MAKING CONNECTIONS:

How Evaluators Can Realize the Impact Trauma Can Have on a Child’s Development

Yvonne Lemons, DI-II, IMH-E IIHallie Shelton, MOTR/L, IMH-E III

Introductions

OBJECTIVE:

TO PROVIDE THE NEW MEXICO FAMILY AND INFANT TODDLER PROGRAM

PROVIDERS WITH A BETTER UNDERSTADNING OF HOW TO EVALUATE AND

SUPPORT FAMILIES AND CHILDREN WHO HAVE EXPEIRIENCED TRAUMA, BASED ON

OUR EXPIERIENCE WORKING WITH THE THIRD JUDICIAL DISTRICT INFANT MENTAL

HELATH TEAM.

Problems You Face:

• Increase in babies and children that have tested positive for substances.

• Increased awareness that children and babies have experienced trauma and that it affects development.

• More family stressors affecting bonding and attachment.

• Gaps with tools that are not sensitive to trauma and development.

• Emotional challenges and stressors for evaluators.

TIME: Why it is important to act fast?

• The first three years of a child’s life are uniquely important because this is the most sensitive period for brain development (Zero to Three, 2016).

• It takes less time, intensity and repetition to organize developing neural systems than to reorganize developed neural systems (Perry, 2006).

• Young children are most vulnerable and have the high victimization rate (Finkelhor, 2013).

• If we don’t catch it the first time, we oftentimes wait 6 months to a year to re-evaluate.

Long Term Effects:

• The exposure to violence also increases the probability of future victimization (Finkelor, 2013).

• Prenatal drug exposure predicts behavioral dysregulation at 8/9 years of age (Clarke, 2014).

• In recent NIH research alterations in Hypothalamus-Pituitary-Adrenal Axis regulation are a known risk factor for the development of anxiety and affective disorders later in life (Clarke, 2014).

Risk Factors/ Short and Long Term Effects:

Fetal exposure to drugs of abuse often produces long-lasting changes in brain structure and function.

(Ross and Graham, 2015)

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• VIDEOS

How You Can Fill in Gaps by Using Observation Skills

What to Look For…

• Autonomic Nervous System Responses

• Motor System

• Regulatory State

• Social Interactive System

(Nugent, 2007)

Autonomic Nervous System:

• Bowel Movements

• Grunting or rapid, shallow breathing

• Startles/ Tremors

• Gagging or Spitting Up

• Substantial Color Change

Motor System:

• Stiffening and Arching Away

• Disorganized Activity /Uncoordinated Movements

• Flailing Movements

• Limpness/Flaccid

• Body Feels Tense/Rigidity

• Jerky Movements

• Unusual Posturing/Positioning

Regulatory State and Social Interactive System:

• Inconsolable Crying/Screaming

• Extreme Irritability

• Twitching Eye Movement

• Panicked Alertness

• Constant Averting

• Cannot be aroused

• Hypervigilance

The Importance of Cumulative Risk Factors: Is this Baby Going to Have a Strong or Weak Foundation?

• Low Birth Weight

• Exposure to drugs

• Respiratory distress

• Disruption in placement

• Failure to thrive

• Health concerns

• Lowered Immune System

Important Information to Think About During Your Assessment:

• Stress Responses

• Trauma Triggers

• Derailment

• Can the child access their skills in all environments

• Sleep Patterns

• Pacing During Mealtimes

• Stress Factors for Family

Important Information to Think About During Your Assessment:

• Does the child have supervised visits?

How often ?

With whom?

• Do you notice anything different after visits?

Sleep patterns

Eating

Regulation

Trauma Triggers

• How long does it take him/her to recover?

Important Information to Think About During Your Assessment:

• How does the child’s caregiver view the child’s experiences?

• How does the evaluator view the child’s experiences?

• Do we see the same child?

Evaluators Must Integrate Attachment, Relationships, and Development:

• Services sooner than later is important

• Collaboration is essential/working with agencies

• Modeling Relationships

• Reflective Supervision

• Administrative support

• Flexibility- with scheduling, frequency and duration of interventions and services

• Holistic view of child, family, caregivers and self as narrators

• Enhancing parents capacity to meet child’s needs

Creating Positive Outcomes for Children and families.

You cannot separate attachment and bonding from development during your assessments.

You must acknowledge trauma and how it affects yourself, families, caregivers, children when performing evaluations.

PLANT A SEED, AN IDEA, A SMILE, A HOPE, A JOY EVEN AMOUNG CHALLENGES

RESOURCES

Clarke, J. (2014). Integrating Practices In Working With Infants. Presentation

David Finkelhor et al., “Violence, Crime and Abuse Exposure in National Sample of Children and Youth: An Update,” Pediatrics 167, no. 7 (2013): 616, accessed May 20, 2018, http//:archpedi.jamanetwork.com/article.aspx?articleid=1686983&resultClick=3.

Nugent, K., Keefer, C., Minear, S., Johnson, L., Blanchard, Y. (2007). Understanding Newborn Behavior & Early Relationships: The Newborn Observations (NBO) System Handbook. Baltimore, MD Brookes Publishing.

Perry. B. (2006). Examining Maltreatment Through Neurodevelopment Lens. Retrieved from http://childtrauma.org

Ross, E.J., Graham, D.L., Money, K.M., Standwood G.D. (2015) Neuropsychopharmacology, 40(1): 61-87.

Zero To Three. (2016) Brain Wonders Nurturing Healthy Brain Development from Birth. Washington, DC: Author.