Big Ideas.. psychologically safe in this space 5 principles this - - PowerPoint PPT Presentation

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2019 National Early Childhood Inclusion Institute Promoting Resilience in Infant-Toddler Child Care: Bringing Trauma-Informed Practice to Child Care Settings

Katie Rosanbalm, PhD & Ennis C. Baker, MSW, LCSW

“ITTI Care Project”

Building Capacity for Infant and Toddler Trauma-Informed Care: A Professional Development Framework

Build a professional development framework for the infant/toddler child care workforce across the state of North Carolina to promote trauma-informed care

• Project staff will train and support technical assistance (TA) specialists to become experts in

trauma-informed care

• TA Specialists will in turn train and coach infant/toddler teachers and child care administrators to:

1) Promote understanding of the impacts of stress and trauma on infants and toddlers 2) Develop infant/toddler/twos teacher skills to form supportive, resilience-building relationships and environments 3) Identify strategies to support child care provider health and wellbeing

This model will leverage the existing early childhood workforce support system to expand trauma-informed knowledge and practice within their regions.

5 principles this project will promote at all levels: the system,

• rganization

and individual (adult and child)

Safety - staff, children, and families feel physically and psychologically safe in this space Peer support and mutual self-help - are key ways to build trust, establish safety, and empowerment. Empowerment, voice, and choice. We recognize, build on

and validate individual strengths and aim to strengthen the staff's, children’s, and family members' experience of choice. This builds on what they have to offer, rather than responding to perceived deficits.

Collaboration and mutuality - There is true partnering at every level. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making. Equity and Inclusion – We actively acknowledge past and

current inequities, and provide all people, particularly those most impacted by racial inequities, the infrastructure needed to thrive, moving past cultural stereotypes and biases, leveraging the healing value of traditional cultural connections, and recognizing and addressing historical trauma.

Big Ideas…..

Understanding Trauma & Stress and Brain Development

• Adverse childhood experiences

and environments can have negative short- and long-term effects on:

• brain development,
• physical health, and
• ability to self-regulate
• The first 5 years of life is a

critical period for brain development

Recognizing the Power of Healthy Relationships to Heal and Protect

We can begin building resilience from birth with healing relationships and environments!

• support and empower

parents and all adults who work with kids to be resilience-builders!

• reduce the dosage of stress

that young children experience

• teach children resilience

skills starting at birth

Trauma-Informed practice starts with YOU!

• Self-care
• Compassion Satisfaction
• Self-Regulation
• Recognizing that creating

trauma-informed environments requires a culture shift at every level (organization, system, community)

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Compassion Fatigue

• “The cost of caring”
• “The profound emotional and physical

exhaustion that helping professionals can develop over the course of their career as helpers”

• Gradual loss of the ability to have empathy,

hope, and compassion for others AND

• urselves
• Signs of compassion fatigue:

– Bitter at work, short-tempered at home – Making errors, crossing boundaries – Less respectful with colleagues and students

Compassion Satisfaction

• “The pleasure you derive from being

able to do your work well”

• Feeling competent in your role at work
• Feeling connected with your

colleagues

• Feeling like your work is making a

positive impact on children and families

Source: The Compassion Fatigue Workbook, Francoise Mathieu, page 8

Loose arm swings

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Understanding Trauma & Stress

“Adverse childhood experiences are different than child trauma, and it’s critical to understand why” Child Trends blog: April 2019

Childhood adversity is a broad term that refers to a wide range of circumstances or events that pose a serious threat to a child’s physical or psychological well-being, such as; child abuse and neglect, domestic violence, bullying, serious accidents or injuries, discrimination, extreme poverty, and community violence. Adverse childhood experiences (ACEs)—a term coined by researchers Vincent Felitti, Robert Anda, and their colleagues in their seminal study conducted from 1995 to 1997—are a subset of childhood adversities. The term ACEs has since been adopted to describe varying lists of adversities.

