MIM Two Day Core Training November 2019 - Child Develop

11/14/2019

1

Two Day Core TrainingDay One

Angelique Jenney, Ph.D, RSWDirector, Safe and Understood Project

Day One, Morning

• Introductions

• Brief overview of MIM

• Infants and Toddlers

– What you need to know

– What infants and toddlers need for healthy development

– Impact of trauma

Day One, Afternoon• Understanding the impact of

trauma on mothers

• Window of tolerance

• Making Connections exercise

• Integration of Self‐Compassion

• Eligibility and Assessment

11/14/2019

2

Day Two, Morning

• ‘Good Mother' Beliefs Reflection

• Moments of Connection and Disconnection

• Responding to Moments of Disconnection

• Putting it all together!

Day Two, Afternoon

• Internal Sustainability Training Model

• Discussion Facilitation Role Play

• Wrap up – online evaluation

Take care of yourself today...

11/14/2019

3

Being Cautious:Mother blaming

The realities of the work you do...

The realities of the work you do...

11/14/2019

4

Mothers in Mind Overview

• Trauma informed mother‐child play group

• Fully interactive

• 10‐sessions

• Mother‐child work within group context

• Uses play, songs, stories to support the work

Goals of Mothers in Mind

1. Provide mothers with the opportunity to access trauma‐informed parenting information, while connecting with other mothers who have had hurtful experiences in their lives.

11/14/2019

5


2. Strengthen mothers’ self‐care, self‐compassion and stress management skills in relation to parenting.


3. Support the mother‐child relationship through enhancing mothers’ sensitivity and responsiveness to her child and strengthening feelings of parenting self‐efficacy.

Infants and ToddlersWhat you need to know

11/14/2019

6

MIM is..Child‐Focused practice• Consider: this may be a shift in your own thinking (especially if you typically work with women)

• Wonder: how can I promote a stance of curiosity about what the child may be thinking, imagining, expressing and feeling (Bunston, 2008)

• Keep in mind: it can be easy to lose sight of the child in the room (for mothers & facilitators)

Healthy Infant and Toddler Mental Health and Development

• experience, regulate and express emotions

• form close personal relationships

• explore their environment and learn

Cohen, J., Oser, C. & Quigley, K. (2012)

Child Development – The BasicsBirth to 12 monthsTrust vs. Mistrust (Erikson)

• infants completely reliant on caregivers for survival

• they are wired for social interaction to get needs met

• consistent, predictable and responsive caregiving helps infant develop trust which they carry to future relationships

• trust leads to hope that as new stresses arise, there will be someone there to help them feel better

11/14/2019

7

Look at what baby can do!

Social and Emotional Development

Birth to 12 months old

Child Development – The Basics1 to 3 years old

Autonomy vs. Shame/Doubt (Erikson)

• Toddlers begin to explore their world – knowing that they can get support from caregiver

• Learn they can control their actions

• Learn they can act in their environment and get results

• Starting to establish some independence

Toddlers – “No, me do it!”

Social and Emotional Development

1 to 3 years of age

11/14/2019

8

The Developing

Brain

beaconhouse.org

What do infants and toddlers need for healthy development?

Attunement

• sensitive responsiveness to infant’s cues

• the caregiver needs to “perceive the cue, make sense of them and respond in a timely manner to the actual moment‐to‐moment signals sent by the infant”

(Srufe & Siegel, p.2)https://www.drdansiegel.com/uploads/1271‐the‐verdict‐is‐in.pdf

11/14/2019

9

Attachment

Is about the caregiver’s role as protector

&

the child’s confidence in their caregiver as a protective figure

Determines quality of attachment

Attachment

• When attachment system is activated in infant:

– Infant tries to ‘get close’ to caregiver

– Caregiver’s response is sensitive, gentle & effective.....helps infant reduce stress response

