Presented by: Rhonda Kent, MA Counselling, RSW

1. YWCA of Calgary Children Exposed to Domestic Violence Presented by: Rhonda Kent, MA Counselling, RSW Clinical Supervisor, Children’s Counselling Services

2. YWCA of Calgary - Children’s Counselling Services • Children’s Counselling Services offers group and individual counselling for children and parents who have been impacted by domestic violence. • Programming is informed by Dr. Bruce Perry’s Neurosequential Model of Therapeutics (NMT).

3. Increase in Children Witnessing • In 2009, over half (52%) of spousal victims with children reported that their children heard or saw the assaults on them in the previous 5 years. • Children were more likely to witness violence when the spousal victim was female. • Spousal assaults witnessed by children also tended to be more severe compared with assaults where children were not present. • The involvement of police was nearly four times higher when children had witnessed spousal violence. From Statistics Canada – Family Violence in Canada: A Statistical Profile, 2010

4. Child Witnessing Many parents believe that their children are not exposed and not aware of the violence that goes on in their home. In reality research shows that 80% to 90% of children indicate the opposite (Jaffe et al., 1990; Jaffe & Geffner, 1998). Even if the children have not been in the room, they will have been able to sense the atmosphere in the home

5. Children at Risk • In 2011, police reported approx 18,300 child victims of family violence under the age of 18. • • While young children have the lowest rates of police-reported family violence against children, these children were most at risk of being killed by a family member. Over a ten-year period, infants under the age of one were most at risk of being killed by a family member, followed by toddlers and preschoolers aged 1 to 3. From Statistics Canada – Family Violence in Canada: A Statistical Profile, 2010

6. Effects of Abuse on Children “Exposure to Family Violence causes a profound and lasting negative impact on the developing child. These effects are due to the remarkable malleability of the developing brain. The brain develops as a reflection of the nature of the experiences of the child – and if these experiences are chaotic, violent and threatening the brain will adapt, resulting in a persistently frightened child. The result is increased hyperactivity, inattention, depression, impulsivity and a host of other serious problems in all aspects of life.” Bruce Perry

7. Maltreated children develop as if the entire world is chaotic, unpredictable, violent, frightening and devoid of nurturing. Unfortunately, the systems designed to help these children continue to expose these children to neglect, unpredictability, fear, chaos and, all too often, more violence.

8. Unique Needs of Children Who Witness Domestic Violence Typically children turn to their parents for protection in stressful or fearful situations. Children who witness DV may not have such emotional support because the perpetrating parent is unsafe and the abused parent may be emotionally unavailable because of their own trauma ( Groves, 1996). Children in a family affected by DV often have complicated ambivalent and overwhelming feelings towards parent who perpetrates the violence.

9. Impact of Domestic Violence • Children’s responses to their experiences vary. They may reveal any number of a range of adjustment problems, or may emerge from their experiences relatively unscathed. • Many children who witness traumatic events such as incidents of DV may feel helpless and see the world as unpredictable, hostile and threatening.

10. Emotional Responses • Intense terror, fear of loss of a parent, fear of death. • Children may conceal rage, feelings of guilt and a sense of responsibility for the violence. • Walking on “egg shells”, children trying to be quieter and not being able to express how they feel. • May Internalize or Externalize behaviors

11. How Children Are Affected By Abuse and Trauma • Normalizes violence in relationships • Engenders a persistent fear state • Creates a disorder of memory • Leads to avoidance of intimacy • Alters brain development

12. The Brain Matters (Perry) • The human brain is the organ responsible for everything we do. It allows us to love, laugh, walk, talk, create or hate. • The brain – one hundred billion nerve cells in a complex net of continuous activity – allows us our humanity. • For each of us, our brain’s functioning is a reflection of our experiences.

13. The Brain is Undeveloped at Birth • The brain changes throughout life. The majority of that change takes place in the first years of life. • At birth the remarkable potential of the brain remains unexpressed. • It is the experiences of childhood that express that potential.

