Electronic Reserve Readings

"I Didn't Think He Remembered": Healing the Impact of Domestic Violence

on Infants and Toddlers Jane R. Ellison

Sauk Rapids/Rice Early Childhood Family Education, Sauk Rapids, Minnesota

ABSTRACT:

The First Steps Domestic Violence Program (First Steps) was developed to address the mental health needs of infants and toddlers entering a domestic violence shelter. When domestic violence occurs, the primary caregiver's ability to help restore a sense of safety for the infant—through regulation of the infant's emotions, sleep, arousal, and attention—helps determine potential long-term impacts on the young child.The First Steps program blends an educational home visiting program with elements of parent-child interventions based on the work of Alicia Lieberman and Patricia Van Horn, with the overarching goal of supporting the relationship between the caregiver and child.

Sara', a young mother, enters a battered wom en’s shelter. She is 22 years old a n d has two young children, a 3-year-old daughter a n d a 9-month-old son. She has broken ribs a n d a black an d blue face. She is brokenhearted, scared, a n d angry, a n d she has nowhere else to go now that she has fin a lly had enough a n d decided to leave her abusive boyfriend. Her son is sleeping in the car seat as they come into the shelter; her daughter keeps checking on him to see i f he is a ll right.

Jolene, a 32-year-old mother o f fo u r enters a shelter in St. Cloud, Minnesota. She was sent there by a social worker in the Twin Cities (approximately 65 miles away) because there were no spaces in shelters in the Cities. She has been in a n d ou t o f shelters several times. H er children range fr o m a fifth grade student to a 1-year-old. She describes her older girls as wonderful a n d a big help. The one boy in the fa m ily is described as “ trouble—-just like his dad? a n d the baby is described as “doingfine, everyone loves her? Her baby’s da d beat her during an argum ent in which she admits she was also “ou t o f control? She’s n o t sure w hat she w ill do next, bu t she’s hoping to go live with her sister in Chicago.

W hat A b o u t the Baby?

hese are riveting stories, two o f the many we encounter at the battered women’s shelter in St. Cloud, Minnesota. There are many needs in each o f these stories that

demand attention. The mom and children need safe housing. Mom needs medical care. The family needs an opportunity to

1 Stories in this article are composites and do not represent particular individuals or families.

heal in a safe environment, while exploring options for next steps. Children need to be connected to school and need support for their emotional health.

This article will focus on one component of these stories, the needs of the babies and toddlers in the families that enter the shelter. This article is about a program that specifically asks the question, “What about the baby?”

In fa n ts' a n d T o d d le rs' Exposure to D om estic Violence

Infants and toddlers are often present during domestic violence incidents. According to one study by McDonald and colleagues. (McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006), 15.5 million children in the U.S. live in families in which partner violence had occurred at least one time during the previous year, and 7 million children were likely exposed to more severe incidents o f partner violence. A 2007 study that looked at the presence of children at domestic violence incidents found that children were present for 43% o f domestic violence police calls, that 81% of those children heard or saw the event, and that 60% o f those children were less than 6 years old (Fantuzzo & Fusco, 2007). There is con­ clusive evidence that early exposure to domestic violence can have a negative impact on neurobiological development and on psy­ chological and social functioning (Bogat, Dejonghe, Levendosky, Davidson, & Von Eye, 2006; Dejonghe, Bogat, Levendosky, Von Eye, & Davidson, 2005; Schechter & Willheim, 2009). This knowl­ edge makes it imperative that clinicians explore ways in which to address the impact of domestic violence on its youngest victims while working to eradicate domestic violence altogether.

Zero to Three • November 2014 49

Development of the First Steps Domestic Violence Program The First Steps Domestic Violence Program (First Steps) was developed based on research that supports (a) the essential role of attachment security as a protective factor for infants and toddlers who have experienced domestic violence and (b) the important role of primary caregivers to restore a sense of safety for the infant through regulation of the infant’s emotions, sleep, arousal, and attention (Scheeringa & Zeanah, 2001). It is a common misper­ ception that infants and toddlers are too young to remember early experiences of domestic violence and for that reason are not impacted by the violence between the adults around them. Research has shown the opposite is true. Not only do infants and toddlers experience and remember domestic violence in their households, but they are in many ways the most vulnerable to neg­ ative impacts because the trauma is occurring during a develop­ mental period in which brain pathways and key neurobiological systems are being developed, including systems that drive regu­ latory capacity (Bogat et al., 2006; Schechter &c Willheim, 2009). One of the most harmful aspects of domestic violence for infants and toddlers is the loss of their primary caregiver as a sensitive and regulatory attachment partner. During incidents of domestic violence, a baby’s primary caregiver is often neither physically nor emotionally available to help the baby manage his physiological reactions to the event (Schechter & Willheim, 2009).

