Supporting Chicago Families With Newborns

family-connects-press-conference-1.jpgAngela Moss, assistant dean for faculty practice in the College of Nursing and nurse practitioner and Gina Lowell, director of community health for pediatrics and pediatrician, discuss Rush’s participation in the Family Connects Chicago program and how it supports our West Side community families.

Moss is one of the nurse leaders operationalizing Rush’s contributions to the Chicago Department of Public Health’s pilot rollout of Family Connects Chicago. Lowell was the co-chair of the city task force and was instrumental in bringing the service to CDPH.

Q: Please explain how the Family Connects Chicago program works?

Lowell: Family Connects Chicago is a service provided voluntarily to families with newborns in the city of Chicago. About three weeks after a baby is born, a community health or public health nurse engages with families in their homes to provide a holistic assessment of family well-being.

The nurse first meets with families after the birth of their baby while they recover on the Mother Baby Unit. Families are offered the service and a date for the nurse visit to their home is set.  The visit itself takes about two hours, during which the mother’s health, infant’s health, family well-being and material needs or supports are identified. The nurse then provides both on-the-spot assistance as well as connections to the resources and referrals to support each family’s unique set of needs.

This home visit happens about three weeks after a baby is born — a very critical time in a family’s life. They may have identified a number of needs they didn’t anticipate before the baby came home. And the mom and the baby may also be going through some unanticipated health issues or other concerns that a nurse visit in their home can serve to address.

Q: How is Rush participating in Family Connects Chicago?

Moss: As a cornerstone of the city’s and Rush’s birth equity strategy, Rush is one of the first hospitals in the city and the only academic institution to initiate Family Connects Chicago. And as you can imagine, launching a pilot project of this scope requires a lot of input from many different stakeholders. The program here at Rush is a wonderful example of collaborative efforts and leadership across Rush University System for Health.

The College of Nursing Office of Faculty Practice is coordinating efforts between the Office of Community Engagement, inpatient Mother Baby Unit, the delivery unit, outpatient OB and pediatric clinics, social work, legal, risk management, security, marketing, other supporting services and many others.

The home visiting nurses are College of Nursing faculty nurse clinicians, employed by the College with financial support from the Division of Women and Children’s Nursing. This makes the Rush program uniquely different from the other pilot Chicago birthing hospitals in that Rush is committing to pay for nurse home visits.  Another unique aspect of Rush’s participation is that because it is situated within the College of Nursing, interdisciplinary university students will have the opportunity to participate in the home visits as part of their clinical learning experiences.

The College of Nursing Faculty Practice already has a robust community-based practice with nurses doing home visits in other contexts so this is a natural fit; this is something we already know how to do. The program aligns with our university and college mission and vision, and larger Rush System mission and vision, to promote health equity in our communities. We are excited to host the Rush participation in Family Connects Chicago.

Q: Is this an initiative of the city of Chicago?

Moss: Family Connects is a program that was actually developed in Durham, North Carolina, and since then has spread to many other U.S. communities and cities, as well as here in Illinois.

Over the past year, the Chicago Department of Public Health worked with the developers of Family Connects to pilot the service in Chicago.

Because the city has approximately 38,000 births per year and 17 birthing hospitals, it was deemed necessary to begin with a pilot, learn from this experience and then work toward scale.  CDPH has public health nurses who can provide the Family Connects Chicago visits, but not enough to reach all 38,000 births. So we proposed a public-private partnership – hiring our own nurses to provide the home visits but working in alignment with the health department for training, quality assurance, data evaluation and program monitoring.

Q: How was Rush selected to participate?

Lowell: Before launching this pilot, the city started out by holding a series of roundtables in the community, listening to different maternal and child health stakeholders to understand what are the gaps for families with new babies in the city of Chicago? How are needs being met currently and how could they optimally be met?

