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Posts from the ‘Prevention’ Category

Child-Parent Psychotherapy: What it is and why it’s essential for Alaska’s children

By Chris Gunderson, LPC-S, NCC, President/CEO, Denali Family Services

In response to a growing need for early childhood mental health services in Alaska, a multi-agency partnership, including the Alaska Children’s Trust and Denali Family Services, is working to disseminate Child-Parent Psychotherapy (CPP) training across Alaska with the goal of training clinicians from around the state in this nationally recognized, evidence-based practice. In this post, I will discuss the need for this training and the reasons why CPP is an essential addition to Alaska’s continuum of care.

In calendar year 2019, the Alaska Office of Children’s services received more than 23,000 protective services reports, nearly half of which were screened-in for further investigation. Federal statistics indicate that younger children, ages 0 to 3, experience rates of maltreatment two to three times that of adolescents. In Alaska, nearly half of all child abuse victims experience their first incident of abuse before the age of 5. Taken together, these numbers tell us that very young children in Alaska are at elevated risk for abuse and neglect. What these numbers do not express is the profound, and disproportionate, impact that maltreatment early in life will have on a child’s development.

All child maltreatment is tragic; however, maltreatment in early childhood has a particularly profound effect on the course of a child’s development. The earliest years in a child’s life are characterized by sensitive and critical periods of development.

· Sensitive periods are times in which essential abilities—including emotional regulation and language usage—are rapidly developing and the child is especially predisposed to learning specific use-dependent skills.

· Critical periods are times in which aspects of physical and cognitive development are especially susceptible to damage.

In other words, young children are optimized to learn and develop from positive, nurturing experiences at specific times in their early life; however, this flexibility also makes them extremely vulnerable to negative, harmful experiences. If young children are not exposed to the interactions necessary for healthy development, or if this development is interrupted by traumatic experiences, they will have an increasingly difficult time learning and mastering these skills as they age.

Another unique aspect of child maltreatment in early childhood is that it typically occurs in the context of the caregiving relationship, which is often referred to as relational trauma. Relational trauma in early childhood is unique from other types of trauma, in that the child loses her sense of safety in the most critical relationships of her early life, those with her primary caregivers. If the child learns that the world around her is not safe, and that those closest to her cannot keep her safe, she is left with the belief that there is no safe place and there are no safe people. This can have a significant impact on a child’s ability to learn, engage with the world, form relationships, and build a healthy self-identity.

Ultimately, young children need safe and nurturing adults to protect them during the critical and sensitive periods of their young lives, helping them achieve the cognitive, social, emotional, and physical development necessary for future growth and maturation. Sometimes caring adults lack the skills, knowledge, or emotional resources to keep their children safe or to help them recover from traumatic events. The purpose of Child-Parent Psychotherapy (CPP) is to help caregivers overcome these obstacles so they can form or repair the caregiving relationship their child needs to thrive.

CPP is an intervention model designed primarily for children aged 0-5 who have experienced at least one traumatic event and are experiencing attachment or behavioral problems as a result. The treatment is based in attachment theory but also integrates a range of clinical and developmental theories appropriate to the unique needs of young children.

CPP is among a growing number of approaches that include the child and parent or primary caregiver in the therapeutic sessions. The primary goal of CPP is to support and strengthen the relationship between a child and her caregiver and to use that relationship to rebuild a child’s sense of safety, which will allow the child to move back toward healthy growth and development.

In September, the first cohort of CPP clinical trainees in Alaska completed an 18-month program of training, supervision, and case consultation that will lead to national recognition as a CPP clinician. Having completed the didactic portion of the training, trainees will receive another three months of supportive consultation to help them implement CPP in their practice. The cohort includes 26 clinicians from 11 communities across Alaska, stretching from Sitka to Kotzebue. The clinicians work in a variety of settings, including community mental health, private practice, primary care, tribal health, and emergency shelter services.

Our hope is that these clinicians will build the foundation for a robust early childhood workforce that can intervene earlier in the lives of young Alaskans exposed to abuse and neglect. Their efforts will lead to better early intervention across our state, which will save time, money, and lives further down the road.

