Tag - Appleseed Pediatrics

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DULCE – An Innovation in Health Care Delivery
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The Difference DULCE Makes
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Questions About Vaccines? Please Ask!

DULCE – An Innovation in Health Care Delivery

By: Scott Johnson

The healthcare sector is experiencing rapid changes. Vermont is on the cutting edge of reform – leading the country in exploring alternative payment systems and finding better ways to measure success for patients and quality of care.

These reform efforts are also impacted by the fast-growing science related to how adversity in childhood impacts health care. Research at Harvard’s Center on the Developing Child reveals the significant impact of early life experiences on the growing brain and other biological, physiological, and neurological systems. According to the Center, in the first few years of life, more than one million new neural connections form every second. This critical developmental stage creates the architectural foundation for the rest of the infant’s life. Chronic stressors on the developing brain impact the quality and quantity of those neural connections.

Activation of the stress response produces a wide range of physiological reactions that prepare the body to deal with threat. However, when these responses remain activated at high levels for significant periods of time, without supportive relationships to help calm them, toxic stress results. This can impair the development of neural connections, especially in the areas of the brain dedicated to higher-order skills. (https://developingchild.harvard.edu/science/key-concepts/brain-architecture/)

Our earliest life experiences can impact how we respond to circumstances and challenges for the rest of our lives. In our region there is an innovative program to assure infants and their families have what they need to get off to a strong start. Appleseed Pediatrics, the Lamoille Family Center, and Vermont Legal Aid are working as a team to support Lamoille area families with newborns. The program is called DULCE (Developmental Understanding and Legal Collaborations for Everyone) and is about to enter its third year of operation.

The DULCE model embeds a family specialist from the Lamoille Family Center into the pediatric practice. The family specialist works with every family who wants her support to assure children in Lamoille get off to the best start possible; reducing the likelihood infants’ fast-growing brains and bodies are exposed to toxic stress and its lingering impact on the child.

Carol Lang Godin – LFC Program Director
and supervisor to DULCE family specialist –
with two DULCE graduates

Lamoille’s DULCE site is the only Vermont site and the only rural model in this national research project (six other sites are in Florida and California). While it’s a free and voluntary program, 98% of families have accepted the offer for support, and since inception in March 2016, DULCE has worked with almost 240 Lamoille families. A detailed and comprehensive evaluation process will begin in the coming months, and early indicators from family surveys tell us that families are benefiting from the support and information they receive from the program. The team, including the family specialist and the attorney help families with a range of issues parents of newborns may face that can impact the family’s health and well-being, including: child development, landlord-tenant challenges, child custody, family court issues, mental health, substance use, housing, economic well-being, safety, food security, and transportation.

The Lamoille Family Center is working with its local and state partners to expand DULCE in other practices in Vermont. This promising innovation that links health care, community services, and legal supports started here in Lamoille and could be a core component of all pediatric practices in Vermont within a few years. Giving children their best chance for a healthy and prosperous future starts with a family-centered approach like DULCE.For more information, contact Scott Johnson at sjohnson@lamoillefamilycenter.org, or Carol Lang-Godin at clang-godin@lamoillefamilycenter.org.


Scott Johnson is Executive Director of the Lamoille Family Center and has worked in Lamoille Valley in human services and education for nearly his entire career. The Family Center has served our community by encouraging, educating and celebrating children, youth and families for forty years.

Scott writes about early care and education, adolescent development and strengthening families that improve conditions of well-being.

The Difference DULCE Makes

By: Scott Johnson

Susan had just had her first child. She was excited to be a new mom but was overwhelmed with caring for her newborn, the family’s financial stress, and tension between her and her partner. At the baby’s initial newborn Well Child visit at Appleseed Pediatrics, Susan met Jenn, our DULCE Family Support worker.

DULCE (Developmental Understanding and Legal Collaboration for Everyone) is a three year demonstration project sponsored by the Center for the Study of Social Policy taking place in seven sites across the country. The Lamoille Family Center and Appleseed Pediatrics is the model for the program in a smaller rural community. DULCE is an innovative pediatric-care-based intervention through which primary care clinical sites proactively address social determinants of health and promote the healthy development of infants from birth to six months of age and provide support to their parents. DULCE’s intervention adds a Family Specialist (FS) to the pediatric care team, and the FS provides support for families with infants in the clinic setting, connecting them to resources based on parents’ needs and priorities – with the option of providing home visits, at the parents’ choice. The DULCE intervention incorporates a protective factors approach and draws on and incorporates components of the Medical-Legal Partnership model to ensure that families have access to the resources they need.

