Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

Sunday, May 5, 2019

Addressing Postpartum Depression in Honor of Mother's Day and Mental Health Month

Soon we will we celebrate mothers for a day- bringing breakfast in bed, going out to dinner, buying flowers. In my personal experience, one of the greatest pleasures of Mother's Day is to take joy in my children as they grow and develop and make their way out into the world.

D. W. Winnicott, pediatrician turned psychoanalyst, famously said, "There is no such thing as a baby." He meant that one cannot fully understand a baby without considering the relationship with the mother. Equally true is that without a child, there is no such thing as a mother. In order to understand a mother's experience, it important to consider the child and what he or she brings to the relationship. 

Winnicott coined the phrase 'the holding environment" to describe the way in which a mother, by being present both physically and emotionally with her baby, helps him to manage and contain intense feelings.  He wrote:

"It will be observed that though at first we were talking about very simple things, we were also talking about matters that have vital importance, matters that concern the laying down of the foundations for mental health."

 A number of years ago I had the privilege of participating in the important work of The Ellen Story Commission on Postpartum Depression. Now retired, Rep. Story (D-Amherst) originally filed a bill that mandated universal PPD screening in multiple settings (OB and pediatric), but it was amended to a law that calls on the Department of Public Health to issue regulations on best practices for PPD screening. The law also created the Commission, whose  job is to help DPH in its work to develop plans for the state of Massachusetts to address PPD. 

Rep Story will be speaking in Dalton,MA on the evening of June 19th at the first quarterly dinner/educational event of the Hello It's Me Project, whose primary aim is to build a community "holding environment" to promote healthy parent-infant relationships. 

What makes postpartum depression different from other forms of depression is that it occurs in the setting of responsibility for a new life-with a person who is completely dependent- who brings his or her unique qualities to the relationship.  To fully hold the mother's experience, it is important to recognize the baby's contribution. 

For example,  a baby who has difficulties settling to sleep, or is not naturally cuddly will have significant impact on a mother's emotional experience. For a mother, sleep deprivation and feelings of inadequacy may compound an existing depression. In turn, the mother's state of mind, particularly if she is preoccupied with her own distress, may impair her ability to help the baby to contain and manage his experience. One study showed that mothers struggling with anxiety and depression often wake their babies at night, offering an example of how mother and baby interact to impact emotional development of one another. 

How fitting that Mother's Day occurs in the middle of Mental Health Awareness Month. The work of Representative Story and the PPD commission is a tribute to both.  When we as a society attend to the emotional needs of new mothers (and fathers- who get their own day in June) we help them to emerge from pain and suffering to take joy in their children.  This not only promotes their children's healthy development, but it also makes for a really great Mother's Day!!

Wednesday, March 6, 2019

Helping New Parents Make Room for Uncertainty

A new program for parents and infants is coming to Pittsfield, Massachusetts. The Hello It’s Me Project shines a spotlight on these tender new relationships, investing resources around the birth of a baby with the long-term goal of building a healthy community from the bottom up. 
When world-renowned child development researcher Dr. Ed Tronick spoke in the spring of 2018 for an audience of a wide variety of practitioners in Berkshire County who work with children and families, he began with a quote from Steven Hawking, “One of the basic rules of the universe is that nothing is perfect. . . .Without imperfection, neither you nor I would exist.”
Perhaps best known for developing the Still Face Paradigm, an experimental manipulation designed to demonstrate the young infant’s tremendous capacity for connection and communication, Dr. Tronick shared his decades of research, revealing not only the inevitability, but also the necessity of imperfection in human interaction.
In contrast to the expectation of a kind of mythical idealized attunement, he found, through detailed microanalysis of interactions in our primary love relationship, that healthy, typical parent-infant interactions are in fact mismatched 70% of the time. Through the repair of these moment-to-moment mismatches we develop sense of agency and hope, a sense that “I can act on my world to make it better.”
Psychologist Dr. Jayne Singer continued the afternoon presentation for the community, sharing the Touchpoints model, developed by Dr. Tronick together with pediatrician T. Berry Brazelton, who passed away in March 2018 at the age of 99.  Touchpoints offers a way to apply the core concept of mismatch and repair beyond infancy in a range of clinical settings.
Pediatricians, early intervention specialists, educators, child protection workers, home visitors, literacy advocates from Berkshire United Way, and others from across Berkshire County engaged in lively discussion. Bringing home the importance of investing in early relationships, Dr. Singer showed a picture of a newborn infant, saying, “This is early literacy.” She encouraged audience members to suspend certainty inherent in being the “expert” and to instead create a space for listening with curiosity.
On the Saturday and Sunday that followed this event, another group gathered for a Newborn Behavioral Observations (NBO) training. While the medical model of care often puts the professional in the role of expert, this intervention seeks to shift that mindset, mobilizing parents’ unique capacity to tune into and respond to their newborn. The 18 neurobehavioral observations of the NBO are not an assessment or evaluation. Rather, they offer a frame in which to support parents’ earliest efforts to get to know their baby.
Community practitioners from a wide variety of disciplines learned from Dr. Claudia Gold and Dr. Kevin Nugent, who developed the NBO, about listening to a baby’s earliest communications. On the second day the group devoted time to thinking together about how to collaborate to provide a holding environment for vulnerable families such as those struggling with opiate addiction. We acknowledged the need to support all families, recognizing the “normative crisis” of the transition to parenthood and the need to destigmatize asking for help.
Dr Gold is collaborating with the Family Birth Center at Fairview Hospital, supporting the efforts of the maternity nurses, who have all been trained, to incorporate the tool into routine care. As Doreen Hutchison, RN, vice president of operations and patient care wisely observed, “We want parents to go home with their baby feeling confident that they know their baby best.”
The Hello It’s Me Project will offer NBO training to all nurses on the Mother-Baby Unit of Berkshire Medical Center with the aim of integrating the NBO into routine care of newborns and their family. Partners in the project include Berkshire Obstetrics and Gynecology where the program will be introduced in the prenatal period. Recognizing critical role of home visiting in promoting health parent-infant relationships the trainings will be offered to Healthy FamiliesPediatric Development Center, and Parents as Teachers, and Berkshire Nursing Families with the aim of integrating the NBO into their respective programs. Recovery coaches in FIRST (Families In Recovery SupporT) Steps Together, a peer recovery and parenting support program for pregnant and parenting women with current or past opioid use disorder, will attend the trainings. The first two of three annual trainings are scheduled for September 2019 and March 2020.
The NBO bring the idea of “play,” with its inherent imperfections, into parent-infant and sibling relationships right from birth. Many parents today are burdened by an expectation of perfection. When we can protect time to listen to parent and baby together, we convey the idea that, in contrast to a “right” way, they will figure things out together. Growth happens through repair of inevitable mistakes we make along the way.