Homelessness is TOXIC STRESS: The Impact of Homelessness on Early Attachment Relationships and

Development in Infants, Toddlers & Very Young Children

Michelle Anderson Deirdre Houlihan DiCaraAnne Giordano FISH ShelterEDUCATION CONNECTION Friends in Service to Humanity

AgendaWelcome & Introductions

Training Objectives for Participants:Understand the Relationship Between Homelessness and Toxic StressUnderstand How Homelessness Impacts Attachment Relationships and DevelopmentLearn Successful Strategies for Engaging Families Learn Strategies for Working Collaboratively with Community Partners

(Adapted from presentation with Roseanne L. Flores, Ph.D., at the Head Start, 11th National Research Conference, 2012)

Introduction Homelessness has often been viewed as an extreme form of

poverty, influenced by an “accumulated lifetime exposure” to environmental risks.1

One woman experiencing homelessness described it as, “a remarkably constant stream of distressing and spirit – breaking encounters, beginning in early childhood”,

including lifelong poverty, parental neglect, exposure to domestic violence, childhood abuse (including sexual abuse), and unhappy and painful interpersonal relationships.2

Why this Matters: Demographics & Numbers

US public schools identified 1,168,354 homeless students in 2011-2012 3

More than half of children living in HUD funded shelters in 2012 were under the age of 6: 3

Under age 1 = 33,044 Ages 1-5 = 134,631

One third of the homeless population are families:o 60% of homeless women have children under the age of 18o 42% of children in homeless families are under the age of 6o 20% of homeless youth become pregnanto 25% of very young children experiencing homelessness evidenced poor social emotional

developmento Homelessness during infancy & toddlerhood linked to early school failure and child welfare

involvemento Homeless in early childhood associated with poor social skills and classroom engagement in

elementary school 3

CT Child Statistics• CT has approximately 108,000 infants and toddlers and 75,000

preschoolers:

• 17% are living in poverty

• 5.5% are born to teen mothers

• 12% are born to mothers without a high school diploma

• 22% of mothers have inadequate prenatal care

• 7.7% are born low birth weight

• 20.7% enter kindergarten without having attended preschool

• 6,965 children were abused or neglected in last year reported (all ages)

And because we know that….• “What happens in the first three years of a child’s

life has a direct and enduring impact on a child’s future learning, behavior and health.”

Lisa Honigfield, Ph.D., CT Child Health & Development Institute (CHDI)

Key Terms:

Attachment

Toxic Stress

Definition of AttachmentAttachment is the ongoing emotional bond that the child builds with a familiar adult through a nurturing relationship.

Infants and toddlers who are building attachment relationships tend to seek and maintain closeness to important people in their lives, especially during stressful situations.

When infants and toddlers have healthy relationships that support attachment, they learn to trust that the world is safe, and they have the confidence to explore and learn!

(DECA –for Infants & Toddlers)

Attachment & the Impact on First Relationships

• The ways in which primary caregivers interact with their babies in their first years of life provide the answers to these critical questions about the baby’s sense of security:

o Is my environment safe for exploration and learning?o Can I count on someone to respond to my needs?o Am I worthy of attention?o Are people trustworthy?

Secure Attachments:When a primary caretaker meets the social and emotional needs of a child in an appropriate, consistent manner, that child feels safe and secure in the attachment relationship:

• Acts as a protective factor.• Helps promote cognitive functioning…if a child feels

safe, they have lower stress levels, so they can stay regulated and maintain low cortisol levels (stress hormone).

• Allows children the freedom to explore their environment, and learn!

Insecure Attachments:

• May occur when caregivers do not respond to their child’s distress signals in a consistent manner.

• Inhibits emotional & cognitive development.• Higher stress results in high levels of cortisol (stress

hormone), resulting in unregulated & insecure children.• Leaves children less likely to explore their world and take in

new experiences.• Negatively affects children’s relationships into adulthood.

