Month: May 2023

  • Small Steps to Big Changes 

    Small Steps to Big Changes 

    Some years ago, I worked in a school district that had a graduation rate of just above 50%. The district was experiencing a significant financial crisis and was embarking on consolidating with a neighboring school district. The tension among staff members was palpable, as a consolidation meant some positions would be lost, leaving some staff without a job in the upcoming school year. As I walked down the hallway leading to my classroom, I passed three Head Start classrooms with students sitting on the ground, legs criss-cross applesauce, with their backs against the wall, waiting to be greeted by their teachers. I reflected on the 50% graduation rate projected for these children, and I wondered which of these four-year-olds would be failed by this struggling school district and where they might find their safety nets. 

    I firmly believe caregivers and parents are their child’s first and most influential teachers, their developmental anchors, and their safety nets when other parts of their ecosystem lack the stability and support to propel them forward.

    In my role as an Early Childhood Specialist (ECS) with the Washtenaw County Early Head Start Program, I work to grow parents’ understanding of the impact they have on their child’s development and to support how they can capitalize on their highly influential relationship. Early Head Start (EHS), is the home-based option for Head Start, the nationally recognized school readiness program that serves families experiencing poverty and other factors that challenge family well-being and positive child outcomes. EHS providers connect with families during a very precarious time, prenatal to age three, before children leave home to begin their educational journey and when 85% of brain development is occurring across all developmental domains. They are developing their identity along with a sense of self-confidence and self-competence, determined in large part by how their caregivers interact with them, and by what is communicated through their environment. This story is about a mom whose interaction style with her children communicated hostility and unpredictability. Our work together took a deep dive into cultivating a secure attachment and parenting through a development-centered lens. This is one mom’s journey toward self-actualization and positive parenting. The names of this mom and her children have been changed to maintain their confidentiality and she has permitted the use of her words in this case study. 

    Monica is a 32-year-old, single mom with three children. Her children are 9, 5, and 3 respectively. She shares custody of her children with their fathers but is no longer in a relationship with any of them. I once asked Monica for the birthday of her 5-year-old and she responded, “Lol, I don’t remember. She don’t stay with me.” I was curious about how connected she felt to her children and how connected they felt toward her. Monica often interacted with them using a loud tone of voice and facial expressions created by furrowed brows, angry eyes, and pursed lips. Her words were often directive, telling the children what to do and where to go to retrieve something she needed. Following her requests with please or thank you was not a part of her communication style. The only child enrolled in the EHS program was her three-year-old son, Patrick. When Monica and I first met, I asked her what her hopes and dreams for Patrick were, and she replied “Not this! To have it be better than this.” Curious to know more, I asked, “What do you mean when you say, ‘This’? “I don’t know, there’s too many things to say all of it.” It was clear Monica wanted her children to have a different life experience in the future than what they were experiencing at that moment. 

    Two practices that I use personally and coach parents to use are self-reflection and self-awareness. In an effort to learn more about what might be influencing Monica’s parenting choices, I tried to support her by reflecting on her childhood. She offered a modest glimpse of her experiences. A recurring theme I noted was Monica feeling unsupported and left to fend for herself. “I’ve been on my own since I was 14. My momma, my sisters, none of them looked out for me.” I could not use the term ‘friendship’ when referring to people in Monica’s life because she would retort, “I ain’t got no friends,” and she would regularly ‘cancel’ relationships. ‘Cancel relationships’ refers to cutting people off after having a disagreement or argument with them. This happened regularly with her relationships. Evidently, her early relational experiences with her mother and siblings had cultivated a felt sense of distrust and a lack of safety, resulting in an internal working model that viewed the world as an unsafe place where she needed to protect herself because in her mind there was no one to protect her. This belief was continually affirmed by the relationships she had with the fathers of her children and other social interactions with her peers. I wondered how Monica interacted and contributed to these relationships. Was she unpredictable, volatile, and did she feel any sense of control? In my experience, her affect could be flat and dismissive to the extent to which I wondered if she was upset with me. I told Monica that if I said or did anything that upset her that she should be sure to let me know and to not cancel me. She smiled but made no promises. 

