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The Perinatal Nurse Support Program · 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. The
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  Health Department recently introduced a new perinatal
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  nurse support program. This program provides
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  support for pregnant and postpartum individuals
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  affected by substance use. They work alongside
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  families during pregnancy and early infancy,
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  offering education, resources, care coordination,
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  and encouragement. Today, we're joined by Kinsey
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  Schreiner, senior public health nurse with the
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  program, and Leanne Frost, who manages maternal,
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  family, and nutrition programs. Kinsey and Leanne,
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  thank you both so much for joining us. Thanks
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  for having us. Thank you. Happy to be here. To
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  start, can you tell us about the Perinatal Nurse
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  Support Program and the work that you do? Yeah,
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  the Perinatal Nurse Support Program connects
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  pregnant and postpartum individuals affected
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  by opioid and substance use disorder with their
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  very own registered nurse, who provides personalized
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  care and ongoing support through home visits.
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  And these home visits are really individualized
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  to what the family needs, so they look very different
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  depending on where people are at in their journey.
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  And how did this program get started? We used
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  to have a program specifically with the Department
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  of Human Services, a nurse that would support
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  young families in their services, something that
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  was really helpful in the community that we no
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  longer had. Funding was a potential for us. I
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  jumped right on it to apply for it. I thought
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  this was a great opportunity to start something
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  like this for this specific population. Another
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  driving factor was just the wideness conception
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  around substance use. Substance use is a symptom
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  of a chronic disease, and a lot of people don't
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  view it that way. And so we want to be able to
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  support that family. We see the need in the community,
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  and we know that nurse home visiting is a great
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  support, a long -term support for those families.
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  It's such a critical period in their life, and
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  so we're just very excited to be able to offer
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  this service. Can you tell us a little bit more
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  about the need for this program here in Larimer
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  County? What gaps in services does it fill? Yeah,
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  well, perinatal substance use is a major issue
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  in Colorado as a whole. The data kind of makes
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  it very clear. Unintentional drug overdose is
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  the second leading cause of maternal death. And
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  in between 2012 and 2018, there was a 98 % increase
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  in newborns exposed to opioids prenatally. At
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  the local level, we're meeting with our partners,
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  and they're telling us there's a lot of great
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  work going on in the community to support these
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  families, and they get the support prenatally.
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  They are getting resources in the hospital, and
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  our partners are telling us that that support
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  drops off after they go home, and they often
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  wonder how those families are doing. Through
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  plans of safe care that they're writing in some
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  of these programs, we can help support those
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  longer term. and hope for those longer -term
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  better outcomes for these families. And what
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  we're finding with our research is individuals
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  actually face a higher risk of recurrence or
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  relapse in kind of the latter half of the first
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  year postpartum. So we want to step up and fill
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  that exact gap. Can you tell me a little bit
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  more about that plan of safe care? What does
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  that look like for individuals? Yeah, a plan
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  of safe care is basically a family -centered
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  plan. that promotes the safety and well -being
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  of both the infant and the parent postpartum.
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  And so it looks like a document, but it's more
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  than that. It's a living plan that really provides
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  coordinated care to support families and improve
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  outcomes in the long term. Who all is eligible
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  to participate in this program? Yes, so we're
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  focusing on pregnant and postpartum people in
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  Larimer County who have been affected by or even
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  have a past history of substance use, particularly
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  with the opioid use. Suicide and accidental overdose
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  are two of the leading causes of maternal mortality
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  here in Colorado. And so what's inspiring or
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  motivating to us is those are preventable causes.
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  And so we really feel like we can make a difference
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  and have an effect on long -term outcomes through
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  home visiting. We're finding it is hard to...
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  to identify this population before they deliver.
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  We're seeing a lot of people in the hospital,
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  and that's okay. That's why we've decreased that
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  barrier. We can roll up to six months postpartum,
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  and we're able to support with that full year
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  postpartum. We really want to be a safety net
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  for families that don't qualify for some of our
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  other perinatal programs. Your income is not
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  a criteria. Your level of education is not a
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  criteria. Whether it's your first baby or 10th
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  baby, it doesn't matter. So again, we wanted
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  to decrease those barriers so we could be a safety
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  net for families that weren't captured by some
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  of our other programs that support. Should a
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  PNSP client experience a miscarriage or infant
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  loss, is this program still something that's
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  available to them to support? I love that you
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  asked that question because that's what this
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  first year is about, is having those questions
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  and having those ideas and seeing the need, right?
