Transcript Toxic Stress - Kansas Division for Early Childhood

Toxic Stress in Early Childhood
31st Annual Kansas Division for Early Childhood Conference
February 28, 2013
Kaela Byers, LMSW
University of Kansas
School of Social Welfare
Kathy Byrnes, MA, LMSW
University of Kansas
School of Social Welfare
Sharah Davis-Groves, LMSW
University of Kansas
School of Social Welfare
Northeast Kansas Infant-Toddler Services
Kristin Pedersen, MA, CCC-SLP
University of Kansas Schiefelbusch
Speech-Language-Hearing Clinic
Northeast Kansas Infant-Toddler Services
Agenda
• Overview of Toxic Stress
• What is it?
• How does it impact children?
• How do you recognize it?
• New research on addressing Toxic Stress
• How does Toxic Stress impact families and your work with
families?
• Strategies for coping with the effects of Toxic Stress in your
work with families.
• How can your program support you?
• Challenges and opportunities in Early Intervention Services.
Toxic Stress: What is it?
• In 2005 the National Scientific Council on the Developing Child
proposed a scientifically grounded taxonomy of the stress
experience to delineate between normative challenges that
promote growth and development and challenges that may be
threatening to child development.
• Positive Stress
• Tolerable Stress
• Toxic Stress
Reference: National Scientific Council on the Developing Child. (2005). Excessive Stress Disrupts the Architecture of the Developing Brain:
Working Paper #3. Available at: http://www.developingchild.net.
Positive Stress
• Positive stress is the reaction to typical daily experiences that
provide opportunities for grown and learning.
Tolerable Stress
• Tolerable Stress is the reaction to more serious stressors
(community violence, natural disaster, frightening accident,
illness, death of a loved one, etc.) and has the potential to
damage the child’s brain structure if left unchecked.
• These stressors subside over time or are
buffered by supportive caregiver relationships.
• Caregiver support
• Promotes feelings of safety
• Facilitate acquisition of coping and
recovery skills
• Protect against escalation of tolerable
stress to toxic stress.
Toxic Stress
• Toxic stress is the reaction to strong, prolonged,
uncontrollable, or chronic stressors activate the body’s stress
response system (e.g. abuse, neglect, parental substance
abuse, maternal depression, etc.).
• Toxic Stress occurs in the absence of a stable and responsive
adult or caregiver to offer buffering protection to the child.
• Ongoing activation of the body’s regulatory/stress response
system over time results in changes to
the architecture of the brain.
• Changes to the brain can promote
short-term effects on behavior and
learning as well as long-term impairments such as chronic
and stress-related health and mental
health problems.
Ecobiodevelopmental Framework
Reference: http://developingchild.harvard.edu/resources/multimedia/interactive_features/biodevelopmental-framework/
Toxic Stress: What Impact Does It
Have On Children?
• Toxic Stress may result in disruption of the child’s stress regulatory
system.
• This disruption increases vulnerability to:
• Ability to detect and respond to emotionally stressful stimuli
such as distress cues of others
• Internalizing disorders (anxiety and depressive disorders)
• Externalizing disorders (early onset aggression, oppositional
defiant or conduct disorder, disruptive behavior disorder,
antisocial behavior)
• Chronic pain syndromes
• Immune-related disorders
• Cognitive deficits
• Disorganized attachment
References: Gunnar & Donzella, 2002; Gunnar & Vazquez, 2001; Heim, Ehlert, & Hellhammer, 2000; Heim & Nemeroff, 2001; McBurnett,
Lahey, Rathouz & Loeber, 2000; Pajer, Gardner, Rubin, Perel, & Neal, 2001
Toxic Stress: How can you
recognize it in children?