    Since reflecting on her childhood and how she was parented was not an emotionally safe space for Monica, I shifted our conversations to discussing how important she was to her children’s well-being. I shared an activity with her called “Wind Beneath My Wings.” It comes from the Zero toThrive, Strong Roots, Mom Power Program. The activity consists of watching a video of mothers interacting with their babies in loving and nurturing ways, smiling, and demonstrating affection. The video is accompanied by the Bette Midler classic, “Wind Beneath My Wings.” During the first viewing, she asked, “Why are we watching this?” I asked her if watching it made her uncomfortable. She said, “I don’t care.” I asked her who she thought was singing to whom in the video. She said, “The mom’s singing to the child.” I asked her to watch it again and think about Patrick singing it to her. She rolled her eyes and with a puzzled look on her face, she asked, “We gone watch it again?” After the second viewing, she told Patrick to come here. He had wedged himself between the couch where she was sitting and an adjacent chair. He didn’t move. Monica repeated, “Come here!” in a more assertive tone. He stood up and walked over to her. She pulled him into an embrace and kissed his forehead. He responded by returning her hug and resting his head on her chest. This was one of similar moments where when prompted or encouraged, Monica demonstrated nurturing interactions with Patrick. She demonstrated the capacity to shift her parenting behaviors when supported with a frame of reference for parenting that differed from her lived experience. 

    Children need to have a felt sense of safety. On a micro level, it supports their emotional balance. When I feel safe my stress hormones remain at normal levels, so flight, fight, and freeze responses are not activated. Therefore, I am better able to regulate and manage my emotions. On a macro level, when I am feeling unsafe, my stress hormones are triggered, and when repeatedly activated can impact brain architecture, and how I view the world and my place in it. This is particularly poignant for children of color because there are many spaces in their world where they will not experience a felt sense of safety. This state of being can activate stress hormones and trigger defensive behaviors that are likely to be interpreted as challenging. Therefore, it is especially important for their caregivers to be their ‘Secure Base,’ a strong foundation that supports their exploration out into the world and serves as a consistent, reliable, and trusted support. Also, children of color need their caregivers to be their ‘Safe Haven,’ a sanctuary when their experiences in the world destabilize their concept of self, their sense of safety, and their understanding that “Justice for All” may not always include them. 

    Over several months we worked at being self-aware of tone of voice, saying please and thank you and ceasing the use of derogatory language such as stupid when referring to the children. I would praise Monica when she caught herself and interrupted her behaviors, and though she sometimes laughed at me when I imitated her and I used different words and a softer tone, I think she enjoyed interacting with her children in more positive ways. Nonetheless, there were moments when it seemed like we had not made any gains at all. During one of our visits, Monica had become very agitated because she had misplaced some paperwork and without warning she began yelling at her children while standing in the middle of the living room. “Leave my @#$% alone, that’s why I can never find nothing.” I was startled by the sudden change in her demeanor and her tone of voice. I told her that she had startled me even though I was an adult and she was not addressing me and I wondered how the children might be feeling being the target of her comments. It was clear that they were anxious as they opened drawers and looked around the room, attempting to find the papers that she was looking for. Monica became increasingly upset and lunged at her eldest son. He slumped down against the wall with his hands raised above his head. I positioned myself in between Monica and her son and asked her to look at me. She walked away, back into the living room and sat down on the couch. I put my hand on Monica’s forearm and met her gaze. “What is going on with you? Why do you treat him like that? “Because he act like a damn kid.” I said, “Monica, he is a kid. He’s only 9 years old. When you treat him like that it’s scary and doesn’t make him feel safe here.

    Outside your door is a world that will not always be kind to your sons and daughter. Here, you can create a home where they feel safe and where they feel loved because of how you choose to talk to them and how you choose to treat them.

    She responded, “I had it worse than that.” I imagined the fear and helplessness Monica must have experienced and the parallel in her son’s posture with his hands raised to protect and defend himself. I validated Monica’s feelings but I also needed her to connect those feelings with her children in the present. So I asked her if she remembered what it felt like for her and if she could then imagine how her eldest son in particular but also how all of her children might feel when she behaves in the way that she just did. I reminded Monica of how important she was to her children and that she could be the difference for them. I was sorry that there was no one for Monica when she was a little girl but her children had someone. They had her, if she chose to be a secure base and a safe haven for them.

    I wondered if fending for herself as a child meant she took on adult responsibilities and because of her experiences she now held expectations of her children that were not developmentally appropriate. Perhaps she was expecting her children to behave more like adults because she lacked knowledge of child development and a frame of reference for typical child-like behaviors for those age ranges. I recall observing her playing with puzzles with Patrick and telling him, “Do it right!” I don’t think she understood that developmentally and experientially, he didn’t know how to “do it right.” 

