NJAIMH: Some History
Jean Mercer
Early in the 1990s I received a mailing from the then just-hatching New Jersey Association for Infant Mental Health. It included a newsletter called The Phoenix--- typed and Xeroxed on yellow paper in the manner of those pre-laser-printer days. Among the people whose names were mentioned in that issue of The Phoenix were the eminent Thea Bry, Gerry Costa, Susan Adubato, Barbara Menzel, Elaine Herzog and (I think) Nancy Murphy. I had had the good fortune to miss all the work of incorporation and by-law writing that had already been done by Thea, Gerry, and the others. I wrote (not e-mailed!) to that group, offering to get involved with the newsletter, and soon there was an arrangement made to have an informational meeting at Richard Stockton College. A large number of people attended that meeting, but as so often happens, very few memberships resulted. (The handwriting was on the wall-- NJAIMH was to remain a north Jersey outfit, at least from the point of view of those of us who live in the south.)
In 1993 I was invited to my first board meeting. Susan Adubato was president at that time, Thea Bry was still very much alive, and of course Gerry Costa brought in not only his own expertise but also the connection with Youth Consultation Services that has been so important to NJAIMH. Soon afterward, the group carried off a large and successful conference at St. Peter’s, featuring Michael Trout, Gordon Williamson, and other stellar presenters. By that time the membership was over 100 and there was money in the treasury, being handled with perfect and timely accuracy by Nancy Murphy, as it would be for quite a few more years.
With the help of Elaine Herzog, NJAIMH board meetings were held for quite a while at the offices of the CARRI program in Piscataway. With Barbara Menzel, and later Gerry Costa, as president, the group held a number of large and small conferences. The famous (and expensive) Charles Zeanah was the major presenter at one of these, which was most instructive and valuable to those who attended, but a financial disaster as it was scheduled in the wake of 9/11 and drew very few paying customers. During this period, smaller meetings with presentations from NJAIMH members also took place; a notable one involved discussion by Isabel Poiret, Vivian Shapiro, and Janet Shapiro of their valuable book on the aftermaths of assisted reproductive technologies and of complex adoption. With the help of Elaine and others with lots of “connections”, NJAIMH during this period also earned money by presenting trainings at various hospitals and agencies. At about this time, some brilliant person (still unidentified, except to herself) suggested the best possible name for our newsletter : Nurture Notes.
One meeting took place on the day after the contested presidential election of 2000, and we all came in looking puzzled and wondering what the next years would hold. Of course, what they did hold was the same for most non-profit organizations: less money, less support from agencies for training, and consequently less membership. I was president for five years of this period, but finally caught Deborah Cherniss in a weak moment; she took the office, but unfortunately her health did not permit a long tenure.
The current NJAIMH president, Judith Wides, has presided over a period of strong interest in legal issues related to infant mental health, such as adoption and child custody decisions. One small and one large conference have been dedicated to this information. With the help of YCS and the Gateway Maternal-Child Health Consortium, the well-attended second conference, in March 2010, brought in Judge Cindy Lederman from Florida as the keynote speaker.
What will be the next events in NJAIMH history? Like infant development, what happens in NJAIMH is a matter of interaction between heredity (members’ interests) and environment (the economy and public perception of the importance of infancy). But however helpful that analogy may be, we don’t know what developmental stage we’re in. Is NJAIMH just starting to toddle, or are we adolescents? Whatever the answer may be, like all development, this will be interesting to be part of!
Profile of Prevent Child Abuse-New Jersey
Prevent Child Abuse-New Jersey is a private, nonprofit organization leading efforts across the state to end child abuse. For more than 30 years, the organization has been dedicated to eliminating child abuse and neglect, in all its forms, for all of New Jersey’s children.
Prevent Child Abuse-New Jersey works to ensure that all children are safe, healthy, nurtured and
encouraged to learn. The organization accomplishes this by developing, training, coordinating, and in many cases, evaluating, a vast network of programs delivered through partnerships with community-based organizations. These programs are developed from evidenced-based models. Many years of research and practice have demonstrated that these models are effective in their various techniques to not only prevent child maltreatment, but also promote healthy childhood outcomes.
Each year, Prevent Child Abuse-New Jersey reaches the families of more than 25,000 children through:
• home visitation programs that ensure babies are healthy and nurtured right from the start,
• education that teaches parents how children develop and grow while offering positive, healthy ways to discipline,
• professional training and community education that builds the skills and knowledge of those who influence the lives of children,
• helping parents get engaged in their child’s education so that families and schools work together to ensure children realize their full academic potential,
• community awareness events that build the promise of prevention,
• and targeted support for children in highly vulnerable families – including those headed by adolescent and incarcerated parents.
Within these programs across the state, Prevent Child Abuse-New Jersey is helping local neighborhoods meet the specific needs of their parents and children, especially those who are vulnerable or already in crisis.
The organization’s approach to building prevention initiatives is to work in local neighborhoods, engaging families where they typically gather, and offering services in places where families are comfortable receiving support. These include hospitals, health care providers, schools, faith-based organizations, community centers, child care centers, libraries and their homes and apartments. By working with the people in the community who influence and interact with families and their children, Prevent Child Abuse-New Jersey builds relationships based on familiarity and trust. This approach allows programs to be responsive to the widely diverse cultural experiences and critical needs of New Jersey’s families while effectively preventing child abuse and promoting healthy childhoods.
To learn more about Prevent Child Abuse-New Jersey and get involved in our work for children, visit www.preventchildabusenj.org or call 1.800.CHILDREN. You can stay updated on our work, listen to our podcasts, join our Facebook cause, subscribe to our e-newsletter, make a donation to help prevent child abuse, and download information for the families in your life.
Programs available in Bergen, Essex, Middlesex, Morris, Sussex, Union and Warren Counties
Access to Care
• Provides prevention, education, support and clinical services to women and their partners
• Aims to lower rates of prematurity, infant mortality, low birth weight and improve rates of early entry into prenatal care
• The communications plan will include utilization of social media to reach our target audience (texting, Twitter and Facebook)
• Contact information: Jeannette Burgos (973) 268.2280 x 109
Baby Basics – Health Literacy for Prenatal Immigrant Women
• Provides pregnant foreign-born women with the Baby Basics (Ola Bebe) books and planners to improve their health literacy skills
• Facilitates Moms Clubs at community-based organizations
• One-on-one instruction provided at prenatal care clinics
• Contact information: Delia Marques (973) 268.2280 x 103
Breastfeeding
• Lactation consulting services are provide to all women who participate in Essex County WIC programs
• Peer outreach and education to promote breastfeeding
• Phone support for breastfeeding WIC moms 7 days a week
• Provide breastfeeding aids to all breastfeeding WIC moms in Essex County
• Contact information: Mackieba Reyes (973) 268.2280 x 106
EPA Renovation, Repair & Painting (RRP) Class/Leadie Eddie Interactive Education Program
• RRP is an accredited EPA training program that certifies individuals as Certified Renovators. Classes are usually given on Tuesday and Fridays and are available in both English and Spanish.
• Leadie Eddie, an original Gateway program, educates children, parents, and professionals about the dangers and sources of lead poisoning, CDC’s number one environmental threat to children
• Leadie Eddie performs puppet shows for preschool and elementary school-aged children
• Contact information: Delia Marques, (973) 268-2280 x103
Essex Metro Immunization Coalition (EMIC)
• Coalition members include: health care providers; schools, state and local health department staff; and community-based organizations
• Provides outreach and education to promote on-time childhood and adolescent immunizations
• Advocates for state laws promoting childhood and adolescent immunization
• Publishes the New Jersey Vaccine Voice
• Contract information: Jane Sarwin (973) 268.2280 x 107
Fetal-Infant Mortality Review (FIMR)
• FIMR is a public health surveillance program that investigates factors associated with fetal and infant mortality using a community based approach
• Gateway’s FIMR program reviews cases of fetal death >20 weeks gestation and infant deaths up to one year of age
• FIMR supports a multidisciplinary Case Review Team (CRT) to examine fetal and infant deaths in an ongoing review process
• FIMR supports a community-based Community Action Team (CAT) to review the formalized recommendations and determine how best to implement community based interventions based on the CRT findings
• One of the most distinctive and valuable elements of FIMR is a home visit/maternal interview with bereaved families
• Public health activities that have been the direct result of FIMR are regional bereavement support, and bereavement training, preterm labor prevention, and kick count education for patients and providers.
• Contact information: Carly Worman Ryan, (973) 268.2280 x 115
Healthy Families
• Healthy Families is a research based, nationally accredited, Home Visitation Program designed to promote positive childhood outcomes and family functioning
• Gateway’s Healthy Families Program promotes healthy parent-child interaction, child development skills and health and safety practices with families, and provides linkages to community resources to improve family self-sufficiency
• Healthy Families-TIP provides free and voluntary services to prenatal families and families with new babies who are at low or moderate risk for child abuse or neglect.
• Healthy Families-TIP serves Morris County
• Contact information: Nicole Poland, (973) 268.2280 x 112
HIV FIMR
• A Newark-based HIV FIMR program that uses the same protocol as FIMR program
• Contact information: Carly Worman Ryan (973) 268.2280 x 110
New Jersey Immunization Registry Training/Recruiting
• The New Jersey Immunization Information System (Registry) is a Statewide automated electronic immunization registry
• NJIIS is the single repository of immunization records in New Jersey
• NJIIS coordinates and promotes effective cost-efficient disease screenings and control efforts throughout the State
• Gateway provides NJIIS training and support to health care providers or social service organizations who are authorized to access the Registry
• Effective 2011, registry participation will be mandatory for all health care providers that give immunizations to children under 7 years old
• Contact information: Joann Jablonski (973) 268-2280 x 105
Perinatal Addictions Prevention Project
• A Statewide initiative dedicated to reducing the number of infants exposed to substances in utero and improve maternal and birth outcomes
• Gateway’s Perinatal Addictions Prevention Project is dedicated to screening pregnant women in the prenatal clinics for substance use
• The Perinatal Addictions Prevention Project provides education to pregnant women, women of child bearing age, professional and the community at large regarding the risks associated with substance use during pregnancy
• Contact information: Anne Harrington (973) 268.2280 x 115
Postpartum Mood Disorders (PPMD)
• Provides a variety of classes for both professionals and laypeople on the risk factors and treatment options symptoms of PPMD
• Women seeking help are referred to support groups or providers
• Promotes awareness of PPMD to community and religious organizations
• Contact information: Naomi Savitz and Ruth Brogden, (973) 268.2280 x 106
Quality Assurance
• Electronic Birth Certificate (EBC) support and technical assistance to member hospitals
• Analyses data for program planning for maternal child health issues
• Conducts chart audits for the purpose of benchmarking indicators
• Provides zip code level EBC data to identify birth trends in service area
• Contact information: Naomi Savitz and Ruth Brogden (973) 268.2280 x 106
Building Healthy, Stronger Families
Central Jersey Agency Launches New Access to Care Initiative
Recently funded through a grant from the New Jersey Department of Health and Senior Services, the Central New Jersey Maternal and Child Health Consortium, will launch a new campaign focusing on women’s health across the life span. Educational activities will highlight the importance of a healthy body, mind and environment before a woman becomes pregnant. “Access to care is about promoting healthy living and giving babies the best start in life”, states Regional Program Director, Betsy Coffin.
Components of the program include:
• Preconception (before becoming pregnant) and interconception (between pregnancies) education and training for healthcare providers, non-obstetrical providers, and the general community, with specific focus on colleges/universities, faith based organizations, businesses and corporations.
• Development of preconception and interconception care protocols to incorporate into existing systems of care.
• County based maternal and child health networks for working professionals, community agencies, healthcare providers, outreach workers, and consumers in the Central New Jersey region with a focus on improving access to care, and promoting the importance of preconception and interconception care.
• Patient Navigators to increase pregnant mom's access to care and ability to navigate the health care system. The Patient Navigators are trained, culturally sensitive health care workers who will provide support and guidance throughout the continuum of pregnancy from the prenatal period to the postnatal period.
The Central New Jersey Access to Care program is a collaborative effort between the Consortium and key maternal and child health providers in Hunterdon, Mercer, Middlesex and Somerset Counties.
About CNJMCHC
The Central New Jersey Maternal and Child health Consortium, Inc. (CNJMCHC) works to improve the health of women of childbearing age, infants, and children in the region through the collaborative efforts of member hospitals, providers, and consumers. Major activities include professional and consumer education, coordination of services, regional planning, and total quality improvement.
The Consortium is recognized statewide for providing quality education and training for maternal and child health professionals. Current educational programs include:
• Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) fetal monitoring courses
• Lectures on various Maternal Child Health topics such as: Breastfeeding, Child Abuse Recognition, Neonatal conditions, Perinatal Bereavement Series, Preconception Health, Pregnancy and Childbirth
• Self study modules-Child Abuse and\Neglect, Malignant Hyperthermia, and Post Partum Depression
• March of Dimes Nursing Modules
• Simulated Clinical Obstetric & Pediatric Evaluation (SCOPE) Program
Other Consortium community based programs that are aimed at improving overall infant health and wellbeing include:
• Prenatal Education Series, Comenzando Bien/Becoming a Mom - a bilingual prenatal education program developed for pregnant Latina women. The program works to increase understanding of the importance of receiving prenatal care from the beginning of pregnancy to delivery.
• Healthy Families and Parents as Teachers Home Visitation – evidenced based in-home prenatal and parenting education program serving Middlesex and Somerset Counties. The HF and PAT programs are free and voluntary services, offered to pregnant women and families with new babies, to promote healthy parent-child interaction, infant child development, health and safety practices, and provides linkages to community resources to improve family self-sufficiency.
• Middlesex/Somerset Central Home Visitation System- provides pregnant women and parents with early linkages to evidence-based home visitation services and other community-based programs. The Central Home Visitation System works to improve coordination among home visitation providers, develop uniform client data collection and analysis, and provide linkages to other supportive services in the region.
