Like the rest of the U.S., Vermont has been hit hard by the opioid crisis. Windsor County has seen a steady increase in heroin- and fentanyl-related deaths, according to Jill Lord, RN, MS, director of community health at Mt. Ascutney Hospital and Health Center in Windsor.
“Our families are grappling with the impact of both the opioid crisis and the significant trauma [this is causing],” Lord said.
Programs to address these challenges are underway.
Windsor County is one of several locations of a new project-based on the Developmental Understanding & Legal Collaboration for Everyone (DULCE) model, which serves all families with newborns up to six months old.
A significant part of the project includes adding a family specialist to Mt. Ascutney’s pediatric practices.
Specifically, a family specialist from the Springfield Area Parent Child Center will be placed at Mt. Ascutney Hospital in Windsor, and a specialist from The Family Place will work at the Ottauquechee Health Center in Woodstock.
Lord noted that Mt. Ascutney Hospital already provides wellness coaching for families with children over 12 months old, offering support around parenting, sleep, nutrition, and healthy coping.
“DULCE just fit like a glove with the family wellness program,” Lord said. “It seemed like an amazing companion program to our existing work.”
DULCE is part of the Center for the Study of Social Policy in Washington, D.C., and is being implemented in other states, including Florida and California.
The DULCE model was developed by Robert Sege, MD, Ph.D., and Samantha Morton, JD. It’s based on research from a randomized controlled trial published in Pediatrics in 2015, which found that DULCE families received support faster; had better completion rates for well-child visits and vaccinations; and had reduced ER visits.
“The most exciting thing about it for me is that we are meeting families where they’re already coming,” said Nancy Bloomfield, executive director of The Family Place.
According to the National Survey of Children’s Health, in 2017, about 92 percent of kids from 0 to 5 years old attended preventative checkups in Vermont, Bloomfield said.
These visits provide an important opportunity to screen families for social determinants of health, such as income, housing, transportation, and partner violence, and immediately provide the support and resources they need.
DULCE uses evidence-based screening tools, including the Safe Environment for Every Kid (SEEK) Parent Questionnaire and the Edinburgh Postnatal Depression Scale.
Family specialists will accompany families to most of their well-child visits, and ensure “all barriers are eliminated to help families get what they need as soon as possible,” said Scott Johnson, part of the DULCE implementation team in Vermont. Johnson retired as the executive director of the Lamoille Family Center, one of the original DULCE sites in Vermont.
For example, Johnson noted that a family specialist has driven families to their well-child visits and to buy groceries. If substance abuse is an issue, instead of handing out a card, a family specialist can offer to call a therapist right then, he added.
Family specialists build a strong relationship with families. Bloomfield noted that their role is to be non-judgmental, curious, strengths-oriented, an attuned listener, and receptive to feedback (e.g., “is this the support you were hoping for, or do you need something else?”).
In addition, physicians, family specialists, and other team members, will regularly meet to discuss each family’s case, including parents’ goals and referrals to external agencies, and develop a plan, Lord said.
DULCE also includes a legal partner, who can help families with everything from navigating Medicaid benefits to housing concerns to immigration, Bloomfield said.
Mt. Ascutney Hospital aims to start the program this September. It is funded for three years by OneCare Vermont, an accountable care organization (ACO) established by The University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center.
“Pediatric practices care deeply for the families they serve, and recognize the pain and trauma that families are experiencing,” Lord said. “And they have hope for reversing what’s happening in our communities.”
Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.