The Change Talks: Maternal health

all right I think we're ready to go um hi everybody uh this is John money I'm the founding editor of NJ Spotlight news uh and welcome to the first of our change talks um which we are having around stories that we are doing uh as part of the change project um which is basically something we we came up with uh a few months back where we really wanted to as journalists look at some issues that we have covered for years uh that seem intractable in some ways uh and look at some things that have shown some promise or uh potential uh to address some of these worries and uh today we'll be talking about maternal Health but we will also you will see stories coming forward about Public Finance about affordable housing about uh early literacy mental health coastal flooding so uh this is going to be the first of many um that we will be doing over the course of the next four or five months um but this is new a little new for us a few of you have probably been along for our our roundtables and we've also do some coffee chats for donors and the like um this is a little uh sort of a mix of all of all those we'll be substantive and talking about real issues but uh also uh more conversational um a little bit behind the curtains on how we do these stor how we got here uh and then we have some special some special guests with us um who uh were either part of the story or part of the thinking behind the story um and so um you know bear with us as we figure this out uh we certainly want uh folks to uh interact with each other and please do so there's the chat uh room is open and please just introduce yourself uh if that's something you want to be doing um and also there will be a Q&A uh area where you can pose questions that we will be also keeping track of and uh hopefully um be able to integrate into the conversation a few of you also submitted some questions as part of the registration which uh we will also be integrating into the conversations um this is being recorded uh and we will be uh sharing this likely either through social media Andor our website or both um so be aware of that um but again please talk among yourselves and and have you know this is the best we can do with networking in this virtual space but I think a lot of folks find it useful we'll also be uh posting uh Links of various resources including the stories uh that we're talking about so joining today um we have uh Lilo stainton uh the star of the show uh the author of the of the uh the the package I guess it was about multiple stories uh dealing with maternal health and and the strategy of family connects that brings nurses into the home um of of families uh and we'll be talking a lot about that we also have with us Robin Doria uh Central Jersey family health Consortium uh who was gracious to be part of very much part of the the series uh both being quoted but also helping us uh find folks who could be take part in it including nurses and the like and had the pleasure of of meeting them I took some of the photos of this and so I saw them in action and impressive group to be sure and then AA Weiss uh executive director of the Burke Foundation which is very much involved in this issue and AA also wrote an oped for us I'll be posting that link um and uh has a lot to say about it and and you know what happens next and I I do want us to talk a little bit about what happens next uh because this is obviously uh it took us a long long time to get to this place and it's going to be a long time in addressing it but let's start Lilo uh how are you good to see you thanks for doing this uh joining on a Friday afternoon you probably thought your weekend was going to start but here we are um how' we you know talk a little bit how we how we got here um why you know I I went to each of the reporters and said what do you wanna what intractable problem do you want to try to solv today um and and I think I went to Lilo and and you know what what what prompted you to tackle this one or at least to try to yeah I mean as John said this is this is not how we usually work right um usually I write several stories a week two or three um and you know this was I was given sort of a month of almost time solid to work on this project and that in alone is sort of a dream for some reporters not all but for some of us um we always talk about having that luxury but we never get it so that in itself was an amazing thing um but it was also it really was a unique opportunity to to to look at not just something in much deeper depth um and really peel back the layers more than we normally have the chance to do but also um to explore something that is positive and is working and as you know people who read our stories know generally you you you start with a problem and you describe the problem and then somewhere near the bottom you may men a potential solution that may be starting somewhere this isn't just a potential Solution that's starting I mean and an opportunity to focus on it but it was also um there's something very unique about this particular particular program and that is instead of being a pilot you know funded by a foundation we're talking about something in this case that is Statewide or will be Statewide and has State backing and that is really unusual when you're talking about new and creative upand com kinds of responses to public policy you know intractable public policy problems and this is this you know New Jersey's maternal mortality rate is is there's statistics in the story there's some great maps from my colleague Colleen OD day um you know it's not great and it's far worse for black women than it is for white women um Hispanic women are somewhere in the middle um but you know I've heard stories from from black um atrians of women who have come to them black women who have come to them and said I do not want to die in childbirth and that is when you think about it a really astonishing thing to have to consider so it's nice to report on something that is actually making a little bit of progress um towards changing that and for for some who may not have read the story and I put the link of the main story up uh what is quick synopsis of of what this program is so family connects is a it's a model that was first developed in um in North Carolina a couple decades ago almost and