ADVERSE COMMUNITY ENVIRONMENTS ADVERSE CHILDHOOD EXPERIENCES

THE PAIR OF ACES – the Building Community Resilience (BCR) Model

Childhood adversity, including ACEs, can cause trauma and toxic stress—and, in turn, have a lasting impact on children’s physical and mental health

• an exclusive focus on the 10 ACEs in the original study risks allowing

some of the most vulnerable children who are in need of support to fall through the cracks

• Important to understand the full range of childhood adversity and

considerable variation in children’s responses to it

“Adverse childhood experiences are different than child trauma, and it’s critical to understand why” Child Trends blog: April 2019

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What is trauma?

Individual trauma results from

• an event, series of events, or set of circumstances
• that is experienced by an individual as physically or emotionally

harmful or life threatening and

• that has lasting adverse effects on the individual’s functioning

and mental, physical, social, emotional, or spiritual well-being.

• SAMSHA

“Trauma is not an event itself, but rather a response to a stressful experience in which a person’s ability to cope is dramatically undermined”

• Cole, S.F., O’Brien, J.G., Gadd, M.G., Ristuccia, J., Wallace, D.L., Gregory, M. (2005). Helping Traumatized Children Learn. Boston,

MA: Massachusetts Advocates for Children, pp. 18.

Early Childhood Trauma

National Child Traumatic Stress Network definition:

• refers to the traumatic experiences that occur to children ages 0 to 6
• infants' and young children's reactions may be different from older

children’s

– may not be able to verbalize their reactions to threatening or dangerous events – many people assume that young age protects children from the impact of traumatic experiences

• young children may be affected by events that threaten their safety or

the safety of their parents/caregivers

• symptoms have been well documented and may continue into

adulthood

Why focus on children under 3?

• Over 25% of children with confirmed cases of child abuse & neglect

are under age 3 and victimization is most common for children under 12 months old (cited in Child Trends/NCCP April 2017 from ACYF Child Maltreatment 2015)

• Of children who experience domestic violence, 60% are under age 6

at the time of exposure (cited in Child Trends/NCCP April 2017 from Fantuzzo & Fusco (2007) article in Journal of Family Violence)

• By parent report, 26% of children experience or witness a traumatic

event before the age of 4 (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010)

• For children living in poverty, the number increases to 49%
• 2/3rds of these traumatic events involve interpersonal violence

Division for Early Childhood (DEC) has identified three key reasons we must take action on child maltreatment:

1) Young children are disproportionately affected by child maltreatment. 2) There is a bi-directional relationship between child maltreatment and disability or developmental delay.

• Meaning, children with disabilities/delays are at a higher likelihood for

experiencing abuse and children who experience abuse are at a higher likelihood for developing a disability or delay.

3) Young children who have been maltreated are participants in early childhood programs (e.g. early intervention, child care, preschool). As early intervention professionals, we recognize and assume responsibilities in both prevention and intervention efforts at local, state, and national levels

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The Intersection of Developmental Delay and Trauma

 In a sample of children

under age 3, on intake to child protective services 66% had significant developmental delays

 In a sample of foster

children under age 6, 80% had developmental or emotional problems— and 50% had both

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Massachusetts Early Childhood Linkage Initiative, 2005 Klee, Kronstadt, & Zlotnick, 1997

Trauma can lead to…

Toxic Stress

https://www.youtube .com/watch?time_co ntinue=111&v=rVwFk cOZHJw

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Harvard Center on the Developing Child

Our Body’s Stress Response System

When we feel threatened, our brains tell our bodies to respond in one of three ways:

• Fight: verbal and physical aggression or defiance
• Flight: instinct to run and escape the danger
• Freeze: wanting to shut down, withdraw, or become invisible

In normal situations, this keeps us safe

• When this becomes a constant state of being, it interferes with functioning in

non-dangerous situations How might infants and toddlers demonstrate these responses? How might adults who are not trauma-informed react?