•
•
•
•
•
No current validated screening tool
Key: Observation
Internalizing/Externalizing disorder symptoms
May not exhibit symptoms
Recognize constellations of
risk factors
• Awareness of parenting
style and attachment
characteristics
• Next steps in measurement/
screening
Toxic Stress: Next Steps
• Early identification of families for early home-based services
• Two-pronged approach to early childhood intervention
• Compensatory mechanisms to temper the effect of toxic stress
exposure in conjunction with elimination of risk factors
• Ex. Promote nurturance, non-frightening parenting behaviors,
following the child’s lead
• Biobehavioral interventions to reverse negative changes, restore
functioning, and build capacity to buffer against future stressors
• Neurosequential Model of Therapeutics (NMT)
• Attachment and Biobehavioral Catch-Up
• Promotes healthy regulatory system development by
enhancing attachment and responsive parenting
• Promising evidence: more secure attachment, better
behavioral and biological regulation, fewer reported behavioral
problems, long-term efficacy
References: Dozier, Bick, & Bernard, 2011; Dozier, Lindhiem, Lewis, Bick, Bernard, & Peloso, 2009; Dozier, et al., 2006; Ferraro & Kelly-Moore, 2003;
Lewis-Morrarty, Dozier, Bernard, Terracciano, & Moore, 2012; Perry, 2009
Toxic Stress: How Does It Impact
Families and Your Work With Them?
• Family engagement in services – Understanding how TS impacts
the Dance or the partnership!
1) Start where families are - listen to more than their words to
understand the impact of TS.
A. What is the family’s understanding of their child’s special
needs or environmental needs?
B. What TS symptoms do you see in caregivers & children?
C. How do these symptoms of TS impact your work with the
family?
D. What do caregivers need to address the impact of the TS?
E. What can we do within our roles to link caregivers with
resources to meet the needs?
References - Eggbeer, Shahmoon-Shanok, & Clark 2010;Gallager, Fialka, Rhodes, Arceneaux, 2002; Lippicott, Williams, &
Wilkins, 2012; McCalister & Thomas, 2007; Virmani & Ontai, 2010
Toxic Stress: What Can You Do
About It?
2) What do YOU need to deal with the impact of the TS families
are experiencing?
A.
B.
C.
D.
Acknowledge the impact on you.
Assess how you feel when you leave?
What do you do with those feelings?
What is your strategy to unload/differentiate your life from
the families you work with? What restores you? Where is
your safe place to process? http://cehdvision2020.umn.edu/wpcontent/uploads/2012/07/Reflective-Supervision.pdf
References: Baker, 2003; Dunn, Bell, & Bellah, 2012; Professional Self Care in Social Work, 2008;Watson & Gatti, 2012; McCalister & Thomas, 2007
Toxic Stress: What Can You Do
About It?
3) What can YOU do to take care of yourself over time as you
work with families experiencing TS?
A. Review strategies that promote personal and professional
well-being. (handout)
B. Make a self care plan. http://www.epsychologist.org/index.iml?mdl=exam/show_article.mdl&Material_ID=1
Toxic Stress: How Can Your
Program Provide Support?
• How do you use team meeting times?
• To vent, share, coach, listen, refresh, rejuvenate
• Is there a balance between business and fun?
• What types of support and feedback are given?
• How do you check in with each other? During the week
• Calls, emails, face to face time between co-visits
• Do you know your team members? What they need?
• Who are the people on the team that are skilled at providing
support? By discipline or personality
• Making sure we take breaks in year-round service provision
• vacation time, days off, covering for each other
• Do you know your self? Do you know what you need and
when? Do you know how to ask for help?
Toxic Stress: Challenges &
Opportunities in Early Intervention
Services
1) Taking time to deal with the impact of TS on families and
workers.
2) Difficult to assess TS & determine change over time (no tools
out there yet), and to articulate impact of TS on children’s
social emotional development.
3) Being patient with self and families.
4) Staying focused on goals due to multiple needs in the
environment.
5) Balance between meeting family needs and staying within
the scope of our roles.
6) Collaboration across agencies to meet the family needs
takes time and consistent effort.
Questions
References
Baker., E.K., (2003). Caring for Ourselves as Psychologists. Retrieved from http://www.epsychologist.org/index.iml?mdl=exam/show_article.mdl&Exam_ID=1&Article_ID=1 on December 15, 2012.
Dozier, M., Bick, J., & Bernard, K. (2011). Attachment-based treatment for young, vulnerable children. In J.D. Osofsky
(Ed.) Clinical Work with Traumatized Young Children. New York: The Guilford Press, pp. 75-95.
