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Our Success Stories

Making the Case for Integrated ECMH 

Early Childhood Mental Health (ECMH) integration strategies can support families in changing the trajectories of child outcomes. The earliest years of life are a time for snuggles and giggles, with occasional bouts of stress and sleepless, tearful discomfort. Unfortunately, far too many families face additional stressors such as housing instability, poverty, and social isolation. These stressors can significantly impact children’s early development and family wellness – important foundations that support children’s ability to form loving bonds with caregivers, play joyfully with others, and enter school prepared to learn.

Inequitable access to a happy, healthy childhood is a problem with widespread consequences. These children and their families must endure situations often referred to as adverse or high risk. These adversities and risks are most often the result of environmental, social, and institutional factors beyond any individual’s control. This variability is perpetrated by racism, poverty, violence, and many other sources of oppression. 

Fortunately, we have found a simple change in primary care practices can make a huge difference for families facing increased risk and adversity. The LAUNCH/MYCHILD Model for ECMH Integration transforms pediatric practices (medical homes) into a source of strength for children. Families and primary care providers become protectors of early childhood mental health with the implementation of LAUNCH/MYCHILD Model for ECMH Integration.

What follows is a snapshot of the impact of the model. The story is told using the thoughts and words of providers, administrators, and most importantly, families. 

    • Some stories are presented as perspectives: these words were recorded directly from the individual. 
    • Other stories are presented as case studies: these are the stories of individuals as told by the providers. 
    • The term parent includes any primary caregiver, whether biologically a parent or not. 
    • All parent names have been changed.

Dr. Fuchsia Mitchell had been a pediatrician at Codman Square Health Center for six years. She saw families everyday in her practice who were experiencing psychosocial stressors starting to impede social and emotional development of young children. LAUNCH/MYCHILD is the specialized service she relied on to work with her youngest patients.

“Before LAUNCH-MYCHILD, pediatricians could refer to Early Intervention or special education; that was it,” Dr. Mitchell said. “We didn’t have the capacity to address the specific group that LAUNCH/MYCHILD is able to target. Our options for supporting families preventively have much improved with the addition of LAUNCH-MYCHILD.”

Melissa Ryan was the clinical administrator for the LAUNCH/MYCHILD program at Codman Square. She said that LAUNCH/MYCHILD transformed the way Codman Square providers care for families.

“Providers have a proactive step to take if there is a concern with a family and a place to follow up with referrals to address a variety of patient needs. If the (integrated behavioral health) program was not here, we would lose a critical resource to help vulnerable families.”

For the pediatricians at Codman Square, the ECMH team was a warm and safe place to refer families in need of the extra support they were unable to provide during traditional doctor visits. In addition to individual support, the LAUNCH/MYCHILD model at Codman Square brought parent-child play groups and other engaging opportunities for families.

Tina was 19 years old and had a one-month-old baby with Down Syndrome. She was experiencing breastfeeding difficulties. Her pediatrician recognized how much stress this was causing Tina and knew she and her baby could benefit from ECMH support.

“My first thought when we met this mother was, ‘How do we help this mom fall in love with this baby?’ Family Partner Jacqueline Rue said. “I saw that she had the energy and we just had to provide some support.”

The ECMH team provided lactation support, then guided Tina in finding specialized childcare and obtaining a voucher that allowed her to go to college. Tina eventually shared concerns about her child’s father not being involved. The team provided emotional support, while mentoring her to find effective ways to communicate with the father.

“Tina is very attuned to her baby’s skills and is proud of her baby,” noted clinician Molly Brigham.

“She is very cued-in to her daughter’s needs and knows how to advocate for those special needs. We are simply here to be an extra layer of support when she needs us.”

Dr. Jessica Roth had been a pediatrician at Martha Eliot Health Center for 12 years. She saw a profound need for the LAUNCH/MYCHILD Model.

“(LAUNCH-MYCHILD) has filled a really important niche,” Dr. Roth said. “It has been one of the most important and successful programs that has been here in the last 12 years. I can’t conceive working without (the ECMH team) now … I feel Martha Eliot would be leaving families so much more vulnerable.”

The ECMH team often served families with complex needs and a history of unsuccessful navigation of convoluted systems meant to support them. With support from LAUNCH-MYCHILD, Dr. Roth said, pediatricians were better equipped to engage families allowing “bridges to be built over dangerous abysses and pitfalls that families have to navigate.”

