The Connected Care Team

Leveraging Patient Engagement Solutions to Provide Infant Feeding Support

• TigerConnect • Season 2 • Episode 1

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The first year of a baby’s life is a vulnerable time for both the baby and the parents. Non-judgmental support and resources can make all the difference for families, particularly in close-knit communities. Heather Preece founded Kodiak Kindness with the goal of nourishing both the body and soul through infant feeding support and compassionate care.

In this episode of The Connected Care Team, Heather discusses using TigerConnect Patient Engagement to support families within the Kodiak community and how her team provides creative care during COVID-19.

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Dr. O'Connor: Today on the show, we have Heather priests. She is the founder and executive director of Kodiak kindness, a program that focuses on infant feeding out of Kodiak, Alaska.

Hi, Heather. Welcome to the show. 

Heather: Hi, thanks for having me. 

Dr. O'Connor: Sure, sure. I'd love to start with you today and hear, um, a little bit about the kindness project.

Heather: Yeah. Well, I'd love to tell you about it. We are a fairly unique program we are located in, on Kodiak island, Alaska, which is a island in the north Pacific, about 250 air miles, Southwest of Anchorage. We have the largest coast guard base in the United States on Kodiak. And so we have a lot of people having babies. Well, I guess relatively. And kindness is an infant feeding support program. We're not a health clinic. We're a nonprofit that operates independently. 

And we provide infant feeding support through the first year of a baby's life, at no cost to the family. So we meet them in the hospital, or if they have a home birth at their home, we also meet them whenever they're on their journey in the first year of life, if they've delivered elsewhere and then moved up to Kodiak.

We don't have an office. we call people and video chat with them and visit them in their homes and give them everything they need as far as education and support goes for any aspect of infant feeding. So I'm a lactation consultant and a pediatric dietician.

The kindness project started in 2006, actually under the auspices of Providence Health and Services. So we operated under Providence, for 15 years and then in 2021, we went independent.

Dr. O'Connor: You know, I was reading a little bit about your, your program and I'm a parent, I'm a father of six. My children are a bit older now, but I remember, you know, running into a lot of issues with feeding them when they were infants. And one of the things that really stood out to me about your program was how proactive you are with the patients - with the moms. Can you talk a little bit about that?

Heather: Oh yeah. That's really, I think a key design element. We do not wait for new parents to reach out to us and feel like you know, decide that there's something wrong because oftentimes we find ourselves wishing that we had been involved days earlier. Sometimes new parents don't know when things are going wrong.

So we're very proactive and preventive. Try to give good information and support. In advance of when things might happen. And with, as you know, a newborn is in a very vulnerable period, especially the first few weeks of life. If a family decides they want to try breastfeeding their baby, there's lots of issues sometimes with latching and how do they know the baby's getting enough milk and all of that kind of stuff.

So on our isolated island, as well, it's when people are living far from extended family members or otherwise don't have the kind of resources that are available on the mainland. Like we don't have regular pediatricians here. We don't have a NICU. So we kind of have to come together as a community and use our resources and do the best we can to prevent things from happening so we don't have kind of crisis situations and medevacs off the island and things like that. 

So that's part of the design element with the proactivity. So we call people at certain times, a lot especially in the first two weeks before they even reach out to us just to check in, ‘Hey, how's it going?’ Ask them a few questions and try to prevent a lot of problems from happening in the first place. 

Dr. O'Connor: Yeah, that's interesting. And so part of it is really the, the remoteness and part of the culture, which seems like it drove some of the need for a program like this because people don't have extended family and things like that.

Heather: Yeah, absolutely. 

Dr. O'Connor: So you reach out to, to parents with, with phone calls. I know recently you also have been using secure messaging and text messaging as well. Can you talk to me a little bit about that and, and some of the different things that's allowed you to do?

Heather: Oh yeah. S,o we are absolutely thrilled with TigerConnect and our ability to do secure messaging, uh, as well as the masked phone call feature, that TigerConnect offers. I'll give you a little, I'll give you a little bit of history, uh, it’s kind of funny slash interesting story about where we started with our communication tools and where we are now.

So I think Alaska really, I mean, I'm not absolutely sure about this, but it's probably one of the last states in the nation to even get cell phone service. As an example of how things have changed, I mentioned we started the program in 2006, but in our database, when we were enrolling people in the program, we actually only recorded their phone numbers using five digits. Phone, numbers are seven digits, right? But every phone number in our small towns started with the same two numbers. So we didn't bother writing the first student numbers down. And of course, no area code. So, you know, go back to – what is that – The Andy Griffith show and they call the switchboard person. Right? It's kind of like that. ‘Hey can you patch me through to Susie down the street?’ 

