Childhood Exposure to Domestic Violence and Health


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This presentation reviews the impact of childhood exposure to domestic violence on health.

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  • Resilience offers a useful framework to shift our thinking from a deficit view of children and youth to a strengths-based view. The theory of resilience is a lens that we can bring to our work that helps us to see how people navigate their way to what they define as healthy amidst even the most adverse conditions. In learning from how people marshal their strengths, resources and relationships in the midst of significant adversity, we can build responsive systems to help support, strengthen, and build upon these resources.
  • A positive view of the strengths of "at-risk" individuals, families, and communities does not ignore their problems or difficulties or the critical need to ameliorate or prevent the harm caused by these difficulties. The key assumptions of this strengths-based approach is that individuals, families, and communities are defined not by their difficulty, but rather by their multiple strengths, and that the amelioration of current difficulties or the prevention of future difficulties begins with the identification and marshaling of these strengths.
  • This representation takes into account that our expriences of helath and well being are socially constructed, complex and contextual. How we understand resilience is negotiated discursively and infuenced by the culture and context in which it is experienced/found. This means that all of this is local – up for definitng and contstruction locally. Broadly we will talk about Resilience nested in a social ecological model. Important point is how we coordinate together within these various relationships in ways that are meaningful and salient to us depending upon our experiences, our culture etc. Resilience is impacted by a child’s interaction and relationships with the various levels that influence their lives. Individual – positive adaptation in the context of significant adversity Relational –how we coordinate with the important relationships in our lives. For young children this is primarily our important caregivers and varies depending upon our culture etc. As we grow older the relationships we begin coordinating with start to include people outside of our families, teachers, coaches, faith community, peers. These relationships are embedded within our communities – the communities that we participate in – neighborhoods, schools, youth programs. All of this is influenced by the contextual view and impact that systems have on our lives – and might include cultural, historical influences, services, politics/policies, media. We are not only just talking about the ordinary magic of resilience but also the very gritty reality of families, communities, our programs, government, changing the opportunity structures around children to make positive adaptation more likely – locally and culturally determined.
  • Framed within a positivist paradigm, proponents of an ecological model must necessarily choose arbitrary distinctions of what are to be accepted as evidences of healthy functioning. Such arbitrariness is more the result of ethnocentricism than cross-cultural study that questions the hegemony of Western middleclass norms. A constructionist interpretation encourages openness to a plurality of different contextually relevant definitions of health, offering a critical deconstruction of the power different health discourses carry. Each localized discourse that defines a group’s concept of resilience is privileged ,more or less depending on the power of those who articulate it. This understanding of resilience, based on discursive power rather than objective measures of health, has implications for the way researchers study resilience and intervene to promote health in at-risk populations. (UNGAR) Brings up the question – who gets to define, whose voice is included in defining what a caring relationship looks like or what safety, power and respect mean? And what positive prevention and successful life outcomes looks like? All of this depends on local definitions– Keeping in mind that all of this depends on local definitions definitions of what youth use – what is meaningful= =local interpretation of what safety and meaning look like – and what positive development – local meaning of what we define as healthy Youth voice – having a say in how things are defined.
  • Share our story --- of hope, what we are doing. Committed to bulding the community capacity to support their youth
  • When we share statistics and potential negative outcomes of childhood exposure to domestic violence we often create a dominant narrative or a single story about the impact of childhood exposure to family violence.   This dominant narrative can lead to assumptions about each other, influencing the beliefs we hold, the stories that are told, and how often they are told. These assumptions can get in our way and impact our relationships with youth. They block us from developing a deeper understanding of each other, what we experience in our lives, and ways we find to get along in life.
  • HPA Axis (Hypothalamic-Pituitary-Adrenal) Glucosteroids (Cortisol) Chronic Activation
  • Administration on Children, Youth, and Families
  • What is possible within the work that you are doing Inspire with ideas of what this looks like in health sector What is the application Connecting it to actual examples of how this shows up
  • Here we can either present the case study to work from or have people think of one thing they could do to bring one of these elements into their work – beliefs, language stories Including voices Building upon or integrating protective factors Build or strengthen partnerships Changing policies or practices Break out into small groups for discussion Provide protective factor cards for each table Large group reflection – What have we learned, what is one small thing we can change/strengthen now?
  • Key characteristics of evidence-based interventions and what we understand about neuroplasticity
  • PETER: please make the following changes to the title at the top of this slide: “ Amazing Brain Series: Educational Resource for Parents” “ The Amazing Brain” is a series of booklets designed to educate parents about early brain development, the impact of trauma on early brain development, and how a child’s brain continues to change during adolescence. The booklets are written at the 5 th grade level in a user-friendly format.
