The Infant Crier

Month: July 2018

  • Enforcing Immigration Policies Frightens and Negatively Affects Children and Their Families

    Enforcing Immigration Policies Frightens and Negatively Affects Children and Their Families

    Parents do not uproot their children to make a long and dangerous journey to an unknown future in the U.S. unless situations in their home country are so threatening that the risks of migration pale in comparison to more certain risks at home. Parents do it because they feel they must!

    Zero To Three is one of many organizations feeling compelled to respond to young children being separated from their parents at the U.S. Border.  In a recent statement:

    “The secure attachments young children form to their caregivers are the bedrock of healthy development and emotional stability, providing a sense of security and a buffer from the toxic effects of stress and trauma. Migrating to a new country is already stressful. 

    Separating children and caregivers destroys the relationships that foster resilience.  Make no mistake: separation at this point is a trauma that can have long-term impacts on an infant’s well-being. 

    Post-traumatic stress disorder, anxiety, depression, and sleep disorders can follow.

    The practice of having border agents remove children from caregivers suddenly and place them institutional care, especially without any policy for visitation, or reunification, amounts to maltreatment.

    Anyone with infant/early childhood mental health expertise – and anyone with a heart for children – will tell you that separating young children from caregivers at the U.S. border is appalling and must be stopped”

     – Myra Jones Taylor, chief policy officer
    ZERO to THREE

    As immigration enforcement ramps up, so increases the fear of undocumented parents about the fate of their children.  There are about 6 million U.S. citizen children with at least one parent who is in the country illegally.  Research shows that harsh immigration enforcement policies have consistently undermined the health, economic security, and overall wellbeing of children of immigrant families.

    Specifically, the current administration’s immigration enforcement orders:

    • Tear families apart
    • Harm children’s short- and long-term mental health
    • Undermine children’s economic security
    • Threaten children’s access to education and basic needs
    • Endanger the lives of asylum-seeking children and families

    Last year, the current administration issued two executive orders that powerfully expanded the intensity and scope of federal immigration enforcement activities in the United States.  These orders have included policy changes that have negative consequences for children living in mixed-status immigrant families. Many of these children are U.S. citizens.  This policy enforcement has dire consequences for unaccompanied children seeking protection here.

    The current administration’s orders call for:

    • An increase in immigration enforcement activities for deportation, triples the number of immigration agents,
    • Increased collaboration between federal Immigration and Customs Enforcement (ICE) and local law enforcement agencies to detain undocumented immigrants,
    • Focus on immigration enforcement along the U.S. southern border,
    • Significant expansion of immigration detention capacity.

    Additionally, the current orders have resulted in the separation of at least 2300 undocumented children from their parents who are placed in governmental care in shelters and foster homes across the United States. At the time of this writing, few have been reunited despite judicial mandates.

    Parents who come to the U.S. have to make very difficult decisions about whether or not to bring their children with them to a new country that is unknown to them.

    There are policy changes that would return more migrants, including women and children seeking asylum, back into harm’s way and strip children of critical protections.  These orders and policies undermine the wellbeing and development of millions of children and are directly linked to the parent-child relationship, external stress factors, and family economic security.

    Parts of these orders may face legal challenges and other parts require additional funding to be fully implemented making these policies not final.

    Significant effects of current immigration enforcement orders:

    1st – Immigration enforcement orders tear families apart and mixed-status families are now more likely to be separated by deportation because every undocumented immigrant is being seen as a priority for removal and quickly processed with deportation orders. The “official guidelines for implementing the orders” rolls back previous Department of Homeland Security (DHS) policy that gave immigration officials discretion in deciding whether to detain certain immigrants, including parents and legal guardians of minor children.

    More than 5 million children in the United States live with at least one undocumented parent and 4.1 million of them are U.S. born citizens.

    As a result of these official guidelines, children are at risk for having a parent or guardian deported.

    The current administration has called for national raids which have captured hundreds of people (parents and young people) previously covered by the Deferred Action for Childhood Arrivals (DACA) program which was established in 2012 giving relief from deportation for undocumented youth who came to the U.S. as children.

    Family separation is one of the most harmful effects of the current administration policies.  As we know, parents are extremely important to the wellbeing of their children and the sudden loss of a parent can have long-term consequences.

