Real Talk: Community Health Care in Action
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Real Talk: Community Health Care in Action
Perinatal Substance Use
Quincy invites Frontier's new Dean of Nursing, Dr. Kristin Ashford, and the Public Health Director at the Woodford County Health Department, Cassie Prather, to discuss perinatal substance use (not abuse!) and local resources in overcoming addiction. ❤️
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Speaker 00:Welcome back to Real Talk. Today, I am joined by Frontier Nursing University's new Dean of Nursing, Dr. Kristin Ashford, and the Public Health Director for the Woodford County Health Department, Cassie Prather, and we will be discussing addiction and substance use. Dr. Ashford is a dedicated researcher in which a majority of her research focuses on improving health for pregnant and postpartum women with addiction, primarily tobacco, electronic cigarettes, and opioid use disorder. Not only is Cassie the Public Health director here in Woodford County, but she also sits on the board of directors for the Woodford County Agency for Substance Use Abuse Policy. This organization began in 2003 to address youth and adult substance prevention, enforcement, and treatment strategies within the community. Thank you both for joining me.
Speaker 03:Thank you for having us. Yes, we're excited.
Speaker 00:So one thing I want us to cover right away is a verbiage that we're using. So I've been saying substance use, but historically we may have heard that referred to a substance abuse can you all share the difference and why we may be saying use over abuse
Speaker 03:sure Cassie would you like me to start please please typically when you think about substance use and the the culture around substance use people often have potentially different thoughts about how that impacts people and a big part of the feelings is related to stigma and so many people with substance use disorder feel others may be judging or have a stigma associated that and words can matter and so when you think about words like abuse versus use it it sounds more harsh to be honest and so you want someone to feel like they're not being judged and so I think using terminology that makes the person feel more comfortable and um welcomed is important. Another word that I think has often been used in the past is, are you clean? Or using words along those lines. And so, you know, thinking about that, what does that really, how does that make that person feel? What we want people to feel is that we are in support of their journey. And so thinking about terms and maybe changing and reframing, for example, using The word recovery, I think, is very important in helping that person feel not judged.
Speaker 01:I couldn't agree more. And I think that it has to be a total mind shift. And I think a lot of people aren't even, they don't realize that what they are saying can be taken as offensive to the person that is struggling. We have a harm reduction program at our health department, which that a started as a syringe exchange program. And we quickly changed that to harm reduction because it's so much more. We don't just exchange dirty needles for clean needles. We're doing lots of education and safe injection practices and making sure people have a safe way to dispose of their needles when they're not at the health department. Making sure law enforcement have Narcan. It's so much more than just someone coming in that is deep within the throes of an illness and trying to help them get out of that. Yes, it's that, but it truly is so much more. And I always like to think of our health department when they come in. It could be the only exchange, human to human, that they have in their life where someone is respecting them, trying to help them, and not judging them. And so, yes, our words matter. And I think that part of that, how they are treated, it keeps them coming back to get the help that they want. Yeah, that's a
Speaker 00:good point. So we're talking about substances. What is a substance? Because I feel like a lot of– what do we think of like I feel like the when people think of a substance they think opioid right away but I
Speaker 03:think there's such a wide range of substances and often people will first go to are they illegal or even the term here again illicit substances because there's also prescription substances that can be not misused and I think often also So when you're talking about those substances, you do often think about maybe heroin, opioids, misuse of prescription drugs, Valium, and things along those lines that are different scheduled drugs. But also, I think people don't also think about tobacco. And being in this state where we have among the highest rates of perinatal tobacco use in the nation, which actually is the most modifiable risk of poor pregnancy outcome. So when I'm talking about, from my heart, pregnant and postpartum women and pregnant and parenting women and persons, you think about what is going to adversely affect their health the most long-term and impact a pregnancy the most. And it actually is tobacco. More women have pregnancy-related adverse outcomes for example, a preterm birth, low birth weight, bleeding disorders in pregnancy, how it affects the infant. They're more likely to be born early, which is associated with lifelong complications. And so certainly we want anybody that has an addiction to any substance, whether it be tobacco, opioids, cannabis, which is emerging, as well as any other drugs, we want them to be able to get some support. And I think an important piece here, and I'm probably getting ahead of the game, but is being able to safely disclose that information. I do believe when we think about substances in general, people are afraid. There's fear of that stigma. There could be fear of legal consequences, especially related to pregnancy. But what we've learned is that women, especially pregnant and parenting women that disclose early and are seeking help, they're more or likely to have the support service they need to get in recovery to be maintained in recovery and to have the supports they have for their children long term
Speaker 01:yes I actually learned quite a bit from your response we do have a huge problem here with tobacco in Kentucky specifically and then of course with now vaping which I think a lot of folks are under the impression that it is safer and that is certainly not the case um but as far as substances in general um like you said these can be things that are perfectly legal just like tobacco alcohol things like that um and i think sometimes people don't think of those things that are so easily accessible and also um really as a society accepted um That's an excellent point.
