By: Amy Copperman
MLPB Executive Director
March 28, 2024
DULCE (Developmental Understanding and Legal Collaboration for Everyone) is an innovative early childhood intervention that is spearheaded by the Center for the Study of Social Policy, and was co-developed by MLPB. Since 2013, the national DULCE initiative has gained ground across several states.
What does DULCE look like in action? Pediatric and family medicine practices who adopt the DULCE approach commit to several key practice transformations:
- adopt a universal application for all babies 0-6 months cared for by the practice;
- assemble a care team that includes a Family Specialist, a medical provider, an early childhood systems representative, a mental health representative, a project lead, and (most important to MLPB) a legal partner;
- enable the Family Specialist to attend each well-child checkup during a baby’s first six months; and
- integrate social care, maternal infant health supports, and legal problem-solving into health care planning.
MLPB has been providing support and technical assistance for DULCE practices on a national level since DULCE began. And in early 2023, under the funding and leadership of the Care Transformation Collaborative of Rhode Island (CTC-RI), MLPB expanded our role by becoming the legal partner for the two inaugural DULCE sites in Rhode Island. We have had an amazing year launching DULCE programs at Coastal Medical Toll Gate Pediatrics in Warwick and the Care New England Medical Group Family Care Center in Pawtucket. In 2024, a new cohort of DULCE sites kicked off, and we now support Hasbro Children’s Hospital, Blackstone Valley Community Health Center, and Tri-County Community Health Centers.
One of the most successful transformational aspects of the program has been the presence of a dedicated Family Specialist, whose job is to focus on the wide range of needs that could arise in the first six months of a baby’s life. I recently had the opportunity to chat with Jalyn Alzate, the DULCE Family Specialist at the Family Care Center, who speaks enthusiastically about her experiences launching the program.
It is clear Jalyn is a central reason why DULCE has been so successful at the Family Care Center (FCC). Jalyn – like all DULCE Family Specialists – is at the forefront of care transformation. The FCC is beta testing the tedious, nitty gritty logistical pathways that are needed to shift culture, create a collaborative team dynamic, build trust with patients, and eventually, change systems. Jalyn noted that DULCE provides a structure that makes it easy for the practice to embrace a “whole person” approach—meaning there’s no need to create artificial distinctions between “medical” needs and “social” needs, since that’s not how a patient experiences their life. Jalyn supports patients with whatever is in front of them.
She is a big believer in the universality of DULCE. Early on, she found that if she asked a parent to enroll, that parent might say no at first – even though those who initially said no often searched Jalyn out for assistance later on. So Jalyn now attends the first two well-child visits for every newborn, and if after the second well-child visit they still aren’t interested, then she doesn’t press. But most are seeing the value and stick with DULCE. Jalyn enrolled a total of 60 families in year one, and even though we are just a few months into year two, she has already enrolled an additional 60 families.
Because Jalyn is employed at a family medicine practice where adults and children both receive care, she is able to enroll prenatal parents as well as newborns. This early access has allowed Jalyn to build a strong relationship with parents before the baby arrives and she finds they seek her out for resources and education faster. Jalyn says she finds it “rewarding to be chosen to be the person” to develop a trusting relationship with families.
Working with MLPB is Jalyn’s first experience having lawyers as part of a care team. She feels empowered by the expansion of her knowledge about different areas of law, like immigration or housing, and she can chart how her skills have developed to provide meaningful legal information and resources to families. In a recent case, MLPB helped Jalyn create a legal strategy for an immigrant parent who gave birth to her infant in the United States. Not only did MLPB provide context about the parent’s rights in the immigration context, but helped Jalyn to understand that because the US-born child was premature, the child is entitled to SSI benefits — something Jalyn didn’t know was a possible source of income for the family.
So far, approximately 350 families across all five Rhode Island locations have participated, and MLPB provided consults to over 180 DULCE patients in 2023. Thanks to CTC-RI, all five Rhode Island DULCE practices will likely be funded through early 2025. We at MLPB are honored to be able to participate in this innovative approach, and to help give shape to what collaborative, coordinated, and person-centered care can look like.