    2nd – Immigration enforcement orders harm children’s short and long term mental health by increasing children’s anxiety about their undocumented parents. At very young ages, children are impacted significantly by parent stress, according to many studies.  High levels of parental stress can result in poor cognitive development in children as young as two years of age.  Persistent stress, also known as “toxic stress”, can have harmful effects on brain development in very young children affected by fear and worries of their family and community, and the trauma of watching a parent be arrested can result in behavioral changes.  Very young children are particularly vulnerable to the impact of toxic stress due to the rapid brain development taking place, as well as their dependence upon familiar, caring adults to assist in regulation of their state of arousal.  The social and emotional development that takes place during the earliest years will impact later functioning for years to come.

    Children of all ages are affected by fear and worries of their family and community, and the trauma of watching a parent be arrested can result in behavioral changes. Children’s sleeping habits often suffer and increased anger or withdrawal is common.  Schoolwork can suffer.  Additionally, the remaining parent may experience depression and withdrawal.  Mixed-status families involved in immigration enforcement often lack access to mental health services that are affordable and culturally and linguistically appropriate.

    3rd – Immigration enforcement orders can undermine children’s economic security. Parental deportation or risk of parental deportation can push children in low-income immigrant families further into poverty.   One study estimates that the sudden loss of a deported parent’s salary can reduce a family’s household income by 73 percent.  Poverty faced by children in mixed-status families results in barriers to basic health and nutrition supports available to non-mixed status families. We know that children living in low-income households when compared to same age peers often experience more hunger, decreased health outcomes, and increased learning disabilities and developmental delays. Poverty faced by children in mixed-status families results in barriers to basic health and nutrition supports. Additionally, poverty causes extreme stress on parents, affecting their ability to recognize cues and attend to their children.

    4th – Immigration enforcement orders threaten children’s access to education and basic needs. The fear of deportation can cause parents to be reluctant to send their children to child care, school or after school activities.  Every day parental responsibilities – transporting children to and from school or childcare – become too risky for undocumented parents.  A routine traffic stop could result in deportation.  Anti-immigrant rhetoric increases parent fears to reach out for a variety of supports for themselves and their young children.  There are also concerns for schools, early childhood education and care programs, health clinics and other programs that serve immigrant children and their families regarding confidentiality.  Current ICE policy restricts immigration enforcements from occurring in “sensitive locations” like schools, child care centers, bus stops, hospitals, and places of worship.  Yet, we know of incidents where parents have been taken into custody at these locations.  There is a need to review policies and to provide protocols to ensure the safety of all children and families.

    5th – Immigration enforcement orders endanger the lives of asylum-seeking children and families.

    These are the children and families that have experienced significant trauma in their migration from their home countries: families primarily from Central America trying to escape violence and instability in their home countries because of drug trafficking, gangs, and organized crime.

    When border patrol agents turn away migrants at the border, forcing them to wait for outcomes outside the United States, their children are exposed and vulnerable to trafficking, and young children are being recruited for gangs.  Policy guidelines need to define who qualifies as an “unaccompanied child” and to provide protections for these children.  The Federal government requires women and children to be placed in detention centers – a controversial practice that has been shown to be detrimental to children’s healthy development. This is being challenged in court.

    These are not the values of America.  This policy enforcement is dangerous to the health of our most vulnerable children.  Separating families sends children deeper into poverty and jeopardizes their rights to basic human protection. Current immigration policies and practice go against MI-AIMH’s mission to promote safe lives and healthy social emotional development for all very young children.

    “MI-AIMH believes that each infant needs to be nurtured and protected by one or more consistent and stimulating caregivers who enjoy a permanent and special relationship with the baby.  This relationship is essential for optimal social, emotional and cognitive growth. MI-AIMH also believes that the failure to provide and maintain nurturing relationships, at least one, during infancy may result in significant damage to the individual and to society.”

    Infant and early childhood mental health specialists understand what is at stake and it is critical that we advocate for practices that protect and support the healthy development of every young child.

    References:

    Cervantes, Wendy, & Walker, Christine (2017) Five Reasons Trump’s Immigration Orders Harm Children. Center for Law And Social Policy, April 2017 1-8. mi.aimh.org

    Njoroge, Wanjiku F. M. (2015) Complex Intervention: A Family’s Story of Loss, Struggle, and Perseverance. Zero To Three Journal, March 53-56.

    Paris, Ruth, & Bronson, Marybeth. (2006) A Home-Based Intervention for Immigrant and Refugee Trauma Survivors: Paraprofessionals Working With High-Risk Mothers and Infants. Zero To Three Journal, November 37-45.

    Prieto, H. Victoria. (2017) Considerations for Serving Immigrant Families With Young Children. Zero To Three Resource for Professionals.