Learn more about CPP and its availability in Alaska on the Denali Family Services website.

Alaska Children’s Trust was pleased to support the CPP training project with a 2019 – 2020 community-based child abuse and neglect prevention grant. Learn more about our grants, grant recipients and application process on our website.

Chris Gunderson, LPC-S, NCC, is President/CEO, Denali Family Services

Prevention in a Time of COVID-19: Building Resilience

In this time of COVID-19, with school closures and families isolating from others, building awareness of child abuse and neglect is more important than ever. This is an incredibly challenging time for all of us, underscoring the need and opportunity to build resilience in our children and in ourselves. We at Alaska Children’s Trust are here, dedicated to supporting Alaska’s children and families. Along with our partners, we are working to provide the resources, knowledge, skills and support Alaska’s families need to thrive, despite the circumstances.

April 1 marked the first day of National Child Abuse Prevention Month. And just as we are all pulling together to prevent the spread of COVID-19, we each must play a role in raising widespread awareness of child abuse and neglect, and what we can do to build resilience and make a positive difference in the lives of children and families around us.

For far too long, Alaska has had one of the highest rates, per capita, of child abuse and neglect. But there are many, many committed individuals and organizations working to change that – and we will succeed. Check out this inspiring map to see the partners across Alaska who are participating with us in Child Abuse Awareness Month.

The first step in any real change is awareness, and Child Abuse Awareness Month is our opportunity to be part of a coordinated, nationwide movement to do just that. Here’s how you can get involved:

  • Spread the word about #Resilient19. We know the COVID-19 outbreak has created an incredible amount of uncertainty in the lives of Alaska’s families. Our hope through #Resilient19 is to share a variety of ways children, families and communities can build the resilience to overcome these challenging times. Learn more about our efforts on our website, follow us on Facebook for the latest #Resilient19 posts, and be sure to share (or post your own!).
  • Download and post our prevention month poster in your home, school, workplace or online to raise additional awareness. It’s available both as a jpeg and as a PDF.
  • Get involved in our virtual statewide Go Blue Day Rally on Friday, April 3! No matter where you live, please join us. Wear blue, make a sign, take a photo and post it using the hashtags #GoBlue4Kids #DareToBeTheOne. Make sure your post is public so Alaska Children’s Trust can share it too! It’s one small, positive and proactive way to show you care.
  • Explore our parent resources. We have compiled resources that can help with building relationships with your child, organizations that can help keep a child safe, and information we trust to support children’s healthy development.
  • Discover ways to make a difference with these tips for families, friends and neighbors, and the community as a whole.

While the important work of preventing child abuse and neglect and building resilience is ongoing, this dedicated month allows us to shine a spotlight on the issue, and educate and inspire others to join with us in our efforts.

We invite you to join us in raising the volume on this issue throughout April – and beyond. Alaska Children’s Trust is actively addressing this complex issue in a variety of ways, and we need and ask for your involvement as we work together for healthier children and families across Alaska. Together we can prevent child abuse and neglect.

Superhero Dreams to Statewide Network: My Story of the Alaska Resilience Initiative

By Laura Norton-Cruz, Alaska Resilience Initiative Program Director

Beginnings

When I was eight years old, I determined that I was going to work to end child abuse. At the time, I imagined myself more in a cape getting rid of bad guys than in business attire facilitating a statewide network, but in some form or another, that’s where my particular journey to the Alaska Resilience Initiative began.

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Me, age 7. As it turns out, working for the safety and well-being of children ends up being less the job of a superhero and more the job of a collaborative host and facilitator.

A few decades later, working for the Alaska Native Tribal Health Consortium on child trauma and violence-related issues, I found that I was involved with and aware of a number of tribal health organizations and nonprofits who were doing great work on adverse childhood experiences (ACEs), intergenerational and systemic trauma, resilience – but I wasn’t sure if they were all aware of and working with each other. A need that I and others in the field kept noting was for some entity who could coordinate between all of the organizations doing work to address ACEs, reduce trauma, and support healing and resilience. I kept thinking, “We would be so much more powerful if we knew what others were doing, if we could spend less time re-inventing the wheel and more time learning from each other, if we had some statewide messaging and systems change work to amplify our efforts. Which organization could take that on? Which individual coordinator could facilitate that?”

