 Welcome to Family Affairs, coming to you live from the Think Tech studios. I'm your host, Lisa Kimura, here to discuss the issues and policies affecting families in Hawaii and how we can collectively impact change. With me today are my guests, Kerry Wheeling and Vivian Choi from Healthy Mothers Healthy Babies Coalition of Hawaii. As many people know, I've been the executive director of Healthy Mothers Healthy Babies for the past few years and I've been very much focused on improving lives for mothers and babies. Now I'm going to be moving on to a new role at Aloha United Way and I wanted to talk about what the future of H from HB looks like. Vivian and Kerry, welcome to the show. Thank you for having us. So we've worked together for a while. What do you love the most about being part of Healthy Mothers Healthy Babies? I'm going to let you go first, Vivian. Thank you. It's been a pleasure being able to work with Healthy Mothers Healthy Babies because it really takes you throughout that whole journey before, during an act of pregnancy, for all families. And even though we're Healthy Mothers Healthy Babies, we do the full family because it does affect every mother and child. And I think the reason that I enjoy working with Healthy Mothers Healthy Babies so much is I have evolved with this organization. I have been involved with it since 2001. I started as a project coordinator, just like Vivian here, and did a little bit as an interim ED, then went on to school, came back, was a board member, and now coming back as a clinical services director. And so I think with me what I can see is the longevity of the organization, how it's changed, how it has evolved, and still seeing those pucas, if you will, in the community where there are still gaps and there's still a purpose because we provide a very good niche that we're not a facility. We go out into the community and we work with families. And the good thing about Healthy Mothers Healthy Babies is that we collaborate so well with our perinatal providers. That's been a key of our success, and it will be an ongoing key to our success as we evolve. I think so too. HMHB is so well integrated in the community. I think our partnerships are so strong and what we're able to do to connect people to services and connect organizations and fill in the gaps is crucial. You talked a little bit about the evolution that you've seen, but what does that look like comparatively, say 10 years ago, to what HMHB is doing now? Well, 10 years ago we didn't have picopals. 10 years ago we didn't have cribs for kids. Probably what we were working on was focusing more on perinatal, improving the system of care for perinatal support workers. So we would do training and education, but I don't think we had the established services that we have now where we can actually work more one-on-one with women and children. And I think that's been a critical or a pivotal point with Healthy Mothers Healthy Babies. Definitely. So Vivian, I know you answered the mother's care line. You take a lot of calls and we used to get, or we still absolutely get, a lot of people looking for postpartum support. Tell us a little bit about the services that we've added. Yeah. So most recently we added a maternal mental health counselor to our on-site services. So it's great because since we do get these calls from mothers all over the island, even statewide, it's nice that we have a direct referral to our two counselors and that way we can get them to help right away. And even if they're on another island, one of our counselors does... Telehealth. Telehealth. So that way you'll still be able to get the help you need, even if you're not able to have transportation or you can't go ahead and fly over to another island, which some mothers do have to in order to get the help they need, including like some hospitals to give birth or whatever, but for mental health we're able to take a step forward with that. Right. And so kind of getting out in the community and things like that and knowing that these questions that moms have are all about how to find support. Tell me about the start of PicoPals and what that program looks like. So the start of PicoPals, it was... I think it was you and a group of friends that had babies at the same time but wanted to... Find a way for moms to get better support, get connected. And especially during that first few months of together with their infant. So PicoPals is for new parents with infant zero to four months and those first few months are very important with the bonding of the child but also a lot of mothers tend to feel isolated and especially when you get to bond with other people with babies of the same age, you start to understand and know that it's normal to feel the way you do and actually get to experience the same things with other people with babies of the same age. So I think that was what got it started and we've been starting to try and expand PicoPals every day. It's a learning experience. Yeah. And Carrie, you led a PicoPals group and you've been there since the beginning of the formation. What was your experience as a leader for a group? I absolutely enjoyed it. What you get out of it is just amazing because you're able to see these women come