14. Resources for Neurosequential Model • www.childtrauma.org (Dr. Bruce Perry)

15. Abstract thought Concrete thought Ability to delay gratification Attachment Language Sexual Behavior Expressive Emotional Reactivity Motor Regulation Arousal Sleep Appetite/Satiety (feeding) Blood Pressure Heart Rate Body Temperature Neocortex Limbic Midbrain Brainstem Bruce Perry

16. Traumatic Event Bruce Perry Prolonged Alarm Reaction Altered Neural Systems

17. (National Scientific Council on the Developing Child, 2010, p. 4)

18. Exposure to Trauma and Neglect(Perry)

19. Key Principles of Neurosequential Development (Perry, 2006) • Principle 1: The brain develops in a sequential fashion. • Principle 2: The brain develops most rapidly early in life. • Principle 3: Neurons and neurosystems are designed to change in a use-dependent fashion. • Principle 4: The brain is organized in a hierarchical fashion, such that all incoming sensory input first enters the lower parts of the brain. • Principle 5: Neural systems can be changed but some systems are easier to change than others. • Principle 6: Human brain is designed for a different world. The ratio of adults to children in a relationally rich world was 4:1, however our children are now growing up in a relationally challenged setting with a ratio of 1:4

20. Current Research • Current research describes the negative impact of childhood trauma on the physical, behavioural, cognitive, social, and emotional functioning of children (Perry & Pollard, 1998; Anda et al., 2006). • We now know that children exposed to violence have increased neuropsychiatric problems (e.g., PTSD, depression, dissociation, and conduct disorders).

21. Research Partnership with Mount Royal University Dawne Clark, PhD Centre for Child Well-Being Mount Royal University Justine Palinkas CHST student, Mount Royal University

22. Literature Review • The NMT shows promise in a variety of clinical settings such as preschools, mental health clinics, and residential treatment centers (Perry, 2006; Barfield, Gaskill, Dobson, & Perry, 2009). • No published studies demonstrating the application of NMT to therapy groups for children exposed to domestic violence. • There is a critical gap in the domestic violence literature.

23. Research Question • What are parent perceptions of the adaptive functioning of their children, ages four to seven, who have been exposed to domestic violence, after receiving intervention techniques informed by Perry’s (2006) Neurosequential Model of Therapeutics (NMT) as compared to the YWCA’s current psycho-educational play therapy based model of intervention?

24. Results Average Overall Score (Achenbach CBCL)*lower scores are better

25. Comments • All groups showed a positive average change in overall score. • In both age groups, group 2 (NMT) seemed to show more positive average change than the other two groups. • There seemed to be more positive change in children in the 1.5-5 year age range than in the 6-18 year age range in all four therapy groups.

26. Parent Comments – NMT informed Changes • Closer as a family • More comfortable with each other • More relaxed • Children more willing to open up • Confidence, not alone • “It’s okay to be wrong, it’s okay to make mistakes” • Do more as a family

27. Parents Comments – NMT informed Activities • Lazy 8’s – (mentioned in all 6 interviews) • Repetitive movement – “I call it the butterfly” • Special playtime, special bag of toys • Yoga and breathing • Music and rhythm • Positive comments

28. Facilitator Focus Group • Facilitators noted that the children seemed more engaged, calm, able to express themselves, and able to self-regulate in the NMT group. • Parents seemed to benefit from the NMT group with the additional knowledge about self-regulation and early brain development. • Parents seemed to appreciate learning about specific activities rather than general concepts such as empathy.

29. Bruce Perry - NMT Regulate-Relate-Reason

30. Model Informed Interventions – Brain Stem • Patterned Repetitive somatosensory activities • Music & Movement (drumming) • Yoga Therapy • Massage • Brain Gym

31. Model Informed Interventions– Limbic System • Play Therapy • Art Therapy

32. Model Informed Interventions – Cortex • Verbal and insight oriented • Use of Cognitive-behavioural or psychodynamic approaches

33. Working with Parents • it is the primary caregiver that has the best opportunity to provide patterned repetitive neural stimulation through consistent, nurturing and predictable responsive caregiving. Bruce Perry

34. Children who have experienced trauma may have a foreshortened sense of future due to the trauma they have experienced. Lenore Terr

35. Creating Hope

37. Rhonda can be reached at rkent@ywcaofcalgary.com Thank you