Foundation for emotion & stress regulation

Serve and Return Interactions

• Back and forth dialogue between mother and infant

• Think of a tennis match—baby sends cue, mother responds

• essential to early learning, health and wellbeing

11/14/2019

10

Serve and Return Interactions

Serve and Return: A little older

• https://www.youtube.com/watch?v=0IaNR8YGdow

Serve and Return Videos

As you watch these videos think about

1. What was working well in these interactions?

2. What is the infant learning in these moments?

3. What is the caregiver learning?

4. What’s happening to their relationship?

11/14/2019

11

Helpful Caregiving QualitiesDaniel Hughes

P.A.C.E. is a way of thinking, feeling, behaving and communicating with your child

Aims to make the child feel safe

P ‐ Playfulness

A ‐ Acceptance

C ‐ Curiosity

E ‐ Empathy

Understanding the Impact of Violence and Trauma on Infants and Toddlers

Lisa 911 Call with 6 year‐old911 Emergency(crying and screaming) My mommy and daddy are having fight!Is he hitting her?Stop it! I’m talking to the police Mommy! Don’t hurt the baby! Don’t take the baby! Stop it, stop it!What’s happening? They’re having a fight because this has been going on forever and ever. (screams) He just knocked my sister down! He pushed her on the floor and she’s crying.Where are they now?They’re in the bedroom. Oh my God! (screaming uncontrollably and sobbing)What’s happening? Something happened!!! Just please, send the Police! Wait, I have to see what happened, please (drops phone)Okay,, the police are on their way okay? Lisa? Oh Sh…(lot s of crying and she gets back on the phone) My daddy has the baby now! (sobs) He’s got the baby and he’s made some red marks on

mommy’s neck.I don’t want him to do nothing strange to the baby because if they drop – because he’s a

newborn baby he’s very delicateWhat do you mean do something strange? What do you think he’ll do to your baby? I think he’s going to take the baby and do something because he’s drunk and he might go

off and drop the babyHow old are you?I’m six and my little sisters four. Okay, could you just send the police please...

11/14/2019

12

Woman Abuse & PregnancyViolence can begin in pregnancy or pre‐existing intimate partner violence can become more severe (Taillieu & Brownridge, 2010)

Risk factors

• Lack of prenatal care

• Fetal trauma, miscarriage

• Impact on fetus’ nervous system

Infant may be born ‘challenging to soothe’

Woman Abuse & Pregnancy“Cascade of Risk”

Mothers who endured 4 or more adversities (ACES) in childhood were more likely to experience:

• prenatal health issues

• postpartum issues (5x as likely)

– depression and marital conflict which can impact her infant’s development

(Madigan et al, 2017)

“Infants [and toddlers] do not like to be frightened and will work very hard to escape from things that are overwhelming.”

Bunston

11/14/2019

13

Still Face Experiment (Tronick)

https://www.youtube.com/watch?v=apzXGEbZht0

Exploring the Impact – Small Group Activity

In your small group, choose one of the following age groups:

1. Birth to 12 months

2. 12 to 36 months

Using the handout and your own knowledge explore the impact of violence on the infant/toddler’s development

Impact of trauma ‐ Physical

Issues with:

• sleeping – difficulty falling asleep or waking frequently

• Eating – refusing to eat, trouble keeping food down

• Toileting ‐ regression

• ‘failure to thrive’

11/14/2019

14

Impact on Development

May see developmental delays in:

• speech and language

• motor skills

• cognitive abilities

• exploration of environment

A simple examplehttps://www.youtube.com/watch?v=7FC4qRD1vn8

Attachment – Relational Impact

• anxiety/panic – increased clinginess, fear

• irritability, excessive crying – difficulty soothing

• frightened/frightening caregiver

• fearful expressions

• startles easily

11/14/2019

15

Attachment – Relational Impact

• withdrawal – decreased levels of social interaction

• doesn’t react to familiar sounds

• gaze aversion

• blank expressions, dissociation

Impact of Domestic Violence on Childrenhttps://www.youtube.com/watch?v=pSe40tX‐oTA

FACTORS THAT INFLUENCE THE IMPACT OF DV ON CHILDREN:

Risks vs Protective Factors

• intensity/duration of violence

• proximity of child to violence

• physical harm to child

• availability of responsive caregiver

• witnessing harm to caregiver

• age and level of cognitive development

• child’s gender

• relationship with siblings• relationship with mother• availability of social supports• co‐occurrence of

maltreatment/caregiver mental health issues

• co‐occurrence of other environmental stressors (poverty, community violence, homelessness/transience)

• relationship/contact with abuser

11/14/2019

16

Levels of Stress

Positive stress brief increase in heart rate, mild elevations in stress hormone levels

Tolerable stress serious, temporary stress responses, buffered by supportive relationships

Toxic Stress prolonged activation of stress response in the absence of protective

relationships.

