Welcome to “Rural,” a yearlong series devoted to rural hospitals and health systems in America. Being a new parent is challenging in the best of circumstances, but it is even harder for expecting and new moms struggling with social and behavioral health needs. In this conversation, two experts from Intermountain Health discuss their "First 1,000 Days of Life" program that provides wraparound services for at-risk new moms. Then, Lacey Starcevich, a former program participant, shares her emotional journey to building a healthy life for herself and her new family. This podcast was recorded at this year's AHA Rural Health Care Leadership Conference.

Tom Haederle

Being a new parent is challenging in the best of circumstances, but it's even harder for expecting and new moms struggling with social and behavioral health needs. And living in a rural community means that the resources available to support new parents may be limited. The first 1,000 days from pregnancy to age two offers a crucial window of opportunity to create brighter, healthier futures.

Tom Haederle

Welcome to Rural, a yearlong series devoted to rural hospitals and health systems in America. I'm Tom Haederle with AHA Communications. St. James Health Care in Butte, Montana, now part of Intermountain Health, is designing care around new moms who need the extra support not just during pregnancy, but during the first two years of the baby's life. At this year's AHA Rural Health Care Leadership Conference, Julia Resnick, director of strategic initiatives at the AHA, spoke with April Ennis Keippel, community health director, Montana/Wyoming Market at Intermountain Health, and Joslin Hubbard, social worker at Intermountain Health at St.James Hospital, about how their first 1,000 Days program provides wraparound services for at risk new moms.

Tom Haederle

They were joined by Lacey Starcevich, a former program participant who shares her powerful journey to build a healthy life for herself and her family.

Julia Resnick

April and Joslin and Lacey, thank you so much for recording this podcast with us. We're here at the AHA Rural Health Care Leadership Conference. I'm really pleased to have all of you. So to kick things off, let's get a little background on your health care system. So can you tell us about Intermountain Health, St.James Hospital, and the community that you serve?

Julia Resnick

April, do you want to kick things off?

April Ennis Keippel

Sure. So we are a part of a large system, Intermountain Health, that includes hospitals in Montana, Colorado, Utah, clinics in Nevada as well. And St. James is located in southwest Montana. It's a community of about 35,000 residents, is a level three emergency department and really provides services for all the surrounding counties, which are primarily rural counties.

Julia Resnick

Anything else you both want to add about the hospital and your community?

Joslin Hubbard

Butte is a really proud community. It has a long history of mining and people are proud to be from Butte. They help each other out. They come together to support one another. And it's just a beautiful place to live.

April Ennis Keippel

And Butte was known as the richest hill on earth at one point and at one time was the largest city between Chicago and San Francisco in its heyday. So rich history in the community.

Julia Resnick

That is quite a history. And I love that piece about community because I think that's really what we're here to talk about. And our focus today is really on maternal health. So, Jocelyn, can you talk at all about the maternal population that you're serving and where your patients come from?

Joslin Hubbard

Yeah. So most of our patients live in Butte or Silver Bow County. We do serve the women from the surrounding counties as well. Our payor mix at our hospital is, you know, around 85% Medicare and Medicaid. And we have women primarily of Caucasian descent. And we serve ages, you know, teen age to later maternal - advanced maternal age, they call it.

Joslin Hubbard

So but just a really great mix of.

Julia Resnick

And even though most of your patient population does identify as white, are there any disparities that you've identified between like different subsections?

April Ennis Keippel

So a lot of the disparities we see in our community health needs assessment are actually related to socioeconomic status. Individuals living in poverty across all health outcomes have poorer outcomes. So anyone 200% or less of the federal poverty level just scores worse on a number of health outcomes.

Joslin Hubbard

April, Do you know what population of our patients fall within that 200% below poverty level?

April Ennis Keippel

The residents, I would say about 20% of overall residents. So one in five are below the poverty level.

Julia Resnick

Got it. And when you're thinking about these new parents in your community, are there any particular challenges that you've been seeing them experience? I know you touched on their socioeconomic status of needs, but in terms of behavioral health and how those challenges are impacting them.

Joslin Hubbard

So we have limited resources for our behavioral health and substance use. So those definitely impact our patients' access to care. When we're talking our socioeconomic struggles, it's even transportation to those appointments. It's housing, working with women and families. It's hard to talk about getting to appointments when they're not sure where they're going to live, you know, or stay that night or how they're going to get to that appointment.

Joslin Hubbard

You know, we have to take in all of that into consideration when we're dealing with people with substance and mental health needs.

Julia Resnick

Absolutely. So we're really here to talk about the Meadowlark Initiative. So can you talk to our listeners about what that is?

April Ennis Keippel

I can maybe start and then you can fill in as needed. So the Meadowlark Initiative is funded through the Montana Health Care Foundation. And it's really focused on providing intensive case management to the most at-risk patients prenatal and then following through til the second year of life. So, really helping to guide and support both prenatally and then also postnatal.

April Ennis Keippel

What else would you add, Jocelyn?

Joslin Hubbard

Yeah, so the initiative initially was funded by the Montana Health Care Foundation, but St.James has continued that, recognizing the need and the importance of this work. And so our program was the first 1,000 Days, which is from conception to age two, recognizing that it is the most critical and crucial time in human development. And when the brain develops, you know, it's just really using that care coordination piece to kind of bridge the gaps between those services, whether it's housing, food issues, transportation, mental health, substance use and the clinic or the hospital and how to connect patients when they come in for prenatal care with those outside resources, and then to continue to be

Joslin Hubbard

a resource and a support for them as they not only through their pregnancy, but as they embark on parenthood.