um essentially it involves it it require it involves a nurse uh a registered nurse who's trained who goes makes a visit to a new family a mom with a baby who has been discharged from the hospital within two weeks so you're there really early on um I'm not a mother I feel like a fraud when I talk about this but you know I understand it's a very hard time and there's a lot going on so these these moms you know these nurses are there to know answer questions do a clinical assessment of mom and baby they also check you know is there postpartum depression is are you having issues with lactation do you have a crib do you have a car seat you know is Dad okay how's you know what's his role everybody in the family gets an assessment and then most importantly perhaps there is also a connection to these Services it's a very live connection with warm handoffs as they say in the business um meaning there's somebody also on the back end making sure that when Mom you know goes to schedule her visit for postpartum that there is actually someone there answering the phone that the program still exists that you know the food bank people are sent to really has food on the shelf that kind of thing so it's it's sort of a closed loop designed to really support all families and the other important thing is it's Universal um in that it is open to any new mom and also um families who are suffered still birth um or adopted uh any new mom regardless of income Insurance even um immigration status so anyone can access this program and everybody I talked to who was involved sees the benefits so great um and we will get to uh some of the nuances and lessons you learned uh in doing the reporting on this and continue to but let's uh introduce our guests uh Robin dor um again Central Jersey family health Consortium uh and the provider of some of the nurses in our story as well as some of her own insights tell us a little bit about yourself and your role in this thank you John thank you Lilo it's a pleasure to be here with you um yes my name is Robin Dior I'm a nurse an advanced practice nurse um with over 40 years experience in the Maternal Child Health space for the first half of my career I was based primarily in patient care in a variety of roles and for the past 20 plus years I've actually worked in the community and have had the privilege of leading the Central Jersey family health Consortium as their CEO the organization itself is a nonprofit it is part of the Maternal Child Health consortia System within New Jersey there are three agencies we being one of them um who are actually legislated to exist through uh the state of New Jersey to provide Maternal Child Health programs our mission is to promote an equitable and Healthy Future for families through Services advocacy and collaboration as well as education and we do that by providing many of the many programs family connects is one of them we were we work mainly in the central part of New Jersey and that how we actually got involved with family connects because one of the counties that we serve is Mercer County which is where the program started it didn't necessarily start out to be the pilot but in fact has turned into somewhat of the pilot uh for the rest of the state and I know we'll talk a little bit more about the program itself and where we are but my colleague Tia Weiss is actually part of the reason we got um invited to be part of this initial program um prior to the start of the Statewide program and I turn it over to her yeah before I jump to AA um I remember uh when I was talking to Lilo I said you know do you have you found some people to talk about this uh and she called and I guess I don't know how she found you um but I remember Lilo said um they can't wait to talk about it um you know this is so I don't know did you just pick up the phone and there was a reporter on the other end or uh yeah kinda luckily our paths had crossed once or twice before um over the years so I knew who Leela was which was the good part um I I have to say though John wanting to to talk about the program I am not not the only one as you found out um all of our nurses and I just shared with the group how um we actually have a meeting today with all of our staff and that are involved with the program and I honestly can say in all my years and there have been many um I have never been involved with a program that is so well supported and truly liked by those who are doing it but because of what we're doing and the impact that we're having on the families that we serve and that we touch it is incredibly gratifying and they themselves can't wait to continue and grow the program so not only is it successful on the the step side but obviously ly some of the early outcomes that we've seen have really shown that this program can make a difference great Atia um I'll join you uh welcome to the conversation uh tell us a little bit about the Burke Foundation to those who may not know about it and um and also uh your interest obviously in this very specific issue but introduce yourself yeah thank you John and it's so nice to be with you here with Lilo and Robin to see you again um so my name is AA Weiss I'm the executive director of the Burke Foundation we were founded by Jim Burke longtime CEO of Johnson and Johnson and he was deeply focused on children's health and families and when he passed away about 10 years ago he put his entire wealth into the foundation and so our Focus really building on his legacy and our passion is to help families Thrive by making sure newborns moms and dads get everything they need for the best art in life um we we sort of consider ourselves kind of a think tank um for babies and families and so what we do a lot of our team is to really think about you know we identify what are the best programs and policies that are out there there that are going to make the biggest difference for families and then we help find incredible partners and organizations people like Robin and her team to really implement the work um and are excited about evaluating its results and then you know if something's work working we're excited to help support the scaling of those program s and you know I think one of the things that we've learned over the years is that um we we believe so deeply in these first 10,000 days so those are the that's