EI Talk: A Blog for Early
Childhood Professionals


Early Childhood Learning – Brain Science and the Effects of Stress and Trauma

Rachel Lipman (GU Certificate in Early Intervention ’20) March 29, 2021

For a developing child, the value of family-centered care and the impacts of trauma on childhood learning are linked. Trauma occurs when children are exposed to events of situations that overwhelm their ability to cope with what they have just experienced. This definition is a powerful reminder that trauma is individualized and providers need to be aware that we all experience and respond to trauma differently.

According to American Speech and Hearing Association (ASHA) family-centered care is a

“collaborative approach to the planning, delivery, and evaluation of clinical services” which involves a “mutually beneficial partnership” for family members and providers”.

Each individual is encouraged to share their ideas, knowledge, and experiences. The benefits of this approach include developing rapport and ensuring that the family members, the individuals, and the providers are all actively involved in service delivery (ASHA, 2020). For families who may be in highly stressful, traumatic circumstances clinician’s expectations for family participation takes on an additional dimension. How do service providers respond to or engage families in the process when it may appear that the family does not have a positive dynamic?

All young children rely on family members for basic needs such as shelter, meals, and safety, appropriate physical contact, love, and communication. Young children assume that relationships include emotional attachment, progressive complexity, reciprocity, and a balance of power. The role of the early intervention service provider includes helping caregivers to provide those elements to affect skill development. Recognizing a family’s circumstances, respecting their perspectives, and engaging in a reciprocal, honest, trusting relationship is critical to mediate the effects of trauma.

Family-centered care involves mutual respect, accurate and appropriate information sharing, participation, and collaboration. This concept is powerful to me as a provider reminding me that our first task in serving young children with disabilities or delays is to create meaningful relationships with families. In order to create environments that support child development, the clinician must meet the child and family where they are for that given day/session. For instance, a family member may be preoccupied with finding appropriate housing for their family and is not able to focus fully on caring for their child and therefore, the provider’s child-directed services may not be effective. Families have complex needs, thus most effective service provision is a team-based model. Providers need to be able to rely on team members creating integrated plans that address the family needs and priorities. When used appropriately, while incorporating the needs for the child, the family members, and the provider, family-centered care is a model for service provision that allows collaboration in the best interest of the child.


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Physician as Advocate

Sarah Berg (M’21) March 15, 2021
A Doctor checking a kid with a nurse

The responsibility of a physician is not limited to just providing medical care. While that is obviously a central tenant of our profession, I think it is diminutive to imply that our responsibility to our patients and communities is confined strictly to the walls of a hospital, office, or clinic. We know the health of individuals is more significantly impacted by social determinants of health than they are by the care that we provide.1 In fact, it is clear that a person’s socioeconomic factors, demographic characteristics, and health insurance status can be just as predictive of outcomes as their genetic predispositions and vital signs.

This intricate interplay between social and economic policy, medical care, and health status highlights the central role of physician advocates in our health care system moving forwards. As experts in the field, who have dedicated their lives to improving the health and well-being of patients and communities, physicians have an obligation to advocate for underserved and marginalized groups. This must extend to our statehouses, courthouses, schools, and businesses. We have a duty to fight for everything from healthier environmental policy and cultural competency training, to expanded insurance coverage and increased access to treatments and cures.

I’m putting advocacy into action on behalf of individuals with disabilities, an increasingly large segment of the population that has been discriminated against, stigmatized, and mistreated. People with disabilities account for 26% of the American population and are high utilizers of the healthcare system.2 However, they are 10x more likely to report a "fair or poor" health status compared to individuals without disabilities, have higher rates of risk factors for poor outcomes, and are less likely to receive preventive care and routine health screenings.3,4 With this in mind, medical schools must make a concerted effort to highlight the unique social, cultural, and medical needs of people with disabilities, something that only 52% of schools do at this time.5 While I know there won’t be a quick fix to this issue, I’m ready to face it head on.

But advocacy can be daunting, too. It is an ever-expanding idea in which each person can play an important role. So, how do we get started? What does “being an advocate” mean in practice?

To me, advocacy means being a student, committing oneself to learning about the culture and needs of underserved communities. It means being a researcher, analyzing data to further our understanding of the vast intersections of medicine, social science, economics, and policy. It means being a community organizer, facilitating change through the collective engagement and action of those in our neighborhoods. And advocacy means being a leader, ensuring that the disparities and injustices which have become far too commonplace do not stay that way, but rather rise to the forefront of our minds, our practices, and our goals, in order to be addressed.

As a soon-to-be physician, I’m excited to begin my professional career at a time in which the importance of advocacy cannot be overstated. I hope you’ll join me, because we have plenty of work to do.

References
  1. Artiga, S., & Hinton, E. (2018, May 10). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Retrieved February 25, 2021, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

  2. Disability Impacts All of Us Infographic. (2020, September 16). Retrieved February 22, 2021, from https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html.

