Supporting Young Children, Families, and the Early Childhood Workforce during COVID-19

Jayne Singer head shot

Jayne Singer, PhD, IECMH-E®

The Brazelton Touchpoints Center recently collaborated with Boston Children’s Hospital and the Massachusetts Department of Early Education and Care on a webinar that explored early childhood development, mental health, and the impact of the coronavirus pandemic on children, families, and the early care and education workforce. 

Jayne Singer, PhD, IECMH-E®—BTC’s Director of Developmental and Relational Health and a clinical psychologist in the hospital’s Division of Developmental Medicin—was a featured speaker. Other speakers included:

  • Sandra Fenwick, Chief Executive Officer, Boston Children’s Hospital
  • Samantha Aigner-Treworgy, Commissioner, Massachusetts Department of Early Education and Care
  • Faye Holder-Niles, MD, MPH, Pediatrician, Children’s Hospital Primary Care Center; Medical Director of Community Primary Care, Office of Community Health
  • Francia Dejesus, Director of the Family Child Care Network, Jamaica Plain Neighborhood Development Corporation
  • Anat Weisenfreund, MS, Director of Head Start & Early Learning Programs, Community Action Pioneer Valley

View the webinar recording: COVID-19: Supporting Young Children, Families, and the EEC Workforce

Access additional resources:

Say Their Names

 

Tanisha Anderson
Armaud Arbery
Jacob Blake – of this list, the only one still alive as of this writing, paralyzed from the waist down
Sandra Bland
Michael Brown
Philando Castile
Stephon Clark
Michelle Cusseaux
George Floyd
Jamel Floyd
Janisha Fonville
Eric Garner
Freddie Gray
Akai Gurley
Botham Jean
Atatiana Jefferson
Justin Howell
Trayvon Martin
Elijah McClain
Sean Monterossa
Gabriella Nevarez
Trayford Pellerin
Tamir Rice
Aura Rosser
Alton Sterling
Breonna Taylor

These are just some of the names we know.
There are so many more whose names we don’t even know.
There are some names of people that some of us may hold deeply in our hearts.

The rate of fatal police shootings in the United States shows large differences based on race. Among Black Americans, the rate of fatal police shootings between 2015 and July 2020 stood at 31 per million of the population, while for White Americans, the rate stood at 13 fatal police shootings per million of the population. (Published by Statista Research Department, Jul 31, 2020)

There will be more names until we do everything in our power to stop the killing of our Black and Brown brothers and sisters.

Speak up, come together and hold each other, act, vote. Never give up.

Josh

PS: A few resources:

How to be an Antiracist, by Ibram X. Kendi

I Fought Two Plagues and Only Beat One, The New York Times

Just Mercy, by Bryan Stevenson

Not My Idea: A Book About Whiteness, by Anastasia Higginbotham

Racism in Health Care Isn’t Always Obvious, Scientific American

Systemic Racism as a Public Health Issue, from the Follow the Data Podcast at Bloomberg Philanthropies​

The Health Care System Has the Black Community in a Choke Hold, California Health Care Foundation

We Need to Talk About an Injustice, Bryan Stevenson’s TED Talk

New Webinar Series and Learning Community Focuses on Virtual Connections

Brazelton Touchpoints Center (BTC), in partnership with the Rapid Response Virtual Home Visiting Collaborative, has launched a webinar series and online learning community that explore the challenges and opportunities family-facing professionals navigate when working with young children and families virtually.

“When the coronavirus pandemic began, family-facing providers in every sector—from early childhood educators to pediatricians to those who work in child welfare—had to quickly pivot to providing services virtually,” said Dr. Joshua Sparrow, BTC’s executive director. “For family-facing professionals accustomed to meeting in classrooms, offices, or homes, switching to text messaging, phone calls, and video-conferencing on mobile phone and tablets has proven challenging, yet has led to some surprising discoveries.”

The webinars build on lessons learned from virtual home visiting programs that began serving families virtually prior to the pandemic, and are offered in three series of six webinars each, beginning July 2020 and running through early 2021. To ensure the webinars meet the fast-moving needs of these field—particularly as states begin to open schools, pediatric offices, and child care centers—the project will employ rapid-cycle testing to inform the design and content of future webinars.

