Caitlin Whyte (Host): Welcome back, listeners. Let's dive into a brand new episode of In Their Words. As we sit down with Susan Brackbill, Program Manager for Nurse-Family Partnership at UPMC in Central PA. Discover the heartwarming stories and transformative impact of the UPMC Magee-Women's Nurse-Family Partnership, or NFP in Central PA, a program dedicated to providing essential medical and social support to income-eligible, pregnant patients.

Join us as Susan unravels the unique journey these families undertake during their pregnancies. And the crucial first years of their child's life. Tune in and be inspired by this and all the stories told "In Their Words."

Susan Brackbill: My name is Susan Brackbill. I have been a registered nurse with, originally back in the day, it was Harrisburg Hospital, then Capital Health System, then Pinnacle Health, and now UPMC since 1989, starting out in the adult critical care unit, and then moving on to the neonatal critical care unit. I was in each of those places for about 12 years. And then, I am now on maybe hopefully my next 12th year or 12th year, you know, interim at Nurse-Family Partnership.

I joined in 2016. I came right from the NICU to the Nurse-Family Partnership. And what really drew me to the Nurse-Family Partnership is when I worked in the NICU, I worked with families preparing them to take their babies home, and often they were medically complex cases. And I did all I could to tie all the loose ends, but there was still some level of you're falling off a precipice when you leave the hospital. And while I worked in the NICU, I had the really great opportunity to interface with Nurse-Family Partnership through clients that they had their babies in the NICU and they were in Nurse-Family Partnership, and I had the opportunity to collaborate with the Nurse-Family Partnership nurses and knowing, and we'll get into this, but how Nurse-Family Partnerships and their nurses support the client throughout their pregnancy up to the child's second birthday. So, it was such a relief knowing that this client was going to have additional support after leaving the neonatal intensive care unit. So, I was very thankful for that. And that's kind of what drew me to where I'm here at Nurse-Family Partnership going on my-- What is it? Seventh year? So, I guess into my eighth year and don't regret a moment of it. It's been an absolute privilege to dig deeper into the social determinants of health and the systemic barriers that prevent people from achieving health and social equity.

A quick nutshell version of Nurse-Family Partnership, the elevator speech version, is that it is a national, evidence-based, which it's an evidence-based home visiting model. And when I say evidence-based, I mean, it was built on years of randomized controlled trials back in the '70s, in the late 1970s, where Dr. David Olds, who's a child psychologist, worked with families, decided that partnering nurses with families to achieve and positively effect pregnancy outcomes, infant growth and development outcomes, and maternal and parental self-sufficiency. And by self-sufficiency, we mean economic self-sufficiency. I mean, that is our end goal. So, we promote self-sufficiency basically right out of the gate when we first enroll new clients.

But more specifically, the Nurse-Family Partnership does exactly what it says. It partners a nurse. We all wish it would really say family-nurse partnership, but that's too confusing because family nurse practitioner and the acronyms get a little confusing. But it's really about the family. And the nurse partners with the client early in the pregnancy through the child's second birthday. And it's completely voluntary. So, it's basically like the client is driving their car, and they have invited you into that car. You might be in the passenger seat, you might be in the backseat, maybe you're in the trunk, but you're in the car and they're asking you guidance, maybe directions on which way might be best way for me to turn, knowing that these are my resources and this is, you know, where I'm at. These are the social determinants that are affecting my outcomes. So, that nurse partners with that client, to achieve their goals around being the best parent they can be. And we know that the evidence and the research really is based on the principle that every parent wants to be the best parent they can be. And so, following the client's heart's desire, which is like a mainstay of Nurse-Family Partnership really means pregnancy and having a baby is a catalyst for change. And so, it's a great opportunity to interrupt some of those intergenerational, prolonged, traumatic stress incidents and situations. And you have the opportunity to interrupt that and support that client because they want to make different changes. And so, we are measured on pregnancy outcomes and infancy outcomes and toddler outcomes. And so, registered nurses are in the home performing registered nursing assessments during pregnancy, checking blood pressures. We have diverted many preeclampsia crises, blood pressure crises, all kinds of things like that, getting clients emergently where they need to go to help them have a better pregnancy outcome. And we are measured on our preterm birth rates and our hypertensive crises and the preterm birth weights and preterm birth rates. So, we're looking at those birth weights, making sure that the babies are growing the way they should by promoting positive maternal health, nutrition, access to prenatal care, making sure that they're signed up with WIC, all those things that help them have the most positive pregnancy outcome.

