Editor's Note: Whether physical or emotional, benign or malicious, neglect alters the developing brain's architecture and circuitry in profound ways that often lead to physical and behavioral problems throughout life. In the final installment of our four-part series on The Neglected Brain we watch Danielle Goodwin, abused and neglected as a child, become a capable, loving parent, spouse and political activist. Read Part 1, Part 2 and Part 3.
The first thing Danielle Goodwin had to do to change her life was stop running.
If she wanted to solve her problems, she needed to face them first. So she turned herself into the police and did time to clear up outstanding charges — in Seattle, Kent, Renton, Edmonds, all over King County. She also met with a social worker to see what she would have to do to regain custody of her five kids.
To reunite with her children, Danielle had to follow through on a range of court-ordered requirements. She had to attend three AA meetings a week, meet with a therapist, go to group therapy and parenting classes and submit to random drug tests. She also had to pay off thousands of dollars in court fees (she's still paying), overcome addiction, get a driver's license and find a job.
Danielle was 29 years old when she landed her first legitimate job cleaning up after games at Safeco Field. She didn’t make much money, but it kept her busy and out of trouble and a trickle of money coming in was better than none at all.
Until she got her license, her friend James Encinas drove her to all her appointments. Before long, James and Danielle were dating, and talking about getting married. As she started arranging visits with her kids, James was the one who explained to her that the whole purpose of the visits was for her to show the social workers, who were observing everything, that she knew what she was doing.
But Danielle didn't know what she was doing. Even the simplest parenting tasks were foreign to her. She had to learn how to be the mother she'd never had. "I'm like, I'm supposed to bring snacks?” says Danielle. "That was eye-opening for me. I didn’t know."
Danielle knew that hers wasn’t the only life she had to get on track. Her kids were going to need extra help too. She asked the court if they could be sent to Childhaven, a non-profit daycare that specializes in helping abused and neglected children.
Danielle had spent time in foster care growing up — not once but twice. It hadn’t been easy for her and her kids were also struggling. They’d been split up and moved from home to home, once because the foster family only wanted kids who were immediately eligible for adoption. Her kids had also spent time in a home that was investigated by the state's Child Protective Services after one of them was hit on the head with a frying pan and made to eat feces. In their last foster placement, with the family of Danielle's ex-husband, one of her boys stopped using the toilet.
Parenting isn’t easy under the best of circumstances, and it doesn’t come naturally to everyone. It’s especially challenging for foster parents who are often caring for children who’ve been abused or neglected and arrive with behavior problems from those experiences. What troubled kids need, according to Dr. Rebecca Wiester, clinical director of the child protection program at Seattle Children's Hospital, are caregivers who understand child development and the impacts of neglect.
Neglected kids, for example, may not act their age. They might need to be rocked to sleep at night like a baby; they may have never learned to associate positive feelings with touch. "It's almost like taking it from the beginning again,” says Wiester, about parenting neglected children. “You just have to redo it."
Besides Seattle Children's Hospital, Wiester also works at Harborview where she is clinical director of the Center for Sexual Assault and Traumatic Stress. The two institutions share many clients, and Wiester spends her time seeing patients, consulting on court cases, teaching resident doctors and advising social workers. "These kids are going to be difficult to raise, and they're just going to have things go wrong for them," she says. "They need people who understand what they're up against, and are ready to stick with that kid while they go through this. Not medicate the kid. Stick with the kid."
Even parents who were abused or neglected themselves, can learn how to treat their own children well. Evidence-based approaches are now being used to teach those parents what to do, how to parent. "The vast majority of people who abuse and neglect a child are not monsters," says Wiester. "They are normal people without skills. They don't really want to hurt their children. Some are downright mean or crazy, but most physical abuse or neglect isn't malevolent. It's just either a bad day or bad couple of days, or a bad life."
"There are very few [good parents] out there that are born," she adds. "Most of them have learned it. And anyone can learn it."
