National Children's Mental Health Awareness Day

Childhood Trauma's Impact on a Child's Developing Brain

Studies on the brain show that physical, emotional, or sexual abuse in childhood can:

• cause permanent damage,
• reduce the size of parts of the brain,
• impact the way a child's brain copes with daily stress, and
• can result in enduring behavioral health problems such as depression, anxiety, aggression, impulsiveness, delinquency, hyperactivity, and substance abuse.
• With help from families, providers, and the community, young children can demonstrate resilience when dealing with trauma.

New brain imaging surveys and other techniques show that physical, emotional, or sexual abuse in childhood (as well as stress in the form of exposure to violence, warfare, or famine) can cause permanent damage to the neural structure and function of the developing brain. In addition to the implications outlined in the data point above, traumatic or stressful experiences can lead to conditions such as borderline personality disorder, dissociative episodes, hallucinations, delusions, psychosis, paranoia, anger outbursts, and impaired attention. Whether in the form of physical, emotional or sexual trauma, or exposure to warfare or famine, stress can set off a ripple of hormonal changes and key brain alterations that may be irreversible.1

However, research has shown that caregivers can buffer the impact of trauma and promote better outcomes for children even under stressful times when the following Strengthening Families Protective Factors2 are present:

• Parental resilience
• Social connections
• Knowledge of parenting and child development
• Concrete support in times of need
• Social and emotional competence of children

Trauma Data Source:
1.    Teicher, M.H. (2002). Scars that won't heal: The neurobiology of child abuse. Scientific American. 68-75. (Retrieved from http://www.icscommunitynetwork.org/scarsthatwon_theal+.pdf [PDF - 295 KB]).
2.    Horton, C. (2003). Protective factors literature review. Early care and education programs and the prevention of child abuse and neglect. Center for the Study of Social Policy. (Learn more at www.strengtheningfamilies.net )

“Children’s early development depends on the health and well-being of their parents.”

-National Research Council and Institute of Medicine, Neurons to Neighborhoods

Parents Matter

"Parents are one of the most important influences in positive child and youth development, yet too many caregivers lack the support they need. By strengthening parents and their connections to resources, communities can help children thrive."

"Parents Matter
Parent/caregivers matter because a caring, strong parent-child relationship is an essential ingredient in development."

"How Parent/Caregivers Matter
Parenting comes with a myriad of roles, often performed with no or little formal training. Their primary caregiving roles are providing sustenance, stimulation, support, structure, and surveillance. At a minimum, these functions assure basic survival. When parent/caregivers are proficient in these five areas, children and youth thrive."

"...providing mental health services and parent training to individuals is only a partial solution; to sustain gains in child development and well-being, the adverse conditions must be altered."

From:
Family Strengthening Policy Center, Policy Brief, An Initiative of the National Human Services Assembly. The Parenting Imperative: Investing in Parents so Children and Youth Succeed, Policy Brief No. 22.

Parent Efficacy

Okay, just quotes from my reading and that's it!

"Parents’ belief in their ability to influence life events is associated with higher levels of family functioning (Failla & Jones, 1991)."

McClendon, Pollio, North, Reid, & Jonson-Reid (2007).  School-Based Groups for Parents of Children With Emotional and Behavioral Disorders

Sabbatical

We all need breaks from time to time, so I am taking a break from blog writing.

I am in the thick of it, so I will focus my limited time and energy on completing a publishable paper, a dissertation proposal and required coursework (Advanced Statistics, Latin American Folk Traditions and Shamanism, and Family Therapy and Research -- cool, right?!).

In the meantime, I want to thank you for your support, for stopping by, for reading and for commenting.

Please continue to use your voice, fight back and reach out for resilience and flourishing.  May all the "good girls" grow up to become "empowered women" making up their own mind and having a say in their own lives.  Men, too, can go from child to adult by choosing their own actions and dealing with the consequences of their choices.  Cheers to agency, empowerment, self-determination, self-efficacy and collective efficacy.  These are important concepts and values in social work and I believe, our birthright. 

Empowerment

In social work, there are concepts that are so important they are referred to repeatedly.  Empowerment is one of those central concepts in the profession.  Used without being defined, the fullness of it's meaning and implication gets lost.  It's nice to have one word that means so much, until the details are forgotten and left behind in the fray of the day to day.