• Perinatal Mood Disorders and Post Partum Depression Education and Training - provides training and education related to perinatal mood disorders and postpartum depression to physicians, nurses, social workers, and other healthcare professionals. The Consortium also provides on-site programs and educational materials to central region hospitals, health centers, faith based organizations, Infants and Children (WIC) offices, women, Division of Youth and Family Services (DYFS) offices, and other agencies that provide care to women and children.
• Perinatal Addictions- Substance Use During Pregnancy Initiative – education is provided for professionals and consumers regarding substance use before, during, and after pregnancy. A regional Advisory Committee works to address and coordinate Perinatal Addictions services, and provides education throughout the central region of New Jersey.
• Regional Early Intervention Collaborative (Mid-Jersey CARES)- works with the statewide early intervention system to ensure that young children ages 0-3 with special needs are offered early intervention services that are high quality and provided in natural environments, where children and family members live, work and play.
• School-Based Oral Health Education Program- provides age-appropriate educational activities for school-age children, pregnant women, parents, and professionals. A variety of oral health teaching kits are available for loan to school nurses and educators. The teaching kits include colorful puppets that are used to instruct children in proper oral hygiene. Oral health education is also provided for parent groups, teen parents, school and public health nurses, educators, and other health professionals.
If you would like to get involved with the Access to Care program, or would like more information about CNJMCHC, please call (732)937-5437. Visit our website at www.cnjmchc.org.
Ensuing a legacy of health… one family at a time
THE COMMUNITY YMCA
YOUNG PEOPLE’S PROGRAM
The Young People’s Program provides counseling services to children ages 3 – 12 and their families. The program is tailored to meet the individual needs of the child and offers the opportunity for change through play and a child/family-centered approach. Through the use of directive and non-directive play therapy techniques, the therapist creates an atmosphere of acceptance, safety, and trust where children feel comfortable expressing their feelings. Parent and Family counseling services are also available.
The Young People’s Program offers assistance for many areas of concern including:
School Difficulties
Parent/Child Conflict
Trauma
Oppositional Behaviors
Grief and Loss
Adjustment to Life Changes (i.e. divorce, step-siblings, moving)
Medicaid and most other insurance are accepted. Sliding scale available
For additional information, please visit our website at CYMCA.org or contact:
Valerie Le Moing, MA, LPC
The Community YMCA
Family Services Branch
166 Main Street
Matawan, NJ 07747
732.290.9040 ext 128.
Postpartum Depression (PPD) Follow Up Program (Monmouth and Ocean Counties)
With grant funding from the NJDHSS, professional staff at RPCMOC outreach to all pregnant and postpartum women who have screened positive for PPD at birth hospitals or at other perinatal /pediatric health care settings in Monmouth or Ocean Counties.
Staff share Information with the mom and her family about PPD and assist with referrals to local and state PPD services and to area PPD support groups. Ongoing individual support is provided to assure that the mom has success in obtaining appropriate PPD services.
Regional Perinatal Consortium of Monmouth and Ocean Counties, Inc. (www.rpcmoc.com) 732-363-5400
Themes and Variations in Development: Can Nanny-bots Act Like Human Caregivers?
Jean Mercer
Can “smart” robots do an effective job of child care? I believe this question actually means, “Is it possible for a human being reared largely under the care of nanny-bots to be the kind of adult we want to know and share our world with?” Sharkey and Sharkey, in their 2010 paper about robot nannies, made it clear that they were considering situations where a major part of the care of young children was done robotically, not simply situations where robots were elaborate monitoring devices. We have little empirical information to help answer the question of outcomes of nanny-bot care, but I will try to bring together some related material and speculate on an answer.
A serious problem for those who want to answer this question is that at this juncture we know a good deal more about how to build “smart” and even “smarter” robots than we do about the specific needs of a specific baby at a given time. We have much knowledge about babies in general and even about a given baby over time, but the general knowledge that a human being can use to generate appropriate care is most difficult to specify and to provide to a robot caregiver. No matter how “smart” a robot we can produce, its “smartness” is of little use unless it includes sufficient correct information about young children and appropriate strategies for solving problems when the right information is not available.
What happens if a caregiver does not understand a baby’s needs or do the right thing at the wrong time? For some aspects of child care, making a mistake at the beginning of an interaction does not really make a lot of difference, as long as the caregiver reads the child’s signals, realizes there is an error (“oh, she’s not hungry, because she’s still crying”), and tries some reasonable alternative until a solution is reached. In communication between adults and babies, it is very common to see “interactive mismatch and repair” of this kind. In fact, such errors and resolutions may be an important thing for a baby to learn about, so he or she understands that communication may take several steps and should not be given up at the first failure. An effective nanny-bot would need the ability to persist in efforts to solve problems; indeed, if it is true that the baby learns from communications that need repair, we might want a nanny-bot to make roughly the same number of errors that a human caregiver does.
So, are there aspects of child care when a quick, accurate, consistent response is important, and there are problems if it does not occur most of the time? To answer this question, we can draw on studies of perinatal mood disorders (for example, postpartum depression) and their effects on infant development. Non-depressed mothers and other caregivers respond quickly and accurately to infants’ communication through facial expression, posture, and gesture (including both movements of hands and head, and eye movements). Videotaping of the faces of non-depressed mothers and their babies shows that although the babies sometimes imitate the mothers, it is even more common for the mothers to imitate the babies. A baby’s very brief facial expression (say, a protruding lower lip) is echoed almost immediately by the mother’s equally quick facial imitation--an involuntary response by the mother. This mirroring of facial expression may help the baby map emotional experience onto facial changes and prepare to “read” the emotions of others on the basis of expression and gesture. However, depressed mothers often fail to notice their infants’ expressions of social interest and greeting, and continue to show a sad expression no matter what the baby does. These mothers fail to provide either an interesting contingency for the baby’s social approaches or a wide range of expressions indicating a wide range of emotions. Whether for these reasons or for other unknown reasons, babies of depressed mothers are slowed in their language development and frequently look sad under circumstances that would not be expected to sadden them. A nanny-bot that could not provide the apparently-necessary imitation of facial expressions might be predicted to produce less than optimal development of both language and regulation of mood. Whether or not it is technically possible to make a robot with a “face” that can change expression realistically, I have no idea, but this capacity would seem to be necessary for normal child development.
As we have seen, there are circumstances where making some errors in response to infants is acceptable and even desirable, and there are other circumstances where a rapid correct response seems to be needed a good deal of the time. (No human caregiver ever does things right all the time.) These facts bring us to an essential consideration in the study of child development: variability. Individual differences between children are very real from the time of birth, variation within a child occurs over time and within specific time frames, and the variability of the world is something children need to learn about. This means that children need different responses at different times and may require experience of variation for optimal development. For example, babies need to learn that sometimes other people respond quickly to a signal, sometimes slowly, and occasionally not at all, and that none of these is a cause for alarm. With respect to language learning, experience of variability is essential. An obvious example is the fact that sounds have different meanings in different contexts (“Bye-bye, I’m going by the store to buy some bi-naries.”). Less obvious is the fact that when babies learn the phonemes of their native language (the sounds which when changed alter the meaning of a word--these may be different sounds in different languages) they do not learn a single sound pattern for each phoneme, but all the sound patterns that fit into that phoneme’s category. These patterns are different when spoken by different people, in louder or softer voices, in conjunction with other sounds, or under the influence of different emotions. To provide appropriate levels of variability, a nanny-bot would need to behave differently on different occasions, and particularly to produce a wide variety of speech sounds.
Considering variability and language learning brings us back to the idea of variation over time. Human caregivers fine-tune their attempts to communicate with infants in ways that appeal to the baby’s developmental status. For example, mothers talking to newborns use very much the same vocabulary, grammar, and subject matter that they would use in talking to an adult, but use a much higher-pitched voice and a different rhythm of speech. They do not expect the baby to understand the words, but know that he or she will find a high-pitched voice interesting. The same mothers, when their babies are six months old, will use simpler words and grammar and will concentrate on talking about things the baby can see or hear; they know that the baby is beginning to get the connection between word-sounds and objects, and they pick upon the baby’s interest and follow it. Part of the mothers’ changing speech is related to a general idea about the baby’s age, but much of it has to do with noticing that the baby is attracted or interested by different things at different ages. An effective nanny-bot could not be programmed simply to produce sounds in a given way throughout the first year, but would need to respond to developmental change. Similarly, of course, even the “dirty” jobs need fine-tuning. Changing the diaper of a month-old baby is a different matter from changing a wiggly 8-month-old who wants to turn over when placed in the diapering position--although a robot with extra arms might do a more efficient job than a two-armed parent.
In Sharkey and Sharkey’s article, some concerns were expressed about the issue of emotional attachment in nanny-bot care. With respect to this topic, I would like to note first that attachment is not only difficult to define in general, but is operationalized in different ways when discussing human beings of different ages. The term “bonding” is rarely used by psychologists today, although one does come across it in judicial proceedings; when it was in more frequent use, perhaps 30 years ago, “bonding” referred to the attitudes of adults toward babies, not the emotional connection babies experience with respect to adults. “Bonding” has become a fairly useless term, as it is popularly used to describe virtually any level of cordiality. To speak of “bonding” in the sense of the Tanaka study--that the children liked the robots and had fun with them--is a choice of language that implies some connection with psychological research and theory but actually has none.
When we consider the potential impact of nanny-bot care on children’s emotional development, the issue of attachment is an essential one. Attachment theory, supported by an enormous amount of empirical and clinical investigation, suggests that early emotional development includes the growth of relationships with a small number of familiar caregivers who are ideally consistent, sensitive, and responsive to the baby’s communications and general needs. These caregivers initially “woo” or “court” the baby and demonstrate enjoyable social interactions; later, they let the baby initiate interactions more often. By about 8-12 months the baby shows strong preferences for the familiar people, especially if frightened or uncomfortable; he or she avoids strangers, and will usually explore new situations freely only if a familiar person is present. These behaviors are interpreted as demonstrating attachment. As the child grows older, attachment behaviors occur less often, but it is thought that attitudes toward the self and others are shaped by the child’s early experiences of secure or insecure relationships with familiar people. While attachment is far from the only factor determining personality development, it is thought to play an important role.
What then, would a robot caregiver have to do in order to foster the child’s attachment to the robot? As far as we can tell, active, interactive social play (not just “entertainment”) is a necessary beginning for attachment and is much more important than providing food or warmth. A nanny-bot would need to begin by “wooing” the child, keeping the social stimulation within boundaries indicated by the baby’s response, and would later need to modulate the social behavior into greater responsiveness to the developing infant’s social bids. In addition, the nanny-bot would need to be able to provide appropriate responses to a toddler’s fears of new objects or situations, as the child seeks information by looking for facial expressions indicating fear or pleasure at a sight (this information-seeking is called social referencing). Human caregivers help the child achieve proximity or direct contact when anxious, so we would expect that a nanny-bot too would need to be able to modulate contact in these ways that are thought to foster attachment.
Given that a robot caregiver could do these complex tasks, would it be possible for the child to become attached to the robot? Yes, I think it would be possible for basic attachment behavior to develop; toddlers show this in rudimentary form even to preferred blankets, teddies, and even familiar places. However, this experience of attachment would lack many of the aspects that we see in normal human attachment. Among these aspects are experience in triadic interaction, with several people interacting in different patterns , or interactions with other children, whose behavior is very interesting to babies. Because of these absent experiences, our question perhaps should be, “Can attachment to a nanny-bot become a good foundation from which personality can develop and on which appropriate social behavior can be based?” Any positive answer to this question would have to be extremely guarded, especially in light of what I said earlier about children of depressed mothers.
In conclusion, let me pose two questions that I think crystallize some of the real issues about child care robots. The first is simply this: What would a nanny-bot do if a toddler hit it? The early years are a period in which children learn about modulating or inhibiting aggression, and they learn this in the context of attachment relationships. Could a robot discriminate between an intentional and an accidental blow, as human beings do? And if it could, what instructions would it have about a response intended to stop this behavior? Would the “first law” of robotics mean that a robot could not punish a child for a behavior that would have been harmful if it had targeted another human being?
And my final question: What other tasks do potential human caregivers have that are so critical as to preclude child care? Why do we not create robots to do other human tasks and free human beings for the complex and challenging task of rearing children to be good members of our community?
References:
Sharkey, N., & Sharkey, A. (2010). The crying shame of robot nannies: An ethical appraisal. Interaction Studies, 11, 161-190.
Wednesday, April 13, 2011
Articles from "Nurture Notes", Spring 2010
New Jersey Division of Youth and Family Services v. L.L.
Mary M. McManus-Smith, Esq.
Chief Section Counsel – Family Law
Legal Services of New Jersey
In late February, the New Jersey Supreme Court handed down the decision in New Jersey Division of Youth and Family Services v. L.L., which clarifies the standards required for vacating or terminating a Kinship Legal Guardianship and reuniting the child with a parent.
Kinship Legal Guardianships (KLG) were legislatively created in 2002, to provide financial support and state recognition for relative caregivers. The legislation incorporates two potentially conflicting principles: (1) termination of parental rights and adoption are not needed to establish permanence for a child who lives with a relative caregiver; and (2) when a parent has been adjudicated to be unable to appropriately parent his or her child, the alternative living arrangement ordered by the court must be more durable than a traditional custody order as between two fit parents. So, the legislation makes clear that the standard for ending a KLG and returning custody to a parent is significantly more stringent than that for modifying a custody order.
