Brain science

Q&A: A researcher who’s seeking nimble interventions for toxic stress

PHOTO: ZEISS Microscopy, Creative Commons

When children endure toxic stress, it can have lifelong impacts on their health, education and well-being. Dr. Philip A. Fisher, professor of psychology and research scientist at the Prevention Science Institute at the University of Oregon, believes traditional evidence-based interventions are too cumbersome and expensive to replicate widely. He argues that researchers, program developers and policymakers must become more flexible and innovative in finding ways to mitigate the effects of toxic stress.

Dr. Fisher spoke Thursday evening at the annual Community Lecture Series hosted by the Marsico Institute for Early Learning and Literacy at the University of Denver. This Q&A, which has been edited for length and clarity, took place earlier in the day.

Q: How did you get interested in the topic of toxic stress?

Dr. Phillip A. Fisher, senior scientist at the Oregon Center for Social Learning.
Dr. Philip A. Fisher

A: In high school, I started volunteering in a residential treatment center for severely emotionally disturbed kids. I worked at summer camps for troubled kids during college.

What I continued to encounter were these things that really didn’t have adequate explanations. So, why were so many of the kids we were working with from disadvantaged communities, from poor backgrounds? Sure, kids who don’t have opportunities don’t do as well, but it didn’t really explain why there were the specific kinds of issues that we saw in these kids.

The models that were out there…mostly consisted of assigning labels to kids. You have conduct disorder. You have attention deficit disorder. They didn’t say much about what was going on.

Q: What is toxic stress?

A: It has to be put out there first and foremost, not all stress is toxic…We know that some stress is probably not a bad thing. It actually can help make people stronger.

In early childhood what [toxic stress] really means is prolonged activation of these bodily systems…that are designed to help us respond to stress, in the absence of any kind of supportive care.

If there’s a lot of distress that a child or infant is experiencing—they’re hungry, they’re tired, they’re scared—and it happens consistently over long periods of time and there’s no caregiving adult present—somebody to help buffer the child from the experiences of stress—that’s when things move from tolerable to toxic.

Q: How does toxic stress manifests itself in children?

A: Kids become much more sensitive to stress in their lives. So, when they experience stress, they tend to function more poorly. We see that not only in terms of their ability to concentrate and focus in class but also health vulnerabilities. They’re more likely to get sick. They’re more likely, over their life span, to have problems with things like diabetes, heart disease and obesity.

It’s also increasingly clear that toxic stress really does have the potential to disrupt the architecture of the developing brain…so (kids who experience) significant toxic stress, of some types, have more difficulty with self-control. In a classroom setting, they tend to be more impulsive. They tend to be the ones more likely to lash out or do things not consistent with the rules. They have a hard time shifting their attention flexibly from one thing to another.

Q: What are the implications of toxic stress for educators tasked with helping children achieve academically?

A: The first thing is just to understand that those kids aren’t (misbehaving) because they’re troublemakers or they’re willfully disobeying you. One of the things that’s become clear from our research is that those kids just don’t process information very well.

(If kids are) doing something that’s not what they’re supposed to be doing, corrective feedback might not be getting through. That’s one of the reasons…having more individualized support for the child, making the signals really clear to them, can be really, really helpful.

Q: You’ve talked about developing flexible, low-dose programs that help with toxic stress. Why is that important?

Where we started developing programs that helped to offset toxic stress, they were large, expensive programs. What I’ve become convinced in the last 10 years is that we’re not going to have impact at scale if that’s all that’s available. It’s just not going to happen.

We have to get a lot smarter about…cutting to the core of what needs to happen most. It’s not like the system’s broken and we should throw it out, but we need to augment what’s out there with other ways of approaching of knowledge development…We have to be committed to a broad array of strategies, and a process of learning about them in a much more rapid-cycle way.

I think school is the perfect innovation platform…If you engineer things properly, then each year can be a new opportunity to gather information, to figure out what’s working and for whom…and for those for whom it’s not, to engineer new approaches.

Q: Right now, what do you consider the most promising interventions for dealing with toxic stress?

A: The majority of the ones that are out there, they’re at a point where there’s good proof of concept. One of the hallmarks of the toxic stressors that we’re talking about is that kids don’t really learn good cause and effect.

A baby crying (will think), “Maybe somebody’s going to come pick me up. Maybe they’re not. Maybe if they pick me up, they’re going to shake me. Maybe they’re not.” That whole learning process really goes sideways.

The things that…help turn that around are things that make it very clear to the child that the environment is consistent, predictable and responsive, and then also warm and nurturing.

