This article appeared in the Winter 2013–14 issue of Erikson on Children.
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The first call was from a father who was a family physician. He called the warmline number in tears, wondering what to do about his baby who cried all the time.

“The hardest part is that I don’t love her,” the father said.

“That’s what he needed to share,” recalls Linda Gilkerson, professor and executive director of Erikson’s Fussy Baby Network®. “Just to have someone to hear it, that’s what he needed. At the end of the call, his relief was just palpable.”

In 2003, Gilkerson and her staff established the Fussy Baby Network, a community-based prevention program, to help parents just like that father. At its founding, the program served families in the Chicago area struggling with their infant’s crying, sleeping, or feeding through warmline telephone support, home visits, parent groups, and a Fussy Baby Clinic in association with the University of Chicago Department of Pediatrics.

Ten years later, the project has become a national model for prevention, expanding to 11 affiliate sites nationwide and pioneering an infusion model into two national, evidence-based home visiting programs.

From the beginning

“I had the experience myself of being a parent of a fussy baby,” Gilkerson says. “My husband and I lived it, and it left me with a passion for helping parents from the very beginning.”

Gilkerson’s research with Larry Gray, M.D., of the University of Chicago and Fussy Baby Network’s medical director, found that one-third of the babies seen for crying in the University of Chicago Emergency Department did not have medical problems. Rather, they were there because of parent stress and worry about their baby.

“Crying is a normal part of development, but what we know now is that it relates to family stress and parental depression, and even can be a trigger for child abuse,” she says.

Gilkerson conducted focus groups with new parents to explore the best ways to offer support. “They told us how alone they were and how criticized they felt because things weren’t going the way others thought they should,” Gilkerson says. “They told us that it felt endless, and they just needed help.”

With support from the Doris Duke Charitable Foundation, the Network began with a dual focus: to help parents with their urgent short-term concerns and build their confidence and competence in meeting their infant’s long-term needs. A critical part of the mission is making services available to all families, regardless of income. Families can receive both pro-bono and sliding scale services based on need, and no one is ever turned away.

The Chicago Public Schools Prevention Initiative also supports services for families with low incomes. Since its founding, the Fussy Baby Network has conducted some 4,200 parent groups for the Chicago Public Schools and other groups under the leadership of Fussy Baby Network’s Michelle Lee.

From warmline to home visit

The warmline is often parents’ first point of contact with the Fussy Baby Network. Infant mental health specialists like Nancy Mork field the calls and respond to parents within 24 to 48 hours.

“As I listen to the story unfold, I try to slow down the pace so I can see where parents are coming from,” says Mork. “I can hear the family start to breathe and be able to take in support.”

Since the project began, the warmline has responded to calls from more than 3,100 families from around the country. Network specialists may talk to a family four times over the course of a month; other families use the warmline as a sounding board for a year. Often, the family just needs one phone call.

“You can hear their confidence go up as they realize, ‘My baby’s okay. I’m okay,’” Mork says.

When families need more support, the specialists arrange a home visit. The Fussy Baby Network’s Chicago staff has conducted home visits for more than 1,100 families over 10 years; the affiliate sites have conducted countless more.

In Chicago, one mother who turned to the Fussy Baby Network for support was Elizabeth Aguilar. Her newborn daughter cried all the time. “It seemed like she was crying 26 hours a day,” Aguilar says. “I would take her to the hospital, but they just told me she was fussy.”

At a loss, she called the Fussy Baby Network. “I felt like I was a bad mom, like it was my fault she was crying,” she says. “I was looking for someone to tell me what to do, and I wanted a quick fix.”

Mork began to visit Aguilar and her daughter, Sophie, once a week in their home.

“Nancy would just listen to me,” Aguilar remembers. “It helped me build my self-confidence and helped me feel comfortable being her mom. Nancy really helped to ground me so that I could read Sophie and could figure out what she was asking of me without words. I could identify when she needed something and when she was just being fussy.”

The mother and daughter’s relationship continued to improve and at eight months, “she flipped,” Aguilar says. “Sophie stopped crying. We formed a different bond, and it was much easier being with her without panicking and feeling it was my fault.”

Around the world

In 2007, the Fussy Baby Network began to expand beyond Chicago, starting with its first official affiliate: Southwest Human Development, a large early childhood agency in Phoenix.

“We saw Fussy Baby as a very compatible approach to how we were working with struggling families,” says Alison Steier, director of the agency’s Harris Infant and Early Childhood Mental Health Training Institute. “It didn’t take very long to recognize the generalizability of that approach to many of the other clinical situations that we deal with in our other programs.”

To enable affiliates to be trained in the Fussy Baby approach, Gilkerson and her team developed the FAN, a visual representation of the Fussy Baby Network’s approach to engaging with families.

“Without the FAN, we could do good work but we couldn’t share it,” Gilkerson says. “One of our goals along with our funders was to create a national model that could be disseminated broadly. We needed to develop practical tools to help practitioners be with families and adjust to need, based on the cues that parents were showing.”

The FAN illustrates each core process in one word: Feeling, Calming, Thinking, Doing, and Reflecting. Each process is centered on parents’ urgent concern and is designed to support them in the moment. Using the model, a specialist can observe parents and determine where they are on the FAN spectrum and what they most need, from listening with acceptance to capacity building. The FAN approach also helps specialists be mindful of their own responses in the moment.

Following Phoenix, the Network quickly expanded to California, Colorado, Florida, Louisiana, Maryland, Massachusetts, New Mexico, and Washington. Affiliate sites replicate the direct service program by providing home visiting and phone support services, infuse the Fussy Baby approach into existing services, or implement a combination of both. The Network also recently went international: it is working with colleagues in Israel to bring the approach to a program in Jerusalem.

A model for intervention

The Fussy Baby Network continues to expand its reach through several large-scale projects. In 2012, the Fussy Baby Network began working with Healthy Families Illinois to develop and implement training for the agency’s home visiting staff based on the Fussy Baby approach. After being piloted in llinois, the training may be added to the national curriculum of Healthy Families America®, a home-visiting program designed to work with families who are at-risk for adverse childhood experiences.

Fussy Baby also is infusing its approach into Healthy Steps, a national model that adds child development specialists to primary care. Additionally, with support from the Doris Duke Charitable Foundation, Fussy Baby is developing and testing the effectiveness of the FAN in training pediatric residents and fellows in family communication.

“We have realized the dream and gone beyond,” Gilkerson says of the new partnerships. “The Doris Duke Charitable Foundation’s goal was to fund a national model, and that’s what the Fussy Baby Network has become. Infusing the model into home visiting and primary health care will allow us to go beyond the affiliate sites to reach even more parents who need help.”

The Irving Harris Foundation also has supported the Fussy Baby Network since its inception, and is now involved in its expansion.

“This project is all about supporting families at a very vulnerable time in their lives and helping them become their child’s best caregiver,” says Phyllis Glink, the foundation’s executive director. “We have been excited to be able to partner with Erikson in the development and early replication of this important model, and we’re excited to see how it will continue to grow and positively influence the services, systems, and public policies targeting pregnant women, infants, toddlers, and their families.”

Barbara T. Bowman, professor and interim president of external affairs at Erikson, also recognizes the value of the Fussy Baby Network.

“It is a perfect example of extending Erikson’s mission to the community,” says Bowman. “We founded the Institute to effect social change and help families across the economic spectrum, and that is exactly what Linda and her team are doing.”