the time um from pregnancy to age two but it's the most important time for a child's development it's it's the time when Peak brain development is happening so it's kind of hard to believe but something like 1 million neurons are being formed every second in a baby's brains um and that window of time is exactly when these amazing early relationships are being built between caregivers the parents and the babies so it's such a critical time to reach babies and families and when we were doing our research six or seven years ago I mean I think we looked at something like a hundred different programs um and you know we went through the research we talked to community folks um we went and visited uh lots of programs across the country and the one that felt the most promising to us was Universal nurse newborn home visiting family connects um so I know we're going to dive into that today but um we are so I I think we can't believe like what we've seen in terms of going to a pilot to having this great partnership with the state who's now expanding it you know to every family in the state and I just want to be perfectly clear that that Burke was really they're the organization that essentially brought the model to New Jersey right and I mean I'm not not to not to say the state is you know wasn't thinking of these kinds of things in fact the state runs several home visitation programs but they they tend to to be and Most states do but um they tend to be highly targeted right to people who have you know addiction issues or you know have been through the Foster system or you know they're just who have real challenges that that we've identified that need to be overcome there that this model is different because it really it assumes that everybody's going to be struggling when they come home with a newborn right it it's just hard right and and so you know it really it it allows that that opportunity for everybody and I think I think it's it was interesting because there was you know there was a little bit of a chick in the egg and the state you know should get a credit for for doing this on this this Statewide level and the fact that there's legislation huge shout out to you know the lawmakers involved Senator Teresa Ruiz um I think as assembly woman Sumpter right um I hope I have that right my goodness um Senator Vitali was involved I believe I mean these are people who know know their stuff and are in it for the right reasons um but you know it's usually it's often pilot projects funded by Foundation that start these little these ideas rolling and that was really here yeah and Leo I would say um appreciate the credit but I I will say that um and we you know we did a fair amount of research about it but it also was something where there were there were folks in leadership positions across New Jersey who just saw the value in the program so people like Christine Byer who's the commissioner of the Department of Children and families who said you know wow I believe in primary prevention this is really important if we can get to families earlier through this kind of home visiting in a universal way they may not end up in the child welfare system and great evidence against that and so you know we thought we were going to be maybe doing this pilot alone but but with I mean this was so exciting to have commission and the Department of Children and Families match our $1.5 million investment was incredible it just showed the value right away and I know we're going to talk a lot about this too but with uh the first lady Tammy Murphy's initiative with nurture New Jersey and the attention on um black maternal mortality which is as you mentioned Lilo so unacceptable we have to do something about it but this this program is the kind of program that can also support universally families um and particularly around maternal infant Health breastfeeding you know catching like complications that can result in more morbidity or more mentality so you know it's like a win-win for so many people um and then the advocacy Community really embraced it as well so um just kind of showing the I mean the concept of home visits obviously as as Leo said it's been around a long time but uh this specifically Oregon was was one of the early adopters on this and then also Durham North Carolina can you just take us outside of New Jersey just a little bit about how this began I don't know who whoever wants to I know Lilo did some reporting on it but T do you want to I mean I think the program originated in Durham North Carolina so that's where it started it was by a researcher named Ken Dodge um who was really I think his his really like the origin story was that looking at ways to really support families and really to um avoid child abuse like that was kind of their early charge with the program started in Durham North Carolina and they they did so many like a couple randomized control trials that showed fantastic data and I think you picked up on that in your story right what yeah I mean in the first year right so so I interviewed U Mr Dodge and he was saying you know they were looking at the problems in that area and they're they he was stunned by he's a clinical psychologist and he said he was really shocked by the high level of violence in in in the homes that these newborns were in so you know that was sort of a a primary thing it cut visits to the ER for mom and baby in half the first year and I think AA it's by a third if you stretch it over two years if I remember correctly um it cut reverse uh reports of child abuse in half uh I think it cut uh reports of postpartum depression and then there were all these other sort of things that are much more hard to quantify like parents were reading to their children more you know they were dads were more engaged I mean there were all kinds of other benefits that I think you know are hard to measure I will note um you know the state and and the first lady have have sort of focused at least their initial part of their nurture New Jersey campaign was was largely or I guess it was primarily driven by the high maral maternal mortality rate but it it's broader than that right and the one one of the things that hasn't been measured with um family connects is the impact on maternal mortality now when I talked to Ken Dodge he said yeah there's no data that