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.

Wednesday, September 25, 2019

The Opioid Crisis and the Next Generation

Joy and love mix with disorganization, sometimes verging on chaos, when a new life enters the world. As renowned pediatrician T. Berry Brazelton and developmental psychologist Ed Tronick have wisely observed, that disorganization itself facilitates healthy growth and development as parents and baby engage in the messy process of getting to know each other. 

The level of chaos and need when a new life enters a family in the grips of opioid use can feel overwhelming.  In a new statewide program in Massachusetts, brave and heroic individuals who have themselves navigated the treacherous waters of addiction, generously draw on their own struggles to help others find a better path. 

The Massachusetts Department of Public Health’s FIRST (Families In Recovery SupporT) Steps Together is a new home visiting program in the Bureau of Family Health and Nutrition’s Division of Pregnancy, Infancy, and Early Childhood. Funding for this project is provided through SAMHSA’s State Opioid Response grant to Massachusetts, administered through the Bureau of Substance Addictions Services.

Clinicians work alongside Family Recovery Support Specialists. As one of the infant-parent mental Health specialists, I aim to promote parent confidence and support healthy parent-infant relationships. 

A recent Sunday issue of the Berkshire Eagle, our local paper in Pittsfield, MA, one of the program's 5 locations, featured an article with the headline "Set them on  healthy path from the beginning," featuring this quote. "If you want to change unhealthy patterns that have been going on for generations, this is the time to do it."

Six months after entering the program with her newborn infant, one mother said of her relationship with her son, "We have a bond that you cannot break."

The first months of life, when parent and infant meet and get to know each other, offer an opportune moment of healing. As a paper from the Alliance for the Advancement of Infant Mental Health wisely explains: "The parent-infant/young child relationship is the vehicle for repair that can break the cycle of substance use-substance abuse-rehabilitation and relapse."

The body of research offering evidence for this dyadic work is captured in a review article titled The opioid dependent mother and newborn dyad: non:pharmacological care, which summarizes the concept:

"By examining the newborn in the presence of the mother, the provider can demonstrate the range of the infant’s physiological and behavioral competencies and weaknesses, as well as adaptive or maladaptive responses to external stimulation. At the same time the maternal responses to each displayed newborn sign can be observed. Attention to maternal reactions and behaviors can direct the intervention with the dyad to diminish emotional overload and provide external organization until the infant can develop higher sensory limits and consistent behavioral self-regulation."

Extensive scientific evidence supports investing in these tender new relationships. The Newborn Behavioral Observations System is one tool we can use. A clinical application of the original observations of Dr. Brazelton that each new baby comes into the world with a unique capacity for connection and communication, the NBO provides a structure for organizing our observations. It brings us into the moment of connection, highlighting the value of listening to parent and infant together.  A new program in Western Massachusetts, The Hello It's Me Project, provides trainings in the NBO to a wide range of practitioners who work with these vulnerable parent-infant pairs. Another tool, the FAN (Facilitating Attuned Interactions) offers a model that can be applied in setting where practitioners work with parents and infants.  It is organized around a core idea of "being with" without attempt to change what another the person is doing or believing. Rather than imposing well-meaning efforts to "fix" a problem, we offer our listening presence to empower parents and build a sense of confidence. In doing so we promote healthy development of both parent and infant. 

The newborn brain makes over one million new connections per second. In the early days, weeks, and months of life, these connections develop in interaction with primary caregivers. Developmental specialists refer to these caregivers as "neuroarchitects." When we acknowledge their expertise in this role, and devote sufficient resources to keep the normal disorganization of this developmental stage at a manageable level, we can get things going right from the start for the whole family. 


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!!