An online learning community, facilitated by BTC trainers and faculty, will include resources, chats, and other supports to help family-facing providers apply the skills they learn in the webinar series. Participation is free and open to everyone, thanks in part to funding from the W.K. Kellogg Foundation and Overdeck Family Foundation.

BTC’s training and support will position family-facing professionals with the assets and skill sets to provide programming that lends itself to virtual delivery, even after the current crisis abates, resulting in more equitable access to those services for the many families who are not currently served due to geographic and transportation barriers as well as limited publicly funded slots and the higher costs of in-person service delivery.

To ensure the training is accessible to Spanish-speaking providers, each webinar offers live Spanish translation. The online learning community also provides Spanish translation of all content. Additionally, the webinars offer closed-captioning to interested participants.

“Families, children, and providers across the country are facing unprecedented stressors,” Sparrow said. “This project offers providers an opportunity to learn new skills, share strategies with one another, and strengthen the virtual supports they can provide to young children and families at this challenging time, while highlighting the urgent need to bridge the digital divide with equitable access for all.”

Learn more.

About the W.K. Kellogg Foundation
The W.K. Kellogg Foundation (WKKF), founded in 1930 as an independent, private foundation by breakfast cereal innovator and entrepreneur Will Keith Kellogg, is among the largest philanthropic foundations in the United States. Guided by the belief that all children should have an equal opportunity to thrive, WKKF works with communities to create conditions for vulnerable children so they can realize their full potential in school, work and life.

The Kellogg Foundation is based in Battle Creek, Michigan, and works throughout the United States and internationally, as well as with sovereign tribes. Special attention is paid to priority places where there are high concentrations of poverty and where children face significant barriers to success. WKKF priority places in the U.S. are in Michigan, Mississippi, New Mexico and New Orleans; and internationally, are in Mexico and Haiti. For more information, visit www.wkkf.org

About the Overdeck Family Foundation
Overdeck Family Foundation was founded in 2011 by John and Laura Overdeck with the goal of providing all children the opportunity to unlock their potential. The Foundation focuses exclusively on education, funding organizations that seek to open doors for every child in the U.S. by measurably enhancing education both inside and outside the classroom.

The Foundation believes that, in order to succeed, children need access to strong foundations for early learning, exceptional educators, innovative schools, and engaging out-of-school opportunities. It supports organizations and researchers that work toward these goals, helping early-stage initiatives develop and validate their programs and scaling evidence-based growth-stage organizations looking to achieve greater impact. For more information, visit www.overdeck.org

Remembering Ann Stadtler, Retired BTC Leader and Faculty

We are deeply saddened by the loss of Ann Coleman Stadtler, DNP, RN, CPNP, who passed on Saturday, July 25, 2020. There are those among us here at Brazelton Touchpoints Center who had the distinct good fortune to have known and worked with Ann closely and for a long time, those here whose lives and work have also been touched by her in ways that they might not even realize, and many more in between, as well as far and wide. And then there are the countless children and families whose lives have also benefited from Ann’s passionate dedication, whether that was because of her direct primary care as a pediatric nurse practitioner; her developmental, behavioral expertise in the Division of Developmental Medicine at Boston Children’s Hospital; her leadership at the Brazelton Touchpoints Center (BTC) as she trained or mentored thousands of practitioners worldwide; her teaching and implementation of the Newborn Behavioral Observations (NBO) with the Brazelton Institute; or her teaching and writing directly to parents of young children.

Ann was an extraordinary pediatric nurse practitioner, one of the first in the country, and the first in the Maryland county where she first practiced when NPs were not permitted into newborn nurseries. Ever one to address barriers to care with her warm yet determined will, she set precedent by seeing the newborns bedside with their new parents as a way to skirt the prohibition, and thus began her use of the NBO and dedication to family-centered practice. Ann began her career in private pediatric practice after she graduated from Boston College but then returned to Boston and joined Boston Children’s Hospital as assistant director of the Medical Diagnostic Programs and later served as director of the Preschool Function Program. Ann was clinical coordinator of the School Function Program, Pain and Incontinence Program, and Early Childhood Program. She had a special interest in children with delays in toileting and was a key designer of the family-centered “Toilet School” treatment program. She co-authored Lessons from Toilet School: A Family-Centered Approach to Toilet Training, which was published in 2017. Remarkably, in her sixties and while extraordinarily busy, she earned her doctorate in nursing practice with a dissertation operationalizing family-centered care within intensive in-patient pediatric settings.