exists on that yet it's really hard to get but you know everybody agrees that anecdotally I mean every nurse I've talked to has practically had a story about a life-saving intervention that they did um the woman who's the current head of family connects International which is the nonprofit that does this work across the country you know said one of the first visits she was on mom had blood pressure that was so low they got right in the car and went to the hospital I mean you so there was a case in Newark early on where a baby May well have been saved I mean you know we're not looking at the medical records but there's a lot of anecdotal evidence there that that lives are being saved so it'll be interesting to see how you know the data on this what this shows over time yeah Robin talk to that I I met one of your nurses and and spoke with her a little bit about I mean it's these aren't always easy situations that your nurses are going into um talk a little bit then and that's one of the uh predominant questions that came from our audience uh was you know how how will this address um that larger uh you know very tragic uh you know problem so a couple things one thing I will say and I think it's important to note because it really adds to the depth and breadth of the research that was done to make this an evidence-based program and that was originally the program sat at Duke University and they supported those initial years for family connects prior to them breaking off um over the just a few years ago actually during our tenure with the program um as a nonprofit and that was another piece of our puzzle that really did um support our adoption of this program and how we really were incredibly excited to get started um and absolutely agree the focus initially was really looking at decreasing levels of child abuse because they were Inc they were astronomically prevalent in certain communities in more rural parts of North Carolina but as a secondary they also saw some benefits for Mom because you can have Focus just on the child you need to focus on them both and those of us that have worked in field no it's very much a diet and the health of one is very much dependent on the other so having uh the let's assessing mom and really um checking in to see how they're doing is incredibly important you're absolutely right part of the interest in a home visiting program and underneath the nurture New Jersey Plan was due to the high rate of maternal mortality New Jersey has had one of the highest rates in all of the United States which somewh incredible knowing that we have you know 48 birthing hospitals had even more up until a few years ago all levels of care the most you know um intensive care that you might need and yet we still have these horrific rates and the disparities are unfortunately right at the top as well and totally unacceptable so having that as really a driver for nure New Jersey I think is incredibly um it was very helpful to get the ball rolling and get us started now I will say when you look at maternal mortality when is that more likely to occur I when you look at overall death of women within one year of a pregnancy event whether that pregnancy went to term or not the majority of deaths occur in the postpartum period and not even in the first week or two we're talking late postpartum period and often we've found through our maternal mortality reviews is that people present with symptoms that can often mimic other types of conditions and are not attributed to the pregnancy so they're not treated in a way of which they can prevent morbidity and mortality such as give me can you give me an example if a person comes in with shortness of breath say three months post Birth has a history of asthma they may at that point and if there's that information is not shared with the health care provider by the pregnant person or the postpartum person they may assume that this is just an exacerbation of their asthma provide an inhaler and off they go when in fact that very well could be a sign or symptom of cardiac disease uh cardiomyopathy happens to be one of the more pre prevalent cardiac diseases that becomes apparent in causes late maternal death so there are a number of initiatives that are being worked on both nationally and within our state to help address that but if we have someone going into a home within those first few weeks to review those signs and symptoms of what could occur and could be a sign of morbidity or just that something's not quite right empowering the woman to say you know what I don't think this is my asthma this is something else so that they feel comfortable in doing that and kind of pushing back a little bit that that in and of itself can save lives just the ver by virtue of going for that postpartum visit with their health care provider whether it being an obstetrician a uh certified midwife a nurse practitioner We Know by going on that visit we can decrease morbidities and what we found in just the first thousand patients that we saw over 90 percent of the women went back for that visit as opposed to the national average which is about 70 y so we know that's just by this visit we can make a difference in both the mom and the infant's life yeah we had a question um and maybe I'll Tia I don't know if you've done research on this uh the return of on investment of A180 to 570 for every dollar spent on home visits yeah I mean I think I think that kind of like original data the big one is James Heckman who actually won the Nobel Prize for econom for economists um out of U Chicago really showing the incredible return on investment when you invest early like but basically the idea is um and family connects brings that to life right if you invest early in a program like this like something like that or high quality early childhood education um you are really saving money from the system in the long run so in the case of family connects a lot less money for ER visits right away the program pays for itself which is incredible and so like that one1 to five dollar is more specifically about home visiting yeah but I mean I think you were the you also AA were someone who underscored that for me when I was doing the research in the beginning is and and we have come a long way I mean I remember back in the days of the Affordable Care Act