Vulnerability theory recognizes that the human experience of constant vulnerability varies as a result of stages in the life-course, social institutions, and law, which often trace intersecting forms of oppression on the basis of race, gender, sexuality, disability, and class. a randomized controlled study, Parent-child interaction therapy: a manualized intervention for the therapeutic child welfare sector, Parent-child interaction therapy: an evidence-based treatment for child maltreatment, Accumulating evidence for parent-child interaction therapy in the prevention of child maltreatment, Parent and child trauma symptoms during child-parent psychotherapy: a prospective cohort study of dyadic change. Refers to efforts to repair the harm that occurs with unjust behaviors, as opposed to retributive or punitive justice, which simply punishes those who have acted unjustly. Other investigators have applied the term ACEs to additional adversities known to affect child health, such as poverty, neighborhood violence, and exposure to racism. Variations, taking into account individual circumstances, may be appropriate. Acronym for Reach Out and Read; ROR is a nonprofit organization and early literacy program. Molecular biological processes play an essential role in human development. Transactional theory emphasizes that: Infants/toddlers and their parents are constantly affecting each other. Efforts to repair strained or compromised relationships are likely to be more effective if other potential barriers to SSNRs are being addressed (eg, parental mental illness and basic needs) and additional efforts are being made to actively promote SSNRs (eg, the provision of developmentally appropriate play). This toxic stress framework is powerful, because it taps into a rich and increasingly sophisticated literature describing how early childhood experiences are biologically embedded and influence developmental outcomes across the life course.1214 This was the focus of the original technical report on toxic stress from the American Academy of Pediatrics (AAP) in 2012.2 Current threats to child well-being and long-term health, such as widening economic inequities, deeply embedded structural racism, the separation of immigrant children from their parents, and a socially isolating global pandemic, make the toxic stress framework as relevant as ever. They have been proven useful and effective in addressing mental health symptoms in pediatrics across the age spectrum (as per the AAP policy statement on mental health competencies in pediatric care). Communication could be further enhanced by cultural humility,164,165 implicit bias training,166171 a more diverse health care team (eg, providing families and patients the opportunity to seeing themselves reflected in the sex, ethnicity, and cultural backgrounds of the team members), and access to professional interpreters. Ecobiodevelopmental Theory b. Overview of Domain-Specific Theories. Feminist theory asserts that gender is a social construct and that the unequal treatment of women is a result of patriarchal norms and values. The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner. For example, in an abusive context, biological changes, such as the methylation of the glucocorticoid receptor gene,35 an increase in the size or activity of the amygdala,68 and a hypersensitivity to potentially threatening cues9 could be considered adaptive, at least initially, because those changes might promote survival in a threatening environment. Developmental science is only beginning to understand the way relational health buffers adversity and builds resilience, but emerging data suggest that responsive interactions between children and engaged, attuned adults are paramount.1,16,114,115 Not only are infants programmed to connect socially and emotionally with adult caregivers,116 but the brains of parents of newborn infants appear to be reprogrammed to connect with their infants.117 Imaging studies of new parents demonstrate changes in several major brain circuits, including a reward circuit, social information circuit, and emotional regulation circuit.117,118 The reward circuit includes the striatum, ventral tegmental area, anterior cingulated cortex, and prefrontal cortex, where dopamine and rising levels of oxytocin interact to make social interactions more rewarding, thereby encouraging more parental engagement in infant care.118,119 The social information circuit includes structures such as the anterior insula, inferior frontal gyrus, superior temporal gyrus, and supplemental motor area, which support internal representations of what others may be experiencing and more empathic responses to infant behaviors.118,119 Finally, the emotional regulation circuit includes the amygdala, superior temporal sulcus, temporoparietal junction, and prefrontal cortex, which promote social cognition and a downregulation of the stress response.118,119 The convergent conclusion from these preliminary imaging studies of the parental brain is clear: much like the infant brain, the parental brain is programmed to connect. These varied adversities share the potential to trigger toxic stress responses and inhibit the formation of SSNRs. Promoting a public health approach that not only prevents, mitigates, and treats toxic stress but, more importantly, proactively promotes, reduces barriers to, and repairs relational health (the capacity to develop and maintain SSNRs with others). Toxic stress explains how a wide range of ACEs become biologically embedded and alter life-course trajectories in a negative manner. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. The text will thoroughly support students' understanding of human behavior theories and research and their applications to social work engagement, assessment, intervention, and evaluation across all levels of practice. The challenge, then, is not only to prevent adversity but also (for mothers, fathers, and other engaged adults) to actively promote positive relational experiences throughout infancy and childhood. The ecobiodevelopmental framework asserts that the ecology becomes biologically embedded, and there is an ongoing but cumulative dance between the ecology and the biology that drives development over the life span. Provide or support positive parenting classes; participate in ROR, VIP, and other programs that support the dyad. These perspectives offer different interpretations of the nature of society and the role of . This policy statement asserts that to move forward (to proactively build not only the healthy, happy children of today but also the well-regulated parents and productive citizens of the future) family-centered pediatric medical homes (FCPMHs) (see the Appendix for a detailed description) need to universally promote relational health. 3. Advocate that health systems, payers, and policy makers at all levels of government align incentives and provide funding to promote the universal primary prevention work discussed in this policy statement. But those same biological changes could prove to be maladaptive, toxic, and health harming over time.10,11. The toxic stress and its impact on development in the Shonkoff's These are just a few examples of the many philosophical perspectives that exist on the analysis of society. Emerging data supporting a biological sensitivity to context (see the Appendix for a glossary of terms, concepts, and abbreviations) begin to explain heterogeneous responses to both adversity and interventions at the population level.92,131136 Consequently, there is an urgent need for a battery of biological, behavioral, and contextual markers that might better stratify both the risks and predicted responsiveness to interventions at the individual level.37 FCPMHs (see the Appendix for a detailed description) are well placed to begin matching levels of need with specific types of interventions, a process known as vertical integration.82. The Healthy Outcomes From Positive Experiences framework promotes relational health through positive childhood experiences, such as being in nurturing, supportive relationships; living, developing, playing, and learning in safe, stable, protective, and equitable environments; having opportunities for constructive social engagement and connectedness; and learning social and emotional competencies.126,127. "The . Itasca, IL: American Academy of Pediatrics; 2018. To prevent childhood toxic stress responses and support optimal development across the life span, the promotion of relational health needs to become an integral component of pediatric care and a primary objective for pediatric research and advocacy. 12.1: Social Emotional Theories of Development Essentials of Human Behavior | SAGE Publications Inc Early childhood behavioral health: can the medical neighborhood move us forward? Employ a vertically integrated public health approach to promote relational health that is founded on universal primary preventions (such as positive parenting programs, ROR, and developmentally appropriate play) but also offers more precise screening for relational health barriers (such as maternal depression, food insecurity, or exposure to racism) as well as indicated treatments to repair strained or compromised relationships (such as ABC, CPP, PCIT, and TF-CBT). Andrew Garner, Michael Yogman; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, COUNCIL ON EARLY CHILDHOOD, Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. The capacity to respond to adversity in a healthy, adaptive manner; resilience is the manifestation of skills (eg, social skills, emotional regulation, language, and executive functions) that can be modeled, taught, learned, practiced, and reinforced. The strongest factor determining how involved a father is in nurturing and providing physical care, cognitive activities and warmth with an infant is: how important he feels his contribution is Nick's (15 months old) parents often didn't respond when he tried to communicate to them. Three indicators of flourishing are amenable to parental report and are rough markers of executive function: (1) the child shows interest and curiosity in learning new things, (2) the child works to finish tasks he or she starts, and (3) the child stays calm and in control when faced with a challenge.59 In analyses of data from the 20162017 National Survey of Childrens Health, the prevalence of flourishing children increased in a graded fashion with increasing levels of family resilience and connection.59 In fact, a higher percentage of children with high adversity (ACE scores 49) but high family connection and resilience were flourishing (30.5%) than children with low adversity (ACE score of 0) but low family resilience and connection (26.8%).59 Approaches to minimizing toxic stress that only look at measures of adversity (such as ACE scores or biomarkers) will miss out on opportunities to support the relational health that promotes flourishing despite adversity. Relational health is a strengths-based approach because it is focused on solutions: those individual, family, and community capacities that promote SSNRs, buffer adversity, and build resilience. For example, expanding family leave policies154 could reduce family stress and promote positive childhood experiences. In the decade since the first AAP policy statement and technical report on childhood toxic stress were published, even more evidence has accumulated that: What happens in childhood does not stay in childhood.186,187 Adverse experiences in childhood are not destiny, but for many children, significant adversity bends life-course trajectories for the worse. These techniques come from family therapy, cognitive therapy, motivational interviewing, family engagement, family-focused pediatrics, and solution-focused therapy. 