One of the techniques parents learn is to focus on the positive. "If you go into a good pre-school, you'll see the same things over and over again," says Wiester. "'I really like it when you use your words.' 'Hitting is not a good thing to do.' It sounds ridiculous, but it works so well."
The power of prevention - and home visits
Parents who are isolated or depressed are at higher risk of neglecting or abusing their kids, but simple interventions can defuse the danger. One of the most successful is a home visit from a public health nurse, a trained professional who can listen, talk to and support the new mother. Unfortunately, says Wiester, funding for public health nurses has been cut repeatedly over the last 20 years. When pediatricians like her encounter cases of neglect, she says, "a lot of us in the community just dream about having our public health nurses back."
It's hard to predict how Danielle Goodwin’s life might have been different if a public health nurse had been there to support her when she gave birth at age 15 — or to support Danielle’s mother before her. But it's safe to say that it would have made a difference, which is why recent cutbacks in the program are so troubling. "We've been doing this work since 1989, and we've been funded continuously for all these years,” says Greenleaf. "Our infrastructure is very much under siege right now, so all the programs are affected.”
Due to budget shortfalls and cuts, last year the number of nurses on staff who do home visits for at-risk families fell from nine (including a part-time coordinator) to five. That meant the number of clients they could serve also plummeted — from 934 in 2012-2013 to 691 in 2013-2014, according to figures provided by King County. When a state representative delivered the most recent news about cuts to the program, says Greenleaf, many of the staff were in tears.
Even as King County cuts back on prevention programs like visiting nurses, it is spending nearly three out of every four dollars from its General Fund on the criminal justice system, which is where many abused and neglected kids will eventually wind up without effective interventions on the front end. But there may be new hope for prevention.
King County Executive Dow Constantine recently proposed a Best Starts for Kids levy, which seeks funding to develop evidence-based programs that help children reach their full potential. The three areas of focus for Best Starts would be pregnancy and early childhood, school-age years and communities. The county is in the early stages of convening experts from nonprofits, schools, businesses and other community partners to develop the framework. The proposal will go before the County Council for its approval and then on to voters next year.
The "Strange Situation" studies
The courts eventually granted Danielle’s request to have her children attend Childhaven. The Seattle nonprofit was founded in 1909 as one of the city’s first daycare centers for working moms. Today, Childhaven is a nationally-recognized leader in caring for abused and neglected children. It currently serves about 300 children and families, and its approach to their care has become a model for similar programs around the country, and in Canada.
For Childhaven kids, the calm, healing approach centers on “Consistency, structured routine, attentive listening, the opportunity to make their own choices, and clear limits and boundaries.” Childhaven teachers provide the intensive nurturing that these kids missed out on, allowing their brains to catch up. Parents need to be helped, nurtured and trained as well. One training method that's worked very well is Parent-Child Interaction Therapy (PCIT). Parents wear an earpiece while playing with their child, and a Childhaven expert, stationed behind a one-way mirror, coaches the parent about what to do or say when the child acts out.
One of the parenting challenges Danielle faced was how to manage her own stress response when her kids got upset. She was suffering from Post-Traumatic Stress Disorder. (Studies show that the rates of PTSD among foster kids and women, like Danielle, who have been prostitutes, are even higher than the rates among military veterans.) Because of her PTSD, Danielle was predisposed to retreat emotionally whenever things got rocky with the kids, an understandable if unhealthy response. But research shows that there are ways to break that cycle of emotional disconnection.
Schechter is based in Switzerland now where he is the Principal Investigator on the Geneva Early Childhood Stress Project. "Essentially, we're interested in how violence and related psychopathology like PTSD are transmitted across generations, and how to interrupt their transmission," Schechter explains. "What we notice is that mothers who are exposed to violence, who have PTSD, have difficulty engaging in mutual regulation, because when the child sends an emotional communication their way, if it's one of helplessness or fear, or a gesture that suggests the child could possibly be aggressive, the mother, rather than help the child be present emotionally, can find herself dysregulated and needing to withdraw from the interaction."
Over time, as the mother continues to withdraw, the child becomes more and more distressed, which continues to push the mother away.
