Helping Foster and Adoptive Families Cope with Trauma

Report
Promoting Community Systems of Care to
Foster Young Children’s Social and
Emotional Development
WELCOME!
• Introductions
– What brought you here today?
– What are you most excited about learning?
– Is there someone you are hoping to make a
connection with while you are here?
Today’s Goals
• Focus on early childhood (birth to age 5)
• Heighten awareness about the importance of
social and emotional development
• Encourage the importance of self-care &
colleague support
• Provide state and national resources related to
social and emotional development
• Allow time to consider your community system
of care related to early childhood social and
emotional development
Guiding Principles
• Child and family focus
• Healing occurs in supportive
relationships
• Professionals must care for themselves and support one
another in order to care for others
• Shared responsibility across professionals sectors is essential
• Children receive support according to their level of need, as
offered by a spectrum of care within the community
The Core Story
1. CHILD DEVELOPMENT IS THE FOUNDATION OF PROSPEROUS
COMMUNITIES.
2. Brains are built over time, from the bottom up (skill begets skill)
3. Genes and experiences together build brains (serve and return
relationships)
4. Cognitive, social and emotional development are inextricably
intertwined
5. Toxic stress damages brain architecture
6. Resilience is not an internal character strength, but rather is built
through combined impact of genes and experiences of a child
7. For many functions, the brain’s capacity for change decreases over
time (cost-effectiveness factor) - but not all
P.Levitt, 2013
The Challenge
• Social and emotional development is
foundational, and impacted by internal and
external forces
• Early traumatic experiences are common
– In Wisconsin (2010)
• 4,839 child victims of maltreatment
• Represents 3.7 children per 1,000 children in
the State
WI Department of Children and Families, Wisconsin Child Abuse and
Neglect Report, 2011
The Challenge: Child Maltreatment
U.S. Dept. Health and Human Services, 2010
The Challenge: Childhood Mental Illness
• >14 million children and adolescents in the
US (1 in 5) with a diagnosable mental health
disorder
• Only 20-25% of affected children receive
treatment or support
US DHHS Surgeon General’s Report (1999);
AACAP Committee on Health care Access and Economics, Pediatrics
(2009)
Community System of Care
• What is a community system of care?
• Who should be a part of a community
system of care?
– Families
– Professionals
Community Systems of Care Goal
Expedited and enhanced care for
children and families to promote
optimal outcomes
Community System of Care:
Pyramid Model for Supporting Social Emotional
Competence in Infants and Young Children
For Consideration
• Where are you in the spectrum of care?
• Who are your community partners in the
other parts of this spectrum?
• How successful are your efforts to
connect with other community partners
on this spectrum?
• How might this connection be improved?
Social and Emotional
Development
What is Social and Emotional Development?
The developing capacity of a young child to:
• Experience, regulate and express emotion
• Form close and secure interpersonal relationships
• Explore the environment and learn
All within the context of family, community and cultural
expectations for young children
Zero To Three : National Center for Infants, Toddler
and Families – Infant Mental Health Task Force
Infant and Early Childhood Mental Health
Develops through relationships with parents
and other caregivers.
Is fostered through nurturing and
supportive relationships.
Teaches the child that she/he has an
impact on her/his environment.
Calm
High Arousal
Relationships are the Basis of a
Child's Stress Response System
Adapted from B. Perry, MD, PhD. (2009)
Calm
High Arousal
Relationships are the Basis of a
Child's Stress Response System
Adapted from B. Perry, MD, PhD. (2009)
“There is no such thing as a baby,
there is a baby and someone else…”
-D.W. Winnicott
Social and Emotional Skills
Think of a child you know who is
socially/emotionally skilled.
What does that look like?
Think of a child who struggles and is hard
to reach.
What does that look like?
