5 Early Intervention

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Trauma-Informed Early Intervention:

Trauma-Informed Early Intervention Helping Florida’s Most Vulnerable Children to Thrive

Trauma Informed Early Intervention :

Trauma Informed Early Intervention 2 IDEA Part C: Ages 0- 3 and IDEA , Part B: Ages 3- 18

Trauma in Young Children In EI:

Trauma in Young Children In EI 3 Trauma is an event that is unpredictable, produces a feeling of helplessness, and overwhelms one ’ s capacity to cope.

Trauma Informed Care Approach:

4 Consider whether trauma has played a role in children. Ask trauma informed questions. Use a trauma lens to understand behavior. Screen as part of services. Ensure emotional safety. Avoid re - traumatization. Consider trauma in all decisions (childcare placement, referrals, etc). Trauma Informed Care Approach

Insensitive Approaches:

Abrupt separation from caregivers to complete an assessment task for a child who was recently removed from the biological home. A sking biological or foster parents to leave the room, so the provider can work with the child alone. Examination of a child’s mouth, if conducted without awareness of a child’s trauma experience. 5 Insensitive Approaches In these examples, consider how routine procedures might adversely affect a child who has suffered trauma. Routine procedures can be intrusive and re-traumatizing!

Barriers to Addressing Early Childhood Trauma in EI:

Barriers to Addressing Early Childhood Trauma in EI Beliefs about young children--too young to remember Parents’ reticence about mental health Need for training, supervision, support System capacity — open floodgates 6 Gilkerson et al, 2011

Elements of a Trauma-Informed System:

7 For all children in EI and their families: EI Values Social/Emotional Competence For children exposed to trauma and their families: Unique Needs Broad Eligibility Trauma Screening Priority on Emotional Safety EI Trauma Specialists Trauma Training, Consultation, & Reflective Supervision Involvement of All Caregivers Coordination of EI Services Interagency Agreements Community Partnerships Secondary Trauma Elements of a Trauma-Informed System

Attachment Relationships:

Consider the child’s developmental needs in the context of their attachment relationships. 8 Elements of A Trauma Informed E.I. System: Attachment Relationships

Trauma Screening Integrated in Assessments:

9 Comprehensive Developmental and Infant Mental Health assessments help to: Identify strategies and interventions to address the affects of early trauma. Address attachment-related, regulatory and developmental challenges. Trauma Screening Integrated in Assessments Elements of A Trauma Informed E.I. System :

Trauma Training for All E.I. Staff:

10 Have you considered whether trauma played a role in these situations? Elements of A Trauma Informed E.I. System : Trauma Training for All E.I. Staff

Simple Ways to Reduce Stress:

11 Elements of A Trauma Informed E.I. System : Simple Ways to Reduce Stress http://vimeo.com/ 24786384

Trauma Expertise:

Elements of A Trauma Informed E.I. System : Use a transdisciplinary early childhood mental health team that includes the Part C team and trauma expertise. Trauma Expertise 12

Provide Reflective Supervision & Consultation on Trauma:

Elements of A Trauma Informed E.I. System : Provide Reflective Supervision & Consultation on Trauma 13

Priority:

14 Elements of A Trauma Informed E.I. System : Priority Emotional Safety & Presence of Co -regulating Caregivers

Trauma-informed Early Intervention in Practice:

15 New Mexico Infant Team Integrated team of trauma specialists and EI providers, closely coordinated with child welfare and court system Baltimore Part C Infant and Toddlers Program Trauma screening triggers referral to collaborating infant mental health agency for consultation or service provision Trauma-informed Early Intervention in Practice

Pyramid for Promoting Social-emotional Competence in Young Children:

Source: The Center on the Social and Emotional Foundations for Early Learning Universal Promotion Prevention Treatment 80% 15% 5% Pyramid for Promoting Social-emotional Competence in Young Children 16

Nurturing & Responsive Relationships:

A powerful buffer against adversity and the damage it inflicts on a child’s stress -response system. Nurturing & Responsive Relationships 17

Nurturing & Responsive Relationships: Supports for New Parents:

Nurturing & Responsive Relationships: Supports for New Parents Family Intervention & Education Services Home Visiting Parenting Education One-on-one Mentoring 18

Fussy Baby Network Approach:

Fussy Baby Network Approach 19

High Quality Environments:

High Quality Environments 20

High Quality Child Care Environments Can Improve Development & Reduce Trauma:

High Quality Child Care Environments Can Improve Development & Reduce Trauma 10 Components of Quality Child Care Health & Safety Staff Well Trained Developmentally Appropriate Environments Small Groups with Optimal Ratios Primary Caregiving & Continuity of Care Active & Responsive Caregiving Curriculum & Individualized Programming Emerging Language & Literacy Family & Cultural Continuity Comprehensive Support Services 21 IHDP (Abecedarian 8-City Replication ) Cognitive Development to Age 18 McCormick, et a., 2006, Pediatrics

Targeted Social Emotional Supports:

Targeted Social Emotional Supports 22

Early Childhood Mental Health Consultation:

Raver , et al, 2008 and Gilliam, 2007 Reduced: Behavior problems in target children Expulsions Stress & depression for teachers Improved: Classroom environments Teacher -child positive interactions Teacher beliefs & practices regarding developmentally appropriate & child centered practices Teacher sense of job control & satisfaction Sensitivity & classroom management Classroom climate Skills to handle difficult behavior Early Childhood Mental Health Consultation 23

Circle of Security:

Circle of Security Step-by-step approach for promoting secure attachment 24

Promoting Emotional Security to Explore :

Promoting Emotional Security to Explore 25

Intensive Intervention:

Intensive Intervention 26

Evidence Based Trauma Treatments:

Evidence Based Trauma Treatments 27

Expand IMH Treatments for Early Intervention::

Expand IMH Treatments for Early Intervention: 28 Problem Target Outcome Children push caregiver away Provide nurturance even when children cue otherwise Secure, organized attachment Children dysregulated behaviorally and biologically Provide responsive care Enhanced self regulation capacity Parent coach provides “ in the moment ” comments to reinforce every opportunity for nurturing. Parent feels supported. Brings parent ’ s attention to specific behavior (child did x, you did x). Follows child ’ s lead. Links behavior with outcomes (e.g., that will help child feel xxx ). Mary Dozier, Ph.D., University of Delaware Attachment & Biobehavioral Catch Up Intervention (ABC ): 10 in-home intervention sessions 28

Promoting Social Emotional Competence Summary:

Promoting Social Emotional Competence Summary 29 Nurturing & Responsive Care Quality Environments Targeted Supports Intensive Interventions & Evidence based Trauma Treatments

What to Know Even More?:

What to Know Even More? 30 Gilkerson , Graham , Harris, Oser , Clarke, Hairston- Fuller & Lertora . (2013) Trauma-Informed Part C Early Intervention: A Vision, A Challenge, A New Reality. Zero to Three, 34:2.

What to Know Even More?:

What to Know Even More? 31

Trauma & Toxic Stress:

32 Trauma & Toxic Stress To learn more about the effects and healing recommendations for trauma and toxic stress, please view other topics in this series: The Lifetime Impact of Trauma Impact of Trauma by Age Effects of Trauma on Brain Development

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