1 00:00:00,000 --> 00:00:03,030 [Angela] So we're gonna transition to the next session, 2 00:00:03,030 --> 00:00:05,160 which is gonna be a panel discussion 3 00:00:05,160 --> 00:00:08,456 about home-based systems of support in Vermont. 4 00:00:08,456 --> 00:00:11,880 And the panel will be led by Katy Leffel, 5 00:00:11,880 --> 00:00:16,477 who I will introduce, and she will introduce the panelists. 6 00:00:16,477 --> 00:00:19,260 So Katy is a public health nurse focusing 7 00:00:19,260 --> 00:00:22,200 on perinatal health for the maternal-child health division 8 00:00:22,200 --> 00:00:24,630 in the Vermont Department of Health. 9 00:00:24,630 --> 00:00:26,970 She facilitates perinatal health coordination 10 00:00:26,970 --> 00:00:29,400 across MCH programs, 11 00:00:29,400 --> 00:00:32,550 the Office of Local Health and other Vermont 12 00:00:32,550 --> 00:00:34,500 community and health partners. 13 00:00:34,500 --> 00:00:37,950 She works closely with the Vermont Perinatal PPQC, 14 00:00:37,950 --> 00:00:40,200 that's us, and is a nurse abstracter 15 00:00:40,200 --> 00:00:42,444 for the Maternal Mortality Review Panel. 16 00:00:42,444 --> 00:00:46,110 Prior to transitioning to state work a year and a half ago, 17 00:00:46,110 --> 00:00:47,670 she worked in a variety of nursing 18 00:00:47,670 --> 00:00:49,680 settings and specialties. 19 00:00:49,680 --> 00:00:51,810 For over 10 years she was in home health 20 00:00:51,810 --> 00:00:54,577 as a maternal-child health nurse and supervisor 21 00:00:54,577 --> 00:00:57,000 providing medical and lactation services, 22 00:00:57,000 --> 00:00:58,740 as well as several evidence-based 23 00:00:58,740 --> 00:01:01,170 nurse home visiting programs. 24 00:01:01,170 --> 00:01:03,669 Katy earned her CLC certification, 25 00:01:03,669 --> 00:01:06,720 Clinical Lactation Consultant in 2013, 26 00:01:06,720 --> 00:01:09,507 and her IBCLC in 2019. 27 00:01:09,507 --> 00:01:14,490 And her RN, MNN, Maternal Neonatal Nursing in 2021. 28 00:01:14,490 --> 00:01:16,260 She's a mother to three girls, 29 00:01:16,260 --> 00:01:20,073 partner to a public school teacher and a pet parent to Amat. 30 00:01:20,940 --> 00:01:23,433 So Katy, we're so happy to have you here today. 31 00:01:24,960 --> 00:01:25,793 [Katy] Thank you. 32 00:01:25,793 --> 00:01:27,570 I am excited to be here and this conversation has really 33 00:01:27,570 --> 00:01:29,910 fired me up and we have a great panel. 34 00:01:29,910 --> 00:01:32,720 We have three people joining us. 35 00:01:32,720 --> 00:01:34,350 I've got bios for two of them, 36 00:01:34,350 --> 00:01:35,970 and then third person will have to introduce 37 00:01:35,970 --> 00:01:37,200 a little maybe about themselves. 38 00:01:37,200 --> 00:01:38,790 So we've got Amy Wenger, 39 00:01:38,790 --> 00:01:40,710 she's a registered nurse and international 40 00:01:40,710 --> 00:01:42,510 board certified lactation consultant. 41 00:01:42,510 --> 00:01:45,210 Her passion for maternal-child health work began 42 00:01:45,210 --> 00:01:48,780 over 20 years ago as a doula and a childbirth educator. 43 00:01:48,780 --> 00:01:51,000 As a nurse, Amy deepened her work with birthing 44 00:01:51,000 --> 00:01:53,340 and lactating people, working on Vermont's 45 00:01:53,340 --> 00:01:55,860 largest postpartum unit in pediatric clinics, 46 00:01:55,860 --> 00:01:58,268 and in her current position as a maternal-child 47 00:01:58,268 --> 00:02:01,716 clinical nurse manager at a community home health agency. 48 00:02:01,716 --> 00:02:05,550 Amy is also the founder and co-executive director 49 00:02:05,550 --> 00:02:07,290 of the Vermont Donor Milk Center, 50 00:02:07,290 --> 00:02:10,020 which provides outpatient pasteurized donor human milk 51 00:02:10,020 --> 00:02:12,480 to infants who require supplementation, 52 00:02:12,480 --> 00:02:14,370 along with crucial lactation supports 53 00:02:14,370 --> 00:02:16,560 and postpartum resources. 54 00:02:16,560 --> 00:02:18,437 Amy is a believer in the strong system of care 55 00:02:18,437 --> 00:02:20,700 that supports the best interests of the client, 56 00:02:20,700 --> 00:02:23,576 that are both trauma-informed and family centered. 57 00:02:23,576 --> 00:02:26,239 Dancing in the gray areas found during the vulnerable 58 00:02:26,239 --> 00:02:29,730 perinatal period, thinking outside of the box solutions 59 00:02:29,730 --> 00:02:32,100 and breaking down barriers is what excites her the most 60 00:02:32,100 --> 00:02:34,920 about the work that she is lucky to be a part of. 61 00:02:34,920 --> 00:02:36,630 And we also have Heidi Gillespie. 62 00:02:36,630 --> 00:02:39,390 She is an RN working as a clinical nurse manager 63 00:02:39,390 --> 00:02:42,270 of Children and Family Services at the VNA in Rutland 64 00:02:42,270 --> 00:02:45,300 and is also the US MECSH consultant. 65 00:02:45,300 --> 00:02:47,460 It's our home visiting program here, 66 00:02:47,460 --> 00:02:50,100 working with Professor Lynn Kemp. 67 00:02:50,100 --> 00:02:52,560 She is the medical director at Camp Thorpe 68 00:02:52,560 --> 00:02:56,025 in Goshen, Vermont, which is a camp for those 69 00:02:56,025 --> 00:02:58,350 with developmental or special health needs. 70 00:02:58,350 --> 00:03:01,020 She also travels annually to Honduras where she serves 71 00:03:01,020 --> 00:03:03,270 with a group of nurses to run a medical clinic 72 00:03:03,270 --> 00:03:05,250 and provide public health services to those 73 00:03:05,250 --> 00:03:07,560 that do not have access to medical care. 74 00:03:07,560 --> 00:03:09,630 She loves spending time with her husband, 75 00:03:09,630 --> 00:03:12,245 her seven children and 11 grandchildren, 76 00:03:12,245 --> 00:03:14,790 as well as assortment of animals 77 00:03:14,790 --> 00:03:16,770 that live on their mini farm. 78 00:03:16,770 --> 00:03:18,900 And we also have Kat Blanchard joining us today. 79 00:03:18,900 --> 00:03:21,090 And I just wanna say a couple things. 80 00:03:21,090 --> 00:03:23,400 This chat has been amazing. 81 00:03:23,400 --> 00:03:25,740 I think talking about the different spaces 82 00:03:25,740 --> 00:03:27,732 that we're joining together in thinking, 83 00:03:27,732 --> 00:03:30,060 we don't need to reinvent the wheel here. 84 00:03:30,060 --> 00:03:33,453 We have nurses, a network of nurses across the state 85 00:03:33,453 --> 00:03:36,750 in every region, and I urge you to look 86 00:03:36,750 --> 00:03:40,332 at our participant list today because there are literally 87 00:03:40,332 --> 00:03:43,890 over a dozen, if not more community partners here today. 88 00:03:43,890 --> 00:03:46,712 They're showing up, they're nurses in home health, 89 00:03:46,712 --> 00:03:49,380 they're children's integrated services nurses, 90 00:03:49,380 --> 00:03:51,300 they're the Department of Health nurse coordinators. 91 00:03:51,300 --> 00:03:53,280 They're here today 'cause they are so passionate 92 00:03:53,280 --> 00:03:56,480 about that community space and supporting families 93 00:03:56,480 --> 00:03:57,660 in that community space. 94 00:03:57,660 --> 00:04:02,280 So I'm just really looking forward to this presentation 95 00:04:02,280 --> 00:04:05,006 and to think about how we connect the clinical spaces 96 00:04:05,006 --> 00:04:06,810 with those services that will last 97 00:04:06,810 --> 00:04:08,963 up to two years postpartum to support these families 98 00:04:08,963 --> 00:04:12,033 in that really vulnerable period. 99 00:04:17,880 --> 00:04:18,720 [Amy] Thanks, Katy. 100 00:04:18,720 --> 00:04:22,983 I'm gonna try to share my screen here, see if I can, 101 00:04:25,830 --> 00:04:28,233 oh, let me make sure that I did that correctly. 102 00:04:32,130 --> 00:04:33,990 [Katy] Yep, that looks fine, Amy. 103 00:04:33,990 --> 00:04:37,170 [Amy] Oh no, I just wanted to share my sound. 104 00:04:37,170 --> 00:04:38,003 Okay. 105 00:04:39,810 --> 00:04:41,940 All right, we're good. 106 00:04:41,940 --> 00:04:43,140 Okay. 107 00:04:43,140 --> 00:04:45,623 Well thanks, Katy, I appreciate that. 108 00:04:45,623 --> 00:04:49,590 I am Amy, I am coming to you from the northern part 109 00:04:49,590 --> 00:04:52,620 of Vermont, not too far from the Canadian border. 