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The Parenting Gap:  What is Wrong with the Parents? Toxic Stress’s Impact on Parents The Parenting Gap:  What is Wrong with the Parents? Toxic Stress’s Impact on Parents

The Parenting Gap: What is Wrong with the Parents? Toxic Stress’s Impact on Parents - PowerPoint Presentation

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The Parenting Gap: What is Wrong with the Parents? Toxic Stress’s Impact on Parents - PPT Presentation

The Parenting Gap What is Wrong with the Parents Toxic Stresss Impact on Parents and Their Children Alan Mease MD FAAP Medical Director of Child amp Adolescent Health Arkansas Department of Health ID: 761568

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The Parenting Gap: What is Wrong with the Parents? Toxic Stress’s Impact on Parents and Their Children Alan Mease, MD, FAAP Medical Director of Child & Adolescent Health Arkansas Department of Health alan.mease@arkansas.gov

Learning Objectives  Define toxic stress and distinguish toxic stress from other forms of stress Understand how toxic stress impacts parenting and early brain development Understand how these change in brain development are associated with developmental, behavioral, mental and physical health issues over the life courseUnderstand how toxic stress affects parenting capacityDefine the biosocial approach to parentingDiscuss the challenges of public parenting policiesReview and discuss cases of parenting dysfunction from a biosocial perspective

Today’s Child Health Crisis

Children & Adolescents at Risk 4-6% Severe Disabilities 14-18% Special Health Care Needs 30-40% Behavioral, Mental Health Learning Problems 50-60% Good Enough By Neal Halfon with permission

Today’s Child Health Crisis = Today’s Parent Crisis

6

Toxic Stress in Childhood Early Childhood is a sensitive period of development Developmental Symbiosis –intertwined biological and environmental factors ( the environment talks and genes listen) Early Childhood is a sensitive period of development Developmental Symbiosis –intertwined biological and environmental factors ( the environment talks and genes listen) Developmental Plasticity - Early adversity associated with broad range of impairments later in life Developmental trajectories emerge early & reinforced by a cascade of differential stresses and risksAdverse childhood experience include the dramatic but more often and more pernicious are the ordinary day to day interactions While exposure to adversity is a significant predictor, they are not inevitable (some are more biologically susceptible to social context) Developmental Plasticity - Early adversity associated with broad range of impairments later in life Developmental trajectories emerge early & reinforced by a cascade of differential stresses and risksAdverse childhood experience include the dramatic but more often and more pernicious are the ordinary day to day interactions While exposure to adversity is a significant predictor, they are not inevitable (some are more biologically susceptible to social context) By Neal Halfonwith permission

Birth Early Infancy Late Infancy Early Toddler Late Toddler Early Preschool Late Preschool Age 6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs Healthy Development Optimizing Health Development: Reducing Risk & Enhancing Protective Factors “At Risk” Trajectory “Delayed/Disordered ” Trajectory “Healthy” Trajectory Positive Emotional Support Reading to child Pre-school Appropriate Discipline Poverty Lack of health services Toxic Stress Health Services Lead Exposure Parental resilience, social connections, knowledge, skills, co parenting relationships

Life Course Model of Stress

Being a Parent Increases Stress and Potential for Toxic Stress Children increase adults’ exposure to a variety of stressors The emotional rewards of having children can be overshadowed by the stress of parenthood.

Biosocial The Study from the American Journal of Sociology (Glass et al, AJS 122 No3, Nov 2016: 886-929)

Stressors of Parents Time and energy demands often coupled with sleep deprivation Work-family conflict Difficulties obtaining high-quality, affordable child care Financial strain

Stressors of Parents These stressors are greater among single than married and cohabiting parents single parents report the lowest levels of emotional well-being of all parents. Disadvantaged parents are exposed to additional sources of parental stress, Stress of living in unsafe neighborhoods with under resourced schools Insufficient food Inadequate child and health care for their offspring Parents of older children Financing of their young adult children’s higher education and independent living while they are facing their own retirement Distal sources of stress, rooted in the larger policy context in which adults parent

These Stressors Will Become Toxic Without Supportive Relationships!

