Family Connects Oregon is a program that brings nurses to the homes of newborns and their families, as NPR recently reported. It’s an opt-in service that aims to improve health and socioeconomic outcomes for parents and children. Family Connects continues to expand in Oregon and has visiting nurses in counties including Jefferson, Lincoln and Washington. We learn more about the service from Barb Ibrahim, a public health nurse for Jefferson County.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. In 2019, without that much fanfare, the Oregon Legislature created the universally offered newborn nurse home visiting program. As NPR recently reported, it’s now known as Family Connects Oregon. It brings nurses to the homes of newborns and their families. It’s totally optional, and totally free for these families. It’s currently offered in eight counties around the state, with more coming online soon.
Barb Ibrahim is a public health nurse who does home visits for programs in Jefferson County, and she joins us now. It’s great to have you on the show.
Barb Ibrahim: Thank you. It’s great to be here.
Miller: Let’s imagine that I had a newborn, and you came to do a first visit at my house. Where would you start?
Ibrahim: I start by greeting the family and saying, “how is it going for you guys, and how are you,” and seeing who all is there for the visit. That’s kind of where we start – with a friendly “hello.” Then we’ll go over the program and what it looks like, and make sure the family feels comfortable. Then we’ll just kind of go from there.
Miller: Are you mainly visiting first-time parents?
Ibrahim: No, this is open to all parents, whether it’s your first baby or … also adoptive parents, children in foster care, children that are living with other relatives, that sort of thing. All new babies.
Miller: So it’s open to all those. But is it people who haven’t had newborns in their homes before who are more likely to ask for your services?
Ibrahim: Not necessarily. I think it just depends. We’re working on our systems of reaching families. Sometimes people that are on their third baby, they do feel like they have enough support and they don’t really have any questions. So that’s a common reason that people don’t do it. But we really feel like every baby is unique and different, and that there’s a big change any time there’s a new baby in the home. So I don’t really see that people accept it more for first births, but I haven’t done the data on that either.
Miller: Why focus on three to five weeks? What is it about this particular time frame?
Ibrahim: Three to five weeks is kind of after a lot of the first doctor visits happen with a newborn, and then before the well newborn checks at like six to eight weeks, when children will receive their immunizations usually. So it’s kind of a period of time when some of the support drops off. So we’re there to come in and assist. Sometimes families will be seeing lactation for a few visits. And so we’re also able to follow up kind of after the lactation visits if there’s some more assistance needed. We kind of focus our visits on what the family’s concerns and interests are. But then we also have a basic visit protocol that we follow.
Miller: What kinds of issues have you found come up most often? What do you most often asked for help for?
Ibrahim: It really varies. Often, reassurance is one of the things that we offer. Then we check with families to see if they know about the WIC [Women, Infants and Children] program and if they’ve had their first visit. Some families have already had a visit after the baby is born. Sometimes the families have some difficulty knowing if their baby got their insurance settled out, or making appointments sometimes can be difficult in our healthcare system.
Miller: You mentioned insurance. My understanding is that this is free for patients. So they don’t have to spend a single penny to have these home visits?
Ibrahim: That’s correct. There’s no cost to the patient. It is billable to the health insurance, both private and public. There are some privately funded insurances that don’t cover it. I think that the counties are offering to those families as well and not charging the family. Not sure about all of those details.
Miller: We asked parents on Facebook what would have been most helpful to them when they had newborns.
Samantha Vembu wrote: “I had a rough birth that ended in a C-section and an infection. I was really sick and unable to take care of myself well. My baby had undiagnosed reflux and lost weight rapidly. I needed help breastfeeding and I was shamed instead of helped. Also, why I had to take my newborn baby to the clinic for a weight check at three days is beyond me. Nurses should come to us. I could barely walk and am lucky I didn’t tear my stitches.”
Brett Howell wrote: “I think more can be to address the mental health needs of new parents. Sleep deprivation, combined with the pressure of your own expectations, a radically new schedule and the changing dynamic of your relationship with your partner all have a significant impact on your mental health. As a new parent, your instinct is to always put your child first, but that can lead to feelings of burnout and frustration that are challenging to cope with.”
A lot in those two statements. I’m curious about the first one from Samantha Vembu, who emphasizes how helpful it would have been for her to have somebody come to her. What do you feel like you’re able to do because you’re in somebody’s home, as opposed to they’re going to you in a clinic, or talking to somebody via Zoom?
Ibrahim: Well, I’ll address the first one, me coming to them. First of all, it’s really hard to get the baby in the car seat and all of that. The nurses have a lot of experience and would be able to come in and C-section scar if the mom wanted, check her blood pressure to check for signs of preeclampsia, ask about any other problems that they have. We all feel comfortable reaching out directly to providers if needed, if a same day appointment is needed or if the family needs to go to the emergency room.
I’d say that’s not as common as … Sometimes families with their birth story, it can be difficult, some of the things that they go through at the hospital. And then some families come home to not a lot of support, or the support people have to go back to work, there’s kind of a drop off there. So we provide a lot of empathy, a lot of reassurance. And then if there’s resources that might help the family, we look into that and help them with accessing those services.
