Welcome to Session 3!

1. Welcome to Session 3! Meeting Developmental Needs: Attachment

2. Remember the Core Competencies of PRIDE: • Protecting and Nurturing Children • Meeting Children’s Developmental Needs and Addressing Developmental Delays • Supporting Relationships Between Children and Their Families • Connecting Children to Safe, Nurturing Relationships Intended to Last a Lifetime • Working as a Member of a Professional Team

3. What did we learn about in Session 2?

4. “Parking Lot” Are there any questions from the last session that we can answer now?

5. Supplemental Handouts for This Session • “A Child’s Needs” • Ways to encourage attachment and build self-esteem • Suggestions for handling drug-exposed babies • Common “Survival” Behaviors

6. Influence of Family, Environment & Attachment • Knowledge of human development is a necessary first step to understanding the children who will be placed in your home • Human development is a combination of genetic and environmental factors • Every child needs to achieve certain physical, intellectual, emotional and social developmental tasks • Name some examples of tasks achieved in the areas of: • Physical development • Intellectual development • Emotional development • Social development

7. Overview of Attachment • Those of us who are experienced parents understand a lot about normal human development and attachment • One doesn’t need to obtain advanced academic degrees to really understand child development • Things we do for our children on a daily basis, meeting their basic needs, naturally develops attachment, security and trust • This is defined by the “Arousal-Relaxation” Cycle (PRIDEBook p.73). Let’s just call it the “Attachment” Cycle

8. The Arousal-Relaxation (Attachment) CycleHow Attachment Develops Child feels discomfort (a hungry baby) Child expresses need (baby cries) Child feels comfortable (baby stops crying/relaxes) Parent satisfies need (feeds the baby)

9. The Arousal-Relaxation (Attachment) CycleHow Attachment Develops Child feels discomfort (a hungry baby) Child develops a sense of safety, security and trust! Child expresses need (baby cries) Child feels comfortable (baby stops crying/relaxes) Parent satisfies need (feeds the baby)

10. Overview of Attachment – Guided Imagery Baby “Amanda” and Baby “Ben” • How was Ben’s ability to bond affected by his parents’ abuse and neglect? • What were the factors that “broke” the attachment cycle? • How will Ben overcome his delays?

11. Factors Leading to Developmental Delays • There are many factors that can lead to developmental delays in children who are involved with the child welfare system • Name some of these factors: • Genetic or congenital conditions (Down’s Syndrome, Cerebral Palsy, congenital blindness or deafness) • Prenatal factors (drug/alcohol exposure, HIV, poor nutrition) • Physical neglect (lack of supervision, poor health care, lack of food/shelter/clothing, lack of stimulation) • Physical abuse • Sexual abuse (fondling, penetration, sodomy, exposure to pornography) • Emotional abuse (verbal belittling, name calling, shaming, isolation) • Accidents and trauma (car accidents, falls, severe beatings, torture) • Inappropriate behavior patterns (observation of domestic violence, substance abuse, adult sexual activity, cruelty to others, criminal acts)

12. Factors Leading to Developmental Delays • Some children may experience multiple factors that impact their growth and development • Adolescents have some unique developmental challenges. Can you name some of them? • Separation from family and developing a sense of independence • Developing a sense of one’s sexuality or sexual identity • Developing a career path • The developmental challenges of teenagers can be significantly compounded by their experiences of abuse and neglect

13. A Child’s Experience of Abuse and Neglect • Over a million children per year are identified as victims of some type of abuse or neglect • Over a thousand of these result in fatalities • It is important to understand the types of abuse and neglect that children experience that are the reasons they are placed into care • While New Jersey has its own laws that define abuse and neglect, federal guidelines have begun to promote a reasonable consistency from state to state • The National Clearinghouse on Child Abuse and Neglect has defined several major areas of abuse and neglect (http://nccanch.acf.hhs.gov)

14. Definitions of Abuse and Neglect • Physical Abuse is physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child. Such injury is considered abuse regardless of whether the caretaker intended to hurt the child. • Sexual Abuse includes activities by a parent or caretaker such as fondling a child's genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials. • Emotional Abuse is a pattern of behavior that impairs a child's emotional development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. Emotional abuse is often difficult to prove and, therefore, child welfare agencies may not be able to intervene without evidence of harm to the child. Emotional abuse is almost always present when other forms are identified.

15. Definitions of Abuse and Neglect • Neglect is failure to provide for a child's basic needs. Neglect may be: • Physical Neglect (e.g., failure to provide necessary food or shelter, or lack of appropriate supervision, etc.) • Medical Neglect (e.g., failure to provide necessary medical, dental or mental health treatment) • Educational Neglect (e.g., failure to educate a child or attend to special education needs) • Emotional Neglect (e.g., inattention to a child's emotional needs, failure to provide psychological care, or permitting the child to abuse substances such as alcohol or other drugs) • These situations do not always mean a child is neglected. Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors, indicating the family is in need of assistance. • Poverty alone does not constitute neglect, however, when a family fails to use information and resources, and the child's health or safety is at risk, then child welfare intervention may be required.

