Scott Johnson | 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.

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.

Childhood Sets the Stage for Everything

Mar 14 2017

By: Scott Johnson

Adverse Childhood Experiences_Live Well Lamoille

Childhood experiences, both positive and negative, have a tremendous impact on future violence, victimization, lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs). Published in 1998, a Kaiser Permanente study of 17,000 people showed a link between the stressful experiences a person has before the age of 18 and a person’s physical, emotional and social health.

The study identified ten adverse childhood experiences:

Physical abuse
Sexual abuse
Emotional abuse
Physical neglect
Emotional neglect
Mother treated violently
Household substance abuse
Household mental illness
Parental separation or divorce
Incarcerated household member

Recent studies of adult Vermonters revealed that 57% have one or more ACEs and 22% have 3 or more ACEs. ACEs have been linked to risky health behaviors, chronic health conditions, and early death. As the number of ACEs increases, so does the risk for these outcomes.

What can be done about preventing ACEs?

The wide‐ranging health and social consequences underscore the importance of preventing ACEs before they happen. Safe, stable, and nurturing relationships and environments can have a positive impact on a broad range of health problems and on the development of skills that will help children reach their full potential and be resilient.

The Lamoille Family Center is one of fifteen Parent Child Centers (PCCs) in Vermont that use the Strengthening Families Framework and have a two‐generation approach to both mitigate and help prevent ACEs. The Centers for Disease Control recommends strategies for preventing ACEs, which resonate with the 8 core services that PCCs offer or that we refer to for support, including:

home visiting to pregnant women and newborns
parent training programs
social supports for parents
parent support programs for teens and teen pregnancy prevention programs
high quality child care
income support for lower income families
intimate partner violence prevention
mental health and substance abuse treatment.

It takes all of us to build flourishing communities that support the healthy and resilient development of our children. Join us in the next few weeks at one of the following showings of the James Redford film Resilience, a one hour documentary that delves into the science of ACEs.

Choose from any of these three dates/locations. Reserve your free ticket today!

March 21st Hazen Showing: https://www.eventbrite.com/e/resilience-film-screening-and-panel-discussion-hazen-tickets-31351447022
March 29th Johnson State Showing: https://www.eventbrite.com/e/resilience-film-screening-and-panel-discussion-at-johnson-state-tickets-31351711814
April 3rd GMTCC Showing: https://www.eventbrite.com/e/resilience-film-screening-and-panel-discussion-at-green-mountain-tech-and-career-center-tickets-31351777009

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

Ready for Kindergarten!

Oct 27 2016

By: Scott Johnson

Kindergarten

“The research is clear that children who have high-quality early learning and development opportunities experience greater success in school, relationships and life. This not only benefits the children; it’s economically beneficial for our society as a whole.” – Let’s Grow Kids

Children need high quality environments that are rich in love, learning and literacy – whether that experience is at home with a parent, with kin or a neighbor, or at one of our many great child care providers in Lamoille Valley.

Since 2000, Vermont has gathered information on the readiness of children entering kindergarten by surveying kindergarten teachers about their students’ knowledge and skills within the first six to ten weeks of school. The effort to measure school readiness is a collaborative project of the Vermont Agency of Education (AOE), the Department for Children and Families, and the Department of Health. (Various surveys for assessing schools’ readiness have been conducted since this effort began.) After extensive expert review, the new Ready for Kindergarten! Survey (R4K!S) has been adopted.

There are many interpretations of what constitutes “school readiness.” Vermont’s concept of children’s readiness is multidimensional and includes:

social and emotional development
communication
physical health
cognitive development and knowledge
approaches to learning (e.g., enthusiasm for learning, persistence, curiosity).

Vermont’s concept also reflects the belief that “school readiness” is interactional: children need to be ready for schools, and schools need to be ready to accommodate the diverse needs of each and every child.

What’s New

The 2015-16 Ready for Kindergarten! Survey (R4K!S) marks the deployment of a new survey instrument, changes in scoring methods, and criteria used for identification of students as “ready.” The survey also includes new and revised questions, including six in the physical development and health domain.

The R4K!S is not a direct assessment of children; rather it relies on the teacher’s accumulated observational knowledge of the child developed during the first few weeks of kindergarten.”

If you’re interested, click here to read the report.

Helping Your Child Be Ready

Parents and caregivers play a critical role in their child’s development. It’s important to offer children opportunities to learn, grow, and be capable every day. Creating environments that are literacy rich, full of adult-to-child interactions, are socially interactive with peers, and that attend to healthy habits are important ingredients to kindergarten readiness.

Here are some of my favorite resources to help:

I Can Teach My Child – “33 Ways To Prepare Your Child For Kindergarten.”

Let’s Grow Kids: A great resource to learn more about the importance of the early years.

The Lamoille Family Center is committed to working with our partners to encourage, educate and celebrate families so we realize the promise of every child. For more information about the Lamoille Family Center call 888-5229 or visit our website at http://www.lamoillefamilycenter.org.

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

Defining Toxic Stress from a Community Perspective

Jun 21 2016

By: Scott Johnson

Screen Shot 2016-06-22 at 10.07.36 AM

The Lamoille Family Center and Building Bright Futures Council are partners with eight other communities across the country in the Early Childhood-Learning and Innovation Network of Communities (EC-LINC). EC-LINC is co-sponsored by the Center for the Study of Social Policy in Washington D.C. and the Children’s Services Council of Palm Beach County. The mission is to support families and improve results for young children in communities across the country with a focus on accelerating the development of effective, integrated, local early childhood systems.

EC-LINC partners have long histories of building effective early childhood systems and share their perspectives and experiences to guide our work and solve common challenges together. EC-LINC works to:

Create a “community of communities” that fuels learning and innovation to tackle the toughest shared challenges and demonstrate results.
Build and disseminate knowledge about the range of community-based efforts across the country.
Develop opportunities for local leaders and state and federal policymakers to work together to accelerate strategies that improve results for children and families.

Over the past year, one of our collective efforts was a Learning Lab on community responses to toxic stress, resulting in this Policy Brief.

“Building on the widely used definition of toxic stress from the Harvard Center for the Developing Child, the [EC-LINC] Learning Lab has worked to define what toxic stress is, why it is of concern and how communities can respond.”

The next question for our community to answer is what we will do in Lamoille to ensure all of our children are healthy, nurtured, supported and free of abuse. Please feel free to share your ideas here, or contact Steve Ames or myself.

Scott Johnson: sjohnson@lamoillefamilycenter.org or 888-5229 Ext. 124

Steve Ames: SAmes@BuildingBrightFutures.org or 279-7558.

For more information about the EC-LINC, visit http://www.cssp.org/reform/early-childhood/early-childhood-linc.

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

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