The COVID-19 pandemic has called on us to find creative ways to connect and learn. In rural western Massachusetts I had scheduled a training for 20 practitioners who work with parents and infants to meet together for two days of learning on April 15 and 16th. Instead I rapidly adapted the training to the online setting. I have had the pleasure of meeting weekly with an extraordinary group that includes peer recovery coaches on the front lines supporting moms with opioid use disorders, clinicians and administrators from Child Protective Services, physicians, occupational therapists, early intervention specialists, and early childhood educators to learn together for a course in Community-Based Parent-Infant Relationship Support.
Pittsfield, Massachusetts exemplifies the term “high needs, low resourced” that has in many academic circles replaced the less specific term “at risk.” The largest city in rural Berkshire county, it is a study in contrasts. A rich cultural community of extraordinary natural beauty is home to poverty, community violence, and a growing crisis of opioid abuse. Berkshire Medical Center, the local community hospital, has seen a dramatic increase in families in crisis, with a 300 percent rise in babies with opioid withdrawal ( neonatal abstinence syndrome) in the past 4 years.
These front line practitioners in our online training interface with vulnerable Pittsfield families at different points of contact. By gathering to learn together over time, we hope to forge relationships that can build what pediatrician D.W. Winnicott named a holding environment. We aim to set development on a healthy path right from the start.
Several years ago I had the privilege of listening to Bessel van der Kolk, trauma researcher and author of The Body Keeps Score. He began his talk with a video clip of a mom and her baby, who looked to be about 3 months old, having a conversation. It started with an exchange of soft sounds, moving on to more complex communication, including shared facial expressions. Palpable delight characterized the moment of meeting.
As the conversation between mother and baby increased in complexity, a slight lapse appeared between the baby’s signal and the mother’s response. Herein lies the development of resilience. As described in our new book, world-renowned child development researcher Ed Tronick, who van der Kolk referenced at the start of his talk, has demonstrated using second-to-second videotape analyses that in typical relationships parent and infant are mismatched in 70 percent of interactions. What he terms “quotidian resilience” develops in the repair of these countless moments.
Ways of being together are laid down in our minds and bodies the early weeks, months, and years of life. They become part of us; part of our DNA. Our earliest relationships sculpt our nervous system and the way our body responds to stress. The moment-to-moment mismatch and repair of early infancy is the material of which our self, with our own skin—our own border—is made. Survival of disruption, together with the joy of repair, creates trust, an essential ingredient of intimacy. We develop a confidence that when we feel bad, we won’t always feel bad. This early experience builds a foundation of hope.
The talk was sponsored by Berkshire United Way, which is taking a lead in making our community “trauma-informed.” Driving the movement to create “trauma-informed communities” is the powerful longitudinal Adverse Childhood Experiences Study showing the poor long-term outcomes of a range of experiences including not only abuse and neglect, but the more ubiquitous experiences of parental mental illness, marital conflict, and divorce. The greater the number of ACEs, the greater the likelihood of a wide range of negative physical, emotional, and social consequences.
The original ACE research grew out of the observed high association between adult obesity and childhood sexual abuse. The original ACE questionnaires address experiences specific to relationships. Recent adaptations have expanded to include external stressors such as poverty and racism. Again looking to the research of Ed Tronick, we can understand the parent-infant relationship as being either a buffer against or a transducer of these stressors.
An extensive body of research shows us how these early experiences get into the body and the brain. But perhaps we need look no further than van der Kolk’s opening video. My colleague in Scotland, Suzanne Zeedyk, who is taking extraordinary strides to make an entire country “trauma-informed” in large part through showings of the film Resilience about the ACEs study, began her work in the arena of public policy with a beautiful film, the connected baby. Both she and van der Kolk recognize that babies have an extraordinary capacity for connection and communication from the moment of birth. “ACEs” are experiences that violate that connection.
Adverse Childhood Experiences can be understood as developmental derailment of the healthy process of mismatch and repair. Prolonged lapse between mismatch and repair occurs when a parent is preoccupied with depression, substance use, marital conflict, or domestic violence. Paucity of repair occurs with an anxious intrusive parent. Unrepaired mismatch occurs in the setting of abuse and neglect.
Van der Kolk went on to demonstrate, using research evidence and clinical examples, how when bad things happen to us early in our lives, the experiences live in the body. Offering a message of hope, he encouraged his audience—a broad range of individuals from our local community—to recognize that healing begins with the body. Theater, martial arts, drawing, drumming, yoga, and dance are among the many ways in which, in the setting of relationships, parts of the brain damaged by the experience of trauma can begin to heal.
In conclusion, van der Kolk returned to babies. He advised us to look to paid parental leave, high-quality daycare for all, and other measures to support new parents as the path to a trauma-informed community. In keeping with his recommendations, our local chapter of Berkshire United Way is supporting The Hello It’s Me Project that aims to engage communities around promoting safe, secure parent-infant relationships from birth.
The word “trauma” can itself be traumatizing. As we move forward with this work, I wonder if we might aim to build not “trauma-informed” communities, but, taking the lead from van der Kolk’s presentation of mother and baby, simply “connected communities.” Parents and babies are an excellent place to start.