Ab Initio International | Building Trust with the NBO

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by Claudia Quigg

He stood with both arms crossed, a defiant look on his face. Everything about this young man identified him as a Tough Guy. “What are you doing with my baby?” the dad challenged. I explained that his wife had agreed to spend time with me getting to know their new daughter, not realizing he was on his way to the hospital. I introduced myself and mentioned that newborn Kelsie seemed so bright and interested in the world around her that I was interested in learning more about her.

“Well, you don’t work with that WIC lady, do you?” he asked, obviously threatened by a prior encounter with another professional. I returned our focus to Kelsie who was demonstrating her lovely motor tone and maturity. “Look how strong your baby is!” I observed to both parents. Over the next few minutes I nervously went through a few items of the NBO with this family. I was just barely able to keep my own anxiety in check with this father who seemed on the edge of anger throughout the exam. Finally we came to the social orientation items and Kelsie was incredibly available to our efforts. She followed the ball beautifully and responded with interest to the rattle each time. When it was time to demonstrate her response to the voice, I asked the dad to call her name softly as I held her near to him. Kelsie immediately turned to her dad with a bright look. At that moment, his posture changed and his anger melted away. He couldn’t stop talking to her, pitching his voice higher and sweeter with each word. As he spoke to her so lovingly, I felt my own anxiety leave with his.

After we all acknowledged how amazing Kelsie was, her dad wanted to know more about my organization, Baby TALK. When he heard that one service we provide is home visiting for families, he wondered if we could “come out to the house next week to see how much smarter Kelsie is.” He had moved from resisting any intervention in his family’s life to inviting us to join their circle, all because we honored the competencies of their baby. Important learning about toxic stress in early childhood and its impact on health and human development has bolstered the impetus for this work. Both public and private funding streams increasingly finance the work of supporting families with children, birth-three. Funders correctly recognize that we have to be more thoughtful of the experiences of young children as we plan for our society’s future.

Most of these funders target families identified as “at-risk,” in some cases even describing families determined to be “the most at-risk.” Programs including Early Head Start, the Maternal Infant Early Childhood Home Visiting Program stemming from federal health care reform, and many state and local initiatives direct services to address factors such as poverty, age of parent, domestic violence, mental illness and substance abuse. Their approach to identifying and serving these families, however, has been problematic. After filling up their caseloads with families who have a few risk factors, many programs then breathe a sigh of relief. But “the most at-risk” families are still out there, falling between the cracks as they protect their anonymity.

Many of these families have learned to be protective as they interact with helping professionals. A lack of trust teaches them to hide the truth or they will lose their children. Screenings often look like this: A professional with a clip board asks them about their history of drug abuse or other experiences that would call into question their ability to raise a child. And these parents lie. Why wouldn’t they? What right-thinking parent would answer such questions truthfully? Our deficit-based efforts push parents away even more, convincing them that we are not worthy of their trust.

At Baby TALK, we are working to develop a Trustworthy System. Erik Erikson identified that during the first 18 months of life, children learn about trust and mistrust through their encounters with people. We believe that during that same period of time, parents are deciding whether or not they can trust their family’s system of care based on the quality of the encounters they have with professionals. Beginning our work with families at hospital OB units, using the NBO as a tool, we are able to begin a relationship based on the competencies of the baby and the family system. We hope that by honoring the family’s strengths, we will gain opportunities to also help them address their challenges. The NBO frames our relationship with families in a way that begins our partnership based not on judgment or agenda, but rather on the reality of their child and all that he has brought into the world with him. Recognizing the strengths of each newborn brings hope to parents, and to us as well.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944