The Supreme Court held that the statutory language describing the standard to vacate a KLG clearly requires that a parent must prove by clear and convincing evidence that both (1) the parent has overcome or eliminated the incapacity that led to the original award of KLG, and (2) that termination of the KLG is in the best interest of the child. The Court further articulated that under the best interest prong of the standard, a trial court must focus on the safety of the child. The Court pointed to DYFS regulations for factors that may assist trial courts in assessing the safety needs of the child. Those factors include:
1. The child’s age;
2. The duration of the Division’s involvement with the child, prior to the granting of kinship legal guardianship;
3. The total length of time the child was in out-of-home placement;
4. The length of time the child has lived with the guardian, prior to and after the granting of kinship legal guardianship;
5. When kinship legal guardianship was granted;
6. What the original harm or risk of harm to the child was;
7. The parent’s present fitness to care for the child;
8. Any subsequent allegations of abuse or neglect received by the Division and their findings; and
9. What plan is proposed for the child if the guardianship is vacated.
The Court pointed to additional factors that may assist trial courts in determining whether termination of the KLG is in the best interest of the child. Those factors include:
“the child’s wishes; the nature and quality of the parent-child relationship during the kinship legal guardianship; the future relationship anticipated between the child and the guardian; the preservation of sibling relationships; the practical impact of vacating the kinship legal guardianship on the child’s day-to-day life (i.e. changes in school, community and friends); and any other relevant factor bearing on the best interests of the child.”
A 2007 study by the Center for Law and Social Policy reveals that kinship caregivers provide greater stability than foster care and are more likely to result in healthy, well-adjusted children. Children in kinship care have fewer behavioral problems, fewer school disciplinary issues and are less likely to run away. They also have a more positive perception of their placement than children in non-kin foster placements. See, T. Conway & R.Q. Hutson, Center for Law & Social Policy, “Is Kinship Care Good for Kids?” (March 2, 2007). (available online at www.clasp.org/publications/is_kinship_care_good.pdf)
Only one other case involving the status of Kinship Legal Guardianship has reached the New Jersey Supreme Court. By articulating clear standards for the termination of a KLG, this Supreme Court decision may, in fact, encourage the use of Kinship Legal Guardianships.
What Is He Trying To Tell Us?
Relationship Instability and Aggression in Pre-school Children
Judith Wides, MA, M.Ed.
Small children who are involved in custody battles, foster care placement and the stress of relationship instability sometimes display overly aggressive behaviors at school. It is helpful for pre-school teachers to think of aggression in young children as a form of communication. Their actions highlight their unique neurological profile, their ability to tolerate stimulation, their relationship patterns, and their exposure to media.
Children who experience early relationship instability are particularly vulnerable if they are pre-verbal or verbally delayed. Many court-involved children have been witness to or victims of domestic violence. In addition they may have suffered other forms of abuse and neglect. Frightened and unhappy children may resort to aggression to communicate their needs and/or protect themselves.
Traditionally, educators have used a model called Applied Behavior Analysis to look at behavior that has been deemed problematic or challenging. Applied Behavior Analysis is particularly valuable in assessing the repetitive disruptive, aggressive and disquieting behaviors often seen in emotionally fragile children. In the classroom, Applied Behavior Analysis allows the teacher to view behaviors in a non-judgmental and functional framework.
When using the model of Applied Behavior Analysis or ABC for short, the understanding is as follows. The A is the antecedent and represents what happens before the identified behavior occurs and where it happened. This includes the setting and the individuals who are present. B represents the behavior itself. C represents the consequence of the behavior. Consequence is a word that is often interpreted to mean punishment. In this case it does not mean punishment. It means what happens as a result of the behavior. What did the child gain from the behavior, attention? access to a toy? release from a disliked activity? physical contact with a peer or teacher?
The critical task for teachers is to identify the triggers that cause the child to utilize a particular behavior in a specific setting. It boils down to recognizing what happens before a problematic behavior occurs, mapping the characteristics of the behavior and then recognizing the outcome of the behavior. A typically developing child will generally avoid behavior that will result in a physical restraint by a teacher. A child who is experiencing relationship instability may bite a teacher with the intent of landing herself in a holding for safety because she does not know any other way of seeking physical contact.
Teachers who have a student who bites in their midst are pretty good at predicting when he or she is most likely to strike. They know the Antecedents well. Often they can predict how well a child’s day will proceed by observing the dynamic between the parent or caregiver and the child as the pair enters the classroom in the morning. The ritual of entering the room, settling in and saying goodbye illustrates for the teacher how well rested they are, and their state of relationship synchrony or discord.
The information gleaned from observing the morning ritual is helpful in planning a successful day for the child. Consider the child who has a history of biting. What might we predict on a morning when the parent roughly removes the snow boots and winter coat and then storms off without a kiss or even making eye contact with her child? The parent shows real signs of stress and frustration. Will the child be more likely to aggress against other children or teachers that morning? Is he likely to lash out when he is tired, hungry, or over excited? Do certain children trigger his tendency toward aggression? Is there a particular toy that always causes him to get into conflict? If you can manage to keep in mind that small children often lack the capacity to communicate in ways other than physical expression you will be better equipped to educate and protect the children you serve.
Finally, all of us who work with children know that consistency, flexibility and creativity are the keys to managing challenging behaviors. It is helpful to keep in mind that children who bite, kick, push and wrangle furniture are desperately trying to communicate something about their internal experience. They need us to see what they are doing on multiple levels.
In closing it is important to reaffirm that it is no small miracle that educators who work with behaviorally challenged children often have very good ‘gut’ feelings about managing those children. However, utilizing an organized framework like Applied Behavior Analysis can help teachers and caregivers alike in understanding on a micro level the range of factors that effect behavior. Mapping out behaviors in the context of analysis allows for the construction of intervention plans that help a child feel safe and contained at school. When a child learns to experience a greater sense of stability and control at school it is often the first step in creating an opening for improved relationships with everyone in the child’s life, including an improved sense of self worth and self efficacy.
Child Sexual Abuse: Problematic, Yes; Traumatic, Not Necessarily
Jean Mercer, Ph.D.
Richard Stockton College of New Jersey
Susan Clancy’s important book “The Trauma Myth” (New York, Basic Books, 2009) is drawing the critical fire of a number of people who have not given it the careful reading it deserves. Some of these critics have claimed that Clancy argues against any deleterious effects of sexual molestation in childhood--- that she defends pedophiles, and even that she is a pedophile herself or that she blames child victims for the behavior of sexually-exploitative adults. These statements are nonsense, and I am going to attempt to counter them.
“The Trauma Myth” emphasizes repeatedly the clear evidence that childhood experiences of sexual exploitation by adults are associated with a long list of later problems, including mood disorders, anxiety disorders, personality disorders, relationship and sexual problems, eating disorders, self-mutilation, and so on. Because one in five children is reported to have experienced sexual abuse (and probably there are more, unreported, cases), such abuse is responsible for significant numbers of mental health problems. It’s important that we learn how to prevent it and to treat its results, not only for the sake of individuals but for the mental health of the whole population. To prevent child sexual abuse and treat problems that result from it, we need to have a real understanding of how these experiences cause bad outcomes. However, much work in this area is based on the assumptions of trauma theory, which attributes many mental health problems to the past experience of severe pain and fear, and trauma theory may not provide a good framework for understanding the impact of sexual molestation in childhood.
Clancy is not the first to point out that children’s sexual experiences with adults are not necessarily experienced as traumatic (severely painful or terrifying) at the time when they occur. But her interview research with adults who had been molested as children clearly showed a continuum of child experiences, ranging from terror and pain at one end, through puzzlement without distress in the middle, to physical and emotional gratification at the opposite end. In fact, most of her interviewees reported that in childhood, at the time of the event, they were not frightened or in pain. The abuser’s actions did not involve force or even penetration of any kind, but were generally limited to rubbing, kissing, or fondling of genitals, nor did most of the abusers threaten the children in any way. Nevertheless, those adults, as well as the ones who had experienced trauma, reported symptoms related to their experiences, and now felt that the sexual event had had a deplorable effect on them.
The question Clancy raises is this: if the abused children did not at the time experience the event as traumatic, how can we explain the connection to their present symptoms? We can’t do this in any simple way by means of applying trauma theory. To make trauma theory work in this context, we would have to add to it the concept of repressed memories-- to say, for example, that the adults Clancy interviewed were really terrified and hurt, that they have repressed and can’t report that part of the experience, but that in its repressed form the memory still affects their mental health. Taking that approach, however, we would come up against an even more complicated issue: why is it that people who were actually hurt and terrified (according to independent evidence) don’t repress what must be a hideous memory? Using the repressed memory concept, then, we find ourselves having to explain why a really terrible experience is remembered with all the emotional factors intact, but a less painful and frightening situation leads to repression of memories of emotion. Although U-shaped functions of this kind are not unknown in psychology, this one does not seem to make much sense.
Clancy concludes from this line of reasoning that trauma theory and the concept of repression are not good ways to explain the most common situations involving childhood sexual abuse and its aftermath in adulthood. Because they are not good ways, they have not done much to help us either prevent or treat the effects of child sexual abuse. We need to explore these matters much more carefully, and, Clancy says we need to make sure that our explanation involves the child’s point of view, which has generally been ignored. To understand that children’s group and individual characteristics affect the sex abuse situation is a far cry from “blaming” the child.
Clancy makes several points about children’s understanding of the world and the ways it can make the child’s view of non-painful sexual abuse rather different from an adult’s. She stresses the ignorance of children about sexuality and their failure to comprehend what an adult wants or what he or she is doing. Why heavy breathing and a red face, for instance? A child has probably observed these things before, but in quite different contexts. The puzzled conclusion may simply be that this is strange and perhaps it’s one of those embarrassing things that you get in trouble for talking about, so best to just keep it to yourself.
Importantly, Clancy also emphasize that there are characteristics of individual children that may make them more likely to be the victims of repeated abuse which they do not report. No, she does not say these children are “seductive”; what she does say is that they are lonely, unsupervised, and grateful for adult attention. They respond to the fascinated attentiveness of the potential abuser as a delightful experience, in sharp contrast with the indifference their caregivers may show. Without experiences of pain or fear, why should they reveal what seems to them like a romance to familiar adults who will probably cause some trouble?
Finally, Clancy says something that is for many readers the unspeakable: that given a kind, careful adult who treats them well, children may enjoy sexual experiences (we are not talking about penetration here, of course). I was reminded of a story I heard from a friend some years ago. She had left her 3-year-old boy with a 13-year-old boy babysitter, and when she came home she became aware that some sort of sex play must have been going on. All she could think of was to give the 3-year-old the old bromide, “if someone touches you and you don’t like it, just tell them to stop”--- to which the 3-year-old replied enthusiastically, “I liked it! When can he babysit me again?” And there you have it in a nutshell; sexual activity of the right kind is pleasurable for everybody at every age. Sexual predators know that very well, and if we want to stop their exploitation of children, we need to be honest about it too, and not to expect children to “tell on” someone who gives them pleasure.
“The Trauma Myth” is a serious effort to deal with child sexual abuse and its aftermath. I’ve had space here to give only the highlights of Clancy’s argument, but the book contains much more of interest, including a discussion of abuse prevention programs as they now exist. I hope readers will give “The Trauma Myth” the careful attention it deserves.
The Value of Play during Infancy and Early Childhood
Connie M. Tang, Ph.D.
Richard Stockton College of New Jersey
We are probably all quite familiar with the old saying that “all work but no play makes Johnny a dull boy.” Before we delve into the issue of play in infants and young children, let us think about the importance of play in adults’ lives: Can you imagine life that is all work but no play? Granted, as adults, our style of play has progressed to grander versions, such as playing with our beloved iPhone or the newest electronic gadget, or playing an online game. But the function of play stays the same: We play to relax, to experience excitement, to have fun, and to be rejuvenated. In infancy and early childhood, play serves all of the functions in adulthood, and more. During these earliest stages of human development, play is leisure, but play is also work.
That is right! For infants and young children, their job is to play. I bet that makes all of us quite jealous. If we say that the most important thing for adults is to work, for school age children is to study, then the most important thing for infants and young children is to play. Playing is preparation for studying, much like studying is preparation for work. So how does play prepare infants and young children for the world of studying, and later working as adults? First of all, playing promotes physical development. Through play, infants and young children get to practice their gross and fine motor skills. They learn to perfect their ability to walk, run, jump, to hold a pen, to glue things together, and to use a pair of scissors.
Second, play is important for infants’ and young children’s cognitive development in terms of thinking and language. According to Swiss psychologist Jean Piaget’s cognitive developmental theory, infants think with their sensations and motor activities, whereas pre-school children think with images, words, and other types of symbols. At the preschool age, children still cannot think things through without acting them out. In order for children’s thinking to mature so that they can mentally problem solve, they first need to have plenty of practices with “acting out”. The more they tangibly experience how things work in real life, the more they are able to imagine how things can work. Play is also critical for infants’ and young children’s language development. Like many other aspects of development, language is believed to have a sensitive period, and this period often includes infancy and early childhood. That is why starting from the first words around age one, children progress rapidly into speaking in simple sentences at age two, and speaking in more complex sentences at age three or four. By the end of the preschool period, children usually display a great deal of knowledge regarding phonology, semantics, syntax, and pragmatics, and their speech can be adult like. Evidence for language having a sensitive period also lies in the finding that learning a second language is often the easiest during infancy and early childhood. Therefore, encouraging infants and young children to play “house” and to play with one another encourages their language development.
Finally, play is important for social and emotional development. When infants and young children play with one another, they learn to take turns, to negotiate, to empathize, and to look at things from someone else’s point of view. When infants and children play “house”, they often “act out” experiences and emotions that they are not able to express verbally (which incidentally is a premise for play therapy), thereby allowing them the opportunity to learn to label their emotional experiences with words. In short, through play, infants and young children not only experience joy, excitement, and the relief of tension; they also learn how to share, to team play, and to get along with others.
Now that we have established the importance of play, we will turn our attention to the types of play and how these play types can make unique contributions to certain aspect of development. There are generally six types of play (Santrock, 2010).
