Early Childhood Development | Live Well Lamoille

DULCE – An Innovation in Health Care Delivery

Mar 20 2018

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 Link Between Childhood Trauma and Tobacco Use

Nov 21 2017

By: Scott Johnson, Lamoille Family Center

Perhaps you’ve heard about the impact of trauma on long-term health. In Vermont and here in Lamoille Valley there is a lot of attention being paid to the set of childhood experiences that are directly linked to challenges later in life. These experiences, called Adverse Childhood Experiences (see the list below), or ACEs, are traumatic events that, if untreated, can have significant negative effects. The most common of these ACEs in Vermont are: divorce/separation, parental substance abuse or mental illness, and extreme economic insecurity.

What may surprise you is the link between these ACEs and tobacco use. The chart below shows the number of ACEs and their relationship to early smoking onset, adult smoking rates, and the lung disease known as COPD. Here are some important statistics about those connections.

If you experience more than three ACEs you are more likely to use tobacco.
88% of Vermont smokers started before age 18.
In Vermont, forty percent of young adults ages 18 to 24 who have experienced more than three ACEs are using tobacco. That’s more than twice the number of users in that age range who have fewer than three ACEs.
Those individuals with four or more ACEs are 3x more likely to start smoking before age 18.

According to the Vermont Department of Health website, tobacco use is the NUMBER ONE preventable cause of death. In Vermont, smoking costs approximately $348 million in medical expenses and results in about 1,000 smoking-related deaths each year.

According to their own internal documents, tobacco companies try to attract new young smokers by targeting retail stores near schools and parks. (http://www.counterbalancevt.com)

According to the 2015 Youth Behavior Risk Survey, almost one-quarter of high school students in Lamoille County have reported using three different types of tobacco products: 27% tried electronic vapor products, 23% tried a flavored tobacco product, and 22% smoked a whole cigarette, with 11% of students reporting that they smoked within the past 30 days.

If we want to reduce the use of tobacco and improve health outcomes in our region we must do something to reduce exposure to those ACEs, or do more to help young people heal from the impact of those experiences before they start using tobacco. The annual focus on urging smokers to quit is called The Great American Smokeout, and it occurred last week on November 16^th. Maybe some of you participated in this event, and remain tobacco free!

The community has an important role to play in reducing the likelihood our young people will choose to smoke. The links between smoking rates and adverse childhood experiences tell us that solutions lie in community-level efforts that support children, youth, and families. Research shows that the kind of help that makes a difference includes community-level activities that:

Make sure all children are socially and emotionally supported, and
Assure each family has two or more people who can offer concrete support in times of need.

As you may have heard, Healthy Lamoille Valley (HLV), our community prevention coalition, has regained tobacco prevention funding and is charged with addressing prevention of initiation of tobacco use among youth, eliminating exposure to second-hand smoke, and increasing tobacco-free policies in towns, public places, workplaces, and college campuses. If you want to get connected to our local efforts, including our reestablished HLV Tobacco Prevention Task Force, contact the HLV Policy and Community Outreach Coordinator, Alison Link at alison@healthylamoillevalley.org. Check out the website at https://www.healthylamoillevalley.org/tobacco.

*ACEs include: mental illness, depression, or person with suicidal intentions in the home; drug addiction or alcoholic family member; parental discord – indicated by divorce, separation, abandonment; incarceration of any family member; witnessing domestic violence against the mother; child abuse (physical, sexual, emotional); child neglect (physical, emotional).

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

How Childhood Trauma Affects Lifelong Health

Nov 01 2017

By: Jessica Bickford

Trauma… it’s the really horrific things that we go through as people… things that deeply impact us. For some, trauma is a single point in time while others experience ongoing trauma and instability.

The Merriam-Webster Dictionary includes these concepts when defining the word trauma:

Injury caused by an extrinsic (outside ourselves) agent

Results in severe mental or emotional stress or physical injury

In many cases when we experience trauma as adults we have gained the tools and relationships to carry us through. When we experience trauma as children we do not necessarily have those resources or the brain development that gives us the resilience needed. The more trauma or adverse childhood experiences (ACEs) that a child experiences, the greater the likelihood these experiences will have negative health impacts throughout their lifespan that can include obesity, heart disease, and substance use disorders.

The good news is that there is new science emerging that gives us hope that our negative childhood experiences do not have to be our destiny. The NEAR* sciences, as they are called, present a picture of hope. Come join Tricia Long** and Daniela Caserta*** at the upcoming “How Childhood Trauma Affects Lifelong Health” Workshops to find out more on how we can come together as a community and build this hope and change our health outcomes!

