Early Childhood Development Joining A System of Care

An ELF 2.0 PresentationSeptember 3, 2014

John HornsteinBrazelton Touchpoints Centerwww.brazeltontouchpoints.org

Early Childhood Development Joining A System of Care

What does this family need?

Human beings become a reflection of the world in which they develop.Bruce Perry

A childs development occurs through a complex, dynamic, self-organizing process Driven by CNS maturation, status, history Experience dependent ALWAYS RELATIONAL Characterized by periodic and predictable disorganization (Touchpoints) Has a unique individual trajectory given biology, family, culture, history

Joining a system of careThe cross-cultural and historical norm is that parenting is nested in a broader system of relationshipsWe are seeking a shift from asking the child and family to join a new system to our joining their system Touchpoints offers a means to join the family system of care

What are Touchpoints?Touchpoints are predictable periods of disorganization in a childs development that can disrupt family relations, but can also provide an opportunity for providers to connect with parents.

Regressions in a childs behavior can disorganize parents

TOUCHPOINTS

The Ideal Baby - PregnancyThe Real Baby - NewbornThe Energy Sink - 3 weeksThe Rewarding Baby - 6-8 wksLooking Outward - 4 monthsUp at Night - 7 monthsThe Pointer - 9 monthsThe Walker - 12 monthsThe Clinger - 15 monthsRebel With a Cause -18 monthsGetting to No! - 2 yearsWhy? - 3 yearsWhat I Do Matters - 4 yearsWho I Am Matters - 5 yearsEntering the Real World 6 yrs.

Questions?

3 PrinciplesUse the behavior of the child as your language2) Look for opportunities to support parental mastery3) Focus on the parent child relationship

Use the behavior of the child as your language.

Focus on the parent child relationship

Questions?

Support Parental Mastery

Tasks of the first year

State regulation Attachment to caregiver Development of trust Sense of self Causality and object permanence

Mobility - 9 months It is exciting seeing him do all of these new things, but I will have to adjust to the changes. Before, where he couldn't really move, I had an advantage because I could get a lot of things done, but now that he can move I am constantly running after him trying to do what I got to do too.

9 months If I'm sitting next to where he is he's O.K., but if I leave the room and he sees me leave I've had it. So if I'm already out of the room and it's O.K I have to run past the living room to get outside or he'll start up.

Toddler Tasks Sense of self, autonomy

Representational thought and language

Mastery, self control

Separation/exploration

Social rules

The advent of language ultimately brings about the ability to narrate ones own life story with all the potential that holds for changing how one views oneself. Stern

Parent of a toddler:One perfect spring day as I sat on my deck, I looked up from the book I was reading to see my daughter, then 21/2, nose-to-nose with the daffodils in our garden. Bending from one flower to another, she gave each of them a gentle kiss. Swamped with love and pride that I had produced such a sweet and tender child, I rushed to sit beside her. Thats when she calmly turned, looked me straight in the eye, and said, Go away, I dont want you here. I want Daddy. I was devastated. [Margery D. Rosen, Pushing Your Buttons, p. 54.]

Preschool Tasks Able to feel and recognize a full range of emotions in self and othersAble to express and communicate feelingsOrganizes behavior to achieve a goalBeginning competence with symbol systemsEngages in dramatic play

Paley: We were taught to say that play is the work of children. But watching and listening to them, I saw that play was nothing less than Truth and Life.

Emma - 4 years old Emmas parents shielded her from news about September 11. She never put arms on the girls she drew. After she was allowed gun play she put arms on her drawings. When asked about her tower building play she replied: I want to know about the Towers, and Im very interested in fighting.Gross and Clemens (2002)

Tyrone: 5 years Look what I made, look at my vampire, and he holds it up for all to see. Mrs. Wright, who overhears from the other side of the room, calls out, Tyrone, I want some nice bunnies, no vampires - Do you hear me? After Tyrone completes his picture, now corrected, he takes it to Mrs. Wright for approval, saying, See, the vampire turned back into a bunny. Mrs. Wright takes the picture you wrote your name backwards Polokow, p. 132.

References:Brazelton, T.B., (1992.) Touchpoints: The Essential Reference. Perseus Books.Brown, S. & Vaughn, C. (2009). Play: How It Shapes the Brain, Opens the Imagination, and Invigorates the Soul . Penguin Group (USA)Gross, T. & Clemens, S. (2002). Painting a Tragedy Young Children Process the Events of September 11. The Learning Collaborative.Hornstein, J. (2013). Brazeltons Neurodevelopmental and Relational Touchpoints & Infant Mental Health. Chapter 4. In Infant & Early Childhood Mental Health: Core Concepts and Clinical Practice. Kristie Brandt, Bruce Perry, Stephen Seligman & Ed Tronick. (Eds). American Psychiatric Press. pp. 71-83.Paley, V. (1990). The Boy Who Would Be A Helicopter: The Uses of Storytelling in the Classroom. Harvard University PressSills, V. (2001). One Family. University of Georgia Press.Stern, D. (1985). The Interpersonal World of the Infant. NY, Basic Books.

Thank youJohn Hornsteinhornstjo@hotmail.com

Questions?

The Early Learning with Families (ELF) 2.0 (http://elf2.library.ca.gov) initiative is supported by the U.S. Institute of Museum and Library Services under the provisions of the Library Services and Technology Act, administered in California by the State Librarian. This material is licensed under a Creative Commons 3.0 Share & Share-Alike license. Use of this material should credit the author and funding source.