I am so grateful for the thinkers and writers and keepers of concepts and words.  Here is a powerful reminder of one of the most important aspects of our work: 

"The process of empowerment involves . . .
. . . the development of attitudes and beliefs about one's efficacy to take action;
. . . the development of critical thinking about one's world;
. . . the acquisition of knowledge and skills needed to take action;
. . . the support and mutual aid of one's peers in any given situation;
. . . and the taking of action to make change in the face of impinging problems.
It is both a process and an outcome."*

This is one of those passages that I could break down, exegesis-style, and preach from it.  But I'll spare you the sermon.  I will say that what strikes me about this definition is the universality of it.  It cuts across all populations.  Ms. Parsons may have been describing the process for clients although I can't help but see the application for social workers ourselves.  If we don't hold the attitudes and beliefs about our own efficacy to take action and develop critical thinking about our world and the rest of it, then how do we hold up and model these beliefs and skills in others?

How empowered are you right now?

*This definition is from Ruth Parsons, by way of Stephen M. Rose in Chapter 10, Empowerment: The Foundation for Social Work Practice in Mental Health in Mental Health Disorders in the Social Environment, Edited by Stuart A. Kirk (my adviser!!!)

The Poem, "Howl," Can Heal

Shame is a characteristic of anxiety and traumatic stress.
Poetry is emotional language.
Sometimes there are no words to soothe the feelings of shame.
Poets tap into the transcendental force and try the impossible anyway.
Thank you to Alan Ginsberg for his artistry and love.

Footnote to Howl by Alan Ginsberg:

"Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy!
The world is holy!
The soul is holy!
The skin is holy!
The nose is holy!
The tongue and cock and hand and asshole holy!
Everything is holy! Everybody's holy! Everywhere is holy!
Everyday is in eternity!
Everyman's an angel!
The bum's as holy as the seraphim!
The madman is holy as you my soul are holy!
The typewriter is holy the poem is holy the voice is holy the hearers are holy the ecstasy is holy!
Holy Peter holy Allen holy Solomon holy Lucien holy Kerouac holy Huncke holy Burroughs holy Cassady holy the unknown buggered and suffering beggars holy the hideous human angels!
Holy my mother in the insane asylum!
Holy the cocks of the grandfathers of Kansas!
Holy the groaning saxophone!
Holy the bopapocalypse!
Holy the jazzbands marijuana hipsters peace & junk & drums!
Holy the solitudes of skyscrapers and pavements!
Holy the cafeterias filled with the millions!
Holy the mysterious rivers of tears under the streets!
Holy the lone juggernaut!
Holy the vast lamb of the middle class!
Holy the crazy shepherds of rebellion!
Who digs Los Angeles IS Los Angeles!
Holy New York Holy San Francisco Holy Peoria & Seattle Holy Paris Holy Tangiers Holy Moscow Holy Istanbul!
Holy time in eternity holy eternity in time holy the clocks in space holy the fourth dimension holy the fifth International holy the Angel in Moloch!
Holy the sea holy the desert holy the railroad holy the locomotive holy the visions holy the hallucinations holy the miracles holy the eyeball holy the abyss!
Holy forgiveness! mercy! charity! faith!
Holy! Ours! bodies! suffering! magnanimity!
Holy the supernatural extra brilliant intelligent kindness of the soul!"

Berkeley 1955

Amen, brother Ginsberg, and again I say amen.

Latinos, Families and Mental Health Intervention

“Secondary data analysis using Add Health data set indicates that high amounts of parental control function positively for Latino families (contrary to some findings for non-Latinos)…Parental warmth significantly reduced alcohol use and also positively affected the parent-youth relationship which decreased alcohol use…Unique family mechanisms for Latino families that should be considered when developing intervention options” (Mogro-Wilson, 2008).

Parent Participation is the Gold Standard

“Community-based child and adolescent mental health services routinely involve parents along parents along with their children; indeed, parent participation is a hallmark of gold standard child mental health interventions. There are compelling reasons for tackling the issue of parent involvement in concert with focused attention to children’s mental health needs. Families provide the primary social context in which children function, influence access to services and shape attitudes toward service use that are critical to outcomes” (Kemp, 2009).