Join us for one of these evenings:

November 7^th, Hazen Auditorium – 6:00-8:00

November 14^th, Green Mountain Technology and Career Center – 6:00-8:00

You can pre-register at https://www.eventbrite.com/e/how-childhood-trauma-affects-lifelong-health-tickets-38547319069. Pre-registration is not required, so grab a friend or neighbor and come out to one of these informative evenings! All are welcome!

* NEAR Science = Neuroscience, Epigenetics, ACEs, & Resilience

** Tricia Long is a clinical mental health counselor, and Director for Resilience Beyond Incarceration at the Lamoille Restorative Center, a program that supports children and families dealing with parental incarceration.

*** Daniela Caserta has been overseeing a variety of programs at the Lamoille Family Center and is transitioning to be the Director of Programs for the Washington County Family Center.

Jessica Bickford has worked as Coordinator of Healthy Lamoille Valley for a little over two years, where she has enjoyed writing for their blog. Writing for Copley’s community blog is a natural extension of this experience! Healthy Lamoille Valley focuses on making healthy choices easy choices, realizing that when we have access to healthy options we are less likely to choose behaviors that are harmful. Prevention is really a lifestyle of wise choices that enable us to live life to the fullest.

The Developing Brain

Oct 03 2017

By: Rebecca Copans

Lucy, 3 years old, heading to her first day of preschool.

As a parent, you want nothing more than for your child to be happy and healthy, to make friends, and to be accepted and integrated with their peers. When one of those pieces doesn’t fall into place as you would hope, you start asking questions. You talk to your friends and neighbors, you ask for help from your primary care provider, and you call Lamoille County Mental Health Services.

From when she was a toddler, my daughter Lucy struggled with communicating her needs in a socially acceptable way. As an infant, we taught her baby sign language and she was incredibly proficient in verbal language at an early age. Also from a young age, however, she was paralyzed by social pressures and extreme shyness. When she was three and entered preschool, it didn’t go well. A brand new teacher fresh out of college combined with some energetic kids is a recipe for chaos. Sprinkle in social, emotional and behavioral challenges, and it can be a recipe for disaster.

It all came to a head when we were invited to a birthday party in March, seven months into the program and I saw firsthand what she had been trying to tell me week after week. She would come home and say, “No one played with me today.” Or, “I don’t have any friends at school.” Impossible, I thought. This is preschool, where they learn to be friends and care about each other equally—right? Wrong. It was like watching a car wreck. I was rooted to the spot, transfixed as parents chatted around me, oblivious to the scene that our children were playing out with each other. There were leaders and followers, cliques and bullying, and passive-aggressive exclusion that was closer to how seventh-grade girls infamously treat each other. This was a 4-year old’s birthday party. I was shocked. I have never felt so acutely that I failed as a parent. I didn’t listen to this tiny little person tell me over and over that she needed help figuring out how to navigate an incredibly stressful situation. It was like a language that everyone else could speak but her.

We asked for advice, I cried a whole lot, and ultimately we changed schools. Within three weeks of being enrolled in her new school, her teachers surged to action. We created a plan and began pulling in an incredible array of wrap-around services.They suggested screenings and behavioral interventions and within months and with some incredible people in her corner, things began slowly to improve, tiny step by tiny step.

From under a porch chair “fort”, 5 year old Lucy weaves a story for her brother Hazen.

Lucy, who suffers from a heady mix of debilitating shyness, ADHD and learning disabilities, was taught to scaffold mental prompts that allow most children seemingly automatically to wait for a turn at the paper towel dispenser (rather than pushing past to avoid having to think of something to say—and then say it—to the child blocking her way), to wait quietly in line to go outside for recess, to ask a teacher for help navigating a problem, or, the Everest: to ask “can I play?” Working with the behavioral interventionist, we created a playbook so that her family and her teachers were all working from the same place and using the same language.

Those early interventions helped to rewire her brain. She was given the tools to ask with her words rather than by hurling her body through space, and was able to integrate gracefully into playing with her peers by having a coach whispering prompts in her ear. As those prompts become ingrained, and with her incredible early educators mimicking the behavior interventionist’s language, the social fabric of her life became more normalized. By the time she entered Kindergarten, that coach standing by her shoulder was no longer needed, and in fact, her problem-solving skills became tools that her Kindergarten peers learned from Lucy.

When Lucy was a toddler, we thought that her actions were simply normal—we had nothing to compare it to. We thought parenting was simply the hardest job on the planet and didn’t realize how much help was available in the community. I didn’t know that our designated mental health agency or our local parent-child center offered resources for someone with Lucy’s developmental challenges, and for us, as parents raising her. I had the misconception that those agencies were reserved only for low-income Vermonters. We had no idea where to turn and grew increasingly panicked.