A Children Exposed to Violence Initiative project was piloted at Anna Marie’s Battered Women’s Shelter in St. Cloud, Minnesota, in September 2001. The initiative was developed by a group of community professionals concerned about escalating regional violence, including domestic violence, and the impact on children and adolescents. The pilot project was designed to provide early intervention by identifying and assessing the needs of children through a multidisciplinary assessment team. In the process of building the initiative, the developers considered how to meet the mental health needs o f the children, including the infants and toddlers. With that in mind, an early childhood mental health specialist/licensed parent educator combined an infant-toddler home visiting curriculum for families who had multiple chal­ lenges with parent-child dyadic interventions based on the work of Alicia Lieberman and Patricia Van Horn (Lieberman & Van Horn, 2005,2008). The program was designed to build protective factors within each infant and toddler’s attachment relationship with their primary caregiver and to address early social and emo­ tional concerns of children from birth to 3 years old while housed at the domestic violence shelter and during their transition back to the community.

Challenges There are a num ber of challenges in the provision of services to the youngest children and their caregivers impacted by domes­ tic violence in shelter settings. These challenges include the following:

1. Families can remain at the shelter only for a short amount o f time. Any intervention needs to be able to

be initiated and accepted by the mother during a time when she is likely to be overwhelmed by emotional and practical concerns. The program also needs to be flexible enough to last for any amount of time, from one session to multiple sessions.

2. The mothers (or other primary caregivers) themselves and often the shelter employees continue to hold the common belief that infants and toddlers are too young to remember or be impacted by domestic violence. The intervention needs to open everyone’s eyes to the harmful impact of domestic violence on infants and toddlers while not adding to the caregiver’s feeling of self-blame—which would undermine her ability to take on the protective role necessary for her child.

3. Domestic violence shelters are primarily designed to provide temporary safe housing to women. As such, regu­ lations and shelter rules may be based on an adult-needs perspective, and may not be in the best interest of the children. For example, a family may be asked to leave the shelter just when the baby is becoming regulated in this new environment.

4 . School-age children often receive help first because they exhibit behaviors that demand adult attention, and shel­ ter staff may have access to more resources for school-age children.

5. Funding the First Start program is an ongoing challenge. In St. Cloud the program is a collaborative between the Anna Marie’s Alliance and a neighboring early childhood family education program. Anna Marie’s Alliance has worked diligently to receive continuous grant funds to support the children in their shelter.

The First Steps Program The First Steps program begins with an introduction to the pro­ gram for every mother who comes into the shelter with a child up to 3 years old. The program is introduced as an opportunity for the mother to spend an hour a week as “sacred time” to focus only on her little one. The introduction, given to each mother individually, might sound like this:

We will meet in the living room here, and l will bring in some toys. I ’ll have a toddler book that I will give you each time. I ’ll bring a toddler song that I can teach you each time, and, i f it is OK with you, I will record your childfor 5 minutes each time and make you a DVD o f your child to keep with you when you leave the shelter. We can talk about how the events that brought you here may have affected your toddler and how you can protect her from those impacts. I have a lot o f experience working with parents and little kids, so i f you have any questions, this would also be a time that I can help you with anything you are wondering about your child.

The purpose of the program is also outlined on the introductory sheet mothers receive to set the first session day and time, with

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O ne o f th e go a ls o f th e p ra c titio n e r is to s u p p o rt the m o th e r in fe e lin g c o m p e te n t and p ro v id e reassurance th a t she has a system o f s u p p o rt so th a t she can m ake safe choices fo r h e rs e lf and her fa m ily .

an explanation o f “why do we do this” (see box An Introduction to First Steps for an example from the introductory sheet).