Center on the Developing Child. Harvard University

Protective Factors – an example

https://sesamestreetincommunities.org/activities/responses‐trauma‐age‐age‐video/

The Impact of Violence & Trauma on Parenting

Research, Theory & Practice

11/14/2019

17

Before we begin…. 1 minute brainstorm

What keeps women in

abusive relationship?

A Powerful Paradox

Women identify their children as a significant reason for staying in an abusive relationship

…but also identify their children as the most powerful motivator to leave the relationship.

Mother and child can sometimes serve as constant reminders to each other of earlier traumatic experiences (Lieberman & Van Horn, 2005)

…and yet the child’s relationship to their mother is the most powerful predictor of positive outcome for the child. .(McGee, 2000)

11/14/2019

18

Parenting by women who have experienced abuse: Research indicates…

• Abused women appear to experience significantly greater levels of stress than non ‐ however this does not necessarily translate into diminished parenting

• Abused mothers may be more likely than others to use some type of aggression against their children but are less likely to do so when they are safe

• In the face of severe stress they may compensate for violent events by offering increased nurturing and protection to their children.

Parenting by women who have experience abuse“Women who live in violent relationships are remarkably similar to comparison women in their beliefs about parenting, their self‐reported parenting behaviors, and their observed interactions with their children. On such variables as providing structure, showing warmth, being emotionally available, and positively reinforcing their children, mothers from violent and nonviolent homes reportedly engaged in similar behavior”

(p.83 Van Horn and Lieberman, 2002)

Impact of Trauma: Window of ToleranceNICABM, 2017

11/14/2019

19

Window of ToleranceNICABM, 2017

• Optimal arousal where we can manage the ups & downs of life

• Able to think rationally and regulate body and emotions

Original concept by Dan Siegel

Stress and Trauma Shrink Window of Tolerance

• Harder to stay calm and focused

• Perceive danger more easily

• May react to stressors (even minor ones) with extreme hyper‐hypoarousal

Fight‐Flight ResponseHyperarousal

• hypervigilence “red alert”

• flashbacks, nightmares

• anxiety ‐ panic

• racing thoughts

• can’t sleep

• aggressive behaviours

• ‘feeling out of control’

Potential bodily responses:

• heart races/pounds

• rapid breathing

• sweating

• increased blood pressure

• increased muscle tension

11/14/2019

20

Freeze ResponseHypoarousal

• detached/empty

• avoidant

• loss of interest

• memory issues

• ‘zoned out’

• numb

Potential bodily responses

• feel sluggish/sleepy

• lower blood pressure

• low muscle tone

How to help

• ask mothers in assessment about what situations/experiences are more challenging • what happens? what helps?

• Pay attention and intervene– notice and intervene if mother is moving into dysregulation

• Slowly help enlarge mothers’ window of tolerance by helping her stay calm, focused and alert when something stressful happens

Impact of Trauma on ParentingMaking Connections Exercise

11/14/2019

21

Making Connections:Impact of Violence on Parenting

Brainstorm 5 experiences a woman may have had living with:

Group 1 ‐‐ an abusive parent as a child

Group 2 ‐‐ an abusive partner as an adult

Group 3 ‐‐ an abusive parent & partner

Making Connections

Using the experiences your group identified, brainstorm the related thoughts a mother may have.

Making Connections

Identify the feelingsa mother may have as a result of her experiences and thoughts.

11/14/2019

22

Making Connections

Experiences

Thoughts

Feelings

Parenting Behaviours

Making Connections

What do mothers needfrom you when they attend MIM?