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  So I don't think it's something we had come across
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  yet, but I would absolutely want to continue
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  to support that family. And they would be eligible
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  on consecutive pregnancies as well. So there
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  wouldn't be any reason we wouldn't continue to
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  support them. We also have other programs in
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  our community that supports fetal loss that we
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  have great partners that can even do a better
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  job maybe than we could to support such a huge
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  loss. So, Kinsey. Walk me through what a typical
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  visit looks like for you when you're meeting
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  with these families. Yeah, it really depends
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  on the family and what they find important to
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  them at that point. To give you some examples,
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  during pregnancy, we might have conversations
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  around connecting them with peer support. So
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  for a lot of people, they find peer support to
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  be a very important part of their recovery. So
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  that's something we could try to get them going
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  on early. Another thing that we might discuss
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  is... preparing for baby, right? Making sure
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  that they have the items they need and the space
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  prepared for after delivery. And then during
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  that initial postpartum period, you really want
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  to focus on how mom and baby are doing. We can
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  do those things from a medical standpoint as
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  nurses. So we might be checking a blood pressure
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  and making sure mom's blood pressure is normal.
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  We might be weighing baby and making sure that
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  their weight is healthy for their growth. And
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  then after that, you know, as we get further
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  into the first year, it's really important that
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  we provide anticipatory guidance to what they're
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  going to expect with their baby. So for instance,
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  you know, around four to six months, we might
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  be discussing the introduction of solid foods.
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  And we might discuss safe storage of substances,
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  making sure that we're providing a safe environment
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  for the baby. So it really depends on where the
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  person is at and what they would like to focus
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  on. But overall, we're connecting them with resources,
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  promoting health and development in both mom
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  and baby, learning about attachment and bonding,
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  and ultimately trying to boost their self -esteem
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  and their confidence. in their parenting, but
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  also in their recovery. So what are some of the
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  complexities or special considerations that providers
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  and pregnant people navigate when addressing
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  substance use disorders during the perinatal
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  period? Is there anything that's unique about
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  it? Absolutely. Good question. It's an important
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  piece of the puzzle. When someone's struggling
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  with long -term substance use, it, over time,
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  changes their brain chemistry. And these changes
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  are called neural adaptations, and they can affect
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  stress, motivation, reward, these systems that
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  kind of naturally happen in our brain. But if
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  you think about if you're a parent or maybe you
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  can put yourself in the shoes of a parent for
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  a moment, you think about a typical pattern of
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  caregiving, right? Maybe it's two in the morning
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  and you wake up to a baby crying. You're going
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  to feel a spike of stress. And that's natural.
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  That stress motivates you to get up out of bed
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  and to go soothe the baby. Finally, after maybe
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  you've changed a diaper or you've done a feeding,
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  the baby calms down. And that parent or that
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  caregiver feels a natural flood of a reward,
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  right? If you think about oxytocin, right, otherwise
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  known as the love hormone, it helps us feel good
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  that we satisfied their need. Because substance
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  use rewires these pathways, it impacts every
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  single part of that caregiving loop. It makes
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  a person much more vulnerable to the daily stresses
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  that a caregiver experiences. And it might also
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  kind of dull that internal motivation and reward
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  system that we're used to experiencing. And that
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  helps caregivers feel fulfilled. As nurses, we
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  can break this down for parents and provide that
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  education. We can provide a safe space to have
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  conversations like these, which will decrease
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  shame. And we can also help connect clients to
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  the individual care that they need to be the
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  best version of themselves. And so when someone
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  is struggling with substance use, fill in the
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  blank of the substance, and they also probably
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  have a mental health concern, those things are
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  risk factors. And as the risk factors increase,
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  their chances of eventually using opioids or
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  turning to that substance is relatively high.
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  And so we want to keep that in mind when we get
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  a referral. We're looking at the whole picture
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  and we're really trying to discern whether this
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  person would benefit from a service like this
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  that will put those supports in place to hopefully
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  prevent future opioid use, right, and support
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  those that maybe have already experienced that
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  in their past or present. How does the Perinatal
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  Nurse Support Program work with community partners
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  here in Larimer County? Yes, we're absolutely
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  partnering. There's a lot of good work going
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  on already in Larimer. So we are actively meeting
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  and collaborating. We're interested in the work
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  that they're doing. We're wondering what they've
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  learned so far. We're trying to identify gaps
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  that they're seeing and seeing how maybe we could
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  help support that. We're trying to avoid duplication
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  of services, of course. Meeting with a lot of
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  our partners, too, just to get our name out.
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  It takes a while when you start a new program
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  to build trust in the community, even with our
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  partners and with our community that we're trying
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  to serve. You mentioned that the community had
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  noticed a gap after new parents leave the hospital,
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  and this program is filling that gap up to that
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  first year. Do we work with any community partners
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  to connect new families to resources after that
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  first year? That's a great question. There are
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  a few. One that's within our own health department,
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  which is awesome. We can definitely refer out
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  after the first year concludes with us. And there
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  is probably continued need, too, as well, for
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  people to have that support alongside them as
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  the child grows. So it's yes and. I think there's
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  room for improvement in that regard. What are
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  your goals for this first year of the program?