Studies from the Center on the Developing Child at Harvard University have shown that in the first years of life, a developing brain forms one million connections every second. By the age of by the age of five, 90% of the brain is developed. If we had waited until Lucy reached Kindergarten before putting behavior interventions in place, the work in bending her trajectory would have become much more difficult.

Lucy is far from alone on her path. A 2015 VT Digger story noted,

“Vermont has the highest rate of identifying students with emotional disturbance in the country. As a percentage of all students who received special education services in the 2012-13 school year in Vermont, about 16 percent were identified with an emotional disturbance, according to federal data. That is more than twice the national average of 6.3 percent.”

Some experts have argued that Vermont is simply doing a better job than other states at early identification and intervention.

During the 2016-2017 School Year, the School-Based Clinician Program at Lamoille County Mental Health supported over 120 children like Lucy from preschool-age to high school seniors. These dedicated individuals provided individual, group, and team support for students in their learning environments. School-Based Clinicians teach and practice mindfulness techniques with children, organize running and fitness groups, support skill development in the areas of self-advocacy, self-regulation, identifying and verbalizing emotional states, peer conflict resolution, verbal and non-verbal communication, and development of reciprocal play skills. They also facilitate training sessions for an increase in trauma-informed approaches in schools. These services are now available in 12 schools with a potential to serve over 200 children in the Lamoille Valley.

The Redwood Program at LCMHS contracts with school districts to offer wrap-around, full-year behavioral interventions for children. The children engaged in the program during the school year then attend a six-week summer camp that has precipitously lowered the crisis rate for kids returning to school in the fall. The Redwood Summer Camp is free for students enrolled in the Redwood Program and prevents a lot of kids from needing more expensive therapies. It maintains structure for the children during the summer and builds and strengthens the relationships between the kids and the incredible cohort of behavioral interventionists.

At 7 years old, Lucy is thriving with school-based supports.

The Access Program at LCMHS offers Community Skills Work (CSW), allowing children to connect with this service when in crisis. At its peak this year, the CSW Program served approximately 60 children at one time. In addition to weekly visits with children, the program also supports activities such as Wellness Camp, Children’s Emotional Wellness Day and the Resource Parent Curriculum Plus (RPC+) Children’s Group—an incredible program that supports placement stability for children in foster care. The CSW Program is connected with several local organizations, offering access to activities such as swimming, ice skating, gyms, game rooms, and State Parks.

During that first year of preschool, I was sure that Lucy would never be able to succeed socially in school. Now as a second grader, she has wonderful friends, she is successful in dance and gymnastics, she is able to have playdates that don’t reliably devolve into tears, and on any given day a stranger in the grocery store wouldn’t know the challenges she faces—all things that would have seemed impossible four years ago. Without those early interventions, this trajectory would be heading in a very different direction. When parents are at a loss as to how to help their child, they need to know that they aren’t alone and that help can be found right here in Lamoille. Parenting is hard in the best of situations and if you are struggling, some days it just feels impossible. Support is just right down the street. If you or someone you know could use some help with a child who is struggling, don’t wait until it’s a crisis to ask for help.

If you or a child you know needs help, call Lamoille County Mental Health at (802) 888-5026 or visit www.lamoille.org.

Rebecca Copans has worked extensively in government affairs, public relations and communications. As a society, our greatest potential lies with our children. With this basic tenant firmly in mind, Rebecca worked most recently with the Permanent Fund for Vermont’s Children and now with Lamoille County Mental Health to secure a stronger foundation for all Vermont families.

A graduate of the University of Vermont and Dartmouth College, Rebecca holds a bachelor’s degree in political science and a master’s degree in globalization. Her thesis concentration was the history and societal use of language and its effect on early cognitive development. She lives in Montpelier with her husband and three children.

The Difference DULCE Makes

Aug 15 2017

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

Help Me Grow

Jul 18 2017

By: Steve Ames

Here in the Lamoille Valley Region, we’ve been excited to assist with the rollout of the Help Me Grow call center and other components of the Help Me Grow project. Together with my council, the Maternal Child Health Team, and other partners, we’ve been spreading the word about the availability of anonymous early childhood support from the Vermont Department of Health.

Help Me Grow is a new part of the Vermont Department of Health’s effort to ensure all children in Vermont are screened for developmental delays and to ensure that all kids and young families have the resources they need to grow and thrive. It’s part of the State’s 2-1-1 information center.