Integration of Self‐Compassion“Treat Yourself the way you would treat a good friend”

11/14/2019

23

Self‐Compassion & TraumaFor some moms self‐judgment can come from 2 directions:

“I’m bad because I was abused” AND

“I was abused because I’m bad”

Self‐Kindness – calms hyperarousal

Common Humanity – antidote for shame and isolation

Mindfulness – helps better manage intrusive memories/feelings

Germer, C., & Neff, K. D. (2015)

Self‐Compassion Quotations• Self compassion quotations are integrated into the sessions starting in Session 2 and throughout the group

• Typically starts the discussion

– Allows the discussion topic to come from a place of self‐compassion

• Essential part of the program – something that is being measured in our program evaluation

11/14/2019

24

Self‐Compassion Quotation Exercise

• Choose a self‐compassion quotation

• With a partner talk about your understanding of the quotation

• What might be helpful for mothers?

• Anything that you can foresee that could be challenging?

• How might you facilitate a discussion on the quotation?

Self‐Compassion Quotations1. Treat yourself the way you would treat a good friend.

2. I am not alone in this. This will pass.

3. Feelings are like waves. We can’t stop them from coming but we can choose which ones to ride

4. Be careful how you are talking to yourself because you are listening.

5. Be gentle first with yourself, if you wish to be gentle with others.

6. Being a mom is hard at times. You are learning and growing and it’s not always easy.

Eligibility & Assessment

11/14/2019

25

Eligibility• Mother indicates history of violence/trauma that she feels may be impacting her ability to parent

• Child under the age of four

• Safety—Are they safe?

• Custody

I need 4 volunteers...please

What are the “blocks” mothers bring to MIM?

11/14/2019

26

Intersectionality‐a reminder• inequities are never the result of single, distinct factors.

• they are the outcome of intersections of different so‐cial locations, power relations and experiences

Hankivsky, 2014

• growing body of literature exploring how intersectionality can impact the lives of women and children

– access to housing, health care and education

– experience with police, child welfare

Three Components of Assessment

• Preparation

• Information

• Observation

Preparation—The roomHave grounding materials available:

• drawing materials available for mothers (i.e. mandalas)

• playdoh

• provide water

• toys for child

11/14/2019

27

Preparation—Are you ready?

• Self‐awareness

• Able to regulate own emotions

• Willingness to debrief with others

• Focus on own self‐care and self‐compassion

Klinic Community Health Care (2013)

Preparation—how to prep momsHelp moms understand ahead of time:

• the types of questions that will be asked

• why we ask these questions

• she has control over what she talks about

• she can stop or take breaks at any time

Reassure her you will contain the experience by:

• pacing the interview appropriately

• asking questions to guide the assessment

• checking in with her about how she is feeling

Information‐What do we need to know and why?

Focus on Mother‐Child Relationship

• Brief child developmental history

• Mother’s history

• Experiences of trauma

• Experiences of her caregiver

• Mother‐child relationship

• Safety

11/14/2019

28

Assessment ExerciseRead the following quote from a mother and think about the following:

• What questions are you interested in asking mom?

• What do you think would be helpful to know?

• How would you ask them?

• When would you ask them?

“I thought she was going to be dead when I was going to have her. I thought I was giving birth to a dead baby.

Because he really, he beat me up really bad… because I am so anxious, giving birth is like a nightmare for me.

Like the whole breastfeeding thing, I can’t do it. I tried to, but I got some mixed feelings about that. “

MIM Participant

What do you do if mom become flooded with memories?Contain the situation

• Take a break

• Identify what you think might be happening

• Help ground mom in the present

– Mental

– Physical

– Soothing

11/14/2019

29

Observation

Mother‐child relationship

• Together or separate?

• Moments of stress?

Mother

• What was mom like talking about the trauma?

Options for interventionBased on the assessment, mother and child could:

1. Go directly into MIM group

2. Make assessment period longer, to support mom before she goes into group

3. Connect mom with individual therapist for trauma work—attend MIM concurrently or after

4. Provide MIM to mother and child individually

5. Let mother know MIM might not be the best fit and support her accessing another service.

End of Day One!