The introduction to the program is designed to focus the care­ giver on the needs of the infant or toddler, to offer a nonthreat­ ening and fun opportunity to spend time with the child, and to offer incentives (books, song sheets, and DVD) that support the relationship between the child and the caregiver. Ninety-nine percent of mothers who are offered the program agree to partici­ pate. The actual num ber of times practitioners successfully meet with a family varies from 1 session to more than 20. The program

A n I n t r o d u c t i o n t o F ir s t S t e p s — A n O p p o r t u n i t y f o r M o m s W it h B a b ie s a n d T o d d le r s

The F irst Steps Series includes:

► playtime to fo cu s on y o u and y o u r ba b y o r to d d le r ► bo a rd b o o k s fo r y o u r ch ild to keep

► s o n g s to share w ith y o u r b a b y o r to d d le r

► m a kin g a D V D o f y o u r ba b y o r to d d le r as a keepsake

W h y d o w e o ffe r th is to you?

► Because w e care a b o u t th e babies and to d d le rs th a t c o m e to th e shelter, and because w e w a n t to s u p p o rt y o u r re la tio n s h ip w ith th e m w h ile y o u go th ro u g h th is c h a lle n g in g tim e .

► Because even babies and to d d le rs are affected by fa m ily stress:

♦ They are s e n s itiv e to y o u r fe e lin g s

♦ You m a y be d istra cte d and less a vailable

♦ Stress can in te rru p t le a rn in g

allows the practitioner to follow the family out into the com­ munity when they leave the shelter if necessary. The program is designed to be flexible enough to manage this uncertainty and to span the continuum between prevention and intervention depending on the needs and desires of the caregiver.

The First Steps curriculum provides a framework within which the practitioner can use elements of dyadic parent-child interven­ tions based on components of child-parent psychotherapy. The First Steps program is not therapy, although it is often therapeutic. It is, however, essential that there is clarity regarding the boundar­ ies around the role of the practitioner and purpose o f the program. It is also essential to provide the practitioners with quality reflec­ tive supervision to support them in their role. If there are greater concerns about a particular child, and a need for trauma-informed child-parent psychotherapy or other interventions, the family can be connected to a trained professional either at the shelter or in the community to provide more intensive intervention.

The curriculum is designed to give the practitioner a framework o f activities and simple information that can be used in a flexible manner. It was developed on the basis o f research on attachment and brain development, and has eleven available sessions (see box First Steps Topic List).

Topic sheets, along with the companion materials, are developed around common concerns of parents of infants and toddlers, such as eating, sleeping, spoiling, and illnesses. Each session is designed to last approximately 1 hour, and all sessions are con­ ducted with the child and parent together. Each session has seven simple components, each of which can be used flexibly at the discretion of the practitioner:

1. A topic sheet—with a one-page handout written simply and designed for low literacy parents;

2. A board book for infants and toddlers that is related to the topic;

3. A song card with an infant-toddler song that is related to the session focus;

F ir s t S t e p s T o p ic L is t

1. A tta c h m e n t: W h y it is im p o rta n t

2 . A tta c h m e n t:T a lk in g w ith y o u r child

3 . A tta c h m e n t: S p o ilin g vs. re s p o n d in g to y o u r child's needs

4 . A tta c h m e n t: Being a p a re n t y o u r ch ild can tru s t

5 . Brain d e v e lo p m e n t: H ealthy brain d e v e lo p m e n t

6 . Brain d e v e lo p m e n t: A p p ro p ria te s tim u la tio n

7. B rain d e v e lo p m e n t: Early literacy

8 . Health and safety: Health p ro m o tin g e n v iro n m e n ts

9 . Health and safety: N u tritio n and m e a ltim e b e h a v io r

1 0 . Health and safety: Sleep

11- Play: H aving fu n w ith y o u r child

Z ero to Three • N o v e m b er 2014 5 1

4. A video component, designed to create a set of 5-minute video clips o f the child, as a keepsake for the parent;

5. A simple engagement activity for the parent and child to enjoy together (e.g., the mother blowing a cotton ball across a table for a toddler to catch);

6. A magnet reminder which provides a short summary of the session focus (e.g., “Babies love their toys and rattles, but the toy they love most is you.”); and

7. A dad’s page that can be offered when appropriate.

Other components that are available as part of the curriculum, include a one-page handout “Effects of Domestic Violence on Infants and Toddlers” (see box), which provides non-blaming language to address how parents can protect their child from the impact of domestic violence. There is also a set of simple devel­ opmental handouts that address developmentally appropriate expectations for children 1 to 5 years old while at the shelter.

