Homelessness is TOXIC STRESS - The National Association for the

Report
Homelessness is TOXIC STRESS: The Impact of
Homelessness on Early Attachment Relationships and
Development in Infants, Toddlers & Very Young Children
Michelle Anderson
Anne Giordano
EDUCATION CONNECTION
Deirdre Houlihan DiCara
FISH Shelter
Friends in Service to Humanity
Agenda
Welcome & Introductions
Training Objectives for Participants:
Understand the Relationship Between Homelessness and Toxic Stress
Understand How Homelessness Impacts Attachment Relationships
and Development
Learn Successful Strategies for Engaging Families
Learn Strategies for Working Collaboratively with Community Partners
(Adapted from presentation with Roseanne L. Flores, Ph.D., at the Head Start, 11th National Research Conference, 2012)
Introduction
 Homelessness has often been viewed as an extreme form
of poverty, influenced by an “accumulated lifetime
exposure” to environmental risks.1
 One woman experiencing homelessness described it as,
“a remarkably constant stream of distressing and spirit –
breaking encounters, beginning in early childhood”,
including lifelong poverty, parental neglect, exposure to
domestic violence, childhood abuse (including sexual
abuse), and unhappy and painful interpersonal
relationships.2
Why this Matters: Demographics & Numbers
 US public schools identified 1,168,354 homeless students in
2011-2012 3
 More than half of children living in HUD funded shelters in 2012 were
under the age of 6: 3
 Under age 1 = 33,044
 Ages 1-5 = 134,631
 One third of the homeless population are families:
60% of homeless women have children under the age of 18
42% of children in homeless families are under the age of 6
20% of homeless youth become pregnant
25% of very young children experiencing homelessness evidenced poor social emotional
development
o Homelessness during infancy & toddlerhood linked to early school failure and child welfare
involvement
o Homeless in early childhood associated with poor social skills and classroom engagement in
o
o
o
o
elementary school
3
CT Child Statistics
•
CT has approximately 108,000 infants and toddlers and 75,000
preschoolers:
•
17% are living in poverty
•
5.5% are born to teen mothers
•
12% are born to mothers without a high school diploma
•
22% of mothers have inadequate prenatal care
•
7.7% are born low birth weight
•
20.7% enter kindergarten without having attended preschool
•
6,965 children were abused or neglected in last year reported (all ages)
And because we know that….
• “What happens in the first three years of a child’s
life has a direct and enduring impact on a child’s
future learning, behavior and health.”
Lisa Honigfield, Ph.D., CT Child Health & Development Institute (CHDI)
Key Terms:
Attachment
Toxic Stress
Definition of Attachment
Attachment is the ongoing emotional bond that the child builds with
a familiar adult through a nurturing relationship.
Infants and toddlers who are building attachment relationships tend
to seek and maintain closeness to important people in their lives,
especially during stressful situations.
When infants and toddlers have healthy relationships that support
attachment, they learn to trust that the world is safe, and they have
the confidence to explore and learn!
(DECA –for Infants & Toddlers)
Attachment & the Impact on
First Relationships
• The ways in which primary caregivers interact with their babies in
their first years of life provide the answers to these critical questions
about the baby’s sense of security:
o
o
o
o
Is my environment safe for exploration and learning?
Can I count on someone to respond to my needs?
Am I worthy of attention?
Are people trustworthy?
Secure Attachments:
When a primary caretaker meets the social and emotional
needs of a child in an appropriate, consistent manner, that
child feels safe and secure in the attachment relationship:
• Acts as a protective factor.
• Helps promote cognitive functioning…if a child feels
safe, they have lower stress levels, so they can stay
regulated and maintain low cortisol levels (stress
hormone).
• Allows children the freedom to explore their
environment, and learn!
Insecure Attachments:
• May occur when caregivers do not respond to their child’s
distress signals in a consistent manner.
• Inhibits emotional & cognitive development.
• Higher stress results in high levels of cortisol (stress
hormone), resulting in unregulated & insecure children.
• Leaves children less likely to explore their world and take in
new experiences.
• Negatively affects children’s relationships into adulthood.