11/14/2019

30

Day TwoCore Training

Clinical Skill: Self‐Reflection

What are your

“Good Mother” beliefs?

The “Good Enough” Mother

• The ‘perfect mother’ doesn’t exist.

• Impossible to satisfy all needs on the spot.

• You are going to make mistakes....it’s okay!

11/14/2019

31

Moments of Connection & Moments of Disconnection

Moments of Connection

What to look for:

• Serve and Return Interactions

• Moments of stress

– child cues mom

– mom responds sensitively

– child feels better

*Can happen at anytime in group.

Moments of Connection‐‐UnderstandAsk yourself what do you think went well?

• try to figure out that moment where connection happened.

• think about what mom/child did that that helped.

• is this a pattern for mom or something new she is trying?

• is there anything about mom’s history/experience that helps us understand?

11/14/2019

32

Moments of Connection—Reflect back to mom

• think about how you might let mom know that you witnessed that connection.

• Timing? now or later?

**Be cautious**

• Don’t want to be a ‘cheerleader’, can be interpreted as patronizing

• Are there ways to support mom is building on this strength?

Reflecting back..The purpose of reflecting back a Moment of Connection is to support mom noticing something she has done that has caused a positive response in her child.

e.g. “He really seemed to like it when you picked him up. He calmed right down.”

What are other ways to reflect back Moments of Connection?

Why are Moments of Connection important?

• It is the only place to start.

• Can’t ask moms to start to think, act & respond differently if we aren’t able to recognize what she does well.

The focus of work in the

first three sessions at least!

11/14/2019

33

Moments of Disconnection ‐ Identify• mothers or children struggling to connect, respond

• moments of frustration, anger, hopelessness

“I never know what she wants!”

• withdrawal by either mom or child.

Moments of Disconnection

Can only begin to address if:

• Created a safe, non‐judgmental environment.

• Spent significant amount of time identifying & responding to moments of connection

• Developed a supportive relationship


Can only begin to address if:

• Created a safe, non‐judgmental environment.

• Spent significant amount of time identifying & responding to moments of connection

• Developed a supportive relationship

11/14/2019

34

Moments of Disconnection‐‐Understand

• Pattern or isolated incident?

• Is violence playing a role in this interaction?

• How might mom be feeling right now?

• How might child be feeling?

• What are they each needing?


Responses that are:

– Sensitive

– Curious

– Self‐reflective

We need to be what we

are asking mothers to be

to their children!

Moments of Disconnection‐Respond

Timing is everything!

• Can’t address every moment of disconnection in the moment.

• Think about whether there could be

repercussions for mother if you respond

now. (i.e. embarrassment, shame etc.)

Think of your options:

• May make more sense to speak with mom after group, call during the week or the beginning of next group.

11/14/2019

35

Sometimes there’s a wall...

• Think about the reasons why mom may have had to build that wall.

• Focus on recognizing & responding to moments of connection.

• Think about ways to sensitively incorporate the larger issue into group discussion to see if mom begins to talk about it.

• Be patient. Be there.

Our ability to make a connection (with a mother or child) is the single most important thing we can do.

If we can do that, we have a shot at helping. If we can’t, then all the strategies and knowledge in the world

won’t help.

Daniel Stern

Clinical Skill: Think relationally

When hurtful things happen in relationships, healing needs to happen through healthy, supportive relationships.

What are the relationships in the room that you need to pay attention to?

11/14/2019

36

Clinical Skill: Attunement

The facilitator’s ability to pick up on the nuances of the mother/child’s response in a way that accurately captures the sense of what they were feeling in that moment.

In that moment the mother/child feels deeply understood, that you “get them”

Attunement“Feeling understood positively impacts the nervous system, triggering the same response in the brain as a secure attachment.” Briere (2012)

This feeling opens up space for mothers to explore the harder parts of their relationship with their child, and their feelings about themselves as mothers.

Clinical Skill: Curiosity

‐ supporting mothers in thinking about just what the infant/child may be thinking, imagining, expressing and feeling.