110 00:04:52,620 --> 00:04:55,080 And with me today is Heidi Gillespie coming to you 111 00:04:55,080 --> 00:04:58,123 from the Southern part, and we represent 112 00:04:58,123 --> 00:05:01,301 our colleagues on all points in between. 113 00:05:01,301 --> 00:05:04,770 We'd like to thank the Icon team for inviting us to speak 114 00:05:04,770 --> 00:05:08,820 about how the maternal/child nurse home visitors 115 00:05:08,820 --> 00:05:11,580 throughout our state support pregnant, birthing, 116 00:05:11,580 --> 00:05:14,319 and postpartum people with substance use disorder. 117 00:05:14,319 --> 00:05:19,131 Our objective today is to really help those here understand 118 00:05:19,131 --> 00:05:23,999 the story behind the nurse home visitor and how our programs 119 00:05:23,999 --> 00:05:27,480 and scope of services make a big impact for our most 120 00:05:27,480 --> 00:05:30,930 vulnerable and isolated communities. 121 00:05:30,930 --> 00:05:32,673 And to look at cute baby pictures. 122 00:05:34,530 --> 00:05:35,943 We have nothing to disclose. 123 00:05:39,390 --> 00:05:42,720 So, nurse home visitors have been here present 124 00:05:42,720 --> 00:05:44,970 in Vermont for well over a hundred years. 125 00:05:44,970 --> 00:05:49,140 Started in 1906 by a small group of women here in Burlington 126 00:05:49,140 --> 00:05:52,008 who really believed that people who were sick 127 00:05:52,008 --> 00:05:53,670 needed care at home. 128 00:05:53,670 --> 00:05:58,020 And then in 1926 in order to decrease 129 00:05:58,020 --> 00:06:02,070 the extremely high rates of infant mortality in Burlington, 130 00:06:02,070 --> 00:06:04,830 the numbers of nurse home visitors were increased, 131 00:06:04,830 --> 00:06:08,200 and that included specialty trained nurse home visitors 132 00:06:09,660 --> 00:06:12,930 who had a specialty in maternity care. 133 00:06:12,930 --> 00:06:16,200 So new nurse home visiting programs were started. 134 00:06:16,200 --> 00:06:18,390 And that included prenatal nursing, 135 00:06:18,390 --> 00:06:22,620 assisting at home deliveries, pre-school health checks, 136 00:06:22,620 --> 00:06:26,181 infant welfare and care for postpartum women. 137 00:06:26,181 --> 00:06:29,670 They also held well baby clinics in four sections 138 00:06:29,670 --> 00:06:31,920 of Burlington during that time. 139 00:06:31,920 --> 00:06:34,320 So we've been here for some time, 140 00:06:34,320 --> 00:06:37,833 and thanks to these sassy ladies in these pictures, 141 00:06:39,431 --> 00:06:43,791 they really saw a need in their community and they filled it 142 00:06:43,791 --> 00:06:47,250 with a full spectrum of care for the baby, 143 00:06:47,250 --> 00:06:50,443 the mom, the mama baby dyads in that time. 144 00:06:50,443 --> 00:06:53,100 Our healthcare system has obviously changed 145 00:06:53,100 --> 00:06:54,720 a lot since the twenties and thirties, 146 00:06:54,720 --> 00:06:57,377 but the need for support and care for our most vulnerable 147 00:06:57,377 --> 00:06:59,910 pregnant and postpartum families 148 00:06:59,910 --> 00:07:03,333 who have substance misuse has only increased. 149 00:07:06,930 --> 00:07:09,007 The maternal-child nurse home visitors of today 150 00:07:09,007 --> 00:07:11,220 have so many more resources 151 00:07:11,220 --> 00:07:13,470 and opportunities for their communities. 152 00:07:13,470 --> 00:07:17,375 We really are the unicorns of the healthcare system. 153 00:07:17,375 --> 00:07:20,670 We're unique in the fact that we span the adult, 154 00:07:20,670 --> 00:07:24,237 the obstetrical, the postpartum, the pediatric, 155 00:07:24,237 --> 00:07:27,450 addiction medicine, all those systems of care. 156 00:07:27,450 --> 00:07:29,760 We are community medical nurses, 157 00:07:29,760 --> 00:07:31,860 educators, and care coordinators. 158 00:07:31,860 --> 00:07:35,220 We sit outside of the medical silos, but are fully 159 00:07:35,220 --> 00:07:38,454 integrated into the medical and community systems. 160 00:07:38,454 --> 00:07:41,490 We bring opportunities, supports, and a full spectrum 161 00:07:41,490 --> 00:07:44,760 of care and complimentary resources straight into the homes 162 00:07:44,760 --> 00:07:46,797 of the families that we serve. 163 00:07:46,797 --> 00:07:50,220 And we are in this fortunate space along with our close 164 00:07:50,220 --> 00:07:52,950 community partners where we can come together 165 00:07:52,950 --> 00:07:55,717 in assessment and advocacy and intervention. 166 00:07:55,717 --> 00:07:58,410 We reach our most rural, most isolated 167 00:07:58,410 --> 00:08:01,287 and our newest families here in Vermont. 168 00:08:01,287 --> 00:08:04,290 We're often sometimes the only people that they may see 169 00:08:04,290 --> 00:08:06,750 during the day or the week. 170 00:08:06,750 --> 00:08:09,930 And we work to meet our families really wherever they're at, 171 00:08:09,930 --> 00:08:11,548 checking in, building connections 172 00:08:11,548 --> 00:08:13,800 and capacity for our clients. 173 00:08:13,800 --> 00:08:16,860 And as nurses, you know that we're always assessing, 174 00:08:16,860 --> 00:08:19,800 which has made for some pretty good clinical catches. 175 00:08:19,800 --> 00:08:21,930 Hello, postpartum high blood pressure 176 00:08:21,930 --> 00:08:23,880 is everywhere right now. 177 00:08:23,880 --> 00:08:25,380 So we've being catching those. 178 00:08:29,070 --> 00:08:32,820 The importance of maternal-child health nursing is felt 179 00:08:32,820 --> 00:08:35,880 throughout our country and it is supported 180 00:08:35,880 --> 00:08:38,280 through the Maternal, Infant and Early Childhood 181 00:08:38,280 --> 00:08:41,847 Home Visiting Grant, also known as MIECHV. 182 00:08:41,847 --> 00:08:45,000 And the MIECHV Grant funds one of our largest 183 00:08:45,000 --> 00:08:47,610 nurse home visiting programs here in Vermont. 184 00:08:47,610 --> 00:08:49,170 The Today Show aired this segment 185 00:08:49,170 --> 00:08:51,989 around five to six months ago on the impacts, 186 00:08:51,989 --> 00:08:55,500 and I really felt it demonstrated the power of what we do. 187 00:08:55,500 --> 00:08:58,737 So I wanted to share it. 188 00:08:58,737 --> 00:09:01,230 Back now, 8:15 with our What Works today. 189 00:09:01,230 --> 00:09:03,870 It's our series highlighting positive stories and people, 190 00:09:03,870 --> 00:09:05,200 people who are working hard to make a difference. 191 00:09:05,200 --> 00:09:06,600 Yeah, and this morning, 192 00:09:06,600 --> 00:09:09,810 a unique national program that's getting resources to rural 193 00:09:09,810 --> 00:09:12,240 areas where they are badly needed. 194 00:09:12,240 --> 00:09:14,310 And there's one young mother who credits it 195 00:09:14,310 --> 00:09:15,606 with saving her life. 196 00:09:15,606 --> 00:09:18,360 NBC Senior national correspondent Kate Snow has the story. 197 00:09:18,360 --> 00:09:19,380 Hi, good morning. 198 00:09:19,380 --> 00:09:21,060 Hi, nice to bring you a little good news. 199 00:09:21,060 --> 00:09:22,770 this morning on such a hard day. 200 00:09:22,770 --> 00:09:24,450 You've probably heard of a house call, right? 201 00:09:24,450 --> 00:09:26,010 Remember that when a doctor would actually 202 00:09:26,010 --> 00:09:27,930 come to your home and treat you? 203 00:09:27,930 --> 00:09:30,210 Well, this program is a similar idea, 204 00:09:30,210 --> 00:09:32,430 bringing nurses and other types of clinicians 205 00:09:32,430 --> 00:09:35,510 directly to new mothers in need. 206 00:09:35,510 --> 00:09:37,140 (ambient music) 207 00:09:37,140 --> 00:09:39,780 In a country with some of the best doctors in the world, 208 00:09:39,780 --> 00:09:42,390 new mothers sometimes struggle to find care 209 00:09:42,390 --> 00:09:43,971 for themselves and their babies. 210 00:09:43,971 --> 00:09:47,399 One report finding seven million women of childbearing age 211 00:09:47,399 --> 00:09:51,630 live where there's little to no access to maternity care. 212 00:09:51,630 --> 00:09:52,980 You see the struggles. 213 00:09:52,980 --> 00:09:56,640 So it's not always easy to be a first time mom. 214 00:09:56,640 --> 00:09:59,430 [Kate] For Debbie Brush, it's emotional to talk about. 215 00:09:59,430 --> 00:10:02,160 As a registered nurse in Spartanburg, South Carolina, 216 00:10:02,160 --> 00:10:04,135 she sees the hardship daily. 