An updated and revised Center of Excellence application (PDF) launched on November 1, 2024. Please review the criteria carefully as you prepare your application. If you have any questions, or concerns, please email centersofexcellence@doh.wa.gov
How to Become Certified
1. Review the application (PDF)
2. Ensure your hospital can meet the criteria listed in the application
Note: Your responses are saved if you need to exit out of the application before it's submitted. However, we highly recommend completing the application in one sitting.
Contact us if you have questions or need guidance.
Ten Criteria and Resources to Meet These Criteria
These criteria guidelines, established by a consortium of experts, reflect best practices in perinatal substance use treatment and care. These resources may also be helpful if you are not a birthing hospital but want to support people with a substance use disorder who give birth.
In addition to the resources below, we suggest you utilize the free resources found in the Perinatal Substance Use Disorder Learning Collaborative online toolkit and the Washington State Perinatal Collaborative provider resources.
General Resources
- Perinatal Harm Reduction: This website includes a substance use toolkit and many free resources.
- Washington’s Pregnant, Parenting, Children and Families (PPCF) : This website consolidates resources for WA residents and providers related to opioid use. Resources include family treatment, childhood court programs, data, housing, Medicaid payment, perinatal SUD services in WA, and state trainings.
Criterion 1: Verbally screen every pregnant or postpartum person for substance use disorder with a validated screening tool. This screening should occur during delivery admission, at a minimum.
Screening Tools
- 5Ps (Recommended Tool):
Sample 5Ps Screening Tool with verbal prompts and recommended actions. Includes directions on a Brief Negotiated Interview.
A validated screening tool during pregnancy, includes violence and depression screening. Copyrighted instrument available at a cost and with training.
- Other validated tools:
Other Resources
- Sample Hospital Policy – Substance Use in the Obstetrical Patient (PDF)
- SBIRT screening codes: How to code for screening based on payor
- Motivational interviewing: Tips on how to conduct motivational interviewing and build trust with patients affected by perinatal SUD (pages 8-9)
- Trauma-informed care practices (pages 13-14)
Education
- Training video using 5Ps and Brief Interview with Dr. Jim Walsh and Tiffani Buck, 11 minutes:
- Training video using Screening, Brief Intervention, and Referral to Treatment (SBRIT):
Criterion 2: Screen every pregnant or postpartum person for Perinatal Mood and Anxiety Disorders (PMADs) with a validated screening tool. This screening should occur during delivery admission, at a minimum (Note: This screening should be in addition to any hospital-wide mandatory mental health screenings and be validated for the perinatal population)
Screening Tools
- Edinburgh Postnatal Depression Scale (EPDS) (Recommended tool): PDF of screening tool in English and Spanish
- PHQ-4 (Patient Health Questionnaire 4): Validated tool for screening depression in adults
- PHQ-2 (Patient Health Questionnaire 2): Validated tool for screening depression in adults
Resources for Clinicians
- UW Perinatal Psychiatry Consultation Line for Providers: FAQ website. Available 9-5, Mon-Fri, 877-725-4666 (PAL4MOM)
- Perinatal Support Washington: Perinatal mental health resources for providers and patients
- Suicide assessment, intervention, and safety plan guide: Includes pocket guide with suicide assessment questions, interventions based on risk, and safety plan template.
- Perinatal safety risk assessments and resources: University of Washington PAL for Moms resources and algorithms for safety assessments and referral regarding mental health and violence
- National Maternal Mental Health Hotline resources - order for FREE
- National Maternal Mental Health Hotline toolkit
Resources for Patients
- Perinatal Support Washington: Perinatal mental health resources for providers and patients
- Mental Health Access in WA with Apple Health (Medicaid): Apple Health and WA Health Care authority information about accessing mental health services
- National Maternal Mental Health Hotline through HRSA: 24/7 text or phone support for pregnant and postpartum individuals and their families
Education
- Webinar on how the National Maternal Mental Health hotline works (starts at 4:45)
- Clinician education, Postpartum Support International education: Purchase advanced education, certificates, conferences, and more
Criterion 3: Have a provider on-site or on-call that can and will initiate and adjust (titrate) medications that treatment opioid use disorder during pregnancy, labor and delivery, and postpartum.
OR
If the hospital does not have an on-site/on-call provider, there is a procedure in place to consult with a provider to initiate or adjust medications to treat opioid use disorder during pregnancy, labor and delivery, and postpartum when needed.
Example Practice Documents
- Example Hospital Guidance – Care and Stabilization (PDF): This example of a written guideline can be borrowed and applied to individual hospital guideline templates. Not all information needs to be included in a guideline or the body of a guideline. Includes example order set, treatment plans, and buprenorphine and methadone titration options.
- Sample Hospital Policy – Guideline for Opioid Use Disorder (PDF)
Policy and Process Implementation
- ScalaNW: Helping hospitals expand to hospital-wide policy and processes for MOUD, including immediate scheduling for lower resource settings
Consultation
- Swedish Perinatal Addiction Provider Consultation Line: 1-833-937-9362 (YESWECAN), available Monday–Friday 8 a.m. – 5 p.m.
- UW perinatal psychiatry and substance use consultation line for providers, information and website. Phone consultation available 9-5, Mon-Fri, 877-725-4666 (PAL4MOM)
Education
- WSHA Webinar: “Medication for opioid use disorder in pregnancy” by Dr. Gillian Zuckerman (5:50 to 45:27, 40 minutes):
- WSHA Webinar: “Compassionate care: The scientific and clinical rationale for split dosing during pregnancy” by Dr. Vania Rudolf (46:30 to 1:03:22, 17 minutes)
- WSHA Webinar: “The opioid epidemic: Fentanyl and optimal approaches for initiation and stabilization with MOUD (buprenorphine)” by Dr. Vania Rudolf (2:57 to 38:03, 35 minutes)
- American Society of Addition Medicine: Educational modules to purchase
Patient-facing Education
- Patient Video Series: How to prepare for ESC, including medications for OUD and support. In this patient-facing series of 3 short videos, the 3rd video reviews perinatal substance use, recovery, treatment, MOUD, and support. It includes a patient story.
