September is National Suicide Prevention Month

In honor of National Suicide Prevention Month this September, let’s talk about mental health. Mental health is part of overall health – especially for pregnant and new moms. Perinatal mental health disorders are the leading causes of maternal morbidity and mortality – but they are preventable.

Consider these facts:

• Research shows that nearly half of perinatal women in Texas with depression do not get the treatment they need (Mathematica)

• Texas has continued to have high shortage in mental health (MH) professionals. Of these available MH health professionals, few have perinatal mental illness training.

Access to mental health professionals can be tough, but a new initiative launched a few weeks ago to help. We’ve shared information about PeriPAN before, but are excited to announce it is online!

The Perinatal Psychiatry Access Network (PeriPAN) is a new state-funded pilot project available to clinicians in four regions of Texas that are treating new and expectant mothers with mental health concerns. Its goal is to increase a provider’s capacity to treat maternal mental health conditions during the patient visit through a consultation phone line. PeriPAN can help with screening, treatment plans and medication management; the regional psychiatrists serve primary care physicians, family doctors, OB/Gyns, pediatricians and midwives in non-hospital settings in four regions.

PeriPAN is here for clinicians so that maternal mental health can be the first thing that you’re assessing and screening for and not the last. Doing this can help prevent the fatal impact perinatal mental conditions have on Texas moms every year.

For more information about where PeriPAN is offered as a pilot, and how to enroll as a provider, visit https://tcmhcc.utsystem.edu/peripan/.  The page includes other resources available statewide, such as.

o   Women & Children | Texas Health and Human Services

o   For immediate mental health resources, call 800-273-8255 or, visit MentalHealthTx.org.

o   Suicide prevention hotline: Call or text: 9-8-8; Chat online: 988lifeline.org

o   The Baby Blues | Texas WIC

NAT is TCHMB's largest Statewide Initiative to Date

The Newborn Temperature Admission (NAT) Project posted new data from the Jan.-March reporting period, showing a majority of hospitals participating, the largest initiative in TCHMB’s history. When the April-June 2022 data is complete (due July 31st), the hospital level data will be shared back via the dashboard. The hospital level dashboard can establish a “baseline” and prepare for implementing evidence-based guidelines to increase the proportion of newborn infants with admission temperatures within normal limits. Read the Jan.-March summary report here.

Key Points:

• An astounding 76 percent of enrolled hospitals reported data for the period.

• There are currently 160 hospitals enrolled, making it TCHMB’s largest statewide initiative to date.

• This is the first time a TCHMB initiative has tracked data by race/ethnicity.

Why it matters:

By tracking data from each hospital, the NAT project can complete statewide analyses, including by region or type and size of hospital, as well as hospital-specific analyses.

Testimonials from NAT Project Ahead of Hospital-Level Dashboard

Only July 31, 2022, hospitals actively participating in the Newborn Admission Temperature Project will submit another round of data, marking one full year of data collection. This data will allow TCHMB to provide participating hospitals with hypothermia prevalence at their own hospitals, and more. Having a full year of data means that the estimates are more reliable, and can provide meaningful insights into patterns at the state and regional levels.

The NAT project is the largest in TCHMB history with 160 hospitals enrolled. During the most recent round of data reporting, over 75% of enrolled hospitals submitted data to TCHMB. See what some hospitals are saying, after nearly one year of participating in the NAT project:

With 25,000 deliveries a year, we were faced with a daunting project to obtain race and ethnicity on each newborn and collect temperatures according to the different parameters for well baby and NICU. We leveraged our ability to create documentation reports and perform data analysis to avoid the manual tracking and chart review, cutting down manual validation by an estimated 95%.

- Memorial Hermann Health System

The project was a definite challenge for our institution because of the large number of patients we care for. Obtaining data was very labor intensive and required working with a data architect to get a custom report built. Building the report, obtaining data outside of our NICUs and validating data were all challenges we encountered which required a lot of time, but we eventually overcame those challenges.

