Excelsior’s Early Childhood Mental Health & Parenting Support Program
An Interview with Debbie Hart, M.A., L.P.C. (Clinical Supervisor of Early Childhood Program)
When Excelsior first began its Early Childhood Mental Health & Parenting Support program back in September 2016, they couldn’t have done it without the expertise of Debbie Hart. An experienced LPC (Licensed Professional Counselor), Debbie had been the Program Director at FACES (Family, Advocacy, Care, Education, Support), a longstanding organization dedicated to early childhood health and parent education. When FACES closed their doors in August 2016, Excelsior continued providing care to the families with whom they had been working. As such, it was natural to ask Debbie to join the Excelsior team to lead this new program and ensure continuity of care for these families. To Excelsior’s great delight, Debbie accepted the position and has been integral in building and growing this program to improve the lives of children and families in our community.
The following is an interview with Debbie Hart regarding Excelsior’s Early Childhood program:
Q: In a simplified nutshell (free from psychiatric jargon), what is this program all about?
DH: When I think about our program, I would sum it up as providing supportive counseling services that strengthen the parent-child bond and relationship so that child gets the best start to life as possible.
Q: Why is it so beneficial to provide these services in the family’s home?
DH: Many of our families face socioeconomic challenges – delivering services in their homes means one less cost to them, and one less stress of loading the family up to ride the bus across town.
Additionally, our philosophy is to meet people where they’re at. And there is nowhere else that people will feel more comfortable, and more empowered, than in their own homes.
Plus, there’s no quicker way to see the dynamics of a relationship than to observe it in a natural setting. This gives our therapists a clearer view and understanding of the family’s values, strengths and challenges.
Q: If you had to narrow it down to one or two, what are the primary challenges faced by families in this program?
DH: Because we’re looking at the situation as a relationship, we need to look at what’s going on with the parent and what’s going on with the child.
When considering the parent, the biggest challenge is their own mental health issues and their own abuse, neglect, and trauma history. Sometimes parents’ own trauma issues don’t surface until they have their own children – this often serves as a trigger for uncovering the way they were raised.
When it comes to the child, the biggest challenge I’ve seen is domestic violence. Children are much more affected by domestic violence than most families realize.
Q: Specifically related to the children’s issues, why is it important that we address these challenges while children are still very young?
DH: There’s an abundant amount of research that shows that children who are raised within safe, nurturing relationships do better in life, both physically and mentally. Specifically, they have fewer behavior problems, higher educational achievement, more productive employment, and they are less involved in the criminal justice system.
Young children who are exposed to trauma are particularly at risk for challenges because their rapidly developing brains are so vulnerable.
So by getting in early, we hope to lessen some of these lifelong effects that so many children who don’t receive treatment can experience.
Q: It’s difficult to picture what therapy looks like with a very young children. Can you briefly describe what mental health counseling looks like with a young child?
DH: Therapy consists of a one-hour session and our medium is play, which simply means the parent and the child interact together for that hour by playing. With babies, we do a lot of floor play. Then as the child gets older, we use age-appropriate play activities that the child enjoys.
As a therapist, my job is to narrate and translate their interactions to help both child and caregiver understand the motivations of one another. We call this assigning the most benevolent motivation to the interaction.
For example, if a child looks straight into mom’s eyes and says “no!”, we interpret that for the mother. We explain that the child is beginning to learn that she’s a different person than you, and her “brain voice” is telling her she needs to start having her own view. So how should mom respond? Since mom agrees she wants her child to be strong and empowered, we teach her to offer choices. When we give the child choices, she’s going to feel more empowered so that she doesn’t have to fight mom every step of the way.
So it’s hard for people to know we’re doing therapy because we’re sitting on the floor with toys, but there’s a lot going on. Children reveal themselves through their behaviors. But parents don’t always know how to read those behaviors.
Q: How might a parent determine if their child needs professional help?
DH: For children between the ages of 0-2, it’s difficult to observe risk factors since behavior isn’t usually all that difficult between those ages. So our youngest children are typically referred due to the parent’s issues, like postpartum depression, depression, or anxiety.
For children between 2-6 years, we look at behaviors that are outside the norm, like excessive tantrums, excessive aggression, self-harm (biting, hitting self, excessive banging of their heads), sleeping problems. We also look for avoidant behaviors – kids who are shut down or are not interacting.
Then also – this is the hardest part of parents – we must look closely at what the child has experienced. If the child has experienced any kind of abuse and neglect, if they’ve been removed from their home, if there’s been a significant death, if there’s been domestic violence, then there is a chance that that child needs some intervention to process what they’ve experienced.
The common assumption that young children don’t need these interventions is a false assumption. They do. They’re just not going to sit down with talk therapy and tell you how they feel about it. They’re going to show you how they feel about it.
Q: On the flip side, how might parents decide if they need professional help?
DH: Any parent who has experienced a change in the way they experience life – a lack of joy, a lack of motivation, excessive or not enough sleep, overeating or undereating, isolating, feeling alone – all of these things can be signs that someone needs professional help.
Also, if they’ve experienced domestic violence or if they’ve had their own past trauma and haven’t dealt with it – they would benefit from seeking help.
And I always say, any parent who is struggling in their parenting role, we can help! Especially for parents who lack strong support systems. We can provide that support and give you a nonjudgmental atmosphere to be heard, to be understood, and to be supported.
Q: Can you share a real-life story of a child and their family that has been helped with this type of intervention?
DH: This story is about a child who was taken away from his mother and placed in foster care at a young age. I came into his life when he was four years old, working with the foster parents who eventually adopted him.
This child grew up with four different abusive men in his home and his mother struggled with drug/alcohol problems. He went through multiple moves and multiple instances of homelessness. Then eventually mom died. The child was placed with his grandparents who could not take care of him.
He was an angry, aggressive little boy. When I started working with them, his foster parents very much wanted to adopt him, but were somewhat naïve – they approached their relationship with him with the idea that “all he needs is love”, which they gave him an abundance of.
But they had a little boy who was raging; he was triggered, and he was raging. It’s been close to two years and the little boy is still dealing with some aggressive levels, but they’re decreasing. But the real success of the story is how their relationship has changed.
I was able to help these parents better understand where the boy’s behaviors were coming from. Any time he was triggered, his brain went into fight or flight. So helping the parents really understand that the behaviors came out of the information that his brain was sending to him; it wasn’t because he’s a bad kid, and it wasn’t because they weren’t loving him enough.
We’ve really helped the relationship so that the parents understand what he needs when he’s triggered. I think that how we’ve helped him is that he knows the most benevolent motivation of his parents – for instance, that they have rules because they love him and want to keep him safe, because they know there are many times he didn’t feel safe in his life.
Q: So to tie it all in to Excelsior’s mission, how does this program further Excelsior’s goal of family preservation?
The great thing about this program is that you’re starting at the beginning. Instead of repairing what’s broken, you’re getting in on the ground floor to give the child the best start possible. We’re getting in and hopefully laying a different, more positive, foundation for the child/parent relationship.
So that is family preservation – keeping the family together by strengthening it from the get-go.
DH: Taking that one step further, how does this program help Excelsior elevate communities?
That goes back to the research. If we think about how we’re helping communities – we know that a strong start to life reduces behavior problems, reduces problems in school, leads to higher education levels and more productive employment and less crime, so that’s going to benefit our community.
Also, the reality is that even though we’re getting in early, these families are facing massive challenges. They have generational patterns of unhealthy behaviors and relationships. Domestic violence is often a generational pattern; and poverty as well as drug/alcohol abuse are all generational patterns. So it takes a lot, but if we get in early, we can hopefully break these patterns.