Presentation on theme: "Early Signs of Vulnerability for Poor Mental Health Chaya Kulkarni, BAA, M.Ed. Ed.D Director Infant Mental Health Promotion."— Presentation transcript:
Early Signs of Vulnerability for Poor Mental Health Chaya Kulkarni, BAA, M.Ed. Ed.D Director Infant Mental Health Promotion
Why Am I Here? Maybe you think you are in the wrong session Director of Infant Mental Health Was every other session full? How is this connected to kids in school? How can this possibly have anything useful for me? Infants can’t possibly have mental health what is she going to talk about for the next hour?
Myth #1 Infants don’t have mental health Do infants show emotions? Do infants, even young infants, respond to comfort? Do infants respond to people?
The truth is….. Infants are born with mental health – it will continue to develop throughout their life
Myth #2 Infants won’t remember the negative experiences they have early in life including the emotional ones.
The truth is… Infants are born relationship ready The relationships they have give them experiences that will in fact shape the architecture of their brain The experience an infant has early in life is wired into his/her brain and will impact his/her development throughout their life.
Myth #3 Infants are resilient and will easily recover from early adversity.
The truth is…. While children are resilient, there is a threshold. When infants experience prolonged and frequent trauma their ability to “bounce back” to be resilient will reach its limits. Exposure to frequent and prolonged stress will impact brain development.
Myth #4 Early experiences don’t really count – it’s what happens when they start school that really matters.
The truth is… The brain develops rapidly in the first three years of life forming 700 new neural connections every second – that would be before school The greater the number of adverse experiences a very young child has the more likely his/her development will be impacted
Myth #5 It is not possible to recognize poor mental health during infancy.
The truth is….. There are behaviors that do tell us when a child is experiencing poor mental health – but we need to know what these look like. We have access to various tools referred to as screening tools that can help us know when a child needs a more in-depth assessment from a clinician. These will not diagnose but they will tell us a child needs more assessment.
Myth #6 Infants and toddlers who experience neglect and/or abuse are getting the help they need to address their mental health needs.
The truth is….. Very little is done to monitor a young child’s development overall much less their mental health. Other jurisdictions are screening for development including early mental health.
Myth #7 Early mental health does not impact mental health later in life.
The truth is The greater the number of early adverse experiences a child has the more likely s/he will experience adversity throughout his/her life.
Myth 8 Whatever adversity a child may have experienced before school can be undone by the programs offered to him/her.
The truth is…. A child who arrives at school with poor mental health is likely already behind. The gap in developmental outcomes and achievement will continue to increase over time. To change this will require MONUMENTAL resources from the system and the child.
When Children Arrive at School A concern may be expressed about that child’s behavior. Sometimes the concerning behavior is distressing all in the classroom – teacher, other children… That child’s behaviour did not happen when he arrived at school. That child has been on a journey that brought him to that place.
While We Can’t Change the Past There are many things that those in the school system can do to support early mental heath. We can screen for early mental health in our classrooms. We can create plans that can be used by teachers, parents and other resource workers in the classroom to support a child’s social emotional development.
But this is major change…. This is about changing: Our knowledge about mental health Our policies around early identification of mental health vulnerability Our practices supporting early mental health. Our beliefs about mental health – when it begins and what influences.
Infants and toddlers are missing from the picture While there has been an important and impactful effort to raise awareness about mental health these efforts have focused on youth and adults suffering Most people do not realize that for too many, poor mental health begins during the first three years and sets a child on path that can be riddled with mental health challenges
Your Context…. Many of you see children when they are on the verge or immersed in a mental health crisis. They are being labeled by others in the system, by their peers, by other parents. They are at a VERY HIGH risk for a life time of poor outcomes physically, emotionally and cognitively
Waiting is not a solution We can begin to work with families to: Understand the mental health needs of their child Create plans that will begin to deal with any vulnerabilities. These plans can be used by the teacher, the parents and any other resource staff working with the child Monitor regularly the child’s development This is not about academic testing but this will impact academic outcomes for a child
An Overview of Early Mental Health Does it really exist?
