"Successful Partnership in Action with Colorado" with Nicole Purnell and Brace Gibson

On this episode of the Power of MoMMAs Voices Podcast, Nicole speaks with Brace Gibson from the Colorado Perinatal Care Quality Collaborative (CPCQC). Brace explains how her desire to make a difference in maternal health outcomes stems from her own lived experience with severe preeclampsia during her first pregnancy and her experience being compounded by the exceptional life circumstances of being 16 years old. She additionally experienced postpartum OCD and PTSD. Now, Brace serves as the Director of Policy and Engagement for the CPCQC. 

The CPCQC has many initiatives to improve the maternal health outcomes in Colorado, and Brace explains some of them, specifically the Family Integration to Restore Trust Program, otherwise known as FIRST. She also explains the importance of Perinatal Quality Collaboratives, or PQCs.

Finally, Brace and Nicole chat about the MoMMAs Voices’ Community of Learning and how it has benefitted the CPCQC.  

“I'm never not amazed by the impact that lived experience integration has on patients, that it has on family members, providers, and care teams.”

“We're doing the work of addressing sources of care disparities through partnerships of care, and it's absolutely evident now that the role of the patient advocate can be leveraged to build alliances and facilitate shifts in practice and in culture.”

“It's my belief that PQCs are well positioned to amplify patient voices and to facilitate more equitable partnerships between patients and clinicians, to ultimately improve care and outcomes.”

“The community of learning sessions were incredibly rewarding. Sharing space with other lived experience experts and just having opportunities to learn with and from other PQCs, I found to be invaluable.”

About MoMMAs Voices
MoMMAs Voices (Maternal Mortality & Morbidity Advocates) is the first-ever maternal health patient advocates program bringing together real patient and family voices. We're made up of dozens of maternal health organizations who represent all types of maternal health conditions, as well as cross-cutting topics like maternal mental health, racial equity, healthcare delivery, and patient-provider partnership. We sit at the center of maternal health improvements, connecting and training patients with lived experiences, providers, quality improvement leaders, researchers, and policymakers to move forward improvements in maternal care. We are a program of the Preeclampsia Foundation.

Episode Transcript

Nicole (00:00):
Hello and welcome to today's episode from The Power
of MoMMAs Voices.
My name's Nicole Purnell, andI'm the program Director for
MoMMAs Voices.
One of our initiatives is ourlived experience integration
training.
This program offers guidance onhow to effectively build a
patient engagement culture andperform work that integrates
patients and those livedexperience into different areas

(00:20):
of QI work.
We are honored to have theColorado Perinatal Care Quality
Collaborative on one of ourfirst sessions, highlighting how
this engagement can work.
We hope that this gives ourPFPs more information about the
types of opportunities availablein their state and help in
understanding ways organizationscan also include patients in
the QI work.
I'm so excited to introduce ourguest today, Brace Gibson as

(00:43):
CPCQC's, director of Policy andEngagement Brace serves as a
liaison between the ColoradoLegislature, state agencies, and
lived experience experts aroundmaternal infant health policy
issues.
Brace is informed by her ownexperience as a former teen
parent who suffered from asevere case of preeclampsia that
was initially misdiagnosed andresulted in the emergency

(01:05):
C-section at 28 weeks gestationand left her navigating her
daughter's three month NICU asan adolescent.
Brace's subsequent experiencedpostpartum PTSD and OCD.
She also fulfills the role ofpatient advocate by leading the
family integration to restorearts program or FIRST and
provides leadership and supportto the Colorado Maternal Mental

(01:25):
Health collaborative.
Brace earned her Juris Doctorfrom Indiana University Maer
School of Law with the focus onpublic interest, law and policy.
Thank you so much for beinghere today, Brace.
If you don't mind, could youshare with us a little bit more
about your personal birthexperience and how that led you
to your professional

Brace (01:44):
roles?
Absolutely.
And first, thank you, Nicole,for inviting me to be featured
on the podcast.
As you mentioned, I share anexperience similar to that of
many other women having sufferedfrom severe preeclampsia during
my first pregnancy.
And that experience was ofcourse then compounded by some