Sensorimotor play mostly describes infants’ play, when they engage in behaviors such as tracking a moving mobile and shaking a rattle. Sensorimotor play is important for infants’ physical and cognitive development.
Practice play occurs throughout life, when we repeat a newly learned behavior, such as climbing stairs or practicing bowling swings on Wii. Practice play augments physical development.
Pretense or symbolic play occurs mostly during the preschool years, such as when boys pretend to be police officers arresting bad guys. Pretense play is very important for cognitive and social development.
Constructive play occurs most often during the preschool and elementary school years, combining the features of sensorimotor, practice, and pretense plays. It is the type of play when children create a product or a solution. Many preschools (such as the Free-to-be Childcare Center at Stockton College) engage children in constructive play when they design themed projects, such as the bird project, the box project, and the concept “big” project. Since constructive play often combines sensorimotor, practice, and pretense plays, it promotes physical, cognitive, and social development.
Social play involves interacting with peers and occurs throughout life. Social play can be further classified into unoccupied, solitary, onlooker, parallel, associative, and cooperative plays. The terms given to these subtypes of social play are quite self explanatory, although I would like to mention cooperative play in particular. Cooperative play is when children and adults do things together as a group. Many themed projects designed by preschools, such as the previously mentioned bird project, box project, and the concept “big” project, can also be cross-classified as cooperative play. Overall, social play stimulates social development throughout the human life span.
Games are defined as activities that are pleasurable, involve rules, and often entail competition. Games are played most often during the elementary and middle school years, such as water balloon tossing and board games. Depending on the type of games, games can be valuable for physical, cognitive, and social development.
In the recent decades, several new trends in the area of play surfaced. Two, in particular, are relevant to our discussion on the value of play in infants and young children. First, television has become an important part of American life. Other than sleep, young children spend time watching television more than any other activity. Then, is television watching play? A distinctive feature of television watching that is different from all of the other types of play is that television watching is passive, whereas traditional types of play are active. I would therefore argue against classifying television watching as play. With today’s television programming becoming more interactive, however, I am open to a mind change. Until then, I regard television watching as leisure, but not play.
Second, today’s toys have multiplied in number, style, and kind, and are becoming ever more specialized. Just about anything that you might encounter in real life, there is now a toy version of it, such as toy microwave oven, toy vegetables, toy cash register, etc. Having so many toys and so many choices are of course welcomed news to sparkly young eyes, although one has to wonder whether this trend is also beneficial to infants and young children’s growth and development. I wonder, for example, whether already possessing a plastic telephone will diminish a young child’s motivation to take a banana and use it as a telephone, thereby decreasing imagination during pretense play. Likewise, many experts of child development have opined that multi-purpose toys (such as blocks) are best. Trends come, and trends pass, but across the human life span, play will continue. For infants and young children, play will always be the most important thing in their day to day life.
Reference:
Santrock, J. W. (2010). Children (11th ed.). Boston, MA: McGraw Hill.
Hudson Perinatal Doula Fellowship Program
Summer 2010
Inspire. Engage. Empower.
Learn the healing arts of labor support; experience the community of supportive women;
Hudson Perinatal is a 501 (c) 3 non profit agency serving the needs of childbearing families in Hudson County, NJ. Through the State of New Jersey's Access to Care program, we are immediately seeking applicants for the HUDSON COUNTY DOULA FELLOWSHIP. Running part time from June 15-August 15, 2010, this community based doula program will be part of the solution to improving better birth outcomes for Hudson County.
WHAT IS A DOULA?
An expectant mother receives medical care and medical management from a health care provider in pregnancy, labor and birth. A doula, a Greek word meaning 'to serve women,' works alongside a medical care provider to compliment the woman's pregnancy through therapeutic touch, relaxation practices and stress reduction tools. Doulas continue to make a difference in improving maternity care.
The Hudson County Doula Fellowship is a life changing, affirming, and exciting program of learning to serve pregnant women in Jersey City and their families at their pre natal, labor and post partum time. Doulas no not provide medical or clinical care, and work alongside a laboring woman and her partner and medical caregiver. In pregnancy, a doula mentors an expectant mother in asking questions at prenatal medical visits, creating healthy food choices, sharing stress reduction practices and being a resource for other social, emotional and physical needs. During labor, a doula uses comfort measures to support the laboring woman alongside the midwife or doctor. Finally, in the postnatal time, a doula assists in breastfeeding support, empowering strategies in newborn care and the emotional transition to motherhood.
WHAT IS THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM?
Women selected to participate in the Hudson Perinatal Doula Fellowship program receive at no cost, a national doula training program from DONA International. In addition to the DONA curriculum the Hudson Perinatal Doula Fellowship will receive at no cost more extensive training and education in a myriad of topics from breastfeeding peer counseling skills, childbirth education, massage/therapeutic touch, integrative nutrition and the wise woman tradition of being present at labor and births. Unique to this training, the doula workshops includes the foundations of creating helping, empathetic relationships, healing arts for labor and gentle body work to embrace that pregnancy is in fact a rite of passage. The Hudson Perinatal Doula Fellowship program covers all training costs, required books, doula supplies for comfort measures at births, the fee for DONA International certification, and coaching to submit the paperwork for your national doula certification. Finally, the Hudson Perinatal Doula Fellows will be mentored on working with their expectant clients and the births. In short, it is a supportive and encouraging program with providing an incubator of information and inspiration for your success.
WHAT IS THE TIME COMMITMENT OF THE HUDSON PERINATAL DOULA PROGRAM?
This program is designed to help you flourish honoring your other vocations and family commitments.
The Hudson Perinatal Doula Fellowship runs June 15-August 15, 2010. Applications are accepted immediately on a rolling basis and can be downloaded atwww.HudsonPerinatal.org The fellowship will be open to 35 women who commit to the time frame of program.
1) In addition to the DONA Doula Training dates, which are full days, 8 am-5 pm June 21-24, 2010, the women awarded the Hudson Perinatal Doula Fellowship commit to six hours a week from June 15-August 15, 2010 either
Mondays, from 10:00 am-4:00 pm
OR
Tuesday and Thursday evenings, 6:30 pm-9:30 pm.
The program will acknowledge adult learning styles and be taught in an experiential, engaging manner. We value the work in the world you have already done.... In short, you are bringing your gifts to the entire training and enhancing yourself and every woman you will serve. We are excited and thrilled to serve you so you can participate in the timeless, compassionate art of serving women. You bring value to people's lives and entering the art of doula work is truly a sincere commitment in changing access to health care and better birth outcomes for women, men, babies, and our community.
2) In addition to the nurturing workshop attendance, reading materials and resource acquisition, the selected doulas will commit to immediately serving three expectant women and attending those three births in Jersey City at medical centers.
WHO CAN APPLY TO THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM?
You can! No pre-requisites required, just a sincere commitment to the dates listed above. No prior experience is required, just an enthusiasm to commit to the community of other doulas and the needs of pregnant women in Jersey City. Arriving on time and staying for each workshop date is required and an obligation to graduate from the program.
WHAT MAKES THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM DIFFERENT THAN OTHER DOULA TRAININGS?
Unlike basic birth doula trainings, the Hudson Perinatal Doula Fellowship will expand your content knowledge and confidence in social justice, women's health, perinatal health disparities and the healing arts.
We look forward to getting to know your passions and your possibilities. Please download the application as a tool of self inquiry and self reflection. We embrace your journey and the unique gifts you offer this world and will offer all women. You will be welcomed on this path of doula work in the deepest of gratitude.
WHERE IS THE LOCATION OF THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM?
Jersey City, NJ; easily accessible from mass transportation.
WHOM DO I CONTACT FOR MORE INFORMATION:
Jill Wodnick, M.A., CD(DONA) Community Doula Coordinator, Hudson Perinatal
Jwodnick@hudsonperinatal.org
HOW DO DOULAS IMPROVE BIRTHS?
In their book, Mothering The Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth, Marshall Klaus, John Kennell and Phyllis Klaus summarize scientific studies which have been carried out on the advantages of doula-assisted births.
Reduced the overall cesarean rate by 50%
Reduced the length of labor by 25%
Reduced oxytocin use by 40%
Reduced the use of pain medication by 30%
Reduced forceps deliveries by 40%
Reduced requests for epidural pain medication by 60%
Reduced incidences of maternal fever
Reduced the number of days newborns spent in NICU (neo-natal infant care unit)
Reduced the amount of septic workups performed on newborns
Resulted in higher rates of breastfeeding
Resulted in more positive maternal assessments of maternal confidence
Resulted in more positive maternal assessments of maternal and newborn health.
Expectant parents can find a doula by searching www.DONA.org or other pregnancy websites.
Mary M. McManus-Smith, Esq.
Chief Section Counsel – Family Law
Legal Services of New Jersey
In late February, the New Jersey Supreme Court handed down the decision in New Jersey Division of Youth and Family Services v. L.L., which clarifies the standards required for vacating or terminating a Kinship Legal Guardianship and reuniting the child with a parent.
Kinship Legal Guardianships (KLG) were legislatively created in 2002, to provide financial support and state recognition for relative caregivers. The legislation incorporates two potentially conflicting principles: (1) termination of parental rights and adoption are not needed to establish permanence for a child who lives with a relative caregiver; and (2) when a parent has been adjudicated to be unable to appropriately parent his or her child, the alternative living arrangement ordered by the court must be more durable than a traditional custody order as between two fit parents. So, the legislation makes clear that the standard for ending a KLG and returning custody to a parent is significantly more stringent than that for modifying a custody order.
The Supreme Court held that the statutory language describing the standard to vacate a KLG clearly requires that a parent must prove by clear and convincing evidence that both (1) the parent has overcome or eliminated the incapacity that led to the original award of KLG, and (2) that termination of the KLG is in the best interest of the child. The Court further articulated that under the best interest prong of the standard, a trial court must focus on the safety of the child. The Court pointed to DYFS regulations for factors that may assist trial courts in assessing the safety needs of the child. Those factors include:
1. The child’s age;
2. The duration of the Division’s involvement with the child, prior to the granting of kinship legal guardianship;
3. The total length of time the child was in out-of-home placement;
4. The length of time the child has lived with the guardian, prior to and after the granting of kinship legal guardianship;
5. When kinship legal guardianship was granted;
6. What the original harm or risk of harm to the child was;
7. The parent’s present fitness to care for the child;
8. Any subsequent allegations of abuse or neglect received by the Division and their findings; and
9. What plan is proposed for the child if the guardianship is vacated.
The Court pointed to additional factors that may assist trial courts in determining whether termination of the KLG is in the best interest of the child. Those factors include:
“the child’s wishes; the nature and quality of the parent-child relationship during the kinship legal guardianship; the future relationship anticipated between the child and the guardian; the preservation of sibling relationships; the practical impact of vacating the kinship legal guardianship on the child’s day-to-day life (i.e. changes in school, community and friends); and any other relevant factor bearing on the best interests of the child.”
A 2007 study by the Center for Law and Social Policy reveals that kinship caregivers provide greater stability than foster care and are more likely to result in healthy, well-adjusted children. Children in kinship care have fewer behavioral problems, fewer school disciplinary issues and are less likely to run away. They also have a more positive perception of their placement than children in non-kin foster placements. See, T. Conway & R.Q. Hutson, Center for Law & Social Policy, “Is Kinship Care Good for Kids?” (March 2, 2007). (available online at www.clasp.org/publications/is_kinship_care_good.pdf)
Only one other case involving the status of Kinship Legal Guardianship has reached the New Jersey Supreme Court. By articulating clear standards for the termination of a KLG, this Supreme Court decision may, in fact, encourage the use of Kinship Legal Guardianships.
What Is He Trying To Tell Us?
Relationship Instability and Aggression in Pre-school Children
Judith Wides, MA, M.Ed.
Small children who are involved in custody battles, foster care placement and the stress of relationship instability sometimes display overly aggressive behaviors at school. It is helpful for pre-school teachers to think of aggression in young children as a form of communication. Their actions highlight their unique neurological profile, their ability to tolerate stimulation, their relationship patterns, and their exposure to media.
Children who experience early relationship instability are particularly vulnerable if they are pre-verbal or verbally delayed. Many court-involved children have been witness to or victims of domestic violence. In addition they may have suffered other forms of abuse and neglect. Frightened and unhappy children may resort to aggression to communicate their needs and/or protect themselves.
Traditionally, educators have used a model called Applied Behavior Analysis to look at behavior that has been deemed problematic or challenging. Applied Behavior Analysis is particularly valuable in assessing the repetitive disruptive, aggressive and disquieting behaviors often seen in emotionally fragile children. In the classroom, Applied Behavior Analysis allows the teacher to view behaviors in a non-judgmental and functional framework.
When using the model of Applied Behavior Analysis or ABC for short, the understanding is as follows. The A is the antecedent and represents what happens before the identified behavior occurs and where it happened. This includes the setting and the individuals who are present. B represents the behavior itself. C represents the consequence of the behavior. Consequence is a word that is often interpreted to mean punishment. In this case it does not mean punishment. It means what happens as a result of the behavior. What did the child gain from the behavior, attention? access to a toy? release from a disliked activity? physical contact with a peer or teacher?
The critical task for teachers is to identify the triggers that cause the child to utilize a particular behavior in a specific setting. It boils down to recognizing what happens before a problematic behavior occurs, mapping the characteristics of the behavior and then recognizing the outcome of the behavior. A typically developing child will generally avoid behavior that will result in a physical restraint by a teacher. A child who is experiencing relationship instability may bite a teacher with the intent of landing herself in a holding for safety because she does not know any other way of seeking physical contact.
Teachers who have a student who bites in their midst are pretty good at predicting when he or she is most likely to strike. They know the Antecedents well. Often they can predict how well a child’s day will proceed by observing the dynamic between the parent or caregiver and the child as the pair enters the classroom in the morning. The ritual of entering the room, settling in and saying goodbye illustrates for the teacher how well rested they are, and their state of relationship synchrony or discord.
