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8/23/13
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R E L A T I O N S H I P S! R E S I L I E N C E! R E A D I N E S S!
Funded by the California Department of Education/
Child Development Division Grant Race to the Top -
Early Learning Challenge
The 3R’s of Early Childhood:
W E B I N A R S E R I E S
Presented by:
Karen Moran Finello, PhD!Mary Claire Heffron, PhD !
August 22, 2013
Welcome
Virginia Reynolds Program Director WestEd Center for Preven>on and Early Interven>on RTT-‐ELC 3R’s of Early Childhood Trainings
Key Areas of the 3 Rʼs Webinars!
Supporting the development and maintenance of healthy infant-toddler-preschool and parent relationships"
Recognizing areas of vulnerability and resilience"
Accessing other resources to support infant, toddler, preschool, and family"
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Early Social & Emotional Development!
Is integral to all development, but often ignored"• Development is interwoven"• Young children cannot be separated into pieces of
development"
The development of social and emotional well-being in children birth-5 years:"• Child behavior and health"• Family functioning and social relationships"• Caregiver-child relationships"
Earliest Period of Infancy Lays the Foundation for Future Development !
Trust in and reliance on others"• “You are there when I need you”"
Emotional expression"• Learning how to express needs"• Understanding needs will be met"
Beginning of regulation"• Self-soothing"• Calming"• Learning what to expect of the world"• Responding to calming influence of caregiver"
Challenges!
Need to move quickly"• Babies canʼt wait"• Period of rapid development"
Must work towards goal of “good enough” parenting"
Must understand developmental functioning of EVERY family member"
(Jones, 1995)"
Relationships are the key to change"
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Critical Characteristics of Infant Social and Emotional Development !
Development of relationships is the KEY to all other areas"• Ability to initiate, discover, & learn"• Development of persistence & attention"• Development of coping mechanisms"• Development of self-regulation"• Development of emotional range"
Developmentally Based Approach!
Focuses on"• Developmental characteristics of child &
caregiver"• Attachment & behavioral manifestation"• Neurobehavioral status/temperament & the
caregiving environment"• Past and present circumstance"• Resilience, health risk, and/or disorder"• Protecting & predisposing environments"• Social and cultural expectations of the community"
Significant Factors Impacting Early Development!
Biological and Constitutional factors" Prenatal factors" Infant-caregiver relationship" Caregiver influences" Experiential influences" Community influences"
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Brain-Behavior Relationships !Pathways to Healthy Social and Emotional Development"
Robust Brain Function"Synapse Development,
Neurotransmitters, Myelination"
Pre-natal Care, Maternal Health, and"Minimal Stress in Pregnancy"
Neonatal Nurturance and Care"
Healthy Nutrition"Good Birth Weight, Expected Size for Gestational Age, Iron Sufficiency"
Healthy !Neurobehavioral
Status!Arousal, Attention, Initiative,
Responsivity, Regulation of Behavior"
Functional Engagement!
Curiosity and Exploratory Behavior + Experiential opportunity"
Healthy Mother-Child Interaction!Reciprocal Dyadic Engagement in Nurturance, Play, Feeding,
Bathing and Other Activities of Daily Living"
Robust "Immune "Status"
Optimal "Health"
Energy Physiologic Resilience Maternal"
Emotional"Availability"
Maternal Responsiveness
Internalized Maternal Representations Maternal Support: Social, Emotional, Spiritual, Economic, Maternal Health,
and Mental Health"
Appropriate Parental Expectations"
Infant !Mental Health!Healthy Attachment, "Emotional/Behavioral "
Self-Regulation, "Engagement "
& Mastery"
University of Southern California | University Center for Excellence in Developmental Disabilities"
Understanding What the Infant Brings to the Relationship !
Temperament & social style" Emotional expression" Neurologic functioning" Physical health status" Cognitive level"
700 New Neural Connections Formed Every Second!
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Development & Neural Connections!
18 Months Age at Which Disparities in Vocabulary Begin to Appear!
Developmental Transactional Model!
Complexity of factors across developmental areas & over time interact with sociocultural context to explain child functioning at present time"
Notion of “cumulative adversity” is important" The greater number of risk factors,
the greater the variation of the outcome" (Sameroff, 1987)"
“Compensating force of opportunity”" (Garbarino & Gonzel, 2000)"
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Risk to Infant-Caregiver Relationship!