(02:05):
exceptional life circumstancesand that I was 16 years old.
At the time that I gotpregnant, I was also poor and on
public health insurance with alimited support system.
As a whole, the experience ofhaving a child with complex
health needs in such a traumaticway and of navigating the
healthcare system as somewhat ofa child myself yet miraculously

(02:28):
coming out on the other endhaving survived those
experiences with my daughter,led me to initially pursue a
career in medicine.
So I went on to undergrad as apre-med major.
Learned a lot more about ourhealthcare system and other
social systems that impact notjust the opportunities that only
some people are given toachieve health and wellness, but

(02:51):
also those that impact the careand treatment that other people
receive when they aren't well.
Ultimately then I decided toattend law school instead.
And while I had always beendriven by my lived experience
and felt that I had to beconnected to my professional
work through them, it wasn'tuntil I stepped into my role at

(03:12):
CPCQC that I really feltcomfortable leading in a more
open and public-facing way withmy lived experience first.
And I have to say that theconnections that I've been able
to form with other birthingpeople, parents, and advocates
since doing so have just beenamazing.
So I now oversee CPCQC'spatient and community engagement

(03:34):
work, as well as its policy andadvocacy work.
And I'm involved in improvingfamily engagement in Colorado's
NICU through CPCQC's definedprogram.
I also hold a couple ofvolunteer roles as an advocate
for teen parents specifically.

Nicole (03:50):
That's so great to hear.
I think that the age factortoo.
It's a space that we, we don'tthink of enough when we talk
about diversity and making sureto include young parents in
quality improvement projects aswell.
Because they have verydifferent experience.
And I've heard this before andI've heard it over and over
again, but it's, it's somethingthat we miss when we're thinking

(04:10):
of diversity.
Thank you again so much forsharing your story and just how
that, there's a lot of peoplethat they have their personal
experience and they feel led towanna improve that for the next
person and to improve outcomesfor others.
And so that tends to lead theminto professional interests and
roles.
And so it's so interesting tosee kind of how it's come full

(04:30):
circle for you and you're ableto really be such a great
liaison to those in the state.
Can you share a little bit moreabout some of the CPCQC's
quality initiatives.
Absolutely.

Brace (04:43):
In addition to serving as the backbone organization for
the Colorado Maternal MentalHealth Collaborative and
implementing a patientnavigation pilot program for
Colorado's rural counties toaddress maternal behavioral
health needs, through our impactbehavioral health initiative,
CPCQC currently has four activeQI programs that include efforts

(05:06):
to improve outcomes forpatients to experience perinatal
substance use and reduceassociated stigma.
We also have a QI project toreduce primary cesarean rates,
and again, one to improve NICUfamily engagement.
But of course, the work that Ilead and am most excited about

(05:27):
is our family integration torestore trust program, otherwise
known as FIRST.
The premise of first is reallyto integrate, lived experience,
expertise into all of ourquality improvement initiatives
and every level of ourorganization.
So it's a two phase programthrough which we provide
participants with patient familypartner certification training

(05:49):
through MoMMAs Voices, ofcourse.
And then we empower our FIRSTprogram champions.
To choose how they want to beinvolved in our organization,
and that can be through any oneof our QI programs.
They can also choose to guidethe strategic direction and
vision of the organization byserving on our board of
directors.
They may choose to offer directpeer support.

(06:11):
Or they may choose to beinvolved in our policy and
advocacy or other maternalmental health initiatives.
Through this program, we reallyhave put into practice the idea
that meaningful improvements inperinatal health outcomes
aren't possible unlessinitiatives that are developed
and overseen by the pregnant andpostpartum people and families

(06:34):
from communities whose health westrive to improve, and we help
to facilitate that meaningfulengagement by empowering
community members and patientsto use their lived experiences
in ways that they're mostpassionate about and can help
have the most impact.

