North Carolina Dependency Treatment Court Conference WITH THE CHILD IN MIND :

1. North Carolina Dependency Treatment CourtConferenceWITH THE CHILD IN MIND: Bringing the Science of Early Childhood Development into the Courts Presenter: Lynne Katz, EdD Linda Ray Intervention Center University of Miami In collaboration with Cecilia Casanueva, PhD Children and Families Program RTI International

2. BUILDING BLOCKS FOR HEALTHY DEVELOPMENT Secure Attachment Relationship Safe Home Safe Environment Health Opportunities To Learn Adequate Shelter and Nourishment

3. Secure Attachment Relationship • The early relationship between the infant and his or her caregiver is critical for the healthy development of children (Bowlby 1973; Ainsworth and Eichberg 1991).

4. Secure Attachment Relationship • Within a good relationship, the caregiver is acting as an organizer of the infant experience, giving predictability, stability and a sense of security that are the primary base where the infant learns how to regulate his or her emotions and behaviors (Demos 1982; Perry 1997; Graham-Bermann 1998; Clark 1999).

5. Secure Attachment Relationship • To develop emotion regulation, babies need to interact and engage with their caregivers in cycles of signals and responses. • A positive engagement requires a process where caregiver and infants respond and reinforce each other contingently, with a caregiver that is aware of and is responding to the infant’s cues and vice versa (Crockenberg and Leerkes 2000).

6. Secure Attachment Relationship • Caregiver sensitivity and responsiveness: A sensitive caregiver provides regulation to the infant’s emotions and through this process the baby learns to self-regulate the intensity and expression of emotions (Cox 1992; Van Den Boom 1994; NICHD, Child et al. 1999; Cox, Paley et al. 2000; Crockenberg and Leerkes 2000).

7. ERIKSON’S STAGES OF CHILDHOOD PSYCHOSOCIAL DEVELOPMENT Trust versus mistrust (infancy) when babies learn, or fail to learn that people can be depended upon and that they can elicit nurturing responses from others. Through love, nurturance and acceptance a baby learns that the world is a safe place

8. TODDLER PERIOD • Child develops a sense of self-control and autonomy • Conflicts arise with feeding, sleeping and toilet training • If adults are harsh and punitive, shame and doubt can result

9. Piaget’s Stages of Cognitive Development • Sensorimotor stage from birth to age two • Child needs to manipulate the environment to gain information about the world • Child seeks stimulation and gets sense of causality

10. Attachment Issues • Optimal parent-child association is a warm, intimate and continuous relationship between a mother and child in which both find mutual satisfaction and joy. • Serve as precursors to the ability to form later relationships

11. ATTACHMENT CATEGORIES

12. ATTACHMENT CATEGORIES

13. ATTACHMENT CATEGORIES

14. DEVELOPMENT IN INFANTS and young TODDLERS

15. DEVELOPMENT IN older TODDLERS AND PRESCHOOL AGED CHILDREN

16. VIOLENCE HAS ITS GREATEST IMPACT: On the youngest children When violence is more severe When violence is more frequent When violence has happened before When the perpetrator is close to the child When the child or close family member is the victim On children whose caregivers provide less or weak support

17. Trauma Symptoms Behaviors not present before the trauma Nightmares, night terrors, or other sleep disturbances Startle responses and hypervigilance Attention and concentration problems Manipulativeness or provocativeness (to gain control) New fears (of dark, toileting alone, separation anxiety, or other fears) Aggression, sexual behaviors, or indications of physical discomfort or pain

18. Mood Disorders • Anxiety of infancy or toddlerhood • Excessive anxiety, panic, agitation, crying, eating/sleep problems, recklessness • Multiple or specific fears, separation anxiety or stranger anxiety

19. Mood Disorders • depression • Pattern of depressed or irritable mood, with lessened interest/pleasure • less ability to protest or interact socially • sleep/eating disturbance, weight loss

20. Mood Disorders Prolonged bereavement/grief reaction Loss of primary caregiver is ALWAYS a problem Any behaviors in stages of protest/despair/detachment Protest: cry, call out for parent, not soothed Despair: emotional withdrawal, sadness, lethargy Detachment: blankness or forgetting of caregiver Alternately, sensitivity to reminders of caregiver

21. Maltreatment Disorder Problems in relationships Child may fail to approach caregivers, approach-avoid, show extreme vigilance, or be constricted or apathetic Developmentally inappropriate social behaviors “social indiscriminateness;” seem quickly attached to and affectionate with relative strangers

22. Warning Signs: Effects of Violence Exposure If exposure is acute or relatively recent, look for changes in personality and behavior New aggression, anger, tantrums, social problems OR New withdrawal, crying, fears, disinterest, sadness

23. Warning Signs: Effects of Violence Exposure If exposure is chronic, look for longstanding problems in children’s behavior aggressiveness social problems learning problems attention problems emotion control problems

24. Biological Correlates of Violence Exposure • In the first few years of life, 700 new neural connections are formed every second. • Sensory pathways for basic vision and hearing are the first to develop, followed by early language skills and higher cognitive functions. • The timing is genetic, but early experiences determine whether the circuits are strong or weak.