Anyway, so that's where I started and we had one flip phone in 2006 and we only used it for incoming calls. So we gave that number out to people who enrolled in the program. They say, ‘Hey here's our cell phone call us.’ But when we did all our proactive calling, we just used whatever landline happened to be close to us because, you know, seriously, the cell phone service was really spotty and you had to pay you know, the the plans that we had back then, it didn't really allow for a lot of outgoing calls. 

So that's how we managed it, but it was really immediately problematic because people would call back whatever landline we called them from And then they were leaving messages on these landlines, all over town, you know, with my peer counselors and myself and the team, a bunch of peer counselors that, were our office phones or whatever. So that was difficult. So we switched to smartphones in about 2010 maybe. And we purchased a second cell phone line and then three or four different peer counselors would pass that cell phone physically around between them when they needed to make calls. Obviously, that was also very problematic.

And me being the on-call person, I carried the main phone number and they all had different phone numbers of course, because they were different phones with different phone lines. So that was very confusing to our participants as well. 

So we just found it increasingly difficult through the years also to keep up with the changing communication preferences of families. You know, we're a phone support program. And in 2006 People answered their phones. And in 2021 people don't answer their phones unless they actually know who's calling. And so if they don't recognize the numbers – so now when we enroll people in our program, we have to emphasize could you please put us in your contacts so that you know, it's us and we're calling, we're trying to check on you and your baby.

If you don't answer the phone, it's really hard for us to provide that service and everybody is, really, I shouldn't say everybody, but a lot of people have morphed more into messaging. That seems to be the go-to.

You know, as a physician yourself, you can imagine – you can probably understand there's only so much we can do to help someone that needs a healthcare service through a text message.

Hearing a back and forth conversation or, you know, doing a home visit and being in their personal space in a very vulnerable, emotional time, even video chat has limits you can't weigh a baby through the video screen. And that's often what we need to do to ensure that the newborn is getting the nutrition that they need, right? 

So we're trying to navigate all these different communication preferences and then the technology and then there's HIPAA considerations, with text messaging and for years, oh, we just kind of went around and round back and forth with you know different logistical problems. When you think it's a simple thing, we're in a small town, there's less than a hundred babies, we can just like run around town, helping people, feed their babies. It doesn't have to be that difficult. 

But so this, uh, TigerConnect really has been an amazing technology boost for us. Now we have two phone numbers, only.

Um there's the main warm line which is a real phone number that people can call. And then we have the masked phone number that TigerConnect provides so that all of our peer counselors can actually use their personal cell phones, but the recipient will see that one number and know that it's us when we're calling. So that's excellent. And then we have the HIPAA compliant, text messaging where we can connect with someone on video chat if we need to have a quick back and forth, which was really essential during COVID too. 

We still did home visits during COVID, when we were shut down in our surge here in Kodiak, because like everywhere in the world COVID reached our little, our little island. But, again, you know, we weighed the risks and benefits of providing that essential service of supporting healthy infant feeding that can really have life long health implications. We're going to go and provide that service to that vulnerable family. 

You know, so we wear our PPE we went to people's houses. We did not go inside of people's houses. We passed baby skills through their doors sometimes through their windows with a little instruction card.

And then talk to them out in their yard, which I'm sure was very entertaining for the neighbors to see me with my baby doll in my stuffed breasts that I used to help moms on how to position their babies, right? We're out there and working around in their bushes while they weigh their babies and pass the scale back to us. But that's how we provided our services.

Um, but with the, you know, the, the TigerConnect secure messaging, it's just like, I think I've gotten five messages this morning already on it, you know, and then people sending me pictures of their baby or a sore on their breasts, that they're worried about it. It's just really taken our service to another level where we were just so limited before.

Dr. O'Connor: That's amazing to, to hear, I think, um, you know, especially. You know, voice is always great, but there are some things, you know, sometimes people are more likely to engage or to start to engage you over a text message rather than call you and being able to share a picture of their baby or a picture of their breasts, uh, to help you, you know, diagnose what's going on does sound like it's really changed things for you and helped improve your service. That's uh, that's amazing. 

One of the other things that was really interesting to me about your program that, that stuck out to me. Cause I remember, I remember feeling a lot of judgment. I remember feeling like we were bad parents, if we weren't doing it the way that was exactly prescribed.

Um, one of the things I heard about your program and saw in the video and reading about it was it was very nonjudgmental. It was very welcoming. and no matter what you decided to do for your baby, you could be part of your program. Can you talk to me a little bit about that and how you arrived at that and what, and what impact that's had?

Heather: Hmm. Yes. I'd really like to. That's a really big part of our program, and a very important part of our program to present a very non-judgemental loving approach to supporting parents in any infant feeding decisions that they make. So we include all families, no matter how they choose to feed their babies and we support parents to make informed choices based on the best of the information that we have.