Dozier, M., Lindhiem, O., Lewis, E., Bick, J., Bernard, K., Peloso, E. (2009). Effects of a foster parent training program
on young children’s attachment behaviors: Preliminary evidence from a randomized clinical trial. Child and
Adolescent Social Work Journal, 26(4), 321-332.
Dozier, M. Peloso, E., Lindhiem, O., Gordon, M.K., Manni, M., Sepulveda, S., Ackerman, J.., Benier, A., & Levine, S.
(2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with
infants and toddlers. Journal of Social Issues, 62(4), 765-783.
Dunn, T., Bell, L., & Bellah, L. (2002). Thinking about reflection. Retrieved from http://www.zerotothree.org/aboutus/areas-of-expertise/reflective-practice-program-development/one-program-shares-its-experience.html on
November 15, 2012.
Eggbeer, L., Shahmoon-Shanok, R., & Clark, R. (2010). Reaching toward an evidence base for reflective supervision.
Zero to Three, 31(2), 39-45.
Ferraro, K.F., & Kelley-Moore, J.A. (2003). Cumulative disadvantage and health: Long-term consequences of obesity?
American Sociological Review, 68(5), 707-729.
Gallager, G.A., Fialka, J., Rhodes, C., Arceneaux, C., (2002). Working with Families: Rethinking Denial. Young
Exceptional Children, 5(2), 11-17.
References
Gunnar, M.R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development.
Psychoneuroendocrinology, 27, 199-220.
Gunnar, M.R., & Vazquez, D.M. (2001). Low cortisol and a flattening of expected daytime rhythm: Potential indices of
risk in human development. Development and Psychopathology, 13, 515-538.
Heim C., & Nemeroff, C.B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders:
Preclinical and clinical studies. Society of Biological Psychiatry, 49, 1023-1039.
Heim, C., Ehlert, U., & Hellhammer, D.H. (2001). The potential role of hypocortisolism in the pathophysiology of stressrelated bodily disorders. Psychoneuroendocrinology, 25, 1-35.
Levine, S., Wiener, S.G., & Coe, C.L. (1993). Temporal and social factors influencing behavioral and hormonal
responses to separation in mother and infant squirrel monkeys. Psychoneuroendocrinology, 18(4), 297-306.
Lewis-Morrarty, E., Dozier, M., Bernard, K., Terracciano, S.M., & Moore, S. (2012). Cognitive flexibility and theory of
mind outcomes among foster children: preschool follow-up results of a randomized clinical trial. Journal of
Adolescent Health, 51, S17-S22.
McBurnett, K., Lahey, B.B., Rathouz, P.J., & Loeber, R. (2000). Low salivary cortisol and persistent aggression in boys
referred for disruptive behavior. Archives of General Psychiatry, 57, 38-43.
McCalister , C.L., & Thomas, T., (2007). Infant Mental Health and Family Support: Contributions of Early Head Start to
an Integrated Model for Community-Based Early Childhood Programs. Infant Mental Health Journal, 28(2), 192215.
References
National Association of Social Workers. (2008). Professional Self-Care and Social Work. Social Work Speaks.
National Scientific Council on the Developing Child. (2005). Excessive Stress Disrupts the Architecture of the
Developing Brain: Working Paper #3. Available at: http://www.developingchild.net.
Pajer, K., Gardner, W., Rubin, R.T., Perel, J., & Neal, S. (2001). Decreased cortisol levels in adolescent girls with
conduct disorder. Archives of General Psychiatry, 58, 297-302.
Perry, B.D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the
neurosequential model of therapeutics. Journal of Loss and Trauma, 14, 240-255.
Rosenblum, L.A., & Andrews, M.W. (1994). Influences of environmental demand on maternal behavior and infant
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Rosenblum, L.A., Coplan, J.D., Friedman, S., Bassoff, T., Gorman, J.M., & Andrews. M.W. (1994). Adverse early
experiences affect noradrenergic and serotonergic functioning in adult primates. Society of Biological Psychiatry,
35(4), 221-227.
Virmani, E. A., & Ontai, L. L. (2010). Supervision and training in child care: does reflective supervision foster caregiver
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Infants and Young Children, 25, 2, 109-121.