Host: Curious about how you can get involved with the Nurse-Family Partnership? Keep listening as Susan illuminates the ways eligible individuals can participate in this transformative initiative.

Susan Brackbill: So, Nurse-Family Partnership, as I mentioned, it's voluntary and there's no charge to the client. So, clients are referred through multiple resources or sources, OB offices, schools, pregnancy testing centers, other school-based programs such as the ELECT program where they support adolescents in school during pregnancy to help get them through education. So, we get referrals that way. Self-referrals, maybe they see it on a poster somewhere out in the community, maybe their sister or their cousin or their best friend had it. So, it's really through many, many different ways. But, you know, those self-referrals are really meaningful, because that client is already taking that step towards self-efficacy in reaching out for that support to help them have the best pregnancy they can have.

Host: But the Nurse-Family Partnership isn't just work for Susan. It's personal. A passion for patients, children, and health that she carries with her each and every day.

Susan Brackbill: And Nurse-Family Partnership embodies a holistic nursing practice. So, you're really looking at all the elements of what goes into that client's life and their lived experience. And through just that partnership with the client, you're really having an opportunity to just sit with that client and listen. And listening is really an intervention. And so for me, that journey has been one of, "Okay, I don't have to always be the one talking. I can listen." And many times, just being a witness to someone's lived experience is all they really need. Many people don't have that. They don't have anyone in their corner. They don't have anyone rooting for them or providing that. And not a cheering section, but just someone that validates what they're experiencing, and then offering opportunities, like helping them identify their own strengths, and then helping them find their own solutions through the identification of their strengths. That's a beautiful thing. So, I've just found that incredibly fulfilling. Going into the client's home, being invited in is such a privilege, so having that opportunity just to be invited in and be part of their lived experience.

I'll share a story with you. So, a number of years ago, I had a client who was from Morocco. And in throughout her visits, we would often FaceTime with her family in Morocco. And the day that I was there doing the safe sleep education, which the foundation provides funding for the Cribs for Kids Program, so I have my pack and play there, and I'm doing my safe sleep demonstration, talking about the dynamics of safe sleep. We were FaceTiming with her family in Morocco because her sister was also having a baby and she wanted to know what safe sleep meant. And so, that was a unique and special moment for me, just being a part of something more than myself and more global than I could have realized, like I certainly had no intention of, you know, reaching out to talk about why we practice certain things around safe sleep to promote baby safety and babies sleeping safely. So, that was such a privilege.

And then in thinking about one of our nurses, and I think you mentioned this, Blandine, so she started out as an NFP client and evolved, like graduated from the program, was very goal-oriented, very, very driven individual who really wanted the best for her and her baby and her future. So, watching her trajectory through all the stages of NFP, starting out as a client, and then she became the administrative assistant in Nurse-Family Partnership. So, she worked while she went to nursing school. And then, she did her time, she developed her nursing skills on a med search floor and then came to Nurse-Family Partnership a few years ago. And so, watching that trajectory and getting to be a part of that, a small part of her journey and knowing how she's impacting clients through her own lived experience, there are no words for what that feels like. And so, she had to learn English. I believe she came in to Florida first, and then came to the central Pennsylvania area. So, all of the education, everything she did was simultaneously done with learning English as a third language really, because she came from a country in West Africa where there was one language, and then they spoke a dialect of French. And so, learning all that, I can't even imagine going to nursing school and getting my bachelor's degree having only mastered English a few years ago. I can't fathom that. So, she was incredibly motivated, incredibly motivated.

Host: It is clear that there are so many facets to the work of the Nurse-Family partnership. One of which includes the Safe Sleep Program.

