1. The Developmental Understanding and Legal Collaboration for Everyone intervention was based on the Healthy Steps and Medical-Legal Partnership models, aiming for better healthcare access for healthy infants through collaboration between infants’ families and a family specialist.
2. While the intervention group showed higher immunization rates at 7 and 8 months of age, and less emergency department utilization by 6 months, these differences were not statistically significant by 12 months.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Exposure to early life toxic stress, especially financial adversity, has been correlated with negative physical and behavioral long-term impacts on children. In an attempt to help alleviate some of this toxic stress and help families access the healthcare system, the Developmental Understanding and Legal Collaboration for Everyone (DULCE) intervention was established in Boston, Massachusetts. With integration of the Healthy Steps and Medical-Legal Partnership models, this intervention trained family specialists to collaborate closely with families of healthy newborns. A randomized control trial of the intervention found DULCE families to have higher infant immunization rates at 7 and 8 months of age, and to be less likely to visit the Emergency Department (ED) when their children were under 6 months of age. However, the study suggested that such intervention group benefits no longer remained statistically significant by 12 months of age. Limitations included unknown generalizability given data collection from a single site. Results suggest that similar interventions may alleviate some aspects of early life stress, but additional research will be needed to further elucidate their value and aid in making results last through childhood.
Click to read the study in Pediatrics
Relevant Reading: The Science of Early Life Toxic Stress for Pediatric Practice and Advocacy
In-Depth [randomized, control trial]: DULCE screened 1378 families of infants less than 10 weeks of age at a single safety net medical center in Boston, Massachusetts. Of these, 330 families of healthy infants were enrolled in the study, with 167 in the intervention group and 163 in the control group. Study families included 73% that defined themselves as having financial hardships, with median income ranging from $10 000 to $30 000. Intervention group families were paired with a family specialist, who participated in the infant’s routine healthcare visits with their medical provider, conducted home visits, and kept in touch with families via telephone, email, or text message. While infants in the intervention group had higher immunization rates compared to controls at 7 months of age (77% vs 63%, p < 0.005) and 8 months (88% vs 77%, p < 0.01), and had fewer visits to the ED by 6 months (37% vs 50%, p < 0.03), these differences were no longer significant by 12 months (immunizations: 95% vs 89%, p = 0.06, ED utilization: 59% vs 65%, p = 0.40).
Image: CC/WikimediaCommons/Nevit Dilmen
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