My Objectives for Today To enhance your knowledge of early mental health – how it develops, what influences it To enhance your practices with young children so that we create opportunities for those in the system to understand each child’s mental health To identify opportunities to create policies that will enable you to support the mental health of TDSB’s youngest pupil
What is early mental health? Early mental health is the social, emotional & cognitive well being of infants and toddlers
When does mental health begin? – A child’s mental health begins at conception –An infant, toddler, preschooler or kindergarten child can have serious mental health and emotional problems –An infant who experiences poor mental health this early in life, will be vulnerable for poor mental health throughout life
Definitions of trauma Trauma can be the result of: Community violence Family violence Child maltreatment
Community Violence Violence outside the home, within the neighborhood Violence committed by people who are not known or related to the child Exposure to weapons, muggings, the sound of bullets, sexual assaults Contact with gangs and guns Being a victim of violence Summers & Fitzgerald. (2012). Understanding early childhood mental health. United States: Brookes Publishing.
Family Violence Violence within the home Violence between family members Summers & Fitzgerald. (2012). Understanding early childhood mental health. United States: Brookes Publishing.
Child Maltreatment Physical abuse, sexual abuse, emotional abuse, neglect Physical abuse includes non-accidental act as that result in injury to a child Neglect includes absence of care by caregivers, failure to supervise young children, or failure to provide for the basic needs of children Summers & Fitzgerald. (2012). Understanding early childhood mental health. United States: Brookes Publishing.
But can young children experience trauma symptoms? Yes they most certainly can. For example, in a study by G. Anne Bogat, Erika DeJonghe, Alytia A. Levendosky, William S. Davidson, Alexander von Eye (September 2005) it was concluded that “infants as young as 1-year-old can experience trauma symptoms as a result of hearing or witnessing IPV.” www.msu.edu/~mis/publish/Infant_Trauma.pdf
Definitions Will Vary For our purposes we define trauma as: “…an event or events that involve actual or threatened death or serious injury to the child or others, or a threat to the psychological or physical integrity of the child or others” Zero to Three, National Centre for Infants, Toddlers and Families. (2005). Diagnositic classification of mental health and developmental disorders of infancy and early childhood, revised (DC: 0-3R). Washington, DC: Zero to Three.
Exposure to trauma can occur once or multiple times, and young children exposed to multiple traumatic events tend to experience worse outcomes than those exposed only once.” Chu, A.T., & Lieberman,j A.F. (2010). Clinical implications of traumatic stress from birth to age five. Annual Review of clinical Psychology, 6, 469-494.
Early is Essential There is a strong link between children’s trauma symptoms and the amount of exposure a child has had to traumatic events. The longer and more often a child is exposed to violence, the worse off the child will be socially, emotionally, and psychologically in the long run. Interventions and supports must address both immediate needs and long-term development and relationship issues. The longer we wait to recognize and respond the more likely the impact on a child’s development will be negative
What is the impact of early trauma? Early trauma affects a young child’s development, behavior and relationships brain development when undetected and untreated, will impact short and long term mental and physical health outcomes Is much harder to recover from the longer it continues undetected and untreated Often leads to prolonged and frequent stress for the child For these reasons, early detection and early intervention are critical for young children
Trauma Symptoms in Young Children “Re-experiencing” or playing out memories of the event Toileting problems Sleep problems Eating problems Verbal or language difficulties Developmental regression Withdrawal Onset of new fears Aggressive outbursts or increased activity level Increased clinginess/separation Anxiety PTSD Relationship problems – including poor attachment or attachment disorders Depression Dysregulation of stress system Low self-esteem Preoccupation with the traumatic event such as bringing up the episode repeatedly or uncontrollably Increased and prolonged stress
Toxic Stress & Brain Development Toxic stress is the frequent, prolonged activation of the stress response system Triggers the release of chemicals that impair brain development and functioning World wide data on the lifelong implications of stress in early childhood
When a child is vulnerable to continued exposure to any of these experiences they are more likely to be traumatized At the time of the trauma the protective factors surrounding a child may help a child overcome and recover from the event But for too many infants and toddlers those factors are not consistently present in their lives
Baby or Toddler who has recovered from traumatic experience/event Protective Factors that may mitigate minimize impact Traumatic events/experiences One parent is an abuser Second parent removes child and her/himself from the situation Parent accesses support Parental death Other family members step in and provide the response the baby needs
Baby or Toddler unable to recover from trauma Limited/weak Protective Factors Traumatic events/experiences Infant or Toddler suffering from poor mental health Mother dies Father emotionally vulnerable/ no one else to respond (examples)
Trauma Stress Brain development Overall development Relationship/ attachment Overall health
Why Do We Make Reasoning Errors? Emotional reasons Cognitive reasons
Common Errors in Reasoning Halo effect Filtering or confirmation bias (Munro) Desensitization & depersonalization Allure of available or vivid evidence Vanity effect Perseverance effect Imposing meaning or causality
How Can We Improve Practice? Accept that we are worse at making decisions than we think we are Train practitioners to be comfortable with dissonant views Train practitioners to use empirical evidence correctly Encourage reflective supervision Create feedback mechanisms
Your role in understanding a child’s development Depending on your role you may or may not be able to diagnose You can implement a developmental screen either in partnership with the biological family, the foster family, through your own observations or a combination of any two of the above You can be trained on how to implement both a screen and curriculum based assessment tool
Your role in understanding a child’s development You can reach out to community agencies such as Early Years Centres, children’s mental health agencies and ask for guidance with the creation of a developmental plan to support the needs of a child You can refer parents to programs in the community that provide guidance around parenting and supporting development
Poor Mental Health Can Impact Health Outcomes – Short and Long Term We know that when young children experience poor mental health the impact is also on their physical health and well being According to researchers at Harvard, children who experience poor mental health experience higher rates of illnesses throughout life.