Societal Trends Increasing Parent Stress Falling fertility rates, Decline in male wages, Increase in female employment Rise of dual-earner and single-parent families Gender inequalities in the home and workplace

Background This pattern first emerged in the 1970s—a period marked by significant social and economic changes including the decline in men’s earnings, the increase in women’s employment, and the rise of both dual-earner and single-parent families! Abundant research shows a significant negative association between parenthood and emotional well-being in developed countries

The United States The United States is exceptional in its failure to develop policies that help offset the financial and opportunity costs associated with raising children, making parenthood unusually expensive in the United States. The costs of children in the United States are increasingly borne by mothers, with recent estimates showing four in 10 households with children are supported solely or primarily by mothers’ earnings But unlike its economically developed counterparts, the United States has done little to offset the costs of raising children and ameliorate the incompatibility be-tween employment and child care. The 1993 Family and Medical Leave Act is the sole federal policy to assist employed parents

The United States Employer-provided family leave, work-time flexibility, and child-care assistance in the United States are significantly more available to men, managerial and professional workers, and workers in large firms Young, poorly educated, female, and single parents most in need of workplace resources and supports are least likely to receive them

The Rest of the Developed World: EU, Canada, Australia Substantial number of public policies reduce both the direct financial costs and the opportunity costs of parenthood and help alleviate work-family conflict and overload These costs have been repeatedly identified as the major sources of the parenthood deficit in emotional well-being in industrialized societies

The Unhappiest Parents Our analyses revealed that not all developed nations exhibit a negative association between parenthood and happiness United States has the largest subjective well-being penalty for parenthood in this group of OECD nations, even after controlling for a host of individual-level variables that affect parental happiness.

Estimated Happiness Scale (0-10)

Impact of Public Policies Largest impact of public policies on happiness came from our comprehensive policy index (CPI), which measured the strength of the work-family “package” of paid parenting leave, work flexibility, and paid sick and vacation leave. In those countries with the strongest policy packages, the parental deficit in happiness was completely eliminated, accomplished by raising parents’ happiness rather than lowering nonparents’ happiness. The synergistic value of these policies as a package, combined with their large positive effects on happiness for parents and nonparents, suggests that a multipronged approach to assisting parents is necessary to address the parental happiness deficit found in many Western industrialized countries.

Impact of Public Policies Among specific policies that reduce the negative impact of parenthood on happiness, those lowering average child-care costs (as a percentage of the median wage) had the greatest impact, Lower child-care costs may be picking up broader cultural support for childbearing and families as well, such as feelings of social inclusion and community support throughout the life course, since the child-care subsidy effect extends beyond parents with children (although it is significantly smaller in magnitude).

Study Conclusions Parenthood as a social role has changed tremendously from the agrarian societies of the past to the competitive postindustrial economies of OECD nations. the stressors associated with parent-hood have intensified while the economic and social rewards of parenthood have declined. This has increased the level of parental and child toxic stress Public policy interventions are necessary to spread the costs of reproducing the labor force more widely

Mid- Brain affiliation/attachment PFC executive function/ impulsivity HPA stress response Toxic Stress Chronic diseases Health behaviors Mental health Epigenome Exposure Endophenotype Phenotype Time Sensitive Pathways of Influence From Hertzman

Case Discussions

Case 1 Ben, age 8, and Sara, age 5, have been in out of home placement (foster care) for a total of 20 months. When Ben was 6 years old, he and an eight-year-old boy broke into a home and stole food and approximately $30. A neighbor witnessed the break-in and gave the police a description of the boys. When the police arrived at Ben’s home to question him, they found Ben and his sister Sara alone (then aged 6 and 3.) There was no running water or electricity and there was no food in the house. Sara and Ben said their mother had to go somewhere and they didn’t know when she would be back. The children were taken into protective custody.

Safe, Stable, Nurturing Relationships Needed Without protective relationships toxic stress has a life long negative effect on the developing brain

Case 2 The mother, Rhonda, age 25, did not receive any outside means of support or economic assistance. She reportedly earned a living by selling drugs. She has identified no immediate or extended family in the area. She reported that the children’s father left them 1 year ago. Early on, the mother cooperated with recommendations for drug treatment and attempts to improve their living conditions. The caseworker assisted her with application for economic assistance. The agency assisted her with getting utilities turned on and worked with her landlord to make some needed repairs on the house. She attended outpatient drug rehab and appeared to stop using. Rhonda attended parenting classes and appeared to make progress (i.e., she demonstrated more frequent and appropriate limit-setting with children, she worked on keeping the home clean, there was usually food in the house, she kept scheduled visits with children.) She said she would do whatever she needed to do in order to get her children back.