Leads to the Formation of the Child’s Internal
Working Model:
• Positive
• Negative
Positive:
Develops when caregivers are nurturing, consistent, loving &
empathic- child’s internal voice says•
•
•
•
“I am loveable”
“I can trust others”
“I deserve to be happy”
“I am capable of making others happy”
Negative:
Develops when caregivers are punitive, abusive, neglectful,
rageful, or self-absorbed- child’s internal voice says•“I am incapable of being loved”
•“I cannot trust others”
•“I am trouble to be around”
3 Types of Stress Responses
•
•
•
Positive Stress
Tolerable Stress
TOXIC STRESS
Positive StressA normal and essential part of healthy
development (working on a challenging task,
getting an immunization, entering childcare,
starting a new job, etc.)
Tolerable StressIf the situation is time-limited, and is buffered by
positive relationships and support from trusted
adults who help the child adapt- the brain and
organs recover (divorce, loss of loved one,
frightening injury, etc.)
TOXIC STRESS
Occurs when a child experiences
strong, frequent/and or prolonged
adversity- without the buffering of
adequate adult support 4
Definition of Toxic Stress (cont.)
• Examples can include: physical or emotional abuse, chronic neglect,
caregiver substance abuse or mental illness, exposure to violence,
and/or the “accumulated burdens of family economic
hardship”.4 (ex. homelessness)
• Toxic stress disrupts the development of brain architecture and of
other organ systems.4
Toxic Stress and Homelessness
• The prevalence of traumatic stress in the lives of families
experiencing homelessness is extraordinarily high and
on-going:
o childhood abuse and neglect
o family disruption & loss
o domestic & community violence
o involvement with the foster care system
o trauma associated with the loss of home, safety and sense of
security 4
ACE Study:
Adverse Childhood Experiences
• Conducted by Kaiser Permanente from 1995-1997 5
• 17,000 participants
• Measured exposure and frequency of early experiences prior to age
18, including:
o Abuse (physical, emotional, sexual)
o Neglect (physical, emotional)
o Household Dysfunction
• Mother treated violently
• Parental substance abuse
• Parental mental illness
• Parental separation/divorce
• Incarceration of family members
Frequency & #’s of ACE’s are strongly
correlated to future mental health & social
complications:
•
•
•
•
•
•
•
•
Alcoholism & substance abuse
Depression
Fetal death
Risk for intimate partner violence
STD’s and multiple sexual partners
Adolescent pregnancy
Smoking
Suicide
ACE’s also linked to future health/medical
complications:
•
•
•
•
•
COPD
Heart disease
Liver disease
Obesity
Health related “quality of life” issues
Toxic Stress and Homelessness
 Children in homeless families experience more stress in their lives,
and at early ages.3o
o
o
o
o
fear that something bad will happen to their families
high rates of family separation
>12% of homeless children are placed in foster care
83% are exposed to a serious violent event by age 12
anxiety over having a place to live or sleep at night
Characteristics of Homeless
Families
 Mothers who are homeless often are: 6, 7
o poorly educated
o
o
o
o
o
o
o
unemployed
lacking in employable skills
earning incomes significantly below FPL
experiencing acute and chronic physical, dental & mental health issues
limited in access to adequate health care
have high rates of substance abuse, severe mental health disorders
exposed to physical, emotional & sexual abuse, both as children & adults
Characteristics of Homeless
Families
 Young children who are homeless often demonstrate: 8,9
o
o
o
o
o
poor educational outcomes
poor school performance
poor health (chronic ear infections, asthma, gastric issues, skin issues)
developmental delays (cognitive, speech & motor)
behavioral/mental health issues
 And:
o experience hunger, disturbances of sleep
o lack appropriate toys & resources
Impact of Homelessness on
Pregnancy
 Women who are pregnant & homeless are most likely:10
o
o
o
o
o
o
o
o
o
o
young/adolescent
highly stressed
socially isolated
malnourished
poor
undereducated/unemployed
experiencing physical/mental health issues
experiencing/have experienced abuse
lacking needed social supports
to have poor relationship histories
Impact of Homelessness on
Pregnancy
 Homelessness interferes with establishing the positive prenatal
characteristics that promote optimal development for the newborn,
including:11,12
o
o
o
o
o
adequate prenatal care
mentally preparing for parenthood
logistically preparing for the birth
forming impressions of the new baby
visualizing where the baby will “be”
o These all promote the early formation of positive, secure attachment
patterns
Impact of Homelessness on
Infants
 Primary developmental task of infancy is to establish security &
trust—parents’ task is to support the infant through responsive and
consistent caregiving.13
