Dr. Lise Johnson, the Brazelton Institute’s New Director, on the Power of the Earliest Interactions

By Michael Accardi, Director of Resource Development, Brazelton Touchpoints Center

Listening is a powerful tool. For Lise Johnson, MD, just as it was for Berry Brazelton, listening is at the center of her work with children and their families, and a key pathway for building critically important relationships right from the start. “It’s very special to be able to engage with families at the very beginning,” says Lise, helping them recognize the unique individual their baby is, with intention, strengths, and vulnerabilities. “It really creates an ideal entry into understanding how important the quality of a baby’s interactions with their caregivers is.” Research confirms that those interactions and the relationships they help form between children and their caregivers are essential variables for child development. 

As the new Director of the Brazelton Institute (BI), Lise—a pediatrician with more than 30 years of experience in newborn care, including 20 years at Boston’s Brigham and Women’s Hospital—knows full well the power of relationships, both within family systems, and between providers and parents. “Increasingly the importance of relationships right from birth is being recognized,” she says, thanks to the research of pioneers in infant behavior and development like T. Berry Brazelton, MD, who revolutionized our understanding of babies and their relationships with those around them. 

Lise took over the leadership of the BI last July from Dr. Kevin Nugent, a world-renowned developmental psychologist who worked closely with Dr. Brazelton and has spent more than 40 years teaching and conducting research on newborn behavior and early parent-infant relations at Boston Children’s Hospital and around the world. Kevin is co-author with Dr. Brazelton of the Neonatal Behavioral Assessment Scale, or NBAS, which assesses the newborn’s behavioral repertoire with 28 behavioral items, each scored on a nine-point scale, as well as the infant’s neurological status on 20 items, each scored on a four-point scale.

Kevin is also lead author of the Newborn Behavioral Observations System (NBO). The NBO is an infant-focused, family-centered relationship-building tool based on the NBAS that blends a conceptual foundation of developmental knowledge with practical ways to engage caregivers around their babies. Through the NBO, providers surface the individual differences and innate skills of each baby, while building circles of trust with caregivers to support sensitive relationships. Kevin’s contributions to the fields of newborn behavior and family development will be celebrated next month at the World Association for Infant Mental Health (WAIMH) Congress in Dublin, Ireland.

Leading the BI, Lise sees the growing recognition of the importance of the earliest interactions in the sheer demand among medical providers for trainings in the use of the NBO.

“Every room I walk into there is something different going on with each family, and as a provider, I need to tailor my approach to them based on who they are and where they’re at,” Lise says, noting how she observes family openness and relational cues to guide how she interacts with each family and starts building a trusting relationship to promote family and clinical outcomes. 

In the past few years, Lise has had the privilege of leading adaptations of the NBO to most effectively partner with families in a variety of cultural contexts and life circumstances, including those living with substance use disorder (SUD). “While many parents and other primary caregivers living with SUD bring enormous trauma and related emotional pain and guilt to their early relationships with their newborns, those relationships also bring a renewed sense of opportunity to families,” observes Lise.

The NBO is uniquely positioned as a strengths-based approach to supporting families in healing those traumas, both by surfacing in families their own capacities as parents, and by building trusting relationships through which providers can nurture patients as they develop their parenting skills, and heal. In addition, the NBO brings parents and other family members together with providers to identify a newborn’s unique strengths and to build on them to address the newborn’s specific vulnerabilities, including those that may be associated with exposure during pregnancy to substances.

The results can be profound. For providers, the NBO promotes a mindset shift that can transform their clinical practice, helping them shed their implicit biases and negative assumptions about families living with SUD. The NBO helps providers let go of deficit-based, punitive practices, and instead focus on parents’ and other caregivers’ strengths. They can then join with them to build their capacities to understand and effectively respond to the needs that their newborns’ behaviors express.  

When families experience welcoming, stigma-free care that offers them hope for their families’ futures even before they feel ready to have hope for themselves, they are more likely to turn to providers when they need help. Substance use disorder is often a chronic, recurrent disease for which a realistic treatment goal may not be a lifelong cure, but a readiness to turn to and accept help at the very first signs of a relapse. This can help reduce relapse frequency and duration, reduce the risk of family separations, and, as a result, benefit healthcare and child welfare systems too.  

The outcomes and impact drive Lise and the BI forward. In 2023, as the world moves into whatever the next phase of the pandemic will be, and rates of burnout have never been higher among healthcare providers, Lise believes that “this ability to have authentic relationships with patients is part of the solution. That feeling of authenticity in your interactions helps keep providers going and feeling like their work is rewarding.”