Ann lived a life of professional and personal selflessness. She was an inspirational figure and embodied all that is best in nursing as clinician, teacher, colleague, and public health advocate. For Ann, nursing was clearly a calling, a lifestyle, and a way of living. Her capacity for empathy enabled her to acknowledge and understand people’s confusion, concerns, doubts, and fears, so that she was optimistic and always hopeful and positive in the face of adversity. Indeed, Ann helped change the way we look at children and families. She always put the patient first, and took the time to listen without judgment or prejudice.

Ann was one of the founding faculty at BTC and, indeed, there would not be a BTC had it not been for her unwavering determination and skills. She served as director of BTC and led BTC’s professional development program for over 20 years. Ann was director of the Touchpoints Outreach and Network Development and also worked with the Brazelton Institute before retiring in 2018. She dedicated her life to finding and developing new models of care to promote a more compassionate, family-centered approach based on respect, openness, equality, and mutuality, and she invited patients to participate in decision-making. She was caring, considerate, concerned, and compassionate. As a result, she commanded the unfailing loyalty and admiration of colleagues—nurses, pediatricians, parents, and children across the world.

Ann received the Massachusetts March of Dimes Nurse Practitioner of the Year Award, the National Association of Pediatric Nurse Associates & Practitioners’ Loretta C. Ford Outstanding Fellow Award, the Wong Hock Boon Professorship from Singapore University Hospital, the BCH Mel Levine Award, That’s the Spirit Award, and the BTC Outstanding Leader Award.

The depth of our sense of loss is equal to her limitless compassion and caring.  She will be profoundly missed.

Kevin Nugent and Jayne Singer

Juneteenth

Dear Friends and Colleagues,

Today, Friday, Juneteenth, 2020 commemorates the end of slavery. We need this day to be a national holiday. Not just to remember the end of slavery, but to remember slavery itself, and the ways that it lives on in the systemic racism that continues to exploit, harm and kill. This can be a day for examining where it is embedded in our institutions, workplaces, and neighborhoods, and in ourselves, and committing to ending it – wherever it lives.

That will mean remembering and recommitting every day.  We each need to find our part in taking racism down. For those of us who experience the privileges it produces, our roles will need to measure up. The signs say, “White Silence is Violence.” We can end racism. Not someday. Not later. But now, and every day.

Words are better than silence but they’re not enough. 

Josh

We Can’t Breathe

At a demonstration Friday night in front of the Boston Police Headquarters, I saw a young woman with a mask on which she’d written the words, “I Can’t Breathe.” Around the country, signs and T-shirts are saying, “Silence is Violence,” “White People: Do Something,” and “Stop Killing Us.”

It was time to stop killing our Black and Brown sisters and brothers, mothers and fathers, sons and daughters, husbands, wives and lovers, grandparents, aunts and uncles 400 years ago. No one in the United States of America should have to fear for their lives—everyday—because of the color of their skin. No parent should have to give “the talk” to their children that every Black and Brown parent knows they must just to try to keep them alive. No virus should have a disproportionate choke hold on Black and Brown people because they have most of the highest-risk jobs, and the least access to healthcare.

Around the country, we’re saying we’re done with this. We were done with this a long, long time ago. And we’re saying we’re done talking about this. It’s time for action.

Breathe. Speak up. You decide what you’re going to stand up for—and how.

