Meeting Infants’ Needs Down East

By Rebecca A. Clay

“A county at the end of the earth.” That’s how Marjorie F. Withers, LCPC, describes Washington County, Maine, a region the size of Rhode Island and Connecticut combined but with fewer than 32,000 inhabitants.

The area is beautiful, said Ms. Withers, with ocean views, many lakes, and blueberry barrens that turn a lovely crimson color in the fall. But that beauty belies some very serious problems: unemployment, poverty, and rampant misuse of prescription opiates.

These problems have hit very young children especially hard: A third of the county’s infants are born at risk because of exposure to substances, low birth weight, or other factors. The county also has the state’s highest percentage of infants in child protective custody, children in special ed, and children under age 4 kicked out of childcare for acting up.

Enter the Community Caring Collaborative, which received one of SAMHSA’s Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) grants in 2008. The program promotes wellness in children from birth to age 8 by addressing their physical, emotional, social, and behavioral needs.

The collaborative, which Ms. Withers directs, brings together representatives of various agencies, the Passamaquoddy Tribe, and families determined to give the county’s children a healthier start in life.

One top priority is to make sure at-risk infants get the services they need after they return home from the neonatal intensive care unit (NICU) at a hospital 90 miles away. In the past, Ms. Withers explained, hospital staff often assumed that families could get the services their infants needed locally or make the trip back to the hospital. “But people don’t have money to fill the gas tank,” said Ms. Withers. “They’d be stuck in Washington County and then people would say they didn’t care about the baby.”

The solution was something called the “bridging” program, which matches each high-risk mother with a nurse or child educator even before her child is born. Together they craft an individualized plan to support the family during the infant’s hospitalization and beyond. Bridging partners take women to visit the NICU ahead of time, so it’s not as intimidating. They can help get the resources families need to travel back and forth. They can even arrange respite care for other children. Home visits and parent support groups provide additional help.

A similar effort is under way at the state level, where Ms. Withers says a child wellness council is working at “busting barriers that make it impossible for us to do what we need to do.” The council is examining the issue of appropriate case loads for case workers in isolated areas like Washington County, where workers must sometimes travel more than 3 hours one way to see a client, for example.

Ask Ms. Withers how well these efforts are working, and she points to a baby recently born at just 24 weeks. “Most babies born under 28 weeks in Washington County have multiple rehospitalizations,” she said. “This was the first baby we can track who’s never been rehospitalized.”

Learn more about Project LAUNCH.