25. Relational Trauma • Abusive caregivers induce extreme levels of stimulation and arousal: • Abuse= Too high • Neglect= Too low • Intense negative emotional states that last for long periods of time = high stress due to “relational trauma” (Schore, 2001). Relational trauma is not a “single-event” but “cumulative.

28. Relational Trauma “High-Risk infants born with delayed brain development and poor interactive capacities, would experience even low levels of relational stress as traumatic. Even so, the severe levels of stress associated with infant abuse and neglect are pathogenic to all immature human brains” (Shore, 2001).

29. Relational Trauma • When protective relationships are not provided, persistent stress results in elevated cortisol levels that disrupt the brain architecture by impairing cell growth and interfering with the formation of healthy neural circuits • Leads to stress management systems that respond at lower thresholds, increasing the risk of stress-related physical and mental illness.

30. Relational Trauma • Intense and unregulated interactive stress trigger a chaotic alteration of the emotion processing limbic system in the right hemisphere. • Right hemisphere: processing of socio-emotional information, bodily states, attachment functions, ability to cope actively and passively with stressors • Severe right brain attachment pathology predisposes latter in life to PTSD and relational violence

31. Toxic Stress • Strong, prolonged activation of the body’s stress response systems in the absence of the buffering protection of adult support. • Precipitants: extreme poverty, family chaos, recurrent physical or emotional abuse, chronic neglect, severe maternal depression, parental substance abuse, family violence • Can damage developing brain architecture and create a short fuse for the body’s stress response systems, leading to lifelong problems in learning, behavior, and both physical and mental health.

32. Infant Trauma and Toxic Stress • Affect the immune system and other metabolic regulatory mechanisms, leading to a permanently lower threshold for their activation throughout life. • Greater susceptibility to stress-related physical illnesses (cardiovascular disease, hypertension, and diabetes) and • Mental health problems (depression, anxiety disorders, and substance abuse). • More likely to exhibit health-damaging behaviors and adult lifestyles that undermine well-being.

34. What does the ‘bringing the science to court’ process really mean?

35. Human Systems “Practices” Desires Agendas Values Dispositions Interests Momentum Beliefs Passions Leanings Concerns Hopes Patty, S. (March, 2010). Moving Icebergs: A Brief Guide to Making a Difference.

36. Implementing the evidence-based practices or programs that supports optimal child development: What does the ‘bringing’ piece look like? Exploration stage: thinking about the innovation, acquisition of knowledge and exploration of options. Decisions to adopt the new approaches do not necessarily result in implementation with fidelity. The will to change what we bring to families in the court system. Program Installation: Structural supports are in place including funding streams, policy development and new protocols, realignment of staff as needed. The process of creating what you will ‘bring’ is developed in pockets and portions of communities. The ‘how’ still remains.

37. What does the ‘bringing’ piece look like? • Initial implementation: The ‘awkward stage’ where the inertia is there but so are anxious administrators, political pressures to reform and change, inter-professional rivalries, staff turn-over and overwhelming influences on practice and management. The realization that the process requires education, practice and time to mature. • Full operation will mean that the new innovations are integrated into practitioner, organizational and community practices, policies and procedures that interface in the court.

38. What does the ‘bringing’ piece look like? • Organizational change and system transformation occurs when we hold human service systems as accountable as we have always held our consumers. We move away from reactive approaches (when our outcomes are not what we wanted) to visionary style of goals and what we do preemptively to reach those goals over time. (Fixsen 2010)

40. Aims and Goals Development of a sustainable infrastructure where systems that link with the Court have been transformed to create the outcomes we want. The Court will see incremental benefits in family outcomes through support of the infrastructure process of change. We will be guided not by folklore, tradition, intuition or ‘the way it has always been done’ Our families will have the best chances of improved outcomes.

41. “In juvenile court, if we use science and do our jobs well, we can change the tragedy that brings children and families into our courtrooms into an opportunity to heal.” The Hon. Cindy S. Lederman