217 00:10:04,135 --> 00:10:07,170 Sometimes there are limited resources. 218 00:10:07,170 --> 00:10:09,860 Maybe being brought up in poverty already 219 00:10:09,860 --> 00:10:12,150 and not really seeing a way out. 220 00:10:12,150 --> 00:10:13,350 -Hi! -Hi, how are ya? 221 00:10:14,430 --> 00:10:16,890 [Kate] But Brush is working to break that cycle, 222 00:10:16,890 --> 00:10:20,471 spending her days making house calls to new mothers in need, 223 00:10:20,471 --> 00:10:23,190 part of a little known national initiative called 224 00:10:23,190 --> 00:10:25,380 The Maternal Infant and Early Childhood 225 00:10:25,380 --> 00:10:27,060 Home Visiting Program. 226 00:10:27,060 --> 00:10:29,400 It was created under the Affordable Care Act 227 00:10:29,400 --> 00:10:32,130 and targets vulnerable populations of women, 228 00:10:32,130 --> 00:10:34,704 including those who have little access to resources 229 00:10:34,704 --> 00:10:37,920 or may be battling things like substance use disorder 230 00:10:37,920 --> 00:10:39,076 or domestic abuse. 231 00:10:39,076 --> 00:10:43,830 We see them in their home where if they go to a doctor's 232 00:10:43,830 --> 00:10:46,098 office, they're not seeing the big picture. 233 00:10:46,098 --> 00:10:48,930 In all 50 states, a nurse or clinician 234 00:10:48,930 --> 00:10:51,150 visits first time mothers on Medicaid, 235 00:10:51,150 --> 00:10:54,090 starting from before their 28th week of pregnancy 236 00:10:54,090 --> 00:10:56,130 until their child turns two, 237 00:10:56,130 --> 00:10:59,070 a critical period in a child's development. 238 00:10:59,070 --> 00:11:01,560 How crucial are those months right before birth 239 00:11:01,560 --> 00:11:02,850 and right after birth? 240 00:11:02,850 --> 00:11:06,330 They're really crucial because the baby's brain is rapidly 241 00:11:06,330 --> 00:11:09,810 developing the foundational structures of the brain. 242 00:11:09,810 --> 00:11:11,430 Home visitors provide everything 243 00:11:11,430 --> 00:11:14,220 from general health checkups for baby and mom 244 00:11:14,220 --> 00:11:17,921 to education on breastfeeding to mental health screenings. 245 00:11:17,921 --> 00:11:21,480 Are these maybe women who wouldn't otherwise get healthcare? 246 00:11:21,480 --> 00:11:23,880 Yes, they are more likely not to get to care, 247 00:11:23,880 --> 00:11:27,575 and the home visiting professional can actually 248 00:11:27,575 --> 00:11:31,775 screen for maternal health issues too, such as depression. 249 00:11:31,775 --> 00:11:34,950 [Kate] 27 Year old Ansley Rogers enrolled in the program 250 00:11:34,950 --> 00:11:37,020 when she was pregnant with her first baby. 251 00:11:37,020 --> 00:11:39,930 She was living in Spartanburg with a supportive husband, 252 00:11:39,930 --> 00:11:43,205 but far from family and without a car, most days. 253 00:11:43,205 --> 00:11:44,834 You're home alone. 254 00:11:44,834 --> 00:11:47,880 There's no way to go anywhere. 255 00:11:47,880 --> 00:11:49,560 [Kate] Earlier this summer, she gave birth 256 00:11:49,560 --> 00:11:52,060 to a healthy baby girl, Annabelle. 257 00:11:52,060 --> 00:11:54,690 There we go. There we go. 258 00:11:54,690 --> 00:11:55,950 [Kate] But three weeks later, 259 00:11:55,950 --> 00:11:58,380 Ansley started having pain in her chest, 260 00:11:58,380 --> 00:12:00,900 so severe she could barely breathe. 261 00:12:00,900 --> 00:12:03,390 Home alone, she shrugged it off. 262 00:12:03,390 --> 00:12:05,940 I was just wishing and hoping that it was something small 263 00:12:05,940 --> 00:12:07,440 because how was I gonna go 264 00:12:07,440 --> 00:12:09,839 to the emergency room with the baby? 265 00:12:09,839 --> 00:12:12,120 [Kate] But when she told Brush about the pain, 266 00:12:12,120 --> 00:12:14,940 the nurse insisted she get to an emergency room 267 00:12:14,940 --> 00:12:17,640 where doctors gave her a frightening diagnosis. 268 00:12:17,640 --> 00:12:19,470 It was not just a blood clot, 269 00:12:19,470 --> 00:12:21,930 but blood clots in both lungs. 270 00:12:21,930 --> 00:12:24,360 [Kate] Without immediate treatment, those blood clots, 271 00:12:24,360 --> 00:12:27,483 a complication from pregnancy, could have been deadly. 272 00:12:27,483 --> 00:12:31,320 100% I think this program did save my life. 273 00:12:31,320 --> 00:12:32,775 [Kate] Now back home with her baby, 274 00:12:32,775 --> 00:12:35,126 Ansley continues to meet with Brush regularly. 275 00:12:35,126 --> 00:12:38,430 I am lucky to have a partner who is supportive 276 00:12:38,430 --> 00:12:41,946 and a lot of women are not, they are alone. 277 00:12:41,946 --> 00:12:46,346 They are possibly ignorant of a lot of things that happen 278 00:12:46,346 --> 00:12:50,730 during pregnancy and during childbirth and afterwards. 279 00:12:50,730 --> 00:12:54,093 So someone coming to you is, it's very important. 280 00:12:55,481 --> 00:12:58,920 So this program serves 70,000 families every year. 281 00:12:58,920 --> 00:13:01,200 Again, many in rural or poorer counties, 282 00:13:01,200 --> 00:13:04,080 but also in low income urban areas as well. 283 00:13:04,080 --> 00:13:07,140 It's also shown not just to improve both mom and baby's 284 00:13:07,140 --> 00:13:09,000 physical health, but also to reduce rates 285 00:13:09,000 --> 00:13:10,620 of child abuse and neglect, 286 00:13:10,620 --> 00:13:12,210 and better success when the kids 287 00:13:12,210 --> 00:13:13,770 are old enough to go to school. 288 00:13:13,770 --> 00:13:15,450 There is one issue, guys, 289 00:13:15,450 --> 00:13:18,600 which is this program could lose its federal funding. 290 00:13:18,600 --> 00:13:20,670 The hope is that Congress will reauthorize it, 291 00:13:20,670 --> 00:13:21,990 but there are no guarantees. 292 00:13:21,990 --> 00:13:24,120 And that would mean a lot of women and children in need 293 00:13:24,120 --> 00:13:25,410 could lose these resources. 294 00:13:25,410 --> 00:13:27,870 But there are some champions on Capitol Hill, 295 00:13:27,870 --> 00:13:30,690 so they're trying to work on reauthorizing the program. 296 00:13:30,690 --> 00:13:31,523 [Craig] It's a great program. 297 00:13:31,523 --> 00:13:33,510 Yeah it's such a critical time, 298 00:13:33,510 --> 00:13:36,360 and every new mom feels overwhelmed. 299 00:13:36,360 --> 00:13:38,420 But even if you have every resource available to you, 300 00:13:38,420 --> 00:13:40,230 it can be a terrifying time. 301 00:13:40,230 --> 00:13:42,810 So it's beautiful that those nurses are coming 302 00:13:42,810 --> 00:13:43,735 right where they're needed. 303 00:13:43,735 --> 00:13:45,246 -Thank you, Kate. -Such good work. 304 00:13:45,246 --> 00:13:47,213 Thank you, Kate. 305 00:13:49,123 --> 00:13:51,764 Hey, thanks for watching our YouTube channel. 306 00:13:51,764 --> 00:13:53,703 Find your favorite recipes, 307 00:13:55,740 --> 00:13:56,573 celebrity 308 00:13:58,440 --> 00:13:59,761 interviews. 309 00:13:59,761 --> 00:14:02,511 [Amy] Let's see, Al Roker doesn't wanna be my friend. 310 00:14:06,199 --> 00:14:08,130 [Reporter] Back now, 8:15. 311 00:14:08,130 --> 00:14:09,540 [Angela] Amy, Amy, this is Angela. 312 00:14:09,540 --> 00:14:12,180 If you go down below where it has the play button, 313 00:14:12,180 --> 00:14:14,430 like all as far down as you can, 314 00:14:14,430 --> 00:14:15,263 [Amy] Yup? 315 00:14:15,263 --> 00:14:18,660 [Angela] Below that, try to click to go to the 316 00:14:18,660 --> 00:14:20,499 -next slide. -[Reporter] today it's, 317 00:14:20,499 --> 00:14:21,499 [Amy] Hmm. 318 00:14:22,397 --> 00:14:24,030 See if it'll let me. 319 00:14:24,030 --> 00:14:26,229 [Reporter] Series highlight. 320 00:14:26,229 --> 00:14:28,909 [Amy] No. 321 00:14:28,909 --> 00:14:31,211 Maybe if I stop sharing and come back. 322 00:14:31,211 --> 00:14:32,710 [Angela] Come back, maybe try to do that, yep. 323 00:14:32,710 --> 00:14:33,793 [Amy] Okay. 324 00:14:37,097 --> 00:14:42,097 I can do that. 325 00:14:42,959 --> 00:14:43,797 Nope. 326 00:14:43,797 --> 00:14:46,500 Highlighting positive stories and people, 327 00:14:46,500 --> 00:14:48,150 people who are working. 