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Community Trauma Prevention Starts with Parent-Infant Relationships

 

The COVID-19 pandemic has called on us to find creative ways to connect and learn. In rural western Massachusetts I had scheduled a training for 20 practitioners who work with parents and infants to meet together for two days of learning on April 15 and 16th. Instead I rapidly adapted the training to the online setting. I have had the pleasure of meeting weekly with an extraordinary group that includes peer recovery coaches on the front lines supporting moms with opioid use disorders, clinicians and administrators from Child Protective Services, physicians, occupational therapists, early intervention specialists, and early childhood educators to learn together for a course in Community-Based Parent-Infant Relationship Support.

Pittsfield, Massachusetts exemplifies the term “high needs, low resourced” that has in many academic circles replaced the less specific term “at risk.” The largest city in rural Berkshire county, it is a study in contrasts. A rich cultural community of extraordinary natural beauty is home to poverty, community violence, and a growing crisis of opioid abuse. Berkshire Medical Center, the local community hospital, has seen a dramatic increase in families in crisis, with a 300 percent rise in babies with opioid withdrawal ( neonatal abstinence syndrome) in the past 4 years.

These front line practitioners in our online training interface with vulnerable Pittsfield families at different points of contact. By gathering to learn together over time, we hope to forge relationships that can build what pediatrician D.W. Winnicott named a holding environment. We aim to set development on a healthy path right from the start.

Several years ago I had the privilege of listening to Bessel van der Kolk, trauma researcher and author of The Body Keeps Score. He began his talk with a video clip of a mom and her baby, who looked to be about 3 months old, having a conversation. It started with an exchange of soft sounds, moving on to more complex communication, including shared facial expressions. Palpable delight characterized the moment of meeting.

As the conversation between mother and baby increased in complexity, a slight lapse appeared between the baby’s signal and the mother’s response. Herein lies the development of resilience. As described in our new book, world-renowned child development researcher Ed Tronick, who van der Kolk referenced at the start of his talk, has demonstrated using second-to-second videotape analyses that in typical relationships parent and infant are mismatched in 70 percent of interactions. What he terms “quotidian resilience” develops in the repair of these countless moments.

Ways of being together are laid down in our minds and bodies the early weeks, months, and years of life. They become part of us; part of our DNA. Our earliest relationships sculpt our nervous system and the way our body responds to stress. The moment-to-moment mismatch and repair of early infancy is the material of which our self, with our own skin—our own border—is made. Survival of disruption, together with the joy of repair, creates trust, an essential ingredient of intimacy. We develop a confidence that when we feel bad, we won’t always feel bad. This early experience builds a foundation of hope. 

The talk was sponsored by Berkshire United Way, which is taking a lead in making our community “trauma-informed.” Driving the movement to create “trauma-informed communities” is the powerful longitudinal Adverse Childhood Experiences Study showing the poor long-term outcomes of a range of experiences including not only abuse and neglect, but the more ubiquitous experiences of parental mental illness, marital conflict, and divorce. The greater the number of ACEs, the greater the likelihood of a wide range of negative physical, emotional, and social consequences.  

The original ACE research grew out of the observed high association between adult obesity and childhood sexual abuse. The original ACE questionnaires address experiences specific to relationships. Recent adaptations have expanded to include external stressors such as poverty and racism. Again looking to the research of Ed Tronick, we can understand the parent-infant relationship as being either a buffer against or a transducer of these stressors. 

 An extensive body of research shows us how these early experiences get into the body and the brain.  But perhaps we need look no further than van der Kolk’s opening video. My colleague in Scotland, Suzanne Zeedyk, who is taking extraordinary strides to make an entire country “trauma-informed” in large part through showings of the film Resilience about the ACEs study, began her work in the arena of public policy with a beautiful film, the connected baby. Both she and van der Kolk recognize that babies have an extraordinary capacity for connection and communication from the moment of birth. “ACEs” are experiences that violate that connection. 

Adverse Childhood Experiences can be understood as developmental derailment of the healthy process of mismatch and repair. Prolonged lapse between mismatch and repair occurs when a parent is preoccupied with depression, substance use, marital conflict, or domestic violence. Paucity of repair occurs with an anxious intrusive parent. Unrepaired mismatch occurs in the setting of abuse and neglect. 

Van der Kolk went on to demonstrate, using research evidence and clinical examples, how when bad things happen to us early in our lives, the experiences live in the body. Offering a message of hope, he encouraged his audience—a broad range of individuals from our local community—to recognize that healing begins with the body. Theater, martial arts, drawing, drumming, yoga, and dance are among the many ways in which, in the setting of relationships, parts of the brain damaged by the experience of trauma can begin to heal. 

In conclusion, van der Kolk returned to babies. He advised us to look to paid parental leave, high-quality daycare for all, and other measures to support new parents as the path to a trauma-informed community. In keeping with his recommendations, our local chapter of Berkshire United Way is supporting The Hello It’s Me Project that aims to engage communities around promoting safe, secure parent-infant relationships from birth.

The word “trauma” can itself be traumatizing. As we move forward with this work, I wonder if we might aim to build not “trauma-informed” communities, but, taking the lead from van der Kolk’s presentation of mother and baby, simply “connected communities.”  Parents and babies are an excellent place to start.