Leads to the Formation of the Child’s Internal Working Model:

• Positive• Negative

Positive:

Develops when caregivers are nurturing, consistent, loving & empathic- child’s internal voice says-

• “I am loveable”• “I can trust others”• “I deserve to be happy”• “I am capable of making others happy”

Negative:

Develops when caregivers are punitive, abusive, neglectful, rageful, or self-absorbed- child’s internal voice says-

•“I am incapable of being loved”•“I cannot trust others”•“I am trouble to be around”

3 Types of Stress Responses

• Positive Stress

• Tolerable Stress

• TOXIC STRESS

Positive Stress-

A normal and essential part of healthy development (working on a challenging task, getting an immunization, entering childcare, starting a new job, etc.)

Tolerable Stress- If the situation is time-limited, and is buffered by positive relationships and support from trusted adults who help the child adapt- the brain and organs recover (divorce, loss of loved one, frightening injury, etc.)

TOXIC STRESS

Occurs when a child experiences strong, frequent/and or prolonged adversity- without the buffering of adequate adult support 4

Definition of Toxic Stress (cont.)

• Examples can include: physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the “accumulated burdens of family economic hardship”.4 (ex. homelessness)

• Toxic stress disrupts the development of brain architecture and of other organ systems.4

Toxic Stress and Homelessness• The prevalence of traumatic stress in the lives of families

experiencing homelessness is extraordinarily high and on-going:

o childhood abuse and neglect o family disruption & losso domestic & community violence o involvement with the foster care systemo trauma associated with the loss of home, safety and sense of

security 4

ACE Study: Adverse Childhood Experiences

• Conducted by Kaiser Permanente from 1995-1997 5

• 17,000 participants • Measured exposure and frequency of early experiences prior to age

18, including:o Abuse (physical, emotional, sexual)o Neglect (physical, emotional)o Household Dysfunction

• Mother treated violently• Parental substance abuse• Parental mental illness• Parental separation/divorce• Incarceration of family members

Frequency & #’s of ACE’s are strongly

correlated to future mental health & social

complications: • Alcoholism & substance abuse• Depression• Fetal death• Risk for intimate partner violence• STD’s and multiple sexual partners• Adolescent pregnancy• Smoking• Suicide

ACE’s also linked to future health/medical complications:

• COPD• Heart disease• Liver disease• Obesity• Health related “quality of life” issues

Toxic Stress and Homelessness

Children in homeless families experience more stress in their lives, and at early ages.3-

o fear that something bad will happen to their familieso high rates of family separation o >12% of homeless children are placed in foster careo 83% are exposed to a serious violent event by age 12o anxiety over having a place to live or sleep at night

Characteristics of Homeless Families

Mothers who are homeless often are: 6, 7

o poorly educatedo unemployedo lacking in employable skillso earning incomes significantly below FPLo experiencing acute and chronic physical, dental & mental health issueso limited in access to adequate health careo have high rates of substance abuse, severe mental health disorderso exposed to physical, emotional & sexual abuse, both as children & adults

Characteristics of Homeless Families

Young children who are homeless often demonstrate: 8,9

o poor educational outcomes o poor school performanceo poor health (chronic ear infections, asthma, gastric issues, skin issues)o developmental delays (cognitive, speech & motor)o behavioral/mental health issues

And:o experience hunger, disturbances of sleepo lack appropriate toys & resources

Impact of Homelessness on Pregnancy

Women who are pregnant & homeless are most likely:10

o young/adolescento highly stressedo socially isolatedo malnourishedo pooro undereducated/unemployedo experiencing physical/mental health issueso experiencing/have experienced abuseo lacking needed social supportso to have poor relationship histories

Impact of Homelessness on Pregnancy

Homelessness interferes with establishing the positive prenatal characteristics that promote optimal development for the newborn, including:11,12

o adequate prenatal careo mentally preparing for parenthoodo logistically preparing for the birtho forming impressions of the new babyo visualizing where the baby will “be”

o These all promote the early formation of positive, secure attachment patterns

Impact of Homelessness on Infants

Primary developmental task of infancy is to establish security & trust—parents’ task is to support the infant through responsive and consistent caregiving.13