328 00:14:48,150 --> 00:14:49,050 [Amy] Hmm. 329 00:14:49,050 --> 00:14:51,180 [Angela] Can you minimize that a little bit, Amy? 330 00:14:51,180 --> 00:14:53,970 And then see if you can see your next slide button, 331 00:14:53,970 --> 00:14:55,200 instead of going full screen? 332 00:14:55,200 --> 00:14:56,200 [Amy] There we go. 333 00:14:57,097 --> 00:14:59,872 All right, thanks. 334 00:14:59,872 --> 00:15:01,710 You know, technology, 335 00:15:01,710 --> 00:15:03,000 I'm a great nurse. 336 00:15:03,000 --> 00:15:04,353 Technology is not my thing. 337 00:15:06,060 --> 00:15:08,100 So that was pretty powerful. 338 00:15:08,100 --> 00:15:11,400 And I really liked how Savannah Guthrie there 339 00:15:11,400 --> 00:15:14,430 really recognized how this is such a critical time 340 00:15:14,430 --> 00:15:18,112 for women and families, and even when someone has 341 00:15:18,112 --> 00:15:21,840 all the resources available to them, 342 00:15:21,840 --> 00:15:25,860 this time can feel really terrifying and overwhelming. 343 00:15:25,860 --> 00:15:29,340 The best news is that we have these programs here 344 00:15:29,340 --> 00:15:32,340 and they are available in every county in Vermont. 345 00:15:32,340 --> 00:15:35,370 Our MIECHV nurse home visiting program is even more 346 00:15:35,370 --> 00:15:39,090 progressive in that we can enroll both first time mothers 347 00:15:39,090 --> 00:15:42,690 and those with any number of subsequent pregnancies anytime 348 00:15:42,690 --> 00:15:46,298 prenatally and up to six weeks postpartum. 349 00:15:46,298 --> 00:15:49,200 The maternal-child health nurses here in Vermont 350 00:15:49,200 --> 00:15:51,720 are specially trained to care for pregnant 351 00:15:51,720 --> 00:15:56,040 and postpartum women and families with substance misuse 352 00:15:56,040 --> 00:15:59,100 and to help them learn how to care for their babies. 353 00:15:59,100 --> 00:16:02,220 Our MIECHV programs are voluntary and they're free 354 00:16:02,220 --> 00:16:06,180 for all of our clients, and our programs have us 355 00:16:06,180 --> 00:16:08,100 in the home until the child turns two, 356 00:16:08,100 --> 00:16:13,100 which really helps that consistency and longevity. 357 00:16:17,280 --> 00:16:19,710 What the nurse in the Today Show clip also said 358 00:16:19,710 --> 00:16:22,080 was about how the nurse home visitors 359 00:16:22,080 --> 00:16:23,700 see that bigger picture. 360 00:16:23,700 --> 00:16:27,150 It is so important and it really encapsulates 361 00:16:27,150 --> 00:16:30,420 what really makes that home visiting unique. 362 00:16:30,420 --> 00:16:33,090 We work kind of beyond the clinical lens. 363 00:16:33,090 --> 00:16:36,840 We know that pregnant and postpartum people 364 00:16:36,840 --> 00:16:39,300 in general are not always held in a way 365 00:16:39,300 --> 00:16:42,120 that meets their needs during this really special 366 00:16:42,120 --> 00:16:44,370 and very vulnerable time in life. 367 00:16:44,370 --> 00:16:46,090 We also acknowledge 368 00:16:47,749 --> 00:16:51,000 that our clients who have substance use disorder 369 00:16:51,000 --> 00:16:53,190 need different care. 370 00:16:53,190 --> 00:16:56,280 And unfortunately the system that we live and work in 371 00:16:56,280 --> 00:16:58,590 is not always set up to care for these families 372 00:16:58,590 --> 00:17:03,000 in a way that they need or really the way they deserve. 373 00:17:03,000 --> 00:17:05,520 Some of our families have very complex issues 374 00:17:05,520 --> 00:17:07,077 coming into pregnancy, 375 00:17:07,077 --> 00:17:10,740 and their substance misuse is just part of that. 376 00:17:10,740 --> 00:17:14,370 These individuals often know the system better than we do, 377 00:17:14,370 --> 00:17:15,870 and they can be guarded, 378 00:17:15,870 --> 00:17:19,350 mistrustful and scared about what's going to happen 379 00:17:19,350 --> 00:17:21,906 to them and their baby. 380 00:17:21,906 --> 00:17:25,950 And this creates a barrier for them and their care. 381 00:17:25,950 --> 00:17:30,060 However, we also know that the touchpoint of pregnancy 382 00:17:30,060 --> 00:17:34,053 is wide open and that is a huge opportunity. 383 00:17:35,280 --> 00:17:38,430 If that touchpoint is supported in a way 384 00:17:38,430 --> 00:17:40,583 that a pregnant person needs, 385 00:17:40,583 --> 00:17:43,593 it can be a turning point in that person's life. 386 00:17:47,280 --> 00:17:49,080 If you've ever heard me speak before, 387 00:17:49,080 --> 00:17:51,630 you've heard me talk about my client Jane. 388 00:17:51,630 --> 00:17:53,400 And Jane was my client who had 389 00:17:53,400 --> 00:17:56,070 a very complex social situation. 390 00:17:56,070 --> 00:17:59,880 She maintained her MAT with each of her pregnancies, 391 00:17:59,880 --> 00:18:02,970 but would stop it within the first year postpartum. 392 00:18:02,970 --> 00:18:05,370 She could not keep up with all the expectations 393 00:18:05,370 --> 00:18:07,651 of her clinic and all of the other services 394 00:18:07,651 --> 00:18:09,810 that she was enrolled in. 395 00:18:09,810 --> 00:18:11,970 And this was in hopes of reunification 396 00:18:11,970 --> 00:18:14,640 with her children one day, which she could not do 397 00:18:14,640 --> 00:18:17,100 because she could not maintain her MAT, 398 00:18:17,100 --> 00:18:18,930 because she could not meet the expectations 399 00:18:18,930 --> 00:18:21,662 of all of her program, or even just simply make it back 400 00:18:21,662 --> 00:18:26,662 in time to DCF in order to see her kids, 401 00:18:26,730 --> 00:18:31,170 or hold a job or, the list just goes on and on. 402 00:18:31,170 --> 00:18:34,050 The amount of work and travel that she had to do 403 00:18:34,050 --> 00:18:37,800 just to maintain her services and her providers, 404 00:18:37,800 --> 00:18:41,640 each with their own expectations, caused Jane to fail 405 00:18:41,640 --> 00:18:44,311 because she simply just couldn't do it, 406 00:18:44,311 --> 00:18:46,830 especially in the immediate postpartum. 407 00:18:46,830 --> 00:18:50,073 This chaotic diagram here shows the services 408 00:18:50,073 --> 00:18:53,100 or service providers that Jane had. 409 00:18:53,100 --> 00:18:55,980 She and I did a map of her visits 410 00:18:55,980 --> 00:18:58,170 with her different providers for the first six weeks 411 00:18:58,170 --> 00:19:00,410 after her baby was born. 412 00:19:00,410 --> 00:19:04,920 And we found that she had 55 visits 413 00:19:04,920 --> 00:19:07,860 within those first six weeks postpartum. 414 00:19:07,860 --> 00:19:10,200 And she lives in east Vermont. 415 00:19:10,200 --> 00:19:13,770 So that's hundreds if not thousands of miles 416 00:19:13,770 --> 00:19:15,966 just to get there from there. 417 00:19:15,966 --> 00:19:19,455 And anyone who's ever had a baby or been a partner 418 00:19:19,455 --> 00:19:21,570 of someone who has just had a baby, 419 00:19:21,570 --> 00:19:24,390 you will feel the inhumanity of this. 420 00:19:24,390 --> 00:19:27,120 I know for me it was just hard enough to get a shower, 421 00:19:27,120 --> 00:19:28,975 let alone leave my house. 422 00:19:28,975 --> 00:19:31,500 And Jane is not alone. 423 00:19:31,500 --> 00:19:35,195 This is the system that so many of our patients 424 00:19:35,195 --> 00:19:37,710 and our clients live in every day. 425 00:19:37,710 --> 00:19:40,920 It's not equitable, it's not family centered. 426 00:19:40,920 --> 00:19:43,803 And for people like Jane, it sets them up to fail. 427 00:19:45,030 --> 00:19:47,730 Our clients and our babies deserve better than this. 428 00:19:47,730 --> 00:19:51,240 And where nurse home visiting and all of the wonderful 429 00:19:51,240 --> 00:19:54,660 programs in our community can have an impact, we really do. 430 00:19:54,660 --> 00:19:56,070 We need to go way upstream 431 00:19:56,070 --> 00:19:57,903 in order to really fix the system. 432 00:20:00,990 --> 00:20:03,772 However, we can shape the trajectory 433 00:20:03,772 --> 00:20:08,040 and we can make ripples in our patients' lives. 434 00:20:08,040 --> 00:20:11,430 One of my wonderful nurses was graduating one of her clients 435 00:20:11,430 --> 00:20:13,963 after being with them for two and a half years, 436 00:20:13,963 --> 00:20:16,764 a mama with a complex social history, 437 00:20:16,764 --> 00:20:19,050 including substance use. 438 00:20:19,050 --> 00:20:21,660 And she had preterm twins. 