D-H Launches Innovative Recovery-Friendly Pediatrics Program

Dr. Chapman and patient

This is one of the best opportunities I have seen to provide recovery and parenting skills so babies are off to a good start.

Steve Chapman, MD, (pictured above)

As part of a multipronged response to the opioid epidemic, Dartmouth-Hitchcock (D-H) is directly connecting families with social vulnerabilities—such as poverty, substance misuse, recovery or just in need of a helping hand—with family resource centers based in their communities through the Recovery-Friendly Pediatrics Program. This program delivers consistent, personalized and targeted support to families as they navigate the challenges of parenting—while also on their way to recovery.

With a major grant from the Couch Family Foundation, the D-H Community Health team is working with regional pediatric practices, to more effectively help families secure their basic needs, develop strong parenting skills, and create strong parent-child bonding that can reduce exposure to adverse childhood experiences and support long-term positive health impacts for children. These practices include the Children’s Hospital at Dartmouth-Hitchcock (CHaD) Pediatrics in Lebanon, NH, Alice Peck Day Memorial Hospital in Lebanon, NH, Valley Regional Pediatrics in Claremont, NH, as well as with TLC Family Resource Center (serving Sullivan and Lower Grafton Counties) and The Family Place Parent Child Center (serving Vermont). These initiatives will provide improved support for all families with young children, but may be increasingly important to support healthy early childhood development for the growing number of children from newborn to age five whose parents are affected by opioid use and other substance use disorders.

Improving Health Outcomes

Holly Gaspar is the Community Health Partnership coordinator for D-H’s Community Health Improvement. Her team worked closely with Steven H. Chapman, MD, a CHaD and the medical director for the Boyle Community Pediatrics Program, to design and launch Recovery-Friendly Pediatrics.

Surveys conducted prior to the program showed providers were spending approximately 50 percent of their patient time on social determinants of health resources such as food, housing, employment, transportation and childcare, to name a few—yet families reported feeling they weren’t receiving enough support.

“The emerging themes from the surveys were that addiction and recovery were often coupled with higher resource needs, and at times, left families with needs unmet and providers experiencing burn out,” Gaspar says. “We realized we needed to work further upstream and attack the problem possibly before birth during pregnancy, and continue close care throughout early childhood when brain development is at a critical point. The idea is to look at various pediatric practices as the hub, and integrate family resource centers to improve health.”

“Family resource organizations are the heartbeat of the community,” explains Chapman. “They connect parents to vital supports like WIC [Women, Infants and Children], home visiting services and parenting and job training resources.”

The ultimate goal is to support families in recovery across organizations, in order to protect vulnerable children and prevent adverse childhood experiences. These toxic stress experiences are proven to have long-term health implications—including heart disease, diabetes and often future substance abuse—for people with two to four adverse childhood experiences.

“We are taking a dyadic approach to pediatrics: healthy babies and healthy children are impossible without healthy moms,” says Chapman. “We must move away from stigmatizing and judgment, and move towards strong parenting.”

Building Trust

Both TLC Family Resource Center and The Family Place report their services are being underutilized, so their home visiting services and parent education programs have capacity for additional clients. Sometimes parents in recovery are wary of trusting new people and programs, and are embarrassed to reach out and/or believe they won’t qualify for services.

The benefit of Recovery-Friendly Pediatrics is placing family-resource program staff in the pediatrician’s office—a trusted environment—to educate, build rapport and enroll families after an introduction from their pediatrician or nurse. Regardless of where a family is in their journey toward recovery, having supportive and trusting relationship will strengthen their skills and ability to care for their child.

“For a parent in recovery with a newborn or in an unstable housing situation, the likelihood to return a call or paperwork is very small,” says Nancy Bloomfield, executive director of The Family Place. “I’m excited at the idea of having a warm hand-off to a friendly face in a setting where parents have already begun establishing relationships with providers.

“Every parent needs a support network. For a parent in recovery, if family relationships are broken, or friends are still misusing drugs, they sometimes have to create an entirely new one. We’re helping parents in especially challenging situations with young kids learn to manage stress and find a foothold. They may have instability in housing or challenges getting to work and appointments. They need someone to wrap around them and at the same time, ensure there is always a focus on their child’s healthy development—this is the beauty of family support.”

Maggie Monroe-Cassel, executive director of TLC Family Resource Center, further describes the community-family resource center model. “Community is lacking in our society. We’re entering into a relationship with families. We want to see reflected in their parent-child relationship.”

The intention of her center’s “Growing Great Kids” program is to strengthen bonds between parents and children to prevent abuse and neglect. “It’s important for our educators to tell parents they’re doing a good job, or point out, ‘Look at how she loves you. Look how she’s looking into your eyes,’” Monroe-Cassel says. “Maybe mom won’t take drugs that day. Building trust between parents and educators leads to very strong relationships, and parents will listen to that person.”

Eliminating Silos

Recovery-Friendly Pediatrics is already making an impact. Bloomfield reports a nurse home visitor had lost contact with a family served by The Family Place. They recently had another baby, and saw their home visitor at the resource table at CHaD Pediatrics—and are now re-engaged with the program. In addition, Chapman walked one of his patient families to the table and introduced them, and today the family is accessing support. Says Gaspar, “Families are seeing their health care linked with their community and are embracing this extensive care relationship.”

“This is one of the best opportunities I have seen to provide recovery and parenting skills so babies are off to a good start,” Chapman says. “It’s helping us design a better system of care. This is the most meaningful work I’ve been a part of.”

Other community pediatric practices are interested in joining this effort to eliminate health care silos, and to extend the support into their patients’ communities, where they live, work and grow. The program is continuing to evolve, and is fine-tuning the best days and times to staff resource tables, encourage families to talk and process intake information on-site. Through process improvement efforts the group is adapting approaches to care, system flow and continuity, communication methods with families and enhancing resources available—keeping the families’ voice at the center of the work. For more information about Recovery-Friendly Pediatrics, contact Gaspar at holly.a.gaspar@hitchcock.org.