Speaker 00:Yes, absolutely. And still just as harmful. Yes, yes. But you have extensive experience in researching perinatal substance use. So how can substance use during pregnancy impact mom and baby and also during the postpartum period?
Speaker 03:It absolutely can affect the mom and baby and does affect the mom and baby, but it really is also somewhat dependent on the substance So different substances affect the mother and the infant differently, potentially. But when I think about maternal mortality, which if you think about the United States and even within the United States, Kentucky, we have among the highest maternal mortality rate among nations as well as just in Kentucky among states. And so when you think about that, The safety issues, about a third to a half of pregnancy-related deaths are caused by substance use that are preventable, preventable. Violence is another. Violence in pregnancy is another whole issue that we're not here to talk about today. But when you think about safety to mother and baby and mortality, you have to address substance use because ultimately it can cause death, often accidental. but not always and so it's something that we definitely need to keep funding programs and research that explore positive pathways for programming and support and treatment but generally substances used in pregnancy when you're are going to be causing effects that are most likely going to cause preterm birth, low birth weight, bleeding disorders. One other piece I just wanted to add is that when you think about that, those early births have lifelong implications on the infant. You would never think that a baby that's born preterm is going to be more at risk for obesity later in life, more risk for cardiovascular disease later in life, more at risk for behavioral problems, for example, ADHD. So those early pregnancies, although they're born, they're like, oh, well, if they grow, they're going to be better, and they'll outgrow it. No. They can adapt, but they many times will be having those lifelong consequences, which actually are very costly, not only in terms of health to the family, but also in terms of dollars to the state and funding programs.
Speaker 00:That's a very good point. So I want to give you all a scenario. I've been using while pregnant, and I want help. What can I do? So Cassie, I'll let you go first.
Speaker 01:Okay.
Speaker 00:Let's say here in Woodford County.
Speaker 01:me
Speaker 00:for you that
Speaker 01:this happens okay um let me get you in contact with someone you know that can help you i'm so glad you know that would be my i'm so glad that you're sharing this with me and um although here at the health department um we do not do any kind of medication treatment or substance use treatment however we can connect you with the resources that you need in order to get um yourself and your baby and you know healthier um and then you know i'll would say one of the first things um is having that person contact um for sales police department if they need a ride or if they want to go get um treatment outside of Woodford County we do not have a lot of treatment offer options in Woodford County we do have Isaiah House which would be one of the first places that I would recommend because Isaiah House is in Woodford and um, it is for women only. Um, but then as close as Jessamine and Frankfurt, um, we actually have access to, um, some medication assisted treatment, uh, options. And so, um, a lot of people do choose that because with that also, um, comes, um, therapy, um, and counseling and things like that. And they will also connect you to, um, groups, um, that you can go to throughout the week, talk to people who are either in the same scenario or have been and that can, you know, have lived experiences and can help you in your journey to getting healthy. So that would be kind of the short and sweet version of what I would give them. Right,
Speaker 00:so if they came to the health department, that's what you would do? That's what we would do, yes. And Dr. Ashford, you already a women's health nurse practitioner. So if you would recommend them talking to their provider, how do they approach their provider about this?
