Bianca D. McCall  (00:00.43)
CASAT Podcast Network.

Welcome to the NOCE Dose Opioid Crisis Unplugged. The NOCE Dose Opioid Crisis Unplugged is a concise and insightful podcast offering a deeper dive into the realities faced by professionals combating the opioid epidemic. Join us as we reconnect with expert panelists from our listening sessions, providing a behind the scenes look at their work and insights into the pressing issues of prevention and diversion.

harm reduction, opioid use treatment, recovery, and reoccurrence prevention.

Bianca D. McCall  (00:45.922)
Welcome to the NOCE Dose brought to you by the Nevada Opioid Center of Excellence at nvopioidcoe.org. I'm your host with the NOCE, Bianca D. McCall, and we're back for season two to examine how opioid use disorder impacts special populations and groups with distinctive health vulnerabilities. In this journey, it takes us across the lifespan and amplifies the voices and unique experiences of these groups.

And I'm grateful that you are joining us in celebrating the resilience of individuals with disabilities and neurodivergence and birthing women and families, professionals and performers alike, honoring cultural traditions and healing trajectories of a beautifully diverse Nevada. Now.

Let's get ready to debrief. During our last listening session, we explored the intergenerational and biological effects of opioid exposure at birth and beyond. We broke down the experiences of birthing mothers, the relationships and engagement opportunities with the healthcare and behavioral health systems, and how in utero exposure impacts bonding, feeding, and long-term neurodevelopment.

Today's guest is Amy Thatcher, a seasoned speech language pathologist and neonatal feeding specialist who brings over 15 years of experience supporting medically fragile infants, especially those affected by neonatal abstinence syndrome. Now she's based in Santa Fe, New Mexico, a state with challenges and patterns that mirror our own here in Nevada when it comes to rural healthcare access, fentanyl exposure,

and methamphetamine co-use. And yes, she also happens to be the one person on a full flight who is willing, willingly took a middle seat next to me so she could talk opioid exposed infants across time zones. And I compassionately refer to Amy as my absolute favorite stranger on a plane and now no longer a stranger on a podcast. Amy, welcome. How are you feeling today? And since the listening session,

Bianca D. McCall  (03:00.13)
What's been happening?

Well, Bianca, it's been a great day. I'm feeling very well. Thank you. Since the listening session, I've of course helped more babies. yeah, this is, it's been, it's been busy. Life is busy. The universe is busy.

Yes, I would say so. We are just slightly ahead of the most wonderful time of the year, right Amy? Where there's lots of busyness going on. And I wonder too, not working in neonatal units and NICU units at the hospital, is this a busy time for deliveries? Are lots of people having babies around this time of year?

You know, there are more babies in the summer because it's winter time and people like to cuddle up and that's so we get more babies in the spring. This is when those babies are happening is this time of year.

Gotcha. Yeah. So we're, we're, we're generating life, right? We're, we're pro life right now. I it. love it. Well, well, let's, let's get right into the conversation. You know, something that you said during the listening session that really resonated with me, and I could not wait to ask you about this. said that it's, it's not enough to meet people where they are, but especially if we're still judging

Amy Thatcher (04:07.97)
Yes, we are.

Bianca D. McCall  (04:30.08)
where they came from. That was kind of like a mic drop moment during the listening session. And I couldn't wait to ask you if you could talk more about what it looks like, especially in the NICU unit at the hospital setting, how clinical teams can move beyond bias and into real trust building with families and with mothers. And how do you personally and professionally move beyond that bias?

So, I don't know, several years ago, many, many years ago, earlier in my career, I met a very seasoned nurse who had a son, a son who was addicted to opiates. And that son was raised in a great home, stable environment. The socioeconomic class was nice, middle class, went to good schools.

had both parents at home and they still ended up with that opioid use disorder. So he said, be real careful when you talk to people, cause you don't know where they came from. You don't know what that one choice was that they made that maybe you didn't that could have made you be in that spot. And I always thought that I was giving people grace.

But I think it's one step beyond that, right? Nothing that I say can change what has happened before I stepped foot in that room. Nothing can change.