Separation & loss" Multiple Caregivers" Repeat hospitalizations" Family instability" Environmental stressors" Substance use in caregiver" Domestic violence" Inadequate support for caregiver"
Maternal Risks and Influences!
Wishes & hopes for this baby" Present circumstances" Health" Mental health" Knowledge" Judgment" Coping mechanisms" Resilience "
Understanding Family Vulnerability!
Past experiences as a mother" Her own history of child rearing
experiences" Psychological state" Health & well-being"
Ghosts in the nursery"
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Additional Challenges!
Physical health of baby" Family crises" Cognitive and/or neurological problems in
the infant or caregiver"
The “Meaning” of Risk Factors!
Having a risk factor does NOT mean the child is at an immediate risk for poor outcomes or needs intervention services"
The child and/or family may need assistance in providing for “extra insulation”"• Most times, the family can provide this insulation"
BUT………………….!
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90-100% Chance of Delay With 7 or More Risk Factors!
How Early Experiences Get Into the Body!
• (from Harvard Center on Developing Child)"
The first is the embedding of disruptions caused by adverse experiences during sensitive periods in the development of the brain or other organ systems"• Example: Lifelong cognitive & physical
impairments associated with significant prenatal alcohol exposure (time-sensitive effect)"
Harvard Center on the Developing Child
How Early Experiences Get Into the Body (Continued)!
The second comes from the cumulative damage, or biological “wear and tear,” caused by recurring experiences such as abuse, chronic neglect, or exposure to violence, particularly when added to the everyday stresses of family economic hardship"
The biological mechanism for this “weathering” effect is related to the adverse impacts of chronic activation of the bodyʼs stress response systems"
Harvard Center on the Developing Child
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How Early Experiences Get Into the Body (Continued)!
The stable relationships with supportive adults that help young children learn how to cope with stressful circumstances, can make the difference between positive adaptation that promotes healthy development and negative disruptions that can undermine the architecture of the developing brain and other biological systems"
Harvard Center on the Developing Child
Family / Caregiver Protective Factors!
Parents / caregivers with personal histories of secure attachment"
Family support in times of stress" Household rules & structure" Support & involvement of extended family" Stable relationship between parents" Parental modeling of competence & coping" Family expectations of prosocial behavior"
Understanding Attachment Issues!
The difference between bonding and attachment:"• Bonding is the love and caring relationship that a
mother develops with the baby immediately after birth" Uni-directional"
• Attachment is the reciprocal affectionate relationship between mother and child" Bi-directional"
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What Is Important About Attachment?!
The “nature of the childʼs ties” (security of attachments)"
(Bowlby, 1958)"
Role of early attachment in laying patterns for all future relationships including later peer socialization & adult relationships"
Special Issues Impacting Relationships and Attachment!
Lengthy and/or repeated hospitalizations during the first two years of life"
Life-threatening special health care needs" Prematurity" Neurologic problems" Separation due to parental hospitalization
or death" Foster placements"
• Especially multiple placements"
Maternal Behaviors Predicting Secure Attachment!
Sensitivity vs insensitivity" Acceptance vs rejection" Accessibility vs being ignored and
neglected" Cooperation vs interference" Comforting child when child needs
comforting" Accepting childʼs range of feelings"
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Maternal Behaviors Predicting Secure Attachment (Continued)!
Sensitivity & responsiveness to childʼs cues"
Avoiding being intrusive or too directive"• Not overwhelming the child"
Showing positive feelings" Showing genuine love and joy" Allowing the child to be separate and
autonomous while still keeping him/her safe"
Conditions That May Lead to a Change in Attachment!
Negative caregiver life experiences"• Death"• Divorce"• Lengthy unemployment"
Positive caregiver life experiences"• New supportive relationships"• Stability of living conditions"
Successful interventions"
Is Attachment Only About Mothers?!
Babies develop attachments with more than one important caregiver"
Attachments are not all of the same quality"• There appears to be an “attachment hierarchy”"
What if there are mixed attachments?"
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Important Points!
Attachment may be different with different adults"• mother, grandmother, dad, child care provider"
There is typically a “primary” attachment to one person"
A referral should be made if the child constantly seems either sad & withdrawn or aggressive & out of control"
Emotional Availability!