  • Reassurance You will take care of them as best that you can You love them unconditionally You will help them to make a safety plan Be willing to talk about the violence Respect their feelings Acknowledge that these feelings are okay Help them to find the words to talk about their feelings Be prepared to hear things that may be painful Ask how the violence made them feel Encourage healthy coping strategies Talking with siblings, friends, safe adult Writing and journaling Drawing, music, arts Sports/exercise Counseling
  • The KISS booklets are provided in PDF format on the DVD provided with this training resource manual. Copies can also be purchased by contacting Jo Sterner at the Pennsylvania Coalition Against Domestic Violence (PCADV) at 800-537-2238
  • This is less a story of transforming others. It is more a story of transforming ourselves and developing a deeper understanding of each other.
  • Reflexive, relatoinally and culturally responsive
  • Definition that teakes into consideration a cultural and contextual view of how resiliecen is expressed by individuals families and communities relationship between risk and protective factors that is characteristically chaotic, complex, relative, and contextual RELATIONAL PROCESS of understanding how we define health, how we navigate for the resources to define ourselves as healthy, what resources are available to us those with the most power to control social discourse influence our definition of what is health and what is illness. Focus on discursive empowerment of resilience that are plagued by cultural hegemony,
  • Building comAs we say resilient versus nonresilient we further pathologize. If we view health care of social services as a resource for people to draw upon - to navigate their lives and expressions of resilience - we might focus on how we increase access and cultural relevance as a measure of how responsive a system is. Does this change our view or definition of what a responsive system is? To make it easier and more relevant for people to navigate in ways they find meaningful to their self-definition of 'healthy'.munity capacity -
  • "Resilience is not something you do alone," he says. "Social cohesion is vital to resilience. People need to feel that they're a part of something larger rather than just atoms in the universe." Economics not indicative - communities that are represented with lower income and other similar demographics but differing levels of collective efficacy had different outcomes. Collective efficacy provides critical protective factors . Carnegie Task Force on Youth Development/Community Programs A community characterized by mutually caring relationships, high expectations, positive beliefs and respect for all citizens (especially those on the margins), with abundant opportunities to participate and contribute. Working in partnership with each other to ensure young people, old people and all in between, receive the critical supports and opportunities necessary for healthy development throughout the lifespan.
  • Building community capacity -
  • As we developed prototypes to tbegin to learn about what it would take to build a responsive system here are some of the things we have learned and pthings in development. collaborative, coordinated, and accessible community response to children and youth exposed to domestic violence. The goal of the resilience framework is to strengthen and sustain the protective factors and responsive services in multiple environments within communities to nurture and support the positive life success, health, safety, and well-being of all. Here are some of our benchmarks How are activities coordined
  • Childhood Exposure to Domestic Violence and Health

    1. 1. Children and youthexposed to domestic violence A responsive system grounded in resilience Linda Chamberlain Jordan Sizelove Devorah Levine Kristin Bodiford
    2. 2. Introductions Please share one word that describes resilience to you
    3. 3. PurposeImpact of exposure to domestic violenceIntroduction to resilienceResearch on neuroplasticity and resilienceBuilding a responsive system with the lens of resilience
    4. 4. Children’s ExposureVisual - as “eyewitness”Audio - hearing the violenceTool of Perpetrator - used in eventAftermath - the impact of violence“Seeing my mom get beat is worse than being beat myself.” (Teen)
    5. 5. ImpactAdverse health outcomesSchool health and performanceGreater rates of antisocial behavior, substance abuse, suicide attempt, mental illnessLinked to other forms of community violence
    6. 6. Voices of Youth“Violence effects kids’ behavior because they think it’s ok to pick on women and those smaller than them.” (Teen)“Most of the times kids know domestic violence is wrong, but they are traumatized by seeing their mom get beat up. I hit my younger bothers and stole cars because I was so angry.” (Teen)
    7. 7. Shifting Our ViewIncrease capacityBuild partnershipsSmall tests for changeStrengths based framework No problem can be solved from the same level of consciousness that created it. We must learn to see the world anew.” Einstein
    8. 8. We get to choose
    9. 9. Strengths-based view….Does not ignore problems/difficulties or the critical need to ameliorate/prevent the harm caused.Key assumptions are: ◦ individuals, families, and communities are defined not by their difficulty, but rather by their multiple strengths, ◦ the amelioration of current difficulties or the prevention of future difficulties begins with the identification and marshaling of these strengths. Kenneth Maton
    10. 10. Resilience … positive adaptationin the context of significant adversity
    11. 11. Human Development Process >>Environmental Resilience in ActionInputs Individual InputsDEVELOPMENTAL IndividualSUPPORTS & THAT MEET OutputsOPPORTUNITIES Societal Impacts DEVELOPMENTAL(Protective Factors) NEEDS PROMOTINGCaring Relationships POSITIVE THUS LovePositive Expectations DEVELOPMENTAL PRODUCINGMeaningful Participation Belonging OUTCOMESIn Respect POSITIVE Power Social PREVENTIONFamiliesSchools &Organizations Challenge Emotional SUCCESSFULCommunities Mastery LIFEPeers Cognitive Meaning OUTCOMES Safety Moral-Spiritual BELIEF in Resilience Voice Voice Benard, 1991
    12. 12. VoiceWho gets to decide?Who has a say?Whose voice is included?Whose voice is left out?