The LAUNCH/MYCHILD model brings an important family centered perspective to the pediatric setting, said Emily Fischer, administrative champion of the model. The Family Partner she worked with, Yokaira Landron, continually reminded medical providers to put themselves in the shoes of their patients, advocating for pediatricians to understand the family’s circumstances in a holistic way.

“I think we have made big strides in creating an environment in pediatrics that acknowledges the strengths and needs of families,” Emily said. “Even when everything is falling apart, families are in the position of guiding their care with support from (the ECMH team).”

Dr. Roth agreed, noting how the whole health center learned from the very warm and connected approach the ECMH team took when working with families, starting with the referral and introduction process known as the “warm hand-off.”

“The (LAUNCH-MYCHILD) model helped us realize that we lose families when we only address immediate emergencies,” Dr. Roth said.

“There needs to be an enduring connection built with families. This way families come in for help before they find themselves in a full crisis.”

Family Partner Yokaira Landron described how she helped a new doctor at Martha Eliot Health Center think about her patients’ needs in a different way.

“A provider came to me with a request to consult with a mother. She was concerned that the baby was sleeping in the bed with the parents.”

“I was happy to go with the provider to speak to the family; but first I asked if she had tried using her own lived experience to connect with the family. I knew she was a mother of an infant; and, I knew she had struggled to get her own baby sleeping in a crib.”

“I said to her, ‘let’s go in there together, and you’re going to tell your own story.’”

“This way the parent can see that they are the same. The parent can see that it is not a weakness or something wrong with them. Very educated people, like doctors, have parenting challenges too.”

“While talking with the mother, we discovered that they were in a one-bedroom apartment and the crib was in the room. The doctor had not asked that.”

“She told me she never thought to ask parents how many beds they have in a room or how many rooms in the apartment.”

“I think it was a valuable experience for the provider on multiple levels.”

Dr. Genevieve Preer had been a pediatrician at Boston Medical Center for 4 years after spending 3 years there in residency.  She relied on the expertise of the LAUNCH/MYCHILD staff to enhance her practice and better respond to parent concerns about behaviors.

“Often, I refer families to (the ECMH team) when the parent voices concern about a behavior that falls in the realm of normal,” Dr. Preer said.  “The behavior might be developmentally appropriate, but the parent needs support.  Whatever guidance I can give in a 20-minute visit is not nearly as effective as what the (LAUNCH-MYCHILD) staff can do.”

The ECMH team at BMC formed a relationship with parents, provided opportunities for the parent to develop and practice new skills, and then maintained a presence for families to turn to when new challenges occur.

“Having the (ECMH) team actualizes what we, as pediatricians, think is best for our patients but would rarely happen in the absence of that support,” Dr. Preer said.

A mother of two children, aged 8 and 6, described what having support from the ECMH team at BMC, meant to her.

“Andrea has been a wonderful support. She has taught me how to think for myself, how to help myself, how to be a better mom and understand my children”

“In my family, disciplining was hitting and screaming. I didn’t want that for my kids.  Andrea taught me the ‘count to 5’ tactic to stay calm when disciplining my children and helped me to understand the importance of explaining to my kids why I am putting them in a time-out. I didn’t know that before.”

“I always thought, ‘my kid is just shy’ but now I understand her mental health. I learned how to have better conversations with my kids and I have more patience with them. I used to get so aggravated that they wouldn’t talk to me, now we have better communication and I am way less aggressive.”

“I have the relationship with my kids now that I always wanted to have with my parents and never had when I was growing up.”

Loraine was an older mother with 2 adult children and Wilson, a 15-month-old son.  Loraine was incarcerated for the first year of Wilson’s life.  She shared with Dr. Preer feeling completely overwhelmed by Wilson’s behavior.

“Although the behaviors were very challenging, such as peeing on the floor, I found they were normal behaviors, perhaps exacerbated by the mother’s anxiety and lack of recent parenting experience,” Dr. Preer said.  “I did not think a referral for In-Home Therapy was appropriate.”

The LAUNCH/MYCHILD team used dyadic play and coaching to help Lorraine appropriately respond to Wilson’s behaviors.  They talked about routines, reducing television time, and having consistent caregivers. 

“I don’t have the skills the ECMH team used to help in this situation,” Dr. Preer said. 

Had the LAUNCH/MYCHILD team not been an option, Dr. Preer would have attempted a referral to a less appropriate service and scheduled a follow-up appointment for the family.

“The referral probably would have been a dead-end and nothing would have been done to truly make a difference for the family,” Dr. Preer said.

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