Pushing Toward Breakthroughs: Using Innovative Practice to Address Toxic Stress
Using the expanding scientific evidence about the long-term, damaging effects of toxic stress, a small but growing group of forward-thinking social service practitioners are trying innovative approaches that target its root causes and could lead to breakthroughs in the effectiveness of interventions—for both children and their caregivers.
The practitioners lead a diverse set of organizations serving infants, toddlers, and preschoolers nationwide, but they share a fierce commitment to finding more effective ways to enhance the capabilities of everyone who cares for children, at home and in the community. They are all members of the Center on the Developing Child’s Frontiers of Innovation (FOI) community, which comprises researchers, practitioners, policymakers, philanthropists, and experts in systems change from across North America.
For example, a national early childhood education company is developing and testing best practices to change the culture of Head Start programs to help stabilize families, institute positive life routines, and prevent the common crises that come from poverty. In Los Angeles, a network of agencies is providing free in-home mental health care and related services to help ensure secure attachments between children and their parents. And in Salem, Ore., a regional faith-based organization is building both parents’ capabilities and neighborhood resources to support families.
Lori Levine, who oversees Head Start Services for Acelero Learning nationally, says the science of toxic stress is changing what they do and how they do it. “The brain development research every day informs us in a way that was only intuitive to us before,” Levine says. “This is an opportunity for people to understand that they can really change the development of kids and make a significant difference in the trajectory of their lives. It’s incredibly compelling.”
Extensive research on the biology of adversity shows that in families experiencing severe and ongoing stress, children need consistent support from caring adults in order to learn to cope. Without it, the body’s stress response system stays on high alert and can trigger toxic stress, weakening the architecture of children’s developing brains and organ systems and causing a host of health, learning, and behavioral problems into adulthood—from depression to diabetes.
Partnering with the Families
Acelero Learning, which is based in New York City, operates delegate agencies that provide Head Start preschool and services to more than 4,000 low-income children and families from Nevada to New Jersey. Before Acelero took over, the programs were among the worst-performing in the country. Now, according to Levine, participating children’s two-year gains in word recognition and in math readiness outperformed Head Start national averages by at least 2 to 1.
While Head Start programs typically have done well at responding to client families’ emergencies, such as running out of food, losing employment, or being evicted, they have been less attuned to the family needs that lead to such crises, Levine says.
“This is an opportunity for people to understand that they can really change the development of kids and make a significant difference in the trajectory of their lives.”
“We need to look at the pattern of what’s happening in the family [and] what’s been going on in the family that they ended up needing a shelter,” Levine explains. “Part of that is changing the mindset about what it means to partner with a family,” she notes, as well as identifying high-need families as early as possible and investing in better-educated staff members.
Another major emphasis for Acelero is creating stable, predictable family practices by strengthening those that show links to school readiness, such as providing a language-rich environment, using positive discipline strategies, and establishing family routines. Helping families plan activities like reading together every night, eating meals together every day, and setting routines like a regular 8 p.m. bedtime can help children develop the ability to regulate their emotions and be ready to learn, Levine argues.
“This is related to the brain research,” says Levine. “We see a lot of families that are coming in with patterns of everyday life that are not very consistent, and we have a sense that’s related to self-regulation and executive function,” she says. So another goal, she says, has become identifying strategies to enhance executive function of not just preschoolers, but their parents, too.
A Broad Spectrum of Care
In Los Angeles, the idea for the Westside Infant-Family Network (WIN) was sparked by the directors of several longstanding health and social service institutions as well as a funder they had in common. They saw the effects of toxic stress on the children and parents they served but were not set up to address such issues as: How does a health clinic help a nine-month-old with symptoms of depression? How should a teacher handle a violent preschooler who is throwing chairs around a classroom?
WIN’s founding director, Anna Henderson, says many of the children’s parents had been physically, sexually, or emotionally abused as children, and they were struggling to raise their kids under the shadow of the damage that their own adverse experiences had caused. Essentially, they were struggling with poorly developed executive function skills. They did not have the impulse control, self-regulation, self-reflection and cognitive flexibility they needed, for example, to provide a positive environment or to form loving, attuned relationships, because that had not been part of their own experiences.