It is important to remember that although the First Steps curriculum materials are useful, it is the professional delivering the program and their understanding of key elements of parent- child dyadic intervention and trauma informed concepts that are at the core o f the program.

Integrating Concepts of Parent-Child Dyadic Work The following concepts, adapted from work by Lieberman and Van Horn (2005,2008), are central to work at the battered women’s shelter.

O V E R A R C H IN G G O A L According to Lieberman (2007), a primary goal of parent-child dyadic work in the context of domestic violence is to improve the quality of the parent-child relationship, in order to restore the child’s trust in the parent’s capacity to keep the child safe. The parent-child relationship can then support the child’s regulation of affect and mastery of developmentally appropriate goals. To begin work on that goal, the practitioner holds the perspective and emotions of both the baby and the mother during each session. This is a central feature of the work at the battered women’s shelter, and it is surprisingly difficult work. In First Steps, the perspective of the child, the caregiver, and the relationship are always held in mind. For example, during a first session of the First Steps program, the caregiver may be feeling ashamed, worried, distracted, lonely, sad; the child in the room may be feeling anxious, needy, confused, angry; and the relationship between the caregiver and the child may feel distant, out of sync, with a loss of joy. The practitioner is holding all the perspectives while providing “sacred time” to focus on healing and strengthening the relationship.

J O IN W IT H T H E P A R E N T

Creating a working alliance with the parent on behalf of the child is essential. The program requires that the practitioner work shoulder-to-shoulder with the mother or primary caregiver. The primary goal is not to teach parenting, but to offer support to the

E f f e c t s o f D o m e s t ic V io le n c e o n I n f a n t s a n d T o d d le r s

Even infants and toddlers are affected by fam ily stress and domestic violence. By understanding how and why, you can help protect your baby or toddler from the effects of fam ily stress.

Why does domestic violence affect babies and toddlers?

► Because babies and toddlers are sensitive to your feelings. Babies use their caregivers to help them learn how to regulate their feelings. When you are scared, anxious, stressed, or angry all the time, your baby or toddler w ill feel your feelings and it can be confusing.

You can help protect your baby or toddler by spending a little tim e every day, getting down on the floor and enjoying playtime with your child. Let go of your worries, get away from distractions, and give your child all your attention.

► You may be distracted and less available to them. Babies and toddlers tell you what they need or what they feel by crying, clinging, using body language, etc. When no one answers their cries they might stop trying or they m ight cry or cling more.

You can help protect your baby or toddler by trying to figure out what they want or need, and responding to them as soon as possible. Babies and toddlers are learning to trust.They might have a hard time trusting after experiencing domestic violence or its aftereffects.They will learn to trust again, if they get their needs met by you.

parent-child relationship. This does not mean that the practi­ tioner never shares information or offers skill development, but only after she understands the perspective of the caregiver and can hold that perspective while maintaining a trauma informed understanding of infant and toddler development in the context of domestic violence. For example a parent says, “I’m not really worried about Grant. He’s too little to remember anything. I just want to get him to stop crying so much.” The practitioner responds, “Sounds like his crying is really hard on you. I bet it’s particularly hard with all that you have going on right nowl’

D O T H E S IM P L E S T T H IN G F IR S T

If developmental guidance is enough, do that. During the 1-hour sessions with the child and caregiver, opportunities arise for simple developmental guidance. For example, a mother won­ ders whether to start toilet training a child who has just turned 2 years old or a grandmother wants her 3-year-old to clean up all her toys by herself each night. The practitioner can weave together developmental information with an understanding of how stress and trauma can impact young children’s behavior and development. If the parent says, “I need to toilet train Connor now, before the baby comes,’” the practitioner may respond, “I can share some information about toilet training if you would like. I know that the average age for toilet training is 2Vi and that it is often harder when there is a lot of stress and change going on for the child.”

52 Z ero to Three • November 2014

COORDINATE CARE, PROVIDE CASE MANAGEMENT A benefit of doing this work in a shelter is that there are other staff and advocates whose job it is to connect women with needed services. The role of the practitioner in the First Steps program is to know available services in the community for children birth to 3 years old and to be able to connect the family to those services.

