When You Talk Too Loud, I Cannot Hear

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When You Talk Too Loud, I Cannot Hear

• Working with Parents of Children Exposed to
  Violence

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Effects of Exposure on Children

• Immediate and long term
• Physiological and neurological reactions that can
  lead to alterations in brain development and
  function

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Witnessing Violence Can Affect a Childs

• Ability to trust adults to keep him safe
• Ability to learn
• Social and emotional development
• Self-esteem
• Ability to be a child

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Reactions to Violence

• Nature of the violence (closeness, intensity,
  frequency)
• Risk and protective factors
• Age and developmental stage of the child

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Reactions to Violence

• Elapsed time since exposure
• Gender
• Temperament
• Presence of child physical or sexual abuse

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Common Symptoms Birth - 5

• Fussiness, uncharacteristic crying and neediness
• Generalized fear
• Startle response to loud or unusual noises
• Regressive symptoms
• Somatic symptoms
• Helplessnesslack of usual responsiveness
• Confusion
• Difficulty talking about event

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Common Symptoms (Birth 5)

• Somatic symptoms (stomachaches headaches)
• Helplessnesslack of usual responsiveness
• Confusion
• Difficulty talking about event

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Common Symptoms (6-11 years)

• Feelings of responsibility and guilt
• Repetitious play and retelling
• Nightmares and other sleep issues
• Concerns about safety
• Aggressive behavior

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Common Symptoms (Older Children)

• Withdrawal, school avoidance
• Worry and concern for others
• Anxiety and fearfulness
• Regression
• Separation anxiety
• Distractability

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Consequences

• Increased involvement in the child welfare and
  criminal justice system.
• Adverse and compromising sexual, reproductive and
  parenting behaviors.
• Intergenerational transmission of violence.

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Protective Factors

• Characteristics that protect children from the
  damaging effects of negative life circumstances
  and events and build resiliency.

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Risk Factors

• Characteristics and experiences that make it more
  challenging for a child to grow and develop
  skills that lead to success in life.

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Resiliency

• The ability to recover readily or bounce back
  from adversity and stressful events.

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Widening Our Lens

• We cant always control the nasty weather
  children might have to endure.
• We can work to build resiliency by promoting
  protective factors and reducing risk factors.

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Widening Our Lens

• Building awareness
• Prevention/building resiliency
• Increasing awareness
• Screening/Identification
• Access to early intervention and treatment
• Integrated systems of care

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Identification

• Gain information from a variety of sources
• -Parents and extended family members
• -Observations of the child
• -Teachers, child care staff, other
• caregivers
• -Community partners

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Identification

• Consider the physical, emotional, cognitive, and
  social strengths of the child, as well as the
  concerns.
• Partner with the non-abusing parent to get
  childs history as well as current circumstances.

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Identification

• Each child responds differently depending on a
  variety of factors same for reactions to
  violence.
• Information gained is to develop goals that
  responds to each child.

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Challenges to Addressing Exposure

• Lack or awareness about impact of exposure and
  interventions
• Fragmentation of services
• Lack of capacity in early care and school
  programs
• Inadequate supply of trained providers
• Inadequat attention to cultural competency

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When to seek help birth to preschool

• Hard time calming down at bedtime needs a lot of
  help to fall asleep
• Abrupt changes in feeding or sleeping
• Cries for long period at a time and is hard to
  calm
• Does not respond when held or cuddle
• Shows little interest in exploring surroundings
• Is delayed (or does not) coo, babble, or speak

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When to Seek Help School Age

• Showing declining performance in school.
• Losing interest in things once enjoyed.
• Experiencing unexplained changes in sleeping or
  eating patterns.
• Avoiding friends or family and wanting to be
  alone all the time.
• Daydreaming too much and not completing tasks.

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When to seek help school age

• Poor concentration and is unable to think
  straight or make up his or her mind.
• Inability to sit still or focus attention.
• Worries about being harmed, hurting others, or
  doing something "bad".
• Racing thoughts that are almost too fast to
  follow.
• Persistent nightmares.

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When to Seek Help Adolescents

• Using alcohol or other drugs.
• Setting fires.
• Doing things that can be life threatening.
• Killing animals.
• Sad and hopeless for no reason, and these
  feelings do not go away.

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When to Seek Help Adolescents

• Very angry most of the time and crying a lot or
  overreacting to things.
• Constant feelings of worthless, guilt, anxiety,
  worry.
• Extremely fearful or having unexplained fears.

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Safe Start Initiative
Purpose of the Safe Start Initiative is to
prevent and reduce the impact of family and
community violence on children and their families.
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Safe Start Definition of Exposure to Violence

• Being a direct victim of abuse, neglect, or
  maltreatment or a witness to domestic violence or
  other violent crime in the community.

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Components

• Practice innovation
• Research
• Evaluation
• Training and technical assistance
• Information and resource development

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Practice Component Phase IDemonstration Sites

• Baltimore, MD Bridgeport, CT Chatham County,
  NC Chicago, IL Pinellas County, FL Spokane,
  WA Pueblo of Zuni, NM San Francisco, CA Sitka
  Tribe of Alaska Rochester, NY Washington
  County, ME

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Phase IIPromising Approaches

• Bronx, NY Chelsea, MA Dallas, TX Dayton,
  OH Erie, PA Kalamazoo, MI Miami, FL New York
  City, NY Oakland, CA Pompano Beach, FL
  Portland, OR Providence, RI San Diego, CA San
  Mateo, CA Toledo, OH

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Phase IIDiversity of Approaches

• Home Visitation
• Domestic Violence Shelter-Based Service
• Motivational Interviewing
• Kinship care /dyad therapy
• Child Welfare-Domestic Violence Integrated
  Services
• After School Support/Kids Club

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Phase II Diversity of Approaches

• Parent Child Interactive Therapy (PCIT)
• Child Parent Psychotherapy (CPP-DV)
• Trauma-Focused Cognitive Behavioral Therapy
  (TF-CBT)
• Trauma Assessment Pathway (TAP)
• Dyadic Therapy

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Phase IIDiversity of Approaches

• In-home, family-centered services
• Integrated case management (mental health/social
  services, family support)
• Trauma-focused curriculum for teachers and
  parents
• Medical home
• Child advocacy center

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Safe Start - Erie

• CAC lead agency with partners
• Partners Achievement Center, Crime Victim
  Center, Edinboro University, Office of Children
  and Youth
• Children age 8 and under
• Eligibility criteria

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Safe Start- Erie

• Majority of referrals from CAC others from
  partner agencies, Head Start, Social Service
• All Safe Start children receive a developmental
  assessment once every six months for two years
• About half of the families are randomly assigned
  to an integrated treatment program

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Benefits

• Quick, integrated responses
• Developmental findings lead to early referrals
• Mobile therapy allows us to reach families that
  would have gone un-served
• Coordination between providers
• Ability to follow over time

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Challenges

• Families are often system wary or focused on
  daily survival which presents recruitment/retentio
  n challenges
• Program visibility and long-term commitment