St. Louis Children’s Hospital is helping new moms, families and communities thrive through its Raising St. Louis program. In this "Caring for Our Kids" episode, Traci Carter, program manager of Raising St. Louis, and Nicole Kozma, director of school and community outreach programs at St. Louis Children’s Hospital and BJC Community Health Improvement, discuss the scope of the Raising St. Louis program — from home visitation teams and early childhood development, to engagement with fathers and plans to expand support with doulas.
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00:00:00:18 - 00:00:23:24
Tom Haederle
Welcome to Advancing Health. Coming up in today's episode, a conversation about how Saint Louis Children's Hospital is supporting new moms so their babies can thrive. It comes down to basics, including systems that surround and support young families. And we'll learn more about a specific program called Raising Saint Louis, which offers multidisciplinary home visitation teams that provide comprehensive care and support.
00:00:23:27 - 00:00:30:08
Tom Haederle
Our host is Julia Resnick, Director of Strategic Initiatives with AHA.
00:00:30:10 - 00:00:40:06
Julia Resnick
Traci and Nicole, thank you so much for being here today. To kick things off, I'd like to learn a little bit more about each of you. So can you introduce yourself to our listeners? Traci, we'll start with you.
00:00:40:08 - 00:01:13:02
Traci Carter
Traci Carter, manager of Raising Saint Louis. Honestly, what kind of drove my work in this space is I've worked in social services for a while. I started off at the Urban League and realized that a lot of the work was always in disparities. And it wasn't really until I went back to school, in 2018 for my MHA, that I actually did my dissertation on infant and maternal child health. Finding and understanding, like the root cause of things.
00:01:13:02 - 00:01:35:28
Traci Carter
And when it came to maternal child health, had been working in that space for a while, just dealing with health disparities. But now it's just like the work that we're doing now is so impactful. And I was really drawn to this position a few years ago when I applied. And, yeah. And it really has impacted so much of what I do because I realized that mothers are suffering every day.
00:01:35:29 - 00:01:41:08
Traci Carter
And it's really about how do we help them? How do we help them in this work?
00:01:41:10 - 00:01:46:06
Julia Resnick
That's wonderful. And we will certainly dig more into that in a few minutes. But, Nicole, I'll turn it over to you.
00:01:46:08 - 00:02:11:15
Nicole Kozma
Sure. So Nicole Kozma, the director of school and community outreach programs for Saint Louis Children's Hospital and BJC Community Health Improvement. I have been working in the field of public health for 25 years. And what I love so much about public health, it's very broad so you can work in so many different health topics and different populations, which I really enjoy.
00:02:11:17 - 00:02:34:13
Nicole Kozma
And I've worked at Saint Louis Children's Hospital for the last 14 years. What I've enjoyed with that is just the variety of programing as well. Working with children and families in our community. And so it's exciting to be able to help people do preventative health education, preventative services, try to keep people healthy so they don't have to come to the hospital and see us.
00:02:34:15 - 00:02:42:26
Julia Resnick
So new moms certainly face a number of challenges. How is Saint Louis Children's helping support new moms so that their babies can thrive?
00:02:42:28 - 00:03:11:26
Traci Carter
Honestly, Julia, we look at that from a host of different areas, right? Starting first and foremost with, like, the Maslow's Law of, hierarchy of need, right? Which is really looking from, you're not worried about certain things if, if you can't even meet those basic needs. So we kind of really start at the basic needs, with realizing that people need resources, they need a system, a village.
00:03:11:27 - 00:03:41:13
Traci Carter
Most families, that's what they're in need of. The mom or the dad, whoever, is just in need of just trying to get those basic quality of life necessities fulfilled. So when we come in our program, we come in to kind of help facilitate with that. From our community health workers, social work - I know we'll go into a little bit more of this - but we really try to provide more like a village around our families to kind of help uplift them along their way on their journey.
00:03:41:15 - 00:03:44:18
Traci Carter
So just providing a slew of resources to them.
00:03:44:21 - 00:03:53:00
Julia Resnick
So that all takes us to your program, Raising Saint Louis. Can you tell us about the program and how infant mortality became a priority for Saint Louis Children's?
00:03:53:03 - 00:04:22:29
Nicole Kozma
I think there are three main points when you're looking at research that really help share the reason why, as a pediatric hospital, we would want to have a program like Raising Saint Louis for our community. One development: research shows that children who are in early intervention programs and they provide those services, they have significant improvements in their physical, cognitive, communication and social development.
00:04:23:02 - 00:04:50:03
Nicole Kozma
Second, early intervention can reduce the need for special education and related services after children enter school, which leads to a huge cost savings for our school districts, which is gigantic. And then there have been long term studies done to show that children who participate in early intervention programs are more likely to graduate from high school, hold jobs, and live independently.