Joshua Sparrow, MD

Here are some of the ways we can stand up:

From The Leadership Conference on Civil and Human Rights Letter to Congress, June 1, 2020

We call on Congress to adopt the following legislative measures to ensure that police officers live up to their oath to protect and serve:

  1. Require a federal standard that use of force be reserved for only when necessary as a last resort after exhausting reasonable options, and incentivize states to implement this standard; require the use of de-escalation techniques, and the duty to intervene; ban the use of force as a punitive measure or means of retaliation against individuals who only verbally confront officers, or against individuals who pose a danger only to themselves; and require all officers to accurately report all uses of force;
  2. Prohibit all maneuvers that restrict the flow of blood or oxygen to the brain, including neck holds, chokeholds, and similar excessive force, deeming the use of such force a federal civil rights violation;
  3. Prohibit racial profiling, and require robust data collection on police-community encounters and law enforcement activities. Data should capture all demographic categories and be disaggregated;
  4. Eliminate federal programs that provide military equipment to law enforcement;
  5. Prohibit the use of no-knock warrants, especially for drug searches;
  6. Change the 18 U.S.C. Sec. 242 mens rea requirement from willfulness to recklessness, permitting prosecutors to successfully hold law enforcement accountable for the deprivation of civil rights and civil liberties;
  7. Develop a national public database that would cover all police agencies in the United States and its territories, similar to the International Association of Directors of Law Enforcement Standards and Training’s National Decertification Index, which would compile the names of officers who have had their licenses revoked due to misconduct, including but not limited to domestic violence, sexual violence, assault and harassment, criminal offense against minors, excessive use of force, violation of 18 U.S.C. § 242; perjury, falsifying a police report or planting and destroying evidence, and deadly physical assault; as well as terminations and complaints against the officers; and
  8. End the qualified immunity doctrine that prevents police from being held legally accountable when they break the law. To overcome the defense of qualified immunity, require that a victim must show that law enforcement violated “clearly established” law by pointing to a case arising in the same context and involving the same conduct.

Now is the time for Congress to pass meaningful police reform legislation. While we appreciate hearings and resolutions, we need comprehensive measures enacted. We need Congress to truly step up to the plate and protect Black communities from the systemic perils of over policing, police brutality, misconduct, and harassment, and end the impunity in which officers operate in taking the lives of Black people.

Read the National Medical Association’s Call for Comprehensive Reform in Response to Police Us of Excessive Force
https://www.nmanet.org/news/509870/NMA-Calls-for-Comprehensive-Reform-in-Response-to-Police-Use-of-Excessive-Force.htm

On May 25, 2020, George Floyd, a 47-year-old black man, was killed by the Minneapolis Police Department.

The National Medical Association (NMA) extends its deepest condolences to the family and friends of Mr. Floyd. The killing of George Floyd is another reminder of the lingering effects of institutional racism in many communities throughout these United States. The conduct of these police officers is reprehensible and requires a full criminal and administrative investigation. The National Medical Association is calling for a national response that includes (but is not limited to):

  1. Comprehensive reforms mandating national uniform implicit bias and anti-racism training for all law enforcement agencies.
  2. Immediate development of a federal office responsible for the review of all fatal police excessive-use-of-force cases occurring in local jurisdictions.
  3. Uniform reporting of all deaths by law enforcement utilizing the US Standard Death Certificate.
  4. The immediate discontinuation of police practices that include life threatening maneuvers like the “choke hold” and the practice of placing weight or force, by any means, on a restrained person’s neck which is particularly vulnerable to injury that can easily result in death as in the case of Freddie Gray and now George Ford. Any occurrence of these unauthorized and potentially life-threatening practices being used by law enforcement should result in immediate dismissal and formal investigation of the officer/officers involved.
  5. All police officers are required to voluntarily report any witnessed unauthorized or excessive use of police force by a fellow officer. An omission of reporting such instances is considered an act of complicity.

The NMA is the largest and oldest national organization representing African American physicians and their patients in the United States. The NMA has long asserted police excessive use of force as a public health issue and has published both a position statement on police excess use of force and a position paper on urban violence in minority communities. The organization is committed to addressing issues of social determinants, structural violence and systemic racism that fosters an environment that leads to the disproportionate policing of communities of color.

The National Medical Association is the collective voice of African American physicians and the leading force for parity and justice in medicine. The NMA is the oldest organization of African American professionals in America representing African American physicians and the patients we serve in the United States and its territories.

Here are some additional resources to help you stand up and take action:

Leadership Conference on Civil and Human Rights—New Era of Public Safety: A Guide to Fair, Safe, and Effective Community Policing
The recommended reforms in this report are intended to create accountability and build better relationships between law enforcement and communities of color.