Speaker (06:52):
One of the things that I kind of wanted to dive into a
little bit more is the FIRSTprogram, and can you share a
little bit about what you did toreally launch this program?
I know you did, you were reallyboots on the ground to make
this successful.
Yeah, absolutely.
Essentially, I figured outpretty early on, that we were

(07:15):
gonna be most successful inrecruitment and in getting the,
the program off the ground if wewent into community itself.
Right.
And like I said, so I led withmy lived experience first.
That's really how I connectedwith individuals.
And I met one-on-one witheveryone who expressed interest

(07:35):
in the program.
So we just sat down,established, our connection
through our lived experiencefirst, and then I led with how I
then used my own livedexperience to get involved in
advocacy and QI work.
And helped the participants whowere interested in the FIRST

(07:56):
program or the people who areinterested in the FIRST program
understand the importance ofdoing this work, the impact it
can have, and also in helpingthem to explore ways in which
they could use their livedexperience to really drive
change.
Did you meet withcommunity-based organizations or

(08:18):
was it just like one-on-oneindividuals?
How did you show up?
Both actually.
So we developed an interestform for the FIRST program
specifically that wedisseminated broadly.
I also visited community-basedorganizations, community support
offices.
So I went to WIC, we went topublic libraries and then we had

(08:40):
established partnerships withcommunity-based organizations.
And so we tried to utilize atrusted-messenger approach in
that way.
So for communities that weperhaps didn't have an
established relationship withalready we were able then to
connect with the communityorganizations that we had

(09:02):
developed partnerships with andgot the word out about FIRST in
that.
Excellent.
And then you have the firstprogram also includes an
application.
Is it an application or is itjust an interest form?
It's an interest form.
So we were really intentionalabout making it an application,
allowing folks to self-disclosewhatever information they wanted

(09:26):
to in the form of an interestform as a first step.
And then I contacted everyoneindividually who filled out an
interest form and again, wasable to connect on a more human
level around our experiences andhelp to guide them in
understanding how they would behelpful to the program or

(09:46):
impactful.
And how the program would thenbe also be beneficial to them.
So you're creating a very safespace for them to share what
they're comfortable with sharingfrom the very start and you're
building that trust from thevery beginning with them.
And I love hearing how you'reable to do that and what you're
doing.
Absolutely.
One of the FIRST program aimsis to ensure that families are

(10:10):
provided with a safe environmentin which to engage productively
with healthcare providers.
So we try to integrate that aimthroughout every step of the
FIRST program, from recruitmentto actually engaging with these
folks and integrating them intoour QI initiatives.

Brace (10:31):
I

Nicole (10:31):
love how you all have really embraced the FIRST
program.
And, congratulations andapplause and, to your credit
because I know you put so muchwork into creating those
relationships as well with, yourFIRST team.
So what was it like?
You've completed two of ourcommunity of learning projects.

(10:52):
You've also been involved withus for, for many years, even
before Colorado started sendingtheir patients through our PFP
training.
You yourself went through it.
And so you've just had a lot ofexposure to the things that we
do.
But what was it like to attendour community of learning
sessions?

Brace (11:10):
The community of learning sessions were incredibly
rewarding.
Sharing space with other livedexperience experts and just
having opportunities to learnwith and from other PQCs, I
found to be invaluable.
We're really looking forward toparticipating in the
forthcoming session, to continuethat type of knowledge sharing

(11:30):
and to have access to tools andto partnerships that will allow
us to continuously improve uponthe work that we're doing.

Nicole (11:40):
So some of the things that we talk about in these
sessions, we really wanted tomake sure that we had a lot of
time for that peer-to-peer andlearning and sharing that is so
valuable with the PQCs becauseeverybody does it a little bit
different and we have so manylessons learned from each other.
But one of those things that wewanted to talk about was
hardships.
So what are some of thehardships that you've overcome

(12:01):
and challenges that you'veovercome?
Experience to include patientswith loved experie.
Well,

Brace (12:08):
when we were initially launching the first program
recruitment was certainly achallenge.
We were also cautious aboutdoing this work in a way that
was meaningful, notre-traumatizing to patients, and
didn't in any way perpetuatethe disconnect between patients
and providers.
That we were effectively tryingto address, right?

(12:30):
So it's certainly been andcontinues to be a learning
process as we do this work, butI think that leading with my own
lived experience, as youmentioned, certainly helped to
overcome some of those initialchallenges.
And a priority of this work isbuilding trusted relationships
and connections withcommunities, and that takes
time.

