Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
A family's story creates the context for child maturation, and it is critical to understand when that story includes parental childhood trauma. This study describes how maternal early life stress impacted the role of caregiver and reduced competency within the mother–child system. Using a trauma-informed approach for the mother improved participation in developmentally appropriate play routines for the child. The occupational profile for mothers guided a client-centered plan of intervention.
Primary Author and Speaker: Rondalyn Varney Whitney
PURPOSE: Children are part of a larger, family unit. Therefore, understanding how a family's story creates a context in which a child will be growing, maturing, and becoming himself is critical when the parent has experienced childhood trauma. This study describes the effects of Adverse Childhood Experiences (ACE) on the occupational role of maternal caregiver and how trauma-informed care facilitated health outcomes for the child with a developmental disability during early intervention.
METHOD: A descriptive case study was used to analyze mother-child co-occupations for a family evaluated for occupational therapy intervention. The Occupational Profile was used to guide the structural interview, evaluation, and develop a trauma-informed intervention plan. The plan for intervention addressed the five domains of family quality of life (FQoL).
RESULTS: This study analyzed the adverse childhood experience of the mother and how that trauma impacted the occupational role of caregiver. Addressing the early life stress a mother experienced and assuring her sense of safety was critical to improving therapeutic alliance and establishing trust. The Occupational Profile for Mothers effectively guided the structured interview. Addressing the maternal trauma improved caregiver-provider trust which, in turn, allowed the initial evaluation and intervention to proceed. More, the child was able to participate in developmentally appropriate play routines previously unavailable to him and formed the foundation for future treatment planning designed to improve family quality of life (FQoL).
CONCLUSION: Case reports are professional narratives that frame reflection on practice and one patient's story does not generalize to the larger population. Still, this report describes the importance of understanding how trauma impacts the parent, the child, and the parent-child system. Future studies are needed to analyze the impact of adverse childhood experiences on the occupational role of parent, and the effectiveness of strategies used to build resilience within the mother-child relationship. The use of the occupational profile for mothers is a promising tool to guide preliminary data gathering.
References
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Racine, N., Plamondon, A., Madigan, S., McDonald, S., & Tough, S. (2018). Maternal Adverse Childhood Experiences and Infant Development. Pediatrics, 141(4), 1-9. https://doi.org/10.1542/peds.2017-2495.
Tarullo, A.R., St John, A.M.,& Meyer, J.S., (2017). Chronic stress in the mother-infant dyad: Maternal hair cortisol, infant salivary cortisol and interactional synchrony. Infant Behavior and Development, 47, 92-102. doi.org/10.1016/j.infbeh.2017.03.007
Whitney, R. (2019). The Occupational Profile as a Guide to Clinical Reasoning in Early Intervention: A Detective’s Tale. AOTA Continuing Education Article, code CEA0419, April, 2019. Available at https://www.aota.org/∼/media/Corporate/Files/Publications/CE-Articles/CE-article-April-2019-Occupational-Profile.pdf
