Expanding our Horizons

Category: disability services

The Impact of Adverse Childhood Experiences: Managing Emotions and Stress

Linda Chamberlain is the founder of the Alaska Family Violence Prevention Project and an internationally recognized advocate for understanding the effects of domestic violence and adverse childhood experiences on brain development and health. She focuses on creating tools that highlight trauma-informed practices for parents, service providers, and organizations that work with kids and families.

Children develop 85% of their core brain structure in their first five years of life and then continue to build on that core foundation the rest of their lives. The young brain is like a sponge—effortlessly, continuously, and indiscriminately soaking up information. From birth, our undeveloped brains are waiting for experiences to shape them. Our first experiences become the building blocks for our whole lives. Our brains are mirrors to our childhood developmental experiences.

Dr. Chamberlain recognizes the importance of social and emotional skills in academic and life success. The biological sponginess of our brains allows us to acquire so much information before age five, but it also makes youth more vulnerable to trauma than people who are older. Most people perceive youth to be more resilient than adults, but it’s actually the opposite; if anyone is impacted by trauma more severely, it’s the youngest child.

Trauma Tree

The roots represent the prenatal stage of growth and where the tree touches the ground is birth. The trunk is infancy, early childhood is the lower branches, and up to adulthood is the top branches. When trauma occurs, the rest of the tree’s (brain’s) growth beyond that point is negatively affected. As you age, you have more life experiences and knowledge to cope, but also more branches to compensate.

This concept becomes significant when we learn that 95% of kids have adverse childhood experiences. Kids who grow up in domestic violence end up with mental health issues more often than kids who are direct victims of physical abuse. Exposure to violence is a lifetime legacy. While domestic violence and abuse are often tangible and identifiable, there’s an endless range of situations and experiences that are adverse (or less tangible and identifiable).

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The brain of a child, Dr. Chamberlain asserts, will become exactly what the child is exposed to. Children exposed to fighting parents will experience a state a fear, and systems in their brains shut down. Parents who fight in front of their kids are literally changing their children’s brains. Moreover, a baby absorbs her parent’s internal state. A kind parent creates a kind child; a patient parent creates a patient child.

Symptoms of chronic stress or signs of exposure to trauma can range from night terrors to attachment issues. Kids who are labeled as ADHD or defiant may be operating in crisis or survival mode. Trauma and stress are stored in our bodies, reside in our nervous systems, and disconnect the person we are from the body we live in. Trauma also interferes with the development of self-regulatory skills.

The great news is that our brains have the capacity to change, heal, and rewire across our lifespans. A resilient individual isn’t someone who avoids stress but someone who learns how to manage it. Kids can develop competence under adverse circumstances because of strong parent-child relationships as well as the ability to self-regulate attention, emotions, and behaviors. Both resilience and mindfulness are learned skills. Kids can even learn resilience vicariously by watching others overcome adversity.

One simple strategy to teach kids to manage emotions and stress is the Fingerhold Practice. It combines breathing and holding each finger and can be helpful when difficult feelings arise or challenging experiences are anticipated. Holding each finger in turn, gently but firmly, with the other hand and breathing comfortably or slowly can be calming, reduce tension, and provide a sense of control. Many adults feel relief after 2-5 minutes per finger, while kids typically feel relief more quickly (30-60 seconds).

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Adverse-Childhood-Experiences-ACEs-CDC

 

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The Five Critical Needs of Children

By Jessica Smolleck, Pyramid Plus Teacher with Grand Beginnings

1) Every person, whether an adult or a child, needs to feel respected.

  • Examine whether you’re treating your children in a positive and respectful way or whether you’re treating them with rudeness by lying to them, demeaning them, or not listening to them. Before you respond to your child, ask yourself: “How would I respond if I was speaking to an adult?”

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2) Children appreciate being made to feel important.

  • Children need to have a sense of value, control, and usefulness. They need to feel that they are somebody. Find a middle ground between being protective and allowing your child to explore the world. Be willing to listen and let them problem solve or make decisions. Let your children take responsibility for some things.

3) All kids desire and need to be accepted for who they are.

  • Children have a right to their own feelings, desires, and ideas and they deserve to be recognized. This doesn’t mean that you have to agree or disagree with everything, it simply means that you acknowledge them. Avoid overreacting, being overly critical, or encouraging kids to suppress their feelings. Instead, listen to them and praise the things you like.

acceptance of the child

4) Everyone likes to be included, but children especially need to feel included.