A “motherʼs readiness to accept and reinforce a wide range of positive and negative emotional expressions that enhance mutual empathy and promote positive child self-perception”"
(Emde, 1989)"
Emotional Availability
Critical factor in parent-child interaction" Quality of emotional exchanges"
• Includes accessibility of parent to child and child to parent"
• Ability to understand each otherʼs communication and to respond appropriately" (Biringen & Robinson, 2000)"
Reciprocal in nature"
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Emotional Availability
Includes factors such as caregiver sensitivity, structuring of environment, non-intrusiveness, non-hostility"
Good global index of overall quality of parent-child affective relationship"
(Biringen, 2000)"
Emotional Ability Scales!
Maternal sensitivity" Maternal non-intrusiveness" Maternal non-hostility" Maternal restructuring" Child responsiveness" Childʼs involvement with caregiver"
(Biringen et al., 1998)
Emotional Availability!
Not just of the caregiver but of the baby, too"• It is important to understand what the baby brings
to the equation" Nurturance and availability require inner
resources"• It is hard to nurture when empty"
Caregiver may need to refer for MH treatment"
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How Early Relationships Effect Development! Exploration of infant / toddlerʼs world is effected
by attachment pattern" Self-regulation skills build from maternal and
dyadic regulation" Engagement with others may be modeled &
effected by attachment style" Language & communication development is
heavily influenced by relationships" Cognitive mastery effects childʼs social
interactions with the wider world"
Focus of Relationship-Based Work!
Changing attachment style by focusing on consistency and responsiveness in caregiver"
Improving caregiverʼs emotional availability "
Enhancing structure & routines in young childrenʼs lives"
Supporting Caregiver in Meeting Infant Needs!
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Role of the Home Visitor!
To support, nurture, and “contain” families" To support the development &
maintenance of healthy infant-caregiver relationships"
To recognize areas of vulnerability & resilience"
To assist families in accessing other resources to support infant & caregiver"
What Can a Home Visitor Do?!
Listen to a motherʼs stories" Reflect on how the motherʼs early
experiences may have shaped her ideas of herself and her relationships, and may account for present behaviors"• Discuss during reflective supervision sessions"
Provide “corrective emotional experiences” and opportunities to connect the motherʼs past with the present"
(Gowen & Nebring, 2002)"
Helping to Build Resilience!
Guide mothers whose babies need a lot of breaks from interactions"
Support parents of fussy, irritable babies" Link families to other resources, both
concrete & emotional"
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Early Childhood Mental Health Service Range! Promotion"
• Aimed at maximizing resilience"• Appropriate for all"
Prevention"• Aimed at reduction of risk"• Includes family support, parent education, & info"• Mentoring of caregivers, screening, & referral"
Early Intervention"• Aimed at the earliest possible point (pre-diagnosis)"
Treatment"• Aimed at existing conditions which are generally severe"• Includes a wide range of approaches, from dyadic therapy to
therapeutic nurseries"
Promotion Strategies!
May include provision of support to caregivers"• Emotional or concrete"
Linkage to or provision of concrete resources"• for example, food & housing"
Developmental guidance" Listening" Helping strengthen family environment
through establishment of routines, rituals, & organization of day"
Prevention / Early Intervention Strategies
Work with new mothers with post-partum depression"
Work with mothers who have mental health diagnoses"• Including depression"
Intervention services at earliest possible point to keep children from “going off the cliff”"
Developmental guidance and other similar strategies may fit both prevention & early intervention"• “Purple Crying” materials at hospital discharge"• STEEP or Seeing is Believing approaches"
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Sample Preventive Interventions!
Family support groups" Part C services" CCS"
• Physical delays, neurological issues" OT for regulatory issues, feeding
evaluations, etc." Fussy Baby services"
Video!
From Oakland Childrenʼs Hospital Fussy Baby Work"
Fussy Baby Network® Fussy Babies, Worried Parents. !
Mary Claire Heffron Children’s Hospital & Research Center Oakland
Early Intervention Services
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Crying as a Regulatory Function All Babies Cry!
Increases lung capacity at birth" Increases motor activity" Helps regulate temperature" Triggers attachment system" Triggers social interaction"
(Lester, 2006) "
Normal Crying Curve!
Peaks at 4-6 weeks" First documented in
Brazeltonʼs practice" Replicated 15 times" Across cultures"
(Barr, Konner, Bakeman, & Adamson, 1991)"
(St. James-Roberts, Bowyer, Varghese, & Sawdon, 1994)"
6 weeks"
12 weeks"
Why Worry About These Fussy Babies?!