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  is more about meeting with our community partners,
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  learning the needs of our community and how we
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  can most effectively serve them. Less of a priority
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  on the number of families we're serving and more
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  on how we can serve them, right? Because our
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  goal is a generational effect. And so it's not
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  a short -term game. It's a long -term game. It
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  may take us a little bit to get up and build
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  that trust I was mentioning and get people even
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  to know that we're offering this service. And
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  we may not see effects right away. We may just
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  be planting the seed today and hopefully we will
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  have a better outcome for this family. One model
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  we use to kind of guide the philosophy of the
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  program is called the Trains Theoretical Model,
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  also known as Stages of Change. And it basically
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  assesses a person's readiness for behavior change
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  and also kind of provides a guide to process
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  them kind of through behavior change. And, you
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  know, really our goal is to not rush them along
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  or push them from one stage to the next. It's
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  more about meeting them exactly where they're
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  at and matching our interventions and our support
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  to line up with what their current stage of change
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  is. Yeah. So that comes up for me when you say
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  how many are you serving? You know, our bosses
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  always want to know how many are we serving?
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  How much good are we doing in the program? But
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  to Kinsey's point, not everyone's ready for this
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  change. And our job is to be there when they
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  are ready. And that may look different every
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  year. Are there other programs either here in
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  Colorado or around the world that are similar
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  to this one? And if so, what does data tell us
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  about the outcomes or impacts for this type of
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  program? Yeah, there are some wonderful peer
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  support programs, doulas and treatment programs
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  here in Larimer County. We aren't aware of any
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  other nurse -led home visiting programs that
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  can serve these families. We value the home visiting
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  piece because we are able to meet them right
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  where they're at. The clinics have a restriction
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  of time, right? They see them for X amount of
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  time and then they're out the door. And through
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  nurse home visiting, we're able to be in the
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  home, reduce those barriers of getting to a certain
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  place and moving at their pace because we have
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  more time. From a national perspective, there's
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  data to show that home visiting specifically
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  is really effective. So there's the MIHOPE study,
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  which stands for Mother and Infant Home Visiting
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  Program Evaluation. And they found that direct
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  interactions between clients and home visitors.
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  as long -term positive impacts on families, such
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  as better maternal mental health, reduced family
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  conflict, strengthened interactions between parent
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  and child, and even improved economic circumstances
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  for families. So we feel very passionate about
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  the home visiting piece and wanted that to be
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  a pivotal part of our program. So I do want to
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  ask you both, what are you most excited about
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  with this program? I know it's a new one, so
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  there's a lot of potential, but is there anything
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  that you guys are really looking forward to?
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  One of my favorite parts is just being able to
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  get invited in to someone's home and to someone's
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  life. Learning from these families, I already
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  feel like we are learning so much and really
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  being present for them to share some of their
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  story. I think there is an amazing opportunity
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  to help them feel heard, which maybe they haven't
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  in a long time. Yes, and actually being able
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  to work alongside these families. and not have
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  them just being identified by the substance use,
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  right? We want to celebrate them as new parents
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  and having a new family and a new start. It's
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  a critical period when you're having a baby,
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  a good time for change. Empower these families
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  without the stigma, right? And they are new parents,
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  and we are here to support you as your new parent
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  role and you and your baby. talk about it being
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  a symptom of a chronic illness. And we wouldn't
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  have expectations of someone, say they have diabetes
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  and they get pregnant, that the diabetes just
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  goes away. And in fact, we would probably support
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  them more, right, to have them have a healthy
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  pregnancy and healthy baby, even though they
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  have diabetes. And so that excites me, that opportunity
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  to be able to provide that extra support and
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  care for these families in similar situations.
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  So for somebody listening to this podcast or
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  who hears about your program, How can they go
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  about participating in it or learning more? It's
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  as easy as Googling. If you Google Larimer County
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  Maternal Child Health, it pops right up. We're
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  the perinatal nurse support program, which is
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  one of the programs listed there. We have our
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  own web page to check out. And for an individual
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  who's kind of intrigued, there is a program interest
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  form. It's very short and sweet. They could fill
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  it out and we would reach out so they can learn
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  more. And what if it's like a provider? You know,
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  they have a patient that they want to refer.
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  Is that kind of the same process or is it a little
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  different? Yes. So I think the website is a great
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  place to find information. We're also actively
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  outreaching. We would love to come meet with
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  you and talk about the program. We have materials
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  that you can share with people you're serving
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  and talk more about the program. So we do have
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  a separate form for providers, but if they want
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  to use the simple form, they can use that too.
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  Leanne, Kinsey, thank you both so much for joining
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  us. Thank you. Thanks so much. Do you have a
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  question about public health in Larimer County
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  or a topic you'd like us to discuss? Let us know.
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  Email us at healthiertogether at larimer .org.
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  Thanks for listening, Larimer County. Until next
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  week, stay well, stay connected, and remember,
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  we really are healthier together.