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Getting health care right

Getting Women’s Health Right: A View from the Perinatal Hope Program

I’ve been with Allegheny Health Network (AHN) since 2014, and it has been a truly wonderful experience. As director of women’s health programs, I am especially proud of the work we’re doing to meet the needs of women of all ages and backgrounds in our communities. You can see “living proof” of that work in our “Women’s 365” stories — a new video each day — at

One AHN program I’ve worked with right from the development stage is the Perinatal Hope Program. Launched in 2016, Perinatal Hope is a one-stop-shop of care for mothers-to-be who are struggling with substance use disorders, including opioid use disorder. It combines obstetrical care, drug and alcohol therapy, and medication-assisted treatment into one clinic visit, and brings together case management, coordinated multidisciplinary care, peer and family support, transitional and follow-up care, to ensure the best possible outcomes for mothers and their babies.

My experiences developing Perinatal Hope touch on many of the reasons I’m excited to be at AHN in general, and why I really believe we are improving health care for our patients and communities.

Person-Centered Care from Start to Finish

Deborah McDonald, MSN, RN, and director of women’s health programs at AHN

Deborah McDonald, MSN, RN, and director of women’s health programs at AHN

We’re not the only health system in the U.S. committed to patient-centered or person-centered care — thankfully. But I like what that commitment means specifically here at AHN. With Perinatal Hope, for example, we started with research into what expectant mothers who had substance use disorders needed. We put them at the center and then it was about figuring out the best ways to surround them with the care and support to meet their needs.

In talking with them to learn what was going on in their lives, we saw that, first, they were struggling through so much without the support or knowledge they needed. At the same time, there is no one type of person who struggles with substance use disorder. Background, socioeconomic situation, physiological and psychological factors, support network — everyone is different, so the challenges and needs vary.

Our “one-stop-shop” approach helps remove some roadblocks these moms-to-be have on the path to recovery. Trying to balance and get to multiple appointments in the same day can be unrealistic, logistically and financially, and even emotionally. So now they can get an OB visit, medication-assisted treatment, and drug and alcohol counseling all in one appointment. Before they go home, we take care of their prescriptions, too.

We’re always thinking about what resources we can make readily available, extending to education, and including family planning. Over 90 percent of our patients in this population did not plan to become pregnant. So while they’re coming in during pregnancy, we talk about contraception and family planning services. We’re not here to tell them what to do — it’s their choice whether they have another child, but we make sure the information and services are there for them and they don’t have to jump through hoops to get it.

Getting back to substance use disorders, we work with the Pennsylvania Organization for Women in Early Recovery (POWER) to offer counseling. Again, the approach is very person-centered. If a woman has a setback, we don’t say, ok, you’re out, we keep working with her to find out what will be most effective. Maybe it’s more frequent counseling, maybe it’s the unique intensive outpatient treatment AHN offers, or inpatient treatment if necessary.

This focus on listening to the patient extends to decision-making. We have a steering committee that consists of multiple disciplines to guide us and look at what we can do better. One of our goals was to have a patient who graduated from the Perinatal Hope Program join that steering committee to provide her real-life experience and point of view. The first patient who joined our steering committee not only delivered her baby successfully, she’s now taking classes to become a peer recovery specialist so she can help other women.

Team-Based Care Is Better Care

Another trend you see in leading health care systems like AHN is coordinated, multidisciplinary care — or, more simply, team-based care. The idea is to bring together different specialties and services that a patient needs, and coordinate them to help that patient, instead of putting the burden on the patient to connect the dots between everyone they need to see for their health issue. AHN has even reorganized services using the Institute model — so even the way we’re structured is about prioritizing what a patient needs instead of a specialty or location.