- Texas Children’s Hospital

In 2019-2020, Doctors Hospital of Laredo (DHL) solely tackled the newborn admission temperature QI project knowing that thermoregulation is the holy grail of neonatology. Huge strides were made towards adequate thermoregulation of the newborn, bringing DHL very close in achieving the goal.

In late 2020, when TCHMB announced the QI initiative of Newborn Admission Temperature (NAT) to increase newborn health care quality and patient safety; DHL did not hesitate in enrolling.  We are hopeful in reaching the goal and provide quality care to every single baby born at DHL by participating in the state-wide NAT project.

Thank you for allowing us to participate.

- Doctors Hospital of Laredo

If your hospital has questions about the project or needs technical assistance in reporting to the project, visit NAT Office Hours, every Wednesday from 12-2 p.m. CST.

Q&A with Dr. Sarah Wakefield

Dr. Sarah Wakefield, Chair of the Department of Psychiatry at Texas Tech University School of Medicine, joined as Medical Director of the new Texas Perinatal Psychiatric Access Network (TX PeriPAN) in March 2022. The new pilot initiative officially kicks off in late summer 2022, and Dr. Wakefield will lead the team to get every detail in place so that four health related institutions can provide support and services to providers who see pregnant women and new mothers suffering from maternal related mental health issues.

We spoke to Dr. Wakefield to learn more about her experience and what drives her to be successful in leading PeriPAN’s charge.

What drew you to the initiative and to become medical director for TX PeriPAN?

I became interested in maternal mental health when I was in my child and adolescent psychiatry fellowship. At the time I was pregnant with my first child and really feeling the weight of all it is to carry a child and be a mother. I would complete assessments with kids, and so many of the moms had untreated mental health distress or pathology. Many of them had been suffering since their pregnancy or postpartum time and were only seeking care now to aid their children. I just realized how many moms out there are suffering silently.

My favorite thing about treating children is that you really can change the trajectory of a someone’s life the earlier you intervene. It became apparent to me that if we could have treated mom when she was pregnant or postpartum, or even before, we could have prevented so many of the things that are happening with the child or at the very least better equip mom to respond in a therapeutic way.

Then I met Susan Kornstein, a founder and leader  in reproductive psychiatry, at a conference. I was finishing my training and contemplating jobs. We talked about women’s mental health and what impacts it could have downstream. She inspired me to set up a reproductive psychiatry clinic at my university, and I had a very supportive chair who gave me the greenlight. So as a brand-new junior faculty member, I set up both a clinic and a psychiatry training experience in perinatal psychiatry. Since then, I have spent a lot of time educating and treating women in this population and advocating for how important this care is. At the same time, reproductive psychiatry initiatives have developed around the country, and we all continue to share resources to improve both care and training. This has reinforced to me how crucial and critical this work is, but also how doable it is. I feel like things are coming full circle to be able to help bring this to Texas.  

Are there any particular stories or experiences that exemplify the dire need for these types of services, especially due to the shortage of mental health providers and needs of women in Texas?

There are two primary categories that stand out to me as points we could have easily changed the trajectory for a mom and her babies if we just did a little better job of working together and collaborating. One is the mom who has just been sick for a really long time. She’s been functional but she’s been sick, and she only justifies treatment in order to give her child a better life. This might even be her second or third child, and she has been through pregnancy, postpartum, and well-child checks without anyone offering her screening, intervention, or resources. The other group is the mom who has been misdiagnosed and has suffered because her treatment doesn’t match her needs. This seems to especially happen in the context of trauma. We have got to do a better job of assessing and responding to the traumas that so many women experience. I think we can help with both of these with appropriate screening.

What challenges do we face with providers serving pregnant women and new mothers who might need help?

When you look at the statistics of how frequent depression, anxiety, trauma and PTSD are, mental health issues should be the first thing that we’re assessing and screening for and not the last. This is a huge shift in medical care but one that is absolutely supported by the evidence.

We know that it takes about 15-20 years on average for research to make it into practice. And this conversation about trauma is a fairly new one respectively in our medical training. The adverse childhood experiences study from the 1990s showed us that the more adverse trauma and childhood experiences you have, the more likely you are to have GI issues, cancer, hypertension, diabetes – in addition to being more likely to present for depression and anxiety. 