(12:51):
It's a genuine effort.
It takes hard conversations,and it takes a willingness to
learn and constantly evolve.
Another challenge is sustainingengagement.
Recognizing that like myself,some of the lived experience
experts who we work with havehad or are presently
experiencing some exceptionallife circumstances or particular

(13:13):
adversities that not only makeit challenging for them to be
consistently engaged in the workbut may also heighten the
emotional burden that is alreadya part of doing work that is
deeply personal.
And I think that for PQCsstruggling to maintain patient
engagement, being understandingand persistent are perhaps the

(13:36):
first steps to overcoming thatchallenge.
And then also providingpatients with the resources they
need for engagement isimportant, including
compensation for their time andexpertise, as well as, again,
just making sure that thepartnership is mutually
beneficial.
And empowering them to decidewhat meaningful engagement

(13:57):
really looks like to them isalso important.

Nicole (14:01):
It's so much about building those relationships as
well and building thatconnection.
And, and I often say at timesit feels like we've lost sight
of humanity in the maternalhealth space in maternal
healthcare.
And we can bring that back,whether it is at bedside or in
meetings and working on researchprojects.
There is a face behind the dataand there's a face behind those

(14:24):
experiences as well.
What are some successes thatyou have seen from having
patients help with this kind ofwork?

Brace (14:33):
I think the impact by far, I'm never not amazed by the
impact that lived experienceintegration has on patients that
it has on family members,providers, and care teams.
I think oftentimes this work isa healing journey for everyone
involved.
I personally find it aprivilege to witness the true

(14:57):
change in practice behaviors andpatient experiences and
outcomes that this work helps tofacilitate.
We're doing the work ofaddressing sources of care
disparities through partnershipsof care, and it's absolutely
evident now that the role of thepatient advocate can be
leveraged to build alliances andfacilitate shifts in practice

(15:20):
and in culture.

Nicole (15:22):
I think you guys have done a great job as well because
of your support of yourpatients that you work with.
It's become almost a launchingpad for them to have other
opportunities as well.
I know there have been severaltimes that we have reached out
and utilized maybe some of yourpatient family partners for a
different project.
I think we had one that workedon a project for IHI.

(15:43):
And so just being able toutilize that and to leverage
that can be such a benefit topatients as well that most
people don't even realize isavailable.
So where do you see the futureof CPCQC going?

Brace (15:58):
Well, I think you know, we strive to continue this work
of creating a collaborativethat's made up of diverse
stakeholders.
That includes patients,providers, families, community
members, advocates, you name it.
And at CPCQC we see ourselvesas the bridge between the

(16:19):
clinical and community settings.
Ultimately facilitating theintegration of those two worlds
and being a convener acrossthose sectors.
That's how we improve care andoutcomes for everyone.
I think we also see ourselvesas continuing to strengthen that
role as we look to our future.

Nicole (16:39):
Well, I, I just applaud you guys for all that you're
doing including patients andtheir voices and these projects
because it's still a challengefor a lot of folks and you guys
are definitely leading the wayand have figured out part of the
magic to it.
So I love to hear that.
What would you, like patientswith lived experience to know
about PQCs in general and howthey can get involved in their

(17:00):
state.

Brace (17:03):
First, thank you for that, for that recognition, and
it's my belief that PQCs arewell positioned to amplify
patient voices and to facilitatemore equitable partnerships
between patients and cliniciansto ultimately improve care and
outcomes.
That's our primary aim, right?

(17:24):
And there's so much momentumright now in actively
recognizing the importance ofensuring that families are
active members of care teams.
And collaborative partners inquality improvement work.
So I think it's our time to, toleverage that momentum.
And one of the most effectiveways, I believe, to address
inequities in care is to makesure that efforts are community

(17:47):
led and that providers possessskills and experience to build
relationships with families andcommunities, and to understand
those historical barriers toestablishing trusted
relationships.
We can't do that work, however,without the patients
themselves.
So it's important to getinvolved with your state's PQC.

(18:09):
And if you're in Colorado, youcan connect with us and our work
through cpcqc.org or byreaching out to me directly at
[e-mail].

Nicole (18:23):
Well, thank you so much Brace for being here today.
It's been a fantastic interviewand I am just so excited to
have you all as the first PQCthat we've gotten a chance to
highlight in this series ofpodcasts because you are just
doing amazing things and we arehere to cheer you on.

Brace (18:40):
Thank you so much for having me today.