16. WARNING! Some of the language contained in this video is offensive.

17. Video Vignette - Annie • What types of abuse or neglect were presented in this clip? • Emotional maltreatment – screaming at the dinner table, trying to force Annie to eat, calling Annie a “bitch”) • Physical abuse – a voice says, “You’re hurting her arm.”; Annie has cuts on her forehead) • Sexual abuse – at the end of the video, the father comes into Annie’s bedroom and Annie says, “Not again, Daddy.” • Does the mother’s failure to protect Annie constitute neglect?

18. Examples of Maltreated Children - Vignettes • How do you think Annie’s experiences might affect her overall development and ability to form attachments? • Unable to trust others, especially adults • Afraid to attach to foster parents because “attachment=abuse” • Problems in school (preoccupied with problems) • Fear of taking risks (low self-esteem) • How do you think Annie’s experiences might affect her behaviors as she is placed in a foster home? • May be afraid to go to bed at night • May be afraid to eat meals with the family • May withdraw because she is ashamed of what has happened • May be angry and act out her anger on the family • May use inappropriate language that she has heard at home • May behave in a sexual manner beyond a normal child of her age

19. Less Secure Attachment More Secure Attachment Unattached - Disorganized - Ambivalent - Anxious - Healthy Attachment Impact of Abuse and Neglect on Attachment • Child maltreatment can strongly affect a child’s ability to form healthy attachments • While children may survive in abusive or neglectful environments, they do not thrive • When thinking about a child’s attachment history, it is helpful to consider a “continuum” that goes from less secure attachment to more secure attachment • It is important to understand that this describes a suggested continuum of attachment and not specific diagnoses of attachment disorders.

20. Impact of Abuse and Neglect on Attachment • An unattached child is rare because most children will have formed an attachment to someone in their lives. • Insecure attachment in some children who do not know how to have their needs met leads to disorganized behaviors, such as being out of control and having difficulty expressing or regulating their emotions and behaviors • Other children may exhibit ambivalence in their behaviors because they may have been punished for expressing their needs and learned that the best strategy for being in a relationship is to hide needs and feelings behind a mask of detachment • Children with anxious attachment exhibit clingy and needy behavior because they may have been left alone frequently or may have experienced multiple, frequent separations • Remember Vernon from the “Making a Difference” video? Where does he fall on the Attachment Continuum?

21. Vernon’s Behaviors • Vernon was very angry when he moved in with the Hansons, even though it was clearly a safe and nurturing environment. Why wouldn’t Vernon be happy or relieved to get away from the environment where he was being hurt? • He was raised in this environment and this is all he knows or understands. The relationship was painful, but it is familiar. • Instead of thinking that his parents are at fault, he blames himself. • Abusive attention may be the only attention he has received. Negative attention may be better than no attention at all. • Vernon’s mother loves him has not intentionally caused him harm. Even when she was abusive or neglectful, she was not consistent in those behaviors. Vernon probably only remembers the “good” times that they had.

22. Maltreated Children and Attachment - Vignettes • Alicia, PRIDEBook Page 75 • Kevin, PRIDEBook Page 76 • Annie, PRIDEBook Page 77 • What behaviors do each of these children exhibit that may be difficult for the foster families to handle? • What are some strategies that can be used to deal with these behaviors? • Think about where these children fall on the continuum of attachment.

23. Video Vignette - Kevin

24. Video Vignette - Kevin • How does the video clip of Kevin make you feel? • What do you think Kevin means by, “My home, my castle?” • How do you think Kevin felt about his own identity? • What does Kevin tell us about what needs to happen within the child welfare system? • Don’t be discouraged by how Kevin is presented! The video highlights the importance of working together as a team to try to prevent children from having the negative experiences that Kevin encountered.

25. Survival Behaviors • Aggressiveness: I’ll hurt you before you can hurt me. • Testing and Control Battles: I feel like my life is out of control, so I’ll try to control you! • Identity Issues: Because of my abuse/neglect, many moves, or believing I was given away, I feel like a nobody. • Anger or Depression: I’m afraid to get close to you. You may hurt me too. • Values Issues/Lying and Stealing: What I learned from my experiences is very different from your family. If I tell the truth, I may be hurt. I must take what I need in order to take care of myself.