When I walk in that room, I have to say, I'm Amy and I'm here to help. And if that means getting food, getting tons of graham crackers and peanut butter, if that means saying, all right, we're going to stay awake for this whole entire feed and not just your baby, but you too. So how can we really build that trust and not judge and

Amy Thatcher (06:41.93)
you know, the things we see in the hospital, the things we see.

How can we support that? So as a team, we talk amongst each other, not at the nursing station, in a team group meeting, and say, can we support this family? And really, it's the family. And I'm sure that you in Nevada have huge families, too. Here in northern New Mexico, there's families of 8, 10 kids. So you might have 8, 10 aunts and uncles coming in. So how do you support

that the parent structure, that family structure to support their baby and let all the other judgment get out of the room. So I think that, you know, we talk about how we can support them as a staff here, as a team here at the hospital, but how do we change that narrative that they're hearing from their family, their grandma, the grandpa, the aunties, the uncles, you know, how do we change that narrative?

So it's more than, so we as a staff, one, we walk in and we call that baby by name, right? We call the mom, mom, or whatever they want to be called. We say, has your baby been? And give them some ownership of that baby. And I may go in there and start the feed and explain things.

But I want to eventually hand that care off to the parents because that's really who's gonna take that baby home. And so that's what we do.

Bianca D. McCall  (08:29.39)
And gosh, you bring up such an important point and something that stands out to me and I hope the listeners are picking this up as well is, it's around the concept that I think the most destructive, detrimental thought pattern for humans is I would never, and I'm thinking about this campaign.

that the state of Montana did around methamphetamine use. And this is years ago at the onset and I think, you know, methamphetamine use in the state. And we're this campaign and talked about, you know, somebody who has this dangerous relationships with methamphetamines in this example. And they said, you know, I would never, you know, fill in the blank. And then it would show these scenes of the drug

kind of distorting realities and inducing this behavior that was out of character and beyond what that person thought they would ever do. Things down to stealing from parents and all these things, right? And so it makes me think of this concept of bias, shame, stigma really being rooted in this thought that professionals could share is that I would never.

And that's really the judgment of where somebody is coming from. And it also speaks to, I think, the power of peer supports, right? And to your point, family members, engaging, involving family members in this care, in the support, I think it's the, can't get beyond or around the I would never, and it's I have survived.

and I am thriving and this is how and I love this, your presentation, it immediately eliminates that degree of separation and you're saying, I'm Amy, I'm here to help. So it's not this, I would never in this distancing, the statement to kind of distance you with the mom and with the babies, but you're naming it. And again, soliciting.

Bianca D. McCall  (10:49.164)
the active participation of caregivers and family members as well in eliminating those degrees of separation. Now, Amy, you were a member of a research team or evaluation team for the assessment tool, Eat, Sleep, and Console, correct?

So I didn't, that's a much bigger project. That's a much bigger project. I was part of the implementation here at our hospital. And when we first, when I first started working with babies, they had like a step down program. So if a baby was showing withdrawal symptoms, they'd put them on methadone and they would start with a certain Dosee every so many hours. And then as that baby was showing fewer signs of withdrawal, they would either step down the Dosee or

elongate the time between the Dosees. And when I first started, we were keeping babies here for six, seven weeks. And it was taking a real, because you can't just get them off of that. That is a step down and it's a very specific process and, you know, looking at all of the, the withdrawal symptoms. And when Eat Sleep Console came out and we started implementing it here, we had a huge drop.

I can't give you the number, I'm so sorry, but a huge drop in the length of stay and the, you know, so that shorter time period of withdrawal symptoms and being able to discharge from the hospital. Because everybody knows you don't want to be in the hospital longer than you need to be. If you're in the hospital longer time, there's risk of infection just because it's a hospital. that Eat Sleep Console, it also gave

the family, the ability to have a vested interest in their baby's recovery. And when you can talk to somebody who, and you've built that trust, and you talk about how they feel when they are having withdrawal symptoms, they can see that in their baby, and then we can take them both together through that, down that road of recovery.

Bianca D. McCall  (13:02.668)
Yeah. And so you mentioned during the listening session and again here just made the point that the only way that we can kind of empower our moms and really positively affect the outcomes is by empowering the family members to be active participants in this. so it's, you know, there's

there's some biochemistry involved, right? You're talking about effectively influencing the Doseage and things like that, but without the family involvement and community involvement, then we don't see such a significant impact on the outcomes. And so with that being said, what are some of the most effective ways that you've seen providers support the caregivers in these families who are overwhelmed, who are stigmatized?

or even afraid of being involved in their baby's care.