together and come to realization that, oh, my God, I'm not the only one going through this. It gives them comfort to know that they have other women that they can share and collaborate with and just watch them grow their concerns, their issues and just knowing like what Vivian said, that they're not alone, that there is support out there in the community. And I think that's one of the hardest things for new moms to find is where are those support systems? Definitely. Because they don't know. And so being able to reach out to them, and I think the coolest part about PicoPals is even though you're with them for 12 weeks, you see the development of the kids and how the moms collaborate and come moderate. But it's also after the fact because you're still connected with these moms. So you're really able to see the kids grow and mature and how everyone just kind of evolves and then submerges back into life after having a baby. And it's really a neat thing to be a part of and to know that we are a resource for them even as they continue to age because oftentimes moms have baby number two, baby number three. And so it's just nice to know where the resources are in the community for them to go to. Well, and I think the thing that's most impactful as the post-group surveys and they talk about how without PicoPals they don't know how they would have gotten through their first year. The fact that they've grown so much in their confidence and they were so scared to leave the house before but then all of a sudden it's like second nature and they look forward to going out and they have connection. From the group leader perspective, what kind of support does HMHB offer in terms of getting new potential group leaders interested and trained? Well, we offer a continual train the trainer, so to speak. So we have a coordinator who really volunteers her time when she comes in and who has helped establish the program. Leanne, Leanne Lam. And she'll come in, provide the training which is a national curriculum that we follow. This is not a curriculum that HMHB just made up out of the blue. This is a curriculum that we follow national standards and have adopted it culturally to meet the needs of Hawaii. And so what we do, we actually pull from the moms who have been part of the program which is how we really, they become so vested. They see the purpose of it, the importance of it and so these moms want to be able to give back to the next class. So actually our PicoPals leaders are often mothers who have participated in a PicoPals class. So we bring them in, we train them, and then we let them grow. And Vivian, what does a typical training look like? Typical training, so we go through, first of all, just go through experiences like if you went through PicoPals, if you haven't, then why do you want to be a group leader? Most of the time people want to give back to community and just see how HMHB, they see the Pukas in the community, how they can give back and how they can connect other moms as well. And then they go through different exercises and just explain what a facilitator is. We're not an educator per se, but it's not a class. It's not a class, but we want to facilitate relationship building with everyone in the group. And make sure everyone gets their rightful and respectful time to speak their own thoughts, their experiences, and just train the facilitator to be able to understand everyone has their own experiences and such. And then in the training, we have certain prompts, and each week we have a certain topic the moms will talk about. So we'll practice going through certain topics and how to lead conversations and such. How many families have gone through PicoPals now? As of right now, I believe the number... So we started in 2017 and we've been gaining momentum, so we should have... The program has served over 130 families so far. And how is it only moms or is it open to everybody? No, it is open to everyone. It is not an only mom group. All partners and spouses are available and they're welcome to come at any time. And I know one of the really thoughtful considerations when the program was developed was to ensure that working moms who need to go back to work also have the option to. So tell me a little bit about the thoughtfulness and the consideration in terms of when groups are scheduled, where they're scheduled. So it really depends on... So one thing that we are definitely trying to work on is doing more group leaders in different areas, different time availability and such. So for working moms, and some group leaders have actually come forth and said, I want to give back to the working mom community. So some group leaders have said, oh, I want to go to lead a weekend afternoon or morning time just to give back and be able to have a group because working moms aren't available in the weekdays. For sure. I mean, I know I went through that myself. I have three children and it's really hard to find things that are open to moms. And the stresses that people face when it comes to caring for family, making sure they make ends meet, figuring out ways that they can engage their children and be good positive parents who are helping them learn. There's a lot there. And on that note, HMHB is very, very