    Zayas, Luis H. (2018) Immigration Enforcement Practices Harm Refugee Children and Citizen-Children.  Zero To Three Journal, 38(3) 20-25.

  • Early Identification of Autism Spectrum Disorder (ASD) and Parent-Child Group Intervention Based on the Early Start Denver Model (ESDM)

    Early Identification of Autism Spectrum Disorder (ASD) and Parent-Child Group Intervention Based on the Early Start Denver Model (ESDM)

    Increasing access to early intervention for ASD, a national and international health priority

    Autism Spectrum Disorder (ASD) now affects approximately 1 in 59 children in the United States.

    Based on the knowledge of developmental science and rigorous intervention studies, we know that early intervention leads to better outcomes when started as early as possible in development. Unfortunately, on average in the United States children with ASD are diagnosed at 4 years of age and start intervention even later, despite the fact that they can be identified as young as 12 months. Usually, children and their families experience long waits before accessing a diagnostic evaluation and after this, they need to wait even longer to start services. The gaps between parents’ concerns and the beginning of services are due to the increase in the number of children with a diagnosis of ASD combined with a scarcity of specialized providers. The National Research Council has recommended a minimum of 25 hours per week of intervention. However, it is nearly impossible to provide such intensity by relying uniquely on professional delivery to all children immediately following diagnosis. One way of increasing access to intervention is to teach intervention strategies to parents. Parent-based interventions have shown positive outcomes in children, as well as in parents. Research has shown that by learning intervention strategies with the help of professionals, parents naturally implement intervention throughout the day during activities such as play, mealtime, and grooming. By including the parents in the intervention, the time spent with a professional will have cascading effects in terms of increasing therapeutically productive time for the child.

    Julie’s story, the importance of paying attention to early signs of ASD

    Julie is a child who was lucky enough to receive an early diagnosis of ASD at 23 months of age, after which she was quickly enrolled in our Parent-Child Group intervention, described below. Julie was born full-term after an uncomplicated pregnancy and was a happy, easy-going baby. She started babbling around 6 months of age and met motor milestones on time. However, her parents became concerned about her development around 18 months of age, because her language was not progressing, she regularly flapped her arms and she did not consistently alert her parents to her needs, despite their sensitive caregiving and responsiveness towards her. Rather, they had to predict when she might be hungry or thirsty or need a diaper change. Furthermore, she has a cousin with a diagnosis of ASD, and her parents noticed similarities between the children. For instance, Julie preferred playing by herself to playing with others, especially other children. She often engaged in repetitive play with a shape sorter or putting toys in a toy box. However, she did engage with peek-a-boo and pat-a-cake appropriately with her mother and enjoyed clapping when excited. She transitioned easily between activities, however she did engage in some repetitive behaviors, especially during bedtime.

    She preferred doors to be closed and also engaged in some repetitive sensory seeking behavior, such as running her hands on walls and placing her fingers in the door latch. Julie also had tactile aversion to messy play and significant temper tantrums if expected to ride an elevator.

    Obtaining a multidisciplinary evaluation for ASD

    Her parents sought out an evaluation based on their concerns and brought her to the University of Michigan Department of Psychiatry when she was 23 months old. Julie and her parents engaged in several interviews and tasks during the assessment. Her parents responded very warmly to her and attempted to engage her in many tasks. At times, she appeared to enjoy back and forth interactions, such as when being tickled. However, more frequently, she did not respond to her parents’ and examiners’ attempts to engage her in developmentally appropriate play. She also tended to run away, rather than toward her parents, when distressed. However, when her parents picked her up to comfort her, she was very quickly soothed.

    Overall, Julie demonstrated strengths in imitation and emerging eye contact. However, she was delayed in the areas of language and communication and reciprocal social interaction and had several restricted and repetitive behaviors. For instance, although she babbled regularly, these vocalizations were not typically directed towards others. She did not point, nor use other gestures. She gave items to her father, but did not show items, and only rarely initiated joint attention, despite enjoying several tasks. Although her eye contact was emerging, it was not regularly used to initiate, regulate, or terminate social interactions. She was able to play appropriately with several toys, including those present in a bath time play activity shared with the examiner However, At other times she engaged in more repetitive play, that was difficult to interrupt, such as repeatedly putting items in and out of bins. She engaged in brief finger posturing and had some sensory interests, often examining items close to her face or sniffing them.