Trevor Storrs, the executive director of Alaska Children’s Trust (ACT), was asking those same questions with the small group of advisors he had assembled informally and named the “Alaska Resilience Initiative.” This group took on a few initial projects towards this goal, from training ACEs and resilience trainers to surveying and mapping who was doing trauma-informed work. In 2015, this group, led by ACT, Rasmuson Foundation, Mat-Su Health Foundation, Alaska Mental Health Trust Authority, and First Alaskans Institute, and in partnership with the Mobilizing for Action through Planning and Partnerships (MAPP) coalition in Homer, applied for and received a grant from the Health Federation of Philadelphia to be able to take on this statewide coordinating and movement-building role. When I heard that a program director would be hired for this work, it sounded like a dream come true – a childhood dream, at that! (Albeit a mature, updated version.) Despite being reticent to leave the tribal health system and the work I loved, I was thrilled when I was hired to join Alaska Children’s Trust and direct this initiative, beginning February 2016.

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Building an Equitable Movement

As one of 14 Health Federation of Philadelphia-funded Mobilizing Action for Resilient Communities (MARC) grantees throughout the country focused on movement-building around trauma and resilience, we (the Alaska Resilience Initiative and our partner coalitions in the Southern Kenai Peninsula and Matanuska-Susitna Valley) have had the spotlight on us to pilot network building and trauma-informed change. While the regional coalitions had already formed over the past few years, the statewide Alaska Resilience Initiative (ARI)’s relatively nascent status meant a considerable amount of work to expand and diversify the network, to form the planning and decision-making bodies needed to move the work forward, and – in order to make sure we were doing the work in a way that was equitable, effective and non-traumatizing – to listen. Especially to listen to Alaska Native people.

Alaska Native people comprise nearly one-fifth of the state’s population, and Alaska Native children represent over half of the children in the foster care system, and yet historically their voices have not been well-included in decision-making about social services, education and behavioral health. That’s why one of the very first things I did on the job was to team up with First Alaskans Institute and the Chickaloon Village Traditional Council to host a gathering, held in May 2016, that put Native perspectives, customs, history and hopes at the center.

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A May 2016 gathering of Alaska Native and Native American people working on trauma and resilience issues around the state led to a number of principles for guiding trauma and resilience work. These included the importance of addressing collective forms of trauma, holding up ancestral knowledge about resilience, and partnering meaningfully with Native communities for solutions.

That gathering of about 30 people set a tone for the whole state that the voices and decision-making of Alaska Native people matter in this process. The goal was to seek input that could guide the Alaska Resilience Initiative, shape the curriculum for ACE/resilience trainers and frame a more inclusive and equitable approach to the work.

This initial gathering helped shape an inclusive approach to all the work that followed, from the large June 2016 gathering of organizations, tribes, schools and state departments from across Alaska to the building of ARI’s structure and processes, and the crafting of the “common agenda,” or shared goal of all ARI members, which is:image 1.5_ACT blog ARINow, in June of 2017, ARI receives its guidance from three active workgroups as well as a 23-member steering committee. The steering committee features a wide range of perspectives and connections, with representatives from social services, health care, behavioral health, community development, K-12 education, universities, early childhood education, philanthropy, government, law enforcement, business, faith-based and tribal organizations.

We also strive for equity by creating group norms that allow for all people to be heard, and by being intentional about diverse representation. The steering committee is still predominately white (69 percent), but both co-chairs are Alaska Native women, representing different regions, and members represent other ethnic and racial groups as well. This isn’t perfect, but it’s more diverse than many boards and leadership councils in Alaska.

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Lisa Wade, a co-chair of the steering committee, is Ahtna Athabascan and is a Nay’dini’aa Na’ / Chickaloon Village Traditional Council member, tribal court judge, and the Director of Education, Health, and Social Services for the tribe. Chickaloon is exemplary in its implementation of trauma-informed practices throughout the school, tribe and clinic. (The other ARI steering committee co-chair is Liz Medicine Crow, Tlingit and Haida from Ḵéex̱/Kake, Alaska, who is CEO of First Alaskans Institute.)

