Alicia Kreutzer is a local nurse, but you won’t find her on a hospital wing. She is always on the road, in and out of apartments, homes and elsewhere meeting with women and their new babies throughout Spokane County. She carries a large bag with a scale and a measuring tape to check a baby’s growth as well as a backpack full of paperwork and resources for new or soon-to-be mothers.
The week of Thanksgiving, her calendar was full of appointments, checking in on families she is working with through the nurse-family partnership program run by the Spokane Regional Health District. The program will expand to serve 50 more families in 2020 after a boost in funding from state lawmakers, meaning more than 200 families will be served by 10 nurses in the new year.
Ashley Bowman recalls being lost in a parking lot earlier this year. She was trying to get to one of her prenatal appointments, but she could not find her doctor’s office. Frustrated, she called Kreutzer, who told her to stay put as she walked a few blocks to find her. Bowman was partnered with Kreutzer in April, about a month after she found out she was pregnant. Bowman was receiving treatment for her substance-use disorder, and her counselor there recommended she try the program. Bowman does not regret it and calls Kreutzer one of her biggest supporters to this day.
“Basically just anything I needed, any questions I had, I could text her any hour of the day, and she messages me back,” Bowman said. “When I’m scared about something, she’s there.”
Bowman said Kreutzer was persistent, showing up in-person if she did not answer her phone.
“It made all the difference, and it made me feel like she really did care,” Bowman said this fall, sitting in her home as her 2-month-old, Judah, snoozed in his baby swing. “It made me comfortable enough, so now anytime I have a question, I feel really comfortable with everything.”
In September, Bowman gave birth to Judah, and she is raising him as a single parent. She first stayed at Isabella House, where she was able to continue to receive treatment and live with Judah, but now she is in her own rented house. Kreutzer still meets with her every other week to check in on Judah’s development and support her with getting access to other resources she needs.
The nurse-family partnership pairs nurses with soon-to-be mothers in the county before they hit their third trimester of pregnancy. The program is for low-income women who often qualify for Medicaid, or the Women, Infants and Children supplemental nutrition program. A nurse meets with pregnant moms weekly in preparation for delivering their baby.
The health district has operated the program for over a decade now, and Susan Schultz, the program manager, said she has seen increased need for it in recent years.
“I have seen real big changes in the families we’re serving as far as the environment they live in, and I think it’s reflective of increased challenges that people are facing in this community,” Schultz said.
At least a third of the women in the program are considered “high risk,” Schultz said, dealing with significant challenges from domestic violence to homelessness to opioid addiction.
“The relationship with the nurse and the regular visitation schedule can make a difference in spite of those risk factors,” Schultz said. “… The community is really concerned about family violence and domestic violence, and we are one of the programs that shows that participation in the program leads to lower levels of abuse and neglect.”
Washington state lawmakers allocated more funds to home-visiting programs throughout the state this year, including the nurse-family partnership program in Spokane. The Spokane Regional Health District will be able to serve 50 more families with a $293,215 increase in funding this year. The funds are designated to be used within the city. This is due to a statewide assessment that found 83% of the risk factors, from pre-term birth to poverty, examined by the state health department are higher than the state mean.
The program model is evidence-based and improves outcomes for both babies and mothers too. From babies being born at full term to breastfeeding measures, the longtime program has a good track record.
In Spokane County, 92% of babies whose mothers are in the program were born at full term, which is important for the baby’s future health. Nearly all of the mothers in the Spokane program start breastfeeding, which can have positive impacts on the health of not only the baby but the mother as well. Mothers in the program are a median of 20 years old, with a median income of $7,500. More than half of mothers who graduate from the program are working when they leave.
Less than three weeks before her son was born, Shawna Reierson was still working on her feet doing security at the Spokane Valley Mall. Most of her co-workers did not realize she was pregnant until she left to give birth to her son in May.
Kreutzer checked in on her and 6-month-old Kameron one morning last month to see how he is growing. Reierson spreads out a blanket on the floor so Kameron can do some tummy time while she and Kreutzer talk.
Reierson asked Kreutzer about Kameron’s development, what foods he can start to eat and how his movement is progressing. Reierson has a wide breadth of knowledge already, however, and a lot of her planning for her son’s care is predetermined by her schedule. Reierson went back to work at a new retail job two months after giving birth to Kameron, and she now has a family friend who watches him while she and her husband are at work. While Kameron has insurance, she does not, currently, and Kreutzer offers to connect her with help to find health insurance.
Reierson understands that her health is just as important as her baby’s health.
“Everything I do healthwise or nonhealthwise, I think about him first,” Reierson said.
During her home visits, Kreutzer asks her clients questions about how their babies are growing, eating and developing in general, but she always leaves time for questions.
“I want more information about teething, and how I can help him,” Reierson said last month when Kreutzer asked.
Kameron’s first baby tooth is starting to emerge, and he has been fussy, Reierson said. She pulled out a teething toy from the freezer later for him. Kreutzer explained that sometimes medicine and cold washcloths are not enough for babies, who will just be naturally fussy. Kreutzer will be with both Bowman and Reierson, as well as 20 other women, until their sons are 2 years old, checking in with them a couple of times a month.
The challenges of having a baby continue well after birth, and Kreutzer’s job extends past plotting the baby’s growth points and answering health questions. Bowman has to activate Judah’s Medicaid coverage before his next appointment, and she is trying to reserve him a spot in day care so she can eventually go back to work. Bowman wants to go back to school to be a nurse. She also this month will start intensive outpatient substance-use treatment, in a program that also offers parenting classes.
“I don’t know if you remember it but when we first started meeting together, I was scared and didn’t know if I was ready for a kid yet,” Bowman told Kreutzer at the end of her visit last month. “I was so scared, and you told me that I won’t feel this way in the end and that it will all come together, and you were right.”
Kreutzer credited Bowman with taking the initiative to make appointments, get the treatment she needed and following through for her and her son’s future.
“She’s the one that follows through with doing it – sometimes that’s a lot for people, so I give her the resource, and she has to do it,” Kreutzer said.
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