ENHANCE SAFETY The practitioner considers both physical and psychological safety for the caregiver and for the child. For example, our experience is that mothers at the shelter are often overwhelmed by the respon­ sibility of caring for their children by themselves. When mothers feel like they are incompetent parents because of their child’s behavior, they are more likely to return to an abusive or unsafe situation. One of the goals o f the practitioner is to support the mother in feeling competent and provide reassurance that she has a system of support so that she can make safe choices for herself and her family.

STRENGTHEN FAMILY RELATIONSHIPS A major component of the work for the First Steps practitioner is to improve the quality of the parent-child relationship. Providing the “sacred time;” to focus on the child; intentionally building connection between the parent and child by providing toys that they can play with together, using the book, song, recording, and engagement activities to build connection; and reffaming the parent’s perception of the child’s bids for “unnecessary attention” as a desire by their child for connection are all part of the work. For example, the practitioner may have to work hard not to focus on his own positive relationship with the child, but rather focus more on supporting the caregiver’s relationship with the child. This focus on the parent-child relationship as opposed to the prac­ titioner-child relationship can be particularly difficult because the child is needy and looking for an available adult who can be responsive. People who work with young children are often excel­ lent at being responsive and meeting needs of little ones. The goal of the program, however, is for the caregiver to be re-established in that role. The child may reach out to the practitioner, but the goal is to turn the parent and child toward each other, not toward the practitioner. For example, the toddler is looking at the practitioner while he is starting to play with the pop-up toy. The mother is sitting on the couch, feeling depressed. The practitioner naturally wants to interact with the toddler and the toy. Instead, the practi­ tioner says, “Let’s go sit by your mom and see if she wants a turn, too!” The next time the practitioner gets together with this family, the child goes immediately to the pop-up toy. The practitioner says, “Look, he chose the one toy that he played with together with you last time! I think he is saying,‘Play with me, Mom!’.”

DEVELOP EMPATHIC RELATIONSHIPS The sessions allow for opportunities for the practitioner to build empathy for the mother toward the child as well as for the child toward the mother. For example, the practitioner may say to the toddler, “Your mom is trying really hard to make changes so that you can stay in a safe place” and say to the mother, “Sometimes toddlers who come to the shelter are so worried that their mom

will go away, that they fall apart every time their mom stands up and looks like she is leaving the room.”

KNOWING TRAUMATHEORYTO GUIDETHE WORK Because children will bring up the trauma experiences that they have had, with words or in their play, the practitioner needs to know how to respond appropriately within the boundaries of her role. Even though the practitioner is not in the role of a therapist, and the goal of First Steps is not therapy, the practitioner needs to respond in those moments in a way that will support the process of healing. An understanding of the goals of trauma interventions for infants and toddlers will help in this regard. Some relevant concepts found in the work of Lieberman and Van Florn (2008), include:

• Acknowledge the impact of the trauma (“She might not be able to sit still because there has been so much that has been scary going on around her.”);

• Differentiate between reliving and remembering (“When you were at Bobby’s house you saw that happen. Your mom brought you here so everyone can be safe.”);

• Normalization o f the traumatic response (“People who have experienced something really scary often feel that way!’); and

• Place the traumatic experience in perspective and make meaning (“This is a really hard time in your life, and you are making some different decisions than you have before.”).

For example, during the sixth session with a mother and a boy who has just turned 2 years old, the child finds a toy that looks like a little gun, stands up, and holds it to his mom’s head. The mom starts to cry. The mom has shared with the practitioner that the dad had put guns to her head during domestic violence inci­ dents. The practitioner says, “You are remembering something scary. It’s scary and sad for your mom, too. Mom has brought you here to keep you safe.’” The mom says, “I didn’t think he remembered seeing that.” Practitioner, “That’s hard to see, isn’t it? I wonder if you might like to work with our early childhood therapist, who knows a lot about how to help little ones work through what they saw?”

Lessons Learned During the 13 years that the First Steps Domestic Violence Program has been in existence, we have learned many lessons regarding implementation o f a program specifically focused on infants and toddlers in a domestic violence shelter.

• It is easy to forget the infants and toddlers in a situation that involves so many immediate family needs.

• Most mothers at domestic violence shelters are glad to have a chance to focus on their infant or toddler.