26. Survival Behaviors • Separation Anxiety: You will leave me, just like everyone else has. • Over-Competency: I don’t trust that you can take care of me, so I’ll have to do it myself. • Inappropriate Sexual Behavior: This is the only way I know how to get close. • Withdrawal From Relationships: I won’t relate to you. That way, I won’t have to care about you. • Hoarding: I think of the world as scarce, and I need to make sure my needs will be met.

27. Survival Behaviors • Hypervigilence: I believe that the world is a cruel and hostile place and I must always be aware that the next disappointment or painful experience is just around the corner. • “Wise Beyond My Years”: I have learned how to manipulate the systems that control me.

28. Impact of Abuse and Neglect on Behavior • Some children are very needy and it may be very frustrating trying to meet their needs • They may be slow to respond to your love and nurturing • When children don’t trust, they can be very rejecting • It is difficult for resource parents to feel the same type of gratification that they may feel, or have felt, with their birth children • The difficult behaviors displayed by children who are abused and neglected can stir up negative feelings in caregivers • Over time, nurturing and perseverance on the part of the caregivers by consistently meeting the child’s needs will instill trust in these children and enable them to form healthy attachments

29. Impact of Abuse and Neglect on Development • See the chart on Pages 82-85 in the PRIDEBook, “Summary of Stages of Child Growth and Development” • While not all children develop at the same rate, there are general predictions about when children should be reaching key milestones • The influences of abuse and neglect can negatively impact the achievement of these milestones • It is important to note that this chart does not include any indication of cultural development, and that as resource parents, we must learn as much as possible about a child’s family culture before expressing a concern to the team about a possible developmental delay

30. Impact of Abuse and Neglect on Development • Neglect • Children who are not supervised my harm themselves, and as a result may learn not to take risks, which can delay development. • A child left alone cannot model or mimic the skills of their caregiver. • Children may not have objects to play with or things to watch and observe and they do not receive adequate stimulation. • Basic needs must be met before children can concern themselves with other developmental tasks. If a child is hungry, sick or craving emotional attention, he or she cannot attend to other skills or learning.

31. Impact of Abuse and Neglect on Development • Physical Abuse • A child who is physically abused may be afraid to take risks for fear of doing something wrong. • Some children sustain serious injuries that affect their development on an ongoing basis, such as hearing loss, blindness or brain injuries. • Sexual Abuse • The effects of sexual abuse may include factors that could impede normal sexual development, such as exposure to sexual activity before a child is physically mature, sexually transmitted diseases and infections, and emotional trauma • The emotional trauma of sexual abuse may take tremendous energy and focus that would otherwise be devoted to age-appropriate developmental tasks. For example, how does an 11 year old who has been sexually abused by her uncle sit around and giggle with her girlfriends about “cute boys” in class?

32. Impact of Abuse and Neglect on Development • Emotional Maltreatment • A child’s self-esteem may be seriously eroded to the point where the child feels incompetent to tackle even basic life skills. • When a child is prevented from developing outside relationships may result in poor social development, lack of social skills, or difficulty with peers

33. Impact of Abuse and Neglect on Development • Consider the various aspects of a child’s development as they relate to the child’s age for a “normal” 8-year old child: • Chronological Age • Physical Appearance • Intellectual Age • School Age • Emotional Age • Social Age • Culture, Ethnic, Religious Experiences • Life Experiences 8 8 8 8 8 8 8 8

34. Impact of Abuse and Neglect on Development • Now consider the same scenario for Vernon from the “Making A Difference” video, who was subjected to abuse and neglect and resides in a foster home, separated from his birth family: • Chronological Age • Physical Appearance • Intellectual Age • School Age • Emotional Age • Social Age • Culture, Ethnic, Religious Experiences • Life Experiences • 8 • (may look a bit younger) 7 • (no obvious concerns) 8 • (below grade level) 6 • (lack of trust, emotional outbursts) 1-2 • (doesn’t get along well with peers) 2-3 • (unclear) • (has experienced more than most of his peers) 17-18

35. Impact of Abuse and Neglect on Development • How can we help equalize things for Vernon? • Be the child-loving family that we are! • Meet his everyday needs • Empower him to make good decisions • Encourage age-appropriate activities (playing, sports, books, TV) • Work with school professionals to get his education on track • Work with other team members (caseworker, school staff, birth father, counselor) to bolster his self-esteem • Get involved in religious community

36. “Parking Lot” Are there any questions that you had that may not have been answered during this session? Let’s add them to our Parking Lot!

37. CLOSURE • Review Key Points, PRIDEBook Pages 100-109 • Review You Need to Know!, PRIDEBook Pages 110-126 • Pay extra attention to p. 117 • Read A Birth Parent’s Perspective, PRIDEBook p. 127 • Complete the PRIDE Connection exercises on PRIDEBook Pages 128 and 129 (copy in packet) • Read Making A Difference!, PRIDEBook Page 130 • Session 4:Meeting Developmental Needs: Loss