Speaker 03:Thank you so much. And I think that's step one, reach out to your provider. The state has really invested a lot of great programming and funds into the Perinatal Quality Collaborative, which is a training system that Dr. Connie White has led for many years to help providers and hospital systems across the the state be trained in these particular areas and how to help provide supports for women with substance use. So there's been a lot of training invested. We have wonderful programs. We have home visitation programs in all of our county's hands. We have Kentucky Moms Matters. Voices of Hope is a phenomenal community-based program that helps support not only pregnant and parenting women, but also adults and children of all ages that can have that connection. The Chrysalis House is also a great resource for pregnant and parenting women across the state. And each of the hospital systems really have unique programs that bring together a team. It's not, I love, of course I'm biased to nursing and nurse practitioners, nurse midwives. I think they're just innately trained to have that culture of caring as one of our frontier goals. But also to have that multidisciplinary. It takes all team members. We need the physicians, the social workers, the community workers, the community health workers, the local health departments, all working together to provide the supports to these women and their families because it takes a team and the school systems as well. So number one, I guess to make it short, be bold, be brave and take that step and reach out because we are there to help you very well said and we want to help you
Speaker 00:and that reminded me you talking about that collaborative teamwork Frontier last year for midwifery week offered a CE session on substance use during pregnancy and we had a nurse midwife from Frontier present along with a mental health provider and a registered nurse so that's kind of how all three of those came together and then presented that because it is a
Speaker 01:teamwork absolutely it takes us all and that's one of the things that you can experience as a leader in the community when you attend one of the ASAP meetings is that is really where a lot of systems coalesce to talk about the substance use disorders and and how we can help the people in our community and connect them to all the resources. I would love for you to attend one of those meetings. I would love to attend. Okay,
Speaker 00:okay. So tell us more about Woodford ASAP.
Speaker 01:Woodford ASAP. So I'm already thinking we need to change the acronym because it does have the word abuse in it. But we're all learning. That's right, exactly, exactly. And we all have to be open to changing our mindset and seeing how even things that we're doing unintentionally can negatively affect those that we are trying to help. But the ASAP, Agency for Substance Use Policy, I'll just use it that way. There you go. That is a group that has been meeting here in the community and I believe is present in if not all of the 120 counties in Kentucky, the majority. And so that was established so that we could have a network of people at in the local community at the local level really talking about exploring options and really breaking down the barriers for people who are suffering with substance use disorder and so that is more of a it's more of a funding source when I first joined my I thought it was more of a program or, you know, we needed to be doing this and this and this in the community or, you know, really it's a funding source. And it's a group of leaders that look at policies and things like that. You know, back 25 years ago, people were still smoking in, you know, community places. So those are some of the things that the group can help change policy and influence policy. That's another... huge component is influencing policies that affect our health. But one of the things that they do is they offer mini grants to people in the community. And those can be, you can write those mini grants. They have applications that are available several times a year, but they can be for treatment, education. The school system uses them for education for kids, scholarships we have several different scholarships that we give students each year who have either been affected by substance use disorder directly or indirectly and then harm reduction we talked about that earlier you know we want to make sure that all of the police department the sheriff's department they all have access to Narcan in their units because they may be the first responders to find someone who is potentially overdosed and we want to make sure that they have what they need to save someone and not have to wait on an ambulance and EMS so of course those people will come later but a lot of times the officers are truly the first people to respond and also to anyone in the community we give Narcan to anyone and so whether you're trying to help a loved one that may be you know suffering with substance use disorder or you're just you want to be prepared as a community member so that's another thing and then we also provide sharps containers for our police department and then you know other law enforcement officers to make sure that they can safely dispose of needles if they should find them and they do occasionally we do use retractable in our program so that it's it's their only one time use and then that needle retractable tracks because we also want to think about the community and the safety so those are just a few things that ASAP can assist in funding but we also were the recipients of the opioid settlement funding and so that's a larger chunk of funding ASAP usually doesn't get a huge amount of funding each year but the opioid settlement funding is going to be a larger chunk and so So we're really right now just trying to gather information on how we can best utilize that funding, and we're trying to look at what other communities are doing and how they've been successful in assisting the substance use community and really helping them get the resources that they need.