    13. 13. Choppin’ it Up – Talking aboutrelationships and resilience
    14. 14. This is a story of one community’s Choppin’ it Up commitment to create change. DPCEngaging thestrengths oftheir youth. Emerging Leaders
    15. 15. Youth and Community DialogueWhat impact does abuse in relationships have on you?What does healthy mean to you? What does a healthy relationship look like?How do you navigate to health?What do you need to support you? Key questions from a resilience perspective
    16. 16. Listening to stories of resilienceMultiplicity of identities, voices and storiesCreative resources and strengthsSometimes powerful hidden resilience ity x mple Co( to hear stories of strength and resilience.)
    17. 17. Our own experiences with resilience
    18. 18. Beliefs >>Influence Language The beliefs we hold influence languageLanguage we useStories we tellHow often we tell themVoices that are includedVoices that are left out
    19. 19. Language and ImagesGenerate Action Language and images lead to actionPositive images of our self and othersImages of the future from action andstrengths in the presentWe get to choose which images propel usto resilience and thriving. Cooperrider, D., Sorensen, P., Whitney, D., & Yaeger, T. (2001).
    20. 20. StatisticsLet’s talk about statistics. Apparently I’m supposed to bepregnant, a drop out, disrespectful and have no morals.I’m actually in school. I have a 3.5 grade point average.I have goals and morals. I plan on going to school and majoring in pre law and criminal justice.
    21. 21. The Amazing Brain: Risk and ResiliencyNeuroplasticity=the ability of thehuman brain toadapt and change inresponse toexperience andenvironment.
    22. 22. What is Trauma?“Overwhelming demands placed on the physiological system that result in a profound felt sense of vulnerability and/or loss of control.” (Robert Macy) Bassuk, Konnath & Volk, 2006
    23. 23. TRAUMA Brain always prioritizes survival BRAIN HPA Axis Stress hormonesCascade of physical, mental,cognitive and behavioral effects
    24. 24. Sequential Development of a Child ’s BrainAbstract ThoughtProblem solvingAffiliation NEUROPLASTICITYAttachmentEmotional ReactivityMotor RegulationSleepDigestionBlood PressureHeart RateRespirationBody Temperature Peter Camburn
    25. 25. Sequential VulnerabilityPoor social skillsReading decrementSpeech problemsAttention problemsSeparation anxietyAggressivebehaviorsHypervigilanceFailure to thriveStomach problemsSleep problemsLow stresstolerance Peter CamburnWhat other effects does violence have on children?
    26. 26. Understanding Developmental Experiences  Tasks Healing And Recovery Coping Environmental Strategies BuffersAdapted from diagram on promoting social & emotional well-beingTo facilitate healing/recovery by Commissioner Bryan Samuels, ACYF
    27. 27. What Children Exposed to DV Need RESILIENCY NEUROPLASTICITY Feel physically and emotionally safe Survival first! Strong bond to non- Social connections build battering parent brain connectionsExpress feelings & frustrations Skill-building for impulse in non-destructive ways control & self-soothing Have their strengths Promote self-esteem and praised and called upon competency to explore & experience the world Bancroft, 2004
    28. 28. What We Can Do•Developmentally appropriateexperiences to heal the brain•Babies learn best through socialinteractions •Increase child-adult time •Reduce exposure to media violence and “media parenting”•Active, experiential learning,enrichment programs •Head Start •Home visitation Magic Trees of the Mind” by Dr. Marian Diamond
    29. 29. Shelter, INC Foster YouthNurtured Heart Parent Support Health Collaborative Approach SEL in Schools Choppin’ it Up Head Start WIC Teen Dating Abuse
    30. 30. Discussion
    31. 31.
