Educational Case Study Slides.pdf

The impact of type 2 trauma: Intervention within the early childhood educational curriculum in Aotearoa/New Zealand SARAH WHITCOMBE-DOBBS, PHD CHILD & FAMILY PSYCHOLOGIST SENIOR LECTURER UNIVERSITY OF CANTERBURY Child abuse & neglect in Aotearoa/NZ  ‘Substantiated findings’ during 12-month perio...

The impact of type 2 trauma: Intervention within the early childhood educational curriculum in Aotearoa/New Zealand SARAH WHITCOMBE-DOBBS, PHD CHILD & FAMILY PSYCHOLOGIST SENIOR LECTURER UNIVERSITY OF CANTERBURY Child abuse & neglect in Aotearoa/NZ  ‘Substantiated findings’ during 12-month period: 1.1% (Oranga Tamariki Evidence Centre, 2020)  Notifications for distinct children 2018-2019: 62,300, or 6.6% of the child population aged 0-14 years (Office of the Children’s Commissioner, 2018; Oranga Tamariki, 2019)  Family violence rates: 7% of children have had a family violence police callout in the past year (Oranga Tamariki, 2020)  1 child dies every 5 weeks in Aotearoa/NZ; Māori are 3.5x more likely to be victims than Pākehā (Connelly & Doolan, 2007; UNICEF, 2018)  Self-reported lifetime prevalence internationally: 13% for sexual abuse, 23% for physical abuse, 16% for neglect; (Stoltenborgh et al., 2015) Whanonga Pono – Principles & Beliefs 1. 2. 3. 4. 5. 6. 7. 8. Child abuse & neglect is harmful, & should not be ignored or justified Children should be listened to & their views taken seriously There is no place for judgement when working with maltreating parents Culturally safe practices are not just compatible with increased child safety & whānau wellbeing, they are essential Most parents involved with child protection services love their children & want the best for them Key underlying drivers for child harm are the social determinants of health (e.g. poverty, colonisation, education, poor housing/deprivation, access) & we must ameliorate these All govt and non-govt services & sectors, not just Oranga Tamariki, have a role to play in ensuring child safety & wellbeing Effective intervention & practice will lead to a reduction in actual harm occurring towards the child, & children developing according to their potential Parents involved with CPS  Multiple disadvantages relative to general population:   Poorer, more children while younger, less-educated, more isolated, less likely to be employed (Ben-Arieh, 2010; Simon & Brooks, 2017) Much more likely to have been maltreated as children themselves (Simon & Brooks, 2017)  Higher rates of psychiatric disorders & substance use problems (e.g. Hammond et al., 2017; Perepletchikova et al., 2012)  Observable parent-child interactional differences from non-maltreating parents (Wilson et al., 2008)   These vary by type of maltreatment – physical abuse/aversive behaviour; neglect/lower involvement Overall lower rates of positivity (NB when observing, remember your sample is biased; look to your social networks for comparison not other clients) Parents involved with CPS  Haskett et al. 2014 followed 54 dyads where physical abuse had occurred     Examined parenting behaviours over time – including direct obs & child report Heterogeneity at individual level, but overall deterioration between preschool and first two years at school Increase in flat affect Decrease in positive regard, decrease in sensitivity  Social stigma and parental engagement  Behavioural vs attitudinal; compliance vs active participation (Staudt,  Parents do not experience CPS as strengths-based – they find it embarrassing, stressful and frightening (Kemp et al., 2014) Lip service externally; anger, ambivalence and desire to exit CPS internally (Yatchmenoff, 2005)  2007) Current approaches  Actions may include:      Closure with NFA Referral to PFO → closure Investigation and assessment Convening an FGC Orders; applying for support, custody or guardianship (Rebstock et al., 2015)  This escalation and retraction of state intervention leaves children and families in a state of threat, while exposure to harm continues → ‘cumulative jeopardy’ → serious, long-term harm (Brown & Ward, 2014)  The principle of minimal sufficiency is absolutely inappropriate for child protection, because it prolongs harm (*SWD opinion*) Our Aspiration for Our Children  “to grow up as competent and confident learners and communicators, healthy in mind, body, and spirit, secure in their sense of belonging and in the knowledge that they make a valued contribution to society” – Part A, Te Whāriki, Ministry of Education, 1996 Jayden, 3 years  Referral information: running away, physical aggression, hurting animals  Assessment summary: interviews, observations & psychometrics      Parental mental health problems; separation & high exposure to adversity (including maltreatment) Development within normal limits Severe and extreme externalising behaviour, including high levels of hyperactivity & inattentiveness in both settings Signals of internalising behaviour in home setting only Overall, significant difficulties with social & emotional development; other areas typical Te Whāriki and Special Needs  The curriculum “assumes that...care and education will be encompassed within the principles, strands and goals”.  Activities will be age- and development-appropriate.  Objectives will be realistic, useful and of value to the child and family.  Inclusive and appropriate for all children How does this sit alongside experiences of neglect?  “The lot of the depressively neglected child is to be raised in an environment in which all the emotional energy has drained out of the system. The psychological traffic between minds has all but stopped. Parents have given up being curious about themselves, their children and people at large. There is no interest in behaviour and relationships. Young minds born to make psychological sense of the self and the social are deprived of the very experiences that help them make that sense.” (Howe, 2005) Some potential effects of early childhood trauma Unpredictable outbursts – anger, aggression, violence Withdrawn/emotionally “flat”/ zoning out Task avoidance/running away No apparent understanding of consequences Odd/bizarre behaviours, eating non-food items Poor social skills Learning delays, or inconsistent academic performance Extremely short attention span/poor impulse control Appetite & growth differences, loss of bladder + bowel control, upset skin  Sense of worthlessness, suicidal ideation and/or behaviour  Indiscriminate friendliness towards strangers          Some parallels  Some parallels between international literature on the needs of children who have been exposed to Type 2 trauma and the tenets of Te Whāriki:      Belonging – development occurs within intimate social relationships – initially with parents, then with others - Perry Wellbeing – physical & emotional safety; physiologial & emotional self-regulation – Gunnar & Quevedo Contribution – areas of control & responsibility support formation of self esteem & sense of belonging Communication – explicit teaching of specific skills Exploration – “Play is treatment in its purest form.”- Zeigler The Individual Plan process  Problem behaviours were of highest concern to teachers and therefore to Jayden’s parent  Running away & into road, biting, hitting, spitting, screaming all at very high frequency  Met together: custodial parent, key teacher and head teacher, Special Education staff member  Blank copies of plan – only information was background and descriptors of Te Whāriki strands  Goals within each strand determined by parents and teachers  Took a looooong time! The Individual Plan process  Special Education role:     Facilitated discussion & took notes Ensured goals phrased realistically Referred to evidence-based practice and gave specialised information & psychoeducation as needed Safety, predictability, repetition, routine all essential components  All strands included specific goals, actions to be taken towards those goals & by whom  Includes outcome measures: how will we know it has worked?  Focus on developmental goals rather than behavioural goals Outcomes  Most goals met despite ongoing behavioural      difficulties Increase in play with other children Increase in communication with teachers Increase in perceived sense of belonging Increase in wellbeing indicators – no more running away! Increase in participation in problem-solving activities Discussion  Advantages of process:  Responsibility for intervention given to those who are actually implementing intervention  Focus on whole child rather than just behaviour problems  Highlights emotional and social needs and steps to address these  Collaboration between home and pre-school – fosters mesosystem  Drawbacks:  Removes control from psychologist (?!)  Time-consuming References        Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. et al. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry & Clinical Neuroscience, 256(3), 174-186. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist , 32, 513-531. Child, Youth & Family (2014). Who we are and what we do. Retrieved from http://www.cyf.govt.nz/about-us/who-we-are-what-we-do/information-for-media-backup.html 11.11.2014. Cicchetti, D., Toth, S. L., & Maughan, A. (2000). An Ecological-Transactional Model of Child Maltreatment. In A. J. Sameroff, Handbook of Developmental Psycholpathology, (2nd ed.) (pp. 689722). New York, NY: Kluwer Academic/Plenum Publishers. Golding, K. (2014). Multi-agency and specialist working to meet the mental health needs of children in care and adopted. In M. Tarren-Sweeney and A Vetere (Eds), Mental health services for vulnerable children and young people: Supporting children who are, or have been, in foster care (pp. 161-179). Oxon: Routledge. Hart, B., & Risley, T. R. (2003). The early catastrophe. Education Review, 17, 110-118. High and Complex Needs Unit. (2007). Better at Working Together: Interagency Collaboration: Part 1 Literature Review. Wellington: High and Complex Needs Unit. References         Howard, J. A. (2013). Distressed or deliberately defiant? Managing challenging student behaviour due to trauma and disorganised attachment. Toowong: Australian Academic Press. Howe, D. (2005). Child Abuse & Neglect: Attachment, development and intervention. Palgrave Macmillan. Ministry of Education (1996). Te Whāriki. Wellington, Learning Media Limited. Retrieved from http://www.educate.ece.govt.nz/~/media/Educate/Files/Reference%20Downloads/whariki.pdf New Zealand Government. (2013). The White Paper for Vulnerable Children Vol 1 and 2. Parenting Research Centre. (2013). Evidence review: An analysis of the evidence for parenting interventions for parents of vulnerable children aged up to six years. Retrieved from: http://www.parentingrc.org.au/index.php/resources/evidence-review-an-analysis-of-the-evidencefor-parenting-interventions-for-parents-of-vulnerable-children-aged-up-to-six-years. Patterson, G. R. (1982). A social learning approach Vol. 3: Coercive family processes. Eugene OR Castalia. Pettit, G. S., & Arsiwalla, D. D. (2008). Commentary on special section on "Bidirectional parent-child relationships": The continuing evolution of dynamic, transactional models of parenting and youth behaviour problems. Journal of Abnormal Child Psychology , 36, 711-718. Tarren-Sweeney, M. & Vetere, A. (Eds.). (2014). Mental health services for vulnerable children and young people: Supporting children who are, or have been, in foster care. Oxon: Routledge.