So I'm going answer that question, but then I'd like to step back for just a second. here at our hospital, the parents can stay. They can room in with their babies. I feel that that is, I mean, not every hospital can do that. We're a small community hospital, and we have that opportunity to keep the parents here, let them eat, show them.

like we talked about in the listening section, modeling those behaviors, modeling all of those, those ways to talk to your baby, to, to treat them like a tiny human and recognize that they are a being. That baby is a being that they get to have the opportunity and the joy of loving their entire life. So that's

Amy Thatcher (14:59.2)
That's one thing is being able to room in. And I think that that's one way we can support the family. Sometimes they have other kids and they just can't do that. And so giving them the opportunity to come in even outside of visiting hours and really monitoring them and giving them the knowledge when they're here and supporting them where they are. Maybe they do have to go home. Maybe they've got another kid and they're...

You know, grandma can watch the kid for this time period or they're in school for this time period. How can we do that? So I want to go back just one step, if that's okay with you. Absolutely. So we talked about how the stigma of, and the judgment that these people often experience. didn't talk about the own self-talk, right? So, you know, you get,

you get these comments, you know, the narrative from outside of yourself and you start to believe it. So if you look at some research into awe, A-W-E, awe, and if you live your life with those glimmers of awe and you just get so excited about little things that you just see in your environment, the, it quiets that negative self-talk.

Right? And so when we go in and we talk about, look at those toes, look how perfect that little foot is, look at this little ear, does this ear look like your ear? And when we start to develop that awe, it can quiet the negative self-talk that they're experiencing themselves. And if you can do that, even just for that moment, they can give themselves permission to love this baby and care for this baby and do the right thing in this moment.

Don't think about what they did before. Don't think about what you're gonna do in the future, but what does this moment look like? And then the second thing I wanted to bring up is, you know, we test every baby, we do every mom, and we had to add fentanyl because fentanyl doesn't show up on just a regular opiate panel that they used to do. And we have found some moms that it's a secret. The dad doesn't know.

Amy Thatcher (17:22.657)
the family doesn't know, and how do you support that? Right? And so being transparent with those things in a kind, compassionate way.

Amy Thatcher (17:34.134)
is an entirely different approach. And so you've got this mom and dad, maybe the mom and dad know, but grandma and grandpa don't. So how do you let that be, how do you encourage that conversation so we're not a secret and we can have that village, we can have that tribe to support the family, to support that baby? So those were the two things. And so sorry I went off on a little tangent, but those are.

two things that I thought were important that we hadn't talked about.

No, listen, I love the tangents because you're speaking my language with these. The fact that we're gonna dive into the inner dialogue, to the self-talk, I love that. I love having those conversations and completely appropriate, right? We're talking to a speech language pathologist, so why not talk about the speech that's happening internally? I love that. I love that as a segue. But before we go there,

I also want to highlight your point of really it's breaking silence. These are acts of breaking silence against the secrets that maybe had amongst the family. But it's also modeling a way of breaking the silence. And I love the use of transparency. We're leveraging transparency. We're doing it in a caring way. And I love awe. I love looking at

at the positives in real time and as positive, natural and positive consequences, right? Of still all of our decisions, still all of our behaviors and the where we've come from is still involved in the moment that has produced awe in such an incredible experience. So I love all these things. And again, talking about self-talk and just the power of self-talk.

Bianca D. McCall  (19:30.382)
And Amy, as a speech pathologist, you bring such a clear lens that often gets overlooked when we talk about opioid exposed infants. In the listening session in here today, you've broken down how early opioid exposure impacts, like feeding and things like that, but taking a deeper dive into the impacts of oral motor development.

and later communication milestones and what signs we should be paying attention to that might otherwise be missed in those first critical months. What are those, Amy? What signs could we be looking out for with communication?