  • Children need to be brought in and made to feel a part of things. They need to feel included in family activities and events. Spend time each day sharing what each person in the family is doing, try to make the kids a part of decisions being made, and find activities that the whole family can do together.

5) Most importantly, children must feel secure.

  • Children need to be in an environment and have relationships that are consistent and caring. They need to know they are loved no matter what and that you have their best interests at heart. Keep this in mind with your interaction with your kids, your discipline, and your relationships with others.
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Unconditional Love

Becoming a Student of My Own Behavior

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Self-reflection, self-improvement

  • Which of my action today were positive in regard to my child/children’s 5 critical needs?
  • Which of my actions today were negative in meeting the five critical needs of my child/children?
  • What does this tell me about myself
  • If I were doing today over again, what would I do differently?
  • What will I change or try to do tomorrow?

 

Be a Brain Builder

The first three years of life boast the most rapid and robust brain growth, when 85% of the physical brain develops. At birth, the brain has about all of the neurons it will ever have and can create synapses faster than it will ever be able to. Synapses between neurons are strengthened by use. Rarely used synapses become weak before being eliminated.

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Synapse density over time.

Every day in the United States, one in 1,000 newborns is born profoundly deaf and another two to three out of 1,000 are born with partial hearing loss. Fluctuating hearing loss due to frequent ear infections could mean a young child is missing vital speech information.

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Dr. Dana Suskind

Dr. Dana Suskind specializes in pediatric hearing loss and cochlea implantation at the University of Chicago and is the founder and director of the Thirty Million Words Initiative. With cochlear implant surgery, Dr. Suskind gave children the gift of sound, changing the trajectory of their lives in one day.

Suskind realized that surgery brought children closer to a new world, but the real change happened after surgery. Regarding development, the ability to hear is trivialized without a language rich environment. Hearing is a way for sounds to get into the brain for processing; we hear with our brains, not with our ears. Children’s brains need words to grow.

The Thirty Million Words Initiative refers to a 1990 study citing how many more words children from higher socioeconomic households were exposed to by age three compared to children from lower socioeconomic households. Those who grew up in word poor homes had smaller vocabularies, poorer grades, and lower IQs.

Thirty Million Words promotes baby talk (using rhythm, melodic pitch, and positive tone not fabricated words) and reading to babies. It encourages bilingual families to use mostly their native language and advocates for increased language exposure using the mantra, “Don’t just do it, talk them through it.” It promotes the Three T’s:

  • Tune in: notice what a child is focused on and talk about it. Respond when a child communicates in any way.
  • Talk more: narrate daily routines such as getting dressed and eating meals. Use description, detail, and variety.
  • Take turns: keep the conversation going. Respond to a child’s sounds, gestures, and words and allow plenty of time for the child to respond. Ask questions that compel more than yes or no answers.

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Teri Kite, Teacher of Deaf and Hard of Hearing for Northwest Colorado BOCES and Horizons Specialized Services, says: “Anything we recommend to increase language acquisition for a child with hearing impairment is also good for a child with normal hearing. Enriching language is a universal need in our world that is increasingly electronic.” Teri has seen how making communication fun can ultimately make for families of good communicators. “It’s never too early to begin purposeful communication with your child. Babies’ minds are little sponges.”

In collaboration with Colorado Hands and Voices, Colorado School for the Deaf and the Blind, and The Listen Foundation, Horizons and BOCES are hosting three presentations on March 11th for Early Childhood professionals, families of children with hearing loss, older children with hearing loss, and families and children of all hearing abilities interested in language acquisition (with Thirty Million Words). For more information, contact Susan Mizen (smizen@horizonsnwc.org) or Teri Kite (teri.kite@nwboces.org).

The Touchpoints Approach: Value Disorganization

TBBT. Berry Brazelton, renowned pediatrician and author, developed the Neonatal Behavioral Assessment Scale. The scale assesses newborns’ physical and neurological responses as well as their emotional well-being and individual differences. Brazelton’s greatest achievement, however, has been to raise awareness for the ways that children’s behavior, activity states, and emotional expressions affect their parents, and the ways that parents’ reactions and behaviors, in turn, affect their children.

At birth, babies are ready to build relationships with parents. Their early emotional experiences are powerful enough to become embedded like architecture in their brains. To capitalize on this, Brazelton created the Touchpoints Approach.

