Trauma-Informed Clinical Interventions for Young Children Norma

Treatment Approaches for Children of Parents with Co-Occurring Substance

Use and Mental Health Disorders and

Histories of Violence/Trauma

Norma Finkelstein, Ph.D.

Karen Gould, LICSW

Institute for Health and Recovery

Strengthening Connections Conference - AIA

September 11, 2012

Austin, TX


Key Facts about

Child Traumatic Stress


Definition: Childhood Trauma

The mental result of one sudden external blow or a series of blows, rendering the young child temporarily helpless and breaking past ordinary coping and defensive operations.


Source: Lenore Terr, M.D. , 1991

Key Facts: Child Traumatic Stress

Child Traumatic Stress is common:

• More than 25% of American youth experience a serious traumatic event by the age of 16, and many children suffer multiple & repeated traumas.

• Common sources of trauma include abuse and neglect; experiencing or witnessing violence in neighborhoods, schools, and homes; serious accidental injury; disasters and terrorism; and treatment for life-threatening illness.

• Young children are exposed to traumatic stressors at rates similar to those of older children. In one study of children aged 2–5, more than half (52.5%) had experienced a severe stressor in their lifetime.


Key Facts: Child Traumatic Stress

Child Traumatic Stress can be identified:

• Signs of traumatic stress include fear, anger, withdrawal, trouble concentrating, nightmares and digestive problems.

• Children’s distress may not be obvious or visible; by talking with them you might find out what is going on.

Children may feel ashamed, guilty, betrayed or weak and may seem numb as they try to avoid their own feelings.

• Prior trauma, past mental health problems, or a familial history of such problems may increase a child's risk.

• Serious, ongoing traumatic stress reactions are hallmarks of Post-traumatic Stress Disorder (PTSD).


Possible Impacts of

Trauma/CODs on Children

• Sleep Disturbance-nightmares, trouble waking and falling asleep

• Separation anxiety and clinginess

• Aggressive behavior and angry feelings

• High activity level, emotional numbing

• Constant worry about possible danger

• Forgetting how to do things that they have mastered

• Withdrawal form friends and activities

• Difficulty in concentrating and then the reference

Source: Child Witness to Violence Project,

Boston Medical Center, Boston, MA


Coping Strategies

Children exposed to traumatic events may develop traumarelated cognitions & coping strategies:

• Inappropriate self-blame

• Global sense of impending danger

• Operating under chronic ongoing distress

• Ongoing or intermittent functional impairment


Biology:

Trauma & the Developing Brain

• Trauma may affect the physical development of the brain

• The brain is on a “use it or lose it” plan

• The brain drives the body’s “fight or flight” stress response

• The biology of resilience


Three Domains Impacted by

Childhood Trauma

1. Affect Identification

• Awareness of/connection to own emotional experience

• Capacity to read cues in others

2. Affect Modulation

• Capacity to self-soothe, calm

• Lack of connection among emotional states

3. Affect Expression

• Capacity to safely express emotions

• Capacity to communicate emotional experience to others


Source: Margaret Blaustein, 2006

Attachment

• The emotional connection children form with their parents or primary caregivers

• Healthy attachment depends heavily on parent or caregiver behavior; it’s important that the process begin as soon as possible

• Early positive attachments help children to develop & maintain health relationships throughout their lives

• Babies with a healthy, secure attachment understand that the parent or caregiver is a source of comfort & a solid base from which to explore and play


Attachment

• Provides a sense of security

• Regulation of affect & arousal

• Expression of feelings

& communication

• A base for exploration


Young Children

• Early development across

5 areas: closely linked

(adaptive, cognitive, communication, motor, social-emotional)

• Attachment as foundation of developing brain

• Young children’s brains: resilient/responsive


What is my baby trying to tell me?

The attachment process boils down to detective work


Family-Centered Interventions

• Benefit both children & parents

• Broaden focus from nuclear family to network of supports – relatives, friends, etc.