All right, well, let's start at the beginning. Okay. One of the things that I said was we treat these babies as tiny humans. When I meet a baby, I introduce myself to the child. I call them by name and I tell them what I'm going to do because I'm going to stick my fingers in their mouths and that's weird. Right? If I was come to you say, Hey Bianca, I'm a stick my finger in your mouth. He'd be like, Whoa, I don't think so. Yeah. But so it didn't.

just for the

For everybody who know, I did not stick my fingers in your mouth, not one time. But the, you know, I introduce myself because this is a little soul. So I'm not a voice they know. I'm not a smell they know. I may not be even be a language they know. So I introduced myself and I tell the parents what I'm doing while I explain it to the baby. Right. So.

Amy Thatcher (21:11.914)
So immediately as I walk in the room, this is a human. This is a tiny human. And they have a soul and maybe they'll remember, I don't know. Maybe they know where they are. Maybe they don't. But I take that time to do that. Then as we build that relationship, okay, so you've seen babies and kids in the grocery store, five, six year olds holding a bottle in their teeth that normally has Coke or sweet tea in it, right?

and they're walking around and I always talk to the family about what they eat now impacts how they'll eat in the future. So if you've got a two day old baby, maybe they've had 10 feeds, right? And the one feed that I'm doing is one 10th of the feeds they've had in their lifetime. Right? When you have lunch today, what

percentage of the meals you've had in your lifetime is that lunch. We can't believe and figure it out, right? It's so minuscule. So that feed that's one-tenth of the feeds they've had in their lifetime is super important. So Bianca, what is your favorite Thanksgiving side dish?

all, can't name multiple things, huh? I'm such a foodie, Amy, I'm such a foodie. I know, I know. I'm gonna go with, under pressure, I'm gonna go with macaroni and cheese.

Fantastic. You know what's been the most popular right recently is stuffing. Who chooses stuffing as their most important, but okay, I'll give you that. So if we don't feed them now with intention, then they're going to have a feeding avoidance and they're going to have an aversion to things in their mouths. And then we're going to have this issue with transitioning from milk liquids formula.

Amy Thatcher (23:12.142)
to purees, to dissolvable solids, to solids, to that mac and cheese that they would love to have at Thanksgiving. So when I talk about feeding first, feeding is super important and it's gonna tell you that you're gonna like mac and cheese when it comes time for you to eat that. So then how do we communicate with these kids, right? So when we talk to a baby, they've heard

They've heard the voices in utero. Not mine. It's not my baby. I just met you and until you come out, I can't do anything. So we need to teach the parents to read to their babies, to talk to their babies. And we really encourage things like the Dolly Parton Library. We make sure we've got some books on the unit to make sure that they can start reading to these babies right away. And maybe that's not something that they've done in their life culturally.

In different cultures, that's not something you would do with your newborn baby. Okay. Teach them how to scaffold the language and help them learn language. Now, I only work with infants. Every once in a while, I'll get a kid that's come in and they're readmitted for something different that I've worked with prior to, and I can model those types of behaviors. But if we don't do it at that stage, right,

at that early stage, we're going to have lack of empathy, right? We're not going to have that theory of mind. And so those early intervention tools for babies, you know, born with NAS, that neonatal abstinence syndrome, they, sometimes just that, they need that early intervention, PTOT speech, figuring out how to meet those developmental milestones.

And so that we don't get to kindergarten, preschool kindergarten, and they don't know how to do the preschool, you know, good mornings. They don't know how to sit at a table and eat their food because maybe they have an aversion and they won't eat anything, but just with a bottle. And so how do we, we get those skills as an infant so that the family can mold that.

Amy Thatcher (25:38.464)
and continue it down the line. So some of the things that we see are that theory of mind, knowing that your actions impact others, that empathy, seeing that, Johnny over there is crying. I wonder what's wrong, right? Did something I do impact that behavior? And then the short-term memory loss. Now we're seeing some, it's such a,

And I know we're not talking about marijuana right now, but you know, marijuana use with breastfeeding moms, it's because it's not regulated the way a lot of opiates are. We, it's a retrospective study and nobody's going to admit what they're doing or what they're taking or what they're using or how often, but we're seeing those babies, those kids, once they get into elementary school, having short-term memory loss or

not developing the short-term memory skills. what I should say.