The information gleaned from observing the morning ritual is helpful in planning a successful day for the child. Consider the child who has a history of biting. What might we predict on a morning when the parent roughly removes the snow boots and winter coat and then storms off without a kiss or even making eye contact with her child? The parent shows real signs of stress and frustration. Will the child be more likely to aggress against other children or teachers that morning? Is he likely to lash out when he is tired, hungry, or over excited? Do certain children trigger his tendency toward aggression? Is there a particular toy that always causes him to get into conflict? If you can manage to keep in mind that small children often lack the capacity to communicate in ways other than physical expression you will be better equipped to educate and protect the children you serve.
Finally, all of us who work with children know that consistency, flexibility and creativity are the keys to managing challenging behaviors. It is helpful to keep in mind that children who bite, kick, push and wrangle furniture are desperately trying to communicate something about their internal experience. They need us to see what they are doing on multiple levels.
In closing it is important to reaffirm that it is no small miracle that educators who work with behaviorally challenged children often have very good ‘gut’ feelings about managing those children. However, utilizing an organized framework like Applied Behavior Analysis can help teachers and caregivers alike in understanding on a micro level the range of factors that effect behavior. Mapping out behaviors in the context of analysis allows for the construction of intervention plans that help a child feel safe and contained at school. When a child learns to experience a greater sense of stability and control at school it is often the first step in creating an opening for improved relationships with everyone in the child’s life, including an improved sense of self worth and self efficacy.
Child Sexual Abuse: Problematic, Yes; Traumatic, Not Necessarily
Jean Mercer, Ph.D.
Richard Stockton College of New Jersey
Susan Clancy’s important book “The Trauma Myth” (New York, Basic Books, 2009) is drawing the critical fire of a number of people who have not given it the careful reading it deserves. Some of these critics have claimed that Clancy argues against any deleterious effects of sexual molestation in childhood--- that she defends pedophiles, and even that she is a pedophile herself or that she blames child victims for the behavior of sexually-exploitative adults. These statements are nonsense, and I am going to attempt to counter them.
“The Trauma Myth” emphasizes repeatedly the clear evidence that childhood experiences of sexual exploitation by adults are associated with a long list of later problems, including mood disorders, anxiety disorders, personality disorders, relationship and sexual problems, eating disorders, self-mutilation, and so on. Because one in five children is reported to have experienced sexual abuse (and probably there are more, unreported, cases), such abuse is responsible for significant numbers of mental health problems. It’s important that we learn how to prevent it and to treat its results, not only for the sake of individuals but for the mental health of the whole population. To prevent child sexual abuse and treat problems that result from it, we need to have a real understanding of how these experiences cause bad outcomes. However, much work in this area is based on the assumptions of trauma theory, which attributes many mental health problems to the past experience of severe pain and fear, and trauma theory may not provide a good framework for understanding the impact of sexual molestation in childhood.
Clancy is not the first to point out that children’s sexual experiences with adults are not necessarily experienced as traumatic (severely painful or terrifying) at the time when they occur. But her interview research with adults who had been molested as children clearly showed a continuum of child experiences, ranging from terror and pain at one end, through puzzlement without distress in the middle, to physical and emotional gratification at the opposite end. In fact, most of her interviewees reported that in childhood, at the time of the event, they were not frightened or in pain. The abuser’s actions did not involve force or even penetration of any kind, but were generally limited to rubbing, kissing, or fondling of genitals, nor did most of the abusers threaten the children in any way. Nevertheless, those adults, as well as the ones who had experienced trauma, reported symptoms related to their experiences, and now felt that the sexual event had had a deplorable effect on them.
The question Clancy raises is this: if the abused children did not at the time experience the event as traumatic, how can we explain the connection to their present symptoms? We can’t do this in any simple way by means of applying trauma theory. To make trauma theory work in this context, we would have to add to it the concept of repressed memories-- to say, for example, that the adults Clancy interviewed were really terrified and hurt, that they have repressed and can’t report that part of the experience, but that in its repressed form the memory still affects their mental health. Taking that approach, however, we would come up against an even more complicated issue: why is it that people who were actually hurt and terrified (according to independent evidence) don’t repress what must be a hideous memory? Using the repressed memory concept, then, we find ourselves having to explain why a really terrible experience is remembered with all the emotional factors intact, but a less painful and frightening situation leads to repression of memories of emotion. Although U-shaped functions of this kind are not unknown in psychology, this one does not seem to make much sense.
Clancy concludes from this line of reasoning that trauma theory and the concept of repression are not good ways to explain the most common situations involving childhood sexual abuse and its aftermath in adulthood. Because they are not good ways, they have not done much to help us either prevent or treat the effects of child sexual abuse. We need to explore these matters much more carefully, and, Clancy says we need to make sure that our explanation involves the child’s point of view, which has generally been ignored. To understand that children’s group and individual characteristics affect the sex abuse situation is a far cry from “blaming” the child.
Clancy makes several points about children’s understanding of the world and the ways it can make the child’s view of non-painful sexual abuse rather different from an adult’s. She stresses the ignorance of children about sexuality and their failure to comprehend what an adult wants or what he or she is doing. Why heavy breathing and a red face, for instance? A child has probably observed these things before, but in quite different contexts. The puzzled conclusion may simply be that this is strange and perhaps it’s one of those embarrassing things that you get in trouble for talking about, so best to just keep it to yourself.
Importantly, Clancy also emphasize that there are characteristics of individual children that may make them more likely to be the victims of repeated abuse which they do not report. No, she does not say these children are “seductive”; what she does say is that they are lonely, unsupervised, and grateful for adult attention. They respond to the fascinated attentiveness of the potential abuser as a delightful experience, in sharp contrast with the indifference their caregivers may show. Without experiences of pain or fear, why should they reveal what seems to them like a romance to familiar adults who will probably cause some trouble?
Finally, Clancy says something that is for many readers the unspeakable: that given a kind, careful adult who treats them well, children may enjoy sexual experiences (we are not talking about penetration here, of course). I was reminded of a story I heard from a friend some years ago. She had left her 3-year-old boy with a 13-year-old boy babysitter, and when she came home she became aware that some sort of sex play must have been going on. All she could think of was to give the 3-year-old the old bromide, “if someone touches you and you don’t like it, just tell them to stop”--- to which the 3-year-old replied enthusiastically, “I liked it! When can he babysit me again?” And there you have it in a nutshell; sexual activity of the right kind is pleasurable for everybody at every age. Sexual predators know that very well, and if we want to stop their exploitation of children, we need to be honest about it too, and not to expect children to “tell on” someone who gives them pleasure.
“The Trauma Myth” is a serious effort to deal with child sexual abuse and its aftermath. I’ve had space here to give only the highlights of Clancy’s argument, but the book contains much more of interest, including a discussion of abuse prevention programs as they now exist. I hope readers will give “The Trauma Myth” the careful attention it deserves.
The Value of Play during Infancy and Early Childhood
Connie M. Tang, Ph.D.
Richard Stockton College of New Jersey
We are probably all quite familiar with the old saying that “all work but no play makes Johnny a dull boy.” Before we delve into the issue of play in infants and young children, let us think about the importance of play in adults’ lives: Can you imagine life that is all work but no play? Granted, as adults, our style of play has progressed to grander versions, such as playing with our beloved iPhone or the newest electronic gadget, or playing an online game. But the function of play stays the same: We play to relax, to experience excitement, to have fun, and to be rejuvenated. In infancy and early childhood, play serves all of the functions in adulthood, and more. During these earliest stages of human development, play is leisure, but play is also work.
That is right! For infants and young children, their job is to play. I bet that makes all of us quite jealous. If we say that the most important thing for adults is to work, for school age children is to study, then the most important thing for infants and young children is to play. Playing is preparation for studying, much like studying is preparation for work. So how does play prepare infants and young children for the world of studying, and later working as adults? First of all, playing promotes physical development. Through play, infants and young children get to practice their gross and fine motor skills. They learn to perfect their ability to walk, run, jump, to hold a pen, to glue things together, and to use a pair of scissors.
Second, play is important for infants’ and young children’s cognitive development in terms of thinking and language. According to Swiss psychologist Jean Piaget’s cognitive developmental theory, infants think with their sensations and motor activities, whereas pre-school children think with images, words, and other types of symbols. At the preschool age, children still cannot think things through without acting them out. In order for children’s thinking to mature so that they can mentally problem solve, they first need to have plenty of practices with “acting out”. The more they tangibly experience how things work in real life, the more they are able to imagine how things can work. Play is also critical for infants’ and young children’s language development. Like many other aspects of development, language is believed to have a sensitive period, and this period often includes infancy and early childhood. That is why starting from the first words around age one, children progress rapidly into speaking in simple sentences at age two, and speaking in more complex sentences at age three or four. By the end of the preschool period, children usually display a great deal of knowledge regarding phonology, semantics, syntax, and pragmatics, and their speech can be adult like. Evidence for language having a sensitive period also lies in the finding that learning a second language is often the easiest during infancy and early childhood. Therefore, encouraging infants and young children to play “house” and to play with one another encourages their language development.
Finally, play is important for social and emotional development. When infants and young children play with one another, they learn to take turns, to negotiate, to empathize, and to look at things from someone else’s point of view. When infants and children play “house”, they often “act out” experiences and emotions that they are not able to express verbally (which incidentally is a premise for play therapy), thereby allowing them the opportunity to learn to label their emotional experiences with words. In short, through play, infants and young children not only experience joy, excitement, and the relief of tension; they also learn how to share, to team play, and to get along with others.
Now that we have established the importance of play, we will turn our attention to the types of play and how these play types can make unique contributions to certain aspect of development. There are generally six types of play (Santrock, 2010).
Sensorimotor play mostly describes infants’ play, when they engage in behaviors such as tracking a moving mobile and shaking a rattle. Sensorimotor play is important for infants’ physical and cognitive development.
Practice play occurs throughout life, when we repeat a newly learned behavior, such as climbing stairs or practicing bowling swings on Wii. Practice play augments physical development.
Pretense or symbolic play occurs mostly during the preschool years, such as when boys pretend to be police officers arresting bad guys. Pretense play is very important for cognitive and social development.
Constructive play occurs most often during the preschool and elementary school years, combining the features of sensorimotor, practice, and pretense plays. It is the type of play when children create a product or a solution. Many preschools (such as the Free-to-be Childcare Center at Stockton College) engage children in constructive play when they design themed projects, such as the bird project, the box project, and the concept “big” project. Since constructive play often combines sensorimotor, practice, and pretense plays, it promotes physical, cognitive, and social development.
Social play involves interacting with peers and occurs throughout life. Social play can be further classified into unoccupied, solitary, onlooker, parallel, associative, and cooperative plays. The terms given to these subtypes of social play are quite self explanatory, although I would like to mention cooperative play in particular. Cooperative play is when children and adults do things together as a group. Many themed projects designed by preschools, such as the previously mentioned bird project, box project, and the concept “big” project, can also be cross-classified as cooperative play. Overall, social play stimulates social development throughout the human life span.
Games are defined as activities that are pleasurable, involve rules, and often entail competition. Games are played most often during the elementary and middle school years, such as water balloon tossing and board games. Depending on the type of games, games can be valuable for physical, cognitive, and social development.
In the recent decades, several new trends in the area of play surfaced. Two, in particular, are relevant to our discussion on the value of play in infants and young children. First, television has become an important part of American life. Other than sleep, young children spend time watching television more than any other activity. Then, is television watching play? A distinctive feature of television watching that is different from all of the other types of play is that television watching is passive, whereas traditional types of play are active. I would therefore argue against classifying television watching as play. With today’s television programming becoming more interactive, however, I am open to a mind change. Until then, I regard television watching as leisure, but not play.
Second, today’s toys have multiplied in number, style, and kind, and are becoming ever more specialized. Just about anything that you might encounter in real life, there is now a toy version of it, such as toy microwave oven, toy vegetables, toy cash register, etc. Having so many toys and so many choices are of course welcomed news to sparkly young eyes, although one has to wonder whether this trend is also beneficial to infants and young children’s growth and development. I wonder, for example, whether already possessing a plastic telephone will diminish a young child’s motivation to take a banana and use it as a telephone, thereby decreasing imagination during pretense play. Likewise, many experts of child development have opined that multi-purpose toys (such as blocks) are best. Trends come, and trends pass, but across the human life span, play will continue. For infants and young children, play will always be the most important thing in their day to day life.
Reference:
Santrock, J. W. (2010). Children (11th ed.). Boston, MA: McGraw Hill.
Hudson Perinatal Doula Fellowship Program
Summer 2010
Inspire. Engage. Empower.
Learn the healing arts of labor support; experience the community of supportive women;
Hudson Perinatal is a 501 (c) 3 non profit agency serving the needs of childbearing families in Hudson County, NJ. Through the State of New Jersey's Access to Care program, we are immediately seeking applicants for the HUDSON COUNTY DOULA FELLOWSHIP. Running part time from June 15-August 15, 2010, this community based doula program will be part of the solution to improving better birth outcomes for Hudson County.
WHAT IS A DOULA?
An expectant mother receives medical care and medical management from a health care provider in pregnancy, labor and birth. A doula, a Greek word meaning 'to serve women,' works alongside a medical care provider to compliment the woman's pregnancy through therapeutic touch, relaxation practices and stress reduction tools. Doulas continue to make a difference in improving maternity care.
The Hudson County Doula Fellowship is a life changing, affirming, and exciting program of learning to serve pregnant women in Jersey City and their families at their pre natal, labor and post partum time. Doulas no not provide medical or clinical care, and work alongside a laboring woman and her partner and medical caregiver. In pregnancy, a doula mentors an expectant mother in asking questions at prenatal medical visits, creating healthy food choices, sharing stress reduction practices and being a resource for other social, emotional and physical needs. During labor, a doula uses comfort measures to support the laboring woman alongside the midwife or doctor. Finally, in the postnatal time, a doula assists in breastfeeding support, empowering strategies in newborn care and the emotional transition to motherhood.