Reduces shame, guilt and judgment

Supports tapping into compassion, kindness and understanding.

11/14/2019

37

Responding to Moments of Disconnection

Adapted from the Fussy Baby Network, Gilkerson, Erikson Institute

1. Self‐Reflection: Checking in• How am I feeling right now? Is my body telling me anything?

• Is there anything I need to do for myself in order to be Calm – Present – Attuned – Genuine

• Are any of my “Good Mother” beliefs getting activated here?

• What is my relationship like with mom and child?

• What does mom/child/relationship need from me right now?

• Do I have any thoughts about what might be going on?

2. Connect with MomSupport mom in checking in with herself

– if mom is escalated, start with her reflecting on how she is feeling in her body ‐what does she notice?

– If needed, support mom in getting back into her ‘window of tolerance’

– can’t go on with the thinking/reflecting pieces if her thinking brain isn’t online

11/14/2019

38

2. Connect with MomAsk mom how she is feeling in the moment

‐Accept, hold, validate, normalize and contain feelings

Is there anything you find hard to validate?

3. Support Mom in Reflecting on Child• What do you think your child is feeling right now? Do you notice anything in their body/behaviour?

• Does this happen a lot? Are there times when it doesn’t happen?

• Do you have any thoughts on what might be causing this/what this might be about? – You might be able a small bit of information – “I wonder if….” What do you think?

3. Support Mom in Reflecting on Child• What’s worked in the past, even a little bit? Is there anything that doesn’t work?

• What do you think your child needs from you right now? What do you think might help?

11/14/2019

39

4. Moving towards Relational Repair with Child

• How are you feeling in this moment – do you feel ready to engage with your child?

• What might the first step look like?

• Do you need anything from me? Would you like me to be beside you to support this moment? What would be the most helpful?

5. Follow up/Check‐in

• How are you feeling now?

• How do you think your child is feeling now?

• What would you like to remember/hold on to from this moment?

Moments of DisconnectionSmall group exercise

Video 1

https://www.youtube.com/watch?v=8BA8CcEUP84

Video 2

https://www.youtube.com/watch?v=9u8ObYi_EB0

11/14/2019

40

Moments of DisconnectionSmall group exercise

Watch the following video and as a group:

Identify: What is the Moment of Disconnection?

Understand: How do you understand it?

Respond: What is the smallest shift I can support mom with? How will I facilitate it?

*** Role Play steps 1 through 5***

Putting it all together:Facilitating a Session!

Small Group Exercise: Weekly Sessions

Choose a session and facilitate the discussion

• Rest of the group will pretend to be clients

– Think about content‐what’s most important

– Trauma? How might you integrate it?

Support: we will stop at any point and brainstorm what to do/say

11/14/2019

41

Internal Sustainability Training Model

• designed exclusively to provide licensed MIM Australian sites with a model to train internal staff on MIM

–To manage staff turnover and to sustain agency capacity

**Model doesn’t permit training or licensing of external agencies.

Internal Sustainability Training Model

• Follow the training model developed by CDI

and evaluate the model as requested

• Develop a MIM Community of Practice within their agency

• Send a representative the MIM Biennial Conference in Toronto

Affiliate sites ‐ responsibilities

11/14/2019

42

• Ensure affiliate sites have resources needed

• Provide consultation to Clinical Supervisors‐Lead Trainers

• Evaluate the model and make revisions as needed

• Provide MIM training at the MIM Biennial conference

CDI ‐ responsibilities

1. MIM Intern

2. Clinical Supervisor –Lead Trainer

3. MIM In‐Group Mentor

Roles

MIM Intern

• in a clinical/therapeutic position

• preferably have graduate level education in a clinical field or equivalent therapeutic experience

(to be determined by Clinical Supervisor – Lead Trainer)

• some group facilitation experience and mother‐child dyadic work is beneficial, but not required

Requirements

11/14/2019

43

MIM Intern

• Interested in becoming a MIM facilitator

• Participates in all four stages of training

• Participates is regular clinical supervision

• Completes reflective exercises and discusses with Clinical Supervisor – Lead Trainer

