Special Delivery nurse case manager supports mother and daughter through years of health challenges

In September 2019, Fredisha Goodfellow, D.M.D. of Marion (Crittenden County in northeastern Arkansas) gave birth to her first child, Winter. While the pregnancy was low risk, the delivery was difficult and led to lasting health issues for the newborn.

Fredisha gave birth at a Tennessee hospital, and Winter was quickly transferred to another one in Memphis to get specialized care. Winter had coverage through Arkansas Blue Cross and Blue Shield and secondary coverage through a state program in Tennessee.

It was a stressful and confusing time for Fredisha, who was struggling with the fact that her baby girl now faced a difficult road ahead. Winter had been diagnosed with cerebral palsy.

“During that time, I didn’t really know what was going on. I just thought it was a bad dream and wondered when I’d wake up from it,” Fredisha said. “There was definitely also some anger, too.”

A season of caring arrives

When Winter was approaching her release from the neonatal intensive care unit, Summer Huddleston, a nurse case manager with the Arkansas Blue Cross Special Delivery program, reached out to Fredisha to help.

“At first I was a little unsure about who this person was and why they were reaching out to me,” Fredisha recalled. But she quickly realized Summer was there to help.

“From then on, every time I see her number pop up on my phone, I’m so excited to hear from her,” Fredisha said.

Fredisha was immediately responsive to Summer’s calls and agreed to have a case opened to help Winter.

“She has lived this with me – the day-to-day of this entire journey,” Fredisha said. “There is a bond between us.”

Summer followed Winter monthly in medical rounds in the neonatal intensive care unit of the Tennessee hospital. When she was 2 months old, she was discharged to her home in Arkansas. This change led to her being dropped by the Tennessee insurance program, creating a barrier to care that Summer helped overcome.

“Summer was everything I could have ever wanted,” Fredisha said recently. “No one could ever replace her. We went through this together – every surgery, every hospital stay.”

Winter came home with a feeding tube and required suctioning every two hours to help her breathe. One blessing during this trying time was that Fredisha’s parents could help care for Winter, allowing both Fredisha and her husband, Jonathon, to return to their jobs.

Around this same time, the Arkansas Blue Cross social work team also stepped in to help and provide follow-up care.

In addition to caring for her baby at home, Fredisha struggled to gather the information required to enroll Winter in the Tax Equity and Fiscal Responsibility Act (TEFRA) Medicaid healthcare program, which helps families of children and youth with disabilities receive care in their homes, instead of in an institution.

When Fredisha had trouble communicating with her local Department of Human Services office, Summer went to the main office in Little Rock in person and obtained the necessary forms to apply for assistance.

Winter’s needs increase

Before she was 6 months old, Winter’s excessive salivation required her to have several surgeries. Around this time, she also began therapy.

“But then the COVID-19 pandemic arrived, and everyone’s world was turned upside down,” Summer recalled. “I recommended the family use telehealth to allow Winter to continue her necessary therapies.”

After Winter’s first birthday, her need for suctioning increased to every 20-30 minutes. But even though this was done faithfully, she began developing pneumonia, and her right lung was severely compromised.

A life-changing addition

Summer suggested to her medical director that a therapeutic vest might help Winter. These vests vibrate to move fluid in the lungs and often are used by cystic fibrosis patients. After several meetings with the medical director and the vest manufacturer, Winter received a cough-assist machine and a vest, which has a lifetime warranty that covers periodic replacement with progressively larger vests as she grows.

After she began using the vest, Winter’s need for medications decreased, the frequency of suctioning was reduced, and her respiratory problems improved.

Another baby on the way

At the end of 2020, Fredisha was expecting her second child, and Summer re-enrolled her in the Special Delivery program. Meanwhile, Winter was aging out of the program and was offered a transition to a general case management program. The bond between Fredisha and Summer had continued to grow deeper, and Fredisha asked for and was given an exception to keep Winter in Special Delivery.

“I just couldn’t find it in my heart to say, ‘Well, she’s over the limited time of 15 months now, so I’ll just pass her on to another case manager,’ ” Summer said. “I wanted to see her through to a positive outcome.”

Care for the caregiver

Fredisha soon learned that her mother, who’d helped so much in caring for Winter, had breast cancer.

“This was a lot to take on,” Summer said. “Although she remained cheerful on every call, I could tell it was taking a heavy toll.” Summer encouraged Fredisha to reach out to a counselor. Fredisha heeded the advice and found it to be helpful.

Baby River arrives

Genetic testing revealed that the new pregnancy was low-risk, and the baby boy, River, arrived by cesarean section in June 2021. After the delivery, Fredisha developed postpartum preeclampsia, but Summer discussed precautions with her, and she recovered well.

A bump in the road

When Winter was 3 years old, the facility where she received care temporarily went out of network with her health plan, which would have affected coverage of Winter’s therapy and specialist services. Summer worked closely with the family, the facility and Arkansas Blue Cross, submitting numerous communications and completing several forms to ensure Winter’s care continued until the facility returned to her health plan’s network.

A second son

In May 2023, Fredisha learned she was expecting her third child, and Summer re-enrolled her in Special Delivery, due to her elevated blood pressure and prior delivery complications. Another genetic test revealed a low-risk pregnancy and that the baby, later named Wave, was a boy.

This pregnancy was even more challenging. Fredisha again had complications with the delivery and postpartum hypertension. But after some education, when she felt well enough and was released by her obstetrician, her case was closed.

This was followed by more good news: her mother had also overcome her cancer.

Growing and thriving

Winter, now 6 years old, has completed a therapeutic program to improve motor skills and developmental delays and has started school. Her case with Summer has been closed. Currently in pre-K, she is set to start kindergarten next year. She continues to receive care at a complex care clinic.

An enduring bond

“We both cried when we closed this case,” Summer said of her bond with Fredisha. “We spoke almost every month for five years.”

“Summer was amazing,” Fredisha said. “Through the hard times and all the highs and lows, especially going through my other pregnancies and births and my mom’s journey with cancer.”

The two women and Fredisha’s family had not met in person until they recently gathered to take a photograph.

“It was my absolute honor to follow and assist Fredisha and Winter during those five years,” Summer said. “This beautiful family has left a special place in my heart through a chronically ill child, two pregnancies and deliveries, family health concerns and recovery.”

Along the way, the case manager also has celebrated everyday victories with the Goodfellows through shared emails, texts and photos – the building of a new home, their move into it, several birthday parties and, as Summer succinctly describes it – “life in general.”