Susan Brackbill: Sure! So, I know that for every scientific concept, there's an opposite side to it, right? And so, there are schools of thought that, you know, promote safe sleep, and there are schools of thought that promote pure parental attachment by co-sleeping with the baby, and we err on the side of safety. And I also sit on the Dauphin County Child Death Review Team. And every year across our country, babies still die directly from unsafe sleep habits. Now, there are different factors that influence that but the bottom line is, when your baby is in bed with you and you're sleep-deprived, no one ever thinks they're going to sleep so soundly that they won't know that the way they're laying is impacting their baby's breathing. But the bottom line is, as a new parent, being sleep-deprived is like being on medications that that induce sleep or grogginess. So, you're not on your A game and nor should you be. I mean, you're a new parent, you're exhausted, you may be trying to breastfeed. You know, you're sore recovering from delivery and babies eat frequently and you're not getting any uninterrupted sleep. So, falling asleep with your baby does pose a risk or choosing to sleep with your baby does pose a risk that your baby can die from suffocation. And do most babies die from that? No. But we know that that is one thing that's absolutely preventable if babies slept on their own sleep surface, so they should always be alone and placed on their back and in their own crib or sleep surface. And there really shouldn't be anything else in the bed with them that would interfere with their breathing.

Host: While we know a bit more about Susan and Blandine, there are so many moving parts and incredible employees that make the work of the Nurse-Family Partnership possible.

Susan Brackbill: Our team, wow. So, the Nurse-Family Partnership model drives what the team looks like as far as structurally. So, every nurse meets with a supervisor weekly for reflective supervision. And so, we have three teams of six nurses each who report to a supervisor, and they have one-to-one reflective supervision. The supervisors do joint visits and just support the team as a whole. So, we've got a program manager and program administrator, which is myself, and we have three supervisors, 18 nurse home visitors, a licensed clinical social worker who does provide mental health support and behavioral health support to families. We know that there is a significant deficit of mental health providers, especially mental health providers who take uninsured or Medicaid-insured clients. So, she can provide a bridge to therapy until clients can get successfully linked with community-based mental health resources, as well as she can do intense case management as well.

And then, we also have an IBCLC, which that is an internationally board-certified lactation consultant. She also happens to be a registered nurse. And so, she directly supports clients in their breastfeeding goals. And she also provides education to the team. And then, we have two administrative assistants. So, we have a comprehensive team that functions very well together. Nobody's doing this job if they don't love it. You know, you think of many people that are kind of stuck in their jobs and they're doing it because maybe they don't have the confidence to do something else, or this is all they've ever done, or "What else would I do?" or "I don't know where to go."

Nurses are not working in Nurse-Family Partnership if they don't love it, because you're driving around in the community, often in dangerous areas, working in, you know, on Allison Hill and um, Hall Manor and various dangerous other places. Rural can be just as dangerous. And so, we support five counties in the Central Pennsylvania region, which comprise rural all the way to urban. So, there are many safety factors. And the nurses are driving from visit to visit, carrying a lot of supplies, maybe having to walk up three or four flights of stairs to an apartment building, to an apartment that has no air conditioning and it's 94 degrees outside. You're not doing this job if you don't love it. So, they're very motivated by that relationship. It's about that relationship that the nurse and the client have as they work together to help that client achieve those positive outcomes.

So, we have a capacity of 437 families. We had the opportunity to expand the number of clients served through our federal and state grants last year. So, we increased to 437 families in the five-county area. And there's a very specific way that nurses load their clients, so they don't start out with full caseloads of 25 to 30 clients. They build that caseload intentionally and slowly, because the NFP model is very intense. It's really like a philosophy immersion class. It's a whole new way of thinking about registered nursing practice in partnership with clients. And so, we're integrating the many tools that are available in the model, as well as assessment tools, such as we're screening for depression and anxiety, intimate partner violence. And then, we have many tools within Nurse-Family Partnership that help the clients through those, you know, if we've got positive depression screens or we've helped clients create safety plans if there's intimate partner violence.