big on advocacy. So tell me a little bit, maybe in a nutshell, we're going to take a break in just a minute, but real quick, tell me about some of the priorities that HMHB has had legislatively. Legislatively, I know we're looking at family leave, making sure that moms can have that support in families, not just moms. It's mom and dad can have that support once they have baby to take the time off that they need to be with baby, cultivate that family and come back. HMHB has always played an important role in our advocacy efforts in improving our system of care for moms and babies. So we have the family leave and... We established the maternal mortality review panel. And the reason for that... For really looking at deaths that occur after birth and why that happens. Because really as a nation, our numbers, as United States, our numbers should be very low, but we still continue to experience death after birth. And so we need to have a better understanding of why that happens and how can we prevent it? What are we doing as a state? What are we doing as a nation? And how can we make those improvements? Right, absolutely. And a lot of it too, looking at the integration between poverty, racism, how those social determinants really affect somebody's life expectancy and their health. Talk to me a little bit about reproductive health education and priorities for that. Well, that is a huge hot topic. It always has been and it always will be. And it's just the importance of being able to have that accessible to women when they need it. So whether that be birth control, whether that be a breastfeeding pump, which we've made huge strides in over the past years, but it's making sure that those services are available to women when they need it for whatever their lifespan gives them, working with teens, working with new moms, working with young women, making sure that they have the choices in life that they want and can make when the time is appropriate for them. And having those services available to them is very important. Absolutely. One of those initiatives is the one key question initiative that's for health professionals. We're going to take a short break right now. We'll get a little bit more into that. Stay with us. We have a lot more to discuss here on Family Affairs at Think Tech Hawaii. Hey, loha. My name is Andrew Lanning. I'm the host of Security Matters Hawaii, airing every Wednesday here on Think Tech Hawaii live from the studios. I'll bring you guests. I'll bring you information about the things in security that matter to keeping you safe, your co-workers safe, your family safe, to keep our community safe. We want to teach you about those things in our industry that may be a little outside of your experience. So please join me because Security Matters. Aloha. Aloha. I'm Stan Osterman, a host here on Think Tech Hawaii, a digital media company serving the people of Hawaii. We provide a video platform for citizen journalists to raise public awareness here on the island. We are a Hawaii nonprofit that depends on the generosity of its supporters to keep on going. We'd be grateful if you go to ThinkTechHawaii.com and make a donation to support us now. Mahalo. Welcome back to Family Affairs on Think Tech Hawaii. I'm your host, Lisa Kimura. With me again today, Carrie Wheeling and Vivian Choi from Healthy Mothers, Healthy Babies Coalition. Welcome back. Thank you. So we were talking a little bit about Healthy Mothers, Healthy Babies and what the contributions have been. What would you say HMHB's greatest contributions have been to maternal child health in Hawaii? Wow, our greatest contributions. We have done so many things over the years. I think even if we start to span back to when I was involved, one of the things that we worked on was improving emergency contraception, access to emergency contraception before it even went available over the counter. We worked with the pharmacist. We worked with the community to see how we can improve access to emergency contraception. Well, many, many years later, here we are on a topic of what's called one key question, right? So one key question is a national initiative that Hawaii is working on and it's really about educating our providers or anyone who has any contact with reproductive age women, right? So spanning many years and asking them really to begin to think about when do you want to be pregnant. Because most people don't, when you're young, you don't think about that thing. You don't put life in that kind of perspective. You may think, oh yeah, I want to have kids, but really being able to plan it so that you have a healthy pregnancy and what does that look like? Because in today's age, we're working with pregnant women who have a lot of health conditions which makes their pregnancy very, very high risk. So the key concept of one key question is to start talking about that early with women. Plan it out with them, what would that look like? How can we make it as healthy as possible? Because even the idea of planning a pregnancy is not a universal belief system. Right. Half percent of our pregnancies in Hawaii are unplanned. Yes, unintended. And just like the national average as well. And it doesn't really vary that much today to say