1. Family-centered, culturally-sensitive, trauma-informed practices (Part 1)
Alyssa Kaying Vang, PsyD, LP
Visible Child Initiative/Family Housing Fund
September 15, 2015
Introduce self professionally, share story of ruam mit with fortune and this being probably more than what I had bargained for. I gone and done it.

2. First reactions. Emotions
First reactions? Emotions? What are some observations you have about the video? The girl? How do you think this particular child will do? Why? What do you think interventions should look like?

3. Culture
Parenting
Trauma
Culture
Parenting
Trauma

4. What is culture?
What drives it? How did it formed? How does it evolve over time? Collective programming of the mind. Learned first in childhood. Norms and values are learned. Collective or individual

5. What is culture? Shared patterns of behaviors and interactions
Programmed in the mind of collective experiences, creating cognitive constructs
Learned through socialization
Collectivist vs. Individualistic
Culture informs our daily practices: relationships with families, how we eat, our food, parenting. Piaget – cognitive construct – meaning is constructed as children interact in meaningful ways with the world around them. Mores is the customs, values, and behaviors (norms) that are accepted by a particular group, culture, etc. (Merriam-Webster Dictionary) examples: eye contact, burping, lines

6. What’s above the surface is built upon what’s below
What’s above the surface is built upon what’s below. What we know, how we communicate, who we surround ourselves with are often the result of what we often are not conscious or aware of.

7. Parenting practices Values Expectations Norms / Mores
Collectivist vs. Individualistic
Sometimes it’s the things that we don’t even think about. Example: “my husband” vs. name of husband, “we” vs. “I”

8. Parenting practices Hmong American
Growth and socialization depends on the child’s ability, desires, and readiness = Passive parenting
Social structure, rites of passage, extended family, lineage – they all provide structure for child
Early teachings/ discipline to fit mold of family and community
Social, emotional, cognitive, and physical development relies on the quality of attachment between infant and caregiver = Active parenting
Parents provide structure and are responsible for raising a self-reliant, respectful, and self-controlled child.
Provide material and emotional care to further physical, emotional, cognitive, and social development (praise, routine, predictability, time with children, extracurricular activities)
Examples: co-sleeping vs. sleeping in their own bed, babies sleep when they are tired vs. scheduled nap times to facilitate optimal growth and mood

9. Hmong
Parenting goal: Raise a mature child that 1) finds a good partner and can have children to preserve lineage and 2) insurance for parents/family
In US, value education for reasons consistent with parenting goal (e.g., better reflection on clan, better choice of spouse, able to care for parents.)
American
Parenting goal: raise emotionally mature adults who are independent, respectful, able to find their place in the world as well-behaved adults
18 year olds
Picking a baby up and soothing them whenever they cry vs. letting the baby cry it out if they are tired and fussy and need sleep, time-outs for bad behaviors vs. “kuv nav kom” or “buy you something” or “scare tactics, older children use choice giving and reasons vs. shame and loss of face

10. Trauma
“A deeply distressing or disturbing experience” (Oxford Advance Learner’s Dictionary)
“An emotional response to a terrible event” (American Psychological Association)

11. Trauma Acute Traumatic Events Chronic Traumatic Events
Events occur at a particular time and place and are usually short-lived
Overwhelming feelings of terror, horror, or helplessness
Examples: school shootings, serious accidents, sudden loss of a loved one
Chronic Traumatic Events
exposure to trauma repeatedly over long periods of time.
intense feelings of fear, loss of trust in others, decreased sense of personal safety, guilt, and shame
Examples: longstanding abuse (physical, sexual), domestic violence, wars
*The National Child Traumatic Stress Network