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Common Stress Reactions in Children Under 3

Fight

• Hit, bite, push, kick
• Yell, scream, cry, growl
• Spit
• Throw things
• Arch back when

picked up

• Tantrum
• Profanity

Flight

• Escaping the room
• Burying face in

blankets or person

• Hiding
• Moving to corner

away from people or noise

• Covering ears or eyes
• Clinging to adult

Freeze

• Burst into tears
• Withdrawn, refusing

to speak

• No eye contact
• Trembling
• Crying
• Curling up in a ball
• Shutting down, listless

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Trauma-Informed Solutions

What will help?

Building trauma-informed, trauma-sensitive environments to re-shape the stress response system

• All adults understand impacts of trauma
• Focus on co-regulation: relationship-building,

structure, and support for skill-building build adult caregiver capacity to serve as a buffer for children Remember: the difference between tolerable and toxic stress is having CAREGIVER SUPPORT!

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Self Regulation & Co-Regulation

Self-Regulation is the act of managing your

• thoughts
• feelings
• behaviors

to reach prosocial goals Co-regulation is a supportive interactional process where you help children to regulate through:

• Fostering a safe, stable, nurturing

relationship

• Building an environment that buffers

against stress and promotes security

• Teaching, modeling, and coaching

self-regulation skills that match developmental stage

What are safe, stable, nurturing relationships?

• Safety: The extent to which an

individual is free from fear and secure from physical or psychological harm within their social, physical, and work environments.

• Stability: The degree of

predictability and consistency in

• ne’s relationships as well as the

social, emotional, and physical environments.

• Nurturing: The extent to which

parents and children have access to individuals who are able to sensitively and consistently respond to and meet their needs.

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To be maximally effective, policies and services should:

• Support responsive

relationships for children and adults

• Strengthen core life

skills

• Reduce sources of

stress in the lives of children and families

Harvard Center on the Developing Child: Three Principles to Improve Outcomes for Children and Families

Foundation for all of the practices in the Pyramid Model are the systems and policies necessary to ensure a workforce able to adopt and sustain these evidence-based practices. Tier 1: Universal supports for all children through nurturing and responsive relationships and high quality environments.

Responding to children in ways that are contingent, sensitive, affectionate and reciprocal

Parent/teacher

• responds to child initiations promptly and

frequently

• perceives and interprets child’s signals

accurately

• responses are appropriate to the

developmental level and mood of the child

• responses are expressive, warm and

affectionate

• responses promote joint attention, turn-

taking and mutually reinforcing interactions

Family-Focused Interventions for Promoting Social-Emotional Development in Infants and Toddlers with or at Risk for Disabilities Diane Powell and Glen Dunlap September 2010

Build capacity

• f teachers to

provide responsive relationships

Active skill building – teach and coach

• Serve-and-return interactions

Talk With Me Baby Serve & Return (2 minutes)

• co-regulation
• reading and responding to children’s cues

Protect teachers’ time for interaction

• reduce class sizes and ratios
• support teacher-parent and teacher-child

interactions of sufficient duration, frequency, and consistency

• Identify sources of stress for teachers and

reduce that stress

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Support parents in providing safe, stable, nurturing relationships and environments

Build responsive relationships with parents

• Listen, ask, adapt
• Build trust, be culturally

responsive and be a resource Connect

Support them in their role as a parent

• Notice their responsive interactions

(serve and return) and “catch them being good”

• Reserve judgment - wonder about what

happened to them instead of what is wrong with them

Support

Strengthen core life skills in classroom settings

• Embed trauma-informed practice into early childhood

systems

• cross-walk developmentally-appropriate practice, early

intervention best practice and trauma-informed practice

• cultivate understanding of the “why” behind all the

requirements and rules and expectations

Help child care directors and teachers identify, plan for and meet their professional goals