Julia Resnick

That's amazing that you have such a long perspective on it and not just, you know, a specific part of pregnancy or postpartum. So who are you partnering with or coordinating with to bring this all to life.

Joslin Hubbard

In terms of community resources? Yeah, Perfect. Yeah. So we have lots of you know, we partner with all of our resources in the community, whether that's private therapists. We partner with our Southwest Montana Community Health Center to provide mental health services as well as primary care following delivery. You know, our mental health centers and parenting agencies in the community as well.

Julia Resnick

So talk me through it...like someone finds out they're pregnant: how do they get enrolled in the program? Like, what happens next? What does that look like?

Joslin Hubbard

The hope is that they would seek prenatal care and come to an appointment. And at that appointment they would be screened for social determinants of health. So we would be screening for transportation issues, food insecurities, housing, as well as mental health and substance use. We would also be screening the partner or whoever is supportive of that woman in pregnancy.

Joslin Hubbard

So that we can really help the whole unit. And then they would meet with a care coordinator. And that care coordinator then would connect with resources and help identify needs, provide education, and then support throughout the pregnancy.

Julia Resnick

It's wonderful. And are there any stories you can share that can really bring this to life?

Joslin Hubbard

Well, I'm fortunate to have Lacey here today. Lacey was one of our moms in our program, and I think that she can speak to her story better than I could ever.

Julia Resnick

Great. Lacey, over to you.

Lacey St.arcevich

I'm Lacey. I just, on the 22nd of February, recently celebrate five years clean. I originally attended my first prenatal appointment actively using drugs. I was screened and obviously made the requirements for the program. At the time, I was homeless and still using. I left that first prenatal appointment not sure if I was going to get clean or not.

Lacey St.arcevich

Not even sure if I wanted to keep Bradon. That's my son's name. He'll be five in August, actually. So with the help of Jocelyn and the Meadowlark Initiative, I was able to connect with these resources and get help. And today I'm present for my children.

Julia Resnick

That's amazing. I'm just so glad you're here to share your story and that you've been involved in the program since, is that?.. Yes.

Lacey St.arcevich

Yeah. So anything I can do to help? There are just so many mothers out there who are in the same position I am. And it's an unfortunate situation. But with things like this, we can try to lower that number.

Julia Resnick

And I'm sure having contact with you helps them feel less alone and that, you know, there is a light at the end of the tunnel.

Lacey St.arcevich

You know, there's nothing more therapeutic than another addict helping another addict.

Julia Resnick

Wonderful. And I know that, you know, we have a great personal story of the impact of this work, but have you been measuring what the impact is on the women that are in the program? Yes. Yes, we have. Is there anything you can share?

April Ennis Keippel

If I look at my notes...I don't know off the top of my head.

Joslin Hubbard

We have found that women who participate in this program are more likely to have consistent prenatal care. They're more likely to take their child home at delivery. And that means from a lower involvement of the Child Protective Services Removals, women have better health outcomes to higher birth weights, lower complications, less hospital stays that are involved in the care as well.

Joslin Hubbard

And a lot of that's probably attributed to the more consistent prenatal care, as well as changing a lot of their lifestyle and ensuring that they have the food and resources that they need, as well as you know, hopefully not using substances.

Julia Resnick

So to wrap us up, I love your words of advice for other rural hospitals that are really thinking about what they can do to improve their maternal and child health outcomes. What have you learned along the way that you can share with them? And Lacey, you'll have a slightly different version of that question.

Joslin Hubbard

You know, when we're dealing with rural, it's hard to find people to fill spots, right? And I think the most important thing is that we realize that this is just has to be someone who cares and who understands the community and the resources out there and who can show understanding and love and kindness to patients. There's not a magic wand. This is hard work, but it's, you know, it's done in partnerships and relationships that are built not only with the patient but with the community.

Joslin Hubbard

And, you know, just really taking time, stepping back, understanding what the needs of your community are and, you know, just addressing it one day at a time.

April Ennis Keippel

Well said.

Julia Resnick

Very well said, April.

April Ennis Keippel

I don't know if I could really add anything more to that. I think it just in looking at having a connector and a go-to person, I think is probably the most important thing so that there's a single point of contact that can help move forward any of the needs and make connections. And I'm not sure that that always would need to be a particular type of training to do that work.

April Ennis Keippel

So I think in a rural community you could customize it to really fit what you have available. But the key piece would be just to have that single person who can really help be the connector.

Julia Resnick

That human connection piece really just came out strongly in both of your answers. And Lacey, from being on the participant side of this and, you know, having been one of the moms in the program, what do you wish that hospitals knew about working with new moms who might need additional social or emotional support?

Lacey St.arcevich

We just need, you know, a setting that's not judgmental. We do not have a village. And programs like this help us create that village, and that sets us up for success. They help me create my family. They help not only me get clean and deliver a healthy baby, but my husband followed ensued because they provided us the resource to be able to do that.

Julia Resnick

It's wonderful.

Joslin Hubbard

I just wanted to call out Lacey. You know, not only does she have Bradon, but she now has a two year-old, Parker. She's married, has bought her own home, and is a role model for other women in our community and just so proud of where she is.

Julia Resnick

I'm so glad we can lift up your story and share it with the world.

Lacey St.arcevich

Thank you.

Julia Resnick

So, Lacey, Joslyn, April, thank you so much for joining this podcast. I look forward to seeing your presentation later today. And just congratulations on the fantastic work you're doing.

Joslin Hubbard

Thank you.

Lacey St.arcevich

Thank you.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and read us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.