Mental health distress like postpartum depression and anxiety are the most common complications of pregnancy, and so for us, it’s about trying to teach mom and teach clinicians that the healthiest mom creates the healthiest possible baby. This concept of epigenetics: what is happening to mom is affecting how your genes are expressed and how genes are passed on, so you have this downstream positive or negative effect. We want babies to have the healthiest start and the healthiest environment in which to grow.

How do you plan to inspire providers to utilize these services?

First you have to tell the story. Mental health feels like such a big vacuum and it feels so complex. In many ways it is and people don’t know what to do about it.

But we can tell people that improving mental health isn’t rocket science. It’s about building relationships and supportive community. It’s about screening early and often as a part of routine medical care. It’s about having an expert you can call for consultation and recommendations, and it’s about utilizing the tools that we have to treat mental health distress.  

Women should know it’s typical to screen when you come into your family medicine doctor, obstetrician or your pediatrician. With the ability to provide support in real time, through lines like the Perinatal Psychiatry Access Network, we can create that culture of support and relationships for clinicians, for moms, for families, and ultimately for the children we are all trying to raise.

A Majority of Birthing Hospitals Enrolled in NAT Project

The Newborn Admission Temperature (NAT) Project is a TCHMB Quality Improvement project to increase the number of newborn infants with admission temperatures within the normal limits – released hospital-reported data from Oct.-Dec. 2021. The project uses this data to inform hospital quality assurance and performance improvement programs, ultimately affecting positive outcomes for infants who are at risk for illness, disease or death if they do not fall in the normal limits.  

From October to November 2021:  

• 3.1% of infants had hypothermia and 5.9% of infants had hyperthermia at admission to the NICU;  

• 0.5% of infants had hypothermia and 3.3 % of infants had hyperthermia at admission to the Mother-Baby Unit;  

• Very low birthweight infants were significantly more likely to have hypothermia and hyperthermia at NICU admission. 

TCHMB continues to work with the RAC Perinatal Care Region (PCR) Alliance in order to connect with every single hospital stakeholder across the state. The current number of enrolled hospitals is 158. It continues to be geographically well-represented across TX. In this reporting period, NAT project covered approximately 58% of annual deliveries in Texas (compared to 51% for the July-September 2021 reporting period).  

The summary is available on the NAT project page. 

Newborn Admission Temperature (NAT) Project Update

The Neonatal Committee of the Texas Collaborative for Healthy Mothers and Babies (TCHMB) has completed two data collection periods for the Newborn Admission Temperature (NAT) Project. Of the 157 hospitals enrolled, 110 (70%) have submitted data for the most recent (second) data collection period. Overall, data quality has improved since the first data collection period, with more hospitals submitting data stratified by race/ethnicity. The NAT team is currently working on a report that will be published to the website in the coming month.

For hospitals needing additional support, we will provide weekly “NAT Office Hours” on Wednesdays from 12-2pm. Please feel free to drop in any time during these sessions for individual support. If you need the link for the meeting or if this time does not work for you, please reach out to us at nat@utsystem.edu.

Q&A with Dr. James Hill, TCHMB's New Obstetrics Committee Co-Chair

In June of 2021, TCHMB Executive Committee was joined by two new Co-chairs of the Obstetrics Committee, Gloria Delgado and Dr. James Hill. We spoke to Dr. Hill to learn more about his experiences as TCHMB Co-chairs so far and his visions for the future of TCHMB.

Tell us a little bit about yourself.

I am currently the Division Chief for the Division of Maternal-Fetal Medicine at the Baylor College of Medicine in San Antonio.  My interest in OB GYN started during the early years of medical school. Since completing my fellowship in Maternal-Fetal Medicine, I have worked in a number of rural and small community hospitals.  During that time period, I recognized that many hospitals were deficit in personnel and material resources critical to providing the necessary care for some of the most complicated cases.  I developed protocols and clinical guidelines for many of these hospitals. Years later, I was invited to join a workgroup of obstetricians, community physicians, maternal-fetal medicine physicians, neonatologists and epidemiologists to discuss the infrastructure for building a maternal and neonatal quality and safety regionalization system in Virginia. This is where my passion for improving maternal health took off.

