Building Better Lives

1. Building Better Lives Ohio Board of Developmental Disabilities December 4, 2013

2. Ohio Statute Created Family and Children First Council in 1993 • Section 121.37 of the Ohio Revised Code established a Family and Children First Council in every county to: • Provide a structure to assess community needs and develop collaborative approaches to accessing resources to meet those needs • Coordinate the provision of child abuse/neglect prevention • Provide service coordination for families and children

3. Family and Children First Council Members

4. The FCFC Mission • Partnering with systems and community to increase the access, capacity and effectiveness of services for the most vulnerable youth and their families.

5. Who does FCFC Serve? • Any family with a child or youth (pre-natal through 21 years) in need of a coordinated plan for their unique needs is eligible for service coordination through FCFC • We serve infants and toddlers through our Help Me Grow program • Children through age 21 are served by our Multi-System Coordination program and HomeChoice services • Referrals come through provider agencies or family members

6. FCFC Guiding Values

7. CHALLENGES • Adoption disruptions • Dually diagnosed children with significant oppositional behavior • School failure / Third grade reading guarantee • Average age of referrals decreasing • Average risk score of referred youth increasing • High number of New American youth in community • Increase in number of youth with Autism/ADHD • Increase in residential treatment placements

8. Child abuse statisticsfor Franklin County • In 2011, new reports of child abuse totaled 13,353. • 19% of these were reports of families in need of specific services, dependency, etc. • 35% were new reports of physical abuse • 22% were new reports of neglect • 11% were new reports of sexual abuse • 12% were reports that contained multiple allegations of abuse and neglect Source: 2013/2014 PCSAO Factbook

9. FCFC is leading the Building Better Lives Initiative as part of a community wide effort to break the cycle of child abuse and neglect within Franklin County by ensuring all child-serving agencies are aware of how complex developmental trauma impacts the development of the brain. This includes work in the areas of prevention, early identification, intervention and treatment that is developmentally appropriate and trauma-informed.

10. Dr. Bruce Perry: In his own words…

11. Who is Bruce D. Perry, MD, PHD • Internationally recognized expert in the effects of child trauma • Trained in both neuroscience and child psychology • His work focuses on the integration of emerging principles of developmental neuroscience into clinical practice • His work with maltreated and traumatized children has resulted in many innovative practices and programs, most notably the Neurosequential Model of Therapeutics (NMT) and Neurosequential Model of Education (NME) • His books, The Boy Who Was Raised as a Dog and Born for Love: Why Empathy is Essential and Endangered, provide a broad introduction to this work

12. What is the Child Trauma Academy? • The Child Trauma Academy (CTA) is a not-for-profit organization based in Houston, Texas • It is the host for an international network of Fellows working on development and application of concepts based on NMT, NME and related work with children who have experienced developmental trauma • Perry is a Senior Fellow at CTA

13. What is “Complex Developmental Trauma”? • Traumatic event and resulting long term effects • Witnessing traumatic events involving others • Child abuse and neglect • Chronic hunger and food insecurity • Environment of chaos or toxic stress • Lack of bonding and attachment • Intra-uterine insult

14. How does trauma impact the developing brain? • Children need healthy brain development for: • social, emotional development • Engagement, regulation of emotional responses • Language, gross motor and fine motor development • academic success • establishing meaningful relationships with others and co-existing within a community

15. Trauma and the developing brain

17. What to do? • Predictable, Reliable, Long term, Supportive, Nurturing Relationships: Children with relational stability and multiple positive, healthy adults invested in their lives improve; children with multiple transitions, chaotic and unpredictable family relationships, and relational poverty do not improve even when provided with the best "evidence-based" therapies.”  - From “The Neurosequential Model of Therapeutics” by Bruce D. Perry and Erin P. Hambrick

18. What to Do? • Rhythmic, Repetitive Sensory Activities • Incorporated in a daily routine to build self-regulation skills and resiliency • Targeted use when dys-regulation occurs to re-gain regulation

19. Rhythmic Activities • Marching/Walking/Skipping • Drumming/Foot Tapping • Singing/ Rhythmic Music • Rocking • Dancing • Yoga/Relaxation / Visualization • Chewing gum

20. How To Use Regulating Activities • Incorporate in transitions • Periodic planned breaks • Incorporate in curriculum • Substitute for punitive approach • Add to other techniques • Help child recognize signs of their own dysregulation and build self regulating skills • Flexibility for child to use regulating strategies as needed

21. How is NMT used? • NMT uses scientific research on the impact of trauma on brain development to formulate strategies that will support positive responses, behavior and functioning of a child and family. • The NMT process helps practitioners match the type and timing of specific therapeutic techniques to the developmental stage of the child as well as to the brain region and neural networks that are likely mediating the neuropsychiatric problems.  

23. Neurosequential Model in Education (NME) • The Neurosequential Model in Education was developed to use in the classroom to: • Expand the lens through which an educator sees a child’s behavior • Help teachers assess the level of regulation skills students have • Provide structure that incorporates principles of regulation • Provide strategies that can be incorporated within a curriculum to increase regulation and self-regulation

26. Community Plan • April 2012 – trained 500 cross system professionals and met with Community Stakeholders to seek input on plan • Developed Community Guiding Group • Spring 2013 –Westerville School Pilot • March 2013 – Trained 400 CSB workers, 250 child care staff, 50 community leaders

27. Community Plan • October 2013 –Partnered with OSU to train over 800 Higher Ed professors and administrators, graduate students, state and local professionals and community leaders • October 2013 – Partnered with United Way to host discussion with 75 community leaders • November 2013 – Launched pilot in 6 child care centers and Southwestern School District

28. Next Steps • Expansion of Education Initiative • Health Care System Infusion • Juvenile Court Initiative • Job and Family Services Initiative • Parent Outreach

29. Parent Tools That Work

30. How does this approach help families who are engaged with the DD system? • A child who is highly dysregulated may be misdiagnosed as having ADHD, Autism Spectrum Disorder, Oppositional Defiant Disorder, Conduct Disorder, etc. • Techniques may be effectively used for children with a dual diagnosis to reduce impact of behavior disorders • Reducing anxiety/increasing regulation will help children with a DD maximize their abilities • Regulated parents are better equipped to effectively regulate their children and to parent appropriately • Harvard studies indicate that toxic stress can reduce IQ scores by up to 13 points

31. BOLD GOALS • 100% of professionals in the community will participate in conversations about how developmental trauma concepts can help address the needs of children and parents who have suffered trauma or maltreatment • 80% of professionals in the community will understand the impact of child maltreatment on brain development and will be able to apply this knowledge to their professional practice • All parents will be aware of the importance of parent/child relationships on healthy development. • Awareness of the impact of trauma on brain development will result in manpower and resource investment that will result in a reduction of future trauma by 50%.