Vermont 2-1-1 is the number to dial to find out about hundreds of important community resources, like emergency food and shelter, disability services, counseling, senior services, health care, child care, drug and alcohol programs, legal assistance, transportation agencies, educational and volunteer opportunities, and now early childhood development. It’s free and confidential for all callers to use.

There are many kids and families who would benefit from support, but who slip through the cracks. They don’t get the help that could benefit them during early childhood – when support is most effective.

Help Me Grow proactively addresses a family’s concerns about their child’s behavior and development by providing an early childhood specialist at the other end of an anonymous phone line (2-1-1 extension 6) and making connections when needed to existing community-based services and high quality parent education resources. For example, a young family looking for child care, a playgroup, or advice on how to handle a rambunctious two year old will find help and solutions with a call. By strengthening connections and providing resources for families in this way, Help Me Grow supports caregivers to promote their child’s social and emotional well-being.

When parents, caregivers or child care providers work with children, a screening tool helps kids learn and adapt very early in their lives, allowing them to develop appropriately and get the help they need, when they need it, early on.

The Help Me Grow project has added a Developmental Screening section to the State’s Immunization Registry so that a child’s physician can see results of a screen and review it without re-screening if the screen was conducted by a child care provider or educator. It’s a great example of making the system of supports more efficient and less duplicative.

Additionally, Help Me Grow now has two Child Development specialists at the 2-1-1 call center that can help anyone with child-related questions. Parents and caregivers can call 2-1-1 x6 anytime and get answers to challenging questions about their kids.

I’ve been psyched to help the Department of Health spread the word about Help Me Grow, and to help develop the website and various tools to measure how effective the 2-1-1 line is. In addition, at our Regional Council meetings, we’ve been sharing call center data to track the development of any gaps in the systems of support for kids and young families.

A team from the Vermont Department of Health and Building Bright Futures was fortunate to be able to attend the Help Me Grow National Conference as well, where we learned about successful aspects of implementation by regions and States from every corner of the Country.

One of the key components of Help Me Grow around the country and here in Vermont is the ability of the team to share anonymous call data with partners and others. For us in the Lamoille Valley, this data sharing allows the Regional Council to get a better sense of what young families are struggling with. We get quarterly reports from Help Me Grow about what areas of concerns folks are calling in about. That allows us to identify gaps in support and work with partners to address those gaps.

Each of these types of activities strengthens kids and families, and the fabric of support that we have all built for our neighbors and fellow citizens. It’s a wonderful time to be a kid in Vermont!

As the Regional Coordinator for Building Bright Futures, Steve staffs The Lamoille Valley Building Bright Futures Regional Council, a volunteer committee focused on the well being of young children and their families. There is one such Council in each of twelve regions of the State. Steve also works with the Playroom in Morrisville. He writes about early childhood, families, community, play, and equity.

Building Bright Futures

Jan 24 2017

By: Steve Ames

Live Well Lamille - Building Bright Futures

It’s a great time to be a kid in Vermont! For the first time, this year, all 3-, 4-, and 5-year-olds who don’t attend kindergarten are entitled to ten hours of free preK a week for 35 weeks of the year. This year 7,300 kids took advantage of public preK at both schools and at qualified child cares!

At the same time, the Agency of Education began to use a revised measure to see how many kids are considered ready for Kindergarten. They found that over 80% of kids in kindergarten are ready! This is great news.

The percent of families living in poverty in Vermont has decreased as well. The outcomes for new moms and kids (Maternal Child Health) is measured as second in the country behind our neighbors in Massachusetts.

More Vermont kids are receiving the full series of recommended vaccines now than ever before – over 76% last year. The list of good news and positive indicators goes on, but there’s always work to do!

As we look ahead, there remain a couple of significant challenges to consider. First, with over 70% of children having both parents in the workforce, it’s critically important that Lamoille Valley kids have high quality child care options. That way, their parents, if they so choose, can work and contribute to our wellbeing and economic prosperity. This is particularly true for infant care – there are virtually no infant care spots in our county, and child care providers have long, long waiting lists for infants.

Additionally, there are troubling trends with the increase of children under age nine entering Department of Children and Families custody in our area, and throughout Vermont. We need to address the causes of this terrible outcome for kids and families.

Building Bright Futures just released their report detailing how young children are faring in the Lamoille Valley, and across the State. To find out more, visit http://buildingbrightfutures.org/initiatives/how-are-vermonts-young-children.

If you want to join the Building Bright Futures team that works to monitor and address challenges (and celebrate successes!) for young children and families, consider coming to a Regional Council meeting at the Playroom on the second Tuesday of the month from 3:30 till 5:30. Hope to see you there!

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Tag - Early Childhood Development