do i look stressed? the impact of stress and trauma in early childhood erin kinavey, m.ed. dhss-ocs...
TRANSCRIPT
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Do I Look Stressed?The Impact of Stress and Trauma in Early Childhood
Erin Kinavey , M.Ed.DHSS-OCSEarly Intervention ManagerPart C Coordinator
Neal M. Horen, Ph.D.Co-Director of Training and Technical AssistanceGeorgetown University Center for Child and Human Development
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Oh, the places we will go
Big PictureSystemsClinical perspectiveCase exampleOne stateCultural issuesStump the speaker
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EARLY CHILDHOOD MENTAL HEALTH SYSTEM OF CAREFosters the social and emotional well-being of infants toddlers, preschool-age children and their families
VALUES
Family Voice
Child and Family Centered
Relationship Based
Culturally Competent
Infused into Natural Settings and Services
Grounded in Developmental Knowledge
Prepared Workforce
Interagency Partnerships
Maximized and Flexible Funding
Building Blocks
Promotion Prevention Intervention
Supports for Parents and Families
Supports for Other Caregivers
Services for Children and Families
Services and Supports
Outcome Evaluation
Strategic Planning, Policies, and Procedures
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Systems and Trauma
What happens to a system in a trauma?What happens to a family who is stressed?What happened to Charles in Austin?
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Stress
What could stress a kid?What stresses you?How do you cope?
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PTSD
Pattern of symptomsMust be understood in context of the developmental level, trauma, temperament, caregiver’s ability to provide protection and safety5 criteria
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Two diagnostic challenges in addressing PTSD in young children
1 Young children have less well-developed verbal capacities. It’s harder to know their internalized world.
2 Young children manifest some symptoms differently than older children and adults due to developmental differences.
Taken from Scheeringa
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Download the criteria from. . .
The modified criteria for PTSD (Scheeringa et al., 2003), plus 12 other disorders in young children, have been incorporated into the Research Diagnostic Criteria - Preschool Age (RDC-PA) (Task Force on Research Diagnostic Criteria - Preschool Age, 2003)
Can download the RDC-PA from www.infantinstitute.org
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The unique influence of the caregiving context for young children
~20 studies confirm an association between more symptoms in parents and more symptoms in children following trauma to the children (reviewed in Scheeringa & Zeanah, 2001)
Maternal depression mediated treatment outcome for preschool children who were sexually abused (Cohen & Mannarino, 1998)
Is this a causal relationship between parents and children? Or shared genetic vulnerability?
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Models of parent-child relational patterns following trauma (Scheeringa and Zeanah, 2001)
Type ofeffect
Childexperiencedthe trauma
Parentexperienceda trauma
Parentimpacts onchild
Minimal Yes Maybe, notnecessary
Minimal orNone
Moderating Yes Maybe, notnecessary
Yes
VicariousTrauma-tization
No Yes Yes
Compound Yes Yes Yes
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Preliminary data on the longitudinal impact of parenting style on child PTSD symptoms
Higher parent emotional sensitivity significantly associated with children with PTSD diagnosis (p<.05), contrary to expectations. As parent sensitivity decreased over two years, children’s PTSD symptoms decreased (r=.38, p<.01) (Scheeringa et
al., in preparation) , contrary to expectations.
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Treatment: play therapy
“..re-experience the trauma and its meaning in affectively tolerable doses in the context of a safe environment so that the overwhelming traumatic feelings can be mastered and adaptively integrated into the person’s emotional life”.
(Gaensbauer and Siegel, 1995)
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Evidence based treatments
Two manualized studies on sex-abused preschool children (Cohen & Mannarino, 1996, Deblinger et al., 2001)
Manualized treatment for preschool children who witnessed domestic/interpersonal violence (Alicia Lieberman, PhD, University of California, San Francisco, personal communication)
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The Preschool PTSD Treatment Manual (Scheeringa, Amaya-Jackson, and
Cohen, 2002): A 12-week cognitive-behavioral treatment combined with parent-child relationship treatment.
“All-purpose”: treatment can be focused on PTSD symptoms from any type of trauma.