Families and Retention in Treatment

“The second reason for working with families is that families are powerful groups of people who exert significant influence on their members. In treatment, families can either be a tremendous support or an impediment which can undermine and sabotage treatment. From a practical standpoint it is wise to involve families in treatment to engender their support. A recent study found a significant difference between two similar treatment facilities in the dropout rate when family therapy was used. In one treatment facility families were involved in family therapy. Within the first week the adolescent was in treatment and continued on a regular basis. This facility had a significantly lower drop out rate than the similar facility which did not involve families in treatment until the third or later month and did not have family therapy as a required treatment component. There was also a significant relationship between the number of family therapy sessions attended and the drop-out rate in that the more family therapy sessions attended the less likely it was that the youth would drop out of treatment” (Weidman, 1985).

Families Matter in Children's Mental Health Treatment

“Regardless of the specific goals of treatment, a fundamental assumption of MST is that the youth’s family or caregiver is the key to favorable long-term outcomes, even if that caregiver presents serious clinical challenges. Treatment goals are therefore largely defined by family members or caregivers, and the vast majority of MST clinical resources are devoted to developing the capacity of the caregiver to achieve those goals (versus treating the child or adolescent individually). Within this context, engagement of the family in the clinical process is viewed as primary – an essential (but not sufficient) step toward achieving targeted outcomes. Regarding outcomes, MST has a strong track record in improving family functioning and decreasing long-term rates of antisocial behavior and out-of-home placement, as demonstrated through numerous randomized clinical trials. Hence, the utility of MST engagement strategies is supported by the effectiveness of interventions used within the MST model; interventions that draw from pragmatic family therapy approaches (Haley, 1976; Minuchin, 1974); evidence-based intervention models such as behavior therapy; and cognitive behavior therapy” (Cunningham, 1999).

Families and Children's Mental Health Treatment

“…treatment cannot progress unless key family members are engaged and actively participating in the treatment process – helping to define problems, setting goals, and implementing interventions to meet those goals.

The clinician may have developed a ‘brilliant’ set of intervention strategies, but such strategies will have little value in the absence of a strong therapeutic alliance.

Practitioners must remember that parents and other family members are essential to achieving positive outcomes, and such outcomes are almost always accomplished through hard work by family members.

Family members who are not engaged in treatment are unlikely to put for the effort needed for favorable outcomes. Hence, concomitant with a thorough assessment process, MST (Multi-Systemic Therapy) practitioners work toward achieving strong engagement from the time of their first contact with the family.

When clinical progress is slow or seems to have stalled, a common reason is that key family members (the child’s caregivers, those adults who control family resources or have decision-making authority) are not truly “on board” with the treatment plan.

Although the therapist may have believed that the family was engaged, a closer look might reveal otherwise. Often, we (therapists, supervisors, consultants) assume that family members are committed to a particular treatment goal that seems logical to us, but may not be viewed in the same way from the perspectives of family members. In any case, engagement is a precursor to successful outcome, and fortunately, the behavioral signs of engagement are available for observation” (Cunningham, 1999).

Family Therapy for Children's Mental Health Problems

"For a wide range of child-focused problems, systemic interventions (for example, family therapy) are effective. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programs for:
sleep,
eating disorders,
feeding and attachment problems in infancy,
child abuse and neglect,
somatic problems,
conduct problems,
emotional problems (anxiety, depression, grief, bipolar and suicidality)
(Carr, 2009).

Understanding Helps Therapists

“…the resistance of many families of substance abusing adolescents to becoming involved in treatment also contributes to therapist reticence about working with these youths and their families. However, the author’s experience has indicated that the resistance of therapists to treating this population in part stems from the therapists’ lack of practical knowledge of how to engage substance abusing adolescents and their families in treatment. Once therapists have a viable framework for understanding substance abuse and specific interventions upon which to draw, they are more willing to work with substance abusing adolescents, and treatment is more successful” (Weidman, 1985).

Family Interventions (!)

“Our results provide support for a family-based approach to prevention intervention…In fact, research suggest that intervening with parents may be more effective than intervening with children…It is also noteworthy that, to date, little research exists in the relation between parental change and child change” (Beardslee et al., 2003).

"We believe in the principles of (1) engaging with parents, (2) providing psychoeducational information, (3) providing strategies for enhancing resilience in children, (4) linking information to the families’ unique experiences, (5) and then providing long-term follow-up and support for the implementation of prevention strategies for a wide range of conditions (divorce, alcoholism), not just parental depression” (Beardslee et al., 2003).