A Pediatric Visit that Strengthens the Whole Family

A Foundation grant to MaineHealth supports a promising setting to address Adverse Childhood Experiences – the pediatrician’s office

Early Childhood Support Specialists Annette Burns (left) and April Fournier are using well-child pediatric visits as a launching point to address family needs, help parents build resiliency, and prevent the kind of Adverse Childhood Experiences that can cause a child long-term harm.

The evidence is clear that a child’s exposure to Adverse Childhood Experiences (ACEs) can create long-term harm in their lives. But we also know that ACEs can be prevented and mitigated, that children can build resiliency in response to them, and that they can do so when their caregivers are able to be their best selves. This is especially true in a child’s first years, when positive interventions have the most significant impact and when children are most dependent on their parents and caregivers to provide the connections and resources they need to thrive.

With a three-year grant from the John T. Gorman Foundation, MaineHealth is testing a new setting to work with children and families to prevent ACEs and build resiliency – the pediatrician’s office. Only one year in so far, this program is already showing great promise in helping families put their children on the path for a brighter future.

Expanding the Scope of the Pediatric Visit

Several years ago, Maine Behavioral Healthcare (MBH) and the City of Portland secured a federal grant with the goal of reducing child and youth exposure to violence. One component was to strengthen the connection between mental health providers and pediatricians working with children who have experienced trauma. MBH Senior Director of Clinical Innovation Rebecca Hoffmann-Frances reached out to Dr. Stephen DiGiovanni, a pediatrician and Medical Director of Maine Medical Center Outpatient Clinics, for assistance.

DiGiovanni said Hoffmann-Frances’ call “really opened my eyes as a pediatrician.” The data was clear that ACEs exposure affected long-term health outcomes for his young patients, but no model had been developed to screen and respond to those issues during office visits. So DiGiovanni and others worked to develop a screening protocol themselves, which has since been adopted throughout MaineHealth, the state’s largest healthcare system. They have also assembled a team across the system to coordinate the new approach to screen for, prevent, and treat ACEs.

In addition to assessing things like parent-child attachment, resiliency and risk factors, providers have worked to relieve stress points for families. But DiGiovanni highlighted several challenges of providing these kinds of supports in a medical setting. Healthcare staff have little time flexibility, don’t have access to flexible funds to help families overcome barriers like transportation or essentials, and, without specific health diagnoses, families aren’t eligible to work with case managers who could offer more intensive services.

After seeing a presentation on the work, Foundation Senior Program Associate Jennifer Beck, PhD., reached out about a potential partnership. “As an important way to improve outcomes for young children, the Foundation has actively sought to advance innovative ways to mitigate ACEs and build resiliency,” Beck said. “It was clear the team at MaineHealth was doing great work that, with the addition of targeted resources, could reach more families and have an even deeper impact.”

Offering Children and Parents Tools for Resiliency

The grant covers the costs of two full-time Early Childhood Support Specialists (ECSS) trained to build relationships with families with children ages 0-3. Since early 2021, ECSS April Fournier has been based in Portland’s Maine Medical Center Pediatric Clinic, which serves a high number of families dealing with exceptional challenges. Many are families with young children who have recently arrived in Portland seeking asylum. Recently, Annette Burns has started as the ECSS at Pen Bay Pediatrics in Rockland serving Knox County, another area identified as high-risk for ACEs exposure.

A key to building children’s resiliency in the presence of adversity is for parents and caregivers to have tools for resiliency as well. As an integral part of the pediatric team, the ECSS works to help families develop these tools – meeting with families when they come to the clinic for well-child visits, and assessing the entire family’s strengths and needs in relation to the child’s well-being.

“We know all the pieces have to be there for a family to thrive and be resilient. If parents don’t have secure housing, consistent income, or if their own health needs are not being met, then their ability to have good attachment to their child and see that the child’s needs are met goes down significantly,” Fournier said. “These visits give us time to talk and hear what parents have to share about what’s working for them and what we can build off of, but also where the pressure points are and where they need assistance. If we can address those things that allow parents to be their best selves, it’s a game changer.”

In her first eight months, Fournier worked with 164 families, providing coaching based on The Incredible Years, an evidence-based model to support children’s healthy social and emotional development. Fournier provided more intensive services to 92 families – helping parents problem-solve, set goals, and work toward solutions. Her days have been busy following up with agencies to ensure families receive needed benefits, working with community organizations to secure strollers and diapers, and making sure families living in hotel shelters have what they need to prepare donated food. (Flexible funding from the Foundation grant has also been used to quickly provide essential items and services that would be a hardship for families to pay for.)

Sometimes a quick call is all that is needed to resolve a situation, but other families have needed ongoing support. The relationships Fournier has built with families has increased trust and made them much more likely to reach out for help instead of letting a situation worsen, she said.

Potential for Replication

Indeed, the goal of this program is to prevent or mitigate issues before they can cause children long-term harm. Over the course of the grant, the team will be closely tracking health outcomes for their patients to test the effectiveness of this approach. But with early findings showing increased rates of well-child visits and parents making marked progress toward their self-identified goals, the team already thinks the model has great potential for replication in other pediatric settings. This month, they are presenting at the national Collaborative Family Healthcare Association conference with the goal of having others take up their work in their own medical systems.

“I think it’s a relatively simple design that would be utterly replicable,” DiGiovanni said. “The biggest challenge is how you can pay for it.” Under Maine’s Medicaid plan, for instance, a child would need a specific medical diagnosis before these kinds of preventive services would be considered reimbursable. Similar requirements exist with other private and government health plans.

“The biggest needs are the cheapest and sometimes they are the hardest to help families access,” added MBH’s Rebecca Hoffmann-Frances. “So I think the opportunity of this grant is not only to allow people like April to do their work, but for us to be able to show the huge impact it can have.”