everything was about price right and we were constantly looking for Savings in the system it seems like the conversation has moved a little away from that probably because it's just impo seems impossible to control cost but honestly when you talk about this program the the cost is so low what is it like $600 or $700 per per visit if I have that correct I mean if you think about that upfront it is really low um I believe the state is now spending about $16 million a year to get it started in the five counties that's going to grow a little bit over years the new budget has 20 million to expand it a little that's may sound like a lot but when you think about it I mean this is a 55.8 billion budget proposal and we're talking about the potential to reach tens of thousands of families and and I think it's you know when you do the math it's pretty shocking I mean it's basic preventative care but um it kind of drives home the point that that it as a as a Statewide initiative it's hard to say this doesn't make sense I think um I mean it's just I'm I'm having a hard time finding arguments against it it's hard to implement in some places I mean we we should talk about some of the challenges right you know getting people to say yes getting the right how and and I would just add like the value is it's very measurable which is really incredible and it's also kind of as you we were saying earlier sort of immeasurable I mean more kids reading right now like early literacy I mean that's amazing bonding like that is so protective for lifelong health and well-being so I think you can very quickly see the value Robin what you were just saying like more people are actually going to that six we visit as a of having a nurse home visit and that means we're much more likely to catch these you know these challenges Mom feels supported dad feels supported you know the the the whole the whole system is better for this baby you know and I think that's I think that's the kind of work and framework that we can build on you know for the better of our kids and our this is voluntary correct I mean talk a little bits yeah talk a little bit about the mechanics of of how uh families get into this maybe Robin yeah I'm happy to So currently there is the website familyc connects nj.org that's all you need to Google and that particular website will bring up all the information you need there is information specific to families specific to Health Care Providers it will walk you through how to schedule a visit there are three ways right now to do that there is a website that can be accessed that will take you to where they can schedule a visit there's a phone number that you can call to speak with somebody and there's actually an interest form that can be filled out that goes to the site who is performing the visits and someone will connect you and call you back eventually the state will have in place a way where you can actually schedule the visit yourself so I'm a um I am a birthing person and I know I want this visit when I have my baby so I can actually schedule myself for the visit in advance and we're advising folks to do that closer to your due date but you can do it that way that will happen probably within the next few months as the website gets more and more up to date I will say to um and I do have some quotes here that I'm happy to share from families just so you can hear from their voice and these are quotes of what they are saying one of the things that I think it's important to note and that people should know is we talked a little bit and when Lilo was giving the overview about um the difference and the disparities in care and much of the work that we do we do recognize that having culturally congruent care is very important and often leads to better birth outcomes than not and the staff that the agencies are employing are being specifically targeting nurses as well as Community enlightment Specialists and program support special specialist that are culturally congruent with those communities that they are serving so we do have bilingual staff that can assist families we do have black nurses that can go into communities that are predominantly black so we and we do have access for those communities that there may not be as many people but we know language is a barrier we do have the ability to speak with them in their language in most cases by the use of something like a language line and I we found that to be very important and that's part of the feedback that we're getting that is really helping to um reinforce how important that is in our care and that's what we're seeing overall in literature today as it relates to maternal Health it oh go ahead I'm sorry I just wanted to add that I think you know I mean this is not fixing the system right I mean it doesn't and and I give the first lady and her team tremendous credit for being very open early on that racism is a problem here right there is tremendous inherent racism in the system in the Health Care system I you know Dr Herb Conway um an assemblyman who's a doctor who's black has talked himself about diagnosis that he made in which he was dismissive of some young man's potential condition because he assumed the man you know was poor you know young black kid from Camden or something I mean black doctors will admit that they are it is almost impossible for anyone not to have a bias and this is a huge problem in the system I mean not to blame anybody in particular but there's just tremendous racism built into are the structures of our world and our government and our systems and this won't fix that per se but the fact that you know you're starting early on and the more diversity you can build into these teams um you know just the the anecdotes I heard from the nurses was were really powerful I mean they are making these connections and this is you know you're meeting people at their most vulnerable position I keep thinking like you know I cringe When anybody comes into my house you know unannounced right I mean but you know imagine you have a baby and you're healing and you're you know you haven't cooked or cleaned or done your hair or anything in a week you know I mean that's a really personal thing um and I just I give them tremendous credit for bridging those gaps and and making those connections because without that it