5, Attachment and the regulation of the right brain, The adaptive human parental brain: implications for childrens social development, Two Open Windows: Infant and Parent Neurobiological Change, The neurobiology of mammalian parenting and the biosocial context of human caregiving, Positive childhood experiences and adult mental and relational health in a statewide sample: associations across adverse childhood experiences levels, Childhood adversity and parent perceptions of child resilience, A systematic review of amenable resilience factors that moderate and/or mediate the relationship between childhood adversity and mental health in young people, A new framework for addressing adverse childhood and community experiences: the building community resilience model, Responding to ACEs with HOPE: Health Outcomes From Positive Experiences, Balancing Adverse Childhood Experiences with HOPE: New Insights Into the Role of Positive Experience on Child And Family Development, Sit down and play: a preventive primary care-based program to enhance parenting practices, Books and reading: evidence-based standard of care whose time has come, Effectiveness of a primary care intervention to support reading aloud: a multicenter evaluation, Differential susceptibility to the environment: toward an understanding of sensitivity to developmental experiences and context, Stress and the development of self-regulation in context, Biological sensitivity to context: II. The Spanking Debate Is Over | Psychology Today Emphasizing that the vertical integration of this public health approach or the layering of primary, secondary, and tertiary preventions and/or interventions is necessary because the heterogeneity of responses to adversity seen at the population level will need to be addressed through a menu of programs that are layered and matched to specific levels of individual need (universal preventions, plus targeted interventions for those at risk, plus indicated therapies for those with symptoms or diagnoses). An FCPMH is not a building or place; it extends beyond the walls of a clinical practice. Dara's child care center is close to her parents . 11, The Timing and Quality of Early Experiences Combine to Shape Brain Architecture. But these same changes could be considered maladaptive over time because the higher cortisol levels could impair learning, and the infants irritability could impair the formation of a strong parental bond with the infant. The toxic stress and its impact on development in the Shonkoff's Acute threats to childhood wellness such as abuse need to be taken seriously; similar attention should be given to the social inequities and ongoing, chronic life conditions that similarly imperil a childs biological wellness and life-course trajectory. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. Foster strong, trusted, respectful, and effective collaborations with the community partners who are well-positioned to provide the individualized prevention, intervention, and treatment strategies. In the end, the ability of the FCPMH to leverage change within the family context is entirely dependent on the capacity of the pediatric providers to form strong therapeutic relationships with the patients, caregivers, and families. But something happened that few predicted. Transactional theory emphasizes that: Drawing on a framework produced by the Center on the Developing Child at Harvard University,192 this policy statement highlights the following 3 science-informed principles to prevent toxic stress responses and to build healthy, resilient children. Chp 2- evolutionary theories Theories of development Theories give a certain perspective Advantages: narrows down way to look at things Negatives: disadvantages to see everything around that one theory (it filters out too many things) Depending on what you are looking at may add different theories NOT JUST 1 5 theories will be seen (removing evolutionary)-Psychoanalytic theories-Humanistic . The commitment of the AAP to the well-being of all children requires that it not only address a wide spectrum of adversities but, also, that it speak against public policies, social constructs, and societal norms that perpetuate the ongoing, chronic precipitants of toxic stress responses such as poverty87,88 and racism166 and for public policies that promote relational health, inclusion, and equity.111,188191. 