We tell all of our families that it is, we truly believe, I really feel, this is really the most important thing that they hear from us is that it's way more important how baby is loved than how they're fed. Sometimes infant feeding doesn't go well and people have strong feelings about that. They might have feelings of disappointment. They might have feelings that they're a bad parent, just as as you mentioned that they didn't measure up to what what the expectation was, whether it was their own expectation they put on themselves or an expectation from a healthcare provider that painted an ideal of this is what we want for all babies this is the way babies need to be fed and grow and all of that. 

All parents love their children and absolutely do their best. Right? So our job is to support the parent, no matter what the outcome, if we can boost that parent's confidence, that has an impact that lasts the lifetime of the child.

It affects the relationship of the parent to the child. And we, if we keep in mind that that love piece and a, and a child feeling loved is truly the most important thing then it puts the rest of, of what happens with infant feeding in perspective.

Absolutely, hands down, biologically mother nature intended for babies to be nourished with their their mother's milk, because that's the way mammals are made. It doesn't always turn out that way. That doesn't mean that that child is not going to thrive and grow and that that parent is a failure of a parent. It's a testimony to the resilience of human biology, actually that we can use other ways of feeding babies. And they still grow up to be quite healthy and grow to their full potential.

So, so I think we've kind of, surely has tried, and I think we have succeeded at capturing that. It's a fine science and art achieving that message of non-judgment and we're pretty proud of it.

Dr. O'Connor: That's, that's – I really wish that I had had  access to something like this when I had a little children. Sounds like such a, such a huge help. And I, I really do remember that the struggles, um, in doing it. And yeah, I laughed when you said you were handing things through the window and cards and things like that, like a manual almost. I really wished, I remember wishing that these children had come with some sort of instruction manual because it was very difficult at times to, to know what to do.

Heather: Oh my gosh. Absolutely even with that approach, we were floored by the kind of results that we were also getting as far as, uh in looking at those extended breastfeeding duration rates, which is a World Health Organization goal point, you know, for improving human health around the world, right? It has, it really is the single most important, biological factor that affects human health in the first years of life. 

But that inclusive non-judgemental approach that whether you're breastfeeding or formula feeding or how long breastfeeding lasts or whether it works out or not still achieves a pretty high level of extended breastfeeding duration rates. The Kodiak Kindness project, we published a paper in 2019, in a lactation journal just to look at our outcomes and see, ‘Hey, are we really making a difference here? Or are we just like being this nice friendly program that supports moms?’ Like do we have statistically proven health outcomes that show that we're making a difference in infant health, because of course, that's also part of the goal. And we found that our breastfeeding duration rates exceeded the 2025 World Health Organization benchmark goals for exclusive breastfeeding and oh, almost 44% of people who were participate in our family are still nursing their babies at age one.

And over 50% of them are exclusively breastfeeding by six months. And that's without really you know, that's by just supporting everybody unconditionally, not pushing breastfeeding per se. So I just wanted to add that in there that you know, we, we can achieve these outcomes in a different way. 

Dr. O'Connor: Great great You mentioned a few things about the technology and some of the things that it has allowed you to to do. Um, one of the things you talked about earlier is before, when you were calling from landlines, people may not have recognized the number. Now they recognize the number and, um, are more likely to pick up. What other types of impacts have the addition of the TigerConnect technology had for how you are running the business and how you're interacting with patients?

Heather: Well, one big thing I can think of just from a compliance perspective is my ability as the program director to have oversight. On the text messaging platform, the way we have it set up, when a family enrolls, we set up a group text message between myself, all of our peer counselors and the family including whatever other member of the family. Like sometimes the dads want to be involved with getting the group messages and sometimes they don't. Then I see all the messages that go back and forth. And when we had separate cell phones for each team member, I didn't have that same kind of oversight, you know, I'm as a lactation professional, I'm the mentor for our peer counselors. And it's really important to us that we're giving consistent messages and evidence-based information to our families.

So with the TigerText group messaging technology that made that so easy, as well as archiving of the messages for compliance audit trails.

Dr. O'Connor: Did you find that technology easy to use, to get started with?

Heather: Super easy. Yeah. And we had a, when we were first onboarded, I think there was like a month of pretty responsive, tech support with TigerCconnect as well. So, you know, as we were building our learning curve on what the technology could do or not do in the apps and, you know, people have an iPhone or a, a different kind of phone, that's maybe not an iPhone, that works a little differently. And so they knew all about that and how the app worked on different devices and really helped us through anything. It was very easy.

Dr. O'Connor: Excellent. It's good to hear. Heather. Thank you so much for joining us today. I know you have a busy schedule and there's probably, I think at the start of the podcast, you already had the hospital calling you with a new baby. So I know you're well busy. We'll let you get back to it, but, thank you very, very much for, uh, for joining us today on the show.

Heather: Uh, my pleasure, you are so welcome. it's a great opportunity for us to be able to talk about the kindness project. It was great to meet all of you. And we really appreciate being on the show.