it just doesn't work a question uh in in the Q&A about uh does do private insurers cover home visits lactation other things that that fall under this at all such a great question can I I'll start but um please you guys probably know more the law the family connects law does require that insurance covers this including Medicaid which is the state um state run you know public plan which pays for 30 at least a third maybe 40% of the births in New Jersey um so that's in incredibly important the state is still working on that process though for both Medicaid and insur in private so I don't think it's yet but some of those services are covered already right right and so right now Family connects is 100% being covered by DCF so it's free to everyone who uses it correct it's free to everyone there is no there are no restrictions whatsoever and that is one of the challenges because many families think this is only for those who have no insurance or who are on public assistance and and that is one of the things we found early on that we need everyone I for myself when I had my babies I had been a labor and delivery nurse for over 10 years and I still went to the pediatrician with a list this long we all bringing a baby home and in to your house is disruptive in a good way in most cases but imagine having one two three toddlers around you and one of the things that's very nice is with this program and this is a scenario that happened with our staff that we talked about was going into a visit mom was by herself she had a one-year-old a two-year-old and a three-year-old with the newborn and trying to do a visit where the kids are kind of climbing all over you know but but that's okay and they worked together and the nice part was the nurse was able to model some behaviors that could be helpful for Mom at a later time and still was able to do an exam on both of them as well as do an environmental type of scan so there was still lots of benefit it might have been a little bit more chaotic and maybe a longer visit but I just to speak to what we were talking about before especially with languages because that's probably one of the biggest challenges one of the comments and this is again verbatim family connects is a good service and option the nurse ask me to text her questions which is very reassuring going to the doctor's office is difficult because the information is in a language I don't understand I'm very thankful for this service so just to be able to start the connection and be able to talk about how so how do we take care of this what are some ways in which we can help you as you move on because you you know you'll be going to the pediatrician very much within the next year and so on I remember um sorry Catherine told one of your nurses was telling a story about how she did a a Well Baby check in the back of a car um because the mom didn't feel safe in the home and you know and and that was another thing I give these nurses incredible credit for navigating you know complicated situations that often require you know really high level critical thinking in real time you know people's lives are in the line which way you know what do you do it's this this is this is not easy this is not easy work what is the case the quote unquote case load Robin for a nurse are they doing two or three a day uh I mean roughly they are doing on average six to seven visits a week okay we usually do a visit in the morning and a visit in the afternoon again because they can be on average two hours in length and there's quite a bit of uh documentation as you can imagine and we leave one day open the nurses meet weekly as a group with a medical director a medical advisor to talk through cases it's a case conference so for those on the call that are familiar with the health care System it's no different than that as well as education Etc we have a question oh go ahead I'm sorry what I will add to that the model itself is one visit per family however we can do a to three visits for a family should they be more in need or more at risk and if we find that the nurse still doesn't feel comfortable and there have been cases like this we will refer to other Home visiting programs to continue that more intensive uh support otherwise we will do like we do for every case do um as Lilo said referrals Andor warm handoffs to our families for other services within the immediate community and within a month after the visit we have another contact phone call to really see were you able to connect with this place this place this place to ensure that those connections are made and we have found especially again where English isn't the first language that sometimes is hard because people don't understand the system or unable to make that connection so we assist at that point as well so there are some checks and balances go ahead yeah with a pilot something like there have been a thousand home visits which is so incredible and something like 3,000 referrals that came out of that um a lot of them are for diapers and Cribs you know kind of just basic needs which we can provide that that is very doable you know other things people are looking for is child care like fin figuring out how to what that looks like um also looking at you know for more home visiting um you know also yeah mental health support too um but the fact of the matter is what Robin what you your team this program is doing you're creating a whole ecosystem for families you know um I love that you connected with a with Isles who's looking at lead remediation right like your Comm your um nurs have been trained on lead so they can go in homes and do that environmental scan and if there's a challenge you know very quickly get resources to that family like you were connecting dots that weren't connecting you know before I think that's so interesting because I wanted to say one of you know the front end of the program I kept calling it the front end and the back end but the the front end gets a lot of attention and rightly so but the back end is so important too and I was speaking to um Robins essentially your your your colleague Helen I think it's Hanigan at the southern New Jersey Perinatal rocket Leo you talked to every single person I did I talked to a lot of people for the story I I may have talked to too many people I apologize if you