    As our visits continued, there were times when I needed to help Monica with being self-aware of her tone of voice, her word choice, facial expression, impatience, indifference, and her level of interaction with her children, but over time, I observed Monica saying please and thank you to her children, using pet names when addressing them, softening the tone of her voice, and interacting with them more gently. At the close of one such visit, the children and I gave Monica a hand clap to acknowledge her involvement and the wonderful time that we had. Monica smiled and said, “Thank you.” 

    I think Monica’s involvement in the Early Head Start Program has given her new information about parenting, a model of a different parenting style, and the opportunity for in vivo practice with the support of an Early Childhood Specialist to coach her and to cheer her on. Go, Monica, go!

  • Supporting and Connecting Those Who Care for Children to Early Intervention Services

    Supporting and Connecting Those Who Care for Children to Early Intervention Services

    Written with collaboration from her team!

    Young children grow and develop at different rates but generally will reach specific developmental milestones (social-emotional, language/communication, cognitive, movement/physical, and self-help) approximately around the same time. When a family or professional has a concern about a child’s development, resources are available to support a child and their family in reaching their full potential. Early On is Michigan’s system for helping infants and toddlers, birth to age 3 and their families, who have developmental delays and/or disabilities or are at risk for delays due to certain health conditions, including infant mental health disorders.  It is designed to help families find the social, health, and educational services that will promote the development of their infants and toddlers with special needs.  

    Mandated by federal legislation, this statewide system called Early On is otherwise referred to as Part C of the Individuals with Disabilities Education Act, (IDEA).  When talking about IDEA Part C and Early On services, you often hear the term “Early Intervention.” The purpose of early intervention is to enable young children to be active and successful participants during the early childhood years and in the future in a variety of settings — in their homes, with their families, in childcare, in preschool, and in the community.  Services are strength-based, family-centered, focused on parent and professional partnerships, provided in a natural environment and based on interagency collaboration.  Interagency collaboration between education and public health, for example, creates a sense of community ownership for supporting children and families and addressing their needs and strengths.  It also reduces duplication of services and allows for greater efficiency in the use of public resources.  

    Services are provided in a natural environment, which can be defined as any place a child and family lives, learns and plays.  This includes settings and activities that are normal for a child’s same-age peers in his/her community who have no disabilities or developmental delays.  

    Young children tend to thrive when they are in familiar surroundings with people and objects that are dear to them and when services are provided during everyday routines.

    An Early On provider supports this intervention through coaching parents/caregivers and early childcare providers.   

    In Michigan, Early On services are free to eligible children and their families. There are multiple ways an infant or toddler may become eligible for Early On, including the presence of a developmental delay or an established condition.  This also includes infant mental health conditions. Infants birth to 2 months qualify for Early On with any delay in development. Children 2 months to age 36 months are eligible with a delay of 20 percent or greater in one or more of the following areas of development: cognitive; physical, including gross and fine motor; communication; social/emotional; and self-care skills.  

    Another way to become eligible for Early On is to have an “established condition,” which is a diagnosed physical or mental condition that has a high probability of resulting in developmental delay.  Infants and toddlers with a diagnosed condition likely to result in a delay qualify for Early On under the category of Established Condition. View a list of conditions that indicate automatic eligibility for Early On supports and services here.  

    Established conditions must be diagnosed by a health care or mental health provider and documented in a medical record.  Mental health providers can diagnose infant mental health conditions that make a child eligible for early intervention.  These mental health conditions consist of the following:  adjustment disorders, depression of infancy and early childhood, diagnosed regulatory disorders, disorders of affect, maltreatment/deprivation disorder, mixed disorders of emotional expressiveness, and post-traumatic stress disorder (PTSD).  

    Some infants and toddlers in Early On with greater developmental delays may also qualify for services through Michigan Mandatory Special Education (MMSE). Eligibility for MMSE services is determined by the Michigan Administrative Rules for Special Education or MARSE. 

    A referral must be made to begin the eligibility process for children to receive Early On services.   Anyone can support a family in making the referral or by offering to make the referral with the family.  You do not need a referral from a physician to start the process.  Either way, the family should be aware and agree to the referral to ensure continued trust and relationship building.

    A referral should be made 

    • When a child isn’t reaching milestones
    • If an established condition exists or
    • When a parent expresses concern 

    Referrals can be made at www.1800earlyon.org or by calling 1-800-EARLYON. You can also contact the Early On coordinator at your county-level intermediate school district, https://eotta.ccresa.org/Contacts.php?id=1. You may want to familiarize yourself with the Early On referral form before talking to families. You can find the form at https://1800earlyon.org/online_referral.php. Families should hear from their local Early On program within 10 calendar days of receipt of referral. 

