[Angela] So we're gonna transition to the next session,
which is gonna be a panel discussion
about home-based systems of support in Vermont.
And the panel will be led by Katy Leffel,
who I will introduce, and she will introduce the panelists.
So Katy is a public health nurse focusing
on perinatal health for the maternal-child health division
in the Vermont Department of Health.
She facilitates perinatal health coordination
across MCH programs,
the Office of Local Health and other Vermont
community and health partners.
She works closely with the Vermont Perinatal PPQC,
that's us, and is a nurse abstracter
for the Maternal Mortality Review Panel.
Prior to transitioning to state work a year and a half ago,
she worked in a variety of nursing
settings and specialties.
For over 10 years she was in home health
as a maternal-child health nurse and supervisor
providing medical and lactation services,
as well as several evidence-based
nurse home visiting programs.
Katy earned her CLC certification,
Clinical Lactation Consultant in 2013,
and her IBCLC in 2019.
And her RN, MNN, Maternal Neonatal Nursing in 2021.
She's a mother to three girls,
partner to a public school teacher and a pet parent to Amat.
So Katy, we're so happy to have you here today.
[Katy] Thank you.
I am excited to be here and this conversation has really
fired me up and we have a great panel.
We have three people joining us.
I've got bios for two of them,
and then third person will have to introduce
a little maybe about themselves.
So we've got Amy Wenger,
she's a registered nurse and international
board certified lactation consultant.
Her passion for maternal-child health work began
over 20 years ago as a doula and a childbirth educator.
As a nurse, Amy deepened her work with birthing
and lactating people, working on Vermont's
largest postpartum unit in pediatric clinics,
and in her current position as a maternal-child
clinical nurse manager at a community home health agency.
Amy is also the founder and co-executive director
of the Vermont Donor Milk Center,
which provides outpatient pasteurized donor human milk
to infants who require supplementation,
along with crucial lactation supports
and postpartum resources.
Amy is a believer in the strong system of care
that supports the best interests of the client,
that are both trauma-informed and family centered.
Dancing in the gray areas found during the vulnerable
perinatal period, thinking outside of the box solutions
and breaking down barriers is what excites her the most
about the work that she is lucky to be a part of.
And we also have Heidi Gillespie.
She is an RN working as a clinical nurse manager
of Children and Family Services at the VNA in Rutland
and is also the US MECSH consultant.
It's our home visiting program here,
working with Professor Lynn Kemp.
She is the medical director at Camp Thorpe
in Goshen, Vermont, which is a camp for those
with developmental or special health needs.
She also travels annually to Honduras where she serves
with a group of nurses to run a medical clinic
and provide public health services to those
that do not have access to medical care.
She loves spending time with her husband,
her seven children and 11 grandchildren,
as well as assortment of animals
that live on their mini farm.
And we also have Kat Blanchard joining us today.
And I just wanna say a couple things.
This chat has been amazing.
I think talking about the different spaces
that we're joining together in thinking,
we don't need to reinvent the wheel here.
We have nurses, a network of nurses across the state
in every region, and I urge you to look
at our participant list today because there are literally
over a dozen, if not more community partners here today.
They're showing up, they're nurses in home health,
they're children's integrated services nurses,
they're the Department of Health nurse coordinators.
They're here today 'cause they are so passionate
about that community space and supporting families
in that community space.
So I'm just really looking forward to this presentation
and to think about how we connect the clinical spaces
with those services that will last
up to two years postpartum to support these families
in that really vulnerable period.
[Amy] Thanks, Katy.
I'm gonna try to share my screen here, see if I can,
oh, let me make sure that I did that correctly.
[Katy] Yep, that looks fine, Amy.
[Amy] Oh no, I just wanted to share my sound.
Okay.
All right, we're good.
Okay.
Well thanks, Katy, I appreciate that.
I am Amy, I am coming to you from the northern part
of Vermont, not too far from the Canadian border.
And with me today is Heidi Gillespie coming to you
from the Southern part, and we represent
our colleagues on all points in between.
We'd like to thank the Icon team for inviting us to speak
about how the maternal/child nurse home visitors
throughout our state support pregnant, birthing,
and postpartum people with substance use disorder.
Our objective today is to really help those here understand
the story behind the nurse home visitor and how our programs
and scope of services make a big impact for our most
vulnerable and isolated communities.