WHAT IS THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM?
Women selected to participate in the Hudson Perinatal Doula Fellowship program receive at no cost, a national doula training program from DONA International. In addition to the DONA curriculum the Hudson Perinatal Doula Fellowship will receive at no cost more extensive training and education in a myriad of topics from breastfeeding peer counseling skills, childbirth education, massage/therapeutic touch, integrative nutrition and the wise woman tradition of being present at labor and births. Unique to this training, the doula workshops includes the foundations of creating helping, empathetic relationships, healing arts for labor and gentle body work to embrace that pregnancy is in fact a rite of passage. The Hudson Perinatal Doula Fellowship program covers all training costs, required books, doula supplies for comfort measures at births, the fee for DONA International certification, and coaching to submit the paperwork for your national doula certification. Finally, the Hudson Perinatal Doula Fellows will be mentored on working with their expectant clients and the births. In short, it is a supportive and encouraging program with providing an incubator of information and inspiration for your success.
WHAT IS THE TIME COMMITMENT OF THE HUDSON PERINATAL DOULA PROGRAM?
This program is designed to help you flourish honoring your other vocations and family commitments.
The Hudson Perinatal Doula Fellowship runs June 15-August 15, 2010. Applications are accepted immediately on a rolling basis and can be downloaded atwww.HudsonPerinatal.org The fellowship will be open to 35 women who commit to the time frame of program.
1) In addition to the DONA Doula Training dates, which are full days, 8 am-5 pm June 21-24, 2010, the women awarded the Hudson Perinatal Doula Fellowship commit to six hours a week from June 15-August 15, 2010 either
Mondays, from 10:00 am-4:00 pm
OR
Tuesday and Thursday evenings, 6:30 pm-9:30 pm.
The program will acknowledge adult learning styles and be taught in an experiential, engaging manner. We value the work in the world you have already done.... In short, you are bringing your gifts to the entire training and enhancing yourself and every woman you will serve. We are excited and thrilled to serve you so you can participate in the timeless, compassionate art of serving women. You bring value to people's lives and entering the art of doula work is truly a sincere commitment in changing access to health care and better birth outcomes for women, men, babies, and our community.
2) In addition to the nurturing workshop attendance, reading materials and resource acquisition, the selected doulas will commit to immediately serving three expectant women and attending those three births in Jersey City at medical centers.
WHO CAN APPLY TO THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM?
You can! No pre-requisites required, just a sincere commitment to the dates listed above. No prior experience is required, just an enthusiasm to commit to the community of other doulas and the needs of pregnant women in Jersey City. Arriving on time and staying for each workshop date is required and an obligation to graduate from the program.
WHAT MAKES THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM DIFFERENT THAN OTHER DOULA TRAININGS?
Unlike basic birth doula trainings, the Hudson Perinatal Doula Fellowship will expand your content knowledge and confidence in social justice, women's health, perinatal health disparities and the healing arts.
We look forward to getting to know your passions and your possibilities. Please download the application as a tool of self inquiry and self reflection. We embrace your journey and the unique gifts you offer this world and will offer all women. You will be welcomed on this path of doula work in the deepest of gratitude.
WHERE IS THE LOCATION OF THE HUDSON PERINATAL DOULA FELLOWSHIP PROGRAM?
Jersey City, NJ; easily accessible from mass transportation.
WHOM DO I CONTACT FOR MORE INFORMATION:
Jill Wodnick, M.A., CD(DONA) Community Doula Coordinator, Hudson Perinatal
Jwodnick@hudsonperinatal.org
HOW DO DOULAS IMPROVE BIRTHS?
In their book, Mothering The Mother: How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth, Marshall Klaus, John Kennell and Phyllis Klaus summarize scientific studies which have been carried out on the advantages of doula-assisted births.
Reduced the overall cesarean rate by 50%
Reduced the length of labor by 25%
Reduced oxytocin use by 40%
Reduced the use of pain medication by 30%
Reduced forceps deliveries by 40%
Reduced requests for epidural pain medication by 60%
Reduced incidences of maternal fever
Reduced the number of days newborns spent in NICU (neo-natal infant care unit)
Reduced the amount of septic workups performed on newborns
Resulted in higher rates of breastfeeding
Resulted in more positive maternal assessments of maternal confidence
Resulted in more positive maternal assessments of maternal and newborn health.
Expectant parents can find a doula by searching www.DONA.org or other pregnancy websites.
Articles from "Nurture Notes", Fall 2009
Breastfeeding: True or False? (Test Yourself)
Jean Mercer, Ph.D.
Richard Stockton College of New Jersey
The important human function of breastfeeding is the subject of many myths and misunderstandings. A fascinating meld of biological and behavioral events, it’s worth the attention of everyone interested in early development, even those who will not be participating at the adult end. Test your knowledge of breastfeeding by reading these “true or false?” questions.
1. Breastfeeding helps the baby resist infectious diseases. True or false?
Very true! Although babies are born with a supply of antibodies they got from their mothers’ immune systems, those antibodies can only protect against diseases the mother had already been exposed to, not exposure to new diseases after the birth. In addition, those antibodies will have diminished by the time the baby is about 8 months old, a point at which infants do not yet do a good job of making their own antibodies. The nursing mother acts as an “auxiliary immune system” to her infant. She supplies more of the antibodies she already had, and if the nursing pair are exposed to a new disease, the mother’s efficient immune system goes to work to produce antibodies and pass them on to the baby in her milk. What if the baby is exposed to something, and the mother not exposed to it? Don’t worry, she will be exposed quickly, because the physical intimacy of nursing (and other infant care) means she will come into contact with the baby’s mucus, urine, and feces.
Do note that the baby can still use this kind of help toward the end of the first year. Babies who live in clean conditions, with modern food supplies and access to modern medicine, are less affected by a lack of breastfeeding, but those living in primitive conditions may die of infections that could have been prevented by breastfeeding.
2. Nursing mothers need to eat a lot more than usual. True or false?
It depends on the conditions. If the mother was well nourished during the pregnancy, she has laid down extra fat and extra calcium in her bones, and these will be used to support lactation, so she needs little if any extra food. If the mother is living at a subsistence level, she will need extra calories to compensate for those consumed by the baby. An ounce of human milk has about 20 calories on the average, so you can do the math, considering the amount of milk consumed by babies of different sizes and ages.
The nursing mother does need to drink a lot more fluid than when she is not breastfeeding. Every ounce of fluid the baby takes needs to be replaced. Many nursing mothers automatically go to drink a glass of water before they pick up the baby to nurse, or have a cup of tea while breastfeeding. Traditionally, nursing mothers drank dark beers like porter, which supplied extra fluid and a hefty dose of B vitamins, and gave everyone a nice nap too--nowadays we tend to frown on this, and certainly this practice would have its dangers if it occurred more than once in a while.
3. You can’t breastfeed a baby once he or she gets teeth. True or false?
False. Babies can easily be taught not to bite the nipple, if the mother is vigilant (and believe me, after one bite she WILL be vigilant). Biting and sucking take different jaw movements, and an attentive mother can see when a sucking baby re-adjusts its jaw position in preparation for a chomp. The mother then gently inserts her finger between the baby’s jaws, toward the back of the mouth. This breaks the suction, so the baby cannot get any milk, and if he or she bites down, there’s not much satisfaction, because those itchy teething gums are in the front. Within 24 hours, the baby will have learned that although you can bite lots of things, you can’t bite that nipple--it just doesn’t work.
Nursing mothers really have to teach biting babies not to bite, or their nipples can actually be damaged, and the baby will have to be weaned from the breast.
4. Nursing babies don’t like the milk that’s flavored by strong-tasting foods their mothers have eaten. True or false?
This is mainly false, with some possible individual exceptions. The taste researchers Menella and Beauchamp fed a group of nursing mothers an all-garlic-flavored lunch, waited a couple of hours, and then timed how long the babies nursed. When they compared this to nursing time after a bland lunch, they found that the babies actually nursed longer when the milk had a garlic flavor.
There may be some individual differences, with particular babies possibly disliking certain flavors. One important point is that when a nursing mother has had a mild breast infection, the milk on that side seems to be a little saltier than usual, and babies may not care for it--to the mother’s frustration, as frequent thorough nursing is a help in clearing up these problems.
How Can We Help to Prevent Child Abuse or Neglect?
Diane E. Ristaino
Prevent Child Abuse New Jersey
On January 1, 2009, New Jersey citizens rang in the New Year with headlines that shocked us with stories of child abuse. On New Year’s Day, we read of a woman accused of hitting a 10-week-old child in the head with a cell phone as she argued with her husband. Just over a week later, a 3-year-old was hospitalized in critical condition after the toddler suffered internal bleeding, lacerations to his liver and stomach and bruising to his forehead, arms and trunk.
I am haunted by these reports. It is difficult to imagine the amount of rage and incoherence one would have to feel to strike a newborn child or toddler. However, New Jersey’s children have long been vulnerable victims to intentional harm. In 2007, the New Jersey Division of Youth and Family Services substantiated 9,900 child abuse and neglect incidents. Twenty-three children died as a result of abuse or neglect in 2006.
While there is never an excuse for hurting a child, the causes of abuse and neglect are known, varied and often preventable. Mental illness, drug and alcohol abuse, domestic violence and a parent’s own childhood experience can lead to abusive behaviors. However, there are also far more common life circumstances that can exponentially increase the risk of abuse. Isolation, teen pregnancy, inexperience with children, low self-esteem, joblessness, lack of education, poverty, homelessness, insufficient access to healthcare, an unexpected or difficult pregnancy, and post-partum depression are some of the stressors that may contribute to abuse and neglect. As the presence of these factors increases, so does the substantial risk for abuse. The prevalence of family conflict and domestic abuse always rises during the holiday season. And, the incidence of these factors is increasing among New Jersey’s families as a direct result of the recent downturn in the economy.
While we may never know whether any specific incident of reported abuse was avoidable, we can all make a resolution to support families and reduce some of the burdens that lead to abuse and neglect. For example,
• Introduce yourself to a family who may be new to your neighborhood and make them feel welcome. Families feel safer and less stressed when they know support is nearby.
• Check-in with a new parent a few weeks after their new baby arrives. Families often go from receiving a lot of support when a baby is born only to be left on their own months later. Ask how they are doing, offer to run an errand or baby-sit long enough for them to take a shower or do laundry.
• If you see a parent and young child in conflict, smile and say something nice to either of them. Your interruption may just offer the time or space they need to “de-escalate.”
• Publically congratulate a parent for doing a good job – praising a parent can raise their self-esteem, reinforce their positive skills, and make them feel good about their commitment to family.
• And, as always, if you suspect child abuse or neglect, call 1-800-792-8610 or 911 immediately.
There are many parenting services available to families through Prevent Child Abuse New Jersey’s home visitation, parent involvement, parenting education workshops and teen parenting programs. Education and training for professionals is also available. Our prevention programs help reduce risk factors and build resiliency in families to prevent abuse from ever occurring. Learn more about how you can help by visiting www.preventchildabusenj.org or calling 1-800-CHILDREN.
It’s your turn to make a difference – what will you do to help prevent child abuse?
Upcoming Conference
XVIIth Biennial International Conference on Infant Studies
Baltimore, Maryland, March 10-14, 2010
New Blog by Our Very Own!
http://www.psychologytoday.com/blog/child-myths
Jean Mercer, Ph.D.
Jean Mercer received her Ph.D. in general experimental psychology from Brandeis University. She taught developmental psychology at Richard Stockton College for many years. For some time the president of the New Jersey Association for Infant Mental Health, she is the author of a textbook on infant development and of Understanding Attachment, a general-interest book about early emotional development. Her interest in pseudoscience and folk beliefs about children led to the publication of the co-authored book Attachment Therapy on Trial her 2009 supplementary textbook, Child Development: Myths and Misunderstandings. She has been instructed about child development by two sons and two stepsons, and two grandsons are continuing her education.
Translating Research into Action: Supporting Sensitive Caregiving from Birth
Cynthia A. Frosch, PhD & Margaret Tresch Owen, PhD
We have all heard the importance of sensitive caregiving for young children’s development. But what does sensitive caregiving really mean? What does sensitive caregiving actually look like? And how can we support parents and caregivers in becoming more sensitive in their interactions with young children?
Whether parent or childcare provider, sensitive care – care that is responsive and in-tune to the child’s needs -- consistently predicts more secure attachment relationships and better social and emotional outcomes for young children. For example, in a longitudinal study of over 1,000 children, the NICHD Early Child Care Research Network reported that maternal sensitivity was the strongest predictor of secure attachment in infants and preschoolers (NICHD ECCRN, 1997; 2001), and children who received more responsive and stimulating care from their mothers had higher scores on cognitive, language, social-emotional, and peer outcomes at all ages from 15 to 54 months of age (NICHD ECCRN, 2006). Quality of care in other settings also contributes to children’s development. For example, findings from the NICHD Study of Early Child Care indicate that in addition to sensitive parenting, quality of non-parental care, comprising the components of sensitive caregiving, relates to more positive cognitive, language, and social skills (NICHD ECCRN, 1998; 2000; 2006).
The literature on caregiver sensitivity indicates that children who experience more sensitive care are more capable of regulating their impulses and better able to control and modulate their attention (Gilliom, Shaw, Beck, Schonberg, & Lukon, 2002; NICHD ECCRN, 2005). With these skills, they are better able to develop good work habits in school, and become more self-reliant learners. Consequently, they show better school achievement and are more likely to experience success in school (e.g., NICHD ECCRN, 2008). Thus, the quality of caregiving that children experience is a critical factor for understanding their development.
