By Caitlin Clark, MSW LICSW, Clinical Program Manager, Boston Medical Center: Project RESPECT (Recovery, Empowerment, Social Services, Prenatal Care, Education, Community and Treatment)

Sitting in the prenatal exam room at 28 weeks pregnant, Casey reflects on how far she has come in her recovery. She has stopped using substances, found safe and stable housing, and attends all her recovery and prenatal visits routinely. Still, her harsh internal voice and fears challenge her as she is about to embark on her first experience in parenting. She asks herself: “I never had a ‘good’ parent. How can I be one?”

Fast forward three months, and Casey is thriving with her infant daughter. She attributes her strong connection and bond to the BRIGHT intervention her peer recovery coach delivered as a routine part of her prenatal and postpartum care. BRIGHT helped Casey visualize the type of parent she wanted to be and actualize it through reflective dialogue and mentalizing.

BRIGHT Intervention: an Innovative, Evidence-Based Treatment Approach to Strengthening Parent-Infant Relationship

The BRIGHT intervention is an evidence-based approach to improving infant and maternal bonding, attachment, and attunement for families affected by substance use disorder. This innovative treatment modality helps reduce child maltreatment and strengthen relationships between the mother-baby dyad. This practice has been adopted in Project RESPECT (Recovery, Empowerment, Social Services, Prenatal Care, Education, Community, and Treatment) at Boston Medical Center. Project RESPECT is an outpatient medical program for birthing people with a history of substance use disorder. At this program, people receive recovery-affirming obstetrical care and behavioral health support during pregnancy and up to one year after delivery. As part of the Innovation Hub, Project RESPECT has adopted BRIGHT as a routine part of clinical care for more than 200 mother-baby dyads served annually.

For Casey, the key components of BRIGHT allowed her to explore her relationship with her daughter fully through open-ended dialogue with her peer recovery coach and social work team. BRIGHT focuses on increasing a parent’s reflective capacity and ability to mentalize how the infant may be feeling, what they may be needing, and more. Clinicians take a stance of open curiosity and wondering and ask the parent of a newborn questions such as these:

“What do you think [your baby] needs right now?”

“What is [your baby] trying to tell you with her crying?”

The clinical team supported Casey by providing a space for her to get to know her infant during pregnancy and beyond. BRIGHT has historically been delivered by licensed clinical social workers and mental health counselors in outpatient settings and during home visits. For Project RESPECT, training was expanded to include not just licensed clinical social workers but also peer support coaches and child life specialists. At each weekly medical visit, Casey was offered at least 15 minutes to build reflective capacity and bond with her infant with a clinical team member while simultaneously receiving medical care and recovery support for her substance use disorder. She also participated in one-hour biweekly virtual sessions with her peer recovery coach to continue to utilize BRIGHT.

Development of this Program

Using support from the Association of Maternal and Child Health Programs (AMCHP), Project RESPECT developed an AIM statement[1], logic model, and evaluation plan. BRIGHT in Project RESPECT aimed to improve parent-child relationships because a parent’s presence has long-term beneficial impacts on the family system’s health and well-being. The project also develops parental resiliency and engagement with their own care.

Accomplishments

At the Boston Medical Center, this project achieved the following anticipated outcomes:

• One hundred percent of the social work, peer recovery coach, and child life specialty team are trained in the BRIGHT intervention.
• A monthly group consultation is held with the clinical team to ensure project fidelity and understanding of the clinical approach while simultaneously collecting buy-in from the team.
• The BRIGHT approach is offered to all patients during their course of care and treatment.

Sustaining a Strong Path Forward

Support from AMCHP’s Innovation Hub has enabled Project RESPECT to build and use a patient advisory panel to receive direct feedback on the value of BRIGHT. The community has strongly advocated for upstream education on the impact of BRIGHT before a birthing person starts this program. The panel advised that even 15-minute sessions tacked onto medical care visits can significantly bolster the dyadic relationship.

To continue sustaining the BRIGHT Intervention in Project RESPECT, all new clinical staff will receive BRIGHT training sessions in their onboarding and orientation sessions. We continue to have a monthly consultation group to discuss the approach and its utilization in patient encounters.

Conclusion

Moving forward, Project RESPECT plans to explore longer-term outcomes of the BRIGHT intervention on sustained recovery capital and reduction in child welfare involvement for families impacted by substance use disorder in our clinical space.

Participating in this Innovation Hub has allowed Project RESPECT to learn how the BRIGHT intervention can function as a routine part of clinical care in our outpatient clinic. In addition, direct feedback from our patients allowed us to plan for and implement changes to the practice to suit their needs better. This evidence-based approach to care supports families affected by a substance use disorder by improving parent-child relationships, decreasing child maltreatment, and ultimately breaking cycles of intergenerational trauma and substance use.

[1] AIM Statement: We aim to improve parent-child relationships because having a present parent can have long-term beneficial impacts on the family system’s health and well-being. We aim to support birthing people with substance use disorder to develop parental resiliency and engage with care through the implementation of the BRIGHT program.