• Are strengths-based and focus on resiliency building

• Are aimed at relationship-strengthening

• Value families having a meaningful voice & choice

• Are inclusive, flexible, responsive & culturally relevant


Project BRIGHT:

Building Resilience through

Intervention – Growing Healthier

Together

Working at the Interface of Substance

Use Recovery & Early Parenting


Project BRIGHT Collaborators

• Institute for Health and Recovery

• Jewish Family & Children’s Service, Center for

Early Relationship Support

• Boston University School of Social Work

• Boston Medical Center, Child Witness to

Violence Project


Project BRIGHT

• Designed to address traumatic stress in parents in recovery from substance use and co-occurring disorders & their children, birth-5

• Parents & children are in residence at one of the

8 Family Residential Treatment (FRT) programs across Massachusetts

• Will serve 80 children & their families over 3 years of grant


Project BRIGHT Goals

• Address symptoms of complex trauma and build resilience in young children in FRTs

• Enhance the quality of parent-child relationships

• Build capacity of FRTs to address children’s trauma needs

• Pilot adaptation of Child

Parent Psychotherapy as model for this population


Family Residential Treatment

• Serve approx. 247 families, with 259 children, per year

• Funded & licensed by Bureau of Substance Abuse

Services

• 8 programs with 10-15 families; each with own culture & approach

• 80% of families have children under 5

• One-third are reunifying with child on site

• Families stay 6-12 months

• Goals are program completion and housing stability


Project BRIGHT in the FRT’s

• For FRT realities:

– Shorter term intervention

– Include pregnant women and mothers with infants

• For challenges/needs of population in early recovery:

– Explicit focus on building Reflective Function

(RF)

– Central role of emotion regulation

– Attunement to issues of separation, loss, and transitions in relationships and in the milieu


Who We Serve

• Caveat: served fathers at 1 of the 8 FRT’s

• Have seen 76 dyads

• Clinical experience of women & children:

– Few capacities for emotion regulation; substance use has been response to intolerable affects

– Most parenting sober for first time

– Extensive maternal trauma histories

– Relationships with children characterized by separations & losses


Child-Parent Psychotherapy (CPP)

• Developed by Alicia Lieberman,

Patricia Van Horn & colleagues at UCSF

• Relationship-based dyadic intervention

• Manualized – Don’t Hit My

Mommy, published by Zero to

Three press

• Home- or office-based

• Bi-lingual capacity

Groves, Noroña, Child to Witness Violence Project 12/9/09


Child-Parent Psychotherapy (CPP)

• Relationship-based treatment for children birth-6 who have been exposed to family violence

• Focuses on the traumaaffected attachment of parents & young children, toward goal of reducing traumatic stress & behavioral symptoms

• Focuses on improving the parent-child relationship


Focus of CPP

• Caregiver-child interactions

• The relationship is the client

• Emotional experience of both caregiver & child are valued

• Targets the system of jointly constructed meanings (often inaccurate and/or problematic) in the caregiver-child relationship

Groves, et al.


BRIGHT Modifications/

Adaptations to CPP

• Length of treatment shortened to 6-8 months

• Aimed at bringing philosophy & ideas of CPP to the

FRT staff & milieu environment

• Include women who are pregnant—anticipate their children’s needs related to danger & safety

• Focus on Reflective Function—the capacity to understand child’s inner world & the link between behavior and intentions, feelings & needs

• For women in recovery from SUD/COD, treatment that targets maternal reflective capacity has been shown to be effective

Suchman, Nancy, et al., (2008) The Mothers and Toddlers

Program, Psychoanalytic Psychology, 25, 499-517


Core Concepts in Project BRIGHT

• Containing/regulating feeling states

– Recognizing own and child’s feelings

– Clinician as calming presence

– Strategies for reducing distress

• Building parental reflective function

– Wondering about child’s perspective

– Making sense of behavior

– Reflective function growth

• “I’m so much more aware of this baby because I was high when my older kids were little.”