• Combining an educational home visiting framework with elements o f child-parent work derived from Lieberman and Van Florn (2005,2008) allows for a flexible program that can range from prevention to intervention.

Zero to Three • November 2014 53

• A positive, fun, strengths-based program with incentives to participate provides a regulating and supportive environment for parent-child work focused on supporting the attachment relationship.

• The framework and activities are helpful, but the most im portant factor is the practitioner’s knowledge and ability. In Minnesota, the use of licensed parent educators with specialized infant and early childhood mental health training has provided the expertise needed.

• Including a “dad’s page” as a com ponent that can be used when appropriate is a good reminder to the practitioner to consider the father. Sometimes the mother is so angry at the father that the page never is offered by the practitioner. However, sometimes the mother expects the father will still be involved in the children’s lives, or the abuser wasn’t the father—and the opportunity to offer a page that can be sent to him is affirming to that m other’s experience.

• A trauma-informed lens is essential. The behavior of both the child and the parent need to be understood with knowledge o f the impact of trauma on physical sensations, development, behavior, and relationships.

• Be intentional when choosing toys to introduce. The purpose o f the toys is to support and strengthen the relationship between the caregiver and the child. All toys teach, however it is not the primary purpose o f the toys to provide teaching opportunities. Examples of toys that encourage play between the caregiver and child include baby dolls with clothes and bottles, dishes and food, simple toddler pop-up toys, toddler-sized building blocks, cars, or a simple toddler doll house with people and furniture.

Program Evaluation In order to evaluate concrete impacts o f the First Steps session, the program objectives are tracked through a simple evaluation given to the mother after the third session and an evaluation interview conducted after the tenth session.

The following objectives are tracked in the First Steps evaluation materials:

• The mother feels supported in her relationship with her infant or toddler

• The mother reads more often to her infant or toddler

• The mother sings more often with her infant or toddler

• The mother can ask parenting questions and receive supportive information

• The mother will understand the effects of domestic violence on infants and toddlers and will know some ways to minimize those effects.

The evaluation form, used after the third First Steps session, directly addresses the objectives listed above, giving parents the option of circling the word Yes, Somewhat, or No. The parent also rates the First Steps program on a scale of 0 {not helpful) to 10 (iextremely helpful), and the parent has an opportunity to write comments after each question and on the bottom o f the form.

During the evaluation interview, parents were asked to share what the program has meant to them. Some sample questions and a few of their responses are located in the box Sample Evaluation Questions and Responses.

S a m p le E v a lu a t io n Q u e s t io n s a n d R e s p o n s e s

M o th e rs w h o p a rtic ip a te d in a t least e ig h t sessions o f F irst S teps w e re asked to re sp o n d to a s h o rt e va lu a tio n in te rv ie w .T h e fo llo w in g are s a m p le s o f responses fro m th o s e e v a lu a tio n in te rv ie w s .

Evaluation question: “ In w h a t w a y s d id y o u feel y o u w e re s u p p o rte d in th e

First S teps P ro g ra m ? ”

Parent responses: “ A lo t o f w ays. You b ro u g h t us closer, e sp e cially at

A n n a M arie's w h e n th e kids w e re w o rrie d . It m a d e m e b e tte r t o o .”

“ I fe lt re a lly listened to . M y son is n 't able to cope w h e n I have h im c o m fo rt m e .”

“ I feel th a t I m ake b e tte r choices because I'm g e ttin g s u p p o rt ra th e r th a n m o n ito r in g .”

Evaluation question: “ Can y o u g iv e a ny e x a m p le s o f h o w p a rtic ip a tin g in

F irst Steps has en co u ra g e d y o u to read, sin g , and play m o re o fte n w ith y o u r c h ild ? ”

Parent responses: “ Because y o u p u t th e ideas in m y head. A n d to see h o w

m uch fu n th e y had in ju s t th a t hour, th e n th e y even b rin g it up to m e and ask m e to do it . ”

“ G e ttin g th e books. I d id n 't have a ny w h e n I ca m e h e re .”

“ She m akes m e sing th a t song y o u ta u g h t us eve ry n ig h t n o w .”

Evaluation question: “ Can y o u th in k o f any e x a m p le s o f h o w p a rtic ip a tio n

helped y o u 'b e th e re ' fo r y o u r c h ild ? ”

Parent responses: “ W h e n I fir s t g o t to A n n a M arie's I had a lo t o f stress.