How do you feel about joining the TCHMB executive committee?

I feel prepared. I have a special interest in quality improvement and I've been an active committee member on various quality improvement projects that have provided me with the experience needed and a better understanding for this position. I’m also excited to work with a number of experienced leaders and dedicated healthcare workers that are dedicated to improving the quality of care that we provide across the state of Texas and the opportunity to continue my efforts of reducing disparities, and maternal morbidity and mortality on a much broader level.

What do you hope to accomplish?

One of my main clinical and research interest is preeclampsia. And so I am excited that the TCHMB Executive approved the Obstetric committee’s most recent project proposal, titled Recognition and Response to Postpartum Preeclampsia in the Emergency Department.

This is a project that focuses on preeclampsia care in the emergency department. I hope to see that project move forward and implemented across the state of Texas.

What made you interested in the quality improvement aspect of healthcare?

The reduction of maternal mortality and morbidity has been and continues my career long passion.  As an African American provider caring for pregnant women, I have a unique perspective regarding healthcare disparities.  I have been very fortunate to have this opportunity, but many others who are minorities may not have.  I am most alarmed at the dismal survival rates for African American mothers and their infants across the United States and Texas.  Reading that women of color and black infants are dying at an alarming rate from preventable pregnancy-related complications is disturbing.  I have not quite figured things out yet, but I want to help.

What appealed to you about the TCHMB executive committee that made you want to join?

The executive committee has many folks who are extremely experienced and through the collaboration with community stakeholders have put together many projects and quality initiatives that I believe identify the correct priorities. I’ve seen the work they have produced, and listened to their discussions, to where I feel confident that the right messages are being delivered with the right focus to advance health care quality and patient safety for all Texas mothers and babies through the appropriate collaboration.

Have you got to do anything interesting during your time so far as chair?

I have enjoyed working with a number of the committee members over the past few weeks.  Namely, Dr. Davidson, the former Obstetric committee chair, who brings a tremendous amount of experience and guidance for my new position. The Texas AIM committee members have also been instrumental in putting together our postpartum project.  I would also like to give a loud shout out to Nagla Elerian, who has been the strong leader of this organization and helps to keep the pieces from falling apart.  Lastly, it has been great to have Gloria Delgado, as a co-chair.  She has an unwavering commitment and is a well-respected and knowledgeable nurse that will help make this position a positive experience.

What is the proudest accomplishment of your career?

While my life has exposed me to many career opportunities and occupations of interest, there have only been a few professions I have every seriously considered.  These are as follows:  military service, medicine, teaching and the clergy.

 I have always had a strong desire to have a career in the military.  My desire for a military career initially stemmed from romantic notions of what such service entailed.  These notions were replaced by a sincere need to feel as though I was doing my part in protecting that which I so fervently believe in, namely, our country and way of life.  With that though in mind and my desire to serve in the armed forces, I decided that West Point was the best place to start my training.  My outstanding 30-year career performance in the US Army has been a testament regarding my feelings about service to this country.

Things you are most excited about with your time on the TCHMB executive committee?

I’m most excited about having the support from the committee in working on the preeclampsia initiative in the emergency departments. This project is modeled after similar successful projects conducted in California, Florida and Illinois. I genuinely think this will allow us to improve care in not only the emergency departments, but also encourage collaboration with the OB units with a special emphasis on the care patients receive in the emergency departments.

Q&A with Gloria Delgado, TCHMB's New Obstetrics Committee Co-Chair

In June of 2021, TCHMB Executive Committee was joined by two new Co-chairs of the Obstetrics Committee, Gloria Delgado and Dr. James Hill. We spoke to Gloria Delgado to learn more about her experiences as TCHMB Co-chair so far and her visions for the future of TCHMB.

Tell us a little bit about yourself.

I was born and raised in Mexico where I developed an early interest in STEM subjects. These interests brought me to college in the United States where I initially planned on studying engineering, however, my passions led me to nursing school. Since then, I have gained 25 years of experience as an obstetrics nurse at The Hospitals of Providence and now the University Medical Center of El Paso.

How do you feel about joining the TCHMB executive committee?

It is challenging but exciting. Working on a program like [the Recognition and Response to Postpartum Preeclampsia in the Emergency Department project] on a state level is something that is new to me. Working with physicians on a first name basis takes a little bit to get used to but everyone at TCHMB has been so kind and helped me greatly. I’m especially excited to join the committee because the work we are doing directly impacts the entire state of Texas.

What do you hope to accomplish?

During my time here, I wish to both learn and help patients deal with the issues I see personally. One problem I see at the hospitals I work at is hypertension in the obstetrics unit. I hope to make it so that people dealing with hypertension can get medication and treatment quickly.

What made you interested in the quality improvement aspect of healthcare?

Quality improvement is something that is considered rather new in the obstetrics department. Compared to other aspects of medicine where quality improvement initiatives were implemented for the past 20 years, in obstetrics we just started 3-4 years ago. We are extremely new to the system so I wanted to learn as much as I can about quality improvement so that we can implement it into obstetrics units across the state.

What appealed to you about the TCHMB executive committee that made you want to join?

Ever since I was in nursing school more than 20 years ago, I’ve always heard that El Paso was behind compared to other cities in Texas for healthcare. Since then, I’ve asked myself why El Paso is behind when the city is just as capable and competitive as any other city. When I heard about the initiatives for TCHMB and its goal to improve healthcare for the entire state of Texas, I was extremely interested.

Have you got to do anything interesting during your time so far as chair?

Meeting all the people involved in TCHMB has been such a rewarding experience for me. During my career, I’ve usually been exposed to a power dynamic between the physicians and nurses where we’re not seen as equals. My time at TCHMB has allowed me to talk amongst physicians without fear of being undermined or not taken seriously. These moments have made me realize how fortunate I am to be a part of this collaborative.

What is the proudest accomplishment of your career?

As the Administrator of Women’s Services at the hospital I work at, I was extremely proud to see that our hospital was awarded the “no findings” level designation for the second time. Our whole team worked remarkably to earn this designation, and to be in a position of leadership during all this was certainly a highlight of my career.

Things you are most excited about with your time on the TCHMB executive committee?

I’m most excited to learn from everyone. I want to learn more about quality improvement and how I can implement it into my own hospital. Since I’m now a part of TCHMB, I can now also help neighboring hospitals that are facing similar issues. This opportunity to help on a broader scale is what excites me most.

Collecting, Stratifying and Understanding Race, Ethnicity and Language (REaL) Data in Healthcare

Please join us on October 22 from 12-1 p.m. CDT for the first in our series of free webinars on collecting, stratifying, and understanding race, ethnicity, and language data in healthcare. The goal of this first webinar is to provide a "farm to table" overview of REaL data collection and use. Future webinars will go into more depth into the different aspects of the process. Topics covered will include:

• The “life cycle” of REaL data in Texas hospitals from collection to use in reporting and visualizing maternal and infant health outcomes by race, ethnicity, and language

• Standards and processes for collecting accurate and complete REaL data

• Who at your institution needs to be involved to improve the collection and use of REaL data for quality improvement in maternal and infant health

The Texas Collaborative for Healthy Mothers and Babies (TCHMB) is a multidisciplinary network made up of health professionals throughout the state. We are dedicated to the goal of reducing disparities in the health outcomes of mothers and babies in Texas.

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Continuing Medical Education:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Texas Medical Association (TMA) through the joint providership of The Texas Department of State Health Services, Continuing Education Service and The University of Texas Health Science Center at Tyler. The Texas Department of State Health Services, Continuing Education Service is accredited by TMA to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education:
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hours of Continuing Nursing Education.

Certified in Public Health
Up to 1.00 CPH Recertification Credits may be earned at this event.