sometimes a little bit worse, but really half of pregnancies aren't intended. And I think the interesting part is that a lot of times the focus is really on how to avoid pregnancy, but we don't often talk about how to have a healthy pregnancy. Correct. And so I think the critical difference with one key question, question being would you like to become pregnant in the next year? So there is a real declaration of intention there, not just about you ever want to get pregnant. Do you think about, do you, you don't want to get pregnant. Do you? Like those aren't very constructive questions, nor does it put it in a framework of only the next year of their life. Right. So it breaks it down to a much more manageable time frame. Right. But how does that differ from how clinicians are now typically screening women? Well, I think, and from my own personal perspective, I feel like one key question is very proactive. We want to get them early on, educate them, work with them, whereas when you see them, when clinicians see them in the hospital, they're already pregnant. So they already have to deal with it at the moment instead of trying to work with preventive measures or planning measures to ensure that they have a healthy pregnancy. And that's what one key question is, you know, really pointed at, trying to get them to where they want to be in life. And if within the next year they don't want to be pregnant, then okay, let's plan for that. What are you doing to prevent pregnancy? And it really opens up a better dialogue instead of coming into the provider's office saying, oh, I missed my period. I think I might be pregnant and sure enough, you know, and then having to backpedal from there. Right. Well, and I think the other half of the equation also is making sure that there's access. Correct. So if someone does desire to get pregnant, or if they don't, they need to be able to have health insurance. They need to have access to contraception. We need to make sure that insurance plans are covering everybody adequately. Right. So again, that's a role that HMHB has really filled in terms of that systems-building component. What do you see as some of the next frontiers for HMHB's role in that systems-building advocacy? Right. This is a very exciting question for me. I'm glad you asked that. Because as I have evolved with HMHB, you see the same issues appearing over and over and over again. So, you know, it seems like in some sense we keep doing the same things and expecting a different outcome. So really what we need to do is do something different so we can improve our outcomes. So with Healthy Mothers, Healthy Babies, I think the next step for them is really building a clinical arm so that we can collaborate better with the community. The beauty about HMHB is that we're not a facility. Women do not walk into our office and expect to receive services. We can go into the community and help them where they're at. The other big plus for us is being able to work with providers. Where do they see their gaps? Are they having a hard time reaching women? So that clinical arm is helping with tobacco, smoking cessation counseling for those women who smoke. Hopefully growing into providing centering pregnancy or some form of that. So we can work with providers. And then I think doula services. So really working with new parents in Hawaii to help fill those pucas again where they may not know these services exist or for whatever reason they're not able to access them in the facilities. And so having Healthy Mothers, Healthy Babies create a new arm, a clinical arm, I think is exciting. Absolutely. And something to look forward to. Absolutely. So kind of on that note of looking forward and future, tell me a little bit about first of all the accomplishments that HMHB has had over the years. Yes. Well, we have had some great accomplishments and they have all been due to the collaborative work of you, Lisa, as the executive director and the team here, Vivian and Caitlin, right? And those big accomplishments have been establishing Cribs for Kids and Peacopals so that we can reach the women when they need the help. And I think one of the biggest things that we've accomplished is your recognition. Lisa was just awarded the Pacific Business News 40 under 40 for her work at HMHB. Which was really exciting. Yeah. Thank you. Yeah. Yeah, that was really fun for all of us. Yeah. I can't celebrate. So she's really, the team there at HMHB has really built a good foundation for us. And like any nonprofit, the challenge is being able to continue it. But how do you sustain your activities without being fully reliant on grant funding? So that's why we're looking at trying to see what we can do with a clinical component and bill for services. Sustainability, peace for nonprofits, is really the key. And I think something that people who aren't part of the nonprofit industry just don't understand. Yeah. And building that in is such an important part of sustainability for revenue for the future for all of the efforts. Tell me about the new baby and me tobacco-free program that's starting. Yes, that's exciting. Healthy Mothers, Healthy Babies was just awarded a four-year grant from the Hawaii Community Foundation, which is our stepping