“The enduring impact of early maternal care and the role of epigenetic modifications of the genome during critical periods in early brain development in health and disease is likely to b one of the most important discoveries in all of science…”Alan Schore, PhD

Case 3 The children were in foster care for 9 months and then returned home. They remained home for approximately 3 months. The caseworker assigned to work with the family moved away and another worker was assigned to the case. After the children returned home, Rhonda attended drug rehab less frequently, was not available for visits, did not keep appointments with the caseworker and quit attending parenting classes. The children were found home alone during a routine home visit. There was little food in the house and the home environment had deteriorated again. The children were taken into protective custody again. The mother returned home the following day. After the children were removed the second time, Rhonda attended outpatient drug rehab for awhile, but then quit abruptly. She missed over half of the scheduled visitations with her children during this time. Rhonda’s behavior was indicative of active substance abuse and her last two urine screens were positive for amphetamines. She now has a live-in boyfriend who is reportedly a drug dealer. Repeated visits to the home show the home environment to be unstable and not improving.

High Priority Measures of Risk & Protective Factors

Case 4 Ben has been in foster care since he was 10 as a result of neglect. He is 15 now. He has an older sister, Jill, who was 15 at the time of removal. She is 20 now. Ben and Jill were very close and depended on each other until they were separated when they came into foster care. Ben and Jill saw each other on and off over the years while in foster care, but have not had regular contact in the last 2 years. They both say they still feel close to each other.

Case 4 Jill remained in foster care after her 18th birthday to continue to receive assistance under the Chafee Foster Care Independence Program. She was not adopted but has a stable life connection from the last foster home she lived in. She is going to college and is doing fairly well. She plans to finish college, get a job, and has said she wants to adopt Ben. Ben’s and Jill’s parents’ rights have been terminated. Previous caseworkers have contacted relatives and two different relatives were identified as potential placement resources. For one relative, the home study was not favorable and placement was not recommended. A home study was never completed on the other relative due to lack of response from the relative during the process.

A New Science of Thriving

Case 4 Ben has behavioral problems and struggles with schoolwork. He has been in six foster placements in the last five years, including four foster homes and two different group homes. He is currently living in a group home. He seems to be fairly stable in his current setting. He has said he wants to “work on computers” when he grows up.

From Broken to Resilient Brains!

Case 5 Two children, Ann Jones (age 7) and Michael Smith (age 5), were picked up by the police walking on a busy street at night. Police brought the children home and found the children’s father, Tim Smith, drunk and passed out. They could not locate the children’s mother, Diana, for over an hour before she returned home. Mrs. Smith reported that she initially left the house because of a marital dispute. She returned to find the children missing and had been out searching for them. She was relieved to see them safely at home and was cooperative with the police and CPS worker.

Safe, Stable, Nurturing Relationships Needed Without protective relationships toxic stress has a life long negative effect on the developing brain

Case 6 May lives with her mother and 2 year-old sister in a local housing project. Last Friday, about the time “Wheel” (Wheel of Fortune) came on, Mom (Ms. B) left the apartment. She told May to “stay inside and watch the baby ‘till I get home.’ Don’t you go out!” On Sunday, when it was getting dark, May went out to look for mother, because as she said, “I was scared someone had hurt her.” May found her mother in the neighborhood. Mother became very angry because May had disobeyed her instructions and left the house. She had also left her baby sister in the house. Mother grabbed May, marched her to the house, and once inside went to Mother’s closet where she keeps the “whipping belt.” “It’s blue!” May said, “I tried to run! I crawled under the bed, but she pulled me out!” May also indicated that this type of punishment happens all the time. You ask if anything else happened and May gets tears in her eyes for the first time. She tells you after the “spanking” her Mother put her in the kitchen utility closet for the rest of the night and didn’t let her eat dinner.

Thank You! Questions? Alan Mease, MD, FAAP alan.mease@arkansas.gov