It is recommended that this presentation be done after the welcome and introductions and the expectations exercise has been done. Presenter can build upon what has been shared by participants regarding their joys/challenges/expectations in their work as you introduce the framework of Touchpoints.

Touchpoints is a way of thinking about all of development occurring within relationships, and how we can support development by supporting the health of those relationships. The Touchpoints approach is also about a way of Being with families. It is about a way of building shared caregiving partnerships between you and parents.The Touchpoints approach is a way of thinking about development in early childhood - birth all the way through 6 years of age. The focus is on the process of development, and how is it that the newborn grows and becomes a child ready for school.

*Development is a complex process in which many elements - biological, historical, parental, cultural - work together to supportt each childs trajectory through life A DYNAMIC INTERACTIONAL PROCESS - not just nature and nurture, but over time and with some sort of cultural goal

It is a social process requiring not only parents but a social system - culture, friends, family, community - in which parents make decisions about how to work with children

There are certain skills - easily learned,and fairly natural - in which we can join this process - we will focus on three

*Many parents either parent alone or do so with many mixed messages about what is right or wrong

If overall goals are healthy development - then this is underneath what we do

Related to another of our principle - support parental mastery*That is, not only is it complex, but it is directed somewhere.

I see this as indicating that the design also requires culture as providing direction in the choices that are made in organizing the world for children

*Genetic traits, human maturational processes, stress or trauma, nutrition,

Epigenetic factors, Perry, Tronick, others, Field - depressed mothers

Mistake to look only at individual maturational processes - always llok at development as in context of relationships - milestones onky have meaning in relationships, and those relationships are themsleves governed by cultural prescriptions

The process requires occasional error or mismatch - we have to work in order to grow up

This last is why I like the approach that - of course we make and rely on patterns, but in joining in the care, education or treatment of ta child we are joining a story, a narrative that has its own plot and themes*As children are designed to be emotionally held so are parents; as well as providersWe arent asking the child to adapt to our system, but that we should reach into the childs system. Touchpoints provides a guide for joining the system already existing among the child and the family. This notion is particularly relevant when providers are working with families whose cultures are different than their own; and when a childs course of development is not typical thats when a family might be especially at the mercy of external systems who are trying to help the child but might have the parents feel undermined

*

I maintain that the system is designed this way. Parents are not alone, and children benefit when the parent communicates with others about parenting.

2 parts to this - developmentAnd how to use these opportunities*When this happens in a child, when the behavior changes because of development - because its confusing, or unexpected - the person or people who are holding the child also become disorganized

Its not just the behavior that we are dealing with, it is the parents feelings and beliefs that are affected, it is also events in the parents lives.

So, a lot of what we are doing with this approach is working with the inner life of the parent.

Change in childs behavior

Behavior can guide or puzzle parents

Relationship can be enhanced or derailed

*The process of developmental regression preceding a burst while a child is mastering a new skills is happening for all these ages; even if a childs developmental course is not typical. The behaviors that communicate this process are very different depending upon the age of the child. The developmental Touchpoints of the first three years are often quite visible, like the mobility of the infant and the tantrums of the toddler. The Touchpoints of the Preschool years are so very often internal processes that express themselves in behaviors, such as being afraid of monsters under the bed. **In vivo - brings all of the representations together

Language of childs behavior - negotiate conflicts not by confronting the parents values, but by a shared focus on the child.

Example - the teacher who likes children to mess around & the parent who wants a very clean child. Whose neighbors child was removed, in part, because of the messy living conditions. (association)

*When parent and child are together, even if not, there are plenty of opportunities to note behavior, and many of those can be used to support parents perception of the relationship

Berry, look how she is clinging to you, or holding your shirt - as a positive*If overall goals are healthy development - then this is underneath what we do

Related to another of our principle - support parental mastery

Not advice - noting strengths, considering challenges together*Shared emotions and range - slide understates emotional understanding*Explain child behavior - developmental burst

Parental responses is disorganized - I had a child that didnt move

Parent -

Practitioner -*Its not just moving though, it means a more profound change in the relationshipThe OTHER and what the other thinks

Behavior - he does seem to know that you are there when you arent aroundRelationship - is deeper He carries you inside of himMastery - How is this changing how you parent?**Behavior of the child - language is key to new sense of self

The act of representation is the process of making sense.

Very important - the brain of a child who has heard a lot of language is different than that of a child who hasnt. His capacity to make sense out of the world, to achieve in a literate society is, in part determined by this.*Behavior - the play the language -Relationship - reaching out from secure baseMastery - she is growing up*Dramatic play and executive functions*Paleys respect for childrens stories is legendary. But why?

She is the ultimate teacher as researcher. Using childrens stories as curriculum. Recognizing that this is how children not only make sense out of the world but construct themselves in relation to that world.

What we are suggesting here is that teachers and their supervisors join that process not as psychotherapists but as learners, observers, listeners, co-constructors.*What do you make of this? Is this disorganizing for parents? The great knowledge and curiosity of the preschooler couple with exposure to the bigger world.

Behavior - play drawings - less clear, but interpretableRelationship - protector/teacher/partner in a scary worldMasetry - trusting child and play

*What does readiness really mean ? How do we manage the transition to more formal schooling? Disorganizing.

Use the behavior of the child as your language - interpret, see the whole child*