605 PDF Toxic stress is a deficits-based approach because it is focused on the problem: those biological processes triggered by significant adversity in the absence of SSNRs. Thinking Developmentally: The Next Evolution in Models of Health Explain how human development is rooted in biological processes that have evolved to promote adaptation and survival. Encourage them to become leaders in interdisciplinary early childhood systems work and vocal advocates for public policies that promote positive relational experiences in safe, stable, and nurturing families and communities. Integrated behavioral health services as part of the FCPMH team might be the next layer for parents who need additional assistance (eg, parental depression), and the need for more intensive skill building (eg, PCIT) for some parents becomes yet another focus for collaboration with key services within the community (eg, ABC, PCIT, CPP, and TF-CBT). Doing so will require all trainees to address their implicit biases, develop cultural humility, and provide culturally competent recommendations. Jon Lang Creating Architectural Theory .pdf - uniport.edu The use of trusted, supportive relationships within the FCPMH to promote the relational health of families is an emerging focal point for pediatric clinical research, and pediatric primary care is increasingly seen as a venue for fostering social-emotional health.193,194 These universal primary prevention strategies form the base of the public health pyramid (Fig 1 and Table 2), but additional, layered interventions that recognize and address child-level (eg, delays in development and a biological sensitivity to context), family-level (eg, poverty and parent mental illness), and community-level (eg, racism and violence) barriers to SSNRs may also be required for some families, whereas others will need even more intensive, evidence-based treatments (eg, ABC, PCIT, CPP, TF-CBT) to repair relationships that are already strained or compromised. Publication Date Jan 2018 Publication History Revised: Dec 2, 2016 First Submitted: May 24, 2016 Language English Author Identifier Branco, Marlia Souza Silva; Linhares, Maria Beatriz Martins Email Search for other works by this author on: National Scientific Council on the Developing Child, Young Children Develop in an Environment of Relationships: Working Paper No. Other common-factors techniques target feelings of anger, ambivalence, and hopelessness, family conflicts, and barriers to behavior change and help seeking. ACE = Events/Incidents which harm social, cognitive, and emotional functioning causing a dramatic upset in the safe, nurturing environments children require to thrive. Acronym for the family-centered pediatric medical home; in an FCPMH, the pediatrician leads an interdisciplinary team of professionals providing care that is: family-centered: the family is recognized and acknowledged as the primary caregiver and support for the child, ensuring that all medical decisions are made in true partnership with the family; accessible: care is easy for the child and family to obtain, including geographic access and insurance accommodation; continuous: the same primary care clinician cares for the child from infancy through young adulthood, providing assistance and support to transition to adult care; comprehensive: preventive, primary, and specialty care are provided to the child and family; coordinated: a care plan is created in partnership with the family and communicated with all health care clinicians and necessary community agencies and organizations; compassionate: genuine concern for the well-being of a child and family are emphasized and addressed; and. For example, the AAP currently recommends screening parents for postpartum depression90 and food insecurity.87,88 Similarly, when clinical markers for an individual childs biological sensitivity to context9194 (see the Appendix for a glossary of terms, concepts, and abbreviations) are available, children of high (versus low) sensitivity may also benefit from different types of interventions.95 In concordance with a layered public health approach, these various targeted interventions will supplement but not replace the universal primary preventions. To determine an individuals ACE score, see http://acestoohigh.com/got-your-ace-score. For children who are symptomatic or meet criteria for toxic stress-related diagnoses (eg, anxiety, oppositional defiant disorder, or posttraumatic stress), indicated, evidence-based therapies are needed. Reciprocal experiences with engaged and attuned adults (like those that occur during developmentally appropriate play) that build SSNRs; they are warm, affirming, and inclusive, and they promote early relational health. Acronym for child-parent psychotherapy; CPP is an evidence-based, psychoanalytic approach for treating dysfunctional parent-child relationships based on the theory that the parent has unresolved conflicts with previous relationships. Neurology also plays a role in the biological perspective of psychology. A public health approach to relational health is built on the SSNRs that buffer adversity and build resilience. These additional interventions are supplemental to and do not replace universal primary preventions. Below we briefly discuss each of the five components, review relevant empirical support, and identify enduring questions. intel director salary. ecobiodevelopmental (EBD) framework to stimulate fresh thinking about the promotion of health and prevention of disease across the lifespan. Bioecological Systems Theory 3. 2. culturally effective: the family and child's culture, language, beliefs, and traditions are recognized, valued, and respected. Children with known adversity but no overt symptoms,18 children with parents who experienced significant adversity as a child,86 and families struggling with the social determinants of health (SDoHs) (eg, poverty leading to food or housing insecurity,87,88 language barriers, or acculturation leading to conflicts within immigrant families89) may benefit from an array of interventions that mitigate specific risk factors. The Theory of Architecture Paul-Alan Johnson 1994-04-18 The Theory of Architecture Concepts, Themes & Practices Paul-Alan Johnson Although it has long been thought that theory directs architectural practice, no one has explained precisely how the connection between theory and practice is supposed to work.