Equal Justice Initiative—Tragic Death of George Floyd Reveals Continuing Problem of Police Violence
The Equal Justice Initiative is committed to ending mass incarceration and excessive punishment in the United States, to challenging racial and economic injustice, and to protecting basic human rights for the most vulnerable people in American society.

Center for Policing Equity—The Science of Justice: Race, Justice, and Police Use of Force
This detailed report delves into police administrative data to show disparities in the use of force.

The National Museum of African American History and Culture—Talking About Race
An online portal to help families, individuals, and communities talk about racism and commit to being antiracist.

Color of Change—Sign a Petition to End Violent Policing Against Black People
Sign this petition calling for the end of police violence against Black people.

Black Futures Lab 
The Black Futures Lab transforms Black communities into active, interdependent, responsive public partners that change the way power operates—at the local, state, and national level.

Movement For Black Lives
The Movement for Black Lives (M4BL) is a space for Black organizations across the country to debate and discuss the current political conditions, develop shared assessments of what political interventions were necessary in order to achieve key policy, cultural and political wins, convene organizational leadership in order to debate and co-create a shared movement wide strategy.

National Black Justice Coalition
The National Black Justice Coalition is a civil rights organization dedicated to the empowerment of Black lesbian, gay, bisexual, transgender, queer and same gender loving (LGBTQ/SGL) people, including people living with HIV/AIDS. NBJC’s mission is to end racism, homophobia, and LGBTQ/SGL bias and stigma.

NAACP Legal Defense Fund
The NAACP Legal Defense and Educational Fund, Inc. is America’s premier legal organization fighting for racial justice. Through litigation, advocacy, and public education, LDF seeks structural changes to expand democracy, eliminate disparities, and achieve racial justice in a society that fulfills the promise of equality for all Americans.

 

May 10, 1918 – Remembering Berry’s Birthday and Who We Always Will Be

Dear Friends and Colleagues,

Noah and Sofia. All day together, closer than ever.

On Wednesday, September 12, 2001, parents and children held each other closer than ever before letting go. Suddenly, life was newly burdened, and more precious. My ninth-grade carpoolers talked about the children they knew whose parents had been on the planes, and then about the helpers, the EMTs, the firefighters, the doctors and nurses. That was who they wanted to become.

The Spanish flu pandemic began in 1918, the year Berry Brazelton was born. That year saw the end of many lives, as we have and will this year. Yet in 1918, babies – Berry, and others – kept being born. Human life clung on. Berry’s life’s work was about life – its beginnings. He watched and listened and learned from babies. Every baby, he learned, knows what really matters, what makes us human, the certainties that ground us in uncertain times, the continuity amidst all the change. Being with babies or keeping a child in mind helps us hold onto who we always will be and our dreams for their futures.

Berry dodged that pandemic, and this one. He would have been quick to see what we all now know: this virus multiplies inequity. It makes us all vulnerable, but those of us who have always been discriminated against are more so. Those who can least afford to lose, lose the most. If he were here, Berry would have helped us summon strengths we never knew we had – the strengths that every baby inspires in us to protect all babies through the worst of times.

In the worst of times, Berry would have dared us to dream of better times, as my ninth-grade passengers did. Some of them are the helpers now. The helpers say they don’t want to be heroes. They want to help and to live. They need us to dream for their futures too, to be strong for them, and through our physical distancing to hold them closer than ever.

Thank you for protecting life and celebrating birth on Berry’s 102nd birthday, and for all you do, for every baby and all their helpers.

Joshua Sparrow, MD
Executive Director, Brazelton Touchpoints Center

In Times of Change, Remember Who We’ve Always Been

In Times of Change, Remember Who We’ve Always Been

Joshua Sparrow, MD, Brazelton Touchpoints Center, Boston Children’s Hospital

Children are having big feelings about the ways the coronavirus is changing their lives. They know that the parents and others who care for them are having big feelings too, all kinds of feelings—fear, anxiety, sadness, and loneliness. They may not understand the worried look on our faces, but even babies can tell that something has changed. Children just a few years older may feel scared when we’re scared, and anxious when we are. They may even feel that they need to make us feel better. That is our job—not theirs.