Social Emotional Competence
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Trust
Self-Confidence
Motivation
Persistence
Self-Control
Stress Impacts Social and
Emotional Development
Stress Responses in Childhood
Stress
Positive
Response
Tolerable
Toxic
Duration
Brief
Sustained
Sustained
Severity
Mild/moderate
Moderate/severe
Severe
Social-emotional
buffering
Sufficient
Sufficient
Insufficient
Long-term effect Return to
on stress
baseline
response system
Return to
baseline
Changes to
baseline
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Some Stressors in Childhood
Child Stressors
Family Stressors
Abuse, neglect, chronic fear state
Parental dysfunction:
•Substance abuse
•Domestic violence
•Mental illness
Other traumas
•Natural disasters
•Accidents and illness
•Exposure to violence
Divorce/single parenting
Disabilities/chronic disease
Poverty
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Other Factors Influencing Stress
Sources of Resilience
Temperament
Social-emotional supports
Learned social-emotional skills
Caregiver response
Other Vulnerabilities
Temperament
Delays in development
Limited social-emotional supports
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Traumatic Alterations
• Experience
• Epigenetic modifications
• Changes in brain structure
and function
• Behavioral attempts to cope
– May be maladaptive in other contexts
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Epigenetic Changes
• Alterations in the way the genetic program
is read
• Can cause structural changes in
developing brain
• Can influence the stress response
Disruptions in Brain
Architecture with Toxic Stress
Three important brain structures:
Amgydala
Hippocampus
Frontal cortex
Prefrontal Cortex
The Impact of Early Adversity
on Children's Development
Disrupted Brain Architecture
Can Influence Behavior
Behavior changes seen in young children
Additional behavior changes seen in older
children, adolescents and young adults
Maladaptive Behavior Can Be
Misleading
• Potential misdiagnoses
– Attention Deficit
Hyperactivity Disorder
– Oppositional
Defiant Disorder
– Bipolar Disorders
Behaviors that worked previously, continue to
result in some gain
Adverse Childhood Events (ACEs)
• ACEs (before age of 18)
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Physical abuse
Emotional abuse
Sexual abuse
Alcohol and/or drug abuser in household
Incarcerated family member
Household member chronically depressed, mentally ill,
institutionalized or suicidal
– Violence between adults in the home
– Parental separation or divorce
• Original Study (1995-1997)
• Wisconsin Behavioral Risk Factor Survey (BRSFS)
(2010)
http://www.cdc.gov/ace/
Significant Adversity Impairs
Development in the First 3 Years
Barth 2008, Center on the Developing Child at Harvard University
State and National Resources
There is Good News…
Identifying toxic stress and social
and emotional development
concerns and referring children
and families to supports and
services have the potential to
positively impact the child’s lifelong health and prosperity.
AAP, Helping Foster and Adoptive Families Cope with Trauma, 2013
Spectrum of Care Resources:
Workforce Resources
Resources for effective workforce
development
• Infant and Early Childhood Mental Health Providers
– Wisconsin Alliance for Infant Mental Health
– Infant, Early Childhood and Family Mental Health Certificate
Program
• Early Care & Education
– YoungStar
– Supporting Families Together Association
• Clinicians & Care Team Members
– American Academy of Pediatrics & The Wisconsin Chapter
• General Development Promotion
• Trauma-Informed Care
• Self & Colleague Care and Reflective Supervision
Wisconsin Alliance for Infant Mental
Health
• To stay connected with other early childhood
professionals and to find out more about
professional development opportunities, visit
us at: www.wiaimh.org.
UW Infant, Early Childhood and Family
Mental Health Certificate Program
Applications are currently being accepted for
this interdisciplinary academic program:
http://infantfamilymentalhealth.psychiatry.wisc.edu/
YoungStar
http://dcf.wisconsin.gov/youngstar/default.htm
Supporting Families Together
Association
https://supportingfamiliestogether.org/
Offers training and technical assistance
support to Child Care Resource and
Referral Centers, Family Resource
Centers throughout the State
Wisconsin Chapter of the American Academy
of Pediatrics Mental Health Webinar Series
Collaboration between Wisconsin Chapter of
American Academy of Pediatrics & Wisconsin
Council of Child and Adolescent Psychiatry
https://www.wiaap.org/wiaap-foundation/wacpp/
American Academy of Pediatrics
(AAP) Mental Health Toolkit
• Focus Areas
– Community resources
– Health care financing
– Support for children and families
– Clinical information systems/delivery system
redesign
– Decision support for clinicians
American Academy of Pediatrics
(AAP) Trauma Guide
Helping Foster and Adoptive Families Cope With Trauma
Webinar
Helping Foster and Adoptive Families Cope With Trauma: A
Guide for Pediatricians
Coding Tips
Visit Discharge and Referral Summary for Family
Parenting After Trauma: Understanding Your Child’s Needs
http://www.aap.org/traumaguide
Child Psychiatry Consultation
Program
• Call-in line for primary care clinicians to
support them in caring for children with
mental health needs
• Staffed by child and adolescent
psychiatrists
• Support available Monday-Friday, during
office hours
• Pilot program beginning January 2015
Birth to 5: Watch Me Thrive
Resources for
– Early Intervention Service and Early Childhood Special
– Education Providers
– Families
– Primary Care Providers
– Communities
– Child Welfare
– Home Visitors
– Behavioral Health Providers
– Housing and Homeless Shelter Providers
– Parents
http://www.acf.hhs.gov/programs/ecd/watch-me-thrive
Trauma-Informed Care
When faced with challenging behavior…
“What happened to this child?” or
“What is this family’s story?”
Rather than
“What’s wrong with this child or
family?”