Yeah. Gosh, so also during the listening session and what is has become even more apparent in our conversation today is that, you know, education really is kind of at the center of this, right? You're doing a lot of teaching and establishing kind of these positive, these healthy patterns, this memory, if you will, this record, first early recorded memory that will be

that will resurface in later milestones with communication and with education, you know, being at the root here. And you also named, you know, poverty, economic status and literacy as the root issues that we can't ignore if we're serious about breaking, especially the intergenerational cycles of opioid use disorder. In your work, what kinds of partnerships, what kind of wrap around

Bianca D. McCall  (27:41.408)
approaches have helped close these gaps for families early on and right there in the hospital or during follow-up care. What should we be doing in terms of matchmaking straight from the NICU?

So that is such an amazing question and it's twofold, right? We have so many resources in our community, right? Your community, my community. I did some research for Nevada. Looks like there's some great resources. But what has to come first? If you don't have that trust, that transparency, that...

non-judgmental help in the hospital, you're not going to let any of those home visitors come into your home. You're to be like, no thanks, I'm good. I have all the support I need. So when you recognize the value of all of those extra resources, when you recognize the fact that if maybe the hospital workers didn't judge you, there's no stigma, maybe the next person.

will treat me just as well, right? And if it's a secret, if it's a secret, how can you accept those resources? You're not gonna go and seek them out unless you can admit that it's happening and you need the help.

Yeah. And Amy, I'm wondering post pandemic, if we've seen any increases in that very point or that very statistic, right? Of not allowing people into our homes, you know, even for services. Because, I say post pandemic is because during the pandemic, during shelter in place, we were very much in our homes and all of the...

Bianca D. McCall  (29:41.088)
All of the things, all the skeletons came out of those pockets, right? We saw everything, every relationship, you know, for what it is, right? And so post pandemic, when we feel sort of exposed, you know, we did the uncovering, the unveiling while sheltering in place. Now, you know, we don't kind of want those slips to show, right?

I believe, I could say this, that people are less likely to invite people into those spaces post pandemic. And so have we seen that parallel to families' willingness to allow people to come into their homes to offer that support?

I've actually seen it from the other side. So I know that there are families that are now saying, yes, yes, I want the help. I need the help. There's just not enough people resources to come into their homes. And because people did so much of the Zoom and like, I know that there are a of people offering services, but it's virtual services. You know, somebody...

maybe they're in a bigger city and they're just offering those services and maybe they straighten up right behind them in the screen and they do what they need to do right then and there. But without getting those people into the homes, we're not seeing the whole picture. And so I think I answered a different question than when you asked. I think people are willing to have people into their homes. Most are.

But a lot of it's virtual. A lot of it's virtual. And so I think those skeletons still can hide beyond the screen.

Bianca D. McCall  (31:34.926)
Yeah, so perhaps the desire's there, but the actual inventory of resources might be the true barrier there into getting people into the homes is not having enough staffing. And that speaks to another issue, another challenge that I think would take us a whole nother podcast.

whole other listening session to go over.

Yeah, the workforce, the development, recruiting, outreach, you know, we've had lots of conversations offline with our whole team just about the impacts, especially post pandemic and with the integration of technologies and things like telehealth platforms where there is the virtual option. There's this mountain in between our services and our clients, patients, consumers.

that we're still trying to figure out how to overcome. Still trying figure out. And so how do we overcome that mountain or that barrier in order to partner with you, Amy? If I'm listening and I want to continue this conversation, how do I get connected and get a hold of you?

So I am truly not on lots of social media with what I do. If I've seen you in the hospital, you have my cell phone number. If I have met you in the community, you have my cell phone number. Easter, Christmas, birthdays, I get pictures. People just text me pictures just out of nowhere.

Bianca D. McCall  (33:05.72)
the

Amy Thatcher (33:20.556)
just saying, thanks so much for helping me with my baby. Look how far they've come. And that's so exciting. I get to see people in the community just out and about. And they're like, and sometimes it's kind of creepy when they follow me around the store and I don't realize that I don't recognize anybody. And then they come up to me and they, talk to me. So how can you in the community? So I think, I think this is hard. Okay. Not hard. It's just different.

So there are resources in the community that don't include therapy. early intervention, phenomenal way. Phenomenal way to support these kids, birth to three, meet those developmental milestones. And I'm gonna tell you those early intervention therapy staff, those people that come into the homes or the daycare or to grandma and grandpa's house or to wherever,

preschool, wherever they need to come, they are going to provide the most beautiful services.