• Coach child care directors and teachers to practice and

prioritize self-regulation for adults and kids in classrooms

• Engage occupational therapists in conversations about self-

regulation and value their expertise in developing classroom strategies

Create regular

• pportunities for

teachers and children to learn and practice self-regulation skills

Reduce sources of stress for teachers and parents

Provide teachers the workplace supports they need such as:

• Reflective supervision
• Mindfulness skill

development

• Workplace wellness

strategies to promote compassion satisfaction

• Opportunities to

collaborate with early intervention, early childhood mental health and health specialists Provide parents the supports they need:

• Connect parents to

community resources

• Teach parents self-

regulation skills

• Strengthen family

protective factors by using Strengthening Families Framework as a guide

Reduce Sources of Stress for Children in Classrooms

Structure: Expectations & Routines

• Clear, concrete rules and expectations
• Use specific praise to draw attention to good choices
• Visual schedules and cues
• Predictable routines
• At least 5:1 ratio of positive to negative interactions

Structure: Environment

• Calm down space
• Frequent physical activity and outside time

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Strategy for Success: Mindfulness for Child Care Providers

Zero to Three Recommends: Providing mindfulness training for parents and child care professionals to support their well-being and improve outcomes for children.

• Adults who practice mindfulness report

experiencing fewer effects of stress and enhanced self-regulation, and are thus better able to assist children in recognizing and learning to manage their own strong emotions.

https://www.zerotothree.org/resources/2270-executive-summary-how-can- mindfulness-support-parenting-and-caregiving

Gather in groups of 3 or 4

As a group, list at least 3 aspects of infant-toddler child care that could

• make self-regulation difficult for teachers or children

OR

• could trigger a stress response in teachers or children

As a group, choose a positive opposite for each aspect, something that would

• promote self-regulation or co-regulation

OR

• minimize the activation of the stress response system in

teachers or children Share back with the full group

Building Trauma- Informed Systems & Communities

Communities can support child care and early intervention staff in implementing trauma-informed care

• train all adults to recognize and respond to the

impact of trauma on young children;

• incorporate strategies for addressing trauma

and its effects into organizational culture, practices, and policies;

• build partnerships that facilitate screening and

services for children and their families; and

• promote collaborations among families, staff,

and mental health professionals to support children’s development.

https://www.childtrends.org/early-care-education-can-help-young-children-overcome- trauma

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Train all adults working in child care settings to be aware of the impact of trauma on young children Challenges:

• Time for teaching staff to be out
• f the classroom for professional

development and meetings with “team” serving kids with identified needs

• Teacher’s limited access to

technology during work day

• Competing mandates for training

Opportunities:

• Higher education – community

colleges, B-K licensure programs

• In-person training – workshops,

conferences

• Web-based, self-paced training
• Technical assistance/coaching

systems

Incorporate strategies for addressing trauma and its effects into

• rganizational

culture, practices, and policies

Challenges:

• Child care and EI systems are underfunded, undervalued

and overwhelmed

• “One More Thing” syndrome
• Child care community is often isolated from early

intervention systems - silos

• Many children with special needs have multiple service

providers and time for communication and collaboration is limited

Opportunities:

• NC state-level priority
• Think Babies, Early Childhood Action Plan, Pathways to

Grade-Level Reading

• More awareness of need for “upstream” solutions focused
• n prevention – universal precautions approach
• Recent NC Part C early intervention coaching training

builds capacity for responsive relationships

NC Infant-Toddler Child Care Workforce (CCSA Workforce Study,

using 2015 data)

Infant/Toddler teachers on average… – 38 years old – 99.7% female – 47% people of color – 74% have children

• 45% have an AA degree or above

(24% in 2003)

• 10 years experience in the field

(5.0 years in 2003)

• Make $10.00 per hour

($9.67 in 2003-adjusted)

On average, when compared to NC teachers of 3- to 5-year-olds, NC teachers of children under 3:

• Have less education
• Have less experience

and

• Earn less

Trauma-informed practice requires cultural responsiveness and a commitment to equity

• Current and historic laws, policies and

practices—both official and unofficial— have created and maintained widespread barriers to opportunity for babies and toddlers of color and their families.