• “I would never think you could ask those questions about your child.”


Evaluation of Project BRIGHT:

An Update on Findings

Ruth Paris, Ph.D.

Gina Mittal, MSW

Lisa Schottenfeld, MSW, MPH


Measures

Traumatic Experiences Screening

Inventory (TESI)

Traumatic Symptoms Checklist –

Young Child (TSCYC)

Adult-Adolescent Parenting

Inventory (AAPI)

Reflective Functioning

Questionnaire (PRFQ)

Brief Symptom Inventory (BSI)

Child’s exposure to traumatic events

Child’s symptoms of traumatic stress

Parenting practices in domains including empathic practices, role reversal, appropriate expectations, and use of physical discipline

Parent’s ability and inclination to engage in reflective functioning

Life Stressors Checklist – Revised

(LSC-R)

Client satisfaction survey and

Qualitative interview

Trauma-Informed Practices

Survey

Staff interviews and/or focus groups

PIR-GAS/RPCL (DC0-3R)

Parent’s symptoms of psychopathology: scales for depression, anxiety, traumatic stress, psychotic thinking, somatization

Parent’s exposure to traumatic life events with an emphasis on events germane to family conflict

Parent’s perceptions of and satisfaction with the intervention and their clinician

Staff member’s knowledge of and self-perceived ability to provide trauma-informed care

Staff members’ perceptions of and satisfaction with the intervention and its effects on the FRT as a whole

Relationship Measures: assessment of overall quality of parent-child relationship and specific problematic aspects

Methods & Demographics

• Design:

– Baseline treatment: n = 76

• Average age of parents: 28.5 years

• Average age of children: 1.6 years

• Evaluation Tools:

– Self-report questionnaires

• 75% white, 21% Latino,

15% African American

– Observer-rated instrument

– Administrative data from the Bureau of Substance

Abuse Services, MA

Department of Public

Health

• 38% did not receive high school diploma or GED

• 97% unemployed

• Substance of choice tends to be heroin or other opiates, cocaine, or crack

• Average number of sessions: 12


Trauma histories (LSC-R and TESI)

*women only

Parents (LSC-R):

• Parents participating in BRIGHT report exposure to a mean of 13 traumatic events

• Common exposures include: physical abuse; emotional abuse or neglect; family members’ substance abuse; abortion, stillbirth, or miscarriage; sudden death of someone close

Children (TESI):

• Parents participating in BRIGHT report that children have been exposed to a mean of 3 traumatic events

• Common exposures include separation from parent or other caregiver; seeing or hearing family members fighting or threatening to harm to each other; seeing or knowing family member arrested or incarcerated; serious illness or medical procedures


Research Question

• Is participation in

Project BRIGHT associated with changes in participants’ psychological health and parenting?


Parents’ Psychological Distress at

Baseline & Post-Treatment (BSI)

Scale

BRIGHT treatment mean at baseline (SD), n=75

1.03** (.61)

BRIGHT treatment mean at post (SD), n=59

.77*** (.58)

Community

Sample mean

Global .30

***p≤.001

• Participants in BRIGHT suffer worse psychological distress (depression, anxiety, hostility, paranoia) than those in the community sample

• BSI scores declined significantly, indicating less psychological distress after receiving Project BRIGHT


Likelihood of Child Maltreatment at

Baseline & Post-Treatment (AAPI)

• Compared to a community sample:

– Parents participating in BRIGHT show tendencies to be at higher risk for lack of empathy towards their children and restricting their children’s power and independence

• Statistical trends demonstrate that the mothers who are less psychologically distressed after Project BRIGHT treatment are less likely to hold inappropriate expectations for their children and less likely to endorse corporal punishment.