Schechter is exploring the principles of attachment research, in which children are brought into a laboratory setting and observed as they play with, separate from and reunite with their caregivers. The original studies that characterized the quality of parent-child attachment analyzed films of parents and children during a half-hour-long research protocol called the "Strange Situation Paradigm." Those original experiments, by Mary Ainsworth and colleagues, were designed to test key principles of attachment theory, a concept popular in psychology since at least the 1950s.
The Strange Situation Paradigm studies how children and parents behave when the child is stressed. Study subjects are typically children between one and two years of age, a stage of development during which a child is still unable to hold the idea of its mother safely in mind when she is out of sight, and so can become extremely distressed whenever mom goes missing.
Attachment theory was developed by British child psychiatrist John Bowlby, and refined by Ainsworth, his Canadian protégée and colleague. Bowlby was himself the product of a neglectful childhood. He rarely saw his father; his mother allowed him to be with her once a day, for one hour at tea time. He was raised by a nanny, and sent away to boarding school at age seven. This early experience shaped Bowlby’s later work as a psychiatrist when he began to study the emotional consequences of the parent-child bond. He found that children tend to exhibit either "secure" or "insecure" attachments, depending on the availability, calmness and attentiveness of their primary caregiver.
Schechter's ongoing studies focus on mothers as the caregivers. He films interactions between mothers and their children, then reviews the videotape excerpts with the mothers to explore what's happening. Before looking at the tape, he and his colleagues talk to the mother about what she remembers from the interaction. Then they review the excerpts with the mother, pointing out the positive things she did, and the ways in which she calmed her child down. The observers then ask the mother to put herself in her child’s shoes and imagine what the child might be feeling at some of the more difficult moments, such as when mom leaves the room and the child feels distressed and helpless.
"Sometimes, it's very hard for the mother," says Schechter. "They think, 'The kid is being controlling and angry; he's manipulating me.’ When in fact, the kid is very scared. We try to help the mom with that, and this is often very reassuring for her. She is often able to reframe the child's expression."
Schechter cautions that a single intervention isn't enough for most parents. Where trauma is more severe, the intervention can take months, or even years. But for many parents, the approach works. He has found that even one session is often enough to show mothers that they can change the way they think about their children.
Turning her life around
After creating the life she wanted for herself, Danielle has also become politically active on behalf of others. She had advocated for prostitution convictions to be removed from women’s records, and for changes to the state’s foster care system. She wrote letters and lobbied lawmakers on behalf of the Family Assessment Response (FAR), a gentler approach to the way CPS responds to charges of abuse and neglect.
The state’s Department of Social & Health Services launched the FAR program in January 2014. Now, a call to CPS doesn’t immediately launch an investigation or a foster care placement. Instead, a caseworker visits the family to listen and offer constructive support (housing, food, childcare, etc.) designed to keep the family together. A framed photograph on a wall in Danielle's living room shows Danielle in glasses and a leopard-print dress standing by then-Washington Governor Christine Gregoire as she signs the FAR bill (aka Engrossed Substitute Senate Bill 6555) into law.
Danielle’s family still goes to counseling. But for the first time in her life Danielle is happy and stable and content. "The wealth of life experiences that I have, and now the professional training that I have has catapulted me forward," she says. "My kids are thriving. We belong to a really supportive church. I wouldn't be who I am without these experiences. I never feel like there's not more work to do."
On a recent Saturday, Danielle sat on her front porch, waiting for her husband to come home with the custom cake she had ordered to celebrate two birthdays — his and one of the kid’s. When James pulled into the driveway, she greeted him with a wide smile.
"What took so long?" she joked. "Did you have to make the cake?"
"Kind of," he replied, pulling the cake box out of the van. "They usually need a day's notice."
"Party planning," said Danielle, nodding. "Something I still need to work on."
Deborah Greenleaf photo courtesy of King County Nurses Association. Photo of Dr. Daniel Schechter courtesy of the University of Geneva Neuroscience Center.