• Improving outcomes for babies and

toddlers of color means putting in place different strategies for action, and changing our current systems and practices so that they work for every child

NCECF 2019 Brief Opportunity for All? NC's Babies and Toddlers of Color

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5/21/2019 11 Understanding the Intersections

• f Equity, Culture &

Trauma

• Culture is central to our identity. It

provides us with a lens through which we relate to others, make sense of events, and cope. Similarly, culture plays an integral role in how we respond to trauma and treatment.

• Recognizing an individual’s culture is

essential when supporting individuals with a history of trauma. Sensitivity to culture must be implicit in any

• rganizational program and policy

decision that affect families that have experienced trauma.

“Culture is the story into which we are born”

Connections Matter Challenge to each of you…

Find creative ways to build and strengthen partnerships between the child care community and the early intervention community to:

• Promote workplace wellness and reduce isolation for staff
• Engage those working directly with children in community resilience work
• Raise awareness of potential for child care providers, child care settings and early

intervention providers to be powerful agents of change And

• Facilitate access to culturally-responsive screening and services for children and

their families in the child care setting

“No Small Matter”

https://youtu.be/Shm-KRh4LFg 3 min.

Self-Regulation Tip Sheets

• https://www.acf.hhs.gov/opre/resource-

library/search?topic%5B6027%5D=6027

• Includes:
• Supporting the Development of Self-Regulation in Young Children: Tips for

Practitioners Working with Infants in Classroom Settings

• Supporting the Development of Self-Regulation in Young Children: Tips for

Practitioners Working with Toddlers in Classroom Settings

• Supporting the Development of Self-Regulation in Young Children: Tips for

Practitioners Working with Preschoolers in Classroom Settings

• Supporting the Development of Self-Regulation in Young Children: Tips for

Practitioners Working with Families in Home Settings

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Handouts – available electronically with slides

8 Things to Remember about Child Development - Harvard Center on the Developing Child 3 Principles to Improve Outcomes for Children & Families 14 pages Helping Young Children who Have Experienced Trauma DEC’s Position Statement on Child Maltreatment Strengthening Families Protective Factors: https://ctfalliance.org/wp- content/uploads/2018/10/PF-Definitions-Alliance-2018.pdf

• Dr. Jack Shonkoff, the director of the Harvard Center on the Developing

Child, was the keynote speaker for the NC Early Childhood Summit on

• Feb. 27, where Governor Roy Cooper and NCDHHS Secretary Dr. Mandy

Cohen launched an Early Childhood Action Plan. The plan is an effort to galvanize coordinated action across public and private stakeholders throughout North Carolina to make measurable changes in early childhood outcomes.

• Dr. Shonkoff’s address:

https://video.unctv.org/video/ncecs-2019-summit-lunchkeynote- speaker-m4zrdp/

Another great one from Harvard Center on the Developing Child: Building Adult Capabilities to Improve Child Outcomes: A Theory of Change- 5 min video 45 46 47 48

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Bringing the Protective Factors Framework to Life in Your Work

• Online training to support

implementation of the Strengthening Families™ Protective Factors Framework in multiple settings

• Free!!
• 7 courses, 2 hours each
• Introduction to the Framework (also

useful as a stand-alone orientation)

• A course on each of the 5 Protective

Factors

• A wrap-up course that moves users

from knowledge to action

Find at www.ctfalliance.org/onlinetraining Contact onlinelinetraining@ctfalliance.org

Questions?

Contact information:

Katie Rosanbalm katie.rosanbalm@duke.edu Ennis Baker ennis.baker@duke.edu

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