Parental Reflective Functioning at

Baseline & Post-Treatment (PRFQ)

High Scale

Low Scale

BRIGHT treatment mean at baseline

(SD), n=76

5.49*** (.61)

2.17*** (.65)

BRIGHT treatment mean at post (SD), n=59

5.55*** (.56)

2.15*** (.70)

Expert rating of standard for highly mentalizing mothers

6.29

1.43

Significance as compared to expert rating ***p≤.001

• At baseline and post, mothers participating in Project

BRIGHT are significantly different from expert ratings of highly mentalizing mothers

• Changes on the high and low PRFQ scales are not statistically significant, however, the change that was measured is going in the desired direction


Parent-Infant Relationship Global

Assessment Scale (PIR-GAS)

• The PIR-GAS assesses relationship between parent and child.

• Secure, insecure, disordered attachments, etc., tend to be powerful predictors of later functioning.

• The majority of mothers in the BRIGHT treatment group have relationships with their children that can be classified as “disordered,”

“disturbed,” “distressed,” or “significantly perturbed.”


Improved Parent-Child Relationship in

BRIGHT Treatment Group (PIR-GAS)

Treatment

Group (n=58)

Mean at baseline (SD)

50.26

(13.91)

Mean at post

(SD)

55.45

(14.29)

Mean difference

(SD)

5.19***

(10.00)

Sig (2tailed)

.000

***p≤.001


Pathways to Better Parenting

• Statistical trends show that less psychological distress after BRIGHT (BSI) is linked to better Reflective

Functioning (PRFQ) and better relationships (PIR-GAS)

– Mothers who are less psychologically distressed after treatment are significantly more likely to have better levels of reflective function.

– Less psychologically distressed mothers are significantly more likely to have better relationships with their children (higher

PIR-GAS scores).

• Better reflective functioning after BRIGHT (PRFQ) is significantly associated with improved parent-child relationships in BRIGHT treatment group (PIRGAS)


Summary of Findings

• Project BRIGHT participants report significantly less psychological distress after treatment.

• Those who are lowest on psychological distress after participating in BRIGHT are less likely to hold inappropriate expectations for their children or to endorse corporal punishment and report better levels of RF.

• In addition, Project BRIGHT clinicians note improvements in mother-child relationships after treatment (PIR-GAS).

• Those who do experience improvements in these relationships are also likely to be more reflective about their children.


Client Interviews

• 41 client interviews conducted at 8 FRTs

• Select themes from client interviews

– Reflective Functioning

– Differences in parenting after

BRIGHT


Reflective Functioning: Sub-Themes

• Self-reflection

• Reflecting on how own childhood affects current parenting

• Reflective parenting


Reflecting on How Own Childhood

Affects Current Parenting

“I didn’t have anybody, like my father was a crackhead and me and my mom used to not get along and I was a daddy’s girl so I was always sticking with daddy, you know, in and out of crack houses and at ten years old I learned how to hit a vein… I was shooting my father up and I was shooting all his friends up and it’s just kinda like, I never had that childhood where you like sit down and color. And I want that for my kids. It’s so important to me to like, sit down and color with them.”


Reflective Parenting

“Putting myself into their shoes and figuring out, you know, what they thought about it and how they felt. Everything from them first moving their heads to, you know, emotions. How frustrating it is that they can’t move their heads, and they can’t tell me what they want. You know, she

[clinician] made me realize that babies have it tough.”



“I also realized like when my patience drops, and

I’m at that breaking point and I’m frustrated… he reads off of my feelings and he gets even more frustrated so as long as I take myself out of the room, like and I come back calm, things are a lot calmer and easier to deal with, and we’ll start from the beginning.”



“Even being in a house, there’s women all the time that… but as I even get into an argument with one, holding my daughter… how do I think they’re feeling listening to their mom tighten up and yell and scream at this other girl? Well, how are they feeling? Because they’re not enjoying it. And they’re getting scared. And I’ll have to walk away, and I’ll think about it.”