Given the importance of providing sensitive care, how can parents and caregivers come to understand their own behavior and increase their sensitivity when interacting with young children? For example, it may be difficult for some parents or caregivers to imagine what a sensitive response would look like in a particular situation. Faced with a crying or fearful baby, should the parent try to comfort the child or let the child work it out alone? What if a baby looks away during face-to-face play with a caregiver? Should the caregiver try harder to regain the child’s attention or allow the child to take a break before continuing on with play? What if a child clearly signals “no” to a game that the caregiver really wants the child to play? Should the caregiver follow the child’s lead or persist with her own agenda because after all, she is the adult?
These are just a few of the everyday situations we address with The READY Method – a visual guide to interacting with young children. Our goal in developing The READY Method was to create a tool that showed parents, caregivers, and educators what sensitive caregiving really looks like and also, what it does not look like. For us, the experience of coding or scoring hundreds of parent-child interactions over the years, and training and supervising others to observe and code (or score) parent-child and caregiver-child interactions has been very powerful in shaping the ways we think about early parent-child and caregiver-child relationships. We wanted to translate the research and what we had learned into an accessible, visual tool for parents, caregivers, and educators. Thus, the core of the Method is a “training tape” that illustrates 5 components of sensitive caregiving: Respond, Engage, Acknowledge, Develop, and Yield. READY caregiving is responsive, engaging behavior, that acknowledges the child’s perspective, supports the child’s development, and yields when possible in order to meet the child’s needs in a sensitive manner.
The READY Method DVD features 37 vignettes of parent-child interaction with their young children who range in age from 5 months to 3 years. We filmed mothers and fathers interacting with their children and then used snippets from the sessions to illustrate interactions that are sensitive (what we call “high examples”) and insensitive (what we call “low examples”) for each of the 5 READY Method dimensions. For the purposes of filming the “low” examples, we asked parents to respond in two ways that were not sensitive. First, we asked parents to become overly directive, controlling, or intrusive. Second, we asked parents to act in an emotionally detached, distracted, and distant way from their child’s signals and needs.
In this way, across the READY Method dimensions, we have captured the two different pathways to insensitivity that we have coded in our observational research. The first form, intrusiveness, reflects a parent’s tendency to control the interaction, enforce his or her agenda on the child, regardless of the child’s response, and interfere with the child’s autonomous strivings. Intrusiveness is often linked with parental hostility and anger with the child, when the child does not comply or becomes frustrated or overwhelmed by the parent’s barrage of directives. The second form of insensitivity, detachment, reflects a lack of a supportive physical and emotional presence for the child.
Although we asked parents to act in less positive ways for the purposes of filming the low examples, we could not control the child’s response in each of the vignettes included on the DVD. The child’s behavior was spontaneous and unscripted. What we found interesting was that, when faced with a parent who was emotionally unavailable, several children demonstrated signs of distress. When faced with a parent who was controlling and intrusive, many of the children withdrew emotionally or sometimes physically by turning away or walking away. In contrast, when the parent was responsive to the child’s cues, interactions were marked by shared smiling and mutual engagement. These contrasts in child and parent behavior clearly illustrate the difference that sensitive and responsive caregiving can make in relationships.
And while the participants in the DVD were parents, the concepts illustrated with The READY Method are equally applicable to all those who care for and interact with young children – from parents to grandparents to childcare providers. When creating the Method, we also wanted to support parents in reflecting on what they bring to their interactions with young children and also what the child brings to the interaction. Toward this end, we created a companion book with exercises to support the parent or caregiver in understanding themselves and their children better.
When parents and caregivers begin to incorporate The READY Method into their relationships with young children, they may find it helpful to choose one or two dimensions to focus on initially. As they experience increased awareness and success with their first one or two dimensions, they may find it easier to incorporate the other dimensions. Increasing sensitive behavior is possible and intervention studies designed to increase sensitivity via video feedback with both parents and child care providers have proven promising (e.g., Juffer, Bakermans-Kranenburg, & van IJzendoorn, 2007). And we suggest that the experience of seeing sensitive parenting in action and reflecting on the characteristics that parents and children bring to their relationships can be a powerful tool for supporting sensitive caregiving and ultimately, the development of strong parent-child relationships.
References and Suggested Reading:
Gilliom, M., Shaw, D., Beck, J., Schonberg, M., & Lukon, J. (2002). Anger regulation in disadvantaged preschool boys: Strategies, antecedents, and the development of self-control. Developmental Psychology, 38, 222-235.
Juffer, F., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2007). Promoting positive parenting: An attachment-based intervention. New York, NY: Taylor & Francis Group/Lawrence Erlbaum Associates.
NICHD Early Child Care Research Network (1997). The effects of infant child care on infant-mother attachment security: Results of the NICHD Study of Early Child Care. Child Development, 68, 860-879.
NICHD Early Child Care Research Network (1998). Early child care and self-control, compliance, and problem behavior at 24 and 36 months. Child Development, 69, 1145-1170.
NICHD Early Child Care Research Network (2000). Early child care and children’s cognitive and linguistic development over the first three years. Child Development, 71, 958-978.
NICHD Early Child Care Research Network. (2001). Child care and family predictors of preschool attachment and stability from infancy. Developmental Psychology, 37, 847-862.
NICHD Early Child Care Research Network. (2005). Predicting individual differences in attention, memory, and planning in first graders from experiences at home, child care, and school. Developmental Psychology, 41, 99-114.
NICHD Early Child Care Research Network. (2006). Child-care effect sizes for the NICHD Study of Early Child Care and Youth Development. American Psychologist, 61, 99-116.
NICHD Early Child Care Research Network. (2008). Mothers' and fathers' support for child autonomy and early school achievement. Developmental Psychology, 44, 895-907.
Cynthia A. Frosch, PhD is a child and family development consultant and the Community Liaison for the Center for Children and Families at the University of Texas at Dallas. Margaret Tresch Owen, PhD is Professor of Psychology and Program Head for Human Development and Early Childhood Disorders at the University of Texas at Dallas. To learn more about the Center for Children and Families, please visit: http://ccf.utdallas.edu. To read more about The READY Method, please visit: www.ReadyMethod.com.
New!!!
Post Graduate Certificate Program in Infant and Early Childhood Mental Health
The primary focus of Infant Mental Health is the connection between infants (0-3) and their parents, the unique contributions each member of the pair makes to this dynamic, yet vulnerable process and problems or failures in attachment that sometimes occur.
Infant Mental Health is an interdisciplinary field concerned with the optimal physical, social, emotional, and cognitive development of an infant, within the context of their primary caring relationships. The infant is viewed within primary caregiving relationships. This pair or
“dyad” is the focus of assessment and interventions when needed. Development continues during the preschool years (3-6), with growth in play, cognition, emotion, communication, and self-regulation linked to the nature of the child’s relationships. In our training and clinical services,
we honor the traditions established by the late Selma Fraiberg and Thea Bry.
The curriculum emphasizes the following areas:
• Normal development in infants and preschool age children, the nature of human attachment
and disorders of attachment.
• Multi-disciplinary diagnostic assessments of caregiver-child dyads, along multiple
developmental lines.
• Infant-Parent (dyadic) psychotherapy and group psychotherapy.
• Unique needs of special populations, including teenage pregnancy, early separations, foster care, and adoptions.
• Training in methods of research and clinical case study.
Who is this certificate program for?
The post-graduate certificate program is designed for practitioners in the fields of psychology,
counseling, social work, education, pediatrics, nursing and other allied disciplines whose careers in their area of licensure would benefit from specialized training and supervisory experience in Infant and Early Childhood Mental Health.
The certificate program will afford participants an opportunity to:
• Acquire essential family/dyadic assessment and intervention skills.
• Learn techniques for integrating infant and preschool mental health principles and practices into clinical, child care, educational and community settings.
• Build skills needed to educate others about the needs of infants, toddlers, preschool children and their families, as well as the skills required to influence policies that impact the mental health of children.
The curriculum encourages candidates to develop applications for use within the scope of their professional licensure and practice. Accordingly, the curriculum and certificate do not permit the graduate to engage in professional activities outside the scope of their professional license or credential.
What are the Certificate Requirements?
Didactic Requirements (10 credits)
The three required courses are:
• Conceptual Foundations of Infant and Early Childhood Mental Health: Theory and Clinical
Practice (3 credits)
• Infant and Preschool Mental Health: Clinical Assessment and Research (4 credits)
• Couple and Family Dynamics: Systemic Perspectives (3 credits)
Supervised Practicum - Minimum 20 hours
Each post-graduate student will independently arrange his/her practicum under the supervision
of faculty. The practicum may include infant parent assessments, interventions and
experiences with preschool-age children in individual, family and group modalities.
For non-clinical candidates, supervision will address the ways in which infant mental health
principles, relationship-based services and reflective practices can be integrated into work
within their professional field.
Integrated Case Report or Project
All clinical students will be required to complete an integrated case report based upon a child/
family case from their practicum. Non-clinical candidates will develop a final project that
involves a comprehensive program in which an infant mental health perspective is integrated
into a training, service or policy program.
For further information, fee schedule and
application, contact:
THE YCS INSTITUTE
for Infant and Preschool Mental Health
60 Evergreen Place – 10th Floor
East Orange, New Jersey 07018
dsquadron@ycs.org
973-395-5500 Ext. 309
www.ycs.org
Jean Mercer, Ph.D.
Richard Stockton College of New Jersey
The important human function of breastfeeding is the subject of many myths and misunderstandings. A fascinating meld of biological and behavioral events, it’s worth the attention of everyone interested in early development, even those who will not be participating at the adult end. Test your knowledge of breastfeeding by reading these “true or false?” questions.
1. Breastfeeding helps the baby resist infectious diseases. True or false?
Very true! Although babies are born with a supply of antibodies they got from their mothers’ immune systems, those antibodies can only protect against diseases the mother had already been exposed to, not exposure to new diseases after the birth. In addition, those antibodies will have diminished by the time the baby is about 8 months old, a point at which infants do not yet do a good job of making their own antibodies. The nursing mother acts as an “auxiliary immune system” to her infant. She supplies more of the antibodies she already had, and if the nursing pair are exposed to a new disease, the mother’s efficient immune system goes to work to produce antibodies and pass them on to the baby in her milk. What if the baby is exposed to something, and the mother not exposed to it? Don’t worry, she will be exposed quickly, because the physical intimacy of nursing (and other infant care) means she will come into contact with the baby’s mucus, urine, and feces.
Do note that the baby can still use this kind of help toward the end of the first year. Babies who live in clean conditions, with modern food supplies and access to modern medicine, are less affected by a lack of breastfeeding, but those living in primitive conditions may die of infections that could have been prevented by breastfeeding.
2. Nursing mothers need to eat a lot more than usual. True or false?
It depends on the conditions. If the mother was well nourished during the pregnancy, she has laid down extra fat and extra calcium in her bones, and these will be used to support lactation, so she needs little if any extra food. If the mother is living at a subsistence level, she will need extra calories to compensate for those consumed by the baby. An ounce of human milk has about 20 calories on the average, so you can do the math, considering the amount of milk consumed by babies of different sizes and ages.
The nursing mother does need to drink a lot more fluid than when she is not breastfeeding. Every ounce of fluid the baby takes needs to be replaced. Many nursing mothers automatically go to drink a glass of water before they pick up the baby to nurse, or have a cup of tea while breastfeeding. Traditionally, nursing mothers drank dark beers like porter, which supplied extra fluid and a hefty dose of B vitamins, and gave everyone a nice nap too--nowadays we tend to frown on this, and certainly this practice would have its dangers if it occurred more than once in a while.
3. You can’t breastfeed a baby once he or she gets teeth. True or false?
False. Babies can easily be taught not to bite the nipple, if the mother is vigilant (and believe me, after one bite she WILL be vigilant). Biting and sucking take different jaw movements, and an attentive mother can see when a sucking baby re-adjusts its jaw position in preparation for a chomp. The mother then gently inserts her finger between the baby’s jaws, toward the back of the mouth. This breaks the suction, so the baby cannot get any milk, and if he or she bites down, there’s not much satisfaction, because those itchy teething gums are in the front. Within 24 hours, the baby will have learned that although you can bite lots of things, you can’t bite that nipple--it just doesn’t work.
Nursing mothers really have to teach biting babies not to bite, or their nipples can actually be damaged, and the baby will have to be weaned from the breast.
4. Nursing babies don’t like the milk that’s flavored by strong-tasting foods their mothers have eaten. True or false?
This is mainly false, with some possible individual exceptions. The taste researchers Menella and Beauchamp fed a group of nursing mothers an all-garlic-flavored lunch, waited a couple of hours, and then timed how long the babies nursed. When they compared this to nursing time after a bland lunch, they found that the babies actually nursed longer when the milk had a garlic flavor.
There may be some individual differences, with particular babies possibly disliking certain flavors. One important point is that when a nursing mother has had a mild breast infection, the milk on that side seems to be a little saltier than usual, and babies may not care for it--to the mother’s frustration, as frequent thorough nursing is a help in clearing up these problems.
How Can We Help to Prevent Child Abuse or Neglect?
Diane E. Ristaino
Prevent Child Abuse New Jersey
On January 1, 2009, New Jersey citizens rang in the New Year with headlines that shocked us with stories of child abuse. On New Year’s Day, we read of a woman accused of hitting a 10-week-old child in the head with a cell phone as she argued with her husband. Just over a week later, a 3-year-old was hospitalized in critical condition after the toddler suffered internal bleeding, lacerations to his liver and stomach and bruising to his forehead, arms and trunk.
I am haunted by these reports. It is difficult to imagine the amount of rage and incoherence one would have to feel to strike a newborn child or toddler. However, New Jersey’s children have long been vulnerable victims to intentional harm. In 2007, the New Jersey Division of Youth and Family Services substantiated 9,900 child abuse and neglect incidents. Twenty-three children died as a result of abuse or neglect in 2006.