Increased risks for"• Child behavior, development, & medical problems"• Parent-child relationship problems"• Shaken baby syndrome"• Abusive head trauma"• Family stress"• Maternal / paternal depression"
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Other Worries!
Sleeping & feeding" Criticism & social isolation" Search for diagnosis" Maternal depression" Parental conflict" Parent-infant relationship distress" Role adjustment"
Risks to Behavior & Development
Severe colic and/or persistent excessive crying in infancy past 5 months has been linked to the following child outcomes"• Motor, language, & cognitive delays"• Behavior problems"
“Temper tantrums”"• Negative reactivity"
“Fussiness”"• Sleep disorders"• Feeding problems"• Hyperactivity"
Risks to Behavior & Development (Continued)!
Infant crying, sleeping, and feeding problems associated with externalizing behavior & ADHD "• Across 22 longitudinal studies"• Particularly in families with multiple risks"
75% of babies seen in Brown University colic clinic demonstrated some degree of atypical sensory processing between 3-8 years of age"
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Underlying Medical Reasons!
Reflux" Milk protein allergy" Serious infection"
• Rare"
Fussy Baby Helps Form a Dual Perspective!
Help parents “in the now” with their urgent concern"
With your eye on their future"• Parentʼs confidence"• Parentʼs view of the child"• Relationship "
Fussy Baby Network Approach
3 goals"• Increase parental confidence"• Strengthen parent-child relationship"• Promote healthy development of parents &
infants"
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Fussy Baby Network Approach!
Page 62"
Helping Parents Find Their Intuitive Capacities to Care for their Babies!
When to Refer!
Sometimes promotion & preventive intervention services are not enough"
The caregiver may need more intense services"• for example, therapy & medication for severe
depression or schizophrenia" The baby may need more intense services"
• for example, dyadic therapy to repair the relationship; intervention following trauma"
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Red Flags in Social / Emotional Development Before Age 2!
Limited interest in other people" Does not initiate interactions or play" Little joy shown in daily activities" Limited range of affect & emotions" Does not use caregiver as secure base or for
comfort" Does not show a connection with primary
caregiver"• May lack discrimination between adults"
Red Flags in Social / Emotional Development Before Age 2 (Continued)!
Excessive crying & irritability" Persistent sleeping and/or feeding problems" Limited or no imitation in play" Inability to recover from distress" Extreme difficulty with transitions" Excessive & unreasonable fearfulness" Limited exploration in play" Extremely limited use of others to help regulate"
• No demonstration of developing self-regulation"
“Relationships hold the potential !to help people grow and change”!
(Shahmoon-Shanok, 2005)!
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Ten Caregiving Gifts (Jeree Pawl)
Gift One: Respond to very young infants in ways that encourage them to feel they can make things happen"
Gift Two: Help young infants learn that they have ways to take care of their own needs"
Gift Three: Help infants and toddlers develop confidence & trust in others"
Ten Caregiving Gifts (Continued)!
Gift Four: Help babies learn about intimacy"
Gift Five: Help toddlers learn that adults cannot solve every problem"
Gift Six: Be tolerant of toddlersʼ internal conflicts & desires"
Gift Seven: Help toddlers sort out the evaluations of adults"
Ten Caregiving Gifts (Continued)!
Gift Eight: Match your reaction to the temperament of the baby"
Gift Nine: Exchange information with parents about their children"
Gift Ten: Remind children in child care of the continued existence of the absent parents"
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Page 70"
For More Information Or Specialized Technical Assistance & Training!
Virginia Reynolds"WestEd Center for Prevention & Early Intervention"[email protected]"
In the next few days you will receive:
1. A short feedback survey regarding today’s webinar
2. An invita>on to the 3R’s website where today’s handouts and addi>onal resources will be posted
Please contact [email protected] for addi>onal informa>on
THE! END!
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Ques+ons?
Karen Moran Finello, PhD Project Director, WestEd Center for Preven>on and Early Interven>on
Associate Professor, University of Southern California Emeri> Center
Mary Claire Heffron, PhD Clinical Director, Early Childhood Mental Health Training Program at Children’s Hospital & Research Center Oakland
Endorsement Coordinator, California Center for Infant-‐Family and Early Childhood Mental Health at WestEd