Lisa Wade, one of the steering committee’s two co-chairs, commented that the opportunity to lead and shape efforts of a statewide resilience effort is not simply having a seat at the table, but an open and inclusive process that creates equity:

“As a Tribal representative, one of the really positive things about participating on the Alaska Resilience Initiative has been the opportunity to develop deeper and more meaningful relationships with coalition partners early on in the process. Our cultural perspective and values have been welcomed into the planning and decision-making process. For instance, our coalition adopted a consensus model of decision-making so that each voice at the table has equal importance. This alone has built equity and justice into our work and begun the creation of a model of compassion-informed community work. This is an exciting time where our collective Alaska Native voices are recognized as valuable and integral to identifying the unique challenges facing our communities and for developing culturally significant strategies that make sense for our children, our families, our communities, and our state.”

As the ARI program director, I recognize frequently that although collaborative, participatory work and the building of a collective structure takes a considerable investment of time, an individualistic, superhero approach or leadership from only one sector, organization or demographic of leaders would not allow us to be effective. Likewise, we have a long ways to go yet in order to really meaningfully include rural voices and all regions and demographics in the state, and to grow our network into a self-sustaining movement. This is one of the ongoing tasks before us that we are eager to embrace.

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I sketched out the above illustration to demonstrate the Alaska Resilience Initiative (ARI) network’s structure. The internal part is the backbone agency, Alaska Children’s Trust (with — part-time backbone staff signified by partial bodies and full-time staff by a full body) surrounded by ARI’s Steering Committee and supported by three workgroups: Communication, Policy, and Trauma-Informed Systems. Crowns symbolize leadership or organizer/facilitator roles. Overlapping with the ARI Network, we also have the regional trauma and resilience coalitions whose work intersects with our own. The little circles represent people — those currently within the network and those not yet involved. The wider ARI’s network and the more engaged its many members, the more we can accomplish.

What’s Happening Now

Over the last few months, in addition to building the initiative’s structure and decision-making processes, the Alaska Resilience Initiative has been working towards revising the ACE training curriculum; giving presentations across Alaska; supporting trauma-informed schools work in the Anchorage School District; developing relationships with policymakers; and pursuing immediate policy objectives such as a sustainable fiscal plan to resolve the state’s budget crisis without cutting early childhood and other funding for children and families.

Another exciting recent development is that the ARI steering committee gathered for an all-day think-tank on May 16, 2017 with a few Mobilizing Action for Resilient Communities (MARC) grant managers in order to ground ourselves in the beliefs, values, and goals that guide us, and to create focus areas for future work. We acknowledged that trauma and resilience work spans vastly, touching issues such as incarceration, historical and ongoing systemic trauma, and addictions. Committee members agreed that it is important to understand the broader societal, historical, economic and institutional contexts in which families and children experience trauma and toxic stress and their effects.

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May 16, 2017 think-tank gathering

Additionally, we acknowledge the importance of our intersections with other coalitions and movements, being thoughtful about how we overlap with and complement their work while maintaining our focus on a child development approach, the NEAR sciences (neurobiology, epigenetics, adverse childhood experiences, and resilience), data, and ancestral understandings of trauma and resilience. In all things, we are guided by equity and an awareness of the importance of early life experiences.

While advocating, networking and educating, ARI members commit to listening, learning and engaging in critical self-reflection. We all agree to be honest and open, and to foster a commitment to authentic relationships. Our actions will be compassionate and kind, with attention to our own wellness. Above all, we plan to value and create space for diverse voices and perspectives. Because this is not the work of superheroes, but rather of a movement. None of us can “save” Alaskan families; only by working together strategically can we create the real shifts in our state that are needed to end child maltreatment, intergenerational and systemic trauma, and to support resilient and healthy children, families, and communities.

To learn more about ARI, please visit our brand new website, www.akresilience.org.

