by Melinda Strauss, LICSW
Pediatric care providers are often the first to observe a parent's worries, sadness or disappointments, or to hear about the concerns and challenges that arise in the first years of parenting, in the families they serve. Some examples include a parent's worries about a child inheriting the depression or hyperactivity of a relative, difficulties in the marital relationship during the child's first year of life, coping with the loss of a job, etc.
Each pediatrician, family physician and nurse practitioner will decide what is the most congenial way to approach the evaluation and management of psychosocial issues for their pediatric patients and families.
Community resources, such as mental health clinics, early intervention programs and domestic violence prevention services, are essential "good medicine" for the present and future health of children and families. Pediatric health care includes knowledge about community resources as well as sensitive and timely referral when families are in need.
How can we expand the walls of our offices to meet the emotional needs of our youngest patients, and to prevent the problems that we see in older children and frustrated parents? Your medical practice may find it advantageous to develop a two-way relationship with a community agency, receiving consultation on psychosocial problems and referring families to programs that can prevent or solve those same problems.
Jewish Family & Children's Service (JF&CS) is a nonprofit, nonsectarian agency serving over 80 communities throughout greater Boston, Massachusetts. Many American cities have a JF&CS that serves all populations with a broad range of services for children, adults and elders.
Boston's JF&CS also serves all ages, and offers specialized programs for parents of newborns and very young children. The JF&CS Center for Early Relationship Support provides group and home visiting services that meet the needs of parents for support, connection and treatment of early relationship vulnerabilities:
Parent Consultations provides any parent of an infant or young child with a professional parent consultant who will provide guidance, information, skills, resources and support for one time or throughout the early parenting journey. Issues such as control, communication, discipline and self-esteem are among the many areas that parents may choose to share and explore. Each family determines the number and schedule of visits.
Early Connections is a therapeutic service, in the home setting, for new families experiencing emotional difficulties in the transition to parenthood. The new mother may be experiencing a postpartum mood disorder or may be recovering from a psychiatric hospitalization. The baby may have special needs or be particularly difficult to soothe. Some families are seen for brief consultation while others are seen over the long term.
Trained parent educators observe parent(s) and baby in their home environment and develop individualized support and guidance. Discussion includes the child's development, temperament, the parents' efforts and involvement, and familial sleeping patterns. Four week Sleep Groups are offered for parents of infants who are are struggling with sleep issues.
Feeding Support staff are certified lactation nurse consultants who share information on all feeding experiences (breast and bottle) in the context of the mother's experience and her developing relationship with her infant. Home visits and/or office visits may also build the bridge to other Center programs such as Early Connections or support groups.
Trained Visiting Moms volunteers are matched with new mothers who have a particular need for a supportive connection, to help them cope with the early months of parenthood. In providing a consistent, committed home visitor who offers ongoing support and guidance during early parenthood, the program focuses on fostering healthy parent-infant bonding and positive patterns of interaction. The program also provides weekly support groups for mothers to discuss concerns and problem-solving approaches.
Parenting Stories is a four week group for parents of young children to explore their own experiences with recurrent parenting themes such as separation, anger and self-esteem. This mutual support and exploration fosters an understanding of how the parents' own experience affects their lives as parents. Groups run continuously throughout the year.
I would encourage physicians to contact JF&CS by phone or make a visit, to familiarize themselves with the programs prior to recommending them to parents in their practice. Among the issues they may wish to inquire about are the professional staff and their training, the agency's experience in dealing with specific problems, and fees. Physicians may also want to discuss how to make referrals and what information they may want to receive in return.
Physicians may also wish to explore the possibility of a special arrangement for an agency clinician to come to their practice and meet with small groups of interested parents.
Parents will want to be sure that the information they share with both physicians and agencies remains confidential. It may be worth reviewing with the agency what type of release forms parents would sign. This is particularly pertinent in view of HIPAA requirements.
For more information on the Center for Early Relationship Support and other programs at Jewish Family & Children's Service, call the Center director, Peggy Kaufman, LICSW, at (617) 558-1278, or visit www.jfcsboston.org on the web. Jewish Family & Children's Service agencies are located in most major U.S. cities.
Other programs that serve children and families, such as child guidance clinics, family service agencies or early intervention programs may be located by contacting your hospital's pediatric department social worker.
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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center, and the families of my medical practice.
I hope you find this site useful and encourage any comments.
- Dr. Howard King, M.D.