Speaker 03:Cassie, there is so much there that also resonated with me, and I just also want to just encourage those that are listening that to reach out to find about more grants and more opportunities. Kentucky, I think it's almost a billion, as in a B, that the state is going to be allocated for funding for opioid abatement. About half of that is already, you know, accounted for in different programming over the course of, we're talking, I think it's 10 years. I could be wrong, could be 15. I'm not sure if you know, Cassie. I'm not sure. It's not just over one year off. obviously. But also, but that other half is really open to, they're exploring the committee and the board is exploring opportunities. They want to help communities. That is their goal. So more to come, be aware and reach out to Cassie or myself. And if we don't know, we can hopefully get you in contact where you could find some more of those grants. I know just from my experience from at University of Kentucky College of Nursing, there are researchers there that are offering mini grants. I know Dr. Amanda Fallon Bennett has a mini grant program that people from every county could apply for. It's more focused on pregnant and parenting women. The Pathways program at University of Kentucky is the one I know best. And they have been in existence for a long time specifically to help pregnant and parenting women. So U.K. pathways program can really get you connected they also have a postpartum program that that was formerly referred to as beyond birth but I think it's now the smart parenting program so there's lots of resources out there but in general all of these programs are ready to meet you where you are if you're talking about starting from tobacco there's tobacco cessation programs and I know the health departments do a phenomenal job with that if you if it's opioids if it's cannabis because it is not safe in pregnancy either and So I think just understanding what are those real effects and reaching out to the health providers and the community supports that you have is a great first step.
Speaker 00:And you both have mentioned hands. So both nod your head real big whenever it's come up. So if you guys want to talk about that a little bit.
Speaker 01:Yes, I can talk about that. So that program, it stands for Health Access Nurturing and Development Services. services and that's actually housed within the health department here in Woodford I know it's in most health departments however not all health departments are required to have that other agencies may manage that but every person in Kentucky should have access to that if you are a new or expectant mom or dad and that's what I love they keep this this program is evidence-based and you know very very very beneficial and uses a lot of the things that you know our medical staff social working staff have so it's kind of like an all-in-one but they keep expanding who is actually able to utilize this and a lot of times it's I think there's because it's offered within the health department they think that there's some kind of financial limitation there's not we are we literally see people that are homeless to living on horse farms and that is absolutely no joke and I think that the law enforcement would tell you that that's the same thing that they see in responding to overdoses it is really there's it serve everyone but in that program we will follow you as soon as you find out you're pregnant to usually when the child turns three years old and we will be with you every step of the way that's why I like that it's hands because we literally hold your hand and follow the steps I love I'm a mother of five and so this is one of my favorite programs that we offer we usually get in contact with our families when they come in for other services and they just don't know that this is one of the other ones we offer but we help make sure mom and baby are developing growing properly we're going to do ages and stages we're going to do all kinds of assessments with you to make sure um you know baby is feeding eating properly growing properly that the baby's safe and that we do you know we do home checklists to make sure you know because there are things in homes that you don't think of that can be harmful and so it really the program does so much and so it's hard to really put it down into like a few sentences um but really every parent needs another set of hands and eyes and ears and that's really what this is and like i said it's also for um new fathers yeah and so and we know every baby is different so even if it's just your second third child that you can be accepted into the program. And again, there are many, many, many, many, many ways to qualify. In fact, it's harder to not qualify for the program. And so if you have questions about it, please go to our website. That's actually out on our front sign in the health department. The state has a great website, but we have social workers and nurses on our team. We also have several people on our hands team that are are fluent in Spanish and English. And so we know here in Woodford, we do have a lot of Hispanic families who also utilize our programs. And so, yes, if you know of anybody that is expectant or just had a baby, I think it's within 90 days that they may be qualified for the program. And we offer many, many incentives for program or, you know, the appointments that are kept. And again, appointments It's really just a visit. And we can do those virtually if needed. So a lot of different options. It's very flexible, but it's also very beneficial for really the family as a whole. You continue to make goals throughout the program. So I'm sorry, I don't want to take up all the time talking about hands, but it is a true passion. It's a wonderful,
Speaker 03:yes, it is a wonderful program. And I think in all 120 counties.
Speaker 00:Yes. And it's not just for checking in on the child. it's checking in on the parents as well yes
Speaker 01:and it's yes and you know a lot of things that other programs or other entities may enforce I guess that's not that's not really what we do of course if if if baby's having you know some some issues let's say with feeding or something like that we may refer you to an outside source but unless something is just true you know we're not there to report you for anything you know that that's That's a really common misconception. Yeah, people think that that's, and that's truly not, you know, we're not reporting anything to ICE. It's nothing like that. You know, we really are just in there to help make sure that mom, baby, the whole family have access and all the resources that they need.
Speaker 00:Right, that's excellent. Well, anything else you two want to mention?
