Parenting is never easy, and today’s caregivers face challenges we couldn’t have imagined several years ago.
We could all use a little help.
Thankfully, there are numerous resources available for behavioral health professionals working with parents who seek treatment for their children. There are also excellent organizations, videos, books, and blogs that can help families learn how to develop resilience and thrive.
Mental and behavioral health challenges are a part of life for many families, and each family has unique needs and circumstances. In a recent Consortium training, Jeanette Radawich, LCSW, IMH-E, and Amy Myers, LCSW, IMH-E, explored strategies for behavioral health professionals working with parents and children.
When children enter a therapeutic relationship, their parents are often with them. And whether they are in the room or not, parents and caregivers bring their own histories of adversity and trauma. That is why experts say the most effective approach to treating children is a dyadic clinical approach — one that considers the family context.
The goal of a dyadic approach is to build a safe treatment relationship with the parent. Unfortunately, that is not always straightforward. It means understanding the family’s involvement with systems, prior treatment experiences, and trauma history.
Children and families are often involved with multiple systems, including
Families have both positive and negative experiences with systems and providers, and if their experiences are challenging, they may not trust service providers or be hesitant to ask for help. They might be guarded and unsure if they can be frank about missteps.
On the other hand, if they have had positive experiences, they may trust service providers, feel safe asking for help, and be able to admit missteps.
Of course, the trauma history of the parents factors heavily into the behavioral and mental wellbeing of children and families.
Behavioral health professionals work with individuals who have experienced trauma, and we know that adverse childhood experiences (ACEs) have lifelong consequences on physical, emotional, and mental health.
Trauma is when an event or circumstances overwhelm a person’s ability to cope. It can include physical or emotional violence, hate crimes, sexual abuse, living in poverty, or experiencing racism.
The CDC-Kaiser Permanente adverse childhood experiences (ACE) study, based on research by Dr. Vincent Felitti and Dr. Robert Anda, provided evidence that childhood exposure to violence, especially harm done by caretakers, has a lasting impact on mental and physical health.
The researchers developed a confidential survey, the ACE Score Questionnaire, which is still used today. They gathered answers from more than 17,000 participants from 1995-1997. The participants all received a physical examination and answered detailed questions about how they were treated (or mistreated) by adults. It also included questions designed to determine whether abuse of others was occurring in the home, and whether they grew up feeling like they didn’t have enough to eat, or if their parents were too impaired by drugs and alcohol to take care of them.
According to the Centers for Disease Control (CDC), 61% of people report experiencing at least one type of ACE before age 18, with one in six experiencing four or more types of ACE.
Data from the ACEs study shows that when people experience three or more ACEs, they are:
That’s a lot to cope with, and adverse childhood and community experiences also cause toxic stress if they are not addressed. Toxic stress puts people’s brains and bodies in “fight or flight” mode, impairing healthy development. Toxic stress response is when someone experiences ongoing adversity like physical or emotional abuse, neglect, caregiver substance abuse, violence or economic hardship and they don’t receive adequate support.
Complex trauma is when families exist in the fighting, fleeing, or freezing states. Parents might find it difficult to think or to reflect on their feelings, and children may have trouble playing with their peers or interacting with adults.
Providers need to be aware of a tendency, identified by attachment expert Dr. Arietta Slade, to blame, judge, or pathologize families. Providers may feel intense, negative feelings like anger, boredom, fear, and avoidance. They may have issues with boundaries, crossing them or adhering too rigidly to them, and they can face difficulties finding effective ways to engage with families with complex trauma.
When providers provide a safe environment for those defenses to calm, parents and providers are better able to work together to heal from complex trauma.
When working with families, it’s important to understand the basics of infant mental health (IMH). The mental health of infants is dependent on the contexts of their families, communities, and cultures. From ages zero to three, children are developing the capacity to:
Several developmental theories cover the period from ages zero to three. This time period is when children learn to trust or mistrust and develop a sense of security. From 18 months to three years old is where they develop autonomy, shame and doubt and develop a sense of security around independence. And from zero to two is when they are developing sensorimotor skills and learn about object permanence and separation anxiety.
Key to all of this is attachment, or the relationship between the child and the caregiver.
Starting early on, humans have a strong instinct to communicate our needs so that caregivers understand what we need and respond appropriately. As we grow, we learn to balance seeking contact with our caregivers and exploring the world. Attachment to a caregiver is the foundation for developing a sense of self.
A brief explanation of attachment theory shows three main models that are based on the primary caregiver’s behavior toward the child and the child’s “working model” of themself.
1. Positive and loved = secure attachment
2. Unloved and rejected = avoidant attachment
3. Angry and confused = resistant
The goals of dyadic treatment are to create safety within the relationship to be a safe base to support exploration and promote responsive caregiving. When parents feel safe, they can build confidence and competence that they are a “good enough” parent.
There are many good resources for learning how to work with parents, children, and caregivers. Dr. Bruce Perry, a pioneering neuroscientist in the field of trauma, identified a simple sequence for interventions. Dr. Perry’s ”The Three Rs” theory is that the first step is to help the child to regulate and calm their fight/flight/freeze responses. Next, clinicians need to relate and connect with the child through an attuned and sensitive relationship. And finally, we can reason by supporting the child to reflect, learn, remember, articulate, and become self-assured.
This works best when following the below guidelines
Listen more than you talk.
Acknowledge and support caregivers’ everyday struggles and efforts.
Normalize and validate the caregivers’ and child’s behaviors and emotions.
Highlight attuned responses and willingness to explore alternative responses.
Support self-identified treatment goals.
This American Psychological Association article provides a list of top scientifically supported sites for helping parents raise their children.
1. Infoaboutkids.org is designed for parents, educators, and behavioral health specialists. It has information on screen time, sleep difficulties, alcohol and drug use, and more. They also have an excellent blog.
2. Effectivechildtherapy.org offers a wealth of evidence-based information on the symptoms and treatments for mental and behavioral health issues in children and adolescents. The site also has a free assessment center and advice for choosing a child psychologist.
3. The ACT Raising Safe Kids Program is a class for parents and caregivers and for professionals working with families. It teaches positive parenting skills to prevent exposure to abuse and adversities.
4. Everyday Parenting: The ABCs of Child Rearing. This is a free online parenting course that addresses problem behaviors. It has 20 how-to videos.
5. The Substance Abuse and Mental Health Services Administration (SAMHSA) has numerous resources for families that are dealing with mental and substance use disorders.
6. The Connecticut Women’s Consortium offers cutting-edge trauma-informed training for behavioral health professionals. Our catalog includes courses on childhood trauma, cultural competency, anger, mindfulness, and many other topics that can assist behavioral health professionals in their journey.
When behavioral health professionals understand the ways complex trauma and adverse childhood experiences affect parents, they are better able to provide effective treatment for struggling families.
Parents need to access resources to build resilience in themselves and their children. When we help them do that, we are helping to create safer and healthier spaces for all children to grow and learn.