Right now, taking care of our own feelings may seem like too big a job even for us grownups. There are so many changes in what we can do, where we can go, and who we can be with. And so many unknowns —about when it will be safe to go to the playground again, where we’ll get the food and supplies we need, whether we and our loved ones will stay healthy or recover, how we will care for our children if they must be at home, what will happen to our jobs if we still have them, and how we will get by until we’re past this.

This time in our lives may be different in some ways, but we’ve all been through hard times before. These are some of the things that have gotten us through.

Honor our strengths: We can remind ourselves of the hard times we’ve gotten our families through before and how we did it. We can take stock of all of the important things we do every day for our families, and all the ways we are exactly the parent or caregiver our children need us to be.

Own what we’re feeling: Sometimes it really helps to cry.

Stay connected: If there are people who have helped us through hard times before, or to whom we can turn now, we can reach out now—with a phone call, a text message, or on Facebook. We need to know they are there. We can share our fears and worries, and also, information, ideas, and solutions.

Be practical: Focus on what we do know and on what we can do.

Simple routines, small pleasures: We can hold onto whatever personal family routines and rituals we still can do with children at home, despite all the handwashing and social distancing.

What always works: We can open up some space in our worries for whatever moves us to a better feeling place—our songs, prayers, family meals, family hugs, and faith.

Look to the future: This won’t last forever. We will get through this.

Let our mission guide us: We know we will do everything we can to protect and nurture our children and families. To do that, we need to remember that they’ll need us to take care of ourselves.

We can’t help having all of the feelings we need to have in these difficult times. It’s natural for us to feel scared, worried and sad. There’s no way we can hide our feelings from our children, and we don’t need to—as long as we don’t leave them all alone with theirs. We can let them know that they don’t need to worry about us. It’s our job to handle our feelings, and to help them handle theirs.

Letter to Berry Brazelton (May 10, 1918 – March 13, 2018)

Noah e Vovo

 

Dear Berry,

I sure wish you were here to help us with this Coronavirus epidemic. You were practical. You stuck with what was in your power to do, and in ours. You inspired us, as you did parents, to do the most good we could by finding that good in ourselves.

You would have reminded us of everything we can do to avoid infection, and that most people who get sick will recover. You would have been obsessed about helping the people at greatest risk – our elders, people with pre-existing illness without health insurance, without paid sick leave, in low wage service jobs, in overcrowded housing, detention centers, or without homes.  You would have insisted that we help the helpers risking their own health, the nursing home workers and health care providers caring for the medically fragile, and those donning masks and goggles to treat one baby or child after another with fever and cough – all day long.

You really knew how to get people to listen. Just as you helped Congress understand why we needed a Family Medical Leave Act (still unpaid), you would have been helping people across the political spectrum understand why, in order to heal and be strong again, our country needs to fund – at the very least – free coronavirus testing, medical treatment, time off from work and unemployment insurance for everyone who needs it in the U.S. who is dealing with this viral illness. You would have kept it simple: any one left untreated or unfunded to stay out of work when potentially contagious becomes one more chance for this virus to spread itself. But you would never have let the physical distance from others we need to stop the spread turn into emotional distance.

Carrying on your good work in these hard times is daunting. Yet one strange twist on the coronavirus epidemic is that, for many of us, the best first thing we can do for ourselves as individuals turns out to be what we are most able to do right now to help others. For many of us, doing everything we can to protect ourselves from the coronavirus may be the first most powerful thing we can do to protect others – and to be ready to continue on with your good hard work as soon as we can.

Thank you for still showing me – and so many – the way. We miss you.

Josh

A Three Generation Approach to the Opioid Epidemic

Every 15 minutes a baby is born in the U.S. with symptoms of opioid withdrawal (view full report here). These newborns are often irritable, difficult to soothe, to settle down to sleep and to feed. These predictable challenges can be draining for already exhausted parents and undermine their sense of effectiveness and competence.  Newborns’ withdrawal symptoms may interfere with their earliest contributions to the attachment process, just as a mother’s struggle with substance use may complicate hers.