By m e e tin g w ith y o u , y o u re m in d e d m e o f w h a t I w a n te d to do w ith m y c h ild re n .”

“ It helped m e th in k a b o u t fo c u s in g m o re a b o u t h im ra th e r th a n all m y w o rrie s and p ro b le m s .”

5 4 Zero to Three • November 2014

L e a rn M o r e

National Child Traumatic Stress Network www.nctsn.org

Mommy Hates Daddy: A Child-Parent Psychotherapy Story of Engagement, Domestic Violence, and Intergenerational Ghosts. M. Mays & A. F Lieberman (2013). Z e r o to T h re e , 33(6), 4-10.

First Steps Home Visiting Curriculum J. Ellison www.thrivingyoungminds.com

The core objective of the First Steps program is to support the primary caregiver to be a sensitive and regulatory attachment partner for the infants and toddlers who come into the battered women’s shelter. The program is a powerful part of a com­ prehensive array of services needed to help families impacted by domestic violence. It addresses the needs of the vulnerable child, the stressed parent, and the parent-child relationship that is at risk. It offers a unique approach that allows the

practitioner to individualize the program to the needs of the parent-child relationship along a continuum from prevention to supportive intervention.

Jane R. Ellison, LMFT, IMH-E®, is a community leader in early childhood mental health. She has more than 30 years of experience working w ith young children and th e ir fam ilies, including clinical work in private practice, parent education in early childhood fam ily education, home visiting, fam ily literacy, child abuse and neglect prevention programs, and a domestic violence shelter. Ms. Ellison holds licensure in parent education, early childhood education, and marriage and fam ily therapy, a certificate in infant and early childhood mental health from the University of Minnesota, and Clinical Level IV Infant Mental Health endorsement. In her private practice, Ms. Ellison does clinical w ork w ith children birth through 5 years old and their families, as w ell as providing consultation and training on early childhood mental health. Ms. Ellison is currently project manager fo r Greater St. Cloud Area Thrive, and early childhood mental health specialist/parent educator fo r the Sauk Rapids/Rice Early Childhood Family Education program and is a Center fo r Early Education and Development affiliate faculty in the University of Minnesota Infant and Early Childhood Mental Health Certificate Program.

REFERENCES Bogat, G. A., Dejonghe, E., Levendosky, A. A., Davidson, W. S., 8c Von Eye, A. (2006). Trauma symptoms among infants exposed to intimate partner violence. Child Abuse and Neglect, 3 0 ,109-125.

Dejonghe, E. S., Bogat, G. A., Levendosky, A. A., Von Eye, A., 6c Davidson, W. S. (2005). Infant exposure to domestic violence predicts heightened sensitivity to adult verbal conflict. Infant Mental Health Journal, 26(3), 268-281.

Fantuzzo, ]., 6c Fusco, R. (2007). Children’s direct sensory exposure to substantiated domestic violence crimes. Violence and Victims, 22(2), 158-171.

Lieberman, A. F. (2007). Ghosts and angels: Intergenerational patterns in the transmission and treatment of the traumatic sequelae of domestic violence. Infant Mental Health Journal, 28(4), 422-439.

Lieberman, A. F., 8c Van Horn, P. (2005). Don’t hit my mommy!: A manualfor child parent psychotherapy with young witnesses o f fam ily violence. Washington, DC: ZERO TO THREE.

Lieberman, A. F., 6c Van Horn, P. (2008). Psychotherapy with infants and young children: Repairing the effects o f stress and trauma on early attachment. New York, NY: Guilford.

McDonald, R., Jouriles, E. N., Ramisetty-Mikler, S., Caetano, R., 8c Green, C. E. (2006). Estimating the num ber of American children living in partner-violent families./oaraa/ o f Family Psychology, 20(1), 137-142.

Schechter, D. S„ 8c Willheim, E. (2009). In C. H, Zeanah.Jr. (Ed.), Handbook o f infant mental health (3rd ed.; pp. 197-213). New York, NY: Guilford.

Scheeringa, M. S., 8c Zeanah, C. H. (2001). A relational perspective on PTSD in early dVAAhooA.Journal o f Traumatic Stress, 14(4), 799-815.

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