Boston Medical Center
CALM Volunteer Guidelines
Version: January 2018
Boston Medical Center
CALM Cuddler Volunteer Program
Supervisors:
(Insert your program contacts and unit numbers here)
In addition to the hospital policies and procedures reviewed during the Volunteer Services orientation and viewing the CALM video orientation (https://vimeo.com/189800546/4b573a7151), the following guidelines are specific to the CALM Program.
Program Purpose
The goal of the CALM Volunteer Program is to help support families after the birth of their infant, particularly in the case of in-utero opioid exposure where infants are at risk of developing Neonatal Abstinence Syndrome (NAS).
Addiction in Pregnancy and Neonatal Abstinence Syndrome (NAS)
Women with opioid use disorder during pregnancy are treated in a specialized, multidisciplinary clinic at Boston Medical Center called Project RESPECT. This unique clinic provides a combination of obstetrical care, intensive case management, psychiatric care, addiction treatment and counselling for women with substance use disorders.
During pregnancy, there are two medications used to treat opioid use disorder, methadone and buprenorphine (also known as subutex). It is not safe for women to wean off of their opioid medication during the pregnancy due to risk for relapse, overdose, in-utero withdrawal, premature delivery, or miscarriage.
There is still a lot of stigma for people with substance use disorders, and this is even greater during pregnancy. It is important to remember that substance use disorder is defined as a chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences. In addition, remember that pregnant women with substance use disorders have high rates of co-occurring mental health disorders including depression, anxiety, and post-traumatic stress disorder. Lastly, 60-80% of these women have experienced a sexual and/or physical assault in their lifetime.
NAS is an opioid withdrawal syndrome that develops due to the sudden discontinuation of the chronic in-utero opioid exposure. Typically, babies are monitored in the hospital for 5 to 7 days for signs of withdrawal. Symptoms they may develop include irritability, poor sleep, high muscle tone, tremors, fevers, fast breathing, poor feeding, vomiting or diarrhea. They are treated first with non-pharmacologic care, then with medication, methadone at BMC, if their withdrawal symptoms become severe enough. Infants are then slowly weaned off the methadone over approximately 2 weeks. Approximately 50% of infants will require medication treatment.
For women with substance use disorders, the hospitalization of their infant is compounded by feelings of guilt and uncertainty of whether their infant will experience withdrawal. Developing positive and compassionate attitudes can be an “essential catalyst” to improving the experience. We have the opportunity through our attitudes and practices to promote maternal self-esteem, self-efficacy, and recovery.
In order to best take care of these dyads, we take a “universal precautions” approach. We assume that all families have been exposed to abuse, neglect, or other trauma. We do not require disclosure of that trauma, and we do not assume that any friends or family members are aware of mothers drug use.
There are five principles of trauma-informed care: the first is awareness. Next is creating an inpatient space that emphasizes safety and trust. Whenever possible, we strive to provide opportunities for choice, collaboration, and connection. We strive to focus on mom’s strengths and resiliency. Finally, we try to minimize the possibility of re-traumatization.
The words we use matter. While you might hear words such as “addicted baby” in the newspaper, these terms are medically inaccurate and only lead to increased stigma for families with substance use disorders.
Menino 4 Pediatrics Unit Description
You will be primarily assigned to the Pediatric Inpatient Unit, located on the 4th floor of the Menino Building. Please always report to this unit first. In this unit, infants who are being monitored and treated for NAS are hospitalized after their mothers are discharged from the postpartum unit. Most rooms are double rooms with two babies / families in each room. One parent may room-in overnight per patient. The pediatric inpatient unit also cares for other infants and children up to late adolescence for a variety of other medical conditions.
Yawkey 4 Mother Infant Unit Description
If there is an infant in need, you may be asked to cuddle on the postpartum Mother Infant Unit, located on the 4th Floor Women & Infants Center of the Yawkey Building. In this unit, women who have just given birth are hospitalized typically for 2-5 days. Infants typically room-in with their mothers in the postpartum room unless there is a medical complication requiring more monitoring in our nursery or newborn intensive care unit. This is an exciting but challenging transition period for new mothers, and respect should be taken at all times to protect privacy and respect parental wishes.
Yawkey 4 NICU Description
While we do have a separate NICU Cuddler Program, it is possible that some of you may be assigned to the NICU if there is not a NICU cuddler available for a baby with NAS. The NICU is located on the 4th floor of the Yawkey Building. There are a mix of single rooms and pods which house up to 4 babies with a variety of conditions, though most commonly prematurity.
Arriving at the hospital
• Sign in and out on the Volunteer computer located in the Yawkey Lobby when you arrive and when leaving.
• Wash hands upon entering the unit.
• Please wear your volunteer T-shirt and ID badge.
• Store your belongings in a safe place.
