Brain Story Certification: Module 7

As I continue through the Brain Story (Alberta Family Wellness Initiative, n.d.), the following learnings were highlighted as a part of the 7th module:

Excerpt from “Child Maltreatment: Implications for Development & Approaches to Prevention,” Harrier MacMillan, MD.

Nurse Family Partnership Program

• Prenatal to 2nd birthday (tapered from weekly to monthly visits).
• Supports to first-time disadvantaged mothers.
• Promotes:
  • Health-related behaviours
  • Maternal life course development
  • Caregiver role in childcare
• The relationship is the key focus.
• Builds capacity in the parents empathy towards the infant, with an aim to reduce neglect.
• Promotes sensitive, responsive caregiving that engages the child.
• Reflects on the mother’s own childrearing history.
• Develop a trusting relationship with the mother so that the mother can be aided in trusting others. Uses ecological, attachment, and self-efficacy principles.
• benefits in reducing child maltreatment, with reduced dependence on health systems for injuries/ingestions.
• Improved broader areas of child development with RN involvement over paraprofessionals.
• Key areas of health benefits included:
  • Improvements in women’s prenatal health
  • Reductions in children’s injuries
  • Fewer pregnancies
  • Greater intervals between births
  • Increased father involvement
  • Increased employment
  • Reduced use of welfare
  • Improvements in child’s readiness for schoool
• In the study of Nurse Family Partnerships (NFPs), there was a significant reduction in verified reports of child abuse/neglect.  For young, poor, and unmarried mothers, there was an 80% reduction in maltreatment of children.  The reductions, however, were not observed in families where there was intimate partner violence.
• Other areas of benefit from NFPs are:
  • a 59% reduction in arrests of children as they grow
  • a 61% reduction in the arrests of mothers
  • a 72% reduction in criminal convictions of mothers
  • and 98% of mothers having a reduction of the number of days in jail.
  • Girls of the mothers have a benefit of prolonged period of time before first arrest over boys.
• At the time of the presentation, there were no NFP programs in Canada.

Excerpt from “Child-Parent Psychotherapy with Traumatized Young Children,” Patricia Van Hom, PhD.

• We all have a story we tell ourselves that guides how we interact with our environment and world.
• These stories grow out of our early relationships.
• Serve and return interactions plays a critical role in developing this story.  The feelings from these relationships in children shape how we understand ourselves and others.
• Attachment is as important as all the other basic needs for our species.  It is about the protection of the young within a species from threat/danger/risk.
• The young are wired to seek the protection of the stronger/wiser for protection.  This is the purpose of serve and return.
• Core stories with experiences of violence highlight developing core stories of insecurity – the internal working model.  This sets up how we expect others to treat us and our place in the world.  This can influence attention biases, parentification, and non-age appropriate tendencies to care for self.

Excerpt from “Child-Parent Psychotherapy with Traumatized Young Children,” Patricia Van Horn, PhD.

• Some of the impacts of trauma on the child-caregiver relationship include:
  • The child not seeing the caregiver as a reliable protector.
  • The child unable to sustain the representation of the caregiver as a secure base.
  • Altered mental representations of who is safe or dangerous.
  • An increased liklihood of intense contradictory emotions.
  • These changes to the individual’s core story are likely a result of the parent’s internal working model that was impacted by adverse experiences in childhood.  This means that intergenerational considerations are worth exploration.
  • Good interactions lead to feelings of safety, worthiness, and understanding of the world.  Bad experiences may lead to expecting bad things to happen to the individual.

Excerpt from “Child-Parent Psychopathology with Traumatized Young Children,” Patricia Van Horn, PhD.

