AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
JEAN VALLIERE: All right. I'm going to tell you a little bit about Best Start, which is a focused initiative that has extreme tertiary aspects. We found that when we got in there.
But it's a maternal and child health mental health and health preventive intervention and treatment program. We have clinical teams that are made up of a trained infant mental health professional and a nurse with this one caveat we key losing money ask we lost one of our contract nurses. We couldn't get another one back so we took that money and put in a new clinician in the area of the state where they had absolutely no infant mental health whatsoever. And she actually is making very nice connections within the public health unit that she's based out of.
And so we adjust to do things a little bit differently. But the whole point of Best Start is to support and when necessary improve the relationship between the mother and the baby. In areas where there's NFP we do not take first time mothers that meet NFP criteria. We do take any other mother under the sun. Regardless of how young, how old, how many kids, what their medical or mental health condition or what have you. And we have to be very flexible for that reason.
Our target population, no surprise, are moms who are at risk for attachment difficulties. This goal as I said was to improve the quality of the parent‑child relationship, and we have an interesting small therapeutic group approach.
What we have found anecdotally in our own efforts in Louisiana is if we do this strictly from a parent education perspective, we don't really get a lot of information through to the people who need it the most, because they lack the identifying experience of thinking about how they were raised and their own experience of being raised.
Now, what we have seen clinically is that seems to be when parents can reflect upon that and we all do. How many of you and everybody in here seems has kids except for Brian or whatever. How many have said to yourself after you've done something with your kids, God it was just like my mother or father and I told myself I'd never do that. And you recognize this other aspect in the otherwise wonderful work your parents did, who has not had that experience as a parent?
I rest my case. But in any event, it seems to help a whole lot when you bring that element in. So this is a psycho therapeutic group. We have four, five women. We keep them stable. We can do it for eight weeks or for 12 weeks.
The curriculum is loosely based on the maternal mental health program, again out of the NCAP (phonetic) school. We have put in some more focused materials and when possible, well, we do provide food. We have pizza party at the end. We find those aren't enough incentives. So we're always building up what kind of incentives we can use for that. We also do it on a home base, service delivery model and this is an area of confusion.
Individual and didactic; didactic means you've seen the mom and the baby or dad and the baby at the same time. It's relationship specific. And we do that kind of treatment and we do individual with parents who need it.
Even in our home‑based approach we do follow our curriculum. And the way our curriculum is based, we really focus on attachment‑related features but then we also add in week by week, because our regular groups are about two hours long or an hour and a half. We do a domestic violence focus. We do a relaxation focus because that's our biggie, right? That's what we've learned big time in the last two years. Lifetime stress is more likely to result in premature delivery and low birth weight. So from the get‑go we incorporate relaxation exercises into our home visits and our groups.
We also take a look at interconceptional health, and all of this, according and growing from the participants own experiences. We don't talk at them. We set it up so they talk to us. So that's pretty much where we're going with that.
Now, we have also developed these relationships that continue to grow. In some of our areas, where we have Healthy Starts and the Healthy Starts work right in the Parish health units we've connected one of our best start programs with them. If they have a young lady they want referred, they'll go out on home visits together.
These communities, while the public health services in Louisiana direct services have been greatly decreased, the nurses in these communities have been there for years. They're part of that community. They know everybody. And it's working out very well. We're very ‑‑ we're seeing that when the public health nurse makes a referral, and that's an area where we don't have either a contract or time wise a public health nurse available.
But they will get these young ladies and they will tend to really strongly encourage that they come in and participate or do a home visit thing. And then we have also with the Tulane Xavier Center for Excellence in Women's Health, we're doing a depression awareness effort in hurricane affected areas of Louisiana. And we certainly are including in that a big push on maternal depression.
Remember, maternal depression is very, very bad for child outcomes. We all know that but we don't have a lot of concerted efforts out there. So we also include that.
Why did it do this? I do no more than I always do. In other areas, too, we're finding that Early Steps, which is our Part C, we had a change of responsible agency over the last couple of years, and it's been really hard getting our feet on the ground and getting the services out. We seem to be caught between the number of kids who qualify for services and our ability to pay for them and to find the specialist. Big surprise. But in our case we don't yet have our early steps programs really incorporating the social/emotional aspect of screening evaluation or services.
And in one of our areas are the coordinator for early steps there is interested in engaging Best Start, now this is because Best Start does endless community PR; infant mental health is so underground, and Paul always calls it infant mental health. I don't. I say success in school. I say social/emotional wellness, any other number of euphemisms. So we are getting our foot in that way, which is good. Once again one of the things that we really keep in mind is if we can impact a larger system at any point, we'll grow top down and bottom up any way it works, you know, we need to do that. The Healthy Start programs I've already mentioned. We are going into addictive disorders programs and providing the Best Start groups immediately after their outpatient groups. We don't really have a Best Start in an area where they have inpatient. So we're not doing that.
Any other target ‑‑ any other state agencies serving the target population for our five tax families they have to have the mandatory parenting, and we are approaching the agency in our state that has a contract for most of that to do a pilot. And I've already mentioned the TUXCO.
So what do I press? End?
UNKNOWN SPEAKER: Page down.
JEAN M. VALLIERE: Best start because it has trained infant mental health clinicians and because in our state the need is very, very great, we do find ourselves originating as a preventive intervention service but ending up being half and half with tertiary, because we do have a lot of infants, a lot of very small children who need a lot of help. And on this note, since we already went by, but to give you an example, in our universal, when Paul was talking about that and we talked about our ECCS, and of course our child care health consultants, we are now training our child care health consultants on problematic behaviors in infants, toddlers or young children, because they go out to teach about medication in child care centers and they get asked these other kind of questions.
So the awareness is rising. We have great parent ed. More therapeutic and other kinds of materials that are being produced but we do have very serious problems going on with the relationship between many parents and they're babies. And they pay an enormous price.
So I'm going to let Brian talk more about tertiary services, and then I'm going to jump back and finish up with some other system and tell you what Katrina has done to them.