Touchpoints are predictable periods of regression and disorganization that occur before bursts in development. What happens between children and their parents at these times? Often, it’s parental frustration and self-doubt, exacerbated by disruption in family relationships. If parents could be warned about these developmental transitions, Brazelton believed they could better understand their children’s behavior, feel more competent, and react positively.

The most critical step in this approach is accepting that development is not linear. The succession of touchpoints in a child’s development is like a map that can be identified and anticipated by parents and providers. Regression, while natural, can cause disorganization. Parents and providers need to embrace the disorganization and value it is a stepping stone—it’s likely a precursor to success. This perspective can change the way parents react to their child, which, in turn, can change the child’s outcome.

Many families of children with delays or disabilities can feel isolated or unsupported. The Touchpoints Approach reinforces providers’ desire to join parents as allies interested in empathetic, not objective, involvement. The approach presents a paradigm shift. It asks us to move from a linear model of development to a multidimensional one. It asks us to focus on parents’ strengths, acknowledging them as the experts on their children. It asks us to see parenting as an ambivalent process built on trial and error. In this way, providers who work with children and families collaborate rather than prescribe, support rather than fix.

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The Touchpoints Approach is an evidenced-based way of understanding and being with families. Providers join the family’s system of care rather than the family joining the providers’ system of care. The child focuses on learning new skills, the parent focuses on developing competencies, and the provider focuses on supporting parents, developing skills, and overcoming assumptions. Goals are optimal child development, healthy and functional families, competent professionals, and strong communities.

While all children develop at their own pace, these Touchpoints typically precede a burst in development and can cause disorganization for the child and family:

  • The Ideal Baby – Pregnancy  TP book
  • The Real Baby – Newborn
  • The Energy Sink – 3 wks
  • The Rewarding Baby – 6-8 wks
  • Looking Outward – 4 mos
  • Up at Night – 7 mos
  • The Pointer – 9 mos
  • The Walker – 12 mos
  • The Clinger – 15 mos
  • Rebel with a Cause – 18 mos
  • Getting to “No!” – 2 yrs
  • “Why?” – 3 yrs
  • What I Do Matters – 4 yrs
  • Who I Am Matters – 5 yrs
  • Entering the Real World – 6 yrs

Excellence: DSPs at Work

All of us

The Capitol Gang: Michael Toothaker, Brittany Smale, Jana Hoffman, Representative Diane Mitsch Bush, Susan Mizen, Heather Gibbon, Yvonne Truelove

At Horizons, we envision a world where people with IDD live community-based lives of their choice supported by highly qualified DSPs. Alliance Colorado celebrated Awareness Day at the Capitol on February 17th, highlighting issues people with IDD face and the work DSPs do. From across the state, 30 DSPs were nominated for the 2016 DSP of the Year Award—all of whom have the knowledge, skills, and values needed to support people with IDD in achieving their life goals.

From Horizons, Jana Hoffman and Brittany Smale were recognized. Jana has worked at Horizons for eight years and Brittany for three. Both Jana and Brittany share a respect for the dignity and completeness of the people in Horizons’ programs.

In the dome

Horizons’ 2016 DSP nominees!

In her worldview, Jana is inherently person centered. She embraces person centered values and employs person centered techniques. When interacting with the people she supports, Jana recognizes their unique attributes and potential. She has exceptional skills and stealth approaches to working with people with IDD, along with the intuitive capacity to understand the person beneath the label.

Jana is respected and admired, quiet and confident, assertive and charismatic. She leads by example and compels others to be their best. Watching her work is like reading a “How To” book—she seamlessly incorporates ideas, strategies, and values to help people achieve their personal goals and greater autonomy. She does this with a gentle spirit and sense of ease: you don’t notice what she’s done until you see the end result. When the people she supports accomplish something you didn’t know they could, that’s when you realize: Jana made this happen.

Jana works well with people who have significant behavioral challenges, people who have extremely high needs, and people who struggle physically or socially. She treats people as individuals without categorizing them, and it works. She makes people feel good about themselves, and it works. Her positivity is contagious, infecting the people she supports and helping them succeed.

Jana with Alliance staff

Jana accepts her nomination as a DSP finalist from Alliance Colorado staff, Ellen Jensby and Josh Rael.