Trauma-Informed Care
Resources in Wisconsin
Resources on Trauma Informed Care including an
active listserv
http://www.dhs.wisconsin.gov/tic/
Children’s Trust Fund :Wisconsin Adverse
Childhood Experience & Trauma
Workgroup
http://wichildrenstrustfund.org/index.php?section=
adverse-childhood
Wisconsin Trauma Project
• Introduce evidence-based trauma
screening, assessment and treatment
• Train parents and agency social workers
on childhood trauma
• Create a more trauma-informed &
responsive system of care
National Child Traumatic Stress
Network (NCTSN)
The NCTSN Mission
To raise the standard of care and improve
access to services for traumatized
children, their families and communities
throughout the United States
http://www.nctsn.org/
Importance of Self-Care and
Colleague Support Among
Professionals
“…We are stewards not just of those who
allow us into their lives but of our own
capacity to be helpful...”
Conte, JR. (2009). Foreword. In L. Van Dernoot Lipsky, Trauma
stewardship. An everyday guide to caring for self while caring for others.
Reflective
Supervision & Consultation
Core elements
– Supervisor/consultant is not the expert, but a
collaborative partner
– Shared exploration of the parallel process
– Professional and personal development within one’s
discipline through attending to emotional content
Social and Emotional Development
Promotion for All Children
Resources to support all children’s
social and emotional development
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Parenting support
Reach Out and Read
Learn the signs. Act early.
2-1-1 and MCH Hotlines
Early Learning Standards
Pyramid Model
Stewards for Children
Parenting Support
• Evidence-based home visiting models
• Family Resource Centers
• Parents Interacting with Infants (PIWI)
groups
• La Leche Leagues
• Fatherhood Initiative
Reach Out and Read
• http://www.reachoutandread.org/
Center for Disease Control (CDC)
Resources
Learn the Signs. Act Early.
Milestone and Disability Specific Fact Sheets
http://www.actearly.wisc.edu/
57
2-1-1 and Maternal Child
Health (MCH)Hotlines
• 2-1-1
Community-based health and human services information and
resources
Call 2-1-1 or visit http://www.211wisconsin.org/
Twenty-four hours/day, 7 days/week
• Public Health Information & Referral Services
For Women, Children & Families
Maternal and Child Health Hotline
1-800-722-2295 http://www.mch-hotlines.org/
Twenty-four hours/day, 7 days/week
Wisconsin Model Early Learning
Standards (WMELS)
• Educate and provide guidance for families,
educators/caregivers, administrators and policymakers
regarding developmental expectations for children birth
to first grade.
• Provide a framework for making local decisions
regarding learning expectations for children birth to 1st
grade in public school, Head Start, preschool, childcare
settings and home.
• For trainings in WMELS
http://www.collaboratingpartners.com/wmels-trainingopportunities.php
Pyramid Model and Resources
http://www.collaboratingpartners.com/
Stewards of Children
Evidence-informed prevention solution that increases
knowledge, improves attitudes, and changes child
protective behaviors to reduce the likelihood of child
sexual abuse
Many local youth and family serving organizations – like
Family Resource Centers – are using as a training for
their staff and for the community at large
Early Identification of Children with
Social and Emotional Challenges
Resources to support the early
identification of children with delays
• American Academy of Pediatrics (AAP)
Guidelines
• For parents
– Easter Seals’ Make the First Five Count
Campaign
• For primary care clinicians
– Practice Education
• For other professionals
– UW Extension ASQ and ASQ:SE Training
Importance of Monitoring
• Social-emotional screening
– SE screening status in early childhood
predicts elementary school outcomes
• American Academy of Pediatrics’
recommendations
– Routine developmental screening
– Pediatric mental health screening
(Briggs-Gowan, 2008; AAP Council on Children With Disabilities, 2006;
AAP Task Force on Mental Health, 2010)
Screen to Intervene
Early identification of needs and timely
referral to appropriate supports increases
the likelihood of child reaching full
developmental potential
Easter Seals’ Make the First Five
Count Campaign
• Offer free, online ASQ-3 questionnaires to
families of children under 5
• Results are emailed to parents within 2 weeks
http://www.easterseals.com/mtffc/asq/
Primary Care Practice
Education
Available Presentations
 Developmental Screening within Well-Child Care
 Pediatric Mental Health Screening Tools
 Pediatric Mental Health Community Resources
 Maximizing Reimbursement for Behavioral Health
Provision in Primary Care
Wisconsin Statewide Medical Home Initiative
www.wismhi.org
Ages & Stages Questionnaire and Ages &
Stages Questionnaire: Social Emotional
Training
• For home visitor and family support professionals
(UW-Milwaukee through the Child Welfare Training
Partnership)
http://www4.uwm.edu/mcwp/programs/home-visitingtraining.cfm
• For early care and education providers
(Milwaukee County Cooperative Extension)
http://milwaukee.uwex.edu/family-living/upcomingtrainings/
