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First 1,000 Days Program

The First 1,000 Days aims to improve the health of families from pregnancy through age 2 by engaging providers from both clinical and community health services. It is being piloted at the MGH Chelsea and Revere HealthCare Centers and DotHouse Health.

Overview

The “First 1,000 Days” —conception to age 2 years— is an important period for the prevention of obesity in mother-child pairs and their families. The First 1,000 Days program aims to prevent the development of obesity among mother-infant pairs at MGH’s Revere and Chelsea HealthCare Centers and DotHouse Health, where rates of maternal-child obesity are higher than local and national averages.

The program engages providers from primary care (obstetrics, pediatrics, adult medicine), mental health, and community health services, such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), home visiting and fatherhood programs. Mother-child pairs are followed from the mother’s first prenatal visit until the child’s second birthday. 

Program components include:

  • Enhanced electronic health records to improve the quality of preventive services and screening for social determinants of health;
  • Consistent behavior change messaging across sectors and providers;
  • Patient education via print, text messaging and short videos;
  • Strengthening of integration of clinical and public health services to support behavior change and address social determinants of health; and
  • Individualized health coaching for mother-infant pairs at high risk of obesity.

 

Please contact the First 1,000 Days Clinical Research Coordinator, Brianna Roche at 617-643-6182 or broche@mgh.harvard.edu for questions or to request more information on the program.

Leadership Team

Photo of Elsie Taveras, MD, MPH

Elsie Taveras, MD, MPH

Co-Director & Principal Investigator, The First 1,000 Days Program
Chief, Division of General Academic Pediatrics
Executive Director, The Kraft Center for Community Health, Mass General Hospital


Photo of Alexy Arauz Boudreau, MD, MPH

Alexy Arauz Boudreau, MD, MPH

Co-investigator, The First 1,000 Days Program
Assistant in Pediatrics, Division of General Academic Pediatrics
Pediatrician, MGH Chelsea HealthCare Center


Photo of Tiffany Blake-Lamb, MD, MSc

Tiffany Blake-Lamb, MD, MSc

Co-Investigator, The First 1,000 Days Program
Obstetrician, MGH Revere HealthCare Center


Photo of Sarah Matathia

Sarah Matathia, MD, MPH

Co-Investigator, The First 1,000 Days Program
Family Medicine, DotHouse Health


Photo of Milton Kotelchuck

Milt Kotelchuck, PhD, MPH

Evaluator, The First 1,000 Days Program
Professor, Division of General Academic Pediatrics


Photo of Meghan Perkins, MPH

Meghan Perkins, MPH

Project Manager, The First 1,000 Days Program
Division of General Academic Pediatrics


Photo of Sarah Price

Sarah Price, MPH

Health Educator, The First 1,000 Days Program
Division of General Academic Pediatrics


Photo of Brianna Roche

Brianna Roche

Clinical Research Coordinator, The First 1,000 Days Program
Division of General Academic Pediatrics


Photo of Karolyn Moni

Karolyn Moni

Patient Navigator, The First 1,000 Days Program
Division of General Academic Pediatrics


Photo of Courtney Coleman

Courtney Coleman

Health Coach, The First 1,000 Days Program
Division of General Academic Pediatrics


Photo of Grace Lovell

Grace Lovell

Clinical Research Coordinator, The First 1,000 Days Program
Division of General Academic Pediatrics


Patient Education

The First 1,000 Days patient education includes print materials, a text message campaign, and online videos. All print material is available in English and Spanish, and many are in Vietnamese and Arabic. See below for more detailed information on each of these forms of patient communication.

Posters

Pregnancy

Each participating OB practice has First 1,000 Days posters in the waiting room. The waiting room poster provides an introduction to the program and a prompt to ask for more information about it. A First 1,000 Days pregnancy goals poster is in each OB exam room. This poster outlines each of the behavioral goals for healthy weight gain in pregnancy and is intended to cue women to consider the recommended behaviors and discuss goal-setting with their clinician.

Pediatrics

First 1,000 Days infant goals are posted in all pediatric waiting rooms and exam rooms and introduce behavioral goals and recommendations for ages 0-2 years.

Booklets

Pregnancy

First 1,000 Days pregnancy booklets are given to patients in the first and second trimesters. The earlier pregnancy booklet focuses on healthy weight gain during pregnancy and outlines the behaviors associated with it. The later pregnancy booklet addresses issues of self-care, including breastfeeding and feeding cues, preparing to be a parent (for both moms and dads), and feelings during pregnancy. The First 1,000 Days postpartum booklet is given to patients at their 6-week postpartum visit in OB. It covers weight loss after pregnancy; breastfeeding tips and support, self-care, and information for dads, All booklets encourage goal-setting and direct women to view the online vidscrips.

Pediatrics

First 1,000 Days pediatric booklets offer parents support and recommendations to help their infants get a healthy start in their first two years. Topics covered include feeding, sleep, hunger and satiety, screen time, and playtime.

Text Messaging

The text message campaign is intended to keep the First 1,000 Days goals present in the minds of the women involved in the program, and to support them in being healthy both during and after pregnancy, in addition to keeping their babies healthy. Goal-specific tips and motivational text messages are sent to support women and encourage behavioral changes. Messages are sent three times per week most weeks during pregnancy and until the baby is approximately 1 year old. In the second year (until the baby turns 2), messages are sent about once a week. The First 1,000 Days also offers text messages for dads in the pregnancy period. Text message campaigns are currently available in English and Spanish.