Criterion 4: Allows the birthing person and infant to room together unless the birthing person is in the ICU or there are medical reasons outside of Neonatal Abstinence Syndrome (NAS) for the infant to be in the NICU/special care nursery.
Resources
Criterion 5: Have evidence-informed guidelines for chest/breastfeeding when using substances or taking medication to treat opioid use disorder (MOUD) that integrates a trauma-informed and harm reduction approach, supports the birthing person’s preferences, and provides information about benefits and considerations for all feeding options.
Resources
- Drugs & Lactation Database (LactMed)
- Hale’s Medications & Mother’s Milk: Print edition and online database available
Guidelines
- DOH Lactation and Substance Use Guidance for Health Care Professionals and Patient Education
- AWHONN Breastfeeding Recommendations for Women Who Receive Medication- Assisted Treatment for Opioid Use Disorders
Education
- Stanford hand expression video (7min34sec)
- NHS hand expression video (2min32sec)
Criterion 6: Practice the use of non-pharmacologic interventions as the first line of treatment for withdrawal symptoms in the infant, centering the parent(s) as the most important aspect to the infant’s care.
Example Practice Documents
- Example Hospital Guideline – Care and Stabilization of Newborn with NOWS - Eat, Sleep, Console: This example of a written guideline can be borrowed and applied to individual hospital guideline templates. Not all information needs to be included in a guideline or the body of a guideline. Includes example order set, treatment plans, and buprenorphine and methadone titration options.
- Sample Hospital Policy – Eat, Sleep, Console (PDF)
- Sample Hospital Documents – Eat, Sleep, Console (PDF)
Resources
Education
- Eat, Sleep, Console Patient-Centered Video - Spokane Regional Health District (YouTube video): Patient facing series of 3 short videos that review caring for babies experiencing neonatal withdrawal symptoms and ESC, with patient story (4min32sec to 5min40sec):
Criterion 7: Align hospital policy for contacting Child Protective Service (CPS) with state policy for reporting and notification. Conduct family-centered, trauma-informed communication with the birth parent about what to expect regarding the reporting or referral process for infants exposed to substances, and what they may expect regarding potential interactions with (CPS).
DCYF Training and Guidelines
- DCYF Technical Assistance Training: Your hospital must receive technical assistance training from the Department of Children, Youth, and Families on the state policy and how to use the Plan of Safe Care Online Referral Portal
- Plan of Safe Care Referral Portal: For birthing hospital staff to submit an online referral
- Plan of safe care, role of providers
- DCYF: Guidelines for notifying and reporting infants exposed to substance
- Plan of Safe Care Rack Card
Handouts
- For clinicians: Help me grow WA flyer
- For patients: Plan of Safe Care flyer
Education
- Example video of how to discuss interactions with CPS. In this patient-facing series of 3 short videos, there is an example of how to talk with patients about expectations and CPS interactions (starts at 3:20 of the 2nd video of the series)
- Help Me Grow educational video for clinicians (patients can watch, too)
Criterion 8: Have a process in place to support patient care coordination and ensure a comprehensive and supportive transition to outpatient or community services.
One-pager Patient Resources
Postpartum Resources
- Help Me Grow, Washington
- WA DOH Pregnant and Parenting Recovery Services Resource Finder
- Perinatal Support Washington (not specific to addiction services)
Education
- The Academy of Perinatal Harm Reduction & National Harm Reduction Coalition: “Pregnancy and Substance Use: A Harm Reduction Toolkit”: A comprehensive resource reviewing care of people affected by substance use from preconception to postpartum and beyond
Criteria 9: Have a process in place to discharge patients who use substances, or use medication for substance use disorder, with naloxone or a prescription for naloxone. Provide patient education about the risk factors of overdose, signs of an overdose, overdose response steps, the use of naloxone, and safe storage (i.e., medication lockbox).
Naloxone Resources
- Washington State Standing Order to Dispense Naloxone: Information and physical order for all people, that can be taken to a WA pharmacy to be filled. Do not need this for distribution
- Naloxone Distribution in Emergency Departments Implementation Toolkit: To help hospitals implement WA law SB 5195 to distribute naloxone in emergency departments - including OB triage
- Overdose Education and Naloxone Distribution: WA DOH website for naloxone information : Includes FAQs on Good Samaritan law, patient-facing 6min how-to video, and detailed instructions in multiple languages.
Patient Education
- Naloxone administration to pregnant person
- WA HCA overdose prevention and naloxone directions for use, 2 page trifold brochure
- WA DOH overdose response instructions, 2 page flier
Naloxone for Free
- The People’s Harm Reduction Alliance
- Finding places to go to get free naloxone in WA
- For people who can’t easily go to a pharmacy to get naloxone:
Criterion 10: Have a process in place to submit coded, and chart abstracted substance use disorder data measures through the Maternal Data Center (MDC), the Alliance for Innovation on Maternal Health (AIM) data center, or the Obstetrical Care Outcome Assessment Program (OBCOAP).
- WSHA Perinatal Substance Use Disorder Learning Collaborative Toolkit
- Data Entry Guide – MDC Users: Users guide for hospitals that use the Maternal Data Center
- Data Entry Guide - Non-MDC Users: Users guide for hospitals that do not use the Maternal Data Center