Research on the long-term effects of exposure to opioids during pregnancy suggests long term developmental impacts, but it is fraught with the confounding factors associated with substance use disorders (SUD), especially other poverty-related adversities, and trauma, which affects half or more of women of childbearing age with SUDs. The research is, however, clear that the single most important way to mitigate the effects of in utero exposure on children’s development is the quality of the primary caregiving relationship.

Yet many children are placed in foster care by state child protective service agencies, even though foster care systems in many communities are too overwhelmed to provide the kind of quality caregiving that these infants need. Whenever possible, strengthening families – including grandparents who step in to help – and the quality of these caregiving relationships is the best hope for children’s recovery, and for parents’. Tragically, many parents who lose custody of a child exposed in utero to substances will deal with this loss by continuing to use substances and go on to bear more children who are exposed. Aplomb

Stigma often prevents these adults from recognizing that they deserve and need help. It also often infiltrates health and mental health professional attitudes toward them, further alienating families from otherwise effective treatments. Parents and expecting parents are often subject to particularly harsh judgment as healthcare providers struggle to deal with their frustration about treating newborns whose distress could have been prevented. Yet the perinatal period and the first years of life offer uniquely powerful opportunities for prevention, healing and recovery. Expectant and new parents may find powerful new motivation to seek treatment for their new baby’s sake, even when they don’t feel that they themselves deserve it. These Touchpoints in a family’s development are times of heightened vulnerability and opportunity when we can touch into the family system to bring hope for families so that they can dare to hope for themselves.

BTC’s work on prenatal exposure to substances can be traced back to the use of Brazelton’s Neonatal Behavioral Assessment Scale to detect behavioral effects at birth of in utero exposure to medications, illicit substances, and environmental toxins. In 2007, BTC began partnering with HRSA/MCHB-funded First 5 Santa Clara County grant to use the Touchpoints approach to create a shared vision and common language for 28 agencies across the county, including the courts, that served families in which an infant had been born exposed in utero to methamphetamine. Since then, BTC has continued to expand its activities in this area in many ways, including a congressional briefing on Capitol Hill on the opioid epidemic, grand rounds and other presentations around the country on a whole family approach to opioid use disorder, consultations to Tribal communities on preventing and treating SUDs, and adapted Touchpoints and NBO trainings.

Through programs and tools like the Touchpoints professional development series and the Newborn Behavioral Observations system (NBO), the BTC and BI are helping families and children overcome the opioid epidemic and helping family-facing professionals battle stigma.  These providers learn to explore together with parents each individual newborn’s competencies.  Practitioners and parents learn together to help infants born exposed in utero thrive by cultivating strong parent-child attachments, building parental confidence as well as motivation for their own recovery process.  Family-facing practitioners learn together with peer recovery coaches who have lived experience of SUD and substance exposures for their own children. This silo-busting approach tackles the implicit biases that can undermine professionals’ relationships with families and children, and, as a result, the effectiveness of the treatments they provide.

Just one result of these joint trainings is a mindset shift toward deeper understanding of SUD as a disease process – opioids can rewire the brain – and greater empathy for parents living with SUD.  Evidence of this mindset shift within the Touchpoints and NBO professional development training and reflective practice activities abounds.  Take, for example, the peer-recovery coach who appreciated what she learned about newborns experiencing effects of exposure but did not think that the direct hands-on use of the NBO would be a natural part of her work with parents in recovery.  Yet, when a new father expressed to her concerns about what to do if his baby cried during an upcoming supervised visitation, she was ready to offer what she’d learned in the NBO training about the challenges with soothing that babies with exposures face, and the strategies for overcoming them.  The father later recounted that not only did he successfully soothe his baby with the specific technique taught to him by his recovery coach, he showed the other fathers in the visitation group how to soothe and console their babies as well.

We can support the attachment process when parent and infant are both struggling with challenges to self-regulation. We can boost parental self-confidence and self-efficacy and help family-facing professionals recover their own sense of effectiveness and overcome the frustration that leads to blame and reinforces stigma. To do so, we need strengths-based approaches like the Touchpoints approach and the Newborn Behavioral Observation that focus not only on the baby or the adult in recovery, but on parent-infant-provider relationships, that build skills for understanding infant behavior as communication, and for self-reflection, so that providers can surface and move beyond bias, and so that parents can dare to believe in themselves and to have hope for their family’s future.