439 00:20:21,660 --> 00:20:23,860 One was born with a congenital heart defect. 440 00:20:25,080 --> 00:20:27,617 When the nurse started working with this mom, 441 00:20:27,617 --> 00:20:30,660 she was really able to develop a strong connection, 442 00:20:30,660 --> 00:20:32,160 strong rapport. 443 00:20:32,160 --> 00:20:34,182 She not only took care of the boys clinically, 444 00:20:34,182 --> 00:20:37,860 but she recognized the signs of postpartum depression 445 00:20:37,860 --> 00:20:41,070 and anxiety that this mom was experiencing. 446 00:20:41,070 --> 00:20:44,190 And so when she screened her, 447 00:20:44,190 --> 00:20:46,890 this mom disclosed her suicidality 448 00:20:46,890 --> 00:20:49,833 amongst several other issues that she was experiencing. 449 00:20:50,760 --> 00:20:53,520 My nurse shared this sentiment with me 450 00:20:53,520 --> 00:20:57,510 after she had left that home for the last time, 451 00:20:57,510 --> 00:21:00,900 and not only did it make me very proud of my nurse, 452 00:21:00,900 --> 00:21:04,350 but it shows the kind of connection that nurses have 453 00:21:04,350 --> 00:21:07,230 with their clients and how this nurse impacted 454 00:21:07,230 --> 00:21:10,200 this mom's life and the life of her children. 455 00:21:10,200 --> 00:21:14,190 This is something this mom will take forward with her. 456 00:21:14,190 --> 00:21:18,226 And especially to be put at the same level as Mary Poppins, 457 00:21:18,226 --> 00:21:21,153 now that's really a whole new plane of awesome. 458 00:21:24,660 --> 00:21:27,984 But Mary Poppins, really is that who we are? 459 00:21:27,984 --> 00:21:31,354 I mean, we do carry really large bags full 460 00:21:31,354 --> 00:21:34,200 of just about anything you can think of, 461 00:21:34,200 --> 00:21:37,050 but are we practically perfect in every way? 462 00:21:37,050 --> 00:21:39,180 Nope, not in this business. 463 00:21:39,180 --> 00:21:41,940 Not every family is going to have a happy ending, 464 00:21:41,940 --> 00:21:44,276 and we may never see that ripple 465 00:21:44,276 --> 00:21:46,830 that we made with that family. 466 00:21:46,830 --> 00:21:49,290 And trust me, there are plenty of people out there 467 00:21:49,290 --> 00:21:51,780 who would like to tell us to go to go fly a kite, 468 00:21:51,780 --> 00:21:54,600 and not in that fun Poppins way. 469 00:21:54,600 --> 00:21:55,953 But stay with me here. 470 00:21:57,060 --> 00:21:59,250 There are lessons in Mary Poppins 471 00:21:59,250 --> 00:22:02,013 that do inform our home visiting practice. 472 00:22:06,450 --> 00:22:09,376 So where we're not practically perfect in every way, 473 00:22:09,376 --> 00:22:13,320 we are practically useful in many ways. 474 00:22:13,320 --> 00:22:15,540 We always bring our clinical nursing practice 475 00:22:15,540 --> 00:22:18,630 for both mother and baby where it is needed. 476 00:22:18,630 --> 00:22:20,520 That is part of what we do. 477 00:22:20,520 --> 00:22:23,550 We do screenings for perinatal mood and anxiety disorder, 478 00:22:23,550 --> 00:22:27,120 social determinants, intimate partner violence and the like. 479 00:22:27,120 --> 00:22:30,000 But we also know that we cannot solve all the issues 480 00:22:30,000 --> 00:22:32,460 and all the trauma and all the history 481 00:22:32,460 --> 00:22:34,740 that our clients are experiencing. 482 00:22:34,740 --> 00:22:37,302 We are not always the right people to do so. 483 00:22:37,302 --> 00:22:40,410 We help by bridging our clients to the experts 484 00:22:40,410 --> 00:22:43,290 in the field that can help them on a larger level, 485 00:22:43,290 --> 00:22:45,000 such as finding them housing, 486 00:22:45,000 --> 00:22:47,250 connecting them with mental health clinicians 487 00:22:49,800 --> 00:22:52,320 or a baby with early intervention. 488 00:22:52,320 --> 00:22:55,860 And we help by breaking down those big things into smaller, 489 00:22:55,860 --> 00:22:57,600 more manageable ones. 490 00:22:57,600 --> 00:23:00,000 We help them fill out applications or refer them 491 00:23:00,000 --> 00:23:01,713 to another community support. 492 00:23:02,820 --> 00:23:06,000 We hold their space in this way so that we can 493 00:23:06,000 --> 00:23:09,180 open the doors for clients to focus on their health, 494 00:23:09,180 --> 00:23:10,920 their pregnancies, their babies, 495 00:23:10,920 --> 00:23:13,950 and what they would like for their families in the future. 496 00:23:13,950 --> 00:23:15,990 Because here's the thing, 497 00:23:15,990 --> 00:23:19,200 we know that babies cannot wait for everything to be solved 498 00:23:19,200 --> 00:23:23,220 so their parents can be ready to focus on their development. 499 00:23:23,220 --> 00:23:25,050 Some of those things could take years. 500 00:23:25,050 --> 00:23:28,830 Some of those things may never be able to be solved. 501 00:23:28,830 --> 00:23:32,220 We know that babies' brains are developing so rapidly 502 00:23:32,220 --> 00:23:34,550 and so critically in those first few years 503 00:23:34,550 --> 00:23:38,096 that sometimes focusing on what they can do 504 00:23:38,096 --> 00:23:42,749 for their baby right now with their time, 505 00:23:42,749 --> 00:23:46,980 instead of what they cannot do, can be very empowering. 506 00:23:46,980 --> 00:23:48,900 Even when going through life stressors 507 00:23:48,900 --> 00:23:50,703 or when things don't feel very good. 508 00:23:52,437 --> 00:23:55,996 Just a spoon full of sugar helps the medicine go down. 509 00:23:55,996 --> 00:23:59,700 All of our practice is trauma informed of course, 510 00:23:59,700 --> 00:24:02,645 and it's very strength-based with a focus on empathy 511 00:24:02,645 --> 00:24:05,556 and continuing to build connections 512 00:24:05,556 --> 00:24:09,150 and consistently showing up and creating a safe space 513 00:24:09,150 --> 00:24:13,165 for our clients to be who they are is our goal. 514 00:24:13,165 --> 00:24:18,165 We had a client once who had a setback in her MAT program. 515 00:24:19,110 --> 00:24:21,417 We knew that she hadn't been to her clinic in some time, 516 00:24:21,417 --> 00:24:24,690 but she was not at a place where she was ready 517 00:24:24,690 --> 00:24:26,523 to disclose that to her nurse. 518 00:24:27,480 --> 00:24:31,020 She began canceling her home visits and kind of 519 00:24:31,020 --> 00:24:34,276 avoiding our phone calls. 520 00:24:34,276 --> 00:24:37,920 But when we were finally able to go see her, 521 00:24:37,920 --> 00:24:40,410 we could see that she was visibly struggling. 522 00:24:40,410 --> 00:24:44,550 So when we finally were able to kind of have that 523 00:24:44,550 --> 00:24:46,740 sit down conversation with her, 524 00:24:46,740 --> 00:24:49,770 we let her know that we saw her and we saw 525 00:24:49,770 --> 00:24:53,220 that she was struggling and that we were thinking about her. 526 00:24:53,220 --> 00:24:56,340 And although she didn't disclose at that visit 527 00:24:56,340 --> 00:24:58,860 with the nurse, it was not long after that 528 00:24:58,860 --> 00:25:01,500 that she called her nurse and disclosed 529 00:25:01,500 --> 00:25:03,900 what was going on and we were really able 530 00:25:03,900 --> 00:25:05,763 to get her some good assistance. 531 00:25:06,630 --> 00:25:10,065 My favorite saying is, disclosure is always a gift, 532 00:25:10,065 --> 00:25:12,180 but it's never the goal. 533 00:25:12,180 --> 00:25:14,184 Substance misuse is a chronic disease 534 00:25:14,184 --> 00:25:16,800 and a lifelong process. 535 00:25:16,800 --> 00:25:19,050 The gift of disclosure takes time, 536 00:25:19,050 --> 00:25:21,030 connection and a whole lot of courage 537 00:25:21,030 --> 00:25:24,120 on the part of the client. 538 00:25:24,120 --> 00:25:28,950 But it also means that they're asking for help. 539 00:25:28,950 --> 00:25:30,690 And for many of our families, 540 00:25:30,690 --> 00:25:33,413 that's the most dangerous and vulnerable 541 00:25:33,413 --> 00:25:35,403 space for them to be in. 542 00:25:35,403 --> 00:25:38,283 And you know, a little love goes a long way. 543 00:25:40,207 --> 00:25:43,500 "In every job that must be done, there's an element of fun." 544 00:25:43,500 --> 00:25:46,440 It's not all serious or didactic. 