00:04:50:05 - 00:05:14:28
Nicole Kozma
And these programs have been associated with lower rates of grade repetition, special education, and justice system involvement later in life. So I think because of all the strong research in early intervention programs and home visiting, that is what led the Saint Louis Children's Hospital to say, yes, this is a program we want to provide to our community.
00:05:15:00 - 00:05:31:04
Julia Resnick
Absolutely. And that early start prevention at the beginning of a child's life is just so huge for supporting their outcomes throughout their life. Traci, I know that raising Saint Louis is really your baby so can you talk me through what happens when a new mom joins the program?
00:05:31:06 - 00:05:51:29
Traci Carter
Yes, absolutely. So one of the great things about Raising Saint Louis is that anybody can refer you to the program. The only criteria that we really have is that we work with 22 zip codes. And they are typically some 22 of the most high need zip codes. But we work with those zip codes. And again, like I said, we take referrals from anywhere.
00:05:51:29 - 00:06:17:13
Traci Carter
But our team is basically once you come in and you are brought in, you are asked whether or not you would like a community health worker. Would you like a community health educator, also known as parents as teachers, and if you'd like, a social worker? And of course, we also offer nurses. We work with a partner, Nurses for Newborn to also help facilitate with that.
00:06:17:15 - 00:07:00:18
Traci Carter
Once you're in, you decide which service line because we again we work with the multidisciplinary staff. And so once you kind of pinpoint where you want to come in, you then are greeted by some of our wonderful coworkers who are there to help facilitate. So you're brought in if you want to work with the community health worker. That community health worker is working with that family, from the very jump to kind of top down and break down those social economic barriers that, you know, most of our families see, and really helping them have a hand in walking through that process of whatever that is, whether it be housing, transportation, food insecurity, they're
00:07:00:18 - 00:07:22:03
Traci Carter
there to help you. Our parent educators, also community health educators, they are working more so with the physical and developmental milestones, with the baby and the parents, making sure that mom and dad are doing their job, they're not noticing anything. And if they are, we're there to kind of talk you through that and let you know and to kind of figure that out for you.
00:07:22:06 - 00:07:34:11
Julia Resnick
I love that you've built in a community building aspect to the program that's really special. So at what point can new moms join the program? Is it once they've had the baby when they're pregnant? What's the timeline like?
00:07:34:14 - 00:07:54:03
Traci Carter
Yes. So the timeline is we work with prenatal and postnatal. So we work with mothers who are prenatal from zero all the way up until 4 to 5 years of age before they hit kindergarten. They graduated from the program. So any time in between that, that 0 to 4 years of age, we are there for the parents if they need us.
00:07:54:06 - 00:08:01:08
Julia Resnick
So let's talk about access for the other parent, dads. How are you supporting new dads as they embark on fatherhood?
00:08:01:10 - 00:08:23:27
Nicole Kozma
That's a great question, Julia. You know, back in 2017, we held two different focus groups with our families, and we were fortunate enough to have men that came to the focus groups. And what we heard was this was a program for moms and babies. And we were like, oh, no. Nope. That wasn't what our intention was. We want dads to know about their involvement.
00:08:23:27 - 00:08:33:13
Nicole Kozma
We want them to feel included and welcomed when the home visitor comes, and also to be able comfortable to ask questions about their child's development and growth. And so
00:08:33:13 - 00:08:34:00
Traci Carter
we
00:08:34:00 - 00:09:03:04
Nicole Kozma
recognized we needed to put dedicated services toward father engagement. So through the years we've done different things. One of them is the evidence based curriculum called 24/7 dads. It has 12 lessons. We've been fortunate through the years to have male team members who have gone and gotten certified in this curriculum, and who are able to participate and lead sessions of this curriculum with different fathers and males who are part of our program.
00:09:03:07 - 00:09:16:23
Nicole Kozma
And we've also done different things with barbershop tours and locker room chats. And Traci can probably share more about some of the fun events that we do to try to engage our males and our fathers.
00:09:16:25 - 00:09:43:20
Traci Carter
Yeah, we've hosted a several series of different events throughout. Speaking of like the barbershop tours where we kind of go out and talk about, you know, the misconceptions of why few black men are really involved or taking better care of themselves from high blood pressure to prostate cancer. You know, we're trying to normalize it and let them know that it's okay to talk about these things or have a community that enables you to.
00:09:43:26 - 00:10:09:09
Traci Carter
We've also done things and work with the Justice Center here in Saint Louis, where we've spoken to some of the men who are actually incarcerated on how they could steal, even though - I think that's the biggest takeaway - even though our families, they may not look like the traditional model, there is this thing where we want you to know that despite it all, there is a way to still be active and present in your children's lives.