And to look at cute baby pictures.
We have nothing to disclose.
So, nurse home visitors have been here present
in Vermont for well over a hundred years.
Started in 1906 by a small group of women here in Burlington
who really believed that people who were sick
needed care at home.
And then in 1926 in order to decrease
the extremely high rates of infant mortality in Burlington,
the numbers of nurse home visitors were increased,
and that included specialty trained nurse home visitors
who had a specialty in maternity care.
So new nurse home visiting programs were started.
And that included prenatal nursing,
assisting at home deliveries, pre-school health checks,
infant welfare and care for postpartum women.
They also held well baby clinics in four sections
of Burlington during that time.
So we've been here for some time,
and thanks to these sassy ladies in these pictures,
they really saw a need in their community and they filled it
with a full spectrum of care for the baby,
the mom, the mama baby dyads in that time.
Our healthcare system has obviously changed
a lot since the twenties and thirties,
but the need for support and care for our most vulnerable
pregnant and postpartum families
who have substance misuse has only increased.
The maternal-child nurse home visitors of today
have so many more resources
and opportunities for their communities.
We really are the unicorns of the healthcare system.
We're unique in the fact that we span the adult,
the obstetrical, the postpartum, the pediatric,
addiction medicine, all those systems of care.
We are community medical nurses,
educators, and care coordinators.
We sit outside of the medical silos, but are fully
integrated into the medical and community systems.
We bring opportunities, supports, and a full spectrum
of care and complimentary resources straight into the homes
of the families that we serve.
And we are in this fortunate space along with our close
community partners where we can come together
in assessment and advocacy and intervention.
We reach our most rural, most isolated
and our newest families here in Vermont.
We're often sometimes the only people that they may see
during the day or the week.
And we work to meet our families really wherever they're at,
checking in, building connections
and capacity for our clients.
And as nurses, you know that we're always assessing,
which has made for some pretty good clinical catches.
Hello, postpartum high blood pressure
is everywhere right now.
So we've being catching those.
The importance of maternal-child health nursing is felt
throughout our country and it is supported
through the Maternal, Infant and Early Childhood
Home Visiting Grant, also known as MIECHV.
And the MIECHV Grant funds one of our largest
nurse home visiting programs here in Vermont.
The Today Show aired this segment
around five to six months ago on the impacts,
and I really felt it demonstrated the power of what we do.
So I wanted to share it.
Back now, 8:15 with our What Works today.
It's our series highlighting positive stories and people,
people who are working hard to make a difference.
Yeah, and this morning,
a unique national program that's getting resources to rural
areas where they are badly needed.
And there's one young mother who credits it
with saving her life.
NBC Senior national correspondent Kate Snow has the story.
Hi, good morning.
Hi, nice to bring you a little good news.
this morning on such a hard day.
You've probably heard of a house call, right?
Remember that when a doctor would actually
come to your home and treat you?
Well, this program is a similar idea,
bringing nurses and other types of clinicians
directly to new mothers in need.
(ambient music)
In a country with some of the best doctors in the world,
new mothers sometimes struggle to find care
for themselves and their babies.
One report finding seven million women of childbearing age
live where there's little to no access to maternity care.
You see the struggles.
So it's not always easy to be a first time mom.
[Kate] For Debbie Brush, it's emotional to talk about.
As a registered nurse in Spartanburg, South Carolina,
she sees the hardship daily.
Sometimes there are limited resources.
Maybe being brought up in poverty already
and not really seeing a way out.
-Hi! -Hi, how are ya?
[Kate] But Brush is working to break that cycle,
spending her days making house calls to new mothers in need,
part of a little known national initiative called
The Maternal Infant and Early Childhood
Home Visiting Program.
It was created under the Affordable Care Act
and targets vulnerable populations of women,
including those who have little access to resources
or may be battling things like substance use disorder
or domestic abuse.
We see them in their home where if they go to a doctor's
office, they're not seeing the big picture.
In all 50 states, a nurse or clinician
visits first time mothers on Medicaid,
starting from before their 28th week of pregnancy
until their child turns two,
a critical period in a child's development.
How crucial are those months right before birth
and right after birth?
They're really crucial because the baby's brain is rapidly
developing the foundational structures of the brain.