545 00:25:46,440 --> 00:25:48,960 We teach our patients 546 00:25:48,960 --> 00:25:51,900 about their babies' development through play. 547 00:25:51,900 --> 00:25:56,520 We do belly castings, we bring in fun crafts, we get messy. 548 00:25:56,520 --> 00:25:59,755 We model healthy play because for some of our families, 549 00:25:59,755 --> 00:26:03,390 play is a struggle and they may not have learned 550 00:26:03,390 --> 00:26:07,110 in their own childhood how to play in a really safe way. 551 00:26:07,110 --> 00:26:10,260 So we show them how and we create a safe space for them 552 00:26:10,260 --> 00:26:12,877 to learn and make positive memories with their babies. 553 00:26:12,877 --> 00:26:16,560 I have a client who, when I call to confirm my visit, 554 00:26:16,560 --> 00:26:19,470 loves to remind me what holiday or season it is 555 00:26:19,470 --> 00:26:22,063 and their ideas for the paintings that we're gonna do 556 00:26:22,063 --> 00:26:24,510 and what color paints I should bring. 557 00:26:24,510 --> 00:26:27,930 And it's something that she and I really look forward to. 558 00:26:27,930 --> 00:26:32,010 And we use that time and she catches me up 559 00:26:32,010 --> 00:26:35,490 on all of what her baby has done since I was there last. 560 00:26:35,490 --> 00:26:38,370 And this client has this huge wall in her home 561 00:26:38,370 --> 00:26:40,260 that's just covered in all these paintings, 562 00:26:40,260 --> 00:26:43,443 and it's really special to me and it's really cute. 563 00:26:46,050 --> 00:26:48,810 And anything can happen if you let it. 564 00:26:48,810 --> 00:26:50,340 Nurse home visiting is a great place 565 00:26:50,340 --> 00:26:52,950 for pregnant and postpartum people to get a full spectrum 566 00:26:52,950 --> 00:26:56,130 of care and community supports and resources. 567 00:26:56,130 --> 00:26:59,040 For those who have perinatal substance misuse, 568 00:26:59,040 --> 00:27:01,650 there's that clinical piece that we as nurses 569 00:27:01,650 --> 00:27:04,010 are trained to serve really well. 570 00:27:04,010 --> 00:27:06,510 But we're not alone in our commitment 571 00:27:06,510 --> 00:27:08,310 in the perinatal community, 572 00:27:08,310 --> 00:27:10,650 especially through children's integrated services, 573 00:27:10,650 --> 00:27:14,220 our parent-child centers, and the Department of Health. 574 00:27:14,220 --> 00:27:18,870 When a pregnant person engages with one community service, 575 00:27:18,870 --> 00:27:22,061 it opens up a whole village of perinatal 576 00:27:22,061 --> 00:27:25,320 supports and services for them. 577 00:27:25,320 --> 00:27:28,170 We all sit together in many different spaces, 578 00:27:28,170 --> 00:27:31,920 including our local charm or charm adjacent teams, 579 00:27:31,920 --> 00:27:33,450 our child protective teams. 580 00:27:33,450 --> 00:27:35,790 We connect with your OBs, the pediatricians, 581 00:27:35,790 --> 00:27:38,631 care coordinators, and we work together 582 00:27:38,631 --> 00:27:41,541 to wrap our clients so they have the best chance 583 00:27:41,541 --> 00:27:44,820 and the best supports possible in their own community. 584 00:27:44,820 --> 00:27:48,090 Honestly, sitting with these teams makes me very proud 585 00:27:48,090 --> 00:27:50,463 to do the work that we get to do every day. 586 00:27:53,040 --> 00:27:56,882 Okay, so I bet some of you are saying, wow Amy, 587 00:27:56,882 --> 00:28:00,729 this sounds wonderful for my prenatal or postpartum clients 588 00:28:00,729 --> 00:28:02,942 with substance use disorder. 589 00:28:02,942 --> 00:28:05,220 How do I make a referral? 590 00:28:05,220 --> 00:28:08,515 Well, that's a great question, I'd love to tell you. 591 00:28:08,515 --> 00:28:11,850 Anyone can refer their patients to have 592 00:28:11,850 --> 00:28:13,470 their very own nurse home visitor 593 00:28:13,470 --> 00:28:15,835 throughout their pregnancy or postpartum journey. 594 00:28:15,835 --> 00:28:18,433 It is already here in their community waiting for them 595 00:28:18,433 --> 00:28:22,110 as well as several other community-based programs. 596 00:28:22,110 --> 00:28:24,114 And the Icon team will be sending out specifics 597 00:28:24,114 --> 00:28:27,480 on how to refer in whatever areas you serve 598 00:28:27,480 --> 00:28:28,773 after this conference. 599 00:28:30,570 --> 00:28:33,840 How you talk to your patient or client about the referrals 600 00:28:33,840 --> 00:28:35,460 makes a big difference. 601 00:28:35,460 --> 00:28:39,720 And we found that when the provider recommends a referral 602 00:28:39,720 --> 00:28:43,833 to nurse home visiting or to another community support, 603 00:28:43,833 --> 00:28:46,980 the rates of engagement are higher. 604 00:28:46,980 --> 00:28:50,040 In Franklin Grand Isle County, we found that when providers 605 00:28:50,040 --> 00:28:53,460 were trying to tell their patients or clients 606 00:28:53,460 --> 00:28:55,950 on the many different community programs 607 00:28:55,950 --> 00:28:59,564 and trying to remember all the specifics on them, 608 00:28:59,564 --> 00:29:02,403 where to send the referral, how to refer, 609 00:29:04,418 --> 00:29:06,940 and really ask their patient 610 00:29:08,640 --> 00:29:13,500 what program they wanted them to be sent to, 611 00:29:13,500 --> 00:29:16,590 it became to be overwhelming. 612 00:29:16,590 --> 00:29:19,127 And we found that it doesn't work, 613 00:29:19,127 --> 00:29:22,170 and most clients are declining. 614 00:29:22,170 --> 00:29:25,650 But when we flipped the script from an opt in to a program 615 00:29:25,650 --> 00:29:28,320 at that time to what we call an opt out, 616 00:29:28,320 --> 00:29:31,830 we found more families are saying yes, they are interested. 617 00:29:31,830 --> 00:29:35,070 And whether it's a nurse home visitor, a doula, 618 00:29:35,070 --> 00:29:37,733 a CIS coordinator who calls them 619 00:29:37,733 --> 00:29:40,050 to talk to them about the program, 620 00:29:40,050 --> 00:29:43,170 they're accepting services to not just one, 621 00:29:43,170 --> 00:29:46,650 but multiple perinatal resources in their community. 622 00:29:46,650 --> 00:29:48,750 So instead of asking your clients, 623 00:29:48,750 --> 00:29:52,170 would you like to be in a certain program or programs, 624 00:29:52,170 --> 00:29:53,430 own our programs with us. 625 00:29:53,430 --> 00:29:56,550 We're an extension of whatever practice 626 00:29:56,550 --> 00:29:58,860 you're in in our community. 627 00:29:58,860 --> 00:30:02,227 So say something similar to this, 628 00:30:02,227 --> 00:30:04,290 "We are so lucky here in Vermont. 629 00:30:04,290 --> 00:30:07,200 We have a great extended community of nurse home visitors 630 00:30:07,200 --> 00:30:08,730 that will come and help you get ready 631 00:30:08,730 --> 00:30:11,640 to have your baby and support you after. 632 00:30:11,640 --> 00:30:14,130 They can get you connected to many resources 633 00:30:14,130 --> 00:30:16,500 and are specially trained to care for you. 634 00:30:16,500 --> 00:30:17,550 I really recommend it. 635 00:30:17,550 --> 00:30:19,600 I'm gonna make a referral for you, okay?" 636 00:30:21,630 --> 00:30:22,800 Can they decline? 637 00:30:22,800 --> 00:30:25,150 Absolutely, we're not taking away autonomy. 638 00:30:25,150 --> 00:30:27,840 Could they decline the person that calls and explains 639 00:30:27,840 --> 00:30:29,520 what the community can offer them? 640 00:30:29,520 --> 00:30:30,462 Absolutely. 641 00:30:30,462 --> 00:30:34,560 But you're also not asking them to commit to any one thing. 642 00:30:34,560 --> 00:30:37,803 And like I said, everything is voluntary. 643 00:30:38,937 --> 00:30:43,937 And we do that so things do not become very overwhelming. 644 00:30:44,501 --> 00:30:47,000 We in the community are always looking for ways 645 00:30:47,000 --> 00:30:49,831 to make referrals as easy as we can for the systems 646 00:30:49,831 --> 00:30:52,759 that we share our clients with. 647 00:30:52,759 --> 00:30:56,010 This work is hard and can break your heart, 648 00:30:56,010 --> 00:30:59,011 and will break your heart in a million different ways. 649 00:30:59,011 --> 00:31:02,961 And this is because we're all human and we all care so much. 650 00:31:02,961 --> 00:31:06,120 There's so many opportunities to make it better and more 651 00:31:06,120 --> 00:31:09,900 cohesive for our perinatal people with substance misuse. 