• An intervention that focuses on the dyad.  Child developmental trajectory is the area of focus
• Takes on ecological considerations.
• Uses a manualized treatment.
• Can take place in a home or office.
• Can be implemented in multilingual capacities.
• Multiple theories are applied in the intervention including:
  • Attachment theory
  • Trauma-informed practice
  • Psychoanalytic
  • Social learning theory
  • cognitive-behavioural theory
  • Culturally-relevant practice
  • Developmentally-informed practice
  • This is in many ways a psychodynamic-based intervention, but CBT can be useful in treating affect disregulation in the child.
• Attachment is the main organizer for a child’s response to danger and safety for the first 5 years of life.
• Emotional and behavioural patterns in infancy and early childhood are best addressed by addressing the attachment relationships.
• Cultivating growth in the caregiver-child relationship supports health development after an intervention is completed.
• To restore a positive developmental trajectory, the practitioner can:
  • Encourage a focus on growth-promoting experiences that recently or currently take place (allow parent and child to enjoy eachother’s company).
  • Work to reestablish trust in relationships.
  • Acknowledge the experience of trauma.
  •  Put into words the feelings/behaviours of trauma.
  • Help the child understand they are not to blame for trauma.
  • Aces score of 4 or higher is where there are stronger disjunctures from positive developmental trajectories.
• Look for interventions that promote a present tense, flourishing relationship.
• If trauma needs to be processed, space needs to be given to process it.  Provide a space for the child to realize they are not at fault for the trauma.  Children may take responsibility for the actions of others.
• Building a new narrative to reprocess trauma is a goal in these interventions.
• Thereaputic objectives include:
  • Regulating affect
  • Understanding the meaning behaind behaviour
  • Normalizing the traumatic response
  • Building reciprocity in relationships – This is especially important and difficult to achieve when the individual is in a state of toxic stress.
  • Developing continuity in daily living
  • Trusting one’s bodily sensations
  • Differentiating remembering from reliving.
• Child behaviours, distress, and post-traumatic distress are improved through psychotherapy interventions.  Healthy parents are thus seen as a means to promote healthy child development.

Excerpt from “Applying Knowledge About How Stress Affects the Developing Brain,” Philip Fisher, PhD.

• Physical development of foster children often lags behind non-fostered children.
• Basic biological systems are impacted.  Cortisol influences the changes in foster children.  There is a blunted response in the HPA-axis.
• Children who experience neglect are the most impacted, followed by physical abuse.  This highlights the significance of serve and return interactions and their relation to toxic stress.
• Foster children do not show typical brain activity to corrective feedback.
• This brings into question if children are simply not making sense of the feedback information they receive.  The Flanker Task can be used to exlpore this idea.
• Fost children have impacted emotional understanding on average over children in the community.  Because this is an average, not all children in foster care are in need of intervention on this front.

Excerpt from “Applying Knowledge About How Stress Affects the Developing Brain,” Philip Fisher, PhD.

• Parenting is a key buffer in anxiety.
• Reducing amount of placement instability helps in keeping strucutre for development.
• Average number of “problem” behaviours a foster parent can handle per day is 6.  After that, the liklihood of the fost parent seeks the child to be moved increases in a linnear manner.  This holds true for youn/old children.  Programs that support foster parents can greatly mitigate the impacts of the behaviours on ending care by a foster parent.
• The more placements a child has, the more likely they will not find a permanent placement.
• Programs targeting the kids at risk can mitigate replacement risks and associated developmental trajectories.

Excerpt from “Interventions for Children in Foster Care, Adopted Children & Other Children Who Have Experienced Abuse & Neglect,” Philip Fisher, PhD.

• Miltidimensional Treatment Foster Care (MTFC) – shift away from traditional service delivery for out of home care.
• Traditional custodial role of basic needs being met by the foster parent, addressing psychosocial issues from the child’s experiences is carried out by a therapist.
• This ignores the problems in relationships and attachment.
• MTFC uses the placement as the location for thereaputic intervention.  Supporting the foster home help the foster parent and foster child.  The approach seeks to help with the transition to life outside of the foster care system – be it adoption or reunification.
• The areas of focus are:
  • Supporting and encouraging positive behaviour.
  • Setting clear and consistent limits in a non-abusive/punitive way.
  • Promoting close supervision of the child.
  • Separation from delinquint peers.
• MTFC is a trans-theoretical approach that can be applied to multiple frameworks.  The3 major components include:
  • The child-caregiver relationship
  • Case Management
  • The Child’s Needs
• The components are viewed within a home perspective, a community perspective, and (pre)school perspective.  This fits well with an ecological approach.
• The Key components of MTFC include:
  • Support and consultation for caregivers
    • Pre-placement training
    • Regular group meetings
  • 24/7 support
  • Regular phone checkins /w the caregiver (behavioural assessments with the caregiver)
  • Child treatment:
    • Thereaputic play groups
    • Skills training with a coach
    • Specified staff roles and responsibilities
  • Parenting support for both the birth and adoptive families

Excerpt from “Applying Knowledge About how Stress Affects the Developing Brain,” Philip Fisher, PhD.

• There is a cost to the MTFC program.  This is aproximately $6138 USD/child at the time of recording.
• Services as usual initially cost less, but the MTFC model ends up costing less per child than services as usual when there is more than 4 placements for the child.  MTFC can be argued as a preventative programming that is cost-saving in the long-run.

References

Alberta Family Wellness. (n.d.). Brain story certification.  Retrieved from https://training.albertafamilywellness.org/