Differences in Parenting After

BRIGHT: Sub-Themes

• Closer to child

• Pay closer attention to child’s needs

• Better understanding of child

• More consistent with child

• Engage & communicate with child


Closer to Child

“I kinda feel the changes in me and in my son, I don’t know, just feel more closer to him. Before I didn’t feel that close, cause I don’t know I was like,

‘oh my god he’s a pain in the butt, oh my god he doesn’t want to sleep in his own bed,’ and now it’s like he doesn’t want to sleep in his own bed because he loves me, he wants to be close to me. So before it was all about complaining, and like now it’s about being grateful.”


Engage with Child

“…’cause I used to think that being a parent… being a mother was just being the mother, just feed ’em, change ’em, and that’s it, you know? I… I did not do any bonding with none of my other kids. I don’t think I even read ’em a book once. The playing… that was a low too... with this, with this baby, I just had changed a lot, my way of thinking.”


Communicate with Child

“So even little things like getting down on her level… I try to stop and explain to her… I’ll like, kneel down and I’ll say ‘mommy will be right back and clean the plates ’cause we’re all finished with dinner’… as simple as I can run it through with her. I’m communicating with her,

I’m not just leaving her there to scream and fend for herself.”


Summary of Findings: Client

Interviews

• With new knowledge about their children, and after learning more about themselves and their past experiences, participants perceived that they were better able to engage in reflective parenting

• Participants were able to share the ways in which they felt that they had changed as parents as well as how their relationships with their children changed after working with the Project BRIGHT clinicians


Clinical Experiences

Signs of success:

• Clients request to be referred to BRIGHT

• Parents welcome focus on relationship with their child

• Parents understand concepts of BRIGHT

• High rates of enrollment & retention

• Clients express satisfaction & learning


Lessons Learned

• Share BRIGHT concepts in userfriendly language

– “You’re using BRIGHT principles when you…”

– Focus on “small moments with big meanings” (transitions, good-byes)

• Encourage a milieu that is childfriendly

– Child’s first day; best practices for reunification

– Saying good-bye; planned & unplanned endings

– Opportunities in daily routines: meals, baths


Lessons Learned

Participation in staff meetings & case conferences:

• Build collaborative relationships with staff

• Model/encourage a curious, reflective stance

• Highlight opportunities for thinking about experience of parent, child & relationship

• Share Project BRIGHT principles as frame


Challenges of Implementation

• How to hold a clinical mind in a non-clinical environment?

• Environment often unpredictable & in crisis

• Focus on recovery & house rules can be in conflict with relational treatment approach

• Guest status at FRTs; not decision-making


Challenges of Implementation

Milieu realities impact treatment:

• Daily routines & demands on women and children

• Lack of consistent treatment space

• Unplanned leavings

• Group living both supports

& stresses coping capacities


…just saying…

• Recovery staff: “It’s so good to hear when anyone talks about the importance of relationships.”

• Mother: “I’ve learned how my relationship with my daughter is a template for her relationships with other people.”

• Mother: “The twins have been through a real lot. Pretty much, I’ve never been a sober mom, ever.”

• Mother: “I think they taught me really how to love them.”

• Mother: “A lot of things that we talked about, like, really did make sense because a lot of things I didn’t understand because I had never parented while I was clean.”


SAMHSA’s Women, Co-Occurring

Disorders & Violence Study

(WCDVS) Children’s Subset Study

2000-2003


Target Population

• Children, aged 5-10, of women enrolled in the

WCDVS

• Children had at least weekly personal contact with mother/caregiver enrolled in WCDVS

• Only one child per family enrolled in the study


WCDVS Children’s

Subset Study Overview

• 4 of the 9 WCDVS women’s study sites chosen to participate

• Development and implementation of standardized, strengths-based interventions

• Outcome evaluation of children enrolled

• Interviews conducted with mothers/caregivers


WCDVS Children’s Study Sites

ALLIES Project

PROTOTYPES

New Directions for Families


W.E.L.L. Project

Children’s Subset Study

Primary Goals

• For children of mothers with co-occurring mental health & substance use disorders & histories of violence:

– Generate empirical knowledge about the effectiveness of trauma-informed, age-specific intervention models

– Identify models of care that will prevent or reduce intergenerational perpetuation of violence


Core Intervention Components

• Clinical assessment – mother & child

• Resource/service coordination & advocacy

• Skills-/resiliencybuilding group

Group Work with Children of Battered Women:

A Practitioner’s Manual, Peled and Davis,

Sage Publications, 1995


Children’s Subset Study:

Primary Research Question

• Are trauma-informed, age-specific interventions for children more effective than usual care conditions in leading to increases in safety, selfcare, positive interpersonal relationships and self-identity?


Sample Overview

• N=253 at Baseline

• N=209 at 6 Months (82.6%)

• N=217 at 12 Months (85.8% Retention)

• N=195 (77.1%) Received Baseline, 6 Month

& 12 Month Interviews

• Intervention & Comparison Groups Statistically

Equivalent on Demographic Characteristics

Across Follow-Ups


Major Group Goals

• To “break the secret” of abuse in their families

• To learn to protect themselves

• To experience the group as a positive & safe environment

• To strengthen their self-esteem


Children’s Group

Key Session Elements

• Message of the week

– Example: “Abuse & violence are not okay”

• Check-in

• Feeling of the day

– Example: “Sad”

• Activities & process

• Personal affirmation

• “Pass the squeeze”

• Snack

• Reward/reinforcement


Children’s Group

Orientation – with mothers & children

• Week 1: Getting to know each other/message: it’s okay to feel & express feelings*

• Week 2: What is abuse? “Abuse is not okay and it’s not my fault.”

• Week 3: Anger “It’s okay to feel and express feelings.”

• Week 4: It’s not always happy at my house

• Week 5: Sharing personal experience with violence

“I am not the only one.”

*Adapted from: Groupwork With Children of

Battered Women, Peled & Davis, Sage Publications, 1995


Children’s Group (Cont.)

• Week 6: Touch - “My body is private and I have a right to protect it.”

• Week 7: Assertiveness/Conflict Resolution - “I can be strong without being abusive.”

• Week 8: Safety (Protective) Planning - “I have the right to be safe.”

• Week 9: Review and good-bye - “It is okay to have fun.”

*Adapted from: Groupwork With Children of

Battered Women, Peled & Davis, Sage Publications, 1995


Characteristics of Children

• Average age – 7.28 years

• In legal custody of mother – 74.3%

• Involved in child welfare system – 39%

• Experiencing emotional or behavioral problems

– 67.5 %

• Parent convicted of a crime – 79.8%

• Parent treated for substance abuse – 98%


Race/Ethnicity

Hispanic/Latina

26%

White/Caucasian

36%

Native

American

1%

Asian/

Pacific Islander

1%

Black/African American

36%

Prevalence of Victimization

60

50

40

30

20

10

0

Sexual Abuse Physical

Abuse

Domestic

Violence


Intervention Group

(n=115)

Comparison Group

(n=138)

WELL Child Outcomes

• Primary Outcome Variable

– Behavioral & Emotional Rating Scale (BERS) Strength

Quotient (Epstein & Skaima, 1998)

• Secondary Outcome Variables

– BERS Subscales

• Tools for improving relationships

• Family involvement

• Capacity for closeness

• Positive self-identity

• Measure of Safety Knowledge

– Child knows what to do to keep self safe when feels threatened by another person (4 Point Scale)


Short-Term Effects

(6 months post baseline)

• Primary Outcomes

– Involvement in intervention lead to comparable, but not better, improvement than treatment as usual

– Mother’s outcomes affected children’s outcomes

– Children in comparison whose mothers had negative outcomes did worse

– Children whose mothers had positive outcomes did well in both conditions


Short-Term Effects


• Secondary Outcomes

– Enrollment in the standardized intervention appears to lead to improvements in positive interpersonal relationships, knowledge about safety & positive self-identity