Targeted Social and Emotional
Supports
Resources to support children in need of
targeted social emotional supports
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Birth to 3 Programs
Home Visiting Programs
Early Headstart & Headstart
Early Childhood Special Education
Evidence-based Parenting Interventions
Regional Centers for Children and Youth
with Special Health Care Needs
Wisconsin Birth to 3 Program
• The Birth to 3 Program supports families
of children with developmental delays or
disabilities under the age of three
• http://www.dhs.wisconsin.gov/children/birt
hto3/
Home Visiting Programs
• Home visitors are nurses, social workers, or early childhood
specialists, who support families regularly in their homes
• Home visit activities
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Assist with accessing quality prenatal care
Conduct screenings and assessments
Provide health education
Connect family to community resources
Offer strategies for parents to support their child’s development physically,
socially, and emotionally
• Together, home visitors and families come up with a set of
goals and activities that they work on
Early Head Start & Head Start
• Early Head Start
-Serves
low-income families
that include
Pregnant mothers
Children ages 0-3
-Provides
Prenatal care
Early childhood
developmental services
Referrals for medical and
dental care
Social service programs
• Head Start
– Serves low income families
that include
Children ages 3 to 5
– Provides
Early childhood education
Referrals to medical and
dental care
Social services programs
Early Head Start & Head Start
To apply for Early Head Start & Head Start
– Children must be the appropriate age for the selected
program
– Families must meet federal income guidelines
– Use zip code to identify nearest Head Start location
– Contact that center to schedule an application
appointment
To find a program near you:
http://eclkc.ohs.acf.hhs.gov/hslc/HeadStartOffices
Early Childhood Special Education
• Conduct educational assessments
• Serve children aged 3-5 years with significant
developmental delays or disabilities
• Located in local public school system
• Contact child’s neighborhood school (where child would
start kindergarten)
http://ec.dpi.wi.gov/ec_ecspedhm
Evidence-Based Parenting
Interventions
– Assist parents in having better
relationships with their children
– Reduce child behavior problems
– Examples :Triple P, Incredible Years
Listening as an Active
Intervention
Regional Centers for Children and
Youth with Special Health Care Needs
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Northern Regional Center
Phone: 866-640-4106
Northeast Regional Center
Phone: 877-568-5205
Southeast Regional Center
Phone: 800-234-KIDS (5437)
Southern Regional Center
Phone: 800-532-3321
Western Regional Center
Phone: 800-400-3678
Intensive Interventions
Resources to support children in
need of intensive intervention
• 0-5 year olds
– Child Parent Psychotherapy
http://www.cebc4cw.org/topic/trauma-treatmentfor-children/
• 3-18 year olds
– Trauma-Focused Cognitive Behavioral
Therapy
Child Parent Psychotherapy
• Evidence-based way of working with very
young children (0-6) exposed to trauma
and their families
• Training available for selected clinicians
through the Wisconsin Early Childhood
Comprehensive Systems grant
• http://nrepp.samhsa.gov/ViewIntervention.aspx?id=194
Trauma-Focused Cognitive
Behavioral Therapy (CBT)
• Evidence-based trauma treatment
• Effective in reducing Post Traumatic Stress
Disorder (PTSD) symptoms
• Attachment-based
• Short-term with a distinct beginning, middle
and end
• Skill-building and desensitization through
gradual exposure
• Healing through meaning making and
relationship
Successful Regional Examples
Small Group Discussion
• Select 1-2 small group discussions
• Small group topics
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Planning in Your Community (both sessions)
Medical Home
Evidence-based Interventions
Parent Engagement and Support
Staff Supporting/Reflective Supervision Your Staff
• Spend 30 minutes discussing the topic of your
choice
• Select a reporter and be ready to share
Small Group Discussion:
Questions
• Are there individuals/organizations doing
this work? Who? Where?
• Who are the leaders/champions?
• What is going well?
• What improvements are needed?
• How might those improvements be made?
• What are next steps?
Report Out
Next Steps
• Available opportunities
– Child Parent Psychotherapy (CPP) training
– Early Childhood Comprehensive Systems
pilot community
– Exploring resources
– Continuing collaboration
Thank you for your attention •
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Collaboration and support provided by
Wisconsin Alliance for Infant Mental Health
Wisconsin Children and Youth with Special Health Care Needs
Program
Wisconsin Department of Children and Families
Wisconsin Division of Public Health
Wisconsin Early Childhood Comprehensive Systems Project
Wisconsin Project LAUNCH
Wisconsin Statewide Medical Home Initiative
Children’s Hospital of Wisconsin

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