After hearing back from all these roundtables and recognizing the community need for improved, coordinated support for families, they then convened a task force with wide participation of these maternal-child health stakeholders to best understand what service could meet all of those needs identified during that learning period.

Rush was selected for a few different reasons. First, we serve a diverse population of families from all over the city, which is wonderful, and it has a concentration of births from some of the highest need areas of our city, mainly being the West and the South Side community areas.

We also have a strong investment from our leadership to address the disparate maternal and infant health outcomes in our West Side community areas. This is primarily called out in our community health needs assessment and community health implementation plan. Participating in Family Connects Chicago is a strong step in that direction.

We also have this benefit of our resources from the highly ranked College of Nursing. We have a really robust college that includes the Office of Faculty Practice, which gives us the depth and breadth of experience in delivering health care through nurse home visits. Thanks in part to that experience, we could say with confidence to CDPH that we have all the necessary programmatic, community alignment and evaluation pieces already in place. But what if we could leverage our resources and expertise, and actually hire our own nurses to go out and do those home visits for Rush babies who live in Chicago?

So we were in this very unique position where we could work with the city, but also provide our own nurses. And again, through the commitment of our leadership, the Division of Women and Children’s Nursing put forward the funding for the College of Nursing’s faculty practice to hire two community health nurses in order to do the home visits for Rush’s Chicago babies.

Q: How many nurses will participate and how will these home visits work?

Lowell: Great questions. Rush delivers about 2,200 babies per year, but only about 1,600 of those are actually babies from the city of Chicago. And with some careful calculations, we started out by securing funding for two nurses. As we demonstrate what is needed for this pilot, we will better understand if we will need to expand this number.

We also would ideally have a program support specialist, and right now the College of Nursing is providing that, and the nursing supervisor, in kind, which is fantastic. This team will work with a CDPH Family Connects liaison and will have quality assurance oversight with both internal and external data evaluation for demonstrating the case for scaling this up to the rest of the city. We hope to develop the blueprint for other hospitals with similar resources to ours to enter into this kind of public-private partnership with CDPH, to ultimately reach all Chicago families.

Q: What kind of outcomes do you anticipate?

Lowell: Based on the successes seen in other cities that have implemented Family Connects, we expect to see both immediate and long-term results in our families. These include increased parenting skills and confidence, increased connections to resources, safer homes, reduction in maternal anxiety, fewer infant emergency medical care cases, reduction in Child Protective Services investigations and overall improved community well-being.  This is achieved by our Family Connects service ensuring families have access to needed services, improving family connections with health care providers and identifying issues regarding gaps in services.

Q: Why did Rush and the College of Nursing find it important to participate in this pilot?

Moss: Well, first of all, we are very proud of the fact the Family Connects International model is a nurse-driven intervention. This is because nurses are one of the most trusted professions in the U.S., and Family Connects found that families are more likely to accept a nurse visit in their home.

Nurses are also specifically trained and highly qualified to assess whole family systems within community context, and then to connect individual and families to needed resources. Also, the College of Nursing has long been recognized as a leader in the public, community and population health arenas. So in many ways, participating in the pilot is a natural fit and a great venue for the College to showcase our expertise and commitment to addressing health disparities in Chicago.

Secondly, we are excited about participating because many of these things around birth equity have already been happening here at Rush in small pockets, and our participation in this pilot is a great opportunity to bring together many different departments in a really big way. There’s just a huge group of people contributing to the success of this program, which is why the College of Nursing is so excited to participate.

Lowell: I think another reason this is so important now is the context of both the national, state and local conversations about the disturbing trends in maternal morbidity and mortality. We understand that there is a racial disparity in outcomes for women of color and that this occurs not only during pregnancy and delivery, but in the postpartum period as well. The majority of adverse health outcomes for women occur after pregnancy and delivery, and as the Illinois Maternal Morbidity and Mortality Review revealed, these are rooted in inequities across multiple domains, including postpartum access to coordinated care.