    Julie was also evaluated just prior to 24 months by Occupational Therapy and at 25 months by Speech-Language Pathology. The Occupational Therapy evaluation noted weaknesses in self-care skills and fine and gross motor as well as sensory aversions. For instance, her motor weaknesses led to difficulty assisting in dressing routines and holding crayons, and she was very averse to engaging in messy play. The Speech-Language Pathologist felt that Julie had moderate Receptive and Expressive Language Delay. All of the combined information from parent report of her development and examiners’ observations led to a diagnosis of ASD. Although Julie’s parents were sad that the diagnosis they feared was confirmed, they were receptive to the feedback and excited to engage in treatment to assist Julie, as soon as possible.

    Parent-Child Intervention Begins-a low intensity group adaptation

    Parent-Child Group Intervention Begins – a low intensity adaptation of the ESDM within a parent-child group setting

    Julie enrolled in our group intervention at 24 months of age. This intervention is based on the Early Start Denver Model (Dawson and Rogers, 2010), an evidence-based intervention that fuses developmental science, relational approaches, and the principles of Applied Behavior Analysis. The Early Start Denver Model (ESDM) has been implemented in many different settings including the more traditional therapist-child delivery, parent coaching, school-based groups, as well as telehealth therapy. In our Department, Dr. Colombi, through internal and federal funds, has developed a Parent-Child Group intervention based on ESDM principles to offer intervention to all families who receive a diagnosis at the University of Michigan and want to start intervention immediately.

    The Early Start Denver Model uses a child-centered, responsive interactive style and 10 foundational intervention themes, including (1) social attention and motivation for learning, (2) sensory social routines, (3) dyadic engagement, (4) non-verbal communication, (5) imitation, (6) antecedent-behavior-consequences relationships, (7) joint attention, (8) functional play, (9) symbolic play, and (10) speech development. From session 2 to session 10, each strategy is the focus of one session in which the parent is taught to deliver the lesson in the context of a shared activity using age appropriate play materials. In session 1, we introduce the structure of the group to the participants. In session 12, we review all strategies.  During the first 45 minutes of the session the interventionist meets with the parents and covers one of the above themes while children play with the supervision of student research assistants. During the last 45 minutes of the sessions, the parents join the children. During this second phase the parents are encouraged to implement the strategies learned during the first phase with the coaching of the interventionist.

    In comparison to the original evidence based Parent – ESDM intervention delivered by the therapist to a single parent-child dyad, some adaptions had to take place for the group delivery. While the topics of each session are the same across Parent-ESDM (single dyad delivery) and Parent-Group delivery, the format of the sessions are slightly different. In Parent-ESDM delivery, therapist, parent, and child are in the same room for the entire session and there is a continuous alternation between verbal discussion and direct practice of the specific intervention strategies. During the Parent-Group delivery, verbal discussion and direct practice are more clearly separated. During the first part of the session (first 45 minutes) therapists and parents discuss the topic while the children play in a different room. Usually, 3-5 children with ASD play with developmentally appropriate toys with the help of 3-4 students. The direct practice of the strategies, with therapist’s coaching and feedback, occurs during the second part of the session, when parents and children reunite. In general, the families who participated in our groups, expressed satisfaction. Moreover, children demonstrated improvement in social communication as measured by the Behavior Observation of Social Communication Change (Lord et al., 2013).

    Julie and her mother participated in our group Parent-ESDM intervention, as described above, and made significant progress. ASD symptoms were evaluated through the Brief Observation of Social Communication Change (BOSCC) (Grzadzinski et al., 2016). The BOSCC was developed as an outcome measure of symptoms associated with an Autism Spectrum Disorder (ASD) for young children. It is responsive to change in core ASD symptoms. Julie and her mother were administered the BOSCC at three time points, during the diagnostic evaluation, just prior to starting the intervention (almost 2 months after initial evaluation), and at the end of the intervention. Higher scores in the BOSCC are associated with higher ASD symptom severity. Julie’s scores were 38 at the time of diagnosis, 44 before starting the intervention, and 17 at the end of the intervention. Thus, Julie’s ASD symptoms worsened from diagnosis to the beginning of the intervention and improved drastically after receiving the intervention. Additionally, Julie ’s mother learned the intervention strategies. At the time of diagnosis and prior to starting the intervention, Julie’s mother worked hard to present many opportunities for Julie to interact with her and with toys, but Julie frequently did not respond to this more directive approach and rather tended to engage repetitively with toys on her own.