Homelessness works against this primary developmental task due to:12

o unpredictable & inadequate physical environments o inability to meet basic needs o exposure to extreme temperatureso overcrowded & over stimulating living conditionso possible presence of multiple adult caregivers

Impact of Homelessness on Infants

Infants may become emotionally flooded and overcome with hunger, physical discomfort, & frustration.14

Infants may be negatively impacted by loss of mother’s emotional response & availability, leading to insecure attachment patterns.14

Consequences can lead to high rates of emotional, physical, health, & developmental issues, & cognitive, motor & language delays.14, 15

Impact of Homelessness on Toddlers

Primary developmental task of toddlers is to develop self-regulation & identity—parents’ task is to support the toddler through scaffolding for regulation and the provision of a safe, secure environment.13

Homelessness works against this primary developmental task due to:16

o poorly maintained & unsafe environmentso restrictions on toddler’s opportunity for free explorationo pressure on parents to manage behavioral outbursts & power struggleso feeling of parenting under a “microscope”—leads to embarrassmento absence of developmentally appropriate materials & activitieso parents’ autonomy to make decisions is sometimes limited due to shelter routines

Impact of Homelessness on Toddlers

Toddlers may begin to demonstrate reactions to continual stress including:13

o feelings of insecurityo distrusto fearso loss of skillso frequent illnesseso irritabilityo stagnancy in developmental skillso regression in developmental skills developmento delays in social, cognition, communication & motor skill developmento behavioral issueso issues of sleeping & eating

Impact of Homelessness on Preschoolers

Primary developmental tasks of preschoolers are to develop recognition of emotional states of others, separating from parents, and to develop social competence with peers & adults—parents’ task is to provide the preschooler with external support in understanding social situations and facilitating relationship building with peers & adults.13, 17

Homelessness works against these primary developmental tasks due to:

o inability to provide a structured & organized environment 18, 19

o inability to provide books & toys that promote development 18, 19

o parents under stress may themselves model poor interpersonal skills with others18, 19

o unruly behavior in children as they get older may cause eviction resulting in additional stress1

Impact of Homelessness on Preschoolers

Preschoolers may begin to exhibit:20

o difficulty with peerso intense emotional reactionso feelings of boredomo frequent illnesseso anxietyo developmental stagnancy or regressiono developmental delays in cognition, communication & school readiness skillso externalizing behaviors in order to exhibit a sense of controlo issues of sleeping & eating

So… what can we do????• Think about the following statement by Bruce Perry, M.D.

o “There is no more effective neurobiological intervention than

a safe relationship…..it changes the brain.”

It’s all about the relationship!• Think about the “parallel process”… “do unto others as you would

have others do unto others” (Jeree Pawl, 1998).

• Parents cannot give what they haven’t received themselves … or may have lost along their journey.

• In order for parents to be able to offer a sense of security to their children… we must first offer it to them!

• Remember that “how we are”…… is often more important than what we do!!!!!!!

So.. How do we do it?• We must first create opportunities for parents to feel:

• Safety

• Security

• Respect

• Trust

• Dignity

Examples in action……McKinney Vento Grant Coordinator- Michelle Anderson

FISH Executive Director-Deirdre Houlihan DiCara

Builds strong relationships with shelter staff, early childhood providers & schools- leads to early identification and immediate connection to families

Instills “family atmosphere” into all aspects of shelter life: holidays, family meals, birthday celebrationspicnics, etc.

Streamlined identification processes & forms- timely response & reduces chance of missing referrals

Hosts baby showers –encourages attachment building

Promptly meets with families one-on-one; provides concrete assistance which promotes security

Promotes sense of “pride” among residents by encouraging their participation in community events

Conducts developmental screenings to identify children at risk for developmental concerns

Attends child events: graduations, award ceremonies, etc.- promotes self concept

Conducts on-site playgroups in shelter-encourages positive child/parent interaction

Invites past residents back to shelter for family dinners- maintains sense of connection & relationships

Treats all with respect & dignity! Treats all with respect & dignity!

