Preventing Maltreatment in infants and toddlers

46 CHILD SEXUAL ABUSE EXCHAngE JANUARY/FEBRUARY 2010

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The issue

Each year more than 1 in 100 children are abused and neglected (United States Department of Health and Human Services, 2008). It is highly likely that there are at least 3 times more cases of abuse and neglect than these numbers suggest (English, 1998; Sedlak & Broadhurst, 1996). Underreporting, incomplete reports, variations in state laws and in data collection practices, misclas- sification of child injuries and deaths, and cultural, racial, and personal bias all contribute to difficulty in understanding the true prevalence of child maltreatment (Baker & Lewit, 1995; Bluestone, 2005: Centers for Disease Control, 2006; Crume, DiGuiseppe, Byers, Sirotnak & Garret, 2002; English, 1998; Lane, Rubin, Monteith & Christian, 2002). In addition, children can be harmed by parenting practices that while harsh or unresponsive may not rise to the level of legally defined abuse or neglect (Smith, 2001).

Infants and toddlers are more likely than older children to be abused, and children under 12 months are at greatest risk (U.S. Department of Health and Human Services [USDHHS], 2008). The younger a maltreated child is the higher is the likelihood of experiencing serious harm or fatality (USDHHS, 2008). Neglect is the most common form of maltreatment reported for infants and toddlers (USDHHS, 2008). Young children of color are over-repre- sented in the child welfare system for reasons that may include ongoing patterns of social injustice (Lane et al., 2002).

Early maltreatment can have both immediate and long-term impacts on development. Experiences during the first years of life impact the way the brain develops, so abuse and neglect, if un- treated, can have lifelong effects (McDonald, 2007). In addition to its incalculable cost in human suffering, abuse and neglect have an economic cost. Child maltreatment costs the United States an estimated $103.8 billion annually (Wang & Holton, 2007).

The prevalence, cost, and harmful impacts of abuse and neglect among very young children cry out for a solution, and child care providers want to be part of that solution. In a national survey conducted by the National Association for the Education of Young Children, providers expressed interest in playing a role in the prevention of maltreatment. They also noted their need for training and support to help them do so (Olson & Hyson, 2003). Fortunate- ly such resources are available.

The good news

Child care providers are in a great position to help prevent child maltreatment. They see children and families almost every day. They get to know families well enough to recognize signs that the family may be under stress. Parents value providers’ insights and are open to support from them, though they don’t want to be told what to do! (Olsen & Hyson, 2003). Child care providers’ brief, daily encounters with parents offer many opportunities throughout the week to build protective factors that can help reduce the risk of child maltreatment (CSSP, 2005).

Protective factors help strengthen families to handle the stresses that life can bring. Building protective factors is helpful because abuse and neglect are more likely to happen when families are overwhelmed by a number of interacting stressors. When child care programs can help to reduce some of the stress families experience and help promote their ability to handle difficulties, the likelihood of abuse or neglect is reduced (Seibel, Britt, Groves- Gillespie & Parlakian, 2006).

Researchers have identified a number of protective factors and are working to understand how these factors interact to support family functioning. There are some that child care providers can directly impact:

1. Parental resilience is the ability to cope in a healthy way when things go wrong.

2. Social connections with caring and supportive friends and relatives allow parents to exchange practical help and emotion- al support.

Nancy Seibel, M.Ed. National Certified Counselor, directs ZEro to thrEE’s Center for training Services. She is an experienced practitioner, director, trainer, and author. She is especially interested in relationship-based and reflective practice, working effectively with families, home visiting, child abuse prevention, family and parent-child

relationships, and infant mental health.

preventing child maltreatment in infants and toddlers: skills for early care and education providers by Nancy L. Seibel

Reprinted with permission from Exchange magazine. Visit us at www.ChildCareExchange.com or call (800) 221-2864. Multiple use copy agreement available for educators by request.

