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2020 Vision: A Milestone Year

12/19/2019

For Milestone Doc

The Nurture Science Program is making great strides in testing interventions that help children and families establish emotional connection, and repair it when it is interrupted.

When the Nurture Science Program (NSP) began its work in 2006, its focus was to establish a scientific basis for parent-child emotional connection. Its research primarily looked at physiological changes in the body that explain why emotional connection is so important to our development and our health. 

Now, collaborating with NICU doctors and nurses, pediatricians, home health workers, and others, the Nurture Science Program is making great strides in not only explaining the science of autonomic emotional connection, but also testing interventions that help children and families establish emotional connection and repair it when it is interrupted. 

“I’m so excited for 2020!” says Martha G. Welch, MD, Director of the NSP. “So much of our research will come to fruition then, and we can publish results that will further understanding of how establishing autonomic emotional connection affects development, and how it can best be provided to all families.”  

Upcoming research milestones in 2020 fall in three key areas:

Completing Replication Research on Family Nurture Intervention in the NICU (FNI-NICU)

Family Nurture Intervention (FNI) was developed by Martha G. Welch, MD, and the NSP to repair emotional connection between parents and children when it has been interrupted by physical separation, stress, or other challenges. In FNI-NICU, families are supported by trained Nurture Specialists so parents and babies can connect emotionally at a visceral level – despite the challenges of the NICU environment. This includes comfort touch, holding, and scent exchange along with emotional communication such as talking, crying, and eye contact. 

The first randomized controlled trial of FNI-NICU found significant benefits for both preterm babies and their mothers. At term age, infants born prematurely who received FNI showed improved brain activity in the prefrontal cortex, the area of the brain most dysregulated by premature birth, compared to preterm infants who did not receive FNI. At 18 months of age, babies who had received FNI-NICU had improved cognition and language, fewer attention problems, and reduced risk for autism, compared to babies who received standard NICU care. Mothers who received FNI with their babies showed improved caregiving behaviors while their babies were still in the NICU. When the babies were four months old, mothers who received FNI reported lower levels of depression and anxiety, compared to mothers who received standard care.  

A multi-site replication study is underway at Columbia University Irving Medical Center and the University of Texas, San Antonio, to see if the promising findings from the initial randomized controlled trial are upheld in the second study. The first findings from these studies are expected to be published in 2020. 

An effectiveness trial of FNI-NICU is underway at The Valley Hospital in Ridgewood, NJ. This study is designed to understand what it takes to provide Family Nurture Intervention to every family in the NICU, as well as the short-term and long-term effects of FNI on families, babies, and NICU staff. Primary outcomes are expected to be published in 2020. 

Findings on Family Nurture Intervention for Preschool Families (FNI-Preschool)

In the Columbia NSP’s FNI-Preschool intervention, parents and their children come together in a group setting to re-establish emotional connection with the guidance and support of Nurture Specialists. 

FNI-Preschool has thus far been studied in two communities in Connecticut – one in collaboration with the Children’s Learning Centers (CLC) of Fairfield County, and the other at the Norwalk Housing Authority. The Norwalk study has been completed, and data analysis is underway. The study at CLC is ongoing, and will be completed in the summer of 2020. While there are not yet findings from these studies, there has been enthusiastic feedback from participating families and CLC staff. In the coming year, the NSP will continue discussions with partners about how to provide this support to all families who need it. 

Studying the Use of WECS and WECS+

Emotional connection is fluid. The challenges of daily life can disrupt emotional connection for any parent and child, but the sooner the parent and child can reconnect the better. Often, families need some support to re-establish and maintain emotional connection. 

The Welch Emotional Connection Screen (WECS) was developed by Dr. Welch and the NSP team to provide an efficient, evidence-based method to assess autonomic emotional connection. The WECS assesses four elements of parent-child interaction: attraction, vocal communication, facial expressiveness, and sensitivity/reciprocity. The WECS is quick – it can be completed in as little as three minutes. Validation studies have found the WECS is reliable in measuring emotional connection between mothers and babies at four months and that early WECS scores predict later behavior. Research has shown that if babies and mothers were not emotionally connected at six months, then the mother is more likely to report that the child has behavior problems when the child is three years old. 

The WECS can be a powerful tool for professionals working with families – such as pediatricians, nurses and social workers – to identify situations where families need some help to re-establish emotional connection. The NSP is working with collaborators to standardize WECS education. It has become clear that once professionals have been trained to use the WECS, they often understand behavioral problems in a new way.  Before, they might have observed a difficult relationship between a parent and child and blamed the parent, but when they look at the situation through the lens of emotional connection, they recognize the emotional connection has been disrupted. 

Work with collaborators has shown once professionals working with families see the need to repair emotional connection, they want to help the family right away.  Referring a family for additional support often cannot meet the families’ immediate needs. Disconnection is very challenging, and families often come looking for help – at the doctor’s office, or another community resource – when they feel like they don’t have any other options. And referral resources are often limited – with referrals leading to a long waitlist rather than providing immediate help. Inaccessible and ineffective support options have motivated the NSP to collaborate with clinicians and researchers to develop and test tools that can be used immediately after the WECS – a “WECS+” approach – to help families re-establish emotional connection. 

Multiple collaborators are working with the NSP to pilot the WECS and WECS+ resources. These collaborative projects include: 

  • Robert Needleman, MD, at MetroHealth Medical Center in Cleveland, is using the WECS in his clinical work and piloting a booklet that provides parents tips for strengthening their emotional connection with their children. 
  • David O’Banion, MD, at Emory University School of Medicine in Atlanta, is piloting efforts to train medical residents to use the WECS, and has plans to oversee residents’ use of the WECS in clinical settings. 
  • The Columbia University Irving Medical Center well-baby nursery is initiating use of the WECS with mothers and children in the NewYork-Presbyterian Morgan Stanley Children’s Hospital. This well-baby nursery is also piloting another WECS+ initiative called the “Welch Method Emotional Exchange.” The mother is encouraged to express her emotions to her baby through using particular questions and prompts, for example telling the story of her baby’s birth. 
  • First3Years is conducting a pilot study to determine the feasibility and effectiveness of a large-scale home visitor WECS training program, and using the WECS during home visits. Fifty-five home health providers have been trained to use the WECS, and currently 39 are using it during home visits. 
  • NSP staff is working with Cliff Goddard, PhD, at Griffith University in Queensland, Australia, and Ulla Vanhatalo, PhD, at the University of Helsinki, Finland, to develop and test a WECS written in clear explicit translatable language (CETL). Using Natural Semantic Metalanguage this WECS-CETL can be readily and accurately translated into multiple languages. 

Each of these efforts will further understanding about the benefits of WECS and WECS+, as well as what is needed to make these resources available to all parent-facing professionals and families.

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