Stulac Sara, Bair-Merritt Megan, Wachman Elisha M, Augustyn Marilyn, Howard Carey, Madoor Namrata, Costello Eileen
Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, United States.
Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States.
Curr Probl Pediatr Adolesc Health Care. 2019 Aug;49(8):100637. doi: 10.1016/j.cppeds.2019.07.002. Epub 2019 Sep 5.
As increasing resources are now being directed towards addressing the growing U.S. opioid epidemic, the long-term care of children from opioid-affected families has been relatively neglected. While an array of evidence suggests long-term negative developmental, medical, and social impacts to children related to their parents' opioid use, there remains much to be learned about how best to support children and families to promote healthy outcomes. Here, we report on the launch of an innovative family-centered pediatric medical home for opioid-affected families in Boston. We describe the program, the patient cohort, and early lessons learned. Important themes include the vulnerability of families with infants whose parents are in early recovery, and the need for compassionate, high-touch, high-continuity, team-based care that views the needs of the family as a whole. We recommend a future emphasis on non-stigmatizing, trauma-informed care; centering the needs of the family by addressing social and logistics barriers and by expanding models of parent-child dyadic care; investing in attachment and mental health interventions; developing strategies for prevention of opioid use disorder (OUD) in the next generation; and grounding our advocacy and actions in a social justice approach.
随着越来越多的资源被用于应对美国日益严重的阿片类药物流行问题，受阿片类药物影响家庭中儿童的长期照料相对受到忽视。虽然一系列证据表明，父母使用阿片类药物会给儿童带来长期负面的发育、医疗和社会影响，但对于如何最好地支持儿童和家庭以促进健康结果，仍有许多需要了解的地方。在此，我们报告波士顿为受阿片类药物影响的家庭推出的一个创新型以家庭为中心的儿科医疗之家。我们描述了该项目、患者群体以及早期经验教训。重要主题包括父母处于早期康复阶段的有婴儿家庭的脆弱性，以及需要富有同情心、高度贴心、高连续性、基于团队的护理，将家庭需求视为一个整体。我们建议未来着重于消除污名化的创伤知情护理；通过解决社会和后勤障碍以及扩展亲子二元护理模式来以家庭需求为中心；投资于依恋和心理健康干预；制定预防下一代阿片类药物使用障碍（OUD）的策略；以及将我们的宣传和行动建立在社会正义方法的基础上。