CHILD SEXUAL ABUSE 47 JANUARY/FEBRUARY 2010 EXCHAngE

3. Concrete help when needed for questions, concerns, or crises can relieve stress and help parents feel helped and cared for.

4. Knowledge of parenting and child behavior helps parents have reasonable expectations of themselves and of their children.

5. Healthy child social-emotional development aids parents and children in establishing responsive and rewarding relationships with each other.

(Strengthening Families Illinois, n.d.; CSSP, 2005)

Child care providers can learn to purposefully use their everyday interactions with parents and children to help reduce the risk of child maltreatment. Building protective factors does not have to cost a lot of money or take a lot of time. It does call for child care providers to understand themselves and to use relationship- building skills with parents.

Self-understanding and understanding others

ZERO TO THREE’s training curriculum, Preventing Child Abuse and Neglect: Parent-Provider Partnerships in Child Care (see Resources) talks about self-awareness, careful observation, and flexible response.

n Self-awareness means recognizing your thoughts, feelings, be- liefs, and attitudes and understanding where these come from.

n Careful observation relates to noticing behaviors and using information learned through observation in combination with other available information to understand what those behaviors might mean.

n Flexible response means interacting with a parent or child in a way that takes their needs into account, and being willing to try a different approach if the first try doesn’t work as expected.

This example shows how a provider might apply these concepts and skills:

Ms. Castle is the teacher in a classroom with four children, age two. She has one very busy, active little girl, Samantha, who is always on the go. Ms. Castle notices that Samantha needs frequent changes of activities to hold her interest and keep her from getting into difficulty (careful observation). Samantha just won’t take a nap, no matter what Ms. Castle tries. She has tried reading to her, singing to her, patting her back, playing soft music, and giving her a quiet toy to play with and none of this works (flexible response). Ms. Castle understands that it might be really hard for a busy child like Samantha to nap in the midst of a busy day in the center. Ms. Castle realizes she is beginning to resent Samantha a bit. It is tiring to care for her, and she can’t even get a brief break at naptime (self-awareness). Also, Samantha seems to get very tired by the late afternoon, and she becomes cranky and prone to tantrums. Ms. Castle decides to meet with Saman- tha’s parents, Mr. and Mrs. Ashton, to see if they have any ideas that might help.

During this meeting, Ms. Castle shares her delight in Samantha’s engaging personality and her appreciation of Samantha’s ‘get up and go.’ The adults share an appreciative laugh, recognizing that a highly active child like Samantha requires a lot of energy from her adult caregivers. Ms. Castle lets Samantha’s parents know of her concerns with Samantha’s naptime and late afternoon behavior, and what she’s tried. She asks them for their insights. Mr. Ashton laughs again and says fondly that when Samantha is excited she doesn’t seem to get tired. He comments that she loves coming to ‘school’ and probably doesn’t want to miss any of the action. Mrs. Ashton adds that she uses a ritual to help Samantha settle down for nap at home. She describes the ritual to Ms Castle, who says she’ll try it out to see if it helps Samantha at least rest quietly at naptime (flexible response). The three adults agree to meet again in a week to see how things are going.

Application of these concepts and skills helped Ms Castle ana- lyze the situation and understand her own responses to it. She tried out some solutions, but they weren’t successful in help- ing Samantha to nap. She decided to reach out to Samantha’s parents and in doing so, gained additional information which enhanced what she had learned by observing Samantha. She can see that Samantha’s parents are very tuned in to her and are affectionate with her. This discussion also helped strengthen the parent-provider relationship. Ms. Castle found that Samantha’s parents were ready to partner with her to help address this problem. Their conversation helped her feel like they were all working together and ready to help each other. The parents, in turn, learned that Ms. Castle respects them and is willing to reach out to them for help in providing the best care for their daughter.

Directors and trainers can help build self-awareness, careful observation, and flexible response by discussing actual experi- ences or vignettes with providers and analyzing them using these concepts. These discussions can take place in one-on-one meet- ings with staff members and during staff meetings. Mentors or coaches can explore these questions with their participants, and trainers can create opportunities to teach about these ideas and build these skills during workshops.