Home visitors provide everything
from general health checkups for baby and mom
to education on breastfeeding to mental health screenings.
Are these maybe women who wouldn't otherwise get healthcare?
Yes, they are more likely not to get to care,
and the home visiting professional can actually
screen for maternal health issues too, such as depression.
[Kate] 27 Year old Ansley Rogers enrolled in the program
when she was pregnant with her first baby.
She was living in Spartanburg with a supportive husband,
but far from family and without a car, most days.
You're home alone.
There's no way to go anywhere.
[Kate] Earlier this summer, she gave birth
to a healthy baby girl, Annabelle.
There we go. There we go.
[Kate] But three weeks later,
Ansley started having pain in her chest,
so severe she could barely breathe.
Home alone, she shrugged it off.
I was just wishing and hoping that it was something small
because how was I gonna go
to the emergency room with the baby?
[Kate] But when she told Brush about the pain,
the nurse insisted she get to an emergency room
where doctors gave her a frightening diagnosis.
It was not just a blood clot,
but blood clots in both lungs.
[Kate] Without immediate treatment, those blood clots,
a complication from pregnancy, could have been deadly.
100% I think this program did save my life.
[Kate] Now back home with her baby,
Ansley continues to meet with Brush regularly.
I am lucky to have a partner who is supportive
and a lot of women are not, they are alone.
They are possibly ignorant of a lot of things that happen
during pregnancy and during childbirth and afterwards.
So someone coming to you is, it's very important.
So this program serves 70,000 families every year.
Again, many in rural or poorer counties,
but also in low income urban areas as well.
It's also shown not just to improve both mom and baby's
physical health, but also to reduce rates
of child abuse and neglect,
and better success when the kids
are old enough to go to school.
There is one issue, guys,
which is this program could lose its federal funding.
The hope is that Congress will reauthorize it,
but there are no guarantees.
And that would mean a lot of women and children in need
could lose these resources.
But there are some champions on Capitol Hill,
so they're trying to work on reauthorizing the program.
[Craig] It's a great program.
Yeah it's such a critical time,
and every new mom feels overwhelmed.
But even if you have every resource available to you,
it can be a terrifying time.
So it's beautiful that those nurses are coming
right where they're needed.
-Thank you, Kate. -Such good work.
Thank you, Kate.
Hey, thanks for watching our YouTube channel.
Find your favorite recipes,
celebrity
interviews.
[Amy] Let's see, Al Roker doesn't wanna be my friend.
[Reporter] Back now, 8:15.
[Angela] Amy, Amy, this is Angela.
If you go down below where it has the play button,
like all as far down as you can,
[Amy] Yup?
[Angela] Below that, try to click to go to the
-next slide. -[Reporter] today it's,
[Amy] Hmm.
See if it'll let me.
[Reporter] Series highlight.
[Amy] No.
Maybe if I stop sharing and come back.
[Angela] Come back, maybe try to do that, yep.
[Amy] Okay.
I can do that.
Nope.
Highlighting positive stories and people,
people who are working.
[Amy] Hmm.
[Angela] Can you minimize that a little bit, Amy?
And then see if you can see your next slide button,
instead of going full screen?
[Amy] There we go.
All right, thanks.
You know, technology,
I'm a great nurse.
Technology is not my thing.
So that was pretty powerful.
And I really liked how Savannah Guthrie there
really recognized how this is such a critical time
for women and families, and even when someone has
all the resources available to them,
this time can feel really terrifying and overwhelming.
The best news is that we have these programs here
and they are available in every county in Vermont.
Our MIECHV nurse home visiting program is even more
progressive in that we can enroll both first time mothers
and those with any number of subsequent pregnancies anytime
prenatally and up to six weeks postpartum.
The maternal-child health nurses here in Vermont
are specially trained to care for pregnant
and postpartum women and families with substance misuse
and to help them learn how to care for their babies.
Our MIECHV programs are voluntary and they're free
for all of our clients, and our programs have us
in the home until the child turns two,
which really helps that consistency and longevity.
What the nurse in the Today Show clip also said
was about how the nurse home visitors
see that bigger picture.
It is so important and it really encapsulates
what really makes that home visiting unique.
We work kind of beyond the clinical lens.
We know that pregnant and postpartum people
in general are not always held in a way
that meets their needs during this really special
and very vulnerable time in life.