Practices to Support Positive Outcomes for Young

Children & Families!

Reflections from the team……• How do we impact and reach out to young children in our

community? What supports do we offer?o Collaborations & Partnerships are KEY!

• McV Sub-grant Coordinator & Shelter Director have strong partnerships with:o Shelter staff- allows for timely identification & connections with families!o Local Continuum of Careo Superintendent & every school social workero City officials & civic organizationso Community Foundations (funding opportunities)o Local library, child enrichment programs o Early Care Programs: PAT, HS/EHS, B-3, Child First, childcare centers, etc.

o On-site shelter services in place:• Home visits to families with children at FISH & SBA• Developmental screenings conducted (ASQ); referrals as needed• Playground & Library established with HS funding• Birthday Parties/holidays/baby showers• GED, life skills, cooking classes• Job preparation

Continued…..• Direct supports for children & families:

o Camperships & enrichment programso Clothingo Backpacks/school supplies/athletic equipmento Early care tuitiono Baby supplieso Books, toyso Food resourceso Tuition to school clubs, class trips, programso Tutoringo Transportation supports

• Partnership Successes:o Annual Homeless Connect event (Children’s Corner)o First Book grant award of free bookso Local donors (i.e.: Walmart cards, etc.)o Local grant awardso Caseworkers at FISH & SBA are well established- allows for direct contacto Local officials, legislators, and school administration on board! o Strong collaborative history in our community!

But as always… there are barriers!

• Lack of available slots to enroll children in early care programs!• Transportation is basically non-existent in our area• Few shelter beds exist in our community• Lack of affordable housing• TRUST… always a work in progress

Strategies for accessing early childhood services

Identify existing early childhood programs in your community Connect with key early childhood stakeholders Advocate for slots for homeless children within early childhood

programs; be “flexible” with requirements Include “homelessness” in selection criteria for enrollment by

classifying homelessness as an “at-risk” factor Designate a “young child” contact at each homeless service program

(homeless/DV/ emergency shelters) in your community

Provider Strategies for Successful Home Visits

with Homeless Families! Be willing to meet families where they are…even getting to a program

a few blocks away can be overwhelming—schedule as much as possible on site where they are.

Be aware that the “multiple provider” approach can be intimidating and confusing to families—sometimes fewer is better!

Offer a variety of locations to conduct home visits— shelter, library, coffee shops, other scheduled appointments the family already has—sometimes this is the only privacy they have.

Provider Strategies for Successful Home Visits with

Homeless Families! Schedule regular visit times to shelters that you are available (i.e.

every Thursday morning) rather than individually set appointments—sometimes better results.

Be flexible—“think out of the box”—and willing to adapt & stretch some program rules to better fit family situation.

Q-TIP: Quit Taking It Personally! Just because a family doesn’t follow through with you, doesn’t mean it is about you or their interest in being the best parent they can be…it may be just all they can do at that particular moment.

Provider Strategies for Successful Home Visits with

Homeless Families! Focus on “what you can do” instead of “what you can’t do”…

accept and expect that there are many barriers to serving this population.

Offer respect and listen—sometimes that is enough!

Remember that it “is all about the relationship”—recognize that you must build trust first, and even then, it can be challenging to keep families engaged with you at times.

Presenter Contact InformationMichelle AndersonEDUCATION CONNECTIONtorringtonfrc@educationconnection.org860-489-8552

Anne GiordanoEDUCATION CONNECTIONgiordano@educationconnection.org860-567-0863 X 236

Deirdre Houlihan DiCaraFISH/Friends in Service to Humanityddicara@fishnwct.org860-482-7300 / 860-605-5135