 Homelessness works against this primary developmental task due
to:12
o
o
o
o
o
unpredictable & inadequate physical environments
inability to meet basic needs
exposure to extreme temperatures
overcrowded & over stimulating living conditions
possible presence of multiple adult caregivers
Impact of Homelessness on Infants
 Infants may become emotionally flooded and overcome with hunger,
physical discomfort, & frustration.14
 Infants may be negatively impacted by loss of mother’s emotional
response & availability, leading to insecure attachment patterns.14
 Consequences can lead to high rates of emotional, physical, health, &
developmental issues, & cognitive, motor & language delays.14, 15
Impact of Homelessness on
Toddlers
 Primary developmental task of toddlers is to develop self-regulation &
identity—parents’ task is to support the toddler through scaffolding for
regulation and the provision of a safe, secure environment.13
 Homelessness works against this primary developmental task due
to:16
o
o
o
o
o
o
poorly maintained & unsafe environments
restrictions on toddler’s opportunity for free exploration
pressure on parents to manage behavioral outbursts & power struggles
feeling of parenting under a “microscope”—leads to embarrassment
absence of developmentally appropriate materials & activities
parents’ autonomy to make decisions is sometimes limited due to shelter routines
Impact of Homelessness on
Toddlers
 Toddlers may begin to demonstrate reactions to continual stress
including:13
o
o
o
o
o
o
o
o
o
o
o
feelings of insecurity
distrust
fears
loss of skills
frequent illnesses
irritability
stagnancy in developmental skills
regression in developmental skills development
delays in social, cognition, communication & motor skill development
behavioral issues
issues of sleeping & eating
Impact of Homelessness on
Preschoolers
 Primary developmental tasks of preschoolers are to develop recognition of
emotional states of others, separating from parents, and to develop social
competence with peers & adults—parents’ task is to provide the preschooler
with external support in understanding social situations and facilitating
relationship building with peers & adults.13, 17
 Homelessness works against these primary developmental tasks due to:
o
o
o
o
inability to provide a structured & organized environment 18, 19
inability to provide books & toys that promote development 18, 19
parents under stress may themselves model poor interpersonal skills with others18, 19
unruly behavior in children as they get older may cause eviction resulting in additional
stress1
Impact of Homelessness on
Preschoolers
 Preschoolers may begin to exhibit:20
o
o
o
o
o
o
o
o
o
difficulty with peers
intense emotional reactions
feelings of boredom
frequent illnesses
anxiety
developmental stagnancy or regression
developmental delays in cognition, communication & school readiness skills
externalizing behaviors in order to exhibit a sense of control
issues of sleeping & eating
So… what can we do????
• Think about the following statement by Bruce Perry, M.D.
o “There is no more effective neurobiological intervention than
a safe relationship…..it changes the brain.”
It’s all about the relationship!
• Think about the “parallel process”… “do unto others as you would
have others do unto others” (Jeree Pawl, 1998).
• Parents cannot give what they haven’t received themselves … or
may have lost along their journey.
• In order for parents to be able to offer a sense of security to their
children… we must first offer it to them!
• Remember that “how we are”…… is often more important than what
we do!!!!!!!
So.. How do we do it?
• We must first create opportunities for parents to feel:
• Safety
• Security
• Respect
• Trust
• Dignity
Examples in action……
McKinney Vento Grant CoordinatorMichelle Anderson
FISH Executive DirectorDeirdre Houlihan DiCara
Builds strong relationships with
shelter staff, early childhood providers
& schools- leads to early identification
and immediate connection to families
Instills “family atmosphere” into all
aspects of shelter life: holidays,
family meals, birthday celebrations
picnics, etc.
Streamlined identification processes & Hosts baby showers –encourages
forms- timely response & reduces
attachment building
chance of missing referrals
Promptly meets with families one-onone; provides concrete assistance
which promotes security
Promotes sense of “pride” among
residents by encouraging their
participation in community events
Conducts developmental screenings to Attends child events: graduations,
identify children at risk for
award ceremonies, etc.- promotes self
developmental concerns
concept
Conducts on-site playgroups in
shelter-encourages positive
child/parent interaction
Invites past residents back to shelter
for family dinners- maintains sense of
connection & relationships
Treats all with respect & dignity!