We also acknowledge
that our clients who have substance use disorder
need different care.
And unfortunately the system that we live and work in
is not always set up to care for these families
in a way that they need or really the way they deserve.
Some of our families have very complex issues
coming into pregnancy,
and their substance misuse is just part of that.
These individuals often know the system better than we do,
and they can be guarded,
mistrustful and scared about what's going to happen
to them and their baby.
And this creates a barrier for them and their care.
However, we also know that the touchpoint of pregnancy
is wide open and that is a huge opportunity.
If that touchpoint is supported in a way
that a pregnant person needs,
it can be a turning point in that person's life.
If you've ever heard me speak before,
you've heard me talk about my client Jane.
And Jane was my client who had
a very complex social situation.
She maintained her MAT with each of her pregnancies,
but would stop it within the first year postpartum.
She could not keep up with all the expectations
of her clinic and all of the other services
that she was enrolled in.
And this was in hopes of reunification
with her children one day, which she could not do
because she could not maintain her MAT,
because she could not meet the expectations
of all of her program, or even just simply make it back
in time to DCF in order to see her kids,
or hold a job or, the list just goes on and on.
The amount of work and travel that she had to do
just to maintain her services and her providers,
each with their own expectations, caused Jane to fail
because she simply just couldn't do it,
especially in the immediate postpartum.
This chaotic diagram here shows the services
or service providers that Jane had.
She and I did a map of her visits
with her different providers for the first six weeks
after her baby was born.
And we found that she had 55 visits
within those first six weeks postpartum.
And she lives in east Vermont.
So that's hundreds if not thousands of miles
just to get there from there.
And anyone who's ever had a baby or been a partner
of someone who has just had a baby,
you will feel the inhumanity of this.
I know for me it was just hard enough to get a shower,
let alone leave my house.
And Jane is not alone.
This is the system that so many of our patients
and our clients live in every day.
It's not equitable, it's not family centered.
And for people like Jane, it sets them up to fail.
Our clients and our babies deserve better than this.
And where nurse home visiting and all of the wonderful
programs in our community can have an impact, we really do.
We need to go way upstream
in order to really fix the system.
However, we can shape the trajectory
and we can make ripples in our patients' lives.
One of my wonderful nurses was graduating one of her clients
after being with them for two and a half years,
a mama with a complex social history,
including substance use.
And she had preterm twins.
One was born with a congenital heart defect.
When the nurse started working with this mom,
she was really able to develop a strong connection,
strong rapport.
She not only took care of the boys clinically,
but she recognized the signs of postpartum depression
and anxiety that this mom was experiencing.
And so when she screened her,
this mom disclosed her suicidality
amongst several other issues that she was experiencing.
My nurse shared this sentiment with me
after she had left that home for the last time,
and not only did it make me very proud of my nurse,
but it shows the kind of connection that nurses have
with their clients and how this nurse impacted
this mom's life and the life of her children.
This is something this mom will take forward with her.
And especially to be put at the same level as Mary Poppins,
now that's really a whole new plane of awesome.
But Mary Poppins, really is that who we are?
I mean, we do carry really large bags full
of just about anything you can think of,
but are we practically perfect in every way?
Nope, not in this business.
Not every family is going to have a happy ending,
and we may never see that ripple
that we made with that family.
And trust me, there are plenty of people out there
who would like to tell us to go to go fly a kite,
and not in that fun Poppins way.
But stay with me here.
There are lessons in Mary Poppins
that do inform our home visiting practice.
So where we're not practically perfect in every way,
we are practically useful in many ways.
We always bring our clinical nursing practice
for both mother and baby where it is needed.
That is part of what we do.
We do screenings for perinatal mood and anxiety disorder,
social determinants, intimate partner violence and the like.
But we also know that we cannot solve all the issues
and all the trauma and all the history
that our clients are experiencing.
We are not always the right people to do so.
We help by bridging our clients to the experts
in the field that can help them on a larger level,
such as finding them housing,
connecting them with mental health clinicians
or a baby with early intervention.
And we help by breaking down those big things into smaller,
more manageable ones.
We help them fill out applications or refer them
to another community support.
We hold their space in this way so that we can
open the doors for clients to focus on their health,
their pregnancies, their babies,
and what they would like for their families in the future.
Because here's the thing,
we know that babies cannot wait for everything to be solved
so their parents can be ready to focus on their development.
Some of those things could take years.
Some of those things may never be able to be solved.
We know that babies' brains are developing so rapidly
and so critically in those first few years
that sometimes focusing on what they can do
for their baby right now with their time,
instead of what they cannot do, can be very empowering.
Even when going through life stressors
or when things don't feel very good.
Just a spoon full of sugar helps the medicine go down.
All of our practice is trauma informed of course,
and it's very strength-based with a focus on empathy
and continuing to build connections
and consistently showing up and creating a safe space
for our clients to be who they are is our goal.
We had a client once who had a setback in her MAT program.
We knew that she hadn't been to her clinic in some time,
but she was not at a place where she was ready
to disclose that to her nurse.
She began canceling her home visits and kind of
avoiding our phone calls.
But when we were finally able to go see her,
we could see that she was visibly struggling.
So when we finally were able to kind of have that
sit down conversation with her,
we let her know that we saw her and we saw
that she was struggling and that we were thinking about her.
And although she didn't disclose at that visit
with the nurse, it was not long after that
that she called her nurse and disclosed
what was going on and we were really able
to get her some good assistance.
My favorite saying is, disclosure is always a gift,
but it's never the goal.
Substance misuse is a chronic disease
and a lifelong process.
The gift of disclosure takes time,
connection and a whole lot of courage
on the part of the client.
But it also means that they're asking for help.
And for many of our families,
that's the most dangerous and vulnerable
space for them to be in.
And you know, a little love goes a long way.
"In every job that must be done, there's an element of fun."
It's not all serious or didactic.
We teach our patients
about their babies' development through play.
We do belly castings, we bring in fun crafts, we get messy.
We model healthy play because for some of our families,
play is a struggle and they may not have learned
in their own childhood how to play in a really safe way.
So we show them how and we create a safe space for them
to learn and make positive memories with their babies.
I have a client who, when I call to confirm my visit,
loves to remind me what holiday or season it is
and their ideas for the paintings that we're gonna do
and what color paints I should bring.
And it's something that she and I really look forward to.
And we use that time and she catches me up
on all of what her baby has done since I was there last.
And this client has this huge wall in her home
that's just covered in all these paintings,
and it's really special to me and it's really cute.
And anything can happen if you let it.
Nurse home visiting is a great place
for pregnant and postpartum people to get a full spectrum
of care and community supports and resources.
For those who have perinatal substance misuse,
there's that clinical piece that we as nurses
are trained to serve really well.
But we're not alone in our commitment
in the perinatal community,
especially through children's integrated services,
our parent-child centers, and the Department of Health.
When a pregnant person engages with one community service,
it opens up a whole village of perinatal
supports and services for them.
We all sit together in many different spaces,
including our local charm or charm adjacent teams,
our child protective teams.
We connect with your OBs, the pediatricians,
care coordinators, and we work together
to wrap our clients so they have the best chance
and the best supports possible in their own community.
Honestly, sitting with these teams makes me very proud
to do the work that we get to do every day.
Okay, so I bet some of you are saying, wow Amy,
this sounds wonderful for my prenatal or postpartum clients
with substance use disorder.
How do I make a referral?
Well, that's a great question, I'd love to tell you.
Anyone can refer their patients to have
their very own nurse home visitor
throughout their pregnancy or postpartum journey.
It is already here in their community waiting for them
as well as several other community-based programs.
And the Icon team will be sending out specifics
on how to refer in whatever areas you serve
after this conference.
How you talk to your patient or client about the referrals
makes a big difference.
And we found that when the provider recommends a referral
to nurse home visiting or to another community support,
the rates of engagement are higher.
In Franklin Grand Isle County, we found that when providers
were trying to tell their patients or clients
on the many different community programs
and trying to remember all the specifics on them,
where to send the referral, how to refer,
and really ask their patient
what program they wanted them to be sent to,
it became to be overwhelming.
And we found that it doesn't work,
and most clients are declining.
But when we flipped the script from an opt in to a program
at that time to what we call an opt out,
we found more families are saying yes, they are interested.
And whether it's a nurse home visitor, a doula,
a CIS coordinator who calls them
to talk to them about the program,
they're accepting services to not just one,
but multiple perinatal resources in their community.
So instead of asking your clients,
would you like to be in a certain program or programs,
own our programs with us.
We're an extension of whatever practice
you're in in our community.
So say something similar to this,
"We are so lucky here in Vermont.
We have a great extended community of nurse home visitors
that will come and help you get ready
to have your baby and support you after.
They can get you connected to many resources
and are specially trained to care for you.
I really recommend it.
I'm gonna make a referral for you, okay?"
Can they decline?
Absolutely, we're not taking away autonomy.
Could they decline the person that calls and explains
what the community can offer them?
Absolutely.
But you're also not asking them to commit to any one thing.
And like I said, everything is voluntary.
And we do that so things do not become very overwhelming.
We in the community are always looking for ways
to make referrals as easy as we can for the systems
that we share our clients with.
This work is hard and can break your heart,
and will break your heart in a million different ways.
And this is because we're all human and we all care so much.
There's so many opportunities to make it better and more
cohesive for our perinatal people with substance misuse.
Please always feel free to reach out and let us know
how we can support you.
Thank you.
And now back to Katy.
[Katy] Well, it's now back to me.
I would love to hear from Heidi
and Kat if she feels comfortable.
Heidi, you wanna take it away and just talk
a little bit about the programs?
You're on mute. (laughs)
[Heidi] I just saw that.
One of the things from the video that I just wanna make sure
we highlight is that we're really fortunate here in Vermont
to have programs that encompass all of our mothers.
Like the programs specifically talked about 28 weeks,
getting them by 28 weeks for first time moms only.
And in Vermont we serve, and Amy did mention this,
but we serve moms in any parity.
One of the things that is so important to recognize
is that the statement we use is risk is not static, right?
First time moms are not the only ones at risk.
Any mom, any time, any situation
can be at risk, and need this extra support.
And so what we want the word to be is there is no one
who nurse home visiting can't touch.
Strong Families Vermont is specific to pregnancy
through six weeks postpartum,
but we also have CIS nursing and MCH nursing
that encompasses moms in any stage of life
with their children who need extra support.
And the same referral will get you in touch
with any of those nurses.
So I just wanna make sure we highlight that.
And just to let you know, just to reach out,
I have kind of a connection story.
We talk about referrals, any door,
there's no wrong door for referrals.
And I just had this most amazing referral come into me
that a mom actually had a friend who she knew
had a nurse home visitor and she wanted something similar.
Somehow she wasn't getting connected through her physician,
through other resources.
So she started searching and reached out
and found this MECSH program on the computer
that sounded like the thing that her friend had.
And so she emailed this MECSH program
and in a roundabout sort of way,
this email got back to me and she had actually emailed
Australia, which is where the MECSH program originated.
And the people in Australia saw where her email
had come from and the county she was in
and got it back to us here in the States so that I could
then reach out to this mom and offer her our programs.
And it just to me is just the most amazing example
of the fact that there truly is no wrong door.
Reach out, ask for programs and somebody somehow
will get that connection back to the right place
so that we can serve these families that need these programs
and resources so desperately.
So just use that as an encouragement
that you can't reach out the wrong way.
There's always gonna get back to us and we're gonna
be able to serve these moms.
I guess, I don't know, unless there's questions?
I think Amy covered it so well.
I would love for Kat to talk a little bit
about how substance use disorder is in Bennington County,
'cause it is a little,
we have the Strong Families Vermont program and we do
all of the same programs, but they have a little bit
of a different way that she connects with moms
that need support and that's we why we invited Kat
to come in, and Kat, you should introduce yourself
'cause we didn't do a proper introduction.
[Kat] So I'm Kat Blanchard.
I'm the maternal-child health nurse in Bennington County
as well as the Strong Families Responsive.
I think I said that right?
And CIS nurse for Bennington County.
So in Bennington, at our hospital here,
a program was developed called the Safe Arms Program,
which encompasses all women that are pregnant
and have a substance use disorder.
And when they do have their baby,
it generates several automatic referrals.
So they automatically make a plan with their pediatrician
that they'll go see them once a week for six weeks.
There's an automatic early intervention referral
for assessment and then there's an automatic
visiting nurse referral for them to see a nurse, which,
it's always me at this point,
once a week for six weeks minimum on the opposite end
of their doctor's appointment.
So really wraparound services for those families.
And you know, when I started doing this 10 years ago,
I had a much higher rate of home not found or not taken up.
But now that I've been established in this community,
it's next to nothing.
Almost every referral accepts visiting nurses
and it's great, I've evolved as a nurse in my own view
on substance use disorder.
And actually, separate from my professional role,
my husband and I adopted a baby that was born
to a mother of substance use disorder.
So I've lived it in my own personal life
and I'm very passionate about it
and I love the conversations today around the stigma
and the wording around referrals.
But I don't know if anybody has any questions
for the way we do things here in Bennington.
I know we're getting close to 10 o'clock, so.
[Katy] Yeah, we do have a couple hands up,
so we have about five minutes left,
just to time check for everybody.
So Marge, do you wanna ask your question?
[Marge] Yeah, and I just wanted, you know, thanks,
that was an awesome presentation and I just wanna emphasize
the pluses and the minuses of the no wrong doors.
I go around the state, the no wrong door,
the flip side of that is that there are very,
very many doors and people are uncertain
about which door might be the best door.
And I'm gonna talk about that in the roadshow.
As you know, I just talked to you guys in Bennington,
you guys are like awesome,
actually Brower also has a lot of things going on,
but there's a lot of variability around the state.
And while I love the idea of the no wrong door,
the idea that we can message perhaps one for sure door
that works in every single community.
I love the Safe Arms, but we can't message that to Copley.
So the idea that we can at least have a statewide message,
there may be other things, but those doors all need to link.
Thanks.
[Kat] Really quickly before we move on to Heather
I just wanna address what Marge said,
which is true, right?
Too many doors could be confusing.
So a couple of points.
The Help Me Grow platform is a universal referral platform
maintained by the state and that will get to every region.
So that is, if the very least, it's a very easy,
simple to remember access point.
There are also the community teams,
the CIS teams and that you can refer
if you are familiar with those connections,
go ahead and do what you're already doing.
If it's working, great.
If it's not working and you're confused or multiple regions
you cover, Help Me Grow can really step in and support that.
And I would say yes, no wrong door can be confusing.
However, you send that referral,
it will get to the right place.
Our community teams work together.
If it comes to the wrong region,
we'll send it to the right region.
I mean, Heidi's story really illustrates that.
Around the world, but still got to the right team.
So that's what we do in the community.
We're really good at that.
We're really good at connecting with each other and saying,
oh wait, this isn't my region, I know who to send it to.
So even though it's confusing, it really truly
is true that there's no wrong door.
But there are some simple solutions like Help Me Grow.
And Heather, you got a question?
[Heather] Just some feedback.
Just wanted to say that it really does matter,
having the provider offices with that opt-out
versus opt-in messaging.
Not only did we see, like Amy said,
the really marked increase in the referrals,
but also the uptake rate.
So once referrals come through, maybe it's 50% or whatever,
of an uptake on that referral,
really, really different situation where most of the people
after being contacted for the referral were like, yeah,
sign me up for whichever service they opted for.
So how that information is shared and your excitement
about what's available for families,
for all families in your community,
and not just after you've identified a problem
and you're making a referral, but like,
this is just how our system of care is in our community.
It really, that message,
it really matters, just like it matters when clinicians make
recommendations about alcohol use and that type of thing.
Same thing applies for referrals to your community.
Thanks.
[Katy] And I just wanna mention that
I saw some people saying that there's hesitancy,
also being really clear with, you know,
the hesitancy comes from that they think that
we work with DCF and where we collaborate with DCF, I think,
we're not there to take their babies away
or harm them in any way, shape or form.
That's a lot of extra paperwork for me.
That's not what we're here for.
We are, it's really more,
we wanna help them keep their babies
and take away that that wonder
of what's gonna happen when I have my baby.
So, is there gonna be something scary that happens?
So we can be there and help them with that too.
[Katy] My favorite Heidi quote, right?
"The nurse is here to help you keep your baby."
We don't wanna help them take your baby away.
We wanna help keep the baby.
So this has been great and I just also wanna
give a shout-out, Margaret Urban just turned her camera on.
She's our nurse coordinator for the Strong Families Program
in Vermont and she's done an amazing job
holding down the program for last.