WIN’s referring partner agencies serve 30,000 individuals annually, across 26 ZIP codes. The network provides integrated health, mental health, early education, and social services to a small subset of those families who are facing multiple challenges simultaneously. With a broad spectrum of care, says Henderson, WIN helps ensure that families of children ages birth to 3 receive focused attention that is not possible through traditional services operating in separate sectors.
“Ideally, what we’d like to be doing is looking at every one of those 30,000 people as a former child and/or a future parent,” Henderson says, “and we’re trying to prevent the anxiety and the misery that causes toxic stress—to prevent families from ever needing the intensive, expensive, whole-family repair that WIN now provides.”
A case manager and a master’s-level therapist are assigned to each family to provide therapy, as well as essential coordination of care through WIN’s partner agencies, including basics such as health care, food pantry access, early education, emergency funds, transportation and housing assistance, and employment training.
Henderson says the key is the free in-home mental health care, deeply nested into holistic supports. Both parent-child therapy and individual adult therapy are provided by highly trained therapists. Such efforts, she notes, are very costly; they require a tightly integrated infrastructure, and can reach only a tiny fraction of the families who need them. In 2012, WIN provided case management and/or mental health therapy services to 336 individual family members, including 91 pairs of children and parents.
“We are providing the highest-end, most intensive services,” she says, “and we are seeing fantastic results—but we need to do more, sooner, before infants come to us already compromised by toxic stress.” In 2012, WIN reported 20 out of 22 children studied showed gains in secure attachment behaviors, and a majority of adults showed improvement in stress levels.
As part of her participation in the Center’s FOI community, Henderson is working with two member groups that she hopes will help WIN expand its impact. One is identifying a set of screening tools based on the Adverse Childhood Experiences (ACEs) studies to rank the risk of children and their parents for toxic stress; the other, with Lori Levine from Acelero, is identifying universal interventions to increase executive function skills of both parents and children.
“This is a community-level public health problem,” Henderson says. “We are not doing true service to the community until we find upstream ways to address these issues.”
‘To Reach Their Dreams’
Jim Seymour has worked for Catholic Charities for 40 years, but he says the past several years of using research on toxic stress to inform his efforts have been the most exciting.
About three years ago, Seymour and his colleagues in Salem, Ore., began noticing continual increases in the number of children entering foster care each month, and they searched for the reasons. Thinking about the potentially devastating impacts of early adverse experiences and toxic stress, they asked themselves questions that led to a reimagining of how to help impoverished families.
Seymour, who is executive director of Catholic Community Services of the Mid-Willamette Valley and Central Coast, says that the effects of the chronic and severe stress of poverty and social dislocation are so debilitating that many parents turn inward just to get through the day. When stress is reduced significantly, though, parents can start envisioning a future and how to plan for it.
“When we connected the Strengthening Families movement and their ‘protective factors’ with the brain research on toxic stress and how you need to build adult capacity—not just to parent well but adult capacity in general—that idea was just kind of revolutionary for us,” Seymour says.
So he and his organization posed this question: Rather than assuming that these parents don’t care about their kids, because of their drug addiction, unemployment, homelessness or other problems, what if social service providers assume the parents want to care for their children but just need help to do so? Or, put another way, how can we build on their strengths?
“The focus for way too long in social services has been on treating disease, disability, and dysfunction,” Seymour says. By contrast, he adds, “this process is really about supporting people to reach their dreams. It assumes that you’ve got a lot of assets, and we’ve just got to get the stress levels down so you can meet the critical life challenges.”
Seymour’s agency leads Fostering Hope, a public-private collaboration and place-based initiative. Its approach is two-pronged: building up the internal resources of parents and reinforcing the external resources in the community to support those in need. “We came to believe that one of the key protective factors is meaningful social connections,” Seymour says.
In the past, Seymour and colleagues put money into parenting classes at one central location, but few people showed up. Now, a network of volunteers cooks and serves weekly community dinners at neighborhood churches, and parents bring their children. After they eat and socialize, the parents meet for classes, while their kids play under the watchful eyes of the volunteers.
The initiative also provides intensive services through home visits to model positive parenting strategies, help parents think through difficult situations, and enhance their caregiving capabilities.
Preliminary results from an external, federally funded study found that Fostering Hope successfully reduced the stress reported by parents, Seymour says. In addition, the number of children in foster care in one county served fell nearly 30 percent in three years.
Given those early findings, Seymour says, he is optimistic about what Fostering Hope can achieve. “We’re convinced,” he says, “we can get far better results, for less money.”