- Stephen DiGiovanni, MD, Department of Pediatrics. Maine Medical Center, Portland, ME
- Stacey Ouellette, LCSW. Director of Behavioral Health Integration, Maine Behavioral Healthcare, Portland, ME
- Dory Hacker, LCSW. Clinical Manager, Department of Clinical Innovation, Maine Behavioral Healthcare, Portland, ME
A focus on ACES in healthcare requires a multi-faceted approach that includes: awareness and education, training, screening, support, treatment, and coordination. In 2014, MaineHealth embarked on an innovative interdisciplinary journey to prevent, identify and treat ACEs and trauma exposure in our pediatric patient population using a multi-tiered, data-driven, and behavioral health-integrated approach. Research and experience tells us that young children are especially vulnerable to the impact of adverse experiences. Events that threaten their sense of safety and that of their caregiver has the potential of negative consequences for years to come. It is because of this impact that we have focused on recognizing and responding to the effects of trauma in the 0-3 age group and their family system. A two generational approach focuses on enhancing the resiliency of the entire family unit. By fully supporting social determinants, medical health and behavioral health, we aim to design a care model that truly supports the needs of families. We have organized multiple layers of support for the 0-3 population. First, we offer a virtual support group to new moms of babies up to 4 months old that focuses on strengthening attachment, promoting safety, and supporting development. Secondly, we have set up system wide screening using the Edinburg Postnatal Depression Screening in pediatrics. We aim to identify women experiencing postpartum depression symptoms and related items that put both the mother and baby at risk. Elevated scores result in a warm hand off to the integrated clinician or referral back to their PCP. And lastly, through funding from the John T. Gorman foundation, we have developed an enhanced focus on the 0-3 age group within a pediatric practice. An Early Childhood Support Specialist (ECSS) interacts with all families during their well-baby visit. Using a trauma-informed, resilience-building approach, this program is designed to promote responsive, nurturing parenting that will strengthen attachment, home safety, and cognitive, language, social and emotional development during infancy. Interventions are categorized into three levels of support ranging from preventive to intensive, with a telehealth component woven in to increase access. Participants will learn about our universal approach to recognizing and responding to ACEs and social determinants of health in the postnatal and 0-3 populations. We will share how we rolled out system wide screening for maternal depression in pediatrics and lessons learned. We will describe our process for developing the ECSS role in pediatrics, including incorporating the Early Childhood Support Specialist into all well-baby visits, the functions of this role, and the proposed benefits to families. Participants will hear about our plans to spread this role and ultimately sustain it beyond the funding of the grant, by way of advocating for policy change and tapping into existing programs.
- Describe a systemic approach to screening for and responding to maternal depression in a healthcare system.
- Identify a universal, tiered approach to addressing ACEs and Social Inequities in the 0-3 population.
- Plan how this information will be applicable to other health systems and examine ways to enhance their present ACES work.