Vidscrips

Vidscrips are short educational videos that engage patients on health topics and clinical services. The First 1,000 Days vidscrips offer short answers to common patient pregnancy and infancy questions. Pregnancy topics include sleep, diet, exercise, depression, and more. Infancy topics include sleep, feeding, soothing, hunger and satiety, and more. Overviews are also presented on the First 1,000 Days program, WIC, and nutrition services, among others. There are also videos introducing the MGH Fatherhood Project. Most First 1,000 Days vidscrips are currently available in English and Spanish.

The Boston Basics

The Boston Basics are 5 fun, simple, and powerful ways that every family can give every child a great start in life. Created for parents of 0-3 year olds, the Boston Basics are parenting and caregiving principles that encompass much of what experts find children really need at this age. It is a period in which skill gaps between socio-economic, racial, and ethnic groups become clearly apparent, but this does not need to be! Everyday interactions between children, their parents, and other caregivers provide abundant opportunities to give children from every background a more equal start in life. Check out the Boston Basics Campaign to learn more.

Clinician Tools/Training

Patient Education Materials

First 1,000 Days patient education materials are shared with patients and used as tools to help guide the conversation at clinical visits. All pregnancy materials are available in English, Spanish, Arabic, and Vietnamese. Pediatric print materials are available in English, Spanish, and Arabic.  Link to Materials

Program Brief

An overview of The First 1,000 Days program, including the background, methodology, program components, and future directions. Learn more.

Expert Recommendations and Resources

Pregnancy

Pediatrics

Provider Newsletters

Training

2016 Introductory trainings presented providers with:

      • Background on the importance of focusing on overweight and obesity, maternal obesity, and risk factors for excess weight gain in early life
      • An overview of the First 1,000 Days program, including the prevention of maternal and child obesity, appropriate weight gain during pregnancy, and appropriate weight gain from birth to age 2
      • Brief Motivational Interviewing training

Specific training dates included:

    • June 2016 MGH Revere and Chelsea Health Centers trainings for providers who see pregnant women
    • June 2016 MGH Revere Health Center training for WIC providers
    • July 2016 MGH Chelsea Health Center training for Community Health Workers and other patient outreach staff
    • November 2016 Revere and Chelsea Health Centers trainings for pediatric providers
    • January 2017 MGH Revere and Chelsea Health Centers Brief Motivational Interviewing training and behavior change counseling for pediatric providers and staff
    • February 2017 Webinar for pediatric providers and staff at MGH Chelsea and Revere Health Centers
    • June 2017 Chelsea Health Center pediatric program overview training for community Health Workers and other patient outreach staff

Research and Publications

  • Blake-Lamb T, Arauz Boudreau A, Matathia S, Tiburcio E, Perkins ME, Roche B, Kotelchuck M, Shtasel D, Price SN, Taveras EM. Strengthening integration of clinical and public health systems to prevent maternal-child obesity in the First 1,000 Days: A Collective Impact approach. Contemporary Clinical Trials. 2018;65:46-52.

  • Gonzalez JJ, Duhaney L, Gerber MW, Roche B, Blake-Lamb T, Perkins ME, Taveras EM. The Association of Food and Housing Insecurity with Adverse Maternal Health Behaviors in Early Pregnancy. MGH Chelsea HealthCare Center Community Research Day Celebration, Chelsea, October 13, 2017. Poster Presentation.

  • Cruz-Bendezu AM, Lovell GV, Horan C, Gerber MW, Roche B, Blake-Lamb TL, Perkins ME, Kotelchuck M, Taveras EM. Pregnancy Intentions among Low-Income Women: Co-Morbid Conditions & Protective Effects of Primary Care. Poster presentation at Massachusetts General Hospital for Children Research Day, Boston, MA; March 27, 2017.

  • Perkins ME, Blake-Lamb TL, Boudreau AA, Matathia S, Kotelchuck M, Shtasel D, Taveras EM. Rationale and Design of the First 1,000 Days Program to Prevent Maternal-Child Obesity and Address Social Determinants of Health.  Accepted for poster presentation at MGHfC Research Day, Boston, MA; March 29, 2016.

  • Blake-Lamb TL, Locks L, Perkins ME, Woo Baidal JA, Cheng ER, Taveras EM. Interventions for childhood obesity in the first 1000 days. A systematic review. Am J Prev Med. 2016;50:780–789.

  • Baidal J.A.W., Locks L.M., Cheng E.R., Blake-Lamb T.L., Perkins M.E., Taveras E.M. Risk Factors for Childhood Obesity in the First 1000 Days: A Systematic Review. Am. J. Prev. Med. 2016;50:761–779.

  • Perkins ME, Blake-Lamb TL, Arauz Boudreau AA, Matathia S, Kotelchuck M, Price S, Roche B, Tiburcio E, Shtasel D, Taveras EM. Rationale and Design of the First 1,000 Days Program to Prevent Maternal-Child Obesity and Address Social Determinants of Health. MGH Chelsea HealthCare Center Community Research Day Celebration, Chelsea, October 7, 2016. Poster Presentation.

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