didn't get quoted as a result but um when Helen said something really interesting and she said one of the benefits already is that it's improved what used to be called Central intake and I just can't you know a cringeworthy name but that was I I guess the referral system for social services and they were all you know that's where you get your food pantries and your you know your fqd your free clinics and things like that that whole network has been is being strengthened and sort of rebranded but apparently the state is also investing in improving it and filling those gaps from what I understand and Helen was saying that that's already had huge impact in partly just with other stakeholders there's sort of a recognition that this is now you know being being focused it's a focus in a new way and I think it sounded like it sort of breathed new life into the system which is one of these things that does so much and we never think about it enough Until It Breaks you know um so I I just think the backend stuff is really important too so I think it's important to point out there are two other key components the nurse obviously is is kind of a Lynch pin in the middle however the community alignment specialist and the program support specialist are the other two key staff involved in the family connects model and that's what really makes this model different in my opinion from other Home visiting models the community alignment specialist is on the ground in the community making those connections learning who those referral sources should they where can we and that's exactly what Helen is speaking to they work they are actually part of the connecting NJ staff which is the rebranded name for Central intake they are so that's very nice because again for New Jersey we are making a whole ecosystem here connecting NJ isn't only for the Maternal Child Community however for us it's it's an integral part and we work hand in hand the community alignment Specialists and the nurses to really figure out where is the best place what given what the needs are for this family the program support specialist is on the front end that's the person who connects the takes the call okay you would like to have this program let's schedule you and does that post visit call so it really that for me is what stands out is that Community alignment to really make this program something that that wasn't around I will tell you as a nurse a postpartum nurse we thought everything was fine and send Mom home and she set with the family but it's very clear to me after 20 years in the community that's not the case we have no idea what all those other pieces are and one of the quotes is that the nurse came checked the baby confirmed that she was all right I forgot the things that they told me at the hospital and this way she repeated them if in case needed help with my baby it felt good that somebody cares yeah so it really that's why I think this might be along with all the other initiatives as part of nurtur n j as part of our New Jersey Perinatal quality collaborative our maternal Care Quality collaborative all of those pieces now we have in place and we should start to see that difference we've seen it a little bit on a very small scale but I know a t and I are both waiting to see what this data shows yeah somebody somebody uh asked the question uh how often these things come down to money um and having the the resources to provide I mean I think AA you mentioned um you know a thousand visits or so but we're talking about 100,000 births in New Jersey every year and even 70% is 70,000 um you know funding is critical having nurses is critical I mean talk a little bit about um you know those components to it because yes there's more money in this budget uh though it's a little unclear how much um but uh you know talk about that because we obviously have a long way to go to get to 70,000 a year we're in a state where they really care about maternal Health right now so we are we're in a in a good place in terms of the fact that state funds have been set aside for the next five years to grow this program program I think what we would all love to see is that this program becomes um like getting a car seat everyone just believes in it they're so excited about it it's so Universal it just becomes part of you know what you get as someone living in New Jersey and I think what you all are doing from an advocacy standpoint you the work that you're doing from NJ Spotlight reporting on it telling people about this will help people we're going to eventually have to continue to make the case for this for funding it um as we weather you know new political Transitions and I and I think that's why advocacy is so vital in this case like let's keep talking about the results Robin you're doing a great job about it you know what's happening what the nurses are saying what you're hearing from the families and I I do believe we're all going to see population level impact you know as given the amount of like work and talent and expertise that's going into it and we got to keep talking about it it can't just be all the bad news it's got to be the good stuff that's happening too so that's number one and John you brought up such an important important Point too about the nursing Workforce and we saw it during covid you know we we need a lot more nurses um in our state and in our country and I will say that's something that um the Department of Children and Families the state has been thinking a lot about you know to get to a program where they're you know um you know serving 100,000 families a year you need 250 nurses um so we actually helped to fund a report a Workforce Report with the Department of Children and Families really looking at um you know how do we retrain an attract nurses to serve in this program you know what are what are the some some of some of the great recommendations that we can do can we look at loan forgiveness can we look at you know how do we support these nurses and in particularly thinking about um black and brown nurses for the for the point that you made Robin around culturally congruent care so there are a lot of great recommendations that the state is looking at and I think that's something another place where a lot of folks can come together um to think about our next generation of nurses that