Speaker 03:Just to build on something that Cassie said about policy I mean because it's so important in your organization is so important and so thinking about how we can advocate more at the local policy we have very supportive mayors in our area in our local areas that are really have this as a priority our state legislators our federal congresspersons senators they are I believe leave really at the forefront of trying to help provide supports. I did have an experience where I was able to be on a committee in Washington, D.C. and work with some of our congresspersons there. And while I was there, there was actually funding on the committee. I was at four home visitation programs. And I'm just very proud to say that our Kentucky congresspersons were all in support for the funding continuation of the home home visitation programs and hands was one of the exemplars and so not only is it just wonderful here in Woodford County and the state but it is known nationwide and there are other programs in the nation that do home visitation but again we need to continue to advocate for those programs because they are so impactful they are they are and I did I
Speaker 01:did forget to mention we we have at my last check over 70 families in our county on the program which is pretty significant for our population size especially when considering Fayette neighboring county much larger and at that time I checked that we actually had more families on our program so outreach is huge for us and making sure that people know who we are what we do and then sometimes what we don't do because that can be more of a program draw and so I think just exactly we have to use any kind of voice and any kind of time that we have with those folks that are making the decisions and have the funding to really boast about our program and how effective they are because you think you know in in 120 counties, we have this program, we have health departments. And so if you're looking for something to infiltrate your community, you already have a brick and mortar of a health department that is serving. And so I think down the road, we're probably gonna see health departments doing more in the way of assisting those with substance use disorder, because we've already been able to, I think we have more harm reduction programs in our counties than any other state. And we need it. So I think that building on those programs, we have the trust of the people that we need to trust us. And so, yes, I think that is so important. Using our voice and any chance we get for the legislators and the powers that be to really tell them what we do. And I think it's just stories like this that we can use. And this affects everyone.
Speaker 03:It crosses all socioeconomic classes, all persons of every ethnicity, age. And so, yes, I completely agree. And Cassie, you said the word trust. And that is, I think, what is going to continue to draw people to the programs is that knowing that they can trust us. They can trust to come to us that we are going to do our best to get them the care that they need and if it's okay with you I would love to Quincy be able to just put a plug in we need more nurses in the nation and thinking about policy and advocacy and workforce and I'm sure from the health department standpoint too we need more nurses and and so Kentucky has a and wonderful programs across the state but I don't think anybody really realizes that We have in Woodford County, Frontier Nursing University. I believe in my heart that it has the most significant impact in communities across the nation. Our mission is to help provide exemplar health care services through midwife and nurse practitioner education to underserved and rural communities. That is our heart. That is our mission. And we need those listening out there, our All those in middle school, high school, adults that are looking for maybe that second career, nursing is such a phenomenal calling. And that trust is what made me think of that, Cassie, when you said the word trust, because we are the most trusted profession. It's cliche, but it's the truth. And so if you have an interest in becoming a nurse or a nurse practitioner, please reach out to us. There's just such great resources right here in your backyard.
Speaker 01:Yes. that's a great way to end I also want to say maybe hopefully I'll be sending two nurses your way but my oldest daughters are very interested in nursing but also I want to give you a thank you you all this education is second to none and one of your graduates actually identified our first case of measles I don't know that you all know that but Dr. Christy Grider with Versailles Urgent Care called me 8 o'clock at night and says I have a patient in the next room and it is a textbook case of measles she's the reason why we had the early identification and her staff were the reason why we were able to stop the spread and that's what we do as part of controlling communicable diseases just the foundational purposes of public health. And I've worked with other practitioners that have graduated from this program as well. And so, again, second to none, the absolute best. And I'm so thankful that you're in our community. Well, and send your daughters my way.
Speaker 03:Or sons, if they're there. I don't know. Because it's one of my most favorite things to do. My husband actually says, you may want to stay away from her because she will be already recruiting you into nursing. And so I would love to talk with them. I have four children as well. And unfortunately, they have wonderful professions, but none of them are nursing. I did actually get several nieces and nephews into the profession, but not my children. But anyways, and I completely believe, agree with you. My first granddaughter, grandchild was delivered by a frontier midwife. And so I have ultimate trust trust in the program
Speaker 01:yes my first two my adult first actually my first three children were delivered by midwife
Speaker 00:oh yeah look at this full circle yes yes yes thank you both so much for joining me today and for sharing your expertise I think this was really a fruitful episode and I know I learned a ton so thank you both so much thank you so much thank you this podcast is a community health initiative brought to you by Frontier Nursing University in the Woodford County Chamber of Commerce to improve community health We'll see you next time.