    Through the group intervention, Julie’s mother became more adept at following Julie’s lead and imitating Julie’s behavior with toys, vocalizations, and actions.

    This captured Julie’s attention more readily and Julie was subsequently better able to imitate her mother’s actions, vocalizations, and play. This led to an increase in Julie’s expressive language and more creative uses of toys and other objects. Perhaps most importantly, Julie and her mother appeared to enjoy their interactions more and had much more shared positive affect by the end of the intervention. In general, both mother and daughter smiled and appeared to have more energy post-intervention. Julie’s mother learned the ESDM strategies, as demonstrated by reaching fidelity in the implementation of the intervention. Moreover, in a satisfaction survey, Julie’s mother indicated that she found the program very helpful.

    Julie’s story reminds us of the importance of early identification and early intervention with the inclusion of parents

    The case study here reported suggests that parents can learn helpful intervention strategies through a low intensity parent-child group program. Moreover, the child described seemed to show a dramatic improvement in her ASD symptoms after participating in the intervention. By learning the intervention strategies, Julie’s mother was able to implement treatment throughout the day. While intensive intervention is still to be considered the gold standard for young children with ASD, it is not realistic at present to administer intensive services to all children immediately after diagnosis. Our case study demonstrated how more children can receive effective intervention in low resource communities or in families without sufficient ASD service benefits.

  • Balancing This Wonderful Work During These Trying Times

    Balancing This Wonderful Work During These Trying Times

    Sharing Our Perspective

    It is our hope to share our perspective and acknowledge the feelings and interactions that come with home visiting during this time of uncertainty regarding today’s social and moral climate in 2018.  Our hearts and our heads literally hurt for all that is happening in society now. It is a difficult task to write about real issues and difficult feelings in a meaningful way. How does one hold and make sense of all of this at one time? In the infant and early childhood field we have the wonderful opportunity to deeply experience and explore feelings.  Yet, right now some of us really don’t want to feel this level of discomfort.  Each day we read the news and there are more challenges: very young children being separated at the border from their traumatized parents, murders that are racially or politically motivated, sexism and a multitude of other injustices. I wonder how anyone holds all of this – work, family, health, political climate, etc.- and then supports the families that we serve. And how can supervisors support supervisees to the extent needed and, in turn, how can supervisors get the support they need? We offer two perspectives in reflection on many of the current happenings in 2018.

    Kristina’s perspective 

    As a home visitor over the last 18 years and specifically as an IMH therapist for the last 10 years, there are many experiences and stories from which I can choose to share.  It is my hope to share my reflections in a way that helps acknowledge the experiences of home visitors and how this work continues to be done with very young children and their families.  In today’s political and social climate so many situations that encompass tragedies, separations and racial inequalities are being played out in the media every day.  Each of us is impacted in some form or fashion whether personally or professionally and for some of us it is both personal and professional. The profound impact of daily inequalities we experience directly and indirectly as clinicians require a safe place to discuss and process our own feelings and experiences as well as the feelings and experiences of the families we serve.

    A privilege to do this work

    It is a privilege to work with each family we encounter.  Often the families we interact with have little trust for people, especially people they may view as in authority.

    The reality is that each of us has initial thoughts, biases and judgements upon our first meeting; assumptions are made by both the clinician and the family.

    The clinician may be wondering: ‘Will I be able to relate to this family?” ‘Can I help this family?’ and possibly, ‘Will this family overwhelm me?’  The client may be wondering: ‘Can this therapist help us?’ ‘Will she take my children from me?’ ‘Will she understand my hurt and pain and that I want better for my children?’ With all of these thoughts, how does a clinician unpack her own experiences and start fresh with each family? Often clinicians have the opportunity to utilize reflective supervision but what about the experiences that are too hard or too charged to talk about?  I have left home visits feeling completely dysregulated because of thoughts, feelings and experiences that have occurred during a two – hour session.

    My own cultural background

    I remember home visits when race was discussed and feelings of prejudice were vocalized by family members without the other person having any recognition of my own cultural background and with no regard as to how these thoughts and feelings might impact me. As an African American clinician with very fair skin, I recognize that some families may be unsure of my race and be surprised to learn that I am not biracial or Latino. I have coined the term, “when I announce my blackness” to describe these conversations with families in an attempt to understand their point of view.  At times I have asked myself if I feel safe and if will I be able to go back and do meaningful work with a family after these conversations have taken place.

    These questions are critical to each unique working relationship and are issues that need to be explored.