    Infant mental health clinicians and providers are in a unique position to notice if a child is not developing through typical stages or milestones.  If you have a concern about a child’s development, you have a responsibility to discuss your concerns with the family right away.  Getting intervention early can make a tremendous difference in the child’s quality of life and learning.  

    More than ever, professionals and parents of children with disabilities are being asked to work in partnership. 

    Professionals working with infants and toddlers must be courageous enough to have these sensitive conversations with families and learn to be effective in creating opportunities for children to thrive.  

    A key component to providing effective family-centered early intervention services is being culturally responsive and aware.  Sometimes, these conversations are difficult to initiate with parents. Janice Fialka, LMSW, ACSW is a nationally recognized lecturer, author, and advocate on issues related to parent-professional partnerships, and has put together a website, Dance of Partnership, to assist professionals and parents of children with disabilities in developing strong partnerships. In addition to the resources found on her website, here are several tips on how to talk to parents about their child’s development with cultural considerations at the forefront of your work:  

    Prepare yourself before talking to the parents.  If they speak another language, make sure to find a way to communicate through the language barriers before your first visit.  Here are a few suggestions:  1)  Collaborate with a trusted interpreter if needed. 2)  Consider hiring bilingual staff from some of the highest represented countries in your community.  3) Work with cultural brokers.  4)  Partner with community organizations/ networks to learn about specific cultures.  5)  Find ambassadors to help manage messaging and a culturally responsive approach to families (i.e.  The Immigrant & Refugee Resource Collaborative of Greater Lansing helps identify needs and optimizes opportunities for families new to the country, as well as those who have been here for generations). 

    Be mindful to keep the family as decision makers at the head of your conversation while being respectful of the culture, beliefs, customs and values of the family.  Recognize there are diverse family structures.  Strive to communicate in ways that inclusively support participation of family members.  

    Choose a time and place where you can talk alone with the parents or caregiver(s). Ask the family about their typical day and week and plan a good time to talk around their activities.  

    Strive to be culturally responsive and aware of the family’s personal cultures and values and to understand how these might impact intervention.  Be careful not to attribute behaviors to disability when they are considered developmentally appropriate within the culture of the family.  

    Give the “big picture” and focus on the child’s strengths and the milestones that they are meeting, not just on the deficits and developmental delays.  

    Put yourself in the parents’ shoes.  Realize that it is not easy to hear that your child may be falling behind.  

    Be sure to ask the parents for their perspective on the issue as well and reassure them that it takes time to feel confident and comfortable with the information being discussed.  Remind them you are there to assist them, and fully engage families in developing strategies. 

    Be prepared for a range of feelings from parents, yourself and others as raising children is complicated and feelings can be strong and unexpected, even from you as the professional.  

    Be open-minded and give them plenty of time to respond to your concerns.  

    Acknowledge that learning to handle strong emotions in yourself and others is an important skill.  

    Seek colleagues who will listen and provide the support that you need.  

    Be aware of your body language and that of the parents.  Ask yourself, “Am I communicating openness?”  Be mindful when people appear agitated or “louder.”  This can be a sign that they do not feel heard or understood.  Listen and ask more open-ended questions if this occurs.  

    Pay attention to the types of verbal and gestural cues that you use.  What is considered respectful differs across cultures.  

    Refrain from using jargon and ensure that the parents understand the terms you are using while consciously working to engage in cultural reciprocity.  The goal is that you can provide support that is in harmony with the beliefs and values of each family.  

    Don’t reassure parents too quickly that “everything is going to be fine,” as this can feel dismissive and shows a lack of understanding.  Remember that you do not have the power to fix the situation or take away the pain. 

    Lastly, pay special attention to and include the parent and family’s wishes for the child and remember to develop solutions and options with the family as a team. 

    The goal of early intervention and early childhood special education is to help parents and caregivers support their child’s learning and development using strategies that occur naturally during the child and family’s day.  Early childhood educators, including Infant Mental Health professionals, play a key role in ensuring that every child and family is aware of and has access to the resources, supports, and services that they need. “Don’t worry.  But don’t wait.”  You can be a key person in connecting families with a free screening or evaluation to see if a child is eligible for services through Early On.  To make a referral in collaboration with the family, complete an online form at 1800EARLYOn.org or call 1-800-EARLY ON (327-5966) today.