1. Evolution Mental Health and Trauma Services, LLC
A Chip Off the Old Block: How a Parents life Experiences Can Effect Their Children.
Vicki Rahenkamp, LCPC
Evolution Mental Health and Trauma Services, LLC
October 14, 2014

2. What is Intergeneration Trauma?
Adverse Childhood experiences (ACE)
What are they?

3. ACE Questionnaire
Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured
Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you
Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other
Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Was a biological parent ever lost to you through divorce, abandonment, or other reason ?
Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs? enter
Was a household member depressed or mentally ill, or did a household member attempt suicide?
Did a household member go to prison? Yes

4. What Else Counts as an ACE?
Parent deployed to the war
Hospitalization
Death of a pet
Frequent moves
Poverty
Community violence
Health issues of a parent.
The more experiences the greater the trauma.

5. Why is this Important ? Puts your child’s behavior into context.
Helps us target the problem behavior and not the “bad kid”.
Helps us see the behaviors as a family dynamic issue and not focused on an individual .

6. How does this happen?
His stuff + My stuff = New stuff (our families stuff).
Entitlements, what does this mean?
Emotional triggers (yours and theirs).
Bonding and attachment impacted by:
Temperment (parent vs child).
Parents bonding with their own parents (we do what we learn).
Parent depression.
Parental stress/anxiety

7. What is Attachment?
Special enduring form of “emotional”relationship with a specific person
Involves soothing, comfort and pleasure
Loss or threat of loss of the specific person evokes distress
The child finds security and safety in the context of this relationship.
( Bruce Perry, Child Trauma Academy)

8. What is Bonding
Simply stated, bonding is the process of forming an attachment. Just as bonding is the term
used when gluing one object to another, bonding is using our “emotional glue” to become
connected to another. Bonding, therefore, involves a set of behaviors that will help lead to
an emotional connection (attachment).
(Bruce Perry, Child Trauma Academy)

9. Bonding cont. (Bruce Perry, Child Trauma Academy)
An emotionally and physically healthy mother will:
Be drawn to her infant
She will feel a physical longing to smell, cuddle, rock, coo and gaze at her infant.
In turn the infant will respond with snuggling, babbling, smiling, sucking and clinging.
In most cases, the mother's behaviors bring pleasure, soothing and nourishment to the infant and the infant's behaviors bring pleasure and satisfaction to the mother.
This reciprocal positive feedback loop, this maternal-infant dance, is where attachment develops.
Therefore, despite the genetic potential for bonding and attachment, it is the nature, quantity, pattern and intensity of early life experiences that express that genetic potential.
Without predictable, responsive, nurturing and sensory-enriched caregiving, the infant's potential for normal bonding and attachments will be unrealized.

10. How does Mother’s Depression impact the Baby
Stop sending emotional signals
Self soothe(thumb sucking or rocking)
Learn that they can not draw responses from others, mom unreliable, world untrustworthy.
Children of depressed moms are at a risk for emotional and cognitive delays
As infants: sleep more, elevated startle reactions, show less interest.
Show less upset when separated from mom.

11. Depressed mother’s often ignore or override baby’s emotional signals
Depressed mother’s often ignore or override baby’s emotional signals. They can be:
Punitive
See baby’s as bothersome, and hard to care for.
Feel their lives are out of control

12. Less motivation to explore environment Prefer less challenging tasks.
As toddlers engage in low levels of symbolic play.
Grow poorly
Behavior problems that last into adolescence
Risk of becoming depressed.
Show first part of the video.

13. Consequences of Trauma seen in Children.
Alterations in brain growth and organization. Specifically:
smaller frontal-occipital circumference and cortical atrophy
Smaller hippocampus
Smaller corpus callosum
These alterations in brain growth lead to problems with:
Impulse control
Cause and effect
Executive functioning
Emotion regulation
Empathy
Cognitive skills-due to deficits in long and short-term memory.