Roles and Responsibilities

MIM In‐Group Mentor

• in a clinical/therapeutic position

• have graduate level education in a clinical field or equivalent therapeutic experience

(to be determined by Clinical Supervisor – Lead Trainer)

• have facilitated at least three cycles of MIM

Requirements


• Provides support to MIM Intern in the group

• Demonstrates various skills and strategies

• Leads prebrief and debrief meetings

–Explains group content, explore group dynamics and mother‐child interactions


11/14/2019

44

Clinical Supervisor – Lead Trainer

• provides reflective, clinical supervision to staff at their agency

• facilitated at least one cycle of MIM

Requirements


• Is the primary trainer to the MIM Intern

• Conducts clinical reflective supervision to both MIM Intern and MIM In‐Group Mentor

• Conducts fidelity checks twice per group

• Participates in regular consultation with CDI


• Group composition – assessments done well? Fit? Ages, stages – developmental fit – numbers? Thought about other members?

• Group location – any foreseen issues (space, location, children’s appropriate and safe toys etc., materials on site, windows – safety/confidentiality – mousetraps?)

• Group readiness – knowledge about the manual, weeks, materials

• Group fidelity – evaluation set up, fidelity checks – structure for pre and debrief (e.g. taking account into set up and take down)

Consultation with CDI – Pre‐Group

11/14/2019

45

• Group composition – did you make the right decisions? How are people doing? Any concerns.

• Group location – Any thing come up – how is it being addressed?

• Group readiness – knowledge about the manual, weeks, materials – anything you are struggling with?

• Group fidelity – is this still happening??? evaluation set up, fidelity checks – structure for pre and debrief (e.g. taking account into set up and take down)

• Clinical consults: particular family issues and how to address them?

Consultation with CDI – around session 4/5

• Group composition – did you make the right decisions? How are people doing? Any concerns. Any lessons learned in hindsight? Referrals needed?

• Group location – Any thing come up – how is it being addressed? Same place next time or will you try something new?

• Group readiness – knowledge about the manual, weeks, materials –anything you are struggling with? On reflection – were you prepared for everything – were there any weeks that were particularly difficult? Or things you never address? Routines?

• Group fidelity – Did you stay on track – have you submitted the fidelity forms, the post evaluation measures? Is there anything you habitually are giving up each week to manage the time?

• Clinical consults: particular family issues and how to address them? Inviting back – referring out – extending services

• Next round preparation/lessons learned

Consultation with CDI – around session 8/9

1. Pre‐Facilitation Training

2. Stage 1 Facilitation



MIM Intern: Stages of Training

11/14/2019

46

Timing: Occurs prior to MIM Intern completing an assessment or facilitating a group.

Purpose: To support the MIM intern in getting an overview of the program, its structure, components and session topics.

MIM Intern: Pre‐Facilitation Training

Process:

• Complete the online Pre‐Training and passes the quizzes with 80% or higher

• Read through the entire MIM online session guide

• Completes the MIM Pre‐Facilitation Self‐Reflection and makes a professional development plan with Clinical Supervisor


Support:

• Meet with Clinical Supervisor‐Lead Trainer

– review the Pre‐Facilitation Self‐Reflection and make a professional development plan

– review the MIM Clinical Assessment


11/14/2019

47

Timing: First 10‐week MIM group

Purpose: To support the MIM Intern in experiencing and becoming comfortable with the program structure, components and flow of the program.

It is an opportunity to better understand the dynamics that can occur in a trauma‐informed mother‐child group program without taking on a lead facilitation role.

MIM Intern: Stage 1 Facilitation

Process

• MIM Intern is third facilitator in group

• Takes an active observational role

• Can lead part of Welcome and Goodbye Circles (e.g. read story, lead songs)

• Completes weekly Stage 1 Discussion Reflection and discusses in supervision

• Conducts the first fidelity check


SupportMIM In‐Group Mentor

• Weekly prebrief and debrief

Clinical Supervisor‐Lead Trainer

• Weekly reflective supervision

– Review weekly Stage 1 Discussion Reflection

– Review Stage 1 “Good Mother” Beliefs Reflection

– Complete Experiences‐Thoughts‐Feelings‐Parenting Behaviours activity


11/14/2019

48

Timing: MIM Intern’s second 10‐week group

Purpose: To provide the MIM Intern with the opportunity to focus on developing skills and knowledge related to the facilitation of the trauma‐informed discussions each week, while sharing the facilitation of the Welcome and Goodbye Circles, as appropriate.