Treats all with respect & dignity!
Practices to Support Positive Outcomes for Young
Children & Families!
Reflections from the team……
• How do we impact and reach out to young children in our
community? What supports do we offer?
o Collaborations & Partnerships are KEY!
• McV Sub-grant Coordinator & Shelter Director have strong partnerships with:
o Shelter staff- allows for timely identification & connections with families!
o Local Continuum of Care
o Superintendent & every school social worker
o City officials & civic organizations
o Community Foundations (funding opportunities)
o Local library, child enrichment programs
o Early Care Programs: PAT, HS/EHS, B-3, Child First, childcare centers, etc.
o On-site shelter services in place:
• Home visits to families with children at FISH & SBA
• Developmental screenings conducted (ASQ); referrals as needed
• Playground & Library established with HS funding
• Birthday Parties/holidays/baby showers
• GED, life skills, cooking classes
• Job preparation
Continued…..
• Direct supports for children & families:
o
o
o
o
o
o
o
o
o
o
Camperships & enrichment programs
Clothing
Backpacks/school supplies/athletic equipment
Early care tuition
Baby supplies
Books, toys
Food resources
Tuition to school clubs, class trips, programs
Tutoring
Transportation supports
• Partnership Successes:
o
o
o
o
o
o
o
Annual Homeless Connect event (Children’s Corner)
First Book grant award of free books
Local donors (i.e.: Walmart cards, etc.)
Local grant awards
Caseworkers at FISH & SBA are well established- allows for direct contact
Local officials, legislators, and school administration on board!
Strong collaborative history in our community!
But as always… there are barriers!
•
•
•
•
•
Lack of available slots to enroll children in early care programs!
Transportation is basically non-existent in our area
Few shelter beds exist in our community
Lack of affordable housing
TRUST… always a work in progress
Strategies for accessing early
childhood services
 Identify existing early childhood programs in your community
 Connect with key early childhood stakeholders
 Advocate for slots for homeless children within early childhood
programs; be “flexible” with requirements
 Include “homelessness” in selection criteria for enrollment by
classifying homelessness as an “at-risk” factor
 Designate a “young child” contact at each homeless service program
(homeless/DV/ emergency shelters) in your community
Provider Strategies for Successful Home Visits
with Homeless Families!
 Be willing to meet families where they are…even getting to a
program a few blocks away can be overwhelming—schedule as
much as possible on site where they are.
 Be aware that the “multiple provider” approach can be intimidating
and confusing to families—sometimes fewer is better!
 Offer a variety of locations to conduct home visits— shelter, library,
coffee shops, other scheduled appointments the family already has—
sometimes this is the only privacy they have.
Provider Strategies for Successful Home Visits with
Homeless Families!
 Schedule regular visit times to shelters that you are available (i.e.
every Thursday morning) rather than individually set appointments—
sometimes better results.
 Be flexible—“think out of the box”—and willing to adapt & stretch
some program rules to better fit family situation.
 Q-TIP: Quit Taking It Personally! Just because a family doesn’t follow
through with you, doesn’t mean it is about you or their interest in
being the best parent they can be…it may be just all they can do at
that particular moment.
Provider Strategies for Successful Home Visits with
Homeless Families!
 Focus on “what you can do” instead of “what you can’t do”…
accept and expect that there are many barriers to serving this
population.
 Offer respect and listen—sometimes that is enough!
 Remember that it “is all about the relationship”—recognize that you
must build trust first, and even then, it can be challenging to keep
families engaged with you at times.
Presenter Contact Information
Michelle Anderson
EDUCATION CONNECTION
[email protected]
860-489-8552
Anne Giordano
EDUCATION CONNECTION
[email protected]
860-567-0863 X 236
Deirdre Houlihan DiCara
FISH/Friends in Service to Humanity
[email protected]
860-482-7300 / 860-605-5135
Resources
 http://www.naehcy.org/early.html
 http://www.horizonsforhomelesschildren.org
 http://www.familyhomelessness.org
 http://www.serve.org/nche
References
•
1David,
D.H., Gelberg, L., & Suchman, N.E. (2012). Implications of homelessness for parenting young children: A preliminary
review from a developmental attachment perspective. Infant Mental Health Journal, 33(1),1-9. doi: 10.1002/imhj.20333.