Licensed Professional Counselors:
Up to 1.00 LPC hours may be earned at this event.

Licensed Psychologists:
The Texas Department of State Health Services, Continuing Education Service is approved as a provider of professional development hours for licensed psychologists, per the Texas Administrative Code Rule §463.35 (f)(1). The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 professional development hours.

Social Workers:
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.

Certificate of Attendance:
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hours for attendance.

Q&A with Dr. Patrick Ramsey, TCHMB Chief Medical Officer

In September of last year, Dr. Patrick Ramsey stepped down from his position as Vice Chair/Chair Elect of the TCHMB Executive Committee in order to serve in a staff role as TCHMB’s first ever Chief Medical Officer. It was a milestone for TCHMB, which launched in 2013 with strong leadership at the Executive Committee level but no one in the CMO role that has been so instrumental to the success of many of the nation’s more established perinatal quality collaboratives.

“Pat was an obvious choice,” says Dr. David Lakey, who helped launch TCHMB when he was Texas state health commissioner and now serves as a member of the Executive Committee. “He has a strong background in both research and quality improvement. He’s been with TCHMB for years, and he was already in a leadership role. And he has the vision and commitment to help take the Collaborative to the next level.”

In addition to his role as CMO, Ramsey is a Professor and Division Chief for Maternal-Fetal Medicine at UT Health San Antonio. He is an active member of the American College of Obstetricians and Gynecologists, the Society of Maternal-Fetal Medicine, and the Infectious Disease Society for Obstetrics and Gynecology, among other organizations. And he is an active researcher and educator, with numerous awards and accolades and more than 100 peer-reviewed papers in major journals. His research interests are clinical trials, prevention of preterm birth, reduction of maternal morbidity and mortality, and management of medical complications of pregnancy.

We spoke to Ramsey about his background, his path to the TCHMB, and his vision for its future.

From where do you hail and how did you end up in Texas?

I’m from Wisconsin originally.  I came here with my wife in 2009. She was a military Ob-Gyn and was assigned to a base in San Antonio. I went to a high-risk pregnancy practice, and then moved over to UT Health San Antonio.

What brought you to TCHMB?

I received an email through the Perinatal Advisory Council that there was an opening. At the time, I didn’t know a lot about TCHMB other than that it was the state perinatal quality collaborative. I knew that the California PQC had done a lot of amazing work, and thought it would be exciting to be involved at the ground level with something that could potentially become very important.

When did you get the QI bug?

I’ve always been interested, as a physician, in evidence-based practice, and in translating research into clinical practice. A lot of my past research has focused on how to prevent women from having a pre-term or recurrent pre-term delivery, and in how to optimize outcomes in women who do deliver preterm. That very naturally led to getting involved with quality improvement work at UT Health San Antonio. That in turn is what led me to the Data Committee on TCHMB.

Your position, Chief Medical Officer, is a new one for the Collaborative. Can you talk about that?

Many of us in the upper leadership of TCHMB came to the realization that the way we were doing things was not sustainable. If we wanted to have the same kind of impact that some of the other PQCs around the country have had, we needed to have a medical leader who could dedicate him or herself more fully to expanding the footprint and visibility of these initiatives. We couldn’t just depend on voluntary service, though that still plays a big role in the operations of the Collaborative. So we created the chief medical officer position.

That was a critical step to making sure we had a bigger impact in the state, and over time more visibility nationally. The even more critical change has been the integration with the RAC-PCR Alliance, which is the implementation arm on the ground. That merger really kicks us up in terms of the level of impact we can have.

Why is the merger so important?

For so many reasons. The RACs and PCRs are the conduit to the hospitals. They are the hospitals. Merging with them is what is going to allow us to implement QI initiatives at a truly state-wide level, which will allow us over time to have a measurable impact on outcomes for mothers and babies. At the same time, TCHMB as an entity has capacities they don’t, in terms of providing QI training, ongoing coordination of initiatives, and coordination of a diverse array of stakeholders from across the state. We have the same goal, but we have different strengths to bring to the table. We need to work together, and now we are.