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December 8, 2023
Early intervention providers within Maine’s Department of Education (ME DOE) are supporting the state’s youngest children affected by substance use disorder (SUD) and their families with the Touchpoints Approach and the Newborn Behavioral Observations (NBO) system). This exciting project is thanks to a partnership between the Brazelton Touchpoints Center (BTC), the Brazelton Institute (BI), and Maine’s statewide early intervention (EI) program.
Over the past 18 months, about 180 EI providers across Maine participated in Touchpoints and NBO trainings that focused on the specific needs of infants exposed to substances in utero and their families. In Maine, all infants exposed to substances during pregnancy and their families are automatically eligible for “Early Intervention for ME,” a federally-funded program for infants and toddlers (birth to 36 months) with conditions that have a high probability of resulting in developmental delay.
Maine’s Early Intervention for ME program is voluntary and free, and overseen within the ME DOE Child Development Services (CDS) system, which operates in every region across the state. Maine’s Early Intervention for ME services can be provided in a child’s home, another familiar environment, or a location convenient for the family, and may include physical, occupational, and/or speech and language therapy, and visits with nurses, nutritionists, and other professionals, such as developmental specialists.
Because of the opioid epidemic, along with polysubstance use, Maine — like other states — has seen growing numbers of infants who have been exposed to substances before birth. As a result, the importance and value of EI providers working with these children and their parents or other caregivers is increasingly vital.
Healing Infants Exposed to Substances
Infants exposed to substances prenatally are likely to have difficulty with self-regulation and can be highly irritable, easily overwhelmed, tense, and difficult to console while going through withdrawal and beyond, said Dr. Jayne Singer, BTC’s Director of Developmental and Relational Health. These infants also can have trouble with sleeping, feeding, and engaging with their caregivers, adding to parental stress.
These struggles place strain upon the emerging infant-parent relationship and compound the challenges parenting individuals may be having with their own recovery, including feelings of shame. Add to this the fact that newborns born with exposures are often placed in kinship or foster care due to child welfare involvement, which even further challenges the early healthy attachment between the baby and birth parents.
“Infants after prenatal exposure need a certain type of care to ensure they have healthy early brain development, healthy attachment with caregivers and family, and positive relational experiences at a young age,” said Dara Fruchter, Manager of Strategic Initiatives and Special Projects for Maine’s EI system. “Those first 1,000 days are so important, the most important for all of us.”
Nurturing the Infant-Parent Relationship
At the heart of the BTC mission is its dedication to foundational relationships as essential for developmental health and progress. The Touchpoints Approach and the NBO are both designed to equip providers with the knowledge and tools to most effectively engage families with their babies in those earliest stages of development, and beyond.
Maine’s EI providers work with adults who are caring for or in relationship with infants, including birth parents, foster parents, grandparents, and other kinship. Touchpoints helps EI providers nurture the infant-parent relationship by focusing on infant behavior as a means of engaging the love and strengths that parents are bringing to their relationship with their child, even if they live apart and visits are supervised. The NBO hones providers’ skills in observing infant behavior and co-constructing with caregivers an understanding of and sensitive responses to what their baby’s behavior is communicating.
As an example, the NBO offers a nine-step process for discovering and enhancing the consolability of an infant. Early interventionists can model and share this process with parents and their babies. This can be especially helpful for infants who show the effects of substance use exposure, Dr. Singer said. Identifying and providing soothing supports to infants in withdrawal is especially critical because their recovery is highly dependent upon the quality of the attachment and sensitivity of caregiving they receive in the newborn period.
Reducing Stigma and Bias
The emphasis of both Touchpoints and the NBO on the parent-child relationship as vital for developmental health also helps reduce the stigmatization of parents of infants exposed to substances, Fruchter said. She came to this work many years ago after volunteering as a cuddler of newborns in the neonatal intensive care unit (NICU) at her local hospital. There, she witnessed a lot of bias, judgment, and negativity toward the mothers with substance use disorder (SUD) coming to visit their babies hospitalized in the NICU because of withdrawal symptoms. This discouraged them from visiting more often, which then harmed their attachment to their baby.
“That was when I really started thinking about how a different stance toward the infants and their families might help the mothers feel less ashamed or intimidated and more confident in their parenting skills, which would improve their babies’ long-term health outcomes,” Fruchter said.
Dr. Singer developed the Touchpoints and NBO training modules adapted for working with families in recovery, including content and experiential exercises designed to uncover and address the biases and stigma that professionals can bring to their work, of which they are often unaware and initially uncomfortable acknowledging. The modules bring together professionals and people with lived experience for powerful perspective-taking opportunities. The training content also explores the nature of SUD as a medical condition situated within social determinants of mental health as opposed to a moral failing on the part of birthing parents.
“We equip providers with strengths-based skills for understanding families and their recovery process and engaging parents in relationships with their children, because birthing families and their infants need as much contact with each other as possible, whether the infant is currently in the parents’ custodial care or not,” Dr. Singer said. These early interactions help promote parent-child bonding and can motivate parents to seek and accept the help they need that they previously may have felt they did not deserve. These efforts also serve the goal of recovery and reunification.
“Fostering the relationship between parent and infant can be a primary source of healing and treatment for both the parent with substance use disorder and the infant,” Dr. Singer added.
Maine’s EI providers are embracing the new perspectives, knowledge, and skills they learned in their Touchpoints and the NBO trainings, Fruchter said.
“I’ve gotten a lot of positive feedback from training participants,” Fruchter said. “It has broadened how they are identifying opportunities to connect with families and caregivers. Situations that might have felt like barriers have become opportunities for folks to relate to families. Conversations are becoming more collaborative.”
As part of its partnership with BTC, Maine’s early intervention provider system also became a Touchpoints Training Site this year. This means BTC faculty trained a small team there to deliver ongoing Touchpoints trainings across the EI system to sustain this powerful initiative. Dr. Singer will provide this new training team with ongoing mentoring, coaching, and implementation support.
Learn more about the Touchpoints Approach.
Learn more about the NBO.
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Early intervention providers within Maine’s Department of Education (ME DOE) are supporting the state’s youngest children affected by substance use disorder (SUD) and their families with the Touchpoints Approach and the Newborn Behavioral Observations system (NBO).