To come up with new ideas to improve people’s lives, Jana taps into her creativity. She discovers new recipes for dinner and unexplored areas of the community for activities. She presents new topics of conversation, unusual games, and unfamiliar faces. In her creativity, Jana is patient and generous. She leads people to new places and waits for them to adapt, accept, decline, or succeed. She wants people to experience life on their own terms, with their own perspective.

Brittany Smale, our other nominee, works weekend shifts at two of our most challenging homes. Residents have high medical and behavioral needs and, at times, Brittany is the only staff for the entire shift. She takes this in stride and no one misses a beat.

Working independently and efficiently, Brittany takes extraordinary care of the people in our programs, paying particular attention to their health. As an LPN, she comes into the office on her time off to talk to her supervisor or agency nurse, following up on health concerns experienced over the weekend. Brittany’s medical knowledge and expertise surpass what’s expected of a DSP and this brings comfort and relief.

Michael, Bob and Brittany

Michael Toothaker, Representative Bob Rankin, Brittany Smale

As a strong natural advocate, Brittany sees people’s strengths rather than their limitations. Her work is predicated on the belief that all people can learn, improve, succeed, and flourish. Her language is person centered and spoken without a trace of negativity, making her a solid support and a consistent leader.

Brittany and Michael

A good team.

Brittany’s actions and words are always a variation on the theme: what can we do to help the people we serve? Her gentle, calm demeanor puts people at ease. Her ability to manage everyone’s needs—the daily details and the big picture—keeps her in high regard among coworkers. She is reliable, dependable, and willing to excel.

When quality is defined at the point of interaction between the DSP and the person with a disability, we feel fortunate to have both Jana and Brittany to fulfill Horizons’ mission.

Horizons Annual Plan Update: Executive Summary, April 2015

When I look back on 2014, I will think of it as a year of growth. We opened a new, seven person apartment building in the spring. By the end of the calendar year, 17 additional people were offered Supported Living (SLS) resources. By March 2015, eleven new people were enrolled in our SLS program with three more in process. In the Children’s Extensive Support Waiver, we have enrolled two new children for a total of four. While these numbers are relatively small, they represent significant growth in our program.

We have achieved many important things:

  1. Seventy-two employees have been trained in Person Centered Thinking.
  2. We are maintaining financial sustainability by limiting growth in agency expenses and increasing revenue.
  3. We developed systems to maximize our use of the funding hierarchy for Early Intervention services.
  4. Individuals are being served in an SLS model using Routt County mill levy funds.
  5. Three individuals were enrolled in our Medicaid comprehensive services program.
  6. Four individuals are enrolled in CES. Three more are approved and one in process. This represents 300% growth for us.
  7. We have 20 one to one mentors for the adults in our programs. These partnerships do a variety of things: attend fundraisers for other non-profits, go skiing, go out for coffee, go for walks, go out for meals, attend social media classes, play billiards, attend local sporting events, go to community concerts, and go to local restaurants for Happy Hour.
  8. We held our third annual Pick a Dish event in Moffat County in April. Interested individuals in Horizons’ adult programs were paired with chefs from local restaurants. Together they prepared a dish to share at the event. About 200 people attended and voted on their favorites. The primary goal of the event was to develop relationships between our chefs and the restaurant chefs that would result in employment. No job offers yet…
  9. Tommy Larson and Sylvia McFeaters were two of the five finalists for the Direct Support Professional of the Year award by Alliance at Awareness Day at the Capitol.
  10. All Adult Service Coordinators have been trained by the Labor Relations Board to conduct investigations.
Jamie Ogden and Ashleigh Santistevan partner with Castle Ranch at this year's Pick a Dish fundraiser in Craig.

Jamie Ogden and Ashleigh Santistevan partner with chefs from Castle Ranch at this year’s Pick a Dish fundraiser in Craig.

Sylvia McFeaters and Tommy Larson were finalists for the 2015 Alliance DSP award. Matt Troeger led the pledge on the House floor on Disability Awareness Day at the Capitol.

Sylvia McFeaters and Tommy Larson were finalists for the 2015 Alliance DSP award. Matt Troeger led the pledge on the House floor on Disability Awareness Day at the Capitol.

We have maintained many important things:

  1. The president of the board of directors is a liaison between the Grand County Advisory Board and Horizons’ board.
  2. We are maintaining our collaborations with Aging Well, the Northwest Colorado Center for Independence, the Yampa Valley Autism Program, Steamboat Adaptive Recreation Services (STARS), and the Council on Aging.
  3. We work closely with Behavior Services of the Rockies and with Mindsprings Health.
  4. We have maintained a high level of supported employment in Routt County.