Q: You’ve described healthy interactions between children and caregivers with a tennis analogy, “serve and return.” What is that?

A: We define serve and return very precisely. It’s an instance in which the child initiates some action, either puts the focus of their attention on the adult or something else in their immediate environment and the adult shares the child’s focus of attention and (responds).

(A serve) could be the child fussing or that they’re delighted. It could be that they’re gazing at something. It could be that they’re pointing to something and saying what it is. The return of the serve is really what’s critical.

Q: What is the video coaching program, Filming Interactions to Nurture Development, or FIND,  you’ve helped develop?

A: It involves basically showing people, using video, instances of themselves engaged in “serve and return” with the children they’re taking care of. Showing people instances of themselves doing this is a profound experience…because they’re seeing something that is the building block of healthy brain development.

What we think is different about this is were not coming from a place of people need to do something they don’t know how to do and therefore we have to instill new skills. I think that’s one of the reasons our existing programs are so costly and cumbersome. They come from the starting point of people are deficient in something and we have to start from the ground up.

New direction

Three years in, an ambitious experiment to improve the odds for kids at one elementary school is scaling back

PHOTO: Ann Schimke
Tennyson Knolls students return to school after a ribbon-cutting ceremony on school grounds in September.

Blocks of Hope was once envisioned as a pint-sized version of the Harlem Children’s Zone.

The project would provide an array of educational and social services to young children and families living within the boundaries of one high-poverty Adams County school — in the process, changing not only the lives of individual children but also the community around them.

But after three years, the Westminster-based nonprofit that spearheaded Blocks of Hope is scaling back its ambitions.

While the project won’t disappear entirely, the nonprofit’s leaders say they’re no longer focusing services and staff so tightly on the school’s boundary zone and may eventually stop using the Blocks of Hope name.

“We’re starting to question whether it’s the right strategic direction for the organization,” said Karen Fox Elwell, the new president and CEO of Growing Home, which launched the project in 2014.

The shifting shape of Blocks of Hope — originally framed as a 20-year effort intended to change the trajectories of children 0 to 9 within the Tennyson Knolls Elementary School enrollment zone — is a disappointment for some advocates who’d hoped this “placed-based” approach would not only be successful, but also possibly serve as a model for other Colorado communities.

A raft of issues have prompted the changes, including greater-than-expected mobility among the school population, fundraising challenges, and the tension that came from devoting resources to the 2.25-square-mile project zone while also trying to serve the broader Adams County community.

“It was hard to find that balance to do both well,” said Fox Elwell, who joined Growing Home in January.

Organizers knew when they started that the community was changing, but gentrification pushed out families faster than they expected. About a quarter of Tennyson Knoll’s students left the school in 2015-16.

Leaders said that was one reason it was tricky to track child outcomes that would demonstrate the project’s impact — a hallmark of successful place-based work.

Fox Elwell said there’s more stability among residents in the Harlem Children’s Zone because of rent-controlled housing.

“So families are really staying in that community for years upon years,” she said. “With Blocks of Hope, it’s just not the case.”

Fox Elwell said the board and staff will determine the future of Blocks of Hope during the group’s upcoming strategic planning process starting in late spring.

Teva Sienicki, the former president and CEO of Growing Home and the project’s original champion, said significant evidence supports the place-based strategy that underpinned Blocks of Hope, but didn’t want to second-guess the decisions of Growing Home’s current leaders.

“I really do wish them the best,” said Sienicki, who left Growing Home last summer.

Even at the outset of the project,  Sienicki acknowledged that changing demographics and funding challenges could alter the long-term course of the project. Still, she was optimistic, projecting a gradual expansion that would bring two to three other elementary schools in the Westminster district under the Blocks of Hope umbrella, and increase the number of employees dedicated to the project from two to 70.

In addition to improving family functioning, the project’s goal was to boost school attendance, kindergarten readiness, and third-grade reading scores, and reduce the number of children referred for special education services. This year, 85 percent of Tennyson Knolls students are eligible for free or reduced-price school meals, a proxy for poverty.

One of the essential ideas behind place-based efforts like Blocks of Hope and the Harlem Children’s Zone is to flood a carefully defined geographic area with services in the hopes of touching a critical mass of residents, usually around 60 percent. By reaching such a large proportion of a population, proponents say such efforts create a kind of tipping point that pushes the whole community to adopt the norms and aspirations of those who receive services.

But Blocks of Hope never got close to that tipping point.

While certain components of the project, such as backpack and school supply giveaways, reached a large number of families, others, such as parent programs, never got above 15 percent, said Fox Elwell.

Aside from high mobