Latest / Healthier Together: Larimer County's Public Health Podcast / How Nurse Partnerships Support Infant Immunizations

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How Nurse Partnerships Support Infant Immunizations · Healthier Together: Larimer County's Public Health Podcast

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Welcome to Healthier Together, Larimer County's
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public health podcast, where we come together
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for healthier lives, connected communities, and
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real conversations. From your local public health
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team, I'm your host, Tom. And I'm Joanna. This
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is your weekly minisode, where we'll provide
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a brief update on local public health news. So
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Tom, what's up in public health this week? Today
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we have Ronya and Nicole here to talk with us
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about the Nurse Family Partnership Program, or
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NFP for short. Ronya and Nicole, thank you so
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much for joining us. Yeah, thanks for having
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us. So Nicole, we'll start with you. What can
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you tell us about what NFP is and what you guys
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do? Sure. So Nurse Family Partnership is a home
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visitation program here in Larimer County. It's
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available to first -time parents, typically who
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are encountering some type of social and economic
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barriers. The program's available from the point
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of pregnancy until baby turns about two years
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old. Obviously, that covers quite a large time
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frame in different stages of their lives. So
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starting in pregnancy, we might be meeting with
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parents to discuss how they're feeling about
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becoming a parent, the symptoms that they're
1:11
experiencing, what's normal, what's not, how
1:14
to be prepared for labor and delivery, what items
1:17
they might need to feel ready to bring baby home,
1:20
all types of preparatory things. And then once
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baby arrives, we might be talking talking about
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anything from feeding, breastfeeding, bottle
1:30
feeding, providing in -home lactation support
1:33
to sleep challenges, soothing, crying, fussy
1:38
babies, addressing developmental milestones,
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sort of looking at what to expect. how to support
1:45
reaching those milestones, and what might be
1:49
needed if we need to intervene to help them reach
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those too. So there's quite a lot along the way.
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Also a lot of emphasis on perinatal mental health
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for the parents. As we know, that starts in pregnancy
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and is relevant to their parenting experience.
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So there's a lot of that woven in as we're talking
2:07
about intentional caretaking and parent -child
2:11
interaction. Zooming out, the three major goals
2:14
of the program are a healthy pregnancy, a healthy
2:17
child, and then promoting the parents' self and
2:20
family sufficiency. Identifying what those goals
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are and helping them to reach those goals. Wow.
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That's fantastic. Can you guys tell me how you
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get paired with these families? Yeah, so typically
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we receive referrals from our community partners,
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most often doctors and OB offices, prenatal clinics,
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but also internally in the health department
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through programs like WIC and our family planning
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clinic. Also, when people apply for Medicaid
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benefits for their pregnancy, we often receive
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their information as well. And so we might reach
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out to a couple of Medicaid referrals. And then
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also just through word of mouth. So sometimes
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friends or family know others that have participated
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in the program and have heard good things and
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want to be a part of it as well. We just recently
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celebrated National Infant Immunization Week.
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And so we did want to change gears and just kind
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of ask you guys some questions about infant immunizations.
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Can you tell us exactly why they're so important?
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Infants and children are in this really vulnerable
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time period. Our program supports the first 1
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,000 days initiative. So they're receiving before
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birth, they're receiving some of that immunity
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from the pregnant parent. And then that immunity
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starts to decrease or wane. in that infant year,
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so typically around like 6 to 12 months. So it's
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really important to get those immunizations during
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that time because the population is just so vulnerable
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to the diseases that we're trying to protect
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from. And how does that factor into the NFP program?
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The best part about this program is that it is
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client -led, but it usually comes up around the
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well -child visits because that well -child checkup
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schedule is... based on the immunization schedule
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as well. So they kind of want to know what to
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expect at those visits. At a certain age, they're
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going to receive different immunizations than
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they would at others. There's been some changes
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to the vaccine recommendations, and that's come
4:24
down from the federal level. And we've had Dr.
4:26
Mayer on here before kind of talking about what
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that looks like. Can you tell us, though, what
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immunizations are recommended? during pregnancy
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and for the first two years of a child's life?
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Similarly to what we've probably already heard
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from Dr. Mayer, but here at the health department,
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we're also still sticking with 2020. Five guidelines
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from the American Academy of Pediatrics. So when
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questions are coming up at different time points
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in our program, depending on baby's age, we're
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still looking at that same vaccination schedule.
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Of course, that doesn't negate talking with your
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provider, asking questions with them to make
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the best decision for you and for your baby.
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Gotcha. If somebody fell then behind on the vaccine
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schedule, are they able to catch up or is it
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something that they kind of have to, that they've
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missed out on? There is definitely a catch -up
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schedule for pretty much all of the immunizations,
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but you can get the vaccine as early as one age
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or as late as another. If you've aged out of
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that recommended time period, most of the vaccines
5:26
can be received later on in childhood. The biggest
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piece to getting them along that schedule is
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to make sure that we're protecting them when
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they're most vulnerable. And a lot of times,
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even receiving some of those vaccines, you can
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have like a broadened immunity to even other
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viruses that we've seen. So there are quite a
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lot of immunizations that are recommended in
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those first two years. Is there a reason why
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they're kind of all recommended early on and
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not spaced further out? Yeah. So again, that's
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because of those immature immune systems. Children
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receive some of the immunity in. from that parent,
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but those start to wane or decrease around that
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six to 12 month time period. They're also a little
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more vulnerable to certain diseases at a specific
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age. So we're trying to get them in this like
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shorter window where we can provide enough protection
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as the immunity from the pregnant parent is waning
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or decreasing. Gotcha. So it's that shortened
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time frame, and that's why there's this larger
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amount of vaccines that are recommended. So,
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I mean, this kind of leads to our next question.
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How are you guys then addressing some vaccine
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hesitancy from the families that you are working
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with? I think the biggest way that we're addressing
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it is just through the therapeutic relationship
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that we've built with our families and the trust
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that we have between us and really just partnering
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with them to determine. What are your concerns?
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What questions? What doubts do you still have
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that are remaining? What are your sources of
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information as well? As we know, a lot of our
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clients are often on social media. And using
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that to obtain a lot of the information. And
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so we talk a lot about to what reputable sources
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are available to them, even on these social media
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platforms. And so really just sort of asking
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them through their motivations, through their
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desires, what it is that they're really concerned
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about and what they're still seeking as far as
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information. And then that way they can make
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an informed decision as a family. I'd say the
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best part about our program is that we're not
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telling parents what's best for them. We're not
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telling them what to do. We're not saying that
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this is right or this is wrong. We're walking
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alongside them to figure out the health care
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information that's out there, helping them understand
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it with the information that we have. And they're
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making the best decisions for their families.
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We do have a pretty great rate of vaccinations
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through our program. And we collect data as a
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site and then we're able to compare it to other
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sites that deliver nurse family partnership in
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the state of Colorado and then also nationally.
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And then we have that data to compare just to
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all other toddlers. Looking at 2025, 92 .3 of
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toddlers in our program were up to date with
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immunizations at 18 months, but then 100 % at
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24 months, which sits a little bit higher than
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other. NFP sites, both in Colorado and nationally.
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Oh, that's great. What do you attribute that
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to? I think it's that relationship that we're
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building, honestly. I mean, the same questions
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that we're receiving here today are some of the
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same questions that our clients are asking and
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knowing the schedule and knowing why we have
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the... recommended schedule that we have and
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knowing that you can catch up on some of those
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vaccines if you've missed appointments or if
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something happened and you had to reschedule
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a visit. I think it's just walking alongside
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with our clients and being able to share that
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information from a trusted source. That's really
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great. So how then are you guys building that
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rapport with the families that you're paired
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with? I'm very curious what that relationship
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building looks like. Yeah, so I think a couple
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of things. Our goal is early enrollment, which
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looks like any time in pregnancy, but ideally
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before the third trimester has even begun. So
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before that 28 -week mark. And pregnancy visits
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tend to have a little bit different of a pace,
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of a tone, because the child isn't there yet.
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And so we're anticipating what's to come, but
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maybe the... The situation that we're discussing
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hasn't actually presented itself yet without
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the child there. And so we just get a lot more
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time to sit and get to know them, kind of learn
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a little bit about who they are, how they were
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parented, and maybe how they would like to hope
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in hope to parent their child. And that way we're
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able to just have the gift of time so that when
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we're coming in postpartum and they're maybe
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a little sleep deprived, they're a little bit
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more stressed, they're getting to know this little
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tiny human and not sure what to do at times.
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We're coming from an angle of... I already know
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this person. This isn't just someone that's going
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to come in and tell me what to do. And then the
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other thing that is just one of my favorite parts
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of this program is we always highlight that the
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client is the expert in their own life. So sort
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of as Rania highlighted it. we're not coming
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in and telling them what to do. And so I like
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to tell them basically at the enrollment visit,
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through our curriculum, through my role as a
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nurse, sure, I'm going to bring you evidence
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-based information, what is recommended by the
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American Academy of Pediatrics, for example.
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But at the end of the day, you get to choose
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what is going to work for you, what's going to
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work for your family, and if you want to apply
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this information or not. And I'm still going
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to come show up at our next scheduled visit and
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support you no matter what. Yeah, I think it's
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that just affirming that they know best and they
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will figure it out. So much of parenting is just
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trial and error and affirming their thoughts,
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affirming their feelings. It's a pretty magical
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moment. What are some common then, I guess, concerns
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that some of these new... Parents have. Yeah.
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So we get questions all the time about, again,
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the immunization schedule, adverse reactions,
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like, are they safe? Like, worry about your child
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is a normal parenting feeling. So just helping
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them to navigate a lot of that and, again, affirming
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those feelings, like your thoughts and your questions
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and your worries. They're real and that's part
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of this journey. And that can be applied to so
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many topics from how do I feed my baby? Should
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I breastfeed or formula feed? Or when should
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I introduce? solid foods to them, to is my baby
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behind on their developmental milestones, or
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are they reaching them? Are they talking? Are
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they walking at the right times? How to, you
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know, get them to sleep on a schedule in an environment
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that is suitable for the family? All sorts of
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questions and concerns along the way. I am curious,
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what does it look like in a typical visit then
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when you guys are, okay, you know, we're here,
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the kid's here. You know, what does that look
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like from start to finish? I think it depends
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on where you are in the program. So if we're
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in pregnancy, for example, we're talking about
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pregnancy symptoms. We're going over like warning
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signs or concerning symptoms. We're going over
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what's considered like normal and how to provide
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comfort for yourself or treat some of those uncomfortable
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symptoms. We're doing a lot of anticipatory guidance
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about This is kind of what it's going to look
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like when you go to the hospital. These are what
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your, you know, labor symptoms are going to be
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like. It's it's really whatever they want to
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talk about. Like we have a plethora of information
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among our team. Like we're just we're so knowledgeable
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in so many of these areas. And we're very well
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supported by nurse family partnership as an umbrella.
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I would also add to that, too, just examples
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of maybe an infancy visit or a toddler visit,
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too. So let's say we're going in and baby is
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there and, I don't know, they're four months
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old, let's say. You know, we're always going
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in and checking in on what's happened since I've
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last seen you, what's new, concerns that you're
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having, anything new that baby's doing this week
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that they weren't doing the last time I was here.
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And then are there... What are your priorities
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for today's visit? Are there things that you
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want to make sure that we talk about? So we could
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be doing a developmental ages and stages questionnaire.
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We could be talking about how to support them
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from rolling over and doing more tummy time to
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kind of get to that crawling stage. And then
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all assorted, you know, mom's feelings, dad's
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feelings along the way of what it's like parenting
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this little one. And then whatever information.
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that they've requested that we go over as well.
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Maybe they're getting ready to introduce solid
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food soon, and so that might be the curriculum
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that we bring that day as well. It just really
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depends, too. And then once the toddler's there,
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play really takes over the visit as well in a
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good way, yes. What does that look like? It's
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a lot of sitting on the floor, and I find myself
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looking and playing in a way that I'm... purposefully
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trying to get them to reach these milestones.
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And so one of my favorites is being in a visit
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and this child has taken steps for the first
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time. And so you and the parent get to celebrate.
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You're so excited. And that child is just beaming
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with pride. And so it's so much fun to like be
15:55
there. Just walk with them as parents and like
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you just remember all the stuff that you did
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with your kids and you're like, oh my gosh, I
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love this stage. So you guys are there for a
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lot of the firsts. In addition to the steps,
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what are the kind of firsts you guys like to
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celebrate? Oh gosh, like rolling over, the first
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words. pointing waving their first smile around
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that two to three weeks even like gets your heart
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every time yes yes so i guess another question
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that i wanted to ask is what kind of like long
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-term impacts does the nfp partnership have with
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the families i'm really curious about what long
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-term development looks like and what those you
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know different social outcomes look like. Yeah,
16:38
definitely. So I think for the family in particular,
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sort of as we've mentioned, there's no handbook.
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These babies aren't born with manuals and parents
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aren't handed an instruction book that says this
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is how your child will be and this is how to
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respond. And so to have someone that is just
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walking alongside of you that whole time to ask
17:00
those questions, to get the answers, but also
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just the affirmations and building up. strengths
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and the confidence in these parents, I think
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is a real gift to have someone in your life that's
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able to provide that. Other things that I think
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of that... Parents learn from this program, you
17:21
know, how to ask questions to their providers,
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how to advocate for themselves, for their children,
17:26
for what they're wanting at their medical visits,
17:30
maybe in any setting during flu season. Maybe
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it's in your next childbirth when we're not in
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the picture anymore. Maybe we are, but you feel
17:40
a little bit more confident in that setting and
17:44
navigating community resources as well. I think
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that's another. major piece of this program that
17:50
we haven't even highlighted yet, but just getting
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to connect with other resources in the community
17:55
that can broaden your network and be part of
17:59
your support system and finding ways to make
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those phone calls. What kind of other partnerships
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do you guys have with other agencies? Oh, yeah.
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So we have a lot of community partners. We receive
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referrals through a lot of obstetric offices
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or prenatal clinics in the area, community clinics
18:18
in the area. We receive referrals through our
18:21
awesome WIC team and the sexual health team and
18:25
the immunization team. Yeah, we work a lot on
18:29
outreach. We do. We do a lot on outreach and
18:32
we do a lot of our own resource research to find
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things that our clients are asking for once they're
18:40
in our program or maybe indicated that they're
18:43
interested in, whether that's parenting groups,
18:46
whether that's clothing banks, diaper banks,
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places that we can go in the community to find
18:52
the next. Stage of clothing as the kids are growing
18:56
out of them at a rapid rate. Community partners
18:59
like La Familia and Peaceful Birth Company who
19:02
support through their doula services, but also
19:07
a ton of support around the Latino population
19:09
in our community and having parent meetups for
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all different walks of life through those programs.
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Mental health resources like Willow Collective,
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Summit Stone. When walking alongside our clients,
19:23
we're also helping them to be able, like Nicole
19:26
said, to advocate for themselves and to reach
19:29
out to these resources as they need. So if they
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need transportation, if they need housing even,
19:37
there are so many things that go into running
19:41
a family. I can only imagine the amount of resources
19:44
that you guys have to bring to the table. And,
19:46
you know, I'm sure every situation is different.
19:49
Everybody has different questions. I did kind
19:51
of want to, though, kind of circle back. I'm
19:53
curious what the outcomes of participation look
19:56
like for people who are involved. Yeah. So we
19:58
have some data nationally. NFP is evidence -based.
20:03
So we have 45 years of data collection and science
20:09
to support that our program will increase behavior.
20:14
Behavioral outcomes, intellectual outcomes in
20:17
children, decreases poverty and child abuse and
20:22
neglect among children, fewer involvement in
20:27
the criminal justice system for both parents
20:31
and children. We have an amazing team here of
20:35
seven nurses, including our supervisor, two bilingual
20:39
nurses, and we are just eager to be out there
20:43
working with the families that could use our
20:45
support. What's your favorite thing about working
20:48
for NFP? Truly, I would say my favorite is, one,
20:52
getting to know my clients. Like, you become...
20:57
almost like an extra extension of their family
21:01
for a little while. It's often very hard to graduate
21:05
them from this program at that two -year mark.
21:08
What about you, Nicole? What's your favorite
21:10
thing about working at NFP? I would have to agree
21:12
with just the honor and privilege of getting
21:16
to know these families and be in their lives
21:19
and be witness, sort of, to just... who they
21:23
are when you've enrolled them and who they've
21:25
become when you graduate them and be there highlighting
21:30
all of those strengths and areas of growth, celebrating
21:34
all of it. Yeah, of course, it's fun to play,
21:38
you know, interact with the babies, but you do
21:40
become very close with these parents as well.
21:44
And then at the end of the day, there are tons
21:46
of benefits as well. You know, they don't have
21:48
to pack up themselves and their babies to get
21:51
to the next appointment to see you. They can
21:54
show up as they are. I don't care if your house
21:57
is clean, if there's toys everywhere. I will
22:00
just jump right in and join in. Fantastic. Well,
22:04
Nicole, Rania, thank you so much for joining
22:06
us. I really do appreciate you guys taking the
22:08
time. Do you have a question about public health
22:12
in Larimer County or a topic you'd like us to
22:15
discuss? Let us know. Email us at healthiertogetheratlarimer
22:19
.org. Thanks for listening, Larimer County. Until
22:22
next week, stay well, stay connected, and remember,
22:25
we really are healthier together.