Manual requests to: [email protected]
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Parent-Child Interaction Therapy (PCIT) (www.pcit.org)
PCIT was originally designed and studied for children with behavioral problems aged 2-7 and their parents or caregivers
PCIT is the creation of Dr. Sheila Eyberg of the University of Florida, applying a model of operant conditioning first developed by Dr. Constance Hanf
Eyberg’s PCIT protocol integrates traditional play therapy techniques into operant conditioning
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Steps in Parent-Child Interaction Therapy
Step 1: Pretreatment assessment of child & family functioning and feedback (1-2 sessions)Step 2: Teaching behavioral play therapy skills (1 session)Step 3: Coaching behavioral play therapy skills (2-4 sessions)Step 4: Teaching discipline skills (1 session)Step 5: Coaching discipline skills (4-6 sessions)Step 6: Post-treatment assessment of child & family functioning and feedback (1-2 sessions)Step 7: Boosters (as needed)
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Parent-Child Interaction TherapyStage One: 7 Sessions CDI: Child Directed Interaction
PRAISE
REFLECT
IMITATE
DESCRIBE
ENTHUSIASM
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PCIT, Trauma, and Maltreatment
Does PCIT help families where children have experienced stress or trauma, such as child
sexual abuse, the witnessing of violence, and physical abuse?
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Advantages of protocol-driven manualized treatment over non-directive play therapySuccessful treatment of PTSD must
involve: an emotional re-engagement with the traumatic memories organization and articulation of a trauma narrative (reviewed in Zoellner et al, 2001)
A manual protocol ensures comprehensive coverage of complicated child, parent, and parent-child relational issues, including relaxation training, graded systematic exposure, and homework.
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Jamaal
3 year-old living with mother and maternal uncleVictim of sexual abuse
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Dante
Living with grandmother and great-grandmother, sistersViolent neighborhoodPoorFamily medical issues
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Early Childhood Trauma and Stress
Alaska
Office of Children’s Services DHSS State of Alaska
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Alaska demographics Population: 655,000.
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Day to day challenges
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Rural and remote
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Access to Prenatal Care2000
% of births to women who receive late or no prenatal care
80.5% of Alaskan women had prenatal care in the first trimester
67.4% had “adequate” care
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Young Children in Poverty% of children under age 6 living in families with
income below the federal poverty level
0%
5%
10%
15%
20%
25%
30%
35%
40%
Under age 6 36% Age 6 & Over 28%
Percent of Alaska’s Children in Low-Income Families (200% FPL)
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11-14 Yrs17%
15-17 Yrs7%
6-10 Yrs31%
0-1 Yrs16%
2-5 Yrs29%
0-1 Yrs2-5 Yrs6-10 Yrs11-14 Yrs15-17 Yrs
Reports of Harm by Age-August 2004
0-5 Years = 45%
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Day to day stress
66% of Alaskan households are supplied water through the public water system.
31% of rural/remote households had NO plumbing and are required to “pack” water from a local source.
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Table 2: from the “Building Blocks” program of the Dept. of Health and Social Services- State of Alaska.
Pop. % of Adults not in the workforce
% Below Poverty level
Women & Children on WIC (12/00)
Pregnant Women in Denali Kidcare (CHIP)
Pop. with TANF in 2000
Pop.with Medic-aid
Poverty of Access?
Alakanuk 622 64 33.8 95 28 140 417 Yes
Chevak 692 75 26.7 79 15 121 533 Yes
Emmonak 700 52 16.2 83 28 100 437 Yes
Marshall 335 48 20.8 47 17 24 226 Yes
Mt. Village 683 58 21.1 83 26 150 443 Yes
Toksook Bay 519 43 26.9 47 13 52 308 Yes
Subsistence lifestyleYup’ik, Cup’ik, Athabascan
Yukon Kuskokwim
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Healthy Alaskan 2010 indicators and goals http://www.hss.state.ak.us/dph/targets/ha2010/PDFs/05_Mental_Health.pdf
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Historical context
Missionaries
TB
Boarding schools Ongoing debate
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Weaving history into practice
Recognizing alternative sources of knowledge
Allowing for program flexibility
Drawing on multiple resources to develop protocol
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Case study
Intergenerational issues FASD Stress and Trauma parental MH issues
Impact on child Multidisciplinary response