  3. Iezzoni, L.I. (2011, October). Eliminating health and health care disparities among the growing population of people with disabilities. Health affairs (Project Hope), 30(10), 1947-1954. https://doi.org/10.1377/hlthaff.2011.0613

  4. Altman B and Bernstein A. (2008). Disability and health in the United States, 2001–2005. Hyattsville (MD): National Center for Health Statistics.
  5. Seidel, Erica & Crowe, Scott. (2017). The State of Disability Awareness in American Medical Schools. American Journal of Physical Medicine & Rehabilitation, 96, 673-676. https://doi.org/10.1097/PHM.0000000000000719
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Applying Brain Science and the Effects of Stress and Trauma on the Practice of Speech and Language Pathology

Angela Prieto (GU Certificate in Early Intervention ’20) February 15, 2021
Child brain image

Because stress and trauma can hinder a child’s development, the child may not communicate their wants and needs effectively. Some examples of how stress can affect a child’s language abilities is if their learning environment is affected. Heidi Reed of Turnaround for Children tells us how important the learning environment is and the negative effects it can have on a child if it is not a positive learning environment. For language development, a positive learning environment includes consistent language input and good “speech models”.

Children, whose home environments are less than positive due to extreme poverty, homelessness, violence, etc., are stressful and can influence language development. For example, in order to provide for the child parents/caregivers may need to work long hours and may not be available to talk to the child with the frequency or intensity to develop language skills. Specifically, trauma can lead to young children to have “selective mutism”. Children with selective mutism chose not to speak or may only speak to certain people they trust because of the trauma they have experienced. Children exposed to neglect and abuse are at-risk for having a developmental delay compared to typical peers, especially in the language domain because they are experience these stressors at a time critical to language development.

Heidi Reed says, “it’s not what the kids or families can do but what we can do“, which reminds us to conduct a thorough parent interview to identify specific family stressors that could impact the child and what the child’s language environment is. We can help the families promote a positive learning and language environment. For example when serving a child, it is imperative for a provider to teach a parent/caregiver how to be a good speech model, and how to promote the best language environment for the child. Recognizing the impact of stress and trauma on a child’s development reminds us of that service providers need to focus on the child, the family, and the community.

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Positive Relationships in Response to Stress Help to Promote Healthy Development

Alexis Montgomery (GU Certificate in Early Intervention ’20) February 01, 2021
Father playing with two kids


Toxic stress situations affect negatively healthy development because the lack of positive relationships. Adverse Childhood Experiences (ACEs) can contribute to a host of negative outcomes including developmental delays and school failure. Examples of ACEs include neglect, abuse, parents with mental illness, poverty, racism, oppression, homelessness, separation from parents, and punitive discipline. Studies have shown that children who experienced 4 or more of these ACEs are 32 times more likely for developing learning or behavior problems.

Many children who are identified in early care and education situations as displaying challenging behaviors or decreased attention have often experienced 4 or more ACEs. The behavior may be the outward manifestation of a host of challenges a young child experiences on a regular basis. Specific ACEs are linked to an increased risk for developmental delay or disability. These include physical abuse, emotional abuse, neglect, restraint and seclusion, sexual abuse, invasive medical procedures, and social rejections.

Children with disabilities who attend a childcare program can’t leave their ACEs at the door, therefore, to help promote learning and development we must help children learn to respond to stress or trauma in healthy, positive ways. Key to promoting positive behaviors in response to stress, childcare professionals should provide a positive, healthy, trusting relationship. A safe, calm, and predictable environment can also help with development by balancing dysregulating environments with coregulating environments, such as in a child care setting. Creating a healthy context for learning helps promote learning in children. In children with disabilities who have also experienced ACEs early intervention providers may also need to explicitly promote the building blocks of learning such as self-regulation, self-management, and attachment. Providing children with disabilities in a childcare setting with the resources that they need based on their developmental level and providing necessary support will foster learning and growth along with their peers.

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Jillian Archer (GU ’24), Rebecca Bullied (GU ’21), Caroline Fisher (GU ’21), Daniela Mateo (GU ’23), Megan McCrady (GU ’21), Quynh Pham (GU ’22) June 15, 2021

Expanding Child Tax Credit

Annie Foley (GU ’22) June 01, 2021

Early Childhood Learning – Brain Science and the Effects of Stress and Trauma

Rachel Lipman (GU Certificate in Early Intervention ’20) March 29, 2021

Physician as Advocate

Sarah Berg (M’21) March 15, 2021

Applying Brain Science and the Effects of Stress and Trauma on the Practice of Speech and Language Pathology

Angela Prieto (GU Certificate in Early Intervention ’20) February 15, 2021

Positive Relationships in Response to Stress Help to Promote Healthy Development

Alexis Montgomery (GU Certificate in Early Intervention ’20) February 01, 2021

Service Coordination and Early Intervention DEC/ITCA Joint Position Statement Executive Summary

Division for Early Childhood (DEC) and IDEA Infant & Toddler Coordinators Association (ITCA) December 2020

The Division for Early Childhood (DEC) January 04, 2021

The Parenting Support Program (PSP) and COVID 19: The Home Visitors Perspective

Clare Williamson July 15, 2020

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