ACEs Community Spotlight Series: Dr. Richard Honigman, Central Nassau Pediatrics

By Maggie Wayne, Health Liaison

For our second community spotlight interview, I spoke with Dr. Richard Honigman, a pediatrician at Central Nassau Pediatrics in Levittown and infant mental health advocate. We discussed the importance of addressing childhood adversity and the relevant work he is doing both inside and outside his practice. Please note that responses have been adjusted for length and clarity.

Dr. Honigman is also the first recipient of the 2019 Ed Tronick Award for Distinguished Contribution to Infant-Parent Mental Health of the alumni from the UMASS Boston Infant-Parent Mental Health post-graduate Fellowship Program (Pictured here with Alexandra Harrison, MD; Marilyn Davillier, LCSW; Ed Tronick, PhD; Dorothy Richardson, PhD). He has completed Bruce Perry’s Child Trauma Academy’s Phase 1 Neurosequential Certification. Additionally, he is an active participant in Docs for Tots ACEs Learning Collaborative that has brought ACEs screening to pediatric offices across Long Island.

How did you get started working with families affected by  ACEs/Trauma on Long Island?

I have been involved with ACEs work for around a decade. Initially, I was doing work on the island of Grenada with a  foundation (Reach Within) that was interested in developing resiliency programs for youth who have experienced abuse and maltreatment living in residential facilities. This led me to do more research into early life adversity. I started to do more and more readings by and attending conferences with experts in the field, such as Dr. Felitti, Bruce Perry, and Bessel Van der Kolk. In 2012, I enrolled in Ed Tronick’s interdisciplinary 2 year Infant-Parent Mental Health Post-Graduate Fellowship Program at UMass Boston. This course covers normal and abnormal early development from a multi-interdisciplinary perspective and how to intervene to assist the infant-parent unit to correct dysfunctional trajectories. Also in 2012, I entered into a pilot program with South Oaks Hospital to co-locate a behavioral-mental health therapist in my office two days a week for my families that need intervention. I am happy to say that this program has been a resounding success and is still going strong.

Can you give me a brief overview of the work you do with ACEs?

I have continued working with experts in the field such as Bruce Perry, Steve Porges, and Ed Tronick. Ed Tronick and I, along with others, completed a pilot ACES study in Grenada that is awaiting publication. I have organized two early childhood development conferences for caregivers in Grenada and have worked with UNICEF there and in South Africa assisting with international conferences. I have also spoken for the local AAP chapter on ACES for a foster care conference and was a speaker on Trauma-Informed Care at the first annual Bermuda ACES conference last year. On Long Island, I work with the Institute for Parenting on their monthly, interdisciplinary infant mental health case conferences. Additionally, I work with the NYS Association for Infant Mental Health.

What inspired this specific work?

In my practice over the years there were more and more questions from parents regarding development and social-emotional issues that led me to delve deeper into the subject and we as pediatricians need to be well versed in this field so I took a deeper dive. From this I was learning all the things I should have learned in medical school but was never taught. I was an early adopter of social-emotional screening and as previously stated was a grant recipient to co-locate a behavioral health worker from South Oaks Hospital in my office two days a week. I got to see firsthand the impact that that change made on some of my patients. The more you learn, the more you see how early childhood events impact social-emotional and physical development over the lifespan.

What are your lessons learned?

If you don’t ask, you won’t know. You might miss something that could lead to poor health outcomes. I try to work with my parents to make them realize that there is more to a preventative pediatric visit than the physical components and see how emotional health impacts the mind and body.

What challenges do you encounter?

There can be an initial pushback when you try to bring these concepts up. Parents want to know why they are filling out all these forms. I work with them to explain the importance of repeat screening and work to normalize it in my office. I try to look at the whole child, speak with parents, and refer as needed.

What are the results of the work?

When a child’s behavior shows dysfunction, it is not always, for example, ADHD. If we address the dysfunction, we can improve their behavior. We know the body keeps score. In my office, I see children thriving better. It’s about moving toxic stress to tolerable stress and to do that we have to look at the child and the family together. I’ve also seen movement within the medical profession towards addressing ACEs. There has started to be general acceptance in the pediatric community.

What do you think is one next critical step we need to take on Long Island to increase ACEs awareness?

We need to have public forums for professionals to come and discuss concerns, obstacles, referral networks, and definitely some training in residency around trauma. If there could be some collaboration between Nassau and Suffolk pediatric societies, New York State Association for Infant Mental Health, and Docs for Tots to come together and learn from each other and discuss the importance of early life experience, I think that could really be something.

What recommendations or advice do you have for someone who wants to get started promoting awareness of ACEs and trauma-informed care on Long Island?

I think we should bring in OB-GYNs. We know that perinatal stress can cross the placenta and affect the growing fetus, effectively meaning infants can be born with perinatal ACEs. This would mean we could catch ACEs and social-emotional concerns even earlier. It’s also important to discuss that it’s not that that the child HAS toxic stress, it’s that the child is living within toxic stress. Sort of like the change in terminology for trauma-informed care from “what’s wrong with you?” to “what adversity has happened to you?” The purpose of this work is to change the environment and the child, we cannot change one without the other. I also want to see more of an emphasis on promoting resilience factors to buffer people who have experienced adversity.

Maggie Wayne is a Health Liaison with Docs for Tots, working with our partners on incorporating into pediatric practices screenings for Maternal Depression and Adverse Childhood Experiences (ACEs).