00:10:09:09 - 00:10:36:14
Traci Carter
And so we really, we kind of bond around that in letting them know that it's okay, you know, it's okay if you and mom aren't together. But here is how you manage that here is how you work through those, those tough areas. And so I think we do a really good job with our team, especially our males CHWs that we have that really, you know, kind of meet those fathers where they are and kind of bring them along and tell them, you know, it's okay, we can get through this.
00:10:36:14 - 00:10:37:15
Traci Carter
And this is how.
00:10:37:17 - 00:10:57:07
Julia Resnick
That's so great, because, you know, no two families look alike and everyone is just trying to forge their own path. So in community health, I know we're always trying to make the case for why these investments are so important and impactful for the communities that we serve. So can you share how you're measuring the impact of Raising Saint Louis and any metrics that you have that that show that?
00:10:57:09 - 00:11:22:25
Traci Carter
So we have an evaluation team who really helps us kind of keep all of our metrics and things together. But what we found is that Raising Saint Louis clients have a 0.4% infant mortality rate, compared to 1.3% mortality rate for ST. Louis city. To put that in perspective, out of 744 babies that we've had come through our program, we have only lost three.
00:11:22:27 - 00:11:29:03
Traci Carter
You know, that's the thing that's showing that what we're doing is making an impact, and we love what we do.
00:11:29:05 - 00:11:31:16
Julia Resnick
Nicole, is there anything else you want to add?
00:11:31:18 - 00:11:54:16
Nicole Kozma
It's hard when you're a health promotion program and...we're not like a research program. We're not doing research on our clients and participants. So sometimes it's hard when we get asked these questions about infant mortality rates and things like that. And because, you know, we can take the small percentage of families we've been with through the years, but then we have to compare that to like a larger population.
00:11:54:16 - 00:12:18:20
Nicole Kozma
So it's not always like apples to apples comparison. So I think sometimes like if you're coming with a research focus, people could have a little bit of a different thought about those. But if you come from a health promotion health evaluation program focus, you know, we are still collecting that data. We're still looking at birth weights, we're looking at gestational age when they're born.
00:12:18:20 - 00:12:51:14
Nicole Kozma
We're talking with our mothers about birth spacing in different things that we know are important in the medical world, right? But along that way, we're really emphasizing child development and child learning and family goals and making sure like Traci mentioned earlier, that families feeling like they have a support system around them. And if there is something that pops up, they're going to have someone who's in their corner who's going to help them.
00:12:51:17 - 00:13:15:15
Nicole Kozma
We have amazing examples of our team members who have gone to doctors visits with our families, because a child might have a diagnosis, and it's overwhelming to the parent. And our community health educator creates a medical binder and says, hey, we're going to keep everything inside this binder so that at the next visit, these are the forms they're always asking us for.
00:13:15:15 - 00:13:39:14
Nicole Kozma
We're going to have a section in here for questions, answers so that we can keep everything together. We've had team members have gone to court for our families, who have been there to support them during those times. We've had families - you know, they just show up. So if they're if they're confused about, oh, you know, my child seems to be a delayed in speech
00:13:39:17 - 00:13:52:29
Nicole Kozma
okay, I can help you get connected with your school district and early education services and help you understand what an IEP is and how do we want to use these services that are available to us.
00:13:53:02 - 00:14:02:04
Julia Resnick
This is such impactful and powerful work. And I'm really curious as you're looking towards the future of Raising Saint Louis, what's next? What's on the horizon for you?
00:14:02:06 - 00:14:48:12
Traci Carter
Oh, Julia. So, we definitely want to keep expanding for sure. Definitely, because the need is great. So we already have our team together now, but we are currently in the process of exploring adding doulas as a source to combat infant/maternal health. And so one of the reasons are the causes behind that is that we know that doulas, they contribute to reducing infant and maternal health risk. Through continuous support, education and, of course, and advocacy and helping to facilitate better communication between the parents, the mom and the clinical staff. Those decision making aspects of what health care looks like.
00:14:48:12 - 00:15:09:23
Traci Carter
And so with doulas, we can help during the pregnancy. It helps during the childbirth and of course, postpartum. But by promoting more personalized and compassionate care, doulas help us ensure the safer and more positive outcomes for mothers and their babies. And so that's all the more reason why we're really looking to adding doulas to Raising Saint Louis.
00:15:09:23 - 00:15:12:21
Traci Carter
So that's my vision for it, for sure.
00:15:12:24 - 00:15:23:23
Julia Resnick
Nicole, Traci, thank you so much for sharing your time and your expertise with us. We look forward to seeing how you continue to grow Raising Saint Louis and grow those kids.
00:15:23:25 - 00:15:32:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.