12. Child Traumatic Stress
Def: When exposure to traumatic events overwhelm children’s ability to cope
Signs of intense distress (may vary depending on age)
Sleep is disturbed
Trouble with attention and concentration
Feeling angry and irritable or may withdraw
Repeated and intrusive thoughts, and extreme distress
Some children develop psychiatric conditions such as posttraumatic stress disorder, depression, anxiety, and other behavioral disorders.
Traumatic experiences can significantly disrupt a child’s development and have profound long-term consequences.
Exposure to traumatic events over time and repeatedly can
affect the developing brain and nervous system
increase the risk for poor academic performance
Increase risk of high-risk behaviors
Cause problems with interpersonal relationships

13. These images illustrate the negative impact of neglect on the developing brain. The CT scan on the left is from a healthy 3-year-old child with an average head size (50th percentile). The image on the right is from a 3-year-old child following severe sensory deprivation neglect since birth. The brain is significantly smaller than average and has abnormal development of cortical, limbic and midbrain structures. -Bruce Perry MD

14. Child Traumatic Stress
Can result in increased access of health and mental health services
Lead to higher involvement with the child welfare and juvenile justice systems.
Adult survivors of traumatic events may:
Have trouble establishing and maintaining fulfilling relationships
Have difficulty finding and holding steady jobs
Struggle to become productive members of society

15. Maybe in the case of homeless families?

16. Intergenerational trauma
Def: When the exposure to traumatic events in one generation continues to have negative effect on subsequent generations
More family perspective
Sexual abuse, traumatic experiences in foster care system
The untreated trauma in the parent is passed on to the child through the attachment process and implicit or explicit message about the world (i.e., relationship to self, safety)

17. Historical trauma
“Cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma.”
-- Maria Yellow Horse Brave Heart, PhD
More communal perspective
Slavery, Holocaust, Native American Removal Act, War survivors
Impact of historical trauma:
Disruption of relationships, loss of identity, loss of culture
Populations affected by historical trauma may find offense to the word, “trauma” and refer to them as “challenging experiences”

18. What does the experience of traumatic events do to culture?
Airports, post 9/11
Culture
Trauma

19. How does prolonged exposure to trauma affect parenting?
Transmission of trauma
Parent-child relationship and interactions
Parenting practices
Ghosts in the nursery – Selma Fraiberg, Edna Adelson, and Vivian Shapiro
“In every nursery there are ghosts. They are the visitors from the unremembered past of the parents…”
When the ghosts of the “unremembered past takes up residence,” we see evidence of problems in infants’ regulatory systems (feeding, toileting, sleep, soothing)
Parents’ compromised ability to meet the needs of the child
Inability to maintain/establish meaningful relationships due to cognitive constructs of traumatic events
Child unwanted due to obsession with paternity
History of disrupted care
Homelessness
History of traumatic events?
Risk factors?
A psychoanalytic approach to the problems of impaired infant-mother relationships, will talk more about this in the intervention talk in Part 2.

20. How does trauma affect culture which affects parenting?
Unsupervised play all summer long
Post 9/11
Culture
Parenting
Trauma

21. Parenting approaches affected by historical trauma
Hmong parents using “stranger” tactic to encourage obedient children
Think of one group who has suffered historical trauma, a group that you are most familiar with (slaver with Afri Amer, Native Amer, war-torn refugees). How has the historical trauma changed the way they parent?

22. Parenting practices (culture or trauma influenced?)
Eating at the table during meal times vs. following child around to get fed
Praising a child vs. not praising a child
Responding to a child’s need vs. letting the child cry themselves to self soothe
Corporal punishment
Being judged of one’s cultural parenting practice by another group
If we understand the underpinnings of their behaviors, whether it be their culture based on values or because of a history of trauma, we less likely to be critical/judgmental and more likely to offer support that is helpful

23. Families we currently work with
Trauma history?
Symptomatic vs. Asymptomatic
Current trauma or repeated trauma
Is being homeless a traumatic event?
What are some things about families you serve that can be frustrating?
My example: Hmong parents and their follow through with kids (school, therapy)

24. Interventions and practical strategies
To be covered in Part 2 October 20, 2015