Miller: I read that comment from Brett Howell. We got one from Josh Powell who wrote: “The thing that impacted me the most was the mental health of my son’s mother. She could have really used a support system after giving birth. In the past, extended family would typically live nearby to offer support for a newborn family member. It seems in the modern era, families are often spread out and unable to provide physical help or even emotional support for new mothers, given how busy everyone seems to be. I think our societal norms have changed and we don’t necessarily have a good answer for the emotional support of new mothers without extended family nearby.”
Barb, I’m wondering how much you find that you’re offering more emotional or mental health support than physical health support or care?
Ibrahim: There is a large component of mental and emotional support. And then because nurses were nurses, we’re not counselors, we do try to check in with families. Are they interested in counseling, or are they interested in talking to their doctor about their mental health? But first step, we talk to them about where they’re at and what might help. We have some standardized screenings that are part of what we offer for perinatal depression.
And then we also do like to bring up that dads can be impacted as well with their mental health. There’s a lot of changes that fathers go through, partners go through when a new baby is in the home. We try to do a lot of listening and support. It’s a little bit of all of it.
Miller: That recent NPR story that I mentioned in my intro, in it the reporter mentioned that you have a “bottomless black bag” that you tote around with you on house calls like Mary Poppins. What is in that bag?
Ibrahim: So it’s basically my baby scale. It’s bright blue. But we also have a lot of supplies in there to weigh and measure the baby, measure the baby’s head. Some hand sanitizer in there, and then we have some emergency supplies as well just in case that was needed. I have another bag with my stethoscope, my planner and just anything that I feel like I might need – blood pressure cuff, the thermometer.
Then we bring the family a gift bag that has a lot of information in it about programs available to families in the region. And then also we have a new parent book that has a lot of educational topics in it as well. We have local and Oregon resources, and then we have the standardized little book. We also have some bath materials, like a baby bathtub, a baby towel. We have a few gifts like that. And then if we have other gifts available for the family, we do provide those, just to encourage them.
Like you said, a lot of families don’t have help around, or maybe they didn’t have a baby shower and don’t have a lot of supplies, that kind of thing.
Miller: You were talking earlier about the benefits of being in someone’s home. It’s also, I can imagine, a sensitive issue. You’re in people’s private spaces. Do you ever worry that families are going to feel like you’re going to be judging them?
Ibrahim: Yeah, I do worry about that. Whenever a family says “sorry, forgive my house, it’s messy,” or whatever, I just reassure them “we’re here to see you.” If there’s any safety concerns, we would bring them up and talk about it to help make the home safe for the baby. But we’re here to support them. When you’re talking to someone, you can kinda see if they feel concerned or nervous, and then try to put people at ease. But it’s all voluntary. If someone wanted to not do part of the visit, that’s totally fine. Or if someone felt like the visit is too much for me all at one time, we can break the visit up into two or three visits.
Miller: As you noted, this is voluntary. How do families connect with this program in the first place? If someone’s listening right now with a newborn or one on the way, and they live in one of the eight counties where this is a possibility right now in Oregon – Crook, Deschutes, Jefferson, Benton, Washington, [Polk], [Lincoln], [Linn] – what do they do?
Ibrahim: Well, Family Connects Oregon has a website, and so they are always working on improving it and getting it updated. So that’d be the first place to go. And then I would also go to your county’s public health department, wherever they host WIC is possibly where they’re also hosting Family Connects. And then we have links on our website for referrals. And we do some outreach at the hospital when the baby is born to tell people about the service. Then we are partnering with WIC in our county to also offer the service. So we have a lot of connection in our own departments. And then we are also working at getting more word out to the local providers. We’ve been working on that all along, but it’s always nice to refresh. And there’s been lots of staff changes, so just make sure everybody knows who everyone is and that we’re here to provide the service.
Miller: How do you know that this program is working as intended? Are there metrics that you can track that show you that it’s working?
Ibrahim: We are continuing to work on evaluations. We work with Portland State University on some evaluations. But also, Family Connects Oregon is based on the model out of Family Connects International. So because it’s a research-based model, they have research that shows that it’s effective when the model is done to fidelity.
Miller: What does it mean to you personally to be doing these visits, to be going a couple times a week directly to families at such an important, challenging and sensitive time for people?
Ibrahim: You know, it’s very fulfilling. It’s really hard to put words to it other than just feel like I’m making a difference. Hopefully, the knowledge that I have from the years of working in public health, and then the knowledge I have from what I’ve learned from other nurses, and the model and the education that I’ve been able to continue to do will help a family, help a baby thrive. And then we look forward to that child entering preschool, kindergarten, third grade, all those metrics where we’re looking at how that child is doing and how that family is thriving. Just starting that system of care for a family is just a great feeling.
Miller: Barb Ibrahim, thanks very much.
Ibrahim: Thank you.
Miller: Barb Ibrahim is a public health nurse for Jefferson County Public Health. She does home visits through Family Connects Oregon. There is a link to the program on our website if you want to connect to it and see all of the places where it is currently in operation.
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