

presenters to our community. Mr. Press e-mailed Audrey to let her know that he has

commitments from several individuals that would come to Sisseton at no cost. Presenters he

identified were: Dr. Tami DeCoteau from Bismarck (who indicated the Casey Family

Foundation would cover her costs). Andi Clifford and another person from Starr Constellation

also said they would come at their own expense.

Mickey reported that the Child Protection Program is sponsoring a 2-day educational

event with the Casey Foundation November 12 & 13, 2019. It is for the community on Trauma

Informed Care and Child Welfare. Once plans are finalized, the information will be sent out.

Team 6 will work

with the Casey

Family Program

and Mr. Daniel

Press for building

trauma informed

communities

training. This will

be coordinated

with related plans

of the Tribal

Secretary’s Office

and CPP.

Mickey will send

information about

the November 12-

13 trauma-

informed training

when plans are

finalized.

ROUNDTABLE

UPDATES &

ANNOUNCEMENT

S

Due to time constraints, participants were asked to bring written to share. The following

information was either in the packets or brought for handout:

Piya Canku akan Maunipi “On the healing road we walk” 2-day Conference, SWO

Memorial Park, August 16-17

“Emily’s Hope” presentation by Angela Kennecke during the Piya Canku akan Maunipi

conference, SWO Memorial Park, August 16-17

Indigenous Breastfeeding Counselor Training, Prairie Knights Casino Pavilion, Standing

Rock, August 27-31

Early Childhood Intervention Program Parent Training, “What are opioids? What are the

effects? What resources are available?”, Tribal Administration Building, August 28

Delta Dental Mobile Program, SD Department of Health (WIC), September 9-13

Center for Disabilities 2019 Symposium and the Jam, “Fostering a Culture of Inclusion”,

Sioux Falls Convention Center, September 16-17

First 1000 Days Interagency Team Meeting Minutes - Page 11 of 11

Recorded by Bridgette Neilan and Sara DeCoteau

8 Marijuana use in pregnancy persists despite dangers, research shows USA Today (8/14, Thornton, O'Donnell) reports despite mounting evidence that marijuana consumption during pregnancy is harmful, many women continue to use marijuana. For example, a study recently published in JAMA found a “sharp increase in the number of pregnant women smoking marijuana and an alarming link between cannabis use and preterm births, defined as 37 weeks or earlier.” Another JAMA study “concluded marijuana is ‘likely unsafe’ because pre-term births were twice as common in marijuana users vs. non users. (12% vs 6.1%).” Meanwhile, women may be subject to misinformation, as an NIH study of “over 400 Colorado dispensaries found nearly 70% recommended treatment of morning sickness with cannabis.” Furthermore, some women may be fearful of discussing marijuana use with their clinicians. Moreover, “with mixed messaging on marijuana in the U.S., pregnant women in need of relief are not able to make fully-informed decisions, physicians say.”

University of South Dakota Center for Disabilities Oyate Circle brochure

University of South Dakota Center for Disabilities Community Engagement and Outreach

flyer, introducing Jim Warne, MS, Community Engagement for Oyate Circle. There was

also a separate bio handout on Jim Warne.

Childbirth Preparation and Breastfeeding, Woodrow Wilson Keeble Memorial Health Care

Center Public Health Nursing Conference Room, September 19 and 26

SD Home Visiting Institute, Pierre Ramkota Hotel and Convention Center, October 22-23

What is Informed Consent? https://www.emedicinehealth.com/informed_consent/article_em.htm#children_and_consent

PowerPoint: American Indian/Alaska Native Addiction Technology Transfer Center,

“Case Study: Supporting Pregnant Women with Opioid Use Disorder (OUD) and their

Infants”

Based on a discussion on marijuana use in pregnancy, Greg offered to send a recently

published article8

WRAP UP Next meeting is Thursday, September 19th and special guest may be ILAUNCH Government

Project Officer Dr. Yanique Edmond