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Meeting looks at child abuse and neglect



Valley News Staff Writer
Thursday, June 20, 2019

LEBANON — The issues of child abuse and neglect have now risen to be among the top concerns communities have identified through recent health needs assessments conducted by Upper Valley health care organizations.

Public health officials say the ongoing opioid epidemic has driven up the number of children, especially infants and toddlers, who have come into state custody in both Vermont and New Hampshire in recent years, and there is more public awareness of the need to address childhood trauma of all kinds and to help build children’s ability to withstand stress.

Though poverty and parental substance abuse are risk factors for child abuse and neglect, it “affects kids across all different circumstances and walks of life,” said Nancy Bloomfield, director of The Family Place, a social service agency in Norwich that supports parents and children.

In an effort to help families, public health advocates are working to expand access to support.

They are doing so in a variety of ways, including by bringing in family specialists during pediatric well-child visits and by offering training for community members such as teachers and police officers on how to work with children who have experienced trauma, ranging from natural disasters, such as earthquakes or floods, to acts of violence, such as domestic assaults or mass shootings.

These and other efforts are on the agenda of a meeting of the Public Health Council of the Upper Valley on Friday.

The discussion at Hypertherm in Lebanon is aimed at creating a community health improvement plan that will address the needs identified in the recent assessments, including the issue of child abuse and neglect, said Alice Ely, the Public Health Council’s director.

Future public health council sessions will focus on other issues the assessments identified such as the health care needs of seniors.

If the goal is to prevent child abuse and neglect, Ely said, the focus has to be on mitigating risks facing children before they are born and in their early days and months.

“That’s why we’re having conversations about housing, transportation, other issues that help families become more stable,” Ely said.

Rather than focusing on the problems of child abuse and neglect, Sara Kobylenski, a consultant for the Couch Family Foundation, said the emphasis ought to be on ways to strengthen families.

“First of all, let’s look at what we want, not what you don’t want,” Kobylenski said.

Though still in its early stages, Bloomfield said a project is in the works to place family specialists in pediatric practices at Mt. Ascutney Hospital and Health Center locations in Windsor and Woodstock. The Mt. Ascutney-based project would be similar to an ongoing project to embed providers from The Family Place and the Claremont-based TLC Family Resource Center in pediatric practices at Dartmouth-Hitchcock to help families in which parents are in recovery from addiction. But the Mt. Ascutney project would be available to all families, not only those affected by addiction.

The idea behind the new effort, which would embed The Family Place staff in the pediatric practice at the Ottauquechee Health Center in Woodstock and staff from the Springfield Area Parent Child Center in the pediatric practice at Mt. Ascutney Hospital in Windsor, is to make it so that “a family can access what they need in one place,” Bloomfield said.

The Mt. Ascutney project would be based on the Developmental Understanding & Legal Collaboration for Everyone (DULCE) model, which in addition to family specialists and medical providers, also brings in legal assistance to families of young children during pediatric visits in the early months of life. The model, which is based on research conducted at Boston Medical Center that was published in the journal of Pediatrics in 2015, aims to provide families with preventative medical care and information and to offer them help with other “social determinants” that may affect their health such as housing, nutrition and health insurance enrollment.

The project also is expected to benefit health care providers, said Jill Lord, Mt. Ascutney’s director of community health, said.

Currently, the pediatricians are doing a lot of work outside their regular appointments with families to help meet their needs.

Lord said she expects the providers will find it to be “such a relief to just be doctors.”

The DULCE project will fit in nicely with a family wellness program already in existence at Mt. Ascutney. For families with children over a year old, a wellness coach provides tips on parenting, sleeping, nutrition, exercise and activities that can be done to help children as they develop.

The DULCE project would be funded through OneCare Vermont, the statewide accountable care organization that is aimed at shifting the way medical care reimbursements work, moving away from fee-for-service to value-based metrics so that providers are paid based on measurements of health such as keeping people out of the hospital and emergency room, according to presentations OneCare officials made to the Vermont Senate Committee on Health and Welfare this winter.

A DULCE project has been operating in Lamoille County since 2015, and is also slated to be rolled out in Burlington and St. Albans this year, according to OneCare’s presentations.

Even with programs such as DULCE in place, Ely said prevention efforts will never be 100% successful.

Addressing trauma is a challenge that can’t be the responsibility of only mental health professionals, said Kay Jankowski, assistant professor of psychiatry at the Geisel School of Medicine.

In part because of a shortage of mental health providers in the Upper Valley and nationally, Jankowski said that the burden of helping children to cope with trauma has shifted to others in the community such as pediatricians and educators.

At Dartmouth-Hitchcock, where Jankowski spends part of her time working as a clinical child psychologist, Jankowski said the pediatric practices are beginning to adopt a trauma-informed lens, she said.

It “does take a village,” Jankowski said.

The best way to build the kind of resiliency children and families need to overcome trauma is to foster healthy relationships, Kobylenski said.

“Relationships are what have caused the traumas, and relationships are what fixes them,” she said.

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.