Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Monday, June 26, 2017

The Decline of Empathy: A Hopeful Solution

Pediatrician T. Berry Brazelton was among the first to recognize the tremendous capacity of the newborn for complex connection and communication. Developmental psychologist Ed Tronick, drawing on this observation, designed the famous Still-Face Experiment to show the devastation, for both parent and baby, when they struggle to connect. Extensive research at the interface of developmental psychology, neuroscience, and genetics, as I document in my first book, shows the long-term benefit of investing in early parent-child relationships.

"Once you know it, you can't un-know it." My wise colleague Kyle Pruett, MD child psychiatrist, said this of the power of working with parents together with very young children to a move a family in a healthy direction.

After having recently written The Silenced Child, an admittedly dark account of how our society fails to listen to parents and children, and the potentially disastrous effects of this course of action, I am overjoyed to now be writing about a hopeful solution to this problem.  The following piece, published in our local paper on Sunday, offers a view into the work unfolding in this small rural town in Western Massachusetts. My hope is to bring this model to other communities. The aim is to offer this listening stance to all babies and families without potentially stigmatizing parents by identifying them as "at-risk."

Giving Every Newborn Baby A Voice
On a stormy November evening in 2016, I led a meeting in the small patient lounge of the maternity unit of Fairview, our local community hospital in rural Western Massachusetts. As the meeting was scheduled at change of shift, all 10 nurses who attend to the approximately 150 deliveries per year squeezed into the warm room. They eagerly shared their troubling feelings of helplessness when they see families who are clearly struggling, and have no choice but to send them home “on a wing and a prayer.”   They listened in rapt attention, and seemed empowered by the idea of learning new ways to support parents and newborns.

As a pediatrician specializing in parent-infant mental health, I attended the meeting under the auspices of the new Human Development Strategic Initiative at the Austen Riggs Center, led by Donna Elmendorf, PhD. a child clinical psychologist and director of the Center's Therapeutic Community Program.  The initiative seeks to bring Riggs’ relational view of early development to a community-based preventive model of care.
About six months later, on a spring weekend when from Friday to Sunday the weather shifted dramatically from snow to warm sunshine, half of these nurses, together with pediatricians, family and nurse practitioners, early intervention specialists, home visitors, and lactation consultants, many of whom are participants in the Berkshire United Way sponsored South County Community Coalition, gathered at Austen Riggs for a training in the Newborn Behavioral Observations system (NBO) to focus on giving babies in our community a healthy start.. The nurses who covered the maternity unit that April weekend traveled to Harvard Medical School in June for the same training.
We now have the opportunity to offer this intervention to every new baby and family, and an extended network of caregivers throughout our community who can support families in a similar way beyond the newborn period.
Early in his work as a general pediatrician in the 1950s, T. Berry Brazelton, recipient of Obama’s Presidential Citizen’s medal in 2012, observed the tremendous capacity of the newborn infant for complex communication. Research based on these observations led to development of the Neonatal Behavioral Assessment Scale (NBAS.) The scale changed the way both child development experts and pediatricians understood babies. The NBO, a clinical application of the NBAS developed by psychologist J. Kevin Nugent and colleagues, is a relationship-building tool that is as its core an opportunity for listening to parents and babies without judgment. Ongoing research around the world demonstrates the role of the NBO in supporting parent-infant relationships.
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.Participants in the training learn together about how to engage parents’ natural expertise and ability to listen to their baby’s earliest communications as they navigate this dramatic transition in their lives.

The Discovering Your Baby Project, the first community project of the Human Development Initiative, grew from a wish to have every family on our community feel heard and valued. We feel so fortunate to
have received local and national grant support for this burgeoning effort. Research at the interface of developmental psychology, neuroscience, and genetics offers evidence for  investing resources in these earliest relationships.
Families who deliver at Fairview Hospital may have relocated from the Upper West Side of Manhattan, lived for generations as local workers, or recently emigrated from Ecuador. Families from the full range of socioeconomic backgrounds may have struggled with generations of mental illness, substance abuse, or other adverse childhood experiences.
At the NBO training one of the nurses who has worked for decades on the same unit shared how she sees troubled family relationships passed from one generation to the next. “Now,” she said, “I feel hopeful that the next generation may have a different path.” 
Our population-based intervention for all families who deliver at Fairview aims to instill confidence and de-stigmatize the struggles of the transition to parenthood, with the larger community of caregivers available to engage families in this way as development progresses. We hope the Discovering your Baby Project can serve as a model for communities large and small, urban and rural, throughout our country.
We learn to listen by being listened to. We see our work as a “baby step” toward giving every person a voice from the moment of birth.  Perhaps it will also be a first step toward restoring empathy in our society.