Health and DevelopmentHealth and Development

Session 1: Impact of Adverse Session 1: Impact of Adverse Childhood ExperiencesChildhood Experiences

Integration of Services Training Series

Module 1 Goal

Apply knowledge of Health and Developmentthrough your work with children, families andother service providers.

Module 1 Objectives

• To understand how environmental factors such as childhood maltreatment can impact development.

• To understand the childhood and long-term health consequences of adverse childhood experiences.

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Module 1 Objectives

• Understand the screening process for health and developmental issues.

• Work with medical and developmental specialists to obtain assessments/examinations, family-centered planning and provide for appropriate interventions.

• Understand how to work with medical and developmental specialists to establish continual support in these areas at the time of case transition.

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Agenda

• Session 1 - 2 hrs

• Session 2 - 2 hrs

• Session 3 - 2 hrs

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Life Long Impacts

• The Adverse Childhood Experiences/Centers for Disease Control and other studies show potential life-long impacts

• The impacts are shown to be cumulative • The more adverse childhood experiences, the

more likely to have multiple health conditions and other disorders.

7Felitti (2004) – reproduced with permission

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What are the associated medical conditions?

• Heart disease• Cancer• Chronic Bronchitis or emphysema• History of Hepatitis/liver disease

What are the associated medical conditions?

• Skeletal fractures• Obesity• Diabetes• Sexually Transmitted Disease

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How are adverse childhood experiences linked to later health conditions?

• Behavioral responses to adverse childhood conditions place people at risk

• Resulting household stress and possible domestic violence

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Ace Score vs. Smoking

Felitti – reproduced with permission

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Ace Score vs. Intravenous Drug Use

Felitti – reproduced with permission

Felitti – reproduced with permission

Shown with permission from www.cavalcadeproductions.com 800-345-5530

Shawn Coughlin (2010)

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The Science of Child Development

19Center for the Developing Child, Harvard University

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Shawn insert the NSCDC slide on Persistent Stress Changes Brain Architecture

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How does chronic stress impact physical health?

• Sustained or frequent activation of the hormonal systems can have serious consequences to development.

• Cortisol, when released long-term, impacts gene expression in neural circuits.

• This impacts the person’s ability to modulate stress responses.

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Early Interventions in Florida

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• Early Head Start• Head Start• Early Steps• Healthy Start

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What we know about impact of multi-risk environments on children

• Child Abuse and Neglect during early childhood results in the most damage to development

• Complex Childhood Trauma• Impact on children is known through research

National Scientific Council on the Developing Child (2010). Persistent fear and anxiety can affect young children’s learning and development: Working paper no. 9, pg. 4. Available from http://www.developingchild.net

Attachments

Attachments are impacted by:• Parents• Child• Environment

Attachment Relationships Key Factors

• Person specific• Persistent• Have emotional significance• Driven by desire for contact/proximity• Involuntary separation results in distress

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Key Age-Related Transitions in Attachment

• At 7 – 9 months babies show stranger wariness

• Attachment develops across first two years of development

• Parental proximity is critical

• By age three children show more tolerance for separation

• Long separations and disruptions can be detrimental

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Secure Attachments

• Parent’s Behaviors

• Child’s Behaviors

Insecure with Avoidance

• Parent’s Behaviors

• Child’s Behaviors

Insecure Attachment with Ambivalence and Resistance

• Parent’s Behaviors

• Child’s Behaviors

Attachment Issues for Children in Child Welfare

• Insecure• Person specific• Context specific

Connectedness – School Age Children

• Child feels emotionally connected with parents

• Child knows parents are looking out for his emotional well-being

• Looks to the parent to help make important decisions

• Enjoys spending time with parent

Kisha’s Song

Health and DevelopmentHealth and DevelopmentSession 2: ScreeningSession 2: Screening

Protective and Risk Factors

• Protective and risk factors are transactional in nature

• Identification of protective and risk factors is an essential component in screening and assessments.

• Factors are viewed as part of the individual’s characteristics or part of environment features and transactions.

