Research & Demonstration Projects

Project DULCE (Boston, MA)

At a Glance

Project Name:

Project DULCE: Developmental Understanding and Legal Collaboration for Everyone

City & State:

Boston, Massachusetts 

Target Population:

Infants between Birth and Six Months and Their Families Who Receive Care at Boston Medical Center 

Partnering Organizations:

Boston Medical Center

Project LAUNCH

Healthy Steps

Medical-Legal Partnership | Boston 

Local Evaluator:

Pediatric Program Evaluation and Development Group at Boston University School of Medicine

Project Overview
View a short video about the project from Dr. Robert Sege

Boston Medical Center is collaborating with Project LAUNCH, Healthy Steps, and Medical-Legal Partnership| Boston to develop and implement project dulce: developmental understanding and legal collaboration for everyone.  The project introduces interventions into the primary care setting through the Patient Centered Medical Home Model.  Important community context is added through the active participation of Boston’s Thrive in Five school readiness initiative, the Massachusetts Children’s Trust Fund, the Department of Children and Families, and the Department of Public Health. The dulce intervention will promote positive parenting while reducing family risk factors and, in so doing, will increase resilience, result in more optimal child development, and reduced maltreatment.

The target population to be served is infants between birth and six months old and their families who receive care at Boston Medical Center. A staff member educated in child development and trained by -Legal Partnership| Boston, a dulce family partner, will reach infants and families through their routine health care visits during their first six months of life and provide them with support for unmet legal needs, screen infants for developmental problems, screen families for mental health problems, and improve families’ knowledge of child development.  Families will meet with the dulce family partner at the initial visit, at their subsequent routine visits, and for home visits if they wish.  At six months the dulce family partner will assess the needs of the family and refer to ongoing services, as necessary.  A follow up call will be made to ensure the family has connected with service providers. The evaluation of project dulce is designed to provide data for evidence-based decision making.  Outcomes and impacts may relate to any level of the Logic Model – from measurements of inputs, activities and outputs, to direct measures of short-, medium- and long- term outcomes.

Project Goals

  1. Assess whether the highly-structured dulce intervention results in: improved individual and family strengths, reduced risks, and decreased likelihood of child maltreatment
  2. Provide system-level information to assess the costs, resource needs, barriers, and benefits that come from implementing the dulce model within a patient-centered medical home
  3. Determine whether project dulce results in measurable community-wide decreases in maltreatment reports and injury-related urgent and emergent medical visits

Participating Organizations

Boston Medical Center: As the largest safety net hospital in New England, Boston Medical Center cares for the most vulnerable of Boston’s residents. As the largest safety net health care provider in the region, we understand deeply that social and economic factors have a profound impact on child health and development. Boston Medical Center strives to provide exceptional care without exception to everyone who walks through the door.

Partner Organizations

Project LAUNCH: A federally funded pediatric patient centered medical home (PCMH) model that will be implemented in the coming months at BMC and at two Federally Qualified Health Centers (FQHCs) in Boston. LAUNCH, directed by Kate Roper of the Massachusetts Department of Public Health (a member of the Dulce Advisory Board), is a universal-level public health intervention designed to support children’s social and emotional health through a medical home model.

Medical Legal Partnership | Boston is the Founding Site of the national MLP Network, comprised of over 76 sister sites partnered with over 180 hospitals and health centers across the U.S. and Canada.  MLP|Boston is co-located at Boston Medical Center, alongside the National Center for Medical-Legal Partnership, which provides technical assistance and other support to the MLP Network.  New best practices development in the course of this project will be disseminated through the National Center to other Network sites.

Healthy Steps has 80 affiliated sites nationwide, largely in clinical settings devoted to the care of high risk families, similar to the BMC population.  Dr. Margot Kaplan-Sanoff, child development team leader in this study, is one of the original developers of Healthy Steps and serves as the National Program Director.  Information from this project will be shared with the other Healthy Steps sites, and will be added to the Healthy Steps Training institutes held around the country.

Partner organizations and roles are listed below:

Partner Organizations

Role 

Boston Medical Center

Lead Agency and Project Site 

Project LAUNCH

Provide data from other sides at Codman Square and Martha Eliot Health Centers; help with implementing the Patient-Centered Medical Home 

Medical-Legal Partnership | Boston

Training and support of dulce family partner, Project LAUNCH staff, and BMC staff; providing family advocacy, consultation, and representation 

Healthy Steps

Training and support of the dulce family partner, Project Launch staff, and BMC staff; Provides telephone support line

Pediatric Program Evaluation and Development Group at Boston University School of Medicine; Edward De Vos, Ed.D, Director

Evaluate the project implementation, process, and outcome data; coordinate with cross-site evaluation; coordinate with aggregate data from Massachusetts Department of Children and Families as well as BMC Pediatric Emergency Data; coordinate and take part in Learning Community of Practice

Local Evaluation Plan
The following table relates the mixed-method evaluation design in Project DuLCe to the ecological model that underlies the intervention and to the specific steps in the Logic model.

Overview of Evaluation Design

Design

Collect Data

Make Meaning 

Individual/Family level outcomes

RCT

Statistical analysis of short and medium term outcomes 

Relationship level - Healthcare system process outcomes

Process data

Implementation data needed for replication (qualitative)

 

   

Community level aggregate outcomes

Pre-Post aggregate data from ER and DCF

Compare population rates in BMC-patient zip codes to secular trends; determine if there is measurable effect on maltreatment

Contact Information

Robert Sege, MD, Ph.D.
Principal Investigator
Boston Medical Center
(617) 414-5946
robert.sege@bmc.edu

Grace Morakinyo
Project Coordinator
Boston Medical Center
(617) 414-3816
oluwatomisin.morakinyo@bmc.org

Edward De Vos, Ed.D.
Local Evaluator
Massachusetts School of Professional Psychology 
(617) 327-6777 x1238
edward_devos@MSPP.EDU

 

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