I think that every baby born with OUD, know, to OUD patients, to families with OUD as neonatal abstinence syndrome, they would benefit from early intervention. Those therapists that make sure they're sitting up, that make sure they're getting the tummy time, that make sure that they're getting, meeting those developmental milestones so that when they get to school,

They don't struggle with those routines that, you know, we teach our kids, you know, eating at the table, reading books, sitting still, singing songs, because I know Bianca likes to sing.

Bianca D. McCall  (35:10.702)
Hey, I was met you and this is crazy, but here's my finger. Now, all right, that was just a little snippet, little snippet.

There you go. A little snippet. I knew you were going to sing. I had to give you an intro. So finding me is different. I'm just in a hospital. I'm in this teeny tiny little hospital in rural New Mexico. But how can you find someone like me? You can find someone like me in so many different places. I specifically work with a neonatal population, but there are therapists out there.

speech therapists, occupational therapists, physical therapists that can support that development so much further than I can even help.

I love that. And I don't think there's enough of that, Amy, in our fields, right? Is that for some of us that have the passion, have the desire, have the capacity and the bandwidth and the willingness to get out there to serve, to help, heal. And there's this sense of, you I've always got to be, I've always got to wear the cape. I've always got to be the hope and be the solution and be the servant. And I love-

that you said, it's not hard, it's different getting ahold of me directly, but I'm going to give you the idea, the hope, the resource of here are people like me, here are people in the field that are doing and researching and serving and helping in different ways, but that are similar to what I do. And so I love that, especially,

Bianca D. McCall  (37:03.282)
for our listeners that may not be in your area and may not be able to follow you around at the grocery store. I love that as a resource. And now I want to shift that to you speaking to the one person out there who hasn't followed you around in the grocery store yet, but who you hope hears this conversation, that you hope that your message has gotten a hold of today.

What do you want to say to that person? And this is the mic drop message, by the way.

Amy Thatcher (37:39.392)
Okay, for the person who's out there, who's pregnant and scared, and you maybe haven't had prenatal care, one, you can, love yourself, love your baby enough to go in and see somebody. And when you get here and you have your baby, I will introduce you to the most beautiful human on the earth that you created. And

before you were born, before your parents even thought of you, you were chosen to be this baby's parent. You were chosen to be this baby's mama. And nobody else can do that but you. You can be supported by so many different people and people love you. Your parents love you. Your grandparents love you. And I will love you too. So,

get some help, come in and just be supported and let yourself be transparent and vulnerable as I will too and we can cry together and then we'll get your baby to eat.

moments, moments. Amy, thank you so much, so much for being here and it's the way that you show up. It's the way that you show up with clarity, with compassion and those moments that will resonate with us for the rest of my day, for the rest of my week, for the rest of my year. Thank you so much. Your insights on not just feeding, but development and family-centered care.

for opioid exposed infants, they're powerful when they're necessary. And I'm grateful for your voice, for the way that you bring others in and for the work that you do every single day to change the outcomes for the most vulnerable. And I'm so glad that we had a chance to have this conversation today. And I would like to thank you to everyone for listening. If today's conversation gave you something to think about like it did me, share it.

Bianca D. McCall  (39:51.118)
talk about it, keep diving deeper. This is how we move the needle. One honest conversation at a time. One awesome conversation at a time. Subscribe, leave a review, and we'll catch you next time on the NOCE Dose. Take great care and let's keep showing up.

Bianca D. McCall  (40:20.728)
Thank you for listening to the NOCE Dose, the opioid epidemic unplugged. We hope that you found this episode compelling and informative. We ask that you please share this episode with your friends and your colleagues. And if you want to learn more, please visit our website at nvopioidcoe.org. The NOCE Dose podcast is brought to you by the Nevada Opioid Center of Excellence or NOCE. NOCE is dedicated to developing

and sharing evidence-informed training and offering technical assistance to professionals and community members alike. Now, whether you are a care provider or a concerned community member, NOCE provides resources to support.

Bianca D. McCall  (41:34.03)
This podcast has been brought to you by the CASAT Podcast Network, located within the Center for the Application of Substance Abuse Technologies, a part of the School of Public Health at the University of Nevada, Reno. For more podcast information and resources, visit casat.org.

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