Health Outcomes: Physiological /Medical Challenges –You can be the FIRST RESPONDER –You cannot diagnose –You can make referrals to the appropriate professional who can diagnose –You can be making observations that can be shared with other professionals (with parental consent) that could be very helpful – for instance, a child with poor muscle tone making observations of movements, any pain the child experiences etc… can be helpful to a clinician –You can be reviewing medical records –You can be consulting with/to the other disciplines involved with the case (with the appropriate consents)
Historically what has neglect/abuse looked like? A baby with broken bones A toddler with healing fractures and other unexplained injuries An underweight infant An unkempt, dirty toddler A baby who has been shaken within inches of his/her life This is what we all looked for and when these things were absent we often thought all was okay
We are good at looking for hazards Typically, when concerned we look for the hazards. But where the mental health of young child is concerned the absence of “normal things, experiences” should be as concerning to us as the hazards that are present – the absence of a warm blanket in the toddlers crib during winter needs to be a concern
We know much more… Neglect and maltreatment lead to poor mental health for infants
Emotional Deprivation in Infancy : Study by Rene A. Spitz, 1952 http://www.youtube.com/watch?v=VvdOe10vrs4
What Does all of this Mean? 1.The Absence of Normal Can’t Be Ignored 2.Monitor the child’s development and provide activities to support development while he is involved with your agency 3.Connections Count - Be connected to resources and professionals who can step in with the expertise you don’t have. 4.Be aware of the interventions that are available to your agency and therefore the children. 5.Educate, Educate, Educate!!! The Judge, The Lawyers, Your Team 6.Advocate for babies and toddlers as a unique group with unique needs
Development Counts but Who is Watching? “Developmental structures are incorporated into later developmental structures, so that early competence tends to foster later competence, and early incompetence tends to promote later incompetence” (Cicchetti & Cohen, 1995; Waters & Sroufe, 1983) If this is the case how is that we don’t monitor development and respond to what a child needs?
Monitor Development In the US every child under the age of three is entitled to a developmental screening and service plan. Monitoring development is not difficult – IMHP will gladly train you and your team to do this! Create a developmental plan that can be shared with those caring for the child. This ensures some consistency of expectations and also supports the child’s development appropriately
Do Screen for Development You can screen for development including mental health using tools such as (but not limited to): ASQ 3 ASQ SE Brief Infant-Toddler Social Emotional Assessment (BITSEA) Eyberg Child Behavior Inventory Vineland Social-Emotional Early Childhood Scales
Make Use of What Might Be Dead Time With the resources available you can be a bridge to the services and supports a child and family may need. Make the appropriate referrals. While waiting for services to kick in, create a plan that supports the child’s development and gives caregivers something to focus on.
Connections Count You can’t be all things to all children and their families – so who else can step in? Have your school update their list of resources – there may be new programs that you are not aware of. Connect to programs such as ECE who may be able to provide students who can provide some developmental guidance to some children.
When Intervening Do it Early and Generously As mentioned early intervention is paramount if you want to have an impact that will change a child’s developmental trajectory Provide interventions and supports generously. Parenting is hard for most of us. For those struggling, the support they may need to make the changes the child needs may require significant supports – early is best and be generous if you are serious
Look at Your Agency Does your agency have best practice guidelines in place specific to infants and toddlers?
Educate! Educate! Educate! IMHP will be creating a brief that will be available to agencies and will provide salient points to share with Judges and others. Other training resources will also be developed Including: Training curricula and modules for Child Welfare Developmental Program Planning Worksheets Temperament training and resources Infant Mental Health Resources