15. How do we make changes? Family therapy vs child only treatment
Individual therapy for parent/parents
Positive parenting vs punitive parenting
Identifying what the “pay off” for the child’s behavior
Early intervention

16. fACES
Intergenerational Trauma-Focused Parenting Program
Serving Parents who have experienced Childhood trauma (sexual, physical and extreme neglect)
Length: Families will be served for 1-3 years depending on severity of the symptoms (pilot program will run 6 months)
Referral source: Families will be referred through Health Dept. Healthy families program and perhaps local pediatricians and hospitals. (Pilot program Healthy families).
Number of families: Based on funding available (pilot program 10 families).
 Program Outline
Families will be referred to the program through Healthy Families, based on their screening process. A referral form will be designed in conjunction with Healthy Families and will be used to refer families to the program.
Once referral is received an in-home parent coach will be assigned and they will meet with the family for an intake session, during this session the PSI (Parenting Stress Index), and the TSI (Trauma Symptoms Inventory) or TSCC (Trauma Symptoms Checklist for children) if the parent is under the age of 18. Families will also fill out intake paperwork and review program objective and expectations during this session.
Families will receive:
Weekly (1.5 hrs) in-home family therapy and parenting education ( psycho-education and modeling). Family therapy used will be Contextual family therapy and Parent- Child Psychotherapy, which addresses intergenerational trauma and impact of families of origin. Parent education will be based on PSI Parent program.

17. Topics addressed (education and modeling) using intensive 1-1 engagement:
How our trauma affects parenting
Healthy bounding and attachment
Child development and healthy expectations
Parent-child boundaries
Positive parenting skills
Weekly individual therapy for parent, using TF Psychotherapy and TF-CBT. Session will be offered in the home, but can happen in the office if family prefers. Focus of the individual therapy is on parents past trauma symptom resolution.
Therapy addresses:
Normal TF therapy to address parent part trauma
Psycho-education on intergenerational trauma
Psycho-education on how parent symptomology affects child development and behavior (specifically regulation and anxiety).
Bi-weekly parent group at office (childcare provided). Group consists of parent support, psycho- education, and a music therapy component (stress reduction).
Child care for the children will be structured and focus emotion regulation.

18. Child Advocacy Center Involvement

19. Healthy Families Mid-Shore

20. Initiative began in 1999 through Healthy Families America and Queen Anne’s County Community Partnerships with Families and Children through Queen Anne’s County Health Department. Then partnered with Talbot County Health Department in conjunction with Talbot Family Network. Began serving families in both counties in January 2000 to Queen Anne’s and Talbot Counties Expanded to Kent County in July 2013.

21. Our Vision: All children receive nurturing care from their family essential to leading a healthy and productive life.
Our Mission: To promote child well-being and prevent the abuse and neglect of our counties’ children through home visiting services.
Core Values: Valuing Children
Strengthening Families
Engaging Communities

22. TARGET POPULATION 1st time parents who reside in Queen Anne’s, Talbot & Kent Counties who are eligible for Maryland Children’s Health Program or uninsured.

23. Have risk because of their own history of abuse as a child, current or past mental illness, substance abuse issues, anger control problems, inadequate support, high stress, limited knowledge about child development and other risk factors.
The assessment process addresses 10 areas discussed in a conversation between the FAW and the potential participant during a home visit.

24. 10 Areas
Parents’ childhood experiences
Lifestyle behaviors and mental health
Parenting experience, prior CPS involvement
Coping skills and support system
Current stressors
Anger management skills
Expectations of infant’s development and milestones
Plans for discipline
Perception of new infant
Bonding and attachment

25. The tool has been standarized and validated as an indicator of risk of child maltreatment. A score of 0,5 or 10 is given to each topic. Must score a 25 or higher to be eligible for services.

26. Home visitors teach parents about parenting and child development using the Growing Great Kids curriculum. Use on-going positive, strength-based relationships to promote growth and change in families.

27. Some of the programs outcomes:
Decrease child abuse and neglect
Healthy birth weights
Completed immunizations
Improved safety in the home
Increased parent knowledge of child development

28. Lessons Learned

30. Healthy Families have very hard to reach families
Healthy Families have very hard to reach families. Not all of the 10 families referred engaged in the “fACES” program.
It is hard for the families to establish trusting relationships with others
Families do not know the difference between therapy and trauma-informed therapy

31. The home visitors and therapists need to meet more often to discuss barriers, challenges and successes.
Suggested to schedule home visits back to back.
It is difficult to get the at-risk families to groups

32. So What Next????
Statistics so far (Three months)
Starting program in a residential setting
Long term hopes/

35. Contact Information
Evolution Mental Health and Trauma Services, LLC 10 West Dover St 2nd FL, Easton MD