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. 

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