    32. 32. NEUROPLASTICITY AND THEIMPACT OF VIOLENCE ON CHILDREN: RISK AND RESILIENCY Linda Chamberlain PhD MPHAlaska Family Violence Prevention Project
    33. 33. Best Practices to Promote Resiliency and NeuroplasticityHealing relationships ◦ Work with nonbattering parent & childrenSocial emotional learning & skills ◦ EmpathySocial supportTrauma-informed parenting skills
    34. 34. Resource
    35. 35. Resource: Strategies to Strengthen Non-battering Parent-Child Bond Reassurance Be willing to talk about the violence Ask how the violence made them feel Encourage healthy coping strategiesBaker L, Cunningham A. Helping Children Thrive: Supporting WomenAbuse Survivors as Mothers. 2004.
    36. 36. Resource: A Kid is So Special (KISS) Series of booklets developed by the Pennsylvania Coalition Against Domestic Violence These interactive booklets are designed to strengthen mother-child bonds ◦“Growing Together” discusses child development ◦ “Playing Together” includes information on what a parent can do when there is hurting at home Pennsylvania Coalition Against Domestic Violence (PCADV) at 800-537-2238
    37. 37. Best Practices: Child-Parent Psychotherapy (CPP) Tailored to age & development stage of child Considers child in context of parental relationship - supporting mother as primary intervention Flexible intervention model includes: Crisis stabilization and advocacy Facilitatechild’s expression through play, verbalization, acting out fears, and anger Help mother to understand child’s behaviors and find protective ways to respond Modeling appropriate protective behaviors; Lieberman et al, 1997; 2006
    38. 38. Child Parent PsychotherapyAt end of one-year treatment period (RCTLieberman et al,2005):◦ Children had fewer behavioral problems, decreased trauma symptoms, and less likely to be diagnosed with PTSD◦ Mothers have fewer postttraumatic stress avoidance symptoms◦ Six months after intervention ended, children had fewer behavior problems and mothers had fewer psychiatric symptoms (RCT, Lieberman et al, 2006)
    39. 39. IQ and Exposure to DVDose response relationship between level of severity of children’s cumulative exposure to DV and IQ scores (Koenen et al, 2003)Trauma-specific treatment (CPP) improves IQ {performance, verbal, and full scale} scores (Lieberman et al, 2005)
    40. 40. TransformationThis is not about changing youth. It isabout unearthing what already exists,transforming narratives about youth tohighlight their strengths, their hopes, andtheir dreams. (Whitney & Trosten-Bloom, 2010)
    41. 41. Beliefs >>Support Resilience Resilience begins with beliefsResiliencebegins with a change inconsciousness,beginning with an act of belief,often in the face of accumulated evidenceto the contrary. Gervase Bushe 2002 (Adapted)
    42. 42. Resilience >> RelationalWe coordinate with the resources and peoplearound us,•generating alternative ways,•for “going on together” or living our lives,•to survive and thrive in the face of challenge. Resilience is our ability to ‘go on together’.
    43. 43. Resilience >> CommunityWe develop capacity to support each otherthrough building relationships of: • trust, • reciprocity, and • caring. Resilience grows from our ability to support each other in community.
    44. 44. Resilience >> SystemsNegotiations between individuals and theirenvironments:for the resourcesto define themselves as healthyamidst conditions collectively viewed as adverse.Systems that are responsive, build resilience. Resilience is contextual, supported by responsive systems. Michael Ungar
    45. 45. Resilience>>Responsive Systems
    46. 46. Community and SystemsDisintegrationBreakdown of community Threat to those life most vulnerable:Loss of social capital •children •youthLoss of linkages that •young families create sense of identity •elders and belongingIncreased disconnectionThe forces of community disintegration have gained steadily and will prevailunless we nurture community and reweave the social fabric. John Gardner
    47. 47. Resilience >> Building Community Quality of caring for each other Strong neighborhood, organizational and community networks Positive social dynamics in community High collective efficacy High levels of trust and reciprocityThe social fabric is at the core for resilience along the lifespan.While research shows us the absence of strong positive community contexts can bedevastating, the presence of strong positive community contexts can be transformational.
    48. 48. Resilience>>CollaborationEffective community and multisystemcollaboration depends on:
    49. 49. Responsive Systems>> PrototypingCaring – Reflexive and responsive to individuals, families and communitiesCapacity & Competency – Increasing our knowledge and skills. Changing policies and practices.Communication & Connection – Regular and ongoing communication. Creating shared language. Developing relationships.Coordination & Collaboration – Developing partnerships.
    50. 50. Environmental FactorsChange environmental policies and practicesAddress issues of social injusticeReflect on beliefs, voice and language we use, stories we tell in systems.Shift relational norms