We also understand that we have had systems in place to identify families who might be at risk for poor maternal and infant health outcomes, but those systems continue to have cracks that families slip through.

The primary system we have in place right now to help families postpartum is solely based on infant risk. It does not take into account maternal risk. And Family Connects is different in that way, since it takes that holistic approach, assessing maternal health, infant health and family health. And by identifying the needs, the strains or stresses within those relationships, Family Connect serves to strengthen families. And that can mean on-the-spot intervention or connections to longer-term support.

For example, if you have a family who has a really colicky infant. The parents aren’t totally sure how to deal with it, and grandma’s unsure also. A nurse who has had the Family Connects training, who also has a lot of experience in maternal and infant health comes to visit and is able to provide on-the-spot support.

Now, let’s say the colic is pretty severe and that on-the-spot support is just not enough. Well then that nurse has more supports at her fingertips, and she can refer them to a place like the Fussy Baby Network or she can refer them for longer term home visiting programs and connect that family with a warm handoff during the visit.

Let’s say there’s an even more urgent, or even emergent issue – perhaps mom has severe hypertension identified during the maternal health check part of the visit. The Family Connects nurse can immediately contact mom’s OB and secure access to care, or if needed, direct mom to the ER.

The other really cool thing about Family Connects International, the greater Family Connects program, is their evidence has shown that upward of 90% of families, regardless of risk, are identified as having at least one need during that nurse home visit.

The Family Connects assessment checks in with families across 12 different factors. And if a family has one factor that they need support in, they provide support for the one factor. But if a family has six factors that they need support in, well then it provides support for six factors. And that’s why I think Family Connects is a service that particularly has equity baked into the model.  If we are using a service which promotes equity in this manner, it has a greater chance of addressing the disparities we’re seeing in maternal and infant health. Participating at this level – in the pilot and through funding support for our own nurses – is an investment in our communities’ health.

Q: How will families be able to participate in the program?

Moss: Nurses on the labor and delivery floor and the Mother Baby unit will all be oriented to the Family Connects Chicago service. In the prenatal clinics, families will receive information, and their OB providers will be talking about it. In fact, one of our College of Nursing DNP students is already contributing to orienting our outpatient providers as part of her doctoral work.

So our plan is for families to begin hearing about Family Connects even before they deliver.  And then when families deliver here at Rush, they’ll receive a personal visit by a member of our College of Nursing Family Connects team to discuss the service and schedule their visit.

Families will have the option to opt out, but based on how this has been piloted in other Chicago hospitals, we anticipate the majority of Rush families will choose to participate in the program.  Our goal is to capture all of the families while they’re inpatient if possible. Connecting with families face to face is very important to us. The nurses who do the in-person, in-hospital invitations and scheduling will be the same faces that ring their doorbells for the home visit. We know that this “warm hand-off” approach will resonate with our families.

Moss: Our two faculty practice nurses start Dec. 2, and will be participating in robust orientation and training for the month of December. The orientation is intense. And given this is a pilot, we want to see how orientation goes, leaving it open to add content if needed, but we anticipate scheduling the first home visits to occur mid-January. It’s so exciting. This has been a long time coming.

Lowell: It’s been such an amazing journey over this past year: witnessing the incredible work of the Chicago Department of Public Health to birth Family Connects Chicago, and working with our leadership, pediatrics and obstetrics departments, the College of Nursing and our Nursing Division of Women and Children to bring this to Rush. The passion and readiness for an initiative like this has been remarkable.

St. Bernard, Mount Sinai and Norwegian Hospital will also be participating in the pilot program. There’s such a readiness from the different stakeholders across Chicago to come together, whether they’re community-based organizations, hospitals, community health clinics, philanthropists, or policymakers, to make a real change for our families at this most critical time in their life. It’s really heartening. I think it energizes everyone to see people coming together and working together with collegiality and a can-do spirit; this is extraordinary.

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