Process

• MIM Intern can be the second facilitator

• Intern gradually takes on discussion facilitation

– Uses notes from weekly Stage 1 Discussion Reflection

• Complete the weekly Stage 2 Moments of Connection and Disconnection Reflection

• As comfort increases reflect back Moments of Connection to mothers in the group


Support

MIM In‐Group Facilitator


– Focused on the facilitation of the discussion – what worked well, what needs more attention

Clinical Supervisor – Lead Trainer (weekly or biweekly supervision)

• Reflective supervision re: discussion facilitation

• Beginning to explore mother‐child dynamics in the group through Stage 2 Moments of Connection and Disconnection Reflection


11/14/2019

49

Timing: MIM Intern’s third 10‐week group

Purpose: To support the MIM intern in focusing their attention on using their skills, knowledge, experience and personal qualities to support individual mother‐child relationships, while continuing to facilitate other components of the program.


Process

• Facilitation of circle times and discussion

• Takes on an active role in supporting mother‐child relationships with Moments of Connection and Discussion

• Complete the weekly Stage 3 Supporting Moments of Disconnection Reflection

• When comfortable the MIM Intern can take on a leadership role in regards to prebrief and debrief


Support



– Focused on group dynamics and supporting each mother‐child relationship in the group


• Reflective supervision focused on supporting the mother‐child relationship during Moments of Disconnection – reflection on use of attunement and curiosity

•** Once MIM Intern has successfully completed this stage they are ready to be a MIM Mentor for another intern


11/14/2019

50

Purpose: To provide an opportunity for those involved in MIM to come together regularly to reflect on the implementation of the program

– what is working well in the program

– what has been learned in the process of implementation

– exploring challenges and brainstorming solutions

**Focus of first two years is developing a solid internal CoP

Developing a Community of Practice

Potential Members of CoP

• MIM Clinical Supervisor – Lead Trainers

• MIM In‐Group Mentors

• MIM Interns

• Potential MIM Interns

• Senior Leadership

• Researchers

• Other Stakeholders as appropriate


Frequency of Meetings: determined by CoP, but quarterly at a minimum

Potential Areas for Exploration

• What is working well in MIM?

• What are the challenges? What has surprised us?

• What ideas/solutions might there be?

• Practical issues – e.g. exploring funding opportunities

• Reviewing program evaluation results and looking at next steps

• Conducting fidelity checks across MIM sites


11/14/2019

51

Putting it all together:It’s Time ‐ Facilitating a Session!

Small Group Exercise: Weekly Sessions

Choose a session and facilitate the discussion

• Rest of the group will pretend to be clients

– Think about content‐what’s most important

– Trauma? How might you integrate it?

Support: we will stop at any point and brainstorm what to do/say

Some final thoughts from MIM moms....

11/14/2019

52

“My son is sleeping through the night.

He does not wake up crying and screaming.

I have stopped screaming and fighting with him so much.”

"I've learned how to connect more with him and how to listen to his cues.

We're definitely closer now.”

“I take time to follow her lead, focus more on my reactions and facial expressions.

I appreciate her more and

understand her actions,

giving me more patience.

She hugs and kisses me

more, seeks me out to play.”

MIM Participant

11/14/2019

53

Contributions

Lisa Sura‐Liddell, MSW, RSW

Manager, Family Violence Services

Mothers in Mind Child & Family Clinicians

Asifa Sheikh

Elise Millett

For more information

Lisa Sura‐Liddell, MSW, RSW

Clinical and Program Manager

Family Violence Services

Child Development Institute

416‐603‐1827 ext. 2306

[email protected]

Documents

MIM Two Day Core Training November 2019 - Child Develop