Collaborations: Dr. David O’Banion Leads WECS Training for Medical Residents

Dr. David O’Banion talks about relational health and his experience using the WECS in clinical care.

Dr. David O’Banion says he would love to be put out of business. As a developmental and behavioral pediatrician, he would like nothing more than to find ways to prevent the problems his patients experience – severe emotional and developmental challenges of all kinds. Through his collaboration with the Nurture Science Program, he believes that might be possible.

As an Assistant Professor of Pediatrics at Emory University School of Medicine and an Adjunct Professor at Morehouse School of Medicine, Dr. O’Banion provides clinical care and teaches pediatric residents and medical students. He has been working with the Nurture Science Program to develop and test ways to empower medical providers with the training and tools they need to evaluate emotional connection between children and parents, and to help overcome or avoid severe emotional, behavioral, and developmental challenges.

Dr. O’Banion spoke at Columbia University Irving Medical Center, where he shared how he was introduced to the Nurture Science Program’s work, how he has been collaborating with the Nurture Science Program team, and how that has influenced his teaching, his clinical practice, and even his own parenting. Following are excerpts from his presentation:

The need for early intervention to prevent behavioral problems

Dr. O’Banion: During my Development and Behavioral Pediatric (DBP) Fellowship in Oklahoma, the clinical focus of the training in the DBP specialty was as evaluators and assessors of conditions that may have been preventable, but we weren’t deployed in a preventable way.

Specialists are tertiary, so our clinical work is very focused, although my interactions with pediatricians then was more about training and supporting them, and focused on how to treat ADHD, how to treat autism, or how they are recognized, instead of things we might be able to do way upstream, before a child gets to this point, that could be helpful.

In Georgia, we have only a few practicing developmental pediatricians. Once I began at Emory, I knew I would get a chance to work in prevention, because I can’t possibly see all of Georgia’s children with developmental and behavioral problems.

Emotional, behavioral and developmental difficulties are often not identified until a child starts preschool.

The staggering prevalence of developmental and behavioral conditions and the limited workforce means that most developmental pediatricians have an eye on improving primary care pediatrics.

When I started on faculty, I called up Dr. David Willis, who had been my mentor in Oregon and who was then at HRSA’s Maternal Child Health Bureau, and asked ‘what do I do?’ Serendipity struck, because he had just met with Dr. Welch’s Nurture Science Program group. He said there are some people at Columbia who you have to meet. They’re doing incredible things with relational health and their evidence is really staggering. This was another moment of serendipity – the Nurture Science Program was preparing to start a work group, with some other developmental pediatricians, to start to disseminate their findings.

Exciting findings from the Nurture Science Program

Dr. O’Banion: One of the findings from the Family Nurture Intervention randomized control trial out of the NICU really stunned me when I saw it. I was shocked when I saw reduction in the risk for autism, based on nurturing interventions done in the NICU. I think you should be shocked, too, if you’re not familiar with this.

This work indicates that a brief intervention that is not incredibly complex and is not incredibly procedural in nature, but is still done in a medical setting, had a massive impact on the way children were developing. 

Family Nurture Intervention in the NICU helps families re-establish emotional connection.

Really, this could put me out of a job quickly if we could roll this out everywhere.

The Family Nurture Intervention that was done was based on the biologic basis for emotional connection, starting when babies were tiny. So, there were 26-weekers, considered very fragile babies. The focus was to help families experience how to be hands-on with their babies, nurture them, and calm them. Of course, it had a profound impact on the families, as well as the children. What was particularly powerful to me about the Family Nurture Intervention was how the method uses biologic, deeply ingrained touchpoints that emotionally connect us all – such as the tone of our mother’s voice or the scent of the baby. This is an incredibly practical intervention that gets at social and emotional reciprocity, which is the real core of who we are as social beings.

Ongoing collaborations

Dr. O’Banion: I’m not the only developmental pediatrician who got excited about this. There is a workgroup that started a couple of years ago with Dr. Welch and other pediatric care providers. We’ve been meeting by video conference every Monday morning for about an hour or so. We started by reviewing cases, watching videos, and discussing what we see. It has evolved from when we were training and learning how to use the Welch Emotional Connection Screen (WECS) to where we really started talking about the science. What are we going to do with this information? It shouldn’t be surprising that the other developmental pediatricians in this group, including Dr. Doug Vanderbilt at the University of Southern California Keck School of Medicine and Dr. Robert Needlman at Case Western Reserve University School of Medicine, also have projects underway at their respective universities. 

Eye contact, physical closeness and warm vocal communication all support emotional connection.

Reviewing videos each week resulted in my ‘ah-ha’ moment. This is what developmental and behavioral pediatrics is all about. 

This is the abstract, black-box concept that’s so hard to teach to residents. This is not a blood draw; this is not measuring heart rate. This is looking at a parent and a baby and the way they interact, and knowing something profoundly important about them.

Teaching the WECS at Emory University School of Medicine

Dr. O’Banion: I had to teach this to residents. Now I’ve been training medical residents in their developmental pediatrics rotation to use the Welch Emotional Connection Screen, the WECS. There are four domains. Based on just three minutes of face-to-face interaction with a family, it is possible to rate the way they are mutually attracted to each other, their mutual vocal communication, their facial communication with each other, and their sensitivity and reciprocity.

It’s really important for me to teach residents that we’re not judging mothering, because pediatricians don’t want to do that and are not going to do that. We’re measuring the quality of the relationship between parents and their children because it’s important.

Child development, according to the American Academy of Pediatrics, should be evaluated at every health preventative visit and screened using universal screeners at 9, 18, and 30 months of age. But by 18 and 30 months, we are often already aware of the concern. There’s an opportunity to intervene earlier, and I see the WECS as a way to capture the concerning interactions at a much earlier age and to monitor treatment and progress.

I’m teaching relational health to residents as one of the earliest universal markers for success – and we’re measuring relational health with the WECS. I base that on the evidence that has come so far out of the work here, where we see WECS scores at four months of age correlate to 18-month scores on developmental screeners. It is astounding that there is something we can do at four months of age that is not intensely procedural, not MRIs or genetic screens, something we can see between a parent and a child that may give us a hint about what could happen down the road. So, a very early chance to intervene is a critical opportunity and the intervention is focused on strengthening the family. It’s very exciting to me.

How Nurture Science Program’s work has affected his own parenting

Dr. O’Banion: One of the parts of Family Nurture Intervention is a scent exchange. My own child preferred his mom a lot. He still does. But at the end of every evening, I would drop one of my T-shirts in his crib (he was past the risk for SIDS). My wife would find it every morning and ask, “What’s this again? Another one of your T-shirts?” I started doing these things right away when I was learning about the Family Nurture Intervention. I want my child and I to have the best relationship we can have and I love feeling emotionally connected with him.

I ride my bike to work, and when I get home I greeted my son who was waiting for me on the back porch. He’d yell “Dada!” and I’d say “Hey!” and then I’d put my bike away and come go up the stairs a second later. I learned the difference between excitedly reconnecting with him when I come home through the work we were doing as a group. Now, as soon as he can see me yells “Dada!” I drop my bike and run up to him, just to make it a lot more exciting and fun. It’s more fun for me, too. 

It’s changed the way I do a lot of things at home, and I’m a developmental and behavioral pediatrician. I thought I had a pretty thoughtful approach to parenting, but I was being too cognitive, too academic. This helped me focus on connecting on a more rewarding level.