Long-Term Effects


• Primary Outcomes

– Involvement in intervention leads to sustained improvement compared to children in comparison group

– Mothers’ outcomes do not play role in sustaining children’s positive outcomes

– Younger children show more improvement regardless of condition

– Children in intervention group performed consistently better across all age groups


Long-Term Effects


• Secondary Outcomes

– Intervention plays role in sustaining improvements in positive interpersonal relationships, knowledge regarding safety & positive selfidentity


Summary of Results

• In short-term (6 months), mother’s overall treatment outcome plays stronger role in children’s outcomes than involvement in the intervention

• In long-term (12 months), participation in intervention leads to sustained positive improvement regardless of mother’s outcome, with younger children showing a greater degree of positive change than older children


Lessons Learned

• Children can be the motivator for women to seek treatment

• Treatment of the woman offers an opportunity to provide services to the children

• Traumatic childhood experiences influence the ability to parent

• Victimization if children triggers memories in the parent

• Motherhood is both a major source of identity and self-worth, and a source of shame and guilt


Lessons Learned

• Extreme guilt & shame must be addressed in order to build healthy parenting relationships

• The support of a parent who has experienced similar challenges is critical to overcome fear and guilt

• Must have well developed working relationships with child welfare agencies

• System-related issues of confidentiality & privacy must be addressed in order to promote healthy boundaries


Children Need…

• Safety

• Developmentally appropriate information about addiction, mental illness, violence and recovery

• To express their feelings about their experiences in a safe place

• Emotional skill-building

• Time to re-establish trust in the parent-child relationship

• Screening/assessment for mental health/trauma and recovery service referral


“Don’t Take the Bait”

Guidelines for self-care when working with children who act out their pain

1. Don’t take the bait: be careful of projective identification

2. Retreat in fantasy: early and often

3. Use your words, not your behavior

4. Don’t take this work too seriously

5. Give to them in ways that are meaningful to them

6. Know your limits: “something has to be something”

7. Learn to measure success differently

8. Look for humor: it is everywhere

9. Keep sanctuary


Source: Lynn Sanford, LICSW

Rules to Practice By

• Children are remarkably resilient

• It’s never too early or too late to intervene

• There must be a commitment from us – the professionals

– to keep children, their voices, and their stories at the core of our work

• We need to understand the full emotional impact of violence on children

• We need to respond to the crisis of violence by reestablishing safety and stability

• Work from a position of constant compassion – easy to say, not easy to do

• Care for your colleagues and care for yourself


Resources and References

• Children of Substance Abusers Resource List, http://womenandchildren.treatment.org/documents/cosa-resource-

508v.pdf

• National Association for Children of Alcoholics http://www.nacoa.org/

• TIE Women’s Forum, Children & Families page http://womenandchildren.treatment.org/resources-children-families.asp

• The National Center on Substance Abuse and Child Welfare www.ncsacw.samhsa.gov

• Adverse Childhood Experiences Study website http://www.cdc.gov/nccdphp/ace/index.htm

• National Abandoned Infants Assistance Center http://aia.berkeley.edu/

• Fetal Alcohol Spectrum Disorders Center for Excellence http://www.fascenter.samhsa.gov/


Selected Parenting Program

Resources

• The Nurturing Program for Families in Substance Abuse

Treatment and Recovery www.healthrecovery.org

• Celebrating Families www.celebratingfamilies.net

• Incredible Years www.incredibleyears.com

• Strengthening Families www.strengtheningfamilies.org


Resources

• ARC: Attachment Regulation and Competency www.traumacenter.org

• National Child Traumatic Stress Network www.nctsn.org

• Child-Parent Psychotherapy (CPP)

“Don’t Hit My Mommy” developed by Alicia Lieberman and Patricia Van Horn

• Adult Children of Alcoholics" by Janet G. Woititz, Ed.D.

• Understanding Addiction and Recovery Through a

Child's Eyes" by Jerry Moe