Our priorities for 2015 include:

  1. Identifying needed growth in infrastructure in response to an additional 15 SLS resources, and growth in CES and comprehensive programs.
  2. Identifying staff to become Person Centered thinking trainers.
  3. Upgrading our vehicles with $81,400 in funding from the Colorado Department of Transportation.
  4. Updating and/or creating policies and procedures.
  5. Improving our system for monitoring agency performance.
  6. Defining our relationship with the local autism program.
  7. Continuing to monitor our budget to ensure that we are limiting growth in expenses and maximizing revenue.
  8. Advocating for choice in Case Management to include Horizons CMs.
  9. Advocating for a solution to CFCM that preserves our mill levy.
  10. Celebrating our 40th anniversary! We are planning 1970’s dance parties in Steamboat and in Craig.

Susan Mizen, Executive Director

I Can Do Better

The R word. The H word. And now the C words: consumers, clients. When can we stop using words to differentiate “us” from “them”? People with disabilities, people in our programs, individuals—do these work? How do we maintain compliance within the current system but still move forward to change it? It was Maya Angelou who said, “I knew then what I knew how to do. Now that I know better, I can do better.”

If language is how we activate our values, what do these words and phrases reveal about us, our perspectives, our intentions and our services? And how do we take buzz words like person first (a good first step) or person centered and transform them into valid change agents for our practices?

At our Person Center Thinking (PCT) Training by Bob Sattler from The Learning Community, we learned that PCT is an ongoing search for effective ways to deal with challenging barriers and conflicting demands. It’s a way to assist people in defining and pursuing desirable futures. PCT takes clarity, commitment and courage. It’s based on respect for the dignity and completeness of every person. To be person centered, we need to ask why (a lot) and consider others’ perspectives. It’s not us versus them; it’s simply us.

Bob Sattler leads the grip of Horizons support professionals through discussion on person centeredness.

Bob Sattler leads a group of Horizons employees through a discussion on person centeredness.

The goal of PCT is to move from a service life to a community life. Bob reminded us that we are not trying to make people independent, but autonomous. After all, how many of us are actually, truly independent? Maybe independence too is a buzz word—one that was well intentioned but not quite accurate?

One focus of the training was the importance of environment. Environment is not a disability issue; everyone is affected by it. Environments can be toxic, tolerated, supportive or healing. A toxic environment can cause depression, aggression or withdrawal. A tolerated environment can lead to feelings of helplessness or powerlessness. Many people live in toxic or tolerated environments and they result in one person (the paid counselor) having power over the other.

Environment is powerful and complex.

Environment is powerful and complex; it can be positive and/or negative.

A supportive environment allows people to grow and blossom. This should be the accepted minimum standard for everyone. A healing environment is needed by those who’ve been hurt in toxic or tolerated environments, and the focus is on restoration and wellness. Both supportive and healing environments foster a sense of empowerment.

While there are distinctions between the kinds of environments we live, work and play in, we can be in multiple environments at the same time. Environments are powerful and multidimensional. They can often be the cause of a symptom we treat; what we see and hear depends on what we’re looking and listening for. This is a reminder to be self-reflective, to continuously look at what’s working and what’s not working, and to address issues effectively.

When we talk about creating person centered lives, we can’t prioritize what’s important to people over what’s important for them. PCT doesn’t mean giving up on health and safety issues for the sake of pure joy and constant happiness. A person centered life is one where a desirable lifestyle has been purposely crafted—it’s full of engaging experiences and rewarding possibilities. It emphasizes dreams and hopes. It fulfills who the person is rather than meeting the needs of the person’s diagnosis.

PCT tells us not to fix people but to support them. Bob’s playful phrase “Don’t should on people!” helps instill this value. And because PCT is part of a process of improving how we support people, it’s important to remember that we’re doing the best with what we know. While Maya Angelou’s words are eloquent and poetic, we can also refer to Bob’s wise words: “My name is [counselor’s name] and it’s been [X] days since I’ve tried to fix someone.”

Adult Program Director Tatum Heath follows up with a work session on implementing PCT tools and strategies.

Horizons Adult Program Director Tatum Heath follows up on Bob’s training with a work session to implement PCT tools and strategies.