Resources http://www.naehcy.org/early.html

http://www.horizonsforhomelesschildren.org

http://www.familyhomelessness.org

http://www.serve.org/nche

References• 1David, D.H., Gelberg, L., & Suchman, N.E. (2012). Implications of homelessness for parenting young children: A preliminary

review from a developmental attachment perspective. Infant Mental Health Journal, 33(1),1-9. doi: 10.1002/imhj.20333. • 2 Styron, T. H., Janoff-Bulman, R., & Davidson, L. (2000). “Please ask me how I am:” Experiences of family homelessness in the

context of single mother’s lives. Journal of Social Distress and the Homeless, 9(2), 143-165. doi: 10.1023/A:1012945602583. • 3Demographic information was extracted from The National Center on Family Homelessness (2011). The characteristics and

needs of families experiencing homelessness. Retrieved from http://www.homelessness.org/media/306.pdf. • 4Center on the Developing Child Harvard University. (2012). Toxic stress: The facts. Retrieved from

http://developingchild.harvard.edu/topics/science_of_early_childhood/toxic_stress_response/.

• 5 ACES: The Adverse Childhood Experience Study. http://www.acestudy.org/index.htm

• 6Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., & Perloff, J. N. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87(2), 241—248. doi: 10.2105/AJPH.87.2.241.

• 7Rog, D. J. & Buckner, J. C. (2007). Homeless families and children. Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. Retrieved from http://aspe.hhs.gov/hsp/homelessness/symposium07/rog/index.htm.

References• 8Haber, M. G., & Toro, P. A. (2004). Homelessness among families, children and adolescents: An ecological-developmental

perspective. Clinical Child and Family Psychology Review 7(3), 123-164. doi: 10.1023/B:CCFP.0000045124.09503.f1.

• 9Better Homes Fund. (1999). Temperament and attachment security in the strange situation: An empirical rapprochement. Child Development, 58(3), 787.795. doi: 10.2307/1130215.

• 10Bassuk, E. L. & Weinreb, L. (1993). Homeless pregnant women: Two generations at risk. American Journal of Orthopsychiatry, 63(3), 348-357. doi: 10.1037/h0085034.

• 11Bassuk, E. L. (1991). Homeless families. Scientific American, 265(6), 66-74.

• 12Galinski, E. (1981). Between generations: The six stages of parenthood. New York, NY: Berkeley.

• 13Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, W. A. (2005). The development of the person: The Minnesota Study of Risk and Adaptation From Birth to Adulthood. New York, NY: Guildford Press.

• 14Easterbrooks, M. A. & Graham, C. A. (1999). Security of attachment and parenting: Homeless and low-income housed mothers and infants. American Journal of Orthopsychiatry, 69(3), 337-346. doi: 10.1037/h0080408.

• 15Garcia Coll, C., Buckner, J. C., Brooks, M. G., Weinreb, L. F., & Bassuk, E. L. (1998). The developmental status and adaptive behavior of homeless and low-income housed infants and toddlers. American Journal of Public Health, 88(9), 1371-1374. doi: 10.2105/AJPH.88.9.1371.

References• 16Smolin, A. G. (2003). Children born into loss: Some developmental consequences of homelessness. Journal of the

Psychoanalysis of Culture and Society, 8(2), 250-257. Retrieved from http://muse.jhu.edu/journals/journal_for_the_psychoanalysis_of_culture_and_society/v008/8.2smolen.html.

• 17Hausen, B. & Hammen, C. (1993). Parenting in homeless families: The double crisis. American Journal of Orthopsychiatry, 63(3), 358-369. doi: 10.1037/h0079448.

• 18Heinicke, C. M. (2002). The transition to parenting. In M. H. Bornstein (Ed.), Handbook of Parenting (2nd ed., pp. 363-388). Mahwah, NJ: Lawrence Erlbaum Associates.

• 19Averitt, S. S. (2003). “Homelessness is not a choice!” The plight of homeless women with preschool children living in temporary shelters. Journal of Family Nursing, 9(1), 79-100. doi: 10.1177/1074840702239492.

• 20From a presentation given by Nancy Suchman, Ph.D. , Associate Professor, Yale University School of Medicine. Mothering from the Inside Out: Promoting Reflective Parenting in At-Risk Mothers Caring for Young Children. Sponsored by, CT Association for Infant Mental Health, April 2012.