Please note this post was originally published on my Child in Mind blog.

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Hi Tim. Thank you for your insight and shedding awareness regarding the recommendations that are circulating with WHO and the medical community. I've studied some child and adolescent development and developmental trauma and have my own experiences, and I get what you are saying. I still recall in the early 1990's when I was informed by the medical community to let my child cry to fall asleep. It still haunts me to this day that I did such a thing for a few months when my son was colic. I thought I was doing the right thing because the the educated professionals told me it was the right thing to do, even though it felt so wrong. It's not only ridiculous but appalling to hear what they are saying. This behavior is actually causing trauma because the child is being neglected in a time of need. I wrote extensively in my book about the child-parent attachment and can foresee the consequences of such behavior. Thanks for the information! 

https://www.acesconnection.com...3#504460909570079013

Whatever policies that are put in place, it will always be critical for critical eyes that have read extensively on child development, human development, development of self, dissociation, implicit memory and who understand child developmental needs and developmental trauma who also have no agenda but the sincere advancement of family and child developmental needs to watch very closely what foundations and governmental agencies are putting out.  

If we who have been impacted and who are concerned because of lived experience are not very aware and very watchful, we could see things done that actually harm children.   

For Example, The WHO put out information that mother's should stay 6 feet away from their newborn infants, put their infants in an incubator to separate the mother and the infant so as not to spread new viral infections that come into human consciousness and that mother wear masks with their infants.  

These policies are absolutely ridiculous and would have devastating impacts on child development.  This is akin to infant neglect and sensory deprivation. We have mothers wanting to do what is best for their infant, being giving advice that actually causes harm  such as non-organic failure to thrive and creates all the developmental consequences of infant neglect - such as autistic like behaviors, sensory integration problems, and adult violence.  

Much of these basic human developmental needs were known by Ph.D and MD doctors since the 50's and 60's.    But that Information has not been shared with parents.   It would be incredibly unwise to give up our sovereign right  to raise our own children to so called experts who may or may not know what developing children actually need. 

I have heard nothing from the AAP about the dangers to child development of some of these policies.  I have only heard further pushes to get kids to wear masks without any advice to protect infants.  

I have seen well-meaning parents with newborn infants in masks. This is such a huge suffocation risk and an incredible developmental risk.  Mothers and infants should never be encouraged to be separated.    

Even in pediatrics education, doctors have been told to counsel mothers to have their 2 month old infants sleep through the night in their own room. "If the baby cries, go to the door, make sure the infant is okay in a SIDS safe sleeping environment and close the door."    

This is horrific advice for healthy infant development but is the kind of advice I have received from a doctor myself.   

It is imperative that those of us with lived experience do not rely on so-called medical experts.  We need to educate ourselves.  

Thanks. .....

Last edited by Tim Cain

Oh my goodness, 'connected communities,' so simple it's brilliant. Thank you for this post and thank you for your incredible book. You and Dr. Tronick offer us real avenues for connection and authentic strategies for repair and resilience.  I am very grateful for this inspiration!

Thank you for your post, Claudia. Education is key and begins early, prior to child development. Certainly, skills can be taught to raise healthy babies and children and need to be incorporated in prenatal educational classes or even earlier. As for your (and van der Kolk's) suggestion regarding the use of "connected" communities rather than "trauma-informed" communities, I still believe after my own research and experiences that we need to use the term trauma (or at minimum both). Individuals who've experienced trauma function differently; we know this through the ACE's studies. I believe, using the term trauma gives trauma survivors that connection to others. Excluding the term would, I feel, be of disservice to these individuals.

As a developmental trauma survivor with an ACE score of 9/10, I isolated myself because of the C-PTSD symptoms and other mental health issues that I struggled with for decades. No one understood me (not even physicians), and when I was going through the healing journey on my own (with trial and error strategies since I couldn't find anything to latch onto to for support at the time) and I finally came across information about "trauma", it gave me a sense of connection. Reading about trauma and understanding trauma allowed me to feel heard; that someone knew what I was going through. It made me finally realize that trauma made me a different person which then allowed me to learn how to accept myself; that I wasn't losing my mind.  I started to feel as though I belonged. Trauma-based books and communities did that so when I seek out information, I look for the term "trauma" to know that I can find support and understanding from a community that "gets" it. Removing the term "trauma" and moving to a more "general" statement doesn't serve trauma survivors.

Although trauma is becoming common-place these days, we need to keep the awareness of the harmful effects trauma does to individuals, groups, and communities. Connected communities is a generalized term, and it removes the trauma-based effects. We do not want to remove the known and researched effects. We do not want to forget how traumatic experiences shape individuals. The alterations that happen in our brains and nervous system are real and the name trauma confirms the need to be understand these life-altering effects so that we can continue to create change.

Dear Claudia:
Thanks for this wonderful post. These two parts struck me most and I'll be thinking more about them all day. THANK YOU!
Cissy

 "The moment-to-moment mismatch and repair of early infancy is the material of which our self, with our own skin—our own border—is made. "

"The word “trauma” can itself be traumatizing. As we move forward with this work, I wonder if we might aim to build not “trauma-informed” communities, but, taking the lead from van der Kolk’s presentation of mother and baby, simply “connected communities.”  Parents and babies are an excellent place to start."

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