•
2
•
3Demographic
•
4Center
•
5 ACES:
•
6Bassuk,
•
7Rog,
Styron, T. H., Janoff-Bulman, R., & Davidson, L. (2000). “Please ask me how I am:” Experiences of family homelessness in the
context of single mother’s lives. Journal of Social Distress and the Homeless, 9(2), 143-165. doi: 10.1023/A:1012945602583.
information was extracted from The National Center on Family Homelessness (2011). The characteristics and
needs of families experiencing homelessness. Retrieved from http://www.homelessness.org/media/306.pdf.
on the Developing Child Harvard University. (2012). Toxic stress: The facts. Retrieved from
http://developingchild.harvard.edu/topics/science_of_early_childhood/toxic_stress_response/.
The Adverse Childhood Experience Study. http://www.acestudy.org/index.htm
E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., & Perloff, J. N. (1997). Homelessness in
female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87(2), 241—248. doi:
10.2105/AJPH.87.2.241.
D. J. & Buckner, J. C. (2007). Homeless families and children. Toward Understanding Homelessness: The 2007 National
Symposium on Homelessness Research. Retrieved from http://aspe.hhs.gov/hsp/homelessness/symposium07/rog/index.htm.
References
•
8Haber,
M. G., & Toro, P. A. (2004). Homelessness among families, children and adolescents: An ecological-developmental
perspective. Clinical Child and Family Psychology Review 7(3), 123-164. doi: 10.1023/B:CCFP.0000045124.09503.f1.
•
9Better
•
10Bassuk,
•
11Bassuk,
•
12Galinski,
•
13Sroufe,
•
14Easterbrooks,
•
15Garcia
Homes Fund. (1999). Temperament and attachment security in the strange situation: An empirical rapprochement. Child
Development, 58(3), 787.795. doi: 10.2307/1130215.
E. L. & Weinreb, L. (1993). Homeless pregnant women: Two generations at risk. American Journal of Orthopsychiatry,
63(3), 348-357. doi: 10.1037/h0085034.
E. L. (1991). Homeless families. Scientific American, 265(6), 66-74.
E. (1981). Between generations: The six stages of parenthood. New York, NY: Berkeley.
L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). The development of the person: The Minnesota Study of
Risk and Adaptation From Birth to Adulthood. New York, NY: Guildford Press.
M. A. & Graham, C. A. (1999). Security of attachment and parenting: Homeless and low-income housed mothers
and infants. American Journal of Orthopsychiatry, 69(3), 337-346. doi: 10.1037/h0080408.
Coll, C., Buckner, J. C., Brooks, M. G., Weinreb, L. F., & Bassuk, E. L. (1998). The developmental status and adaptive
behavior of homeless and low-income housed infants and toddlers. American Journal of Public Health, 88(9), 1371-1374. doi:
10.2105/AJPH.88.9.1371.
References
•
16Smolin, A.
G. (2003). Children born into loss: Some developmental consequences of homelessness. Journal of the
Psychoanalysis of Culture and Society, 8(2), 250-257. Retrieved from
http://muse.jhu.edu/journals/journal_for_the_psychoanalysis_of_culture_and_society/v008/8.2smolen.html.
•
17Hausen,
•
18Heinicke,
•
19Averitt,
•
20From
B. & Hammen, C. (1993). Parenting in homeless families: The double crisis. American Journal of Orthopsychiatry, 63(3),
358-369. doi: 10.1037/h0079448.
C. M. (2002). The transition to parenting. In M. H. Bornstein (Ed.), Handbook of Parenting (2nd ed., pp. 363-388).
Mahwah, NJ: Lawrence Erlbaum Associates.
S. S. (2003). “Homelessness is not a choice!” The plight of homeless women with preschool children living in temporary
shelters. Journal of Family Nursing, 9(1), 79-100. doi: 10.1177/1074840702239492.
a presentation given by Nancy Suchman, Ph.D. , Associate Professor, Yale University School of Medicine. Mothering from
the Inside Out: Promoting Reflective Parenting in At-Risk Mothers Caring for Young Children. Sponsored by, CT Association for
Infant Mental Health, April 2012.

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