DULCE – An Innovation in Health Care Delivery
By Scott Johnson
This article was originally published by Scott Johnson, Executive Director of the Lamoille Family Center, in the Copley Hospital Blog.
The health care 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 (https://developingchild.harvard.edu/) 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 a 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.
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.