• Please report to Menino 4 East Pediatric Inpatient Unit first
• Check in with the 4 East Unit Coordinator to say you are the CALM Cuddler volunteer between 8am-3pm, or the 4 East Charge Nurse between 3:00pm – 6:00am. The Unit Coordinator / Charge Nurse will identify which infants can be cuddled.
• Please also check with the CALM logbook located at the Unit Coordinator’s desk on 4E, and update it with relevant information after your shift.
• You may be shifted from 4 East Pediatrics to Yawkey 4 Mother Infant or the NICU depending on patient need. On these units, please check in with the Charge Nurse to find a baby to be cuddled.
• Please check in with the NICU if there is no baby in need of cuddling on the other units. If this is not an infant with NAS in need of cuddling, there are many other babies in need in our NICU.
• Special instructions for first cuddling shift of each day:
o Please complete the CALM logbook with the name the room number of the babies in highest need of cuddling for that day, and any relevant comments
o This list is generated by speaking with the Unit Coordinator on 4 East, the charge nurse on Mother Infant Unit (call 45858), and the charge nurse in the NICU (call 44359)
Please be sure to follow all infection control and safety guidelines listed below
Infection Control and Safety Guidelines
Please:
1. Wash hands when you arrive on the floor.
2. Perform a 3 minute scrub once inside the unit.
3. Wash hands before and after holding babies.
4. Ask the nurse if you have any concerns about the baby you are cuddling.
5. Never feed babies.
6. Never pick up or put down the baby. Ask the nurse to do this.
7. Never have any unnecessary contact (other than holding) with the baby to avoid transference of potentially dangerous germs.
8. Never handle blood or bodily fluids.
9. Do not come to the units if you are not feeling well or have any other medical condition that might affect your ability to safely hold an infant.
Other important reminders:
Please:
• Do not ambulate with baby in arms
• Do not pick up or put down any infant. The nurse will transfer the baby out of and into the crib and hand the baby to you.
• Do not touch monitors or equipment
• Do not give any medical advice or information to families. Refer all questions to medical staff.
• Respect patient confidentiality. Refer to your Volunteer Services handbook for further information.
• Check with the nurse if you have any concerns while holding the infant.
• Ask staff how you can be helpful.
Please use caution if feeling sleepy:
If you are feeling sleepy during your shift while you are holding an infant, please notify a nurse immediately and have the nurse take the baby from you. The infant’s safety is the number one priority. It is okay to end your shift early if you are feeling too tired to safely hold the infant. Cases in which volunteers are found falling asleep while cuddling an infant will be reported to the CALM supervisors.
Boston Medical Center
CALM Volunteer Guidelines
Version: January 2018
Boston Medical Center
CALM Cuddler Volunteer Program
Supervisors:
In addition to the hospital policies and procedures reviewed during the Volunteer Services orientation and viewing the CALM video orientation (https://vimeo.com/189800546/4b573a7151), the following guidelines are specific to the CALM Program.
Program Purpose
The goal of the CALM Volunteer Program is to help support families after the birth of their infant, particularly in the case of in-utero opioid exposure where infants are at risk of developing Neonatal Abstinence Syndrome (NAS).
Addiction in Pregnancy and Neonatal Abstinence Syndrome (NAS)
Women with opioid use disorder during pregnancy are treated in a specialized, multidisciplinary clinic at Boston Medical Center called Project RESPECT. This unique clinic provides a combination of obstetrical care, intensive case management, psychiatric care, addiction treatment and counselling for women with substance use disorders.
During pregnancy, there are two medications used to treat opioid use disorder, methadone and buprenorphine (also known as subutex). It is not safe for women to wean off of their opioid medication during the pregnancy due to risk for relapse, overdose, in-utero withdrawal, premature delivery, or miscarriage.
There is still a lot of stigma for people with substance use disorders, and this is even greater during pregnancy. It is important to remember that substance use disorder is defined as a chronic, relapsing brain disease characterized by compulsive drug seeking and use, despite harmful consequences. In addition, remember that pregnant women with substance use disorders have high rates of co-occurring mental health disorders including depression, anxiety, and post-traumatic stress disorder. Lastly, 60-80% of these women have experienced a sexual and/or physical assault in their lifetime.
NAS is an opioid withdrawal syndrome that develops due to the sudden discontinuation of the chronic in-utero opioid exposure. Typically, babies are monitored in the hospital for 5 to 7 days for signs of withdrawal. Symptoms they may develop include irritability, poor sleep, high muscle tone, tremors, fevers, fast breathing, poor feeding, vomiting or diarrhea. They are treated first with non-pharmacologic care, then with medication, methadone at BMC, if their withdrawal symptoms become severe enough. Infants are then slowly weaned off the methadone over approximately 2 weeks. Approximately 50% of infants will require medication treatment.
For women with substance use disorders, the hospitalization of their infant is compounded by feelings of guilt and uncertainty of whether their infant will experience withdrawal. Developing positive and compassionate attitudes can be an “essential catalyst” to improving the experience. We have the opportunity through our attitudes and practices to promote maternal self-esteem, self-efficacy, and recovery.