will be serving this program yeah I mean go ahead Lea I'm sorry there is that is something the state has also recognized in the budget um of course you know the you got to put your money where your mouth is and they are um there's five million dollars in the new budget proposal that the governor just introduced um earlier this week that would um a lot of it is for loan forgiveness for nurses and primary care doctors there's a couple hundred thousand 200 and some thousand specifically to train nurses who commit to family connect so I thought that was really interesting um and yeah like I said they have laid out the money for the next couple years but we're I feel like I should have made this clear at the top you know there's five counties now in play New Jersey has 21 counties I Believe by the way you know off the top of your head the five I do I do good work Cumberland Blaster Mercer Middle sex and Essex right um now my friends from formerly Twitter uh schlomo had a question in the um in the some of the materials that were circulated earlier if we know what counties are next I believe we don't or at least the public doesn't no we do we do okay we do and if somebody can pull up family connects NJ it does have the next it will talk speak to the counties through January of 27 now that is subject to change according to DCF but as of right now they are they are the counties are okay I the five that were chosen were ones where I think that they're some of the greatest needs in terms of maternal help out them so I think like they selected um I think they were very strategic in the places that they picked they go into it seems very I mean there's 11 catchment areas and I think they're expanding you know they're trying to to touch as much as they can where the need is the greatest but yeah it's it's going to be it this is going to be a lot of work I mean it's by no means a done deal right now that it's in legislation and start the funding is starting I I feel like I feel like we can't you know those of you who are doing the work nobody can take their foot on the off the gas ah look at that look at this where is one of our is a phenomenal partner at Department of Children and Families leading this work it's great to have you on thank you Andrea for posting that as wellbody also asked what what responsibility do hospitals and insurers have in addressing this we're talking a lot about the state being at the core of this but um what about you know some of the the private sector on this I do know that and DCF was very strategic in how they were planning um this program Universal home visiting and there has been a work group specific looking at payers and what their role is and I know they continue to meet to see where they fit in knowing that we have to think the Long Haul I will tell you especially coming from an agency that's primarily Grant funded for our programs it's hard because you know you put everything you have into it but it's Grant funded it could end at the end of that Grant year and a program like this will need time to be able to show its efficacy and success and knowing that in a short term we've seen some success we do need to give a time so I'm grateful that we're already in you know halfway into this first year but you know there are plans hopefully with the budget that we will continue this because it will be multiple years before we start to see anything demonstrable there's not not one thing that this we know there's not one thing that will decrease maternal morbidity and mortality in New Jersey nor take away the disparities that we see in these numbers but given the fact that we have all of these initiatives going and this is kind of the icing on the cake for all of these initiatives I think we are better situated than and just about any other state that I know of working on different National initiatives to be able to address this issue and that goes the same for infant mortality as well as morbidity and looking at child abuse Aces Etc I would just note that Oregon is the only other state that is trying to do this Statewide at this point they have I think 36 counties there and it's now in five or so I mean that their roll out has been challenged and they do not have as much State funding behind it not nearly as much so this is hard work this is you know it is not easy to do so yeah New Jersey has received lots of credit for their commitment to this all right well we're uh about about done I mean there's we could be talking about this a lot um one of the charges of our project and and Lilo knows this is to stay on it um we really uh didn't want you know this project to be one-offs where we write about something that's either tragic or great or both and then move on to the next we've really asked our reporters to really make this part of their beats and Lilo has done so she did a follow-up story this week on the funding uh but it this will continue to evolve um and um you know we're we're thrilled to have the work and we're thrilled to have you know folks like AA and Robin who've you know really helped us do the work as well um you know it's been great so um thank you uh thank everybody for joining us I I would be remiss and not doing some Shameless fundraising um NJ spotlights a a nonprofit and we can't do this without the support of our readers and subscribers like who are on this call uh so certainly um any support you can provide uh whether it's just reading us or or other means uh is greatly appreciated because these they may be free for you but it does require some costs as well we have our own funding issues as they say um but uh I want to thank Tia Robin certainly Lilo uh you and I will be talking plenty anyway but uh thank you all for joining us uh and and please uh continue following this issue obviously a critical one so have a great rest of the day and a weekend ahead and uh we'll see you next time we'll be doing uh continue to do these uh every other week or so on different issues so uh keep an eye out in in the newsletter and elsewhere but thanks everybody it's been thank you John thank you for a great conversation everyone Take Care thank you Robin and pleasure and your nurses Robin and everyone to nurses everywhere let them know I think we do we stay on or not oh no special shout out to my mother-in-law for still yes she