While there is never an excuse for hurting a child, the causes of abuse and neglect are known, varied and often preventable. Mental illness, drug and alcohol abuse, domestic violence and a parent’s own childhood experience can lead to abusive behaviors. However, there are also far more common life circumstances that can exponentially increase the risk of abuse. Isolation, teen pregnancy, inexperience with children, low self-esteem, joblessness, lack of education, poverty, homelessness, insufficient access to healthcare, an unexpected or difficult pregnancy, and post-partum depression are some of the stressors that may contribute to abuse and neglect. As the presence of these factors increases, so does the substantial risk for abuse. The prevalence of family conflict and domestic abuse always rises during the holiday season. And, the incidence of these factors is increasing among New Jersey’s families as a direct result of the recent downturn in the economy.
While we may never know whether any specific incident of reported abuse was avoidable, we can all make a resolution to support families and reduce some of the burdens that lead to abuse and neglect. For example,
• Introduce yourself to a family who may be new to your neighborhood and make them feel welcome. Families feel safer and less stressed when they know support is nearby.
• Check-in with a new parent a few weeks after their new baby arrives. Families often go from receiving a lot of support when a baby is born only to be left on their own months later. Ask how they are doing, offer to run an errand or baby-sit long enough for them to take a shower or do laundry.
• If you see a parent and young child in conflict, smile and say something nice to either of them. Your interruption may just offer the time or space they need to “de-escalate.”
• Publically congratulate a parent for doing a good job – praising a parent can raise their self-esteem, reinforce their positive skills, and make them feel good about their commitment to family.
• And, as always, if you suspect child abuse or neglect, call 1-800-792-8610 or 911 immediately.
There are many parenting services available to families through Prevent Child Abuse New Jersey’s home visitation, parent involvement, parenting education workshops and teen parenting programs. Education and training for professionals is also available. Our prevention programs help reduce risk factors and build resiliency in families to prevent abuse from ever occurring. Learn more about how you can help by visiting www.preventchildabusenj.org or calling 1-800-CHILDREN.
It’s your turn to make a difference – what will you do to help prevent child abuse?
Upcoming Conference
XVIIth Biennial International Conference on Infant Studies
Baltimore, Maryland, March 10-14, 2010
New Blog by Our Very Own!
http://www.psychologytoday.com/blog/child-myths
Jean Mercer, Ph.D.
Jean Mercer received her Ph.D. in general experimental psychology from Brandeis University. She taught developmental psychology at Richard Stockton College for many years. For some time the president of the New Jersey Association for Infant Mental Health, she is the author of a textbook on infant development and of Understanding Attachment, a general-interest book about early emotional development. Her interest in pseudoscience and folk beliefs about children led to the publication of the co-authored book Attachment Therapy on Trial her 2009 supplementary textbook, Child Development: Myths and Misunderstandings. She has been instructed about child development by two sons and two stepsons, and two grandsons are continuing her education.
Translating Research into Action: Supporting Sensitive Caregiving from Birth
Cynthia A. Frosch, PhD & Margaret Tresch Owen, PhD
We have all heard the importance of sensitive caregiving for young children’s development. But what does sensitive caregiving really mean? What does sensitive caregiving actually look like? And how can we support parents and caregivers in becoming more sensitive in their interactions with young children?
Whether parent or childcare provider, sensitive care – care that is responsive and in-tune to the child’s needs -- consistently predicts more secure attachment relationships and better social and emotional outcomes for young children. For example, in a longitudinal study of over 1,000 children, the NICHD Early Child Care Research Network reported that maternal sensitivity was the strongest predictor of secure attachment in infants and preschoolers (NICHD ECCRN, 1997; 2001), and children who received more responsive and stimulating care from their mothers had higher scores on cognitive, language, social-emotional, and peer outcomes at all ages from 15 to 54 months of age (NICHD ECCRN, 2006). Quality of care in other settings also contributes to children’s development. For example, findings from the NICHD Study of Early Child Care indicate that in addition to sensitive parenting, quality of non-parental care, comprising the components of sensitive caregiving, relates to more positive cognitive, language, and social skills (NICHD ECCRN, 1998; 2000; 2006).
The literature on caregiver sensitivity indicates that children who experience more sensitive care are more capable of regulating their impulses and better able to control and modulate their attention (Gilliom, Shaw, Beck, Schonberg, & Lukon, 2002; NICHD ECCRN, 2005). With these skills, they are better able to develop good work habits in school, and become more self-reliant learners. Consequently, they show better school achievement and are more likely to experience success in school (e.g., NICHD ECCRN, 2008). Thus, the quality of caregiving that children experience is a critical factor for understanding their development.
Given the importance of providing sensitive care, how can parents and caregivers come to understand their own behavior and increase their sensitivity when interacting with young children? For example, it may be difficult for some parents or caregivers to imagine what a sensitive response would look like in a particular situation. Faced with a crying or fearful baby, should the parent try to comfort the child or let the child work it out alone? What if a baby looks away during face-to-face play with a caregiver? Should the caregiver try harder to regain the child’s attention or allow the child to take a break before continuing on with play? What if a child clearly signals “no” to a game that the caregiver really wants the child to play? Should the caregiver follow the child’s lead or persist with her own agenda because after all, she is the adult?
These are just a few of the everyday situations we address with The READY Method – a visual guide to interacting with young children. Our goal in developing The READY Method was to create a tool that showed parents, caregivers, and educators what sensitive caregiving really looks like and also, what it does not look like. For us, the experience of coding or scoring hundreds of parent-child interactions over the years, and training and supervising others to observe and code (or score) parent-child and caregiver-child interactions has been very powerful in shaping the ways we think about early parent-child and caregiver-child relationships. We wanted to translate the research and what we had learned into an accessible, visual tool for parents, caregivers, and educators. Thus, the core of the Method is a “training tape” that illustrates 5 components of sensitive caregiving: Respond, Engage, Acknowledge, Develop, and Yield. READY caregiving is responsive, engaging behavior, that acknowledges the child’s perspective, supports the child’s development, and yields when possible in order to meet the child’s needs in a sensitive manner.
The READY Method DVD features 37 vignettes of parent-child interaction with their young children who range in age from 5 months to 3 years. We filmed mothers and fathers interacting with their children and then used snippets from the sessions to illustrate interactions that are sensitive (what we call “high examples”) and insensitive (what we call “low examples”) for each of the 5 READY Method dimensions. For the purposes of filming the “low” examples, we asked parents to respond in two ways that were not sensitive. First, we asked parents to become overly directive, controlling, or intrusive. Second, we asked parents to act in an emotionally detached, distracted, and distant way from their child’s signals and needs.
In this way, across the READY Method dimensions, we have captured the two different pathways to insensitivity that we have coded in our observational research. The first form, intrusiveness, reflects a parent’s tendency to control the interaction, enforce his or her agenda on the child, regardless of the child’s response, and interfere with the child’s autonomous strivings. Intrusiveness is often linked with parental hostility and anger with the child, when the child does not comply or becomes frustrated or overwhelmed by the parent’s barrage of directives. The second form of insensitivity, detachment, reflects a lack of a supportive physical and emotional presence for the child.
Although we asked parents to act in less positive ways for the purposes of filming the low examples, we could not control the child’s response in each of the vignettes included on the DVD. The child’s behavior was spontaneous and unscripted. What we found interesting was that, when faced with a parent who was emotionally unavailable, several children demonstrated signs of distress. When faced with a parent who was controlling and intrusive, many of the children withdrew emotionally or sometimes physically by turning away or walking away. In contrast, when the parent was responsive to the child’s cues, interactions were marked by shared smiling and mutual engagement. These contrasts in child and parent behavior clearly illustrate the difference that sensitive and responsive caregiving can make in relationships.
And while the participants in the DVD were parents, the concepts illustrated with The READY Method are equally applicable to all those who care for and interact with young children – from parents to grandparents to childcare providers. When creating the Method, we also wanted to support parents in reflecting on what they bring to their interactions with young children and also what the child brings to the interaction. Toward this end, we created a companion book with exercises to support the parent or caregiver in understanding themselves and their children better.
When parents and caregivers begin to incorporate The READY Method into their relationships with young children, they may find it helpful to choose one or two dimensions to focus on initially. As they experience increased awareness and success with their first one or two dimensions, they may find it easier to incorporate the other dimensions. Increasing sensitive behavior is possible and intervention studies designed to increase sensitivity via video feedback with both parents and child care providers have proven promising (e.g., Juffer, Bakermans-Kranenburg, & van IJzendoorn, 2007). And we suggest that the experience of seeing sensitive parenting in action and reflecting on the characteristics that parents and children bring to their relationships can be a powerful tool for supporting sensitive caregiving and ultimately, the development of strong parent-child relationships.
References and Suggested Reading:
Gilliom, M., Shaw, D., Beck, J., Schonberg, M., & Lukon, J. (2002). Anger regulation in disadvantaged preschool boys: Strategies, antecedents, and the development of self-control. Developmental Psychology, 38, 222-235.
Juffer, F., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2007). Promoting positive parenting: An attachment-based intervention. New York, NY: Taylor & Francis Group/Lawrence Erlbaum Associates.
NICHD Early Child Care Research Network (1997). The effects of infant child care on infant-mother attachment security: Results of the NICHD Study of Early Child Care. Child Development, 68, 860-879.
NICHD Early Child Care Research Network (1998). Early child care and self-control, compliance, and problem behavior at 24 and 36 months. Child Development, 69, 1145-1170.
NICHD Early Child Care Research Network (2000). Early child care and children’s cognitive and linguistic development over the first three years. Child Development, 71, 958-978.
NICHD Early Child Care Research Network. (2001). Child care and family predictors of preschool attachment and stability from infancy. Developmental Psychology, 37, 847-862.
NICHD Early Child Care Research Network. (2005). Predicting individual differences in attention, memory, and planning in first graders from experiences at home, child care, and school. Developmental Psychology, 41, 99-114.
NICHD Early Child Care Research Network. (2006). Child-care effect sizes for the NICHD Study of Early Child Care and Youth Development. American Psychologist, 61, 99-116.
NICHD Early Child Care Research Network. (2008). Mothers' and fathers' support for child autonomy and early school achievement. Developmental Psychology, 44, 895-907.
Cynthia A. Frosch, PhD is a child and family development consultant and the Community Liaison for the Center for Children and Families at the University of Texas at Dallas. Margaret Tresch Owen, PhD is Professor of Psychology and Program Head for Human Development and Early Childhood Disorders at the University of Texas at Dallas. To learn more about the Center for Children and Families, please visit: http://ccf.utdallas.edu. To read more about The READY Method, please visit: www.ReadyMethod.com.
New!!!
Post Graduate Certificate Program in Infant and Early Childhood Mental Health
The primary focus of Infant Mental Health is the connection between infants (0-3) and their parents, the unique contributions each member of the pair makes to this dynamic, yet vulnerable process and problems or failures in attachment that sometimes occur.
Infant Mental Health is an interdisciplinary field concerned with the optimal physical, social, emotional, and cognitive development of an infant, within the context of their primary caring relationships. The infant is viewed within primary caregiving relationships. This pair or
“dyad” is the focus of assessment and interventions when needed. Development continues during the preschool years (3-6), with growth in play, cognition, emotion, communication, and self-regulation linked to the nature of the child’s relationships. In our training and clinical services,
we honor the traditions established by the late Selma Fraiberg and Thea Bry.
The curriculum emphasizes the following areas:
• Normal development in infants and preschool age children, the nature of human attachment
and disorders of attachment.
• Multi-disciplinary diagnostic assessments of caregiver-child dyads, along multiple
developmental lines.
• Infant-Parent (dyadic) psychotherapy and group psychotherapy.
• Unique needs of special populations, including teenage pregnancy, early separations, foster care, and adoptions.
• Training in methods of research and clinical case study.
Who is this certificate program for?
The post-graduate certificate program is designed for practitioners in the fields of psychology,
counseling, social work, education, pediatrics, nursing and other allied disciplines whose careers in their area of licensure would benefit from specialized training and supervisory experience in Infant and Early Childhood Mental Health.
The certificate program will afford participants an opportunity to:
• Acquire essential family/dyadic assessment and intervention skills.
• Learn techniques for integrating infant and preschool mental health principles and practices into clinical, child care, educational and community settings.
• Build skills needed to educate others about the needs of infants, toddlers, preschool children and their families, as well as the skills required to influence policies that impact the mental health of children.
The curriculum encourages candidates to develop applications for use within the scope of their professional licensure and practice. Accordingly, the curriculum and certificate do not permit the graduate to engage in professional activities outside the scope of their professional license or credential.
What are the Certificate Requirements?
Didactic Requirements (10 credits)
The three required courses are:
• Conceptual Foundations of Infant and Early Childhood Mental Health: Theory and Clinical
Practice (3 credits)
• Infant and Preschool Mental Health: Clinical Assessment and Research (4 credits)
• Couple and Family Dynamics: Systemic Perspectives (3 credits)
Supervised Practicum - Minimum 20 hours
Each post-graduate student will independently arrange his/her practicum under the supervision
of faculty. The practicum may include infant parent assessments, interventions and
experiences with preschool-age children in individual, family and group modalities.
For non-clinical candidates, supervision will address the ways in which infant mental health
principles, relationship-based services and reflective practices can be integrated into work
within their professional field.
Integrated Case Report or Project
All clinical students will be required to complete an integrated case report based upon a child/
family case from their practicum. Non-clinical candidates will develop a final project that
involves a comprehensive program in which an infant mental health perspective is integrated
into a training, service or policy program.
For further information, fee schedule and
application, contact:
THE YCS INSTITUTE
for Infant and Preschool Mental Health
60 Evergreen Place – 10th Floor
East Orange, New Jersey 07018
dsquadron@ycs.org
973-395-5500 Ext. 309
www.ycs.org
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