In order to best take care of these dyads, we take a “universal precautions” approach. We assume that all families have been exposed to abuse, neglect, or other trauma. We do not require disclosure of that trauma, and we do not assume that any friends or family members are aware of mothers drug use.
There are five principles of trauma-informed care: the first is awareness. Next is creating an inpatient space that emphasizes safety and trust. Whenever possible, we strive to provide opportunities for choice, collaboration, and connection. We strive to focus on mom’s strengths and resiliency. Finally, we try to minimize the possibility of re-traumatization.
The words we use matter. While you might hear words such as “addicted baby” in the newspaper, these terms are medically inaccurate and only lead to increased stigma for families with substance use disorders.
Menino 4 Pediatrics Unit Description
You will be primarily assigned to the Pediatric Inpatient Unit, located on the 4th floor of the Menino Building. Please always report to this unit first. In this unit, infants who are being monitored and treated for NAS are hospitalized after their mothers are discharged from the postpartum unit. Most rooms are double rooms with two babies / families in each room. One parent may room-in overnight per patient. The pediatric inpatient unit also cares for other infants and children up to late adolescence for a variety of other medical conditions.
Yawkey 4 Mother Infant Unit Description
If there is an infant in need, you may be asked to cuddle on the postpartum Mother Infant Unit, located on the 4th Floor Women & Infants Center of the Yawkey Building. In this unit, women who have just given birth are hospitalized typically for 2-5 days. Infants typically room-in with their mothers in the postpartum room unless there is a medical complication requiring more monitoring in our nursery or newborn intensive care unit. This is an exciting but challenging transition period for new mothers, and respect should be taken at all times to protect privacy and respect parental wishes.
Yawkey 4 NICU Description
While we do have a separate NICU Cuddler Program, it is possible that some of you may be assigned to the NICU if there is not a NICU cuddler available for a baby with NAS. The NICU is located on the 4th floor of the Yawkey Building. There are a mix of single rooms and pods which house up to 4 babies with a variety of conditions, though most commonly prematurity.
Arriving at the hospital
- Sign in and out on the Volunteer computer located in the Yawkey Lobby when you arrive and when leaving.
- Wash hands upon entering the unit.
- Please wear your volunteer T-shirt and ID badge.
- Store your belongings in a safe place.
- Please report to Menino 4 East Pediatric Inpatient Unit first
- Check in with the 4 East Unit Coordinator to say you are the CALM Cuddler volunteer between 8am-3pm, or the 4 East Charge Nurse between 3:00pm – 6:00am. The Unit Coordinator / Charge Nurse will identify which infants can be cuddled.
- Please also check with the CALM logbook located at the Unit Coordinator’s desk on 4E, and update it with relevant information after your shift.
- You may be shifted from 4 East Pediatrics to Yawkey 4 Mother Infant or the NICU depending on patient need. On these units, please check in with the Charge Nurse to find a baby to be cuddled.
- Please check in with the NICU if there is no baby in need of cuddling on the other units. If this is not an infant with NAS in need of cuddling, there are many other babies in need in our NICU.
- Special instructions for first cuddling shift of each day:
- Please complete the CALM logbook with the name the room number of the babies in highest need of cuddling for that day, and any relevant comments
- This list is generated by speaking with the Unit Coordinator on 4 East, the charge nurse on Mother Infant Unit (call 45858), and the charge nurse in the NICU (call 44359)
Please be sure to follow all infection control and safety guidelines listed below
Infection Control and Safety Guidelines
Please:
- Wash hands when you arrive on the floor.
- Perform a 3 minute scrub once inside the unit.
- Wash hands before and after holding babies.
- Ask the nurse if you have any concerns about the baby you are cuddling.
- Never feed babies.
- Never pick up or put down the baby. Ask the nurse to do this.
- Never have any unnecessary contact (other than holding) with the baby to avoid transference of potentially dangerous germs.
- Never handle blood or bodily fluids.
- Do not come to the units if you are not feeling well or have any other medical condition that might affect your ability to safely hold an infant.
Other important reminders:
Please:
- Do not ambulate with baby in arms
- Do not pick up or put down any infant. The nurse will transfer the baby out of and into the crib and hand the baby to you.
- Do not touch monitors or equipment
- Do not give any medical advice or information to families. Refer all questions to medical staff.
- Respect patient confidentiality. Refer to your Volunteer Services handbook for further information.
- Check with the nurse if you have any concerns while holding the infant.
- Ask staff how you can be helpful.
Please use caution if feeling sleepy:
If you are feeling sleepy during your shift while you are holding an infant, please notify a nurse immediately and have the nurse take the baby from you. The infant’s safety is the number one priority. It is okay to end your shift early if you are feeling too tired to safely hold the infant. Cases in which volunteers are found falling asleep while cuddling an infant will be reported to the CALM supervisors.
