Overview of Improving Child Development and Reducing Maltreatment
Project DULCE introduces a Strengthening Families intervention model into the primary care setting at Boston Medical Center through the Patient Centered Medical Home. The DULCE intervention partners with parents to adapt to their newborns with the dual goals of improving child development and reducing maltreatment.
Caretakers and parents of newborns are recruited in the primary care pediatric clinic at Boston Medical Center when they come for one of their new baby’s first visits. As soon as the consent process is completed, the family is randomly assigned to either the intervention or control group.
Families in the control group receive an informational session on safe sleep and safe transportation, with an option of receiving either a portable crib or car seat.
Families in the intervention group are assigned a DULCE Family Specialist who works and partners with the family during the first six months of the baby’s life. The DULCE Family Specialist provides families with support for unmet legal needs and provides information on child development.
- We work to strengthen families by providing extra support during the critical first six months of life
- Our work is embedded in the patient-centered medical home
- We work together with our families, to empower them to solve their own problems
- Universal recruitment: there is no stigma attached in participating
Families meet with the DULCE Family Specialist at all routine visits, and for home visits and telephone check-ins depending on the needs of the family. At six months, the DULCE Family Specialist hands off care to the primary care team and any other ongoing services at Boston Medical Center or in the family’s neighborhood, as necessary.
The intervention component adapts and combines elements of two existing programs: Healthy Steps and Medical-Legal Partnerships|Boston (MLP|Boston). The evidence-based Healthy Steps program adds a professional with knowledge of child development to a child's pediatric primary care team to support positive parenting through knowledge, modeling, ongoing support, referrals (when needed), optional home visits and a telephone phone line. MLP|Boston supports families by providing legal advice, consultations, and representation to address their civil legal needs. The DULCE Family Specialist is trained by MLP|Boston to identify legal and social needs that may affect a child's health and development and to take action either by helping the family advocate for themselves, or by referring them to an appropriate public health, legal, or social service agency or resource (including MLP|Boston).
A community component is added through the active participation of a number of programs: Boston’s Thrive in Five school readiness initiative, the Massachusetts Children’s Trust Fund, the Massachusetts Department of Children and Families, the Massachusetts Department of Public Health and the Boston Public Health Commission, all of whom collaborate with DULCE formally and informally.
All healthy infants between birth and six months old who receive care at Boston Medical Center primary care pediatrics.
Data is collected from participants twice: within the first month of recruitment and following the baby’s 6-month well child visit.
The project goal is to recruit 30 families per month for 16 months: 480 families. Recruitment and data interviews are currently going as scheduled.
- Poster presented at the 2011 Medical-Legal Partnership Summit: A New Standard of Care
- Keynote address at New Jersey CARES Institute Annual Child Abuse Summit
- Poster at the 2011 Helfer Society Annual Meeting
- Healthy Steps and Medical-Legal Partnerships|Boston: training for DULCE Family Specialists and Project LAUNCH Family Partners in child development and legal advocacy for families
- Project DULCE Training: Participants from 23 different agencies from across Boston working with infants and young children
- Parents are willing to sign up – despite the research requirements (50% recruitment)
- First visit takes time – since visits are relationship-based, sufficient time with the Family Specialist needs to be planned for. To avoid interrupting the clinic’s flow, this would preferably be in a clinical area other than the exam room.
- Immigration concerns are frequent
- Adjusting practice to best suit families’ needs
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