The DULCE family specialist meets with families at their first newborn pediatric visit and stays connected with them through their first six months. This gives new families support with issues that arise, but also in connects families to concrete supports that are designed to help families thrive.

Jenn referred Susan and her family to Economic Services and encouraged them to apply for Reach Up, a program that helps eligible parents gain job skills and find work so they can support their children. This family was already receiving WIC and 3Squares food benefits but they didn’t know about the program that provides supplemental income support for families with children. Receiving these benefits helped ease their financial stress.

Jenn worked with the DULCE Medical Legal Partner to help the child’s father apply for Social Security benefits. Over the next six months Jenn’s encouragement helped the family keep their scheduled well child visits, increased their food stability, and lifted some of the financial stress with a monthly Reach Up grant.  They also connected to Children’s Integrated Services at the Family Center for additional in-home parenting support and education.

In the year since their child was born, the increased support of the DULCE program helped the family develop a good rapport with their Pediatrician, keep current on their well child visits, and enroll in social programs that strengthen their family.

“I think this service was a nice addition to the already wonderful relationship we enjoy with Dr. Balu. I believe for families in more difficult family or friend circumstances it is probably essential. I can’t stress enough how important these types of services are to families. Emotional support and creating access to vital resources.” – DULCE parent

For more information about DULCE, visit https://www.cssp.org/pages/dulce.


Scott Johnson is Executive Director of the Lamoille Family Center and has worked in Lamoille Valley in human services and education for nearly his entire career. The Family Center has served our community by encouraging, educating and celebrating children, youth and families for forty years.

Scott writes about early care and education, adolescent development and strengthening families that improve conditions of well-being.

Questions About Vaccines? Please Ask!

By: Leah Hollenberger

The topic of vaccines and immunizations can be an emotional one. Certainly, as a parent, we want to protect our community, but at the same time, we want to do what is best for our child and avoid any harm. I did some reading on my own and, I am sure many of you can agree, it is easy to get overwhelmed with the amount of information and opinion that is available today.

I spoke with pediatrician Adrienne Pahl, MD with Appleseed Pediatrics. Dr. Pahl encouraged me to talk with my doctor. “Share your concerns, share what you are worried about with your doctor,” Dr. Pahl said.  “We can talk about current studies and findings and talk through recommendations with you. The most important thing to remember is that it is ok to ask.”

Dr. Pahl believes that vaccines are safe and effective and should be administered unless the child is unable to be vaccinated due to other health reasons. She bases her belief on extensive scientific evidence demonstrating the safety of vaccines and having cared for thousands of children. She explains that while we may not see many of the diseases for which we vaccinate, the bacteria and viruses that cause them are still around – here and in other countries. Vaccinations, along with better nutrition, better living conditions, hand-washing, and appropriate use of antibiotics, has meant many of us have never had to deal with an outbreak of polio or mumps. Her goal is that we never have to.

Here are several resources Dr. Pahl recommends to parents interested in learning more about vaccines:

Healthychildren.org – The American Academy of Pediatricians has a website that covers a wide variety of information of interest to parents. They have a number of articles about vaccines and immunizations, including a good FAQ.

Oktoaskvt.org – The Vermont Department of Health’s website about vaccines. Look here for information about state vaccine requirements. Dr. Pahl especially likes this site because of the “Ask” section: you can submit your questions about vaccines and local medical professionals will answer them.

What We Know About Vaccines and Autism – A blog article from UVM about vaccines and autism

Vaccine Education Center at Children’s Hospital of Philadelphia – Comprehensive and reliable information about vaccines for patients and healthcare professionals.

A listing of community resources for a variety of issues and topics is available online at copleyvt.org/community-resources.


Leah Hollenberger is the Vice President of Marketing, Development, and Community Relations for Copley Hospital. A former award-winning TV and Radio producer, she is the mother of two and lives in Morrisville. Her free time is spent volunteering, cooking, playing outdoors, and producing textile arts. Leah writes about community events, preventive care, and assorted ideas to help one make healthy choices.