652 00:31:09,900 --> 00:31:12,360 Please always feel free to reach out and let us know 653 00:31:12,360 --> 00:31:13,893 how we can support you. 654 00:31:15,210 --> 00:31:16,043 Thank you. 655 00:31:20,280 --> 00:31:21,633 And now back to Katy. 656 00:31:23,670 --> 00:31:24,960 [Katy] Well, it's now back to me. 657 00:31:24,960 --> 00:31:26,100 I would love to hear from Heidi 658 00:31:26,100 --> 00:31:28,115 and Kat if she feels comfortable. 659 00:31:28,115 --> 00:31:30,600 Heidi, you wanna take it away and just talk 660 00:31:30,600 --> 00:31:32,200 a little bit about the programs? 661 00:31:34,920 --> 00:31:36,510 You're on mute. (laughs) 662 00:31:36,510 --> 00:31:37,710 [Heidi] I just saw that. 663 00:31:37,710 --> 00:31:40,470 One of the things from the video that I just wanna make sure 664 00:31:40,470 --> 00:31:44,131 we highlight is that we're really fortunate here in Vermont 665 00:31:44,131 --> 00:31:47,760 to have programs that encompass all of our mothers. 666 00:31:47,760 --> 00:31:51,419 Like the programs specifically talked about 28 weeks, 667 00:31:51,419 --> 00:31:55,020 getting them by 28 weeks for first time moms only. 668 00:31:55,020 --> 00:31:58,950 And in Vermont we serve, and Amy did mention this, 669 00:31:58,950 --> 00:32:01,915 but we serve moms in any parity. 670 00:32:01,915 --> 00:32:05,370 One of the things that is so important to recognize 671 00:32:05,370 --> 00:32:08,550 is that the statement we use is risk is not static, right? 672 00:32:08,550 --> 00:32:11,010 First time moms are not the only ones at risk. 673 00:32:11,010 --> 00:32:15,000 Any mom, any time, any situation 674 00:32:15,000 --> 00:32:17,580 can be at risk, and need this extra support. 675 00:32:17,580 --> 00:32:20,539 And so what we want the word to be is there is no one 676 00:32:20,539 --> 00:32:23,943 who nurse home visiting can't touch. 677 00:32:25,230 --> 00:32:27,584 Strong Families Vermont is specific to pregnancy 678 00:32:27,584 --> 00:32:29,250 through six weeks postpartum, 679 00:32:29,250 --> 00:32:32,133 but we also have CIS nursing and MCH nursing 680 00:32:32,133 --> 00:32:35,820 that encompasses moms in any stage of life 681 00:32:35,820 --> 00:32:38,700 with their children who need extra support. 682 00:32:38,700 --> 00:32:41,640 And the same referral will get you in touch 683 00:32:41,640 --> 00:32:43,254 with any of those nurses. 684 00:32:43,254 --> 00:32:45,783 So I just wanna make sure we highlight that. 685 00:32:46,783 --> 00:32:48,510 And just to let you know, just to reach out, 686 00:32:48,510 --> 00:32:50,340 I have kind of a connection story. 687 00:32:50,340 --> 00:32:53,003 We talk about referrals, any door, 688 00:32:53,003 --> 00:32:55,620 there's no wrong door for referrals. 689 00:32:55,620 --> 00:32:59,280 And I just had this most amazing referral come into me 690 00:32:59,280 --> 00:33:02,730 that a mom actually had a friend who she knew 691 00:33:02,730 --> 00:33:06,720 had a nurse home visitor and she wanted something similar. 692 00:33:06,720 --> 00:33:09,242 Somehow she wasn't getting connected through her physician, 693 00:33:09,242 --> 00:33:11,213 through other resources. 694 00:33:11,213 --> 00:33:13,590 So she started searching and reached out 695 00:33:13,590 --> 00:33:17,044 and found this MECSH program on the computer 696 00:33:17,044 --> 00:33:20,862 that sounded like the thing that her friend had. 697 00:33:20,862 --> 00:33:23,490 And so she emailed this MECSH program 698 00:33:23,490 --> 00:33:25,620 and in a roundabout sort of way, 699 00:33:25,620 --> 00:33:28,335 this email got back to me and she had actually emailed 700 00:33:28,335 --> 00:33:33,335 Australia, which is where the MECSH program originated. 701 00:33:34,200 --> 00:33:36,900 And the people in Australia saw where her email 702 00:33:36,900 --> 00:33:39,450 had come from and the county she was in 703 00:33:39,450 --> 00:33:42,660 and got it back to us here in the States so that I could 704 00:33:42,660 --> 00:33:46,003 then reach out to this mom and offer her our programs. 705 00:33:46,003 --> 00:33:49,650 And it just to me is just the most amazing example 706 00:33:49,650 --> 00:33:53,190 of the fact that there truly is no wrong door. 707 00:33:53,190 --> 00:33:56,693 Reach out, ask for programs and somebody somehow 708 00:33:56,693 --> 00:34:00,030 will get that connection back to the right place 709 00:34:00,030 --> 00:34:03,180 so that we can serve these families that need these programs 710 00:34:03,180 --> 00:34:05,105 and resources so desperately. 711 00:34:05,105 --> 00:34:07,800 So just use that as an encouragement 712 00:34:07,800 --> 00:34:10,402 that you can't reach out the wrong way. 713 00:34:10,402 --> 00:34:12,780 There's always gonna get back to us and we're gonna 714 00:34:12,780 --> 00:34:14,373 be able to serve these moms. 715 00:34:16,620 --> 00:34:19,260 I guess, I don't know, unless there's questions? 716 00:34:19,260 --> 00:34:20,490 I think Amy covered it so well. 717 00:34:20,490 --> 00:34:22,440 I would love for Kat to talk a little bit 718 00:34:22,440 --> 00:34:27,440 about how substance use disorder is in Bennington County, 719 00:34:27,630 --> 00:34:28,500 'cause it is a little, 720 00:34:28,500 --> 00:34:31,740 we have the Strong Families Vermont program and we do 721 00:34:31,740 --> 00:34:33,990 all of the same programs, but they have a little bit 722 00:34:33,990 --> 00:34:37,080 of a different way that she connects with moms 723 00:34:37,080 --> 00:34:39,685 that need support and that's we why we invited Kat 724 00:34:39,685 --> 00:34:41,940 to come in, and Kat, you should introduce yourself 725 00:34:41,940 --> 00:34:44,280 'cause we didn't do a proper introduction. 726 00:34:44,280 --> 00:34:45,810 [Kat] So I'm Kat Blanchard. 727 00:34:45,810 --> 00:34:49,560 I'm the maternal-child health nurse in Bennington County 728 00:34:49,560 --> 00:34:52,589 as well as the Strong Families Responsive. 729 00:34:52,589 --> 00:34:54,630 I think I said that right? 730 00:34:54,630 --> 00:34:59,460 And CIS nurse for Bennington County. 731 00:34:59,460 --> 00:35:02,641 So in Bennington, at our hospital here, 732 00:35:02,641 --> 00:35:06,540 a program was developed called the Safe Arms Program, 733 00:35:06,540 --> 00:35:11,400 which encompasses all women that are pregnant 734 00:35:11,400 --> 00:35:14,010 and have a substance use disorder. 735 00:35:14,010 --> 00:35:16,710 And when they do have their baby, 736 00:35:16,710 --> 00:35:21,090 it generates several automatic referrals. 737 00:35:21,090 --> 00:35:24,614 So they automatically make a plan with their pediatrician 738 00:35:24,614 --> 00:35:27,843 that they'll go see them once a week for six weeks. 739 00:35:29,130 --> 00:35:31,770 There's an automatic early intervention referral 740 00:35:31,770 --> 00:35:34,980 for assessment and then there's an automatic 741 00:35:34,980 --> 00:35:39,722 visiting nurse referral for them to see a nurse, which, 742 00:35:39,722 --> 00:35:42,003 it's always me at this point, 743 00:35:43,170 --> 00:35:47,220 once a week for six weeks minimum on the opposite end 744 00:35:47,220 --> 00:35:49,260 of their doctor's appointment. 745 00:35:49,260 --> 00:35:52,290 So really wraparound services for those families. 746 00:35:52,290 --> 00:35:56,431 And you know, when I started doing this 10 years ago, 747 00:35:56,431 --> 00:36:01,130 I had a much higher rate of home not found or not taken up. 748 00:36:01,130 --> 00:36:05,160 But now that I've been established in this community, 749 00:36:05,160 --> 00:36:07,980 it's next to nothing. 750 00:36:07,980 --> 00:36:11,100 Almost every referral accepts visiting nurses 751 00:36:11,100 --> 00:36:15,588 and it's great, I've evolved as a nurse in my own view 752 00:36:15,588 --> 00:36:17,643 on substance use disorder. 753 00:36:19,675 --> 00:36:23,617 And actually, separate from my professional role, 754 00:36:23,617 --> 00:36:26,217 my husband and I adopted a baby that was born 755 00:36:26,217 --> 00:36:28,470 to a mother of substance use disorder. 