Ask any parent with a young child, and they'll tell you how challenging it can be. Tears, tantrums, and exhaustion are all in a day's work — and that's on a good day. Stress levels climb even higher if a child shows signs of developmental delays, emotional problems, or acting out.
Now add to the mix a parent with serious depression or anxiety, a loss in the family, or any of the many sources of trauma associated with poverty: homelessness, food insecurity, exposure to violence. Anyone of these challenges — and they rarely come in ones — can both magnify and overshadow the everyday stress of raising a kid.
"If a caregiver is having a hard time personally, it becomes harder to parent," says Cleisa Gomes, a family partner at Codman Square Health Center, in Dorchester, Mass. "It's harder to communicate with the child. It's harder to be attuned to their needs. It's not anyone's fault. It's just a reality."
Untangling the knot of stressors that can interfere with child development and parental attachment is the core purpose of BRANCH, a new approach to supporting families and addressing behavioral health in early childhood that is now being established in primary care settings at Codman Square and several other community health centers in Massachusetts.
BRANCH, which stands for Building Resilience and Nurturing Children, is a brief and targeted intervention that includes both the child and parent (or another primary caregiver) and involves assessing a child's development, listening to the parent and family's needs, and devising a game plan for connecting the family to specialty care or other supports as needed.
BRANCH is just one in a continuum of services that make up TEAM UP for Children, a model of integrated behavioral health in pediatric primary care that was launched in 2016 and is supported by the Richard and Susan Smith Family Foundation The Klarman Family Foundation. Based at community health centers, TEAM UP comprises interdisciplinary teams of providers working within a shared framework that combines a focus on early childhood, a broad view of behavioral health that transcends specific diagnoses, and an emphasis on family and community engagement.
"There's a growing recognition of the importance of early childhood in the overall development of healthy children and young adults," says Emily Feinberg, a pediatric nurse practitioner and the director of TEAM UP. "BRANCH is a recognition that primary care is a really important space to begin to think about the social-emotional needs of very young children and the positive role that primary care clinicians can play in child development."