stone into trying to bill for services so we can generate a little bit more income. So what we will be doing is, hopefully, collaborating with the OBGYNs and other perinatal providers who have any moms who are smoking during their pregnancy. There are other hospitals and clinics who do offer this, but it really is a smoking cessation program that works with moms who smoke and it gets them to stop, begin the process of cutting back and stopping smoking. So we reach out to them a few times during their pregnancy. We actually test them because the tobacco and baby-free program offers support, so we can test them to see if they're still smoking. We can offer incentives so that when they are tobacco-free, we can give them vouchers that is good for shopping, whatever they need for them, or baby, and so it's a program to really address smoking cessation during pregnancy and reaching out to the moms. And smoking being one of the highest causes of preterm birth and many, many other serious issues, including, of course, death for mom and baby. But tell me a little bit about the referral channel. It's going to be coming from Cribs for Kids. Yes, yes. So our referral channels right now, we're going to work with Cribs for Kids, our existing programs, and PicoPals. Then from there, what we'll do is we'll reach out to the perinatal providers and it's all about collaboration. This is not about trying to coach any women away from any other programs because it's all about supporting them where they're at. And specifically mothers who have really specific needs. Yes, and sometimes the OBGYNs that they are having their care through does not offer smoking cessation services. So it would be a nice collaboration because then that OB can say, hey, I can refer you to a program if you're interested in quitting and then we're able to reach out to them, meet them where they're at. Absolutely. And so how does HMHB most effectively reach people where they're at? A lot of it is grassroots community efforts. So have you speak to your... Yes, so following on that point with the Tobacco Free Program that we are doing with the Cribs for Kids channel, it is a safe sleep education class that we do have referral agencies. So we do work with partner agencies for that program. And on the referral form, there are certain risk factors that we do check off and one of them is do you smoke? Have you been smoking for mom and family members? And that way, as of right now for all our Cribs for Kids participants, around 20% have already admitted to have been smoking while pregnant. And that's already the first step, getting to know who is smoking, identifying who has been smoking if they're going to be smoking afterwards. And then that would be our first step in following up with them after they take our class. So for Cribs for Kids, it's very special because only one of us kind in Hawaii will follow up with mom and baby all the way to their first year of life. So that way, it's a good channel for us to follow up, keep track of baby's health, and also being able to follow up with our, have you been, you know, that's the channel of being able to connect with the tobacco-free program. Right. And also a good chance to follow up with whatever kind of case management they might need in the first year because moms are struggling with a lot of things a lot of times, including mental health often. And now we have women referred to HMHB's licensed clinical social workers for support. What does that new mom experience feel like? Can you speak to that a little bit as far as the isolation and feelings? Oh, well, I think that that's one of the biggest aha moments that we get with Pico pals is moms come in and they're so thankful that they are not alone because they don't know who to talk to because they don't have anyone to talk to because dad's off at work, you're home alone with baby. And so that's true sense of isolation and being alone is very true. And that's one of the main things we don't want to do with our moms. We don't want to isolate them. We want them to get out. And so I think having this program lifts the weight, so to speak. They have collaboration. They have other women that they can share their worries with. They have a lot of friends that they can share. I guess that's what I learned today. This is what my baby did. What's different about Pico pals is people don't intentionally tell people, oh, you should do this with your baby, but most of the time it's family members who've already had kids. They're a little bit older or your friends that have already babies, but they're not going through it so it'll get better. Don't worry, it's fine, but you truly don't see it happening at the same time as you. You're not going through the same experiences. It's not intentional, but at the same time being able to see other moms with their babies. 100%. Thank you so much for sharing all this. Thanks for being here today. I know that working with HMHB has been absolutely a joy and a pleasure. And I want to thank you both for being here and sharing your experience and helping to contribute to make Hawaii a better place for moms and babies. So with that said, thank you. Thank you for joining us on Family Affairs. I'm Lisa Kimura. Aloha.