Emma Hodges Family Therapist Children’s Program

1. Emerge’s early intervention with mother-infant dyads living in refugeOPEN Sector Research Symposium 2017October 30th, Melbourne University Emma Hodges Family Therapist Children’s Program

2. Introduction

3. Emerge Support Network for Women & Children The organisation offers a diverse range of support services to women, and women with children who have experienced family violence.   Emerge programs also include outreach support, community education, art therapy for women & children, legal support and advocacy. Our mission is to enable independence for women and children by breaking the cycle of domestic violence.  Emerge services cover the south metro area including LGA’s of Bayside, Kingston, and Glen Eira

4. Key Objectives of the Infant Mental Health interventions 1. Baby as subject Babies aren’t the plus 1 on a referral Babies are not an extension of the mother 2. Interventions are cognisant of infant subjectivity Assessment often overlooks the infant’s experience of family violence, their needs, and also what interventions they might benefit from Therapeutic interventions aim to understand how things feel on the inside, not just how they look on the outside 3. Trauma-informed & Infant-led approach Emphasis is on restoring relational resources, promoting optimal development and supporting rights of the child

5. DV & Homelessness- The impacts for infants

6. Case: Infants in refugeWhat is the reality and challenge of working with infants most in need, but last to receive? • Intervening with infants in refuge is THE opportunity! Infants cannot afford to wait. • Significant body of research showing exposure to FV in infancy causes: • extreme anxiety responses • inhibitive affective dysregulation • Post-traumatic responses of hypervigilance, hyperarousal, avoidance and intrusion symptoms • ‘Severe’ response variables • Intensity of traumatic event • Proximity • Direct witnessing • Relationship with perpetrator and/or victim • (Jordan, 2014)

7. Peek-a-Boo Club (Bunston, Eyre, Carlsson, & Pringle, 2016) • Results – improvements in the following areas • Infant presentation • Socio-emotional competence and pro-social interactions • Less challenging internalizing, externalising and dysregulating behaviours • Gaze, affection, pleasure & compliance • Mother-infant Relationship • Reduced levels of interpersonal distress and conflict • Improvement in domains of ‘quality of attachment’ and ‘pleasure in interactions’ • More adaptive flexibility in the relationship Developed by Dr Wendy Bunston at the Children’s Hospital in 2005 Main aims – early intervention for infants and mothers impacted by family violence to repair relational ruptures Approach – infant-led Theoretical underpinnings – Object Relations and attachment theory Evaluation - Pre versus post-pilot evaluation 30 groups, N = 128 mothers and infants

8. Incorporating the Peek-a-boo Club™ (PAB) into the Children’s Art Therapy program. • To provide a therapeutic service for infants in refuge responding to their needs • Implement an approach that could be delivered by Arts Therapists • Trauma-informed and infant-led • Counter-point to other parent efficacy and attachment-oriented programs which do not include the infant in the therapeutic process. I.e. doing with, not doing to

9. Attachment based Art therapy with dyads (Malchiodi & Crenshaw, 2014) Draws from concepts of • ‘The good enough’ parent (Winnicott) • Transitional object and transitional space )Object relations theory) • Neuroscience

10. What have been the additional benefits observed? Right brain, left brain activation Translating concepts into meaningful constructs by creating representations of Ghosts and Angels in the nursery Putting language around traumatic memories and experiences – helping infants – and mothers- make sense and meaning Attachment as a meaning-making experience rather than an abstract concept that often inadvertently pathologises the parent-child relationship

11. What have been the additional benefits observed? Creating both shared and independent narrative Increase communication skills Specific art therapy interventions utilised facilitate a deeper understanding AT enhances mentalisation and reflective functioning b Improve motor skills/physical coordination Not manualised or licensed

12. What have been the challenges? Presentations of acute and/or chronic traumatisation in both mother and child inhibits ability to engage verbally Managing feelings of mistrust or distrust based on prior experiences with CPS The infant’s participation is entirely contingent on their mother’s commitment. Disengagement means infant is lost from view and unable to access a service it would hopefully benefit from Filling the gaps in services post group – who do we refer to for comprehensive assessment, ongoing infant-parent therapy?

13. What are the limitations? Expertise and training in IMH, attachment and FV for therapists and agencies Not manualised Access to funding which is focused on qualitative gains and outputs over targets and outcomes Clients who do not have English as a first language Different interpretations of trauma-informed practice Under-responsive and/or over-reactive system Father-infant dyads are missing from the picture!

14. Where to from here? Evaluation of Art Therapy with mother-infant dyads Measure changes in attachment and trauma symptomatology in infants PAB for families in refuge – Bunston et al study community sample

15. Questions?

16. Thank you! emma@emregesupport.org.au www.emergesupport.org.au