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To read about some of the fantastic trauma and resilience work happening around the state, including with our partner coalitions, Raising Our Children with Kindness (R.O.C.K.) Mat-Su and the Southern Kenai Peninsula Resilience Coalition, please visit the Alaska Resilience Initiative’s blog and/or Facebook page – and look at the album called “site visits.”

The Best Food You Don’t Have to Buy

By Michelle Tschida, CNM, IBCLC Alaska Native Medical Center, and Tamar Ben-Yosef, All Alaska Pediatric Partnership

Here’s some food for thought: More lives could be saved annually by increasing breastfeeding rates to recommended levels than lives saved annually by car seats.

Unfortunately, breastfeeding is poorly supported in our country. Car seat laws aside, we never hear a doctor, nurse or grandparent say, “Well, using that car seat seems kind of complicated and inconvenient” or “We don’t want to make that family feel guilty about not using a car seat, so let’s not talk about it.” But parents hear those same messages when it comes to breastfeeding. What they don’t routinely hear is that their decision whether or not to breastfeed is one of the most important health decisions they will make for their child.  

Over the course of the last 30 years, the research has mounted about the overwhelming benefits to breastfeeding. Babies that are breastfed are less likely to get sick from allergies, asthma, and respiratory and gastrointestinal infections.

The benefits extend beyond infancy: Breastfeeding results in lower risks of developing childhood cancers, diabetes and obesity, in addition to lowering the mother’s risks for breast and ovarian cancer. Also, though not guaranteed, mothers have found that breastfeeding, which is a high-calorie burning activity, has helped them shed their extra pregnancy weight quicker.

A recent study has shown that more breastfed babies go on to attain higher education and earn more money than do babies who were not.

Here’s some of the science: Breastmilk contains special fats called polyunsaturated fatty acids. These fatty acids support healthy brain growth and development, placing breastfed babies in a better position to become the next Nobel laureates.

And since we’re throwing money into the mix, breastfeeding is considered an economic equalizer, meaning that all parents, regardless of race or social class, have access to the perfect food for their baby and can provide them with the best start to life.

Breastfed babies are held more and have consistent intimate contact with their mothers. This contact along with the repetitive release of the hormone oxytocin (the hormone responsible for childbirth, love, and bonding) during breastfeeding creates a special bond and closeness not easily replicated.

When we at the All Alaska Pediatric Partnership talk about the benefits of breastfeeding, there is one in particular that we look at the closest: the impact that breastfeeding has on rates of child abuse and neglect. In Alaska, where we have some of the highest rates of abuse and neglect in the nation, we also have little support for breastfeeding mothers in the areas of the state that need it most.

Women having babies in rural communities do not have access to lactation consultants like the women of Anchorage do. While our breastfeeding initiation rates are on par with other states and sometimes higher, without the much-needed support and assistance overcoming the difficulties, many of our mothers are switching to formula soon after leaving the hospital. Let’s face it, even breastfeeding does not happen stress-free.

Lastly, many smart folks have done the math and found that the U.S. would save around $13 billion per year in health care costs if breastfeeding rates increased to recommended levels.

Not motivated by doing it for your country? Do it for your own pocket, because families of breastfed babies save money, too. A year of formula costs approximately $1,300. There’s a lot you can do with $1,300, including paying a babysitter to watch the kids while the adults take a much-needed night out on a regular basis.

All of these benefits are seen best when babies are exclusively breastfed for the first six months of their lives, meaning no other foods or drinks are introduced before the baby is half a year old. After six months of age, the introduction of solid foods with continued breastfeeding through at least the first birthday will provide babies the best start to life.

Michelle Tschida is a Certified Nurse-Midwife and International Board Certified Lactation Consultant. She works at the Alaska Native Medical Center helping mothers deliver babies and provides assistance with breastfeeding. She is also a wife and mother of two young sons.

Tamar Ben-Yosef is the executive director for the All Alaska Pediatric Partnership, a nonprofit organization that works to improve health and wellness outcomes for children and families in Alaska through cross-sector partnerships and collaborations, education and communication.