Here are some questions that directors, supervisors, mentors, and trainers can use in their conversations with providers:

Self-awareness • How did you feel? • What did you think? • What do you suppose caused you to think/feel that? • Does this child remind you of anyone else?

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Careful observation • What did you notice? • What do you suppose that behavior means? • When does it happen? • Could you keep some notes to help you see if

there is a pattern to this child’s behavior?

Flexible response • What have you tried? • How did it work? • What else could you try? • Do you need more information?

Such discussions encourage careful thinking about the work. They can help providers think about their own role and impact on chil- dren and parents, and work to understand why a child — or parent — is doing or saying something. Being able to come up with more than one response helps providers tailor their approaches to the situation and the individual needs of each child and family.

Strategies for building protective factors

In the example above, Ms. Castle was supporting parental resil- ience by building a strong connection with the Ashtons, and also helping to promote Samantha’s social-emotional development by seeking to individualize her care to Samantha’s needs. Another way to help providers identify and use practices that support pro- tective factors is to discuss and define them and then brainstorm ways to support each protective factor. Here are some examples that providers have generated:

Build effective relationships with parents • Greet parents when they arrive at the beginning and end of

each day. • Ask parents how they are and take a minute to listen. • Help a parent search for their child’s ‘blankie’ or other transition

object if it’s missing at pick-up time. • Let parents know how much you enjoy their child. • Ask parents to show you the caregiving routines they use with

their child. • Do a home visit with each family at least once a year.

Build social connections • Hold family events, like picnics or potluck dinners, regularly. • Introduce the parents of the children in your classroom to each

other. • Set up a small parent lounge area where parents can sit and

talk over a cup of coffee. • Ask parents for their ideas for workshops or events the center

could host. • Encourage parents to work together on a project of interest,

such as planning a discussion group, a family picnic, or a celebration.

Provide concrete help in times of need • Keep a supply of diapers in various sizes on hand to help a

parent who has run out of them. • Refer a parent to a support group or counseling as needed. • Keep numbers for local social services and crisis services on

hand and offer them as needed. • Create a referral list that parents can contribute to, including

such things as good children’s clothing resale stores, repair services, and health care services.

• Be willing to listen and express caring. • Invite a staff member at the local referral hotline to meet with

center staff and discuss local programs.

Build knowledge of parenting and child Development • Set up a resource center for parents with handouts, flyers,

DVDs, and books to borrow. • Survey parents to see if they would like parenting workshops

and get their ideas about topics. • Provide parents with a handout that responds to their questions

about their child and discuss it with them. • Show parents some web sites that have good child development

information.

Promote healthy child social-emotional development • Observe each child to understand his or her temperament and

preferences. • Discuss these observations with parents. • Use caregiving approaches that are as much like the child’s

home experiences as possible. • Ask each family to bring in a family photo to post in the class-

room for the child to see during the day. • Help children calm down when they are feeling out of sorts or

out of control. • Keep expectations of young children in line with what is to be

expected developmentally at different states.

As providers come up with their own ideas for supporting the pro- tective factors, have them develop a plan for putting those ideas into practice. Those plans might involve getting further training, making changes in the classroom or center environment, or trying out some new strategies and practices. Teachers are powerful in- fluences in children’s and families lives and can use that influence to build protective factors that help to strengthen families, support children’s development, and reduce the risk of child maltreatment.

48 CHILD SEXUAL ABUSE EXCHAngE JANUARY/FEBRUARY 2010

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Child care providers are in a great positon to help prevent child maltreatment.

They see children and families almost every day.

References

Baker, L. S., & Lewit, E. M. (1995). Child indicators: Unintentional injuries. The Future of Children, 5(1). Retrieved online on March 30, 2006 at futureofchildren.org/information2826/information_ show.htm?doc_id=79899

Bluestone, C. (2005). Personal disciplinary history and views of physical punishment: Implications for training mandated report- ers. Child Abuse Review, 14, 240-258.