756 00:36:28,470 --> 00:36:31,950 So I've lived it in my own personal life 757 00:36:31,950 --> 00:36:34,590 and I'm very passionate about it 758 00:36:34,590 --> 00:36:38,085 and I love the conversations today around the stigma 759 00:36:38,085 --> 00:36:41,902 and the wording around referrals. 760 00:36:41,902 --> 00:36:44,580 But I don't know if anybody has any questions 761 00:36:44,580 --> 00:36:46,777 for the way we do things here in Bennington. 762 00:36:46,777 --> 00:36:50,670 I know we're getting close to 10 o'clock, so. 763 00:36:50,670 --> 00:36:52,717 [Katy] Yeah, we do have a couple hands up, 764 00:36:52,717 --> 00:36:55,140 so we have about five minutes left, 765 00:36:55,140 --> 00:36:56,790 just to time check for everybody. 766 00:36:56,790 --> 00:36:59,703 So Marge, do you wanna ask your question? 767 00:37:01,140 --> 00:37:02,940 [Marge] Yeah, and I just wanted, you know, thanks, 768 00:37:02,940 --> 00:37:07,699 that was an awesome presentation and I just wanna emphasize 769 00:37:07,699 --> 00:37:11,160 the pluses and the minuses of the no wrong doors. 770 00:37:11,160 --> 00:37:14,291 I go around the state, the no wrong door, 771 00:37:14,291 --> 00:37:17,430 the flip side of that is that there are very, 772 00:37:17,430 --> 00:37:20,490 very many doors and people are uncertain 773 00:37:20,490 --> 00:37:23,730 about which door might be the best door. 774 00:37:23,730 --> 00:37:25,675 And I'm gonna talk about that in the roadshow. 775 00:37:25,675 --> 00:37:29,910 As you know, I just talked to you guys in Bennington, 776 00:37:29,910 --> 00:37:32,580 you guys are like awesome, 777 00:37:32,580 --> 00:37:35,250 actually Brower also has a lot of things going on, 778 00:37:35,250 --> 00:37:38,160 but there's a lot of variability around the state. 779 00:37:38,160 --> 00:37:41,250 And while I love the idea of the no wrong door, 780 00:37:41,250 --> 00:37:45,985 the idea that we can message perhaps one for sure door 781 00:37:45,985 --> 00:37:48,720 that works in every single community. 782 00:37:48,720 --> 00:37:52,950 I love the Safe Arms, but we can't message that to Copley. 783 00:37:52,950 --> 00:37:57,950 So the idea that we can at least have a statewide message, 784 00:37:58,056 --> 00:38:02,970 there may be other things, but those doors all need to link. 785 00:38:02,970 --> 00:38:03,803 Thanks. 786 00:38:04,652 --> 00:38:06,513 [Kat] Really quickly before we move on to Heather 787 00:38:06,513 --> 00:38:09,661 I just wanna address what Marge said, 788 00:38:09,661 --> 00:38:11,355 which is true, right? 789 00:38:11,355 --> 00:38:14,011 Too many doors could be confusing. 790 00:38:14,011 --> 00:38:15,608 So a couple of points. 791 00:38:15,608 --> 00:38:20,100 The Help Me Grow platform is a universal referral platform 792 00:38:20,100 --> 00:38:24,120 maintained by the state and that will get to every region. 793 00:38:24,120 --> 00:38:27,809 So that is, if the very least, it's a very easy, 794 00:38:27,809 --> 00:38:31,318 simple to remember access point. 795 00:38:31,318 --> 00:38:33,870 There are also the community teams, 796 00:38:33,870 --> 00:38:35,940 the CIS teams and that you can refer 797 00:38:35,940 --> 00:38:37,560 if you are familiar with those connections, 798 00:38:37,560 --> 00:38:38,940 go ahead and do what you're already doing. 799 00:38:38,940 --> 00:38:40,320 If it's working, great. 800 00:38:40,320 --> 00:38:43,020 If it's not working and you're confused or multiple regions 801 00:38:43,020 --> 00:38:46,230 you cover, Help Me Grow can really step in and support that. 802 00:38:46,230 --> 00:38:51,030 And I would say yes, no wrong door can be confusing. 803 00:38:51,030 --> 00:38:52,890 However, you send that referral, 804 00:38:52,890 --> 00:38:54,120 it will get to the right place. 805 00:38:54,120 --> 00:38:55,860 Our community teams work together. 806 00:38:55,860 --> 00:38:58,560 If it comes to the wrong region, 807 00:38:58,560 --> 00:38:59,490 we'll send it to the right region. 808 00:38:59,490 --> 00:39:02,250 I mean, Heidi's story really illustrates that. 809 00:39:02,250 --> 00:39:04,500 Around the world, but still got to the right team. 810 00:39:04,500 --> 00:39:07,266 So that's what we do in the community. 811 00:39:07,266 --> 00:39:08,970 We're really good at that. 812 00:39:08,970 --> 00:39:11,550 We're really good at connecting with each other and saying, 813 00:39:11,550 --> 00:39:14,760 oh wait, this isn't my region, I know who to send it to. 814 00:39:14,760 --> 00:39:17,130 So even though it's confusing, it really truly 815 00:39:17,130 --> 00:39:20,388 is true that there's no wrong door. 816 00:39:20,388 --> 00:39:23,370 But there are some simple solutions like Help Me Grow. 817 00:39:23,370 --> 00:39:26,040 And Heather, you got a question? 818 00:39:26,040 --> 00:39:28,920 [Heather] Just some feedback. 819 00:39:28,920 --> 00:39:32,430 Just wanted to say that it really does matter, 820 00:39:32,430 --> 00:39:36,278 having the provider offices with that opt-out 821 00:39:36,278 --> 00:39:38,389 versus opt-in messaging. 822 00:39:38,389 --> 00:39:41,103 Not only did we see, like Amy said, 823 00:39:42,020 --> 00:39:44,640 the really marked increase in the referrals, 824 00:39:44,640 --> 00:39:46,560 but also the uptake rate. 825 00:39:46,560 --> 00:39:50,509 So once referrals come through, maybe it's 50% or whatever, 826 00:39:50,509 --> 00:39:53,220 of an uptake on that referral, 827 00:39:53,220 --> 00:39:56,310 really, really different situation where most of the people 828 00:39:56,310 --> 00:39:59,400 after being contacted for the referral were like, yeah, 829 00:39:59,400 --> 00:40:02,970 sign me up for whichever service they opted for. 830 00:40:02,970 --> 00:40:07,110 So how that information is shared and your excitement 831 00:40:07,110 --> 00:40:09,300 about what's available for families, 832 00:40:09,300 --> 00:40:10,860 for all families in your community, 833 00:40:10,860 --> 00:40:13,104 and not just after you've identified a problem 834 00:40:13,104 --> 00:40:15,120 and you're making a referral, but like, 835 00:40:15,120 --> 00:40:19,066 this is just how our system of care is in our community. 836 00:40:19,066 --> 00:40:21,483 It really, that message, 837 00:40:22,710 --> 00:40:25,710 it really matters, just like it matters when clinicians make 838 00:40:25,710 --> 00:40:28,530 recommendations about alcohol use and that type of thing. 839 00:40:28,530 --> 00:40:32,926 Same thing applies for referrals to your community. 840 00:40:32,926 --> 00:40:33,759 Thanks. 841 00:40:35,070 --> 00:40:36,802 [Katy] And I just wanna mention that 842 00:40:36,802 --> 00:40:40,680 I saw some people saying that there's hesitancy, 843 00:40:40,680 --> 00:40:43,636 also being really clear with, you know, 844 00:40:43,636 --> 00:40:48,207 the hesitancy comes from that they think that 845 00:40:48,207 --> 00:40:53,207 we work with DCF and where we collaborate with DCF, I think, 846 00:40:53,661 --> 00:40:57,000 we're not there to take their babies away 847 00:40:57,000 --> 00:40:58,980 or harm them in any way, shape or form. 848 00:40:58,980 --> 00:41:00,600 That's a lot of extra paperwork for me. 849 00:41:00,600 --> 00:41:01,920 That's not what we're here for. 850 00:41:01,920 --> 00:41:03,813 We are, it's really more, 851 00:41:05,070 --> 00:41:08,370 we wanna help them keep their babies 852 00:41:08,370 --> 00:41:12,210 and take away that that wonder 853 00:41:12,210 --> 00:41:15,210 of what's gonna happen when I have my baby. 854 00:41:15,210 --> 00:41:18,300 So, is there gonna be something scary that happens? 855 00:41:18,300 --> 00:41:21,183 So we can be there and help them with that too. 856 00:41:22,710 --> 00:41:24,457 [Katy] My favorite Heidi quote, right? 857 00:41:24,457 --> 00:41:26,460 "The nurse is here to help you keep your baby." 858 00:41:26,460 --> 00:41:29,340 We don't wanna help them take your baby away. 859 00:41:29,340 --> 00:41:30,843 We wanna help keep the baby. 860 00:41:31,770 --> 00:41:33,840 So this has been great and I just also wanna 861 00:41:33,840 --> 00:41:36,210 give a shout-out, Margaret Urban just turned her camera on. 862 00:41:36,210 --> 00:41:38,730 She's our nurse coordinator for the Strong Families Program 863 00:41:38,730 --> 00:41:40,230 in Vermont and she's done an amazing job 864 00:41:40,230 --> 00:41:42,483 holding down the program for last.