The level of chaos and
need when a new life enters a family in the grips of opioid use can feel
overwhelming.  In a new statewide program in Massachusetts, brave and
heroic individuals who have themselves navigated the treacherous waters of
addiction, generously draw on their own struggles to help others find a better
The Massachusetts
Department of Public Health’s FIRST (Families In Recovery SupporT) Steps
Together is a new home visiting program in the Bureau of Family Health and
Nutrition’s Division of Pregnancy, Infancy, and Early Childhood. Funding for
this project is provided through SAMHSA’s State Opioid Response grant to
Massachusetts, administered through the Bureau of Substance Addictions

Clinicians work
alongside Family Recovery Support Specialists. As one of the infant-parent mental Health
specialists, I aim to promote parent confidence and support healthy parent-infant relationships. 

A recent Sunday issue of the
Berkshire Eagle, our local paper in Pittsfield, MA, one of the program’s 5 locations, featured 
an article with the headline “Set them
on  healthy path from the beginning,” featuring this quote. “If you want to
change unhealthy patterns that have been going on for generations, this is the
time to do it.”

Six months
after entering the program with her newborn infant, one mother said of her relationship
with her son, “We have a bond that you cannot break.”
The first months of life,
when parent and infant meet and get to know each other, offer an opportune
moment of healing. As a paper from the Alliance for the Advancement of Infant Mental Health wisely explains: 
“The parent-infant/young
child relationship is the vehicle for repair that can break the cycle of
substance use-substance abuse-rehabilitation and relapse.”
examining the newborn in the presence of the mother, the provider can
demonstrate the range of the infant’s physiological and behavioral competencies
and weaknesses, as well as adaptive or maladaptive responses to external
stimulation. At the same time the maternal responses to each displayed newborn
sign can be observed. Attention to maternal reactions and behaviors can direct
the intervention with the dyad to diminish emotional overload and provide
external organization until the infant can develop higher sensory limits and
consistent behavioral self-regulation.”
Extensive scientific evidence supports investing in these tender new relationships. The Newborn
Behavioral Observations System
 is one tool we can use. A
clinical application of the original observations of Dr. Brazelton that each
new baby comes into the world with a unique capacity for connection and
communication, the NBO provides a structure for organizing our observations. It brings us into the moment of connection, highlighting the value of listening to parent and infant together.  A new program in Western Massachusetts, The Hello It’s Me Project, provides trainings in the NBO to a wide range of practitioners who work with these vulnerable parent-infant pairs. Another tool, the FAN (Facilitating Attuned Interactions) offers a model that can be applied in setting where practitioners work with parents and infants.  It is organized around a core idea of “being with” without attempt to change what another the
person is doing or believing. Rather than imposing well-meaning efforts to
“fix” a problem, we offer our listening presence to empower parents
and build a sense of confidence. In doing so we promote healthy development of both parent and infant. 

The newborn brain makes over one million new connections per second. In the early days, weeks, and months of life, these connections develop in interaction with primary caregivers. Developmental specialists refer to these caregivers as “neuroarchitects.” When we acknowledge their expertise in this role, and devote sufficient resources to keep the normal disorganization of this developmental stage at a manageable level, we can get things going right from the start for the whole family. 


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