DHMC’s recovery-friendly pediatrics program supports parents struggling with addiction

  • Pediatrician Steve Chapman examines Sienna Pavila, 4 months, at the Boyle Community Pediatrics Program at the Children'€™s Hospital at Dartmouth-Hitchcock in Lebanon, N.H. on Jan. 31, 2019. Her mother Brittany Smith, of Lebanon, is in recovery from an opioid addiction and sits on an advisory committee for the Recovery-Friendly Pediatrics program at the hospital. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Medical Assistant Anna Spaulding gives Moses Wyman, four months, a vaccine while his mother Tiffany Kennedy, of West Lebanon, N.H., holds him at the Boyle Community Pediatrics Program at the Children’s Hospital at Dartmouth-Hitchcock in Lebanon, N.H., on Thursday. Medical Resident Megan Reynolds, left, talks with Hayden Kennedy, 6, Kennedy's older son during an appointment. Kennedy is enrolled in the Recovery-Friendly Pediatrics program at the hospital. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Published: 2/9/2019 9:18:12 PM
Modified: 2/9/2019 9:18:13 PM

The opioid epidemic continues to affect families in myriad ways, including preventing parents from being present in their children’s lives and contributing to traumatic experiences that can impede their kids’ development.

To make it easier for parents — who sometimes are in the very early stages of recovery — to maintain sobriety, and develop the skills and obtain the resources they need to care for their children, a team at the Children’s Hospital at Dartmouth-Hitchcock is working to change the way they provide medical care.

“It was really pretty obvious that we could do better,” said Dr. Steve Chapman, the director of Boyle Community Pediatrics Program at CHaD.

The need for a “recovery-friendly pediatrics” program has grown in recent years, as more babies have been born addicted to opioids and suffering from neonatal abstinence syndrome and more children have been placed in foster care, Chapman said.

He could tell that both families and providers were unsatisfied because common health care practices weren’t addressing fundamental challenges that often come with addiction and recovery, such as food scarcity, transportation and homelessness.

“Everybody was frustrated,” he said.

The effort to become recovery-friendly, which began about a year and a half ago, is still taking shape, but so far it includes working to ensure that families see familiar providers when they come for pediatric visits, having medical assistants call parents in between appointments to check in and offering training in trauma-informed care to the providers.

For Brittany Smith, a 29-year-old mother of two who is in long-term recovery from opioid addiction, the small things that can go a long way toward helping parents in recovery feel more comfortable getting the help they need.

Smith, who sits on an advisory committee informing the recovery-friendly effort, has pushed for clinicians to change the language they use to talk about addiction. Instead of referring to people struggling with addiction as “users” or “addicts,” she said she has advocated for describing them as people who have a substance use disorder.

Input from mothers “is really important,” Smith said as she sat in a waiting area in Dartmouth-Hitchcock Medical Center’s Boyle clinic late last month holding her 4-month-old daughter, Sienna Pavila.

“I love being on that advisory team,” she said.

The effort to become recovery-friendly also includes increasing collaboration between the hospital-based providers and community-based family centers. In addition to offering educational programs and support, family centers can help parents in recovery navigate a range of bureaucracies such as the U.S. Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants and Children; Medicaid rides to medical appointments; child care and housing assistance.

Employees of the Norwich-based Family Place and the Claremont-based TLC Family Resource Center began spending two days a week in D-H’s pediatric practice in October. In January, TLC employees began spending one day a week in Valley Regional Hospital’s pediatric practice.

In doing so, through an effort supported by the Couch Family Foundation, the hope is that families — both those affected by addiction and others — will find it easier to access the services offered by these organizations.

“One parent said, ‘It’s easier to buy a gun than it is to sign up for services,’ ” Chapman recalled. “That shouldn’t be.”

Employees from TLC and the Family Place set up shop outside DHMC’s Molly’s Place on the sixth floor of the Faulkner Building on Tuesdays and Thursdays when families are bringing children to medical appointments. That location lets them introduce their services to busy parents without requiring them to make a phone call at another time.

It “makes perfect sense for this to help bring people to what we already offer,” said Maggie Monroe-Cassel, TLC’s director.

Relevant programs include TLC’s comprehensive family support program, in which case managers help parents and caregivers set goals such as being and staying in recovery, escaping homelessness and treating mental illness, Monroe-Cassel said. TLC also offers a peer recovery center and a parent education program that can help parents develop attachment to their children.

“When attached, the parent will protect the child,” Monroe-Cassel said. “With our curriculum, we hope to help them find the tools they need to be who they want to be.”

As TLC does, the Family Place also offers a range of services to support families, Family Place Director Nancy Bloomfield said.

The two groups “offer a whole lot of things that a family might be able to benefit from,” Bloomfield said. It “starts with that friendly and helpful relationship (and) builds from there.”

So far, Bloomfield said, a few families who have learned about the Family Place through the recovery-friendly pediatric program have begun receiving home visits. At least one other has begun attending the Family Place’s playgroup.

The two-year grant from the Couch Family Foundation — in an amount that both hospital and foundation officials declined to disclose — helps support staff at the two organizations spend the time necessary to be present at the clinic. The financial leeway also let the Family Place hire a new home visitor.

Home visits allow staff to assess children’s development, answer questions about food, nutrition and sleep.

“It can look very different depending on the family,” Kelly Wallace, the Family Place’s children’s integrated services coordinator.

In addition to connecting families with support they need, the program has helped inform medical providers about the services TLC and the Family Place offer. Community support providers may be better-equipped to assess and address social factors such as food access issues that may be contributing to a patient’s health status, said Holly Gasper, D-H’s community health partnership coordinator.

“Sometimes clinicians don’t have enough time in their appointments,” Gasper said.

So far, Gasper said, clinicians are finding that more families are connecting with TLC or the Family Place since the program started.

“All the staff, they’re so engaged,” Gasper said. “They want to support families. Everyone is seeing the need out there.”

The program’s efforts have cut the no-show rate in half for the Boyle clinic’s appointments, Chapman said. Clinicians also are reaping the rewards of seeing parents find stability.

“They’re heroes,” Chapman said. “Everybody sees that.”

As the program takes shape, Chapman, who also is president of the New Hampshire Chapter of the American Academy of Pediatrics, said he hopes to share it with other pediatric practices in New Hampshire and beyond.

“I would love to see this idea of recovery-friendly pediatric practices grow,” Chapman said.

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

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