    Great support is needed not only by supervisors, but also from peers and the agencies where we work.  Without exploring these very deep issues, our relationships become compromised and we are unable to be our best and do justice to our work.

    I can also reflect on experiences when families were facing separation from their children due to child protective services involvement, incarceration of a parent, non-involvement of a parent, immigration laws or homelessness. The very idea that a family cannot be together due to challenging circumstances or past mistakes can be too much to bear at times and heartbreaking for all involved. I cannot help but think about innocent children being affected by the new immigration laws that are separating them from their parents without any warning or plan of reunification. My feelings about issues impact me deeply and affect my ability to effectively do my job. I need supportive supervision to discuss these as well.

    My own experience with immigration

    I am the wife of a legal immigrant who came to this country for a better opportunity. My husband came to the United States at the age of 19 to live the American Dream that is so proudly talked about and held in such high regard. He obtained his citizenship in 2012 which was a very happy day for him and our family. As an American citizen I felt proud to witness so many people actualizing their dreams and pursuit of happiness that day.

    I held my oldest son high off the ground, so he could see his father presented with his citizenship and shake the judge’s hand after they all took their oath to be upstanding citizens here in America.

    I remember saying to our son, “We are so proud of Daddy.  This is such a great day.”

    However, with that vivid memory of joy I also have a vivid memory of uncertainty and fear. Thirteen years ago, my husband and I were planning to travel out of the country for vacation and my husband realized his green card had expired. In that moment, sheer panic set in and we were terrified as to what this would mean not only for my husband but for me as well. We quickly went to immigration services and had our lives in the hands of someone who knew nothing about us, who we were as individuals or as a couple. I remember my husband pleading his case to have his green card extended for an additional thirty days so he could properly renew his status. In that moment, our entire lives were hanging in the balance and we were at the mercy of a stranger. I prayed silently that she would help but feared she would make a judgement or have a bias and say” sorry, I can’t help you.” She decided to help us and gave my husband an extension, but this is not always the reality for the families we serve and the countless families here in the United Sates that are undocumented immigrants who just want a better life for their children.

    As clinicians how do we hold these stories, advocate on families’ behalf and witness these realities without being impacted? It’s impossible and this is worthy to be discussed.

    Andrea’s Perspective

    We are in a unique place and time in history. While very cognizant of issues of racism, sexism and overall hatred and injustice, these last few years have been a harsh wake up call. Our nation is not new to consistent calamity. We have seen and experienced a great deal in the past 100 years, from WWII, to the Civil Rights Movement, Vietnam, the War on Poverty and new age terrorism to name a few.  I not only see a nation divided but a nation of overwhelmed, frustrated and overall hurting people. What is the answer? I even googled that question to come up with something.  I know some of you have watched the news, read your social media feeds, talked with loved ones and then also pondered that same question. In the infant and early childhood mental health field, we are the helpers. What is it that we as the helpers can offer as a salve on this gaping wound of intolerance? We the helpers must first do what we do best, start with self-reflection. We look within and become aware of our own inner workings to find common ground with our neighbor, our co-worker, and our clients.  We start within and go beyond, moving to society as a whole. Our country needs an IMH worker!

    What I have held on to in these uncertain times is not just believing but knowing that what separates is so much less than what brings us together. While I have seen racism, sexism and many other intolerances, I have also see those who demonstrate unity and healing in word, action and deed. I know individuals in this wonderful profession who advocate for those who look nothing like them. We make assumptions all the time, and privilege allows us to do so. However, if you are like me, you, too, are wondering ‘what can I really do to make a difference?’ We must be intentional about responding when issues of diversity, equity and inclusion come to our attention. It is difficult to be the person to speak up but if we don’t, who will? No one can afford to turn a blind eye to injustice and inequity.

    We cannot do this work alone

    We cannot do this work alone. We need each other: home visitors, clinicians, educators, advocates, policy makers-all are essential to this great work. We will voice the interests of infants, toddlers and families, and we will do this FOREVER!

    Both supervisors and supervisees need support and supervision.  Recognize when your cup is empty and identify for yourself who to turn to when it needs to be filled.   You can’t pour out of an empty cup.

    Together we can make a meaningful difference

    In the end you don’t have to be Latino to care about immigration, you don’t have to be African-American to care about black lives matter. You don’t have to be Native American to care about sacred grounds; You don’t have to be in poverty to care about the poor and you don’t have to be female to care about women’s rights. We are all connected and that’s what matters and together we all can make a meaningful impact!

    “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” Margaret Mead