Centers for Disease Control. (2008). Nonfatal maltreatment of infants and toddlers in the United States-October 2002-Septem- ber 2006. Retrieved online on April 6, 2008 from www.cdc.gov/ mmwr/preview/mmwrhtml/mm5713a2.htm

Crume, T. L., DiGuisseppi, D., Byers, T., Sirotnak, A. P., & Garret, C. M. (2002). Under-ascertainment of child maltreatment fatalities by death certificate, 1990-1998. Pediatrics, 110(2), 118-123.

English, D. J. (1998). The extent and consequences of child maltreatment. The Future of Children, 8, 39-53.

Lane, W. G., Rubin, D. M., Monteith, R., Christian, C. W. (2002). Racial differences in the evaluation of pediatric fractures for physical abuse. Journal of the American Medical Association, 288(13), 1603-1609.

McDonald, A. (2007). Brain development in childhood: The Dana guide. Retrieved online on August 6, 2009 at www.dana.org/news/brainhealth/detail.aspx?id=10054

Olsen, M., & Hyson, M. (2003). Early childhood educators and child abuse prevention. Washington, DC: NAEYC.

Sedlak, A. J., & Broadhurst, D. D. (1996). Third national incidence study of child abuse and neglect. Washington, DC: U.S. Depart- ment of Health and Human Services.

Seibel, N. L., Britt, D., Groves-Gillespie, L., & Parlakian, R. (2006). Preventing child abuse and neglect: Parent-provider partnerships in child care. Washington, DC: ZERO TO THREE.

Smith, W. H. (2001). Child abuse in family emotional process. Family Systems: A Journal of Natural Systems Thinking in Psychiatry and the Sciences, 5(2), 101-126.

Strengthening Families Illinois. (n.d.). Six ways to keep families strong through early care and education. Chicago: Strengthening Families Illinois.

U.S. Department of Health and Human Services. (2008). Child Maltreatment 2006. Retrieved online on August 12, 2009 at www.acf.hhs.gov/programs/cb/pubs/cm06/

Wang, C. T., & Holton, J. (2007). Total estimated cost of child abuse and neglect in the United States. Retrieved online on February 25, 2008 at www.preventchildabuse.org/about_us/ media_releases/pca_pew_econonomic_ impact_study_final_pdf

Further information

Zero to three is a national nonprofit organi- zation that promotes the health and develop- ment of infants and toddlers. The web site has information about publications, training, and resources on a range of early child- hood issues for use by adults who influence the lives of young children. www.zerotothree.org

Center for the Study of Social Policy’s Strengthening Families through early Care and education — Information about protec- tive factors, a self-assessment guide for programs, and resources for those interested in learning about the national Strengthening Families Initiative. www.strengtheningfamilies.net/

Child Welfare Information Gateway provides access to infor- mation and resources to help protect children and strengthen families. www.childwelfare.gov

The National Association for the education of Young Children Information, publications, resources, and conferences for early care and education providers, including position statements on prevention of child abuse. www.naeyc.org

Resources

Preventing Child Abuse and Neglect: Parent-Provider Partner- ships in Child Care. ZERO TO THREE Training Curriculum. Avail- able for purchase at www.zerotothree.org/bookstore

Information on training for trainers available www.zerotothree.org/training

Protecting Children by Strengthening Families: A Guidebook for Early Childhood Programs. Available online or for download at www.strengtheningfamilies.net/self_assessment/

Six Ways to Keep Families Strong through Early Care and Educa- tion available online at www.strengtheningfamiliesillinois.org/ downloads/6_Factors.pdf

Strengthening Families and Communities: 2009 Resource Guide is produced by the Child Welfare Information Gateway and available at www.childwelfare.gov/pubs/res_guide_2009/

© ZERO TO THREE, 2009. All rights reserved. Please visit www.zerotothree.org for permissions.

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