Presentation on theme: "Evolution Mental Health and Trauma Services, LLC"— Presentation transcript:
1Evolution Mental Health and Trauma Services, LLC A Chip Off the Old Block: How a Parents life Experiences Can Effect Their Children.Vicki Rahenkamp, LCPCEvolution Mental Health and Trauma Services, LLCOctober 14, 2014
2What is Intergeneration Trauma? Adverse Childhood experiences (ACE)What are they?
3ACE QuestionnaireDid 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 injuredDid 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 youDid 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 otherDid 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? enterWas a household member depressed or mentally ill, or did a household member attempt suicide?Did a household member go to prison? Yes
4What Else Counts as an ACE? Parent deployed to the warHospitalizationDeath of a petFrequent movesPovertyCommunity violenceHealth issues of a parent.The more experiences the greater the trauma.
5Why 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 .
6How 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
7What is Attachment?Special enduring form of “emotional”relationship with a specific personInvolves soothing, comfort and pleasureLoss or threat of loss of the specific person evokes distressThe child finds security and safety in the context of this relationship.( Bruce Perry, Child Trauma Academy)
8What is BondingSimply stated, bonding is the process of forming an attachment. Just as bonding is the termused when gluing one object to another, bonding is using our “emotional glue” to becomeconnected to another. Bonding, therefore, involves a set of behaviors that will help lead toan emotional connection (attachment).(Bruce Perry, Child Trauma Academy)
9Bonding cont. (Bruce Perry, Child Trauma Academy) An emotionally and physically healthy mother will:Be drawn to her infantShe 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.
10How does Mother’s Depression impact the Baby Stop sending emotional signalsSelf 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 delaysAs infants: sleep more, elevated startle reactions, show less interest.Show less upset when separated from mom.
11Depressed mother’s often ignore or override baby’s emotional signals Depressed mother’s often ignore or override baby’s emotional signals. They can be:PunitiveSee baby’s as bothersome, and hard to care for.Feel their lives are out of control
12Less motivation to explore environment Prefer less challenging tasks. As toddlers engage in low levels of symbolic play.Grow poorlyBehavior problems that last into adolescenceRisk of becoming depressed.Show first part of the video.
13Consequences of Trauma seen in Children. Alterations in brain growth and organization. Specifically:smaller frontal-occipital circumference and cortical atrophySmaller hippocampusSmaller corpus callosumThese alterations in brain growth lead to problems with:Impulse controlCause and effectExecutive functioningEmotion regulationEmpathyCognitive skills-due to deficits in long and short-term memory.
15How do we make changes? Family therapy vs child only treatment Individual therapy for parent/parentsPositive parenting vs punitive parentingIdentifying what the “pay off” for the child’s behaviorEarly intervention
16fACESIntergenerational Trauma-Focused Parenting ProgramServing 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 OutlineFamilies 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.
17Topics addressed (education and modeling) using intensive 1-1 engagement: How our trauma affects parentingHealthy bounding and attachmentChild development and healthy expectationsParent-child boundariesPositive parenting skillsWeekly 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 traumaPsycho-education on intergenerational traumaPsycho-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.
20Initiative 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.
21Our 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 ChildrenStrengthening FamiliesEngaging Communities
22TARGET POPULATION 1st time parents who reside in Queen Anne’s, Talbot & Kent Counties who are eligible for Maryland Children’s Health Program or uninsured.
23Have 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.
2410 AreasParents’ childhood experiencesLifestyle behaviors and mental healthParenting experience, prior CPS involvementCoping skills and support systemCurrent stressorsAnger management skillsExpectations of infant’s development and milestonesPlans for disciplinePerception of new infantBonding and attachment
25The 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.
26Home 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.
27Some of the programs outcomes: Decrease child abuse and neglectHealthy birth weightsCompleted immunizationsImproved safety in the homeIncreased parent knowledge of child development
30Healthy 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 othersFamilies do not know the difference between therapy and trauma-informed therapy
31The 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
32So What Next????Statistics so far (Three months)Starting program in a residential settingLong term hopes/