Perinatal Hope is part of the AHN Women and Children Institute, and a team-based approach is especially important to the women we serve. As mentioned above, we’re not stopping with the OB-GYN exam and then they’re on their own. For example, in our PregnancyCentering® classes for the women, we bring in an anesthesiologist, a lactation consultant, women’s behavioral health specialists, and neonatologists who explain neonatal abstinence syndrome, which are conditions a baby may experience because of being exposed to substances and medications in the womb. We’ve had women’s shelters come in, and there is care management support as well, which continues after a mother and baby have gone home. No one just brushes their hands and says I did my job so I’m done now — we’re always looking to connect the woman with the full range of care and support she needs.

Katrina Siders and Ashley Schultz sharing a computer screen as part of their work with the Perinatal Hope Program

Katrina Siders, a nurse practitioner (left), and Ashley Schultz, program coordinator (right), are two of the AHN health care professionals helping to bring the Perinatal Hope Program to women in need.

It’s been inspiring to see how many people throughout AHN are invested in working with this population and helping them live their best lives. We first took the problem to Dr. Mark Caine, a maternal fetal medicine specialist, and he was so excited about creating a program to help using a patient-centered, medical home model. The program itself includes many people — Ashley Schultz, our program coordinator, Katrina Siders, our nurse practitioner, Lauren Narbey, who’s a midwife and nurse practitioner, OB-GYN doctors like Dr. Brandon Bell and Dr. Eric Lantzman, and Dr. Janice Anderson in family medicine. The list keeps growing as we add other locations — we have a Natrona Heights site coming that will include two more OB-GYN doctors, Dr. Jenny Halfhill and Dr. Genevieve Hunkel. Dr. Allan Klapper, chair of the AHN Women and Children Institute, has been incredibly supportive in growing the program and moving it out into our communities.

And I really can’t say enough about the value of the women’s behavioral health team. Many women in Perinatal Hope have had trauma throughout their lives, such as adverse childhood events, rape or abuse. That can tie in with substance use disorder and their apprehension at coming in for care and delivery. Perinatal depression, bipolar disorder, anxiety, mood disorders — whatever the challenge, the behavioral health specialists are there to help, and that makes a huge difference.

Simply put, the team-based approach means that we’re maximizing the resources within reach for every woman we serve.

Taking Care into Our Communities

One main focus throughout AHN and across Highmark Health is getting care out to the communities we serve instead of making people find ways to get to us. This is another advantage of our Institute model. No matter what AHN hospital or facility you walk into, you get the same quality care, because our evidence-based policies and practices, our peer review, everything we do, we do as a system. With AHN you don’t have to worry that if you don’t come into the city your care will not be as good.

Having said that, some hospitals have different specializations, and we’re going to make sure you get the best resources available for your needs. West Penn Hospital, for instance, is a tertiary care center with Level III Neonatal Intensive Care Units (NICU), so that’s going to be the best place for certain types of high-risk pregnancy and babies who need the highest level of care. Community-based care means we do whatever is in the best interest of mother and child. If that means coming to, or being transferred to, West Penn, great. But for many women, what’s in their best interest is to have them deliver their baby and receive care in a community hospital near their home and family.

With the Perinatal Hope Program specifically, we have worked to educate all of our OB units across the entire AHN system. We’ve done whole-house education so that our employees and staff understand what these women are dealing with and how we can help them.

A Passion for Care

Like many people in health care, my passion is helping people, including the women we serve in the Perinatal Hope Program. I see these women and babies and I want to do whatever we can to help them. That includes helping other people understand the magnitude of this problem, and that it doesn’t do the mother, baby, or community any good to judge them as if some people are worthy of care and some aren’t. Everyone deserves to get better.

The Perinatal Hope “graduate” on our steering committee will tell you that one of the biggest fears for a pregnant woman with a substance use disorder is that if she admits to a problem, her child will be taken away or she’ll be treated as less than a person. She said our program made her feel welcome and important, and helped her see that her substance use disorder did not define who she is, but how she worked through it did.

The experience she had wasn’t just about the program itself, it was about the caring attitude of the people in the program. AHN encourages that kind of caring, and the Perinatal Hope Program is a great example of what can be accomplished when an organization really supports its people in acting on their motivation to help others.

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