- Davies, 2004 and Horwath, 2009

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Protective factors may include areas such as:

• Intelligence• Flexible (easy going) temperament• Athletic ability• Good school performance and relationships with peers• A close relationship with an adult• Faith and community participation• Shared care giving with adult family members and

friends, etc. - Davies, 2004 and Horwath, 2009

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Risk factors may include areas such as:

• Medical problems• Sensory integration and emotional regulation

problems.• Unresponsive parenting• Poverty • Social Isolation• Poor relationships with extended family etc. • Feisty (difficult) temperament

- Davies, 2004 and Horwath, 2009

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Sudden Unexpected Death of an Infant (SUDI)

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• Sudden Unexpexted Death of an Infant (SUDI) is an initially unexplained death

• The cause of deaths such as suffocation are determined later

• Sudden Infant Death (SID) is the term used for a death when no cause is determined

Sudden Unexpected Death of an Infant –Risk Factors

• Young maternal age• Smoking during pregnancy

– five times the risk• Exposure to second hand smoke• Inadequate prenatal care• Low Birth Weight

- Bright Futures

Risk Factors that Parents Can Control

• Don’t smoke are be around smokers during pregnancy and don’t expose the baby to smoke.

• Where children sleep and on what surface– don’t co-sleep and have the baby sleep on a firm surface.

• No loose bedding, or soft objects in the crib. • How children sleep--- Back to Sleep

- Bright Futures

Substance Exposed Newborns

• This discussion includes the use of alcohol and illicit drugs and does not address cigarette smoking.

• About 10 to 11% of births show exposure.• Harm can be lifelong• Younger women are at a higher probability for

using substance during pregnancy.

- SAMHSA, 2009

Risk Has Not Been Reduced

• The rate of substance abuse in women has not improved significantly.

• If the mother does not disclose use it is often difficult to detect exposure at the time of birth.

- Office of Applied Studies

Substance Use and Abuse Remains a Problem

• Illicit drugs used during pregnancy can include:

• Cocaine• opiates• Methamphetamines• Barbiturates

Risks for the Infant

• Risks include:• Miscarriage• Pre-mature birth• Complications at delivery• Later neurological problems• Medical problems

Use of alcohol during pregnancy

• The use of alcohol during pregnancy can have a devastating impact on the child’ development and future.

• Fetal Alcohol Syndrome (FAS) includes physical, neurological, behavioral and cognitive disorders.

• Fetal Alcohol Effect (FAE) is not physically obvious but can have very similar consequences for health and development.

Fetal Alcohol Effect

• Women may drink not knowing that they are pregnant.

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Fetal Alcohol Effect, Cont.

• Symptoms may include cognitive delays, speech and language delays, behavioral problems, problems in regulating emotions and deficits in problem solving.

• Children with FAE may have problems forming relationships.

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Inflicted Traumatic Brain Injury

• Child maltreatment is the leading cause of serious head injuries in children under the age of two.

• Rates of survival of a serious head injury for infants and toddlers is from 60 to 85%

Keenan et al. 2003

Inflicted Traumatic Brain Injury

• “Inflicted” means that is was caused directly by human behavior

• Maltreatment is the primary cause of Inflicted TBI

• It is suspected that many cases of less severe TBI go undetected

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Mild to Moderate TBI

• Mild to moderate TBI may be difficult to diagnose• Symptoms are very similar to the symptoms for

mental health disorders, and results of pre-natal exposure to substances.

• It is almost impossible sometimes to tell why a child or parent is having a particular problem.

• The most important thing is to try and find an intervention or coping mechanism that helps.

- Keenan et al JAMA 2003

The American Academy of Pediatrics (AAP) has long recognized that the health of the individual child is the product of myriad social, environmental, and genetic factors and that adverse conditions in any of these areas undermine the wellness of the child.

American Academy of Pediatrics

Children and adolescents in foster care are known to be at high risk for persistent and chronic:

physical

emotional

developmental conditions

because of multiple and cumulative adverse events in their lives. - AAP

Health Care Vulnerabilities

Research shows…

• high rates of chronic medical problems, developmental delays, educational problems, and behavioral health disorders.

• between 80% and 90% of the children have abnormalities in at least one body system resulting in special health care needs.

Physical conditions include:

• growth abnormalities, • neurological disorders, • asthma, • failure to thrive, • malnutrition, • infectious diseases, • exposure to high rates of lead, • hearing and vision problems and • dental decay

Screening Process

• Collecting initial information

• Observation (Positive signs of safety and worries)

• Interviewing – Telling Their Story

• Use of standardized or formal screening

Health and DevelopmentHealth and DevelopmentSession 3: Assessments, Interventions Session 3: Assessments, Interventions and Collaborationand Collaboration

Review

• Raised in multi-risk situations

• Living in poverty

• Experiencing poor health

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Poor health can be detrimental to parenting.

Family Centered Practice Model

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Assessments for Health Care

• A comprehensive health assessment

• Parents’ involvement assessment

• Parents’ understanding of the findings

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Safety-Risk Asssessment

• Signs of Present Danger

• Child Vulnerability

• Protective Capabilities

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Helping Babies from the Bench

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