Host: The UPMC Pinnacle Foundation plays an integral role in ensuring that the Nurse-Family Partnership can impact the lives of hundreds of families. Listen in as Susan tells us more about how their work is supported.

Susan Brackbill: So, our funding, we have received federal, state, and private philanthropic funding over the years during our implementation since 2009, with the bulk of our current funding occurring through our state funding source, which is under the Office of Childhood Development and Early Learning. And all of our funds funnel through the foundation, and so having access to the foundation's resources and support grant writing. The fiscal support has been incredibly beneficial. It's enabled us to really keep our program front and center in the community and constantly being able to evolve and leverage the community support that we have.

And so, additionally, I should say that our UPMC healthcare system contributes to our operational costs in that our overhead, like our building occupancy, administrative costs, IT support, HR support, all those things are provided as a community benefit to this program. And some standalone agencies don't have that. So, we never take that for granted. We are always thankful for our federal and state funding sources as well as the support we receive through the foundation and through our healthcare system. And while it is a large healthcare system and it can be really easy to get lost in that, knowing that the values of Nurse-Family Partnership aligns with the values of UPMC makes it just kind of a very organic and natural fit.

And so, many people say that Nurse-Family Partnership is the best kept secret. And so, we need to stop having it be a secret, so whatever opportunities we have to share the benefits of Nurse-Family Partnership eligibility criteria for the program and outcomes and just those relationships and opportunities to interrupt the cycle of intergenerational trauma and poverty. We'll take whatever opportunity we can get because we are very passionate. We know that Nurse-Family Partnership, UPMC, the UPMC Pinnacle Foundation are all committed to really eliminating those systemic barriers that prevent anyone in our service area from achieving their optimal health outcomes. And we're also equally committed to positively impacting the national crisis of maternal morbidity and mortality. We know that as a highly resourced country in the United States. Our maternal morbidity and mortality should not be what they are. And yet, we know that the social determinants of health Dramatically impact those things. And those are things that the foundation, NFP, and UPMC are very committed to mitigating.

I would just say that in that partnership of the nurse and the client and/or whoever else the client wants present during the visit, we support the clients. We partner with them for up through the child's second birthday. And so, after the child's born, you may wonder what we're doing then. And so, we are continuing to assess that postpartum mom, checking blood pressures, again that maternal mortality and morbidity crisis crunch. And then, we're also doing infant weights and measurements, and we're doing developmental screenings. And we're also doing do a lot work around assessing the maternal caregiver mental health because we know that that affects child development as well as we're very cognizant of the fact that parents are the infant's first teachers. And so, we have tools that promote positive shared experiences between the mother, the father, the caregiver, and that child.

And basically, Nurse-Family Partnership underpinned by three theories, self-efficacy, human ecology, and attachment theory. And so, it's that attachment theory that I'm thinking of when I talk about those positive shared experiences between a caregiver and the child as that first teacher helping that child see the world around them and be a part of their first lived experiences. And that can be the difference between breaking that cycle or perpetuating the cycle of intergenerational trauma and poverty. So, we really thrive on that relationship development between the parent and the child. And we just partner alongside them with whatever that looks like for them, offering tools and support to make that happen. And then, again maternal and parental self-sufficiency. So, we don't do things for the clients. We do them with the client. We partner with them around what the client identified, where they want to go, what their trajectory is going to look like. It's not about me. It's about our families. And again, those social determinants of health that we got to do a better job of leveling the playing field.

One small change at a time. That's one of the main concepts of NFP. Only a small change is necessary.

Host: As we conclude this inspiring episode of In Their Words, we extend our heartfelt gratitude to Susan Brackbill for sharing the remarkable stories and insights behind the UPMC Magee-Women's Nurse-Family Partnership in Central PA. If you've been touched by these narratives and wished to make a difference, visit upmcpinnaclefoundation.org to learn more about how you can support the program, and sharing that more families received the vital medical and social assistance they deserve. Let's continue to build a community where every pregnancy is met with support, understanding, and compassion. Thank you for joining us on this journey on In Their Words. Until next time, take care and stay tuned for more stories that inspire.