1. The Influence of Trauma and Toxic Stress on the Social-Emotional Health of Infants, Toddlers and their Families Monday, 12/8/08 Kim Diamond Berry, Ph.D Court Teams for Maltreated Infants and Toddlers ZERO TO THREE kdberry@zerotothree.org

2. Improving Understanding of Maternal and Child Health Project The ABA’s IUMCH Project seeks to improve child health-related knowledge and skills of attorneys, judges and other legal professionals who handle cases involving very young children from birth to age five. The ABA is working with project partners:  ZERO TO THREE ZERO TO THREE  National Council of Juvenile and Family Court JudgesNational Council of Juvenile and Family Court Judges

3. Copyright © 2008 by ZERO TO THREE Overview 1.Typical Child Development 2.Impact of Maltreatment and Toxic Stress on Infant and Toddler Development 3.Practices that Support Healthy Infant and Toddler Development

4. ZERO TO THREE Early experiences matter. The care that adults provide for infants and toddlers has an enduring effect on their health and development. Investments in high quality care and services yield significant social and economic benefits today and in the future.

5. Copyright © 2008 by ZERO TO THREE Typical Child Development Five domains of development:  Physical/Motor  Cognition  Communication  Adaptive  Social/Emotional  Domains are interrelated Example: Infant Mental Health Handout

6. Copyright © 2008 by ZERO TO THREE Factors Influencing Child Development Health  Prenatal Care  Maternal Health  Child Health Relationships  Infant/Caregiver; Child/Caregiver  Attachment

7. Copyright © 2008 by ZERO TO THREE Factors Influencing Child Development Environment Safe Constant routines Predictable

8. Copyright © 2008 by ZERO TO THREE Impact of Trauma on Infants and Toddlers After birth (difficult infant/caregiver relationships) Two types of trauma causing inability to thrive: Before birth (congenital)

9. Copyright © 2008 by ZERO TO THREE Impact of Trauma on Infants and Toddlers Congenital examples of:  Fetal-Alcohol Spectrum Disorder  Babies born addicted to drugs  Other genetic disorders Cause:  Failure to thrive  Difficulty making all necessary neural connections  Difficulty learning and developing to full potential

10. Copyright © 2008 by ZERO TO THREE Impact of Trauma on Infants and Toddlers Infant/Caregiver Relationships Disrupted by:  Multiple out-of-home placements  Exposure to chronic maltreatment (violence/abuse)  Irregular daily routines

11. Copyright © 2008 by ZERO TO THREE Impact of Trauma on Infants and Toddlers Infant/Caregiver relationship disruptions cause:  Infant Mental Health Disorders (Handout)  Attachment Disorders

12. Copyright © 2008 by ZERO TO THREE Impact of Trauma on Infants and Toddlers Natural Disasters can also cause trauma…

13. Copyright © 2008 by ZERO TO THREE What’s Happening in the Brain?  Genes are responsible for wiring and general connections of parts  Experiences are responsible for fine-tuning the connections  Brain development is activity-dependent  Experiences excite neural activity 1998. ZERO TO THREE. Reproduced with permission of copyright holder. BrainWonders Online: http://www.zerotothree.org/brainwonders. Baby Brain Map Image copyright 2007 ZERO TO THREE. Further reproduction requires expressed permission from ZERO TO THREE (www.zerotothree.org). http://www.zerotothree.org/brainwonderswww.zerotothree.orghttp://www.zerotothree.org/brainwonderswww.zerotothree.org

14. Copyright © 2008 by ZERO TO THREE What’s Happening in the Brain? Newborn Early Childhood Later Childhood Pruning

15. Copyright © 2008 by ZERO TO THREE Impact of Trauma on Infants, Toddlers and Families  Many infants and toddlers exposed simultaneously to congenital and social- emotional traumas.  Intergenerational cycle of trauma that needs comprehensive intervention strategies

16. Copyright © 2008 by ZERO TO THREE Meeting Trauma-Exposed Infants, Toddlers and Families Where They Are  Prenatal Care & Interventions  Prenatal History (when available)  Early Intervention (EI) Screening

17. Copyright © 2008 by ZERO TO THREE Meeting Trauma-Exposed Infants, Toddlers and Families Where They Are (cont.)  Permanency Placement Plans (a.s.a.p.)  Training and Support for Early Childhood Development Specialists and Caregivers  Formation of coalitions of Caregivers, Parents and Early Childhood Development Specialists to develop comprehensive case plans

18. Copyright © 2008 by ZERO TO THREE Scenarios for discussion What’s the ticket…? What’s the destination…?

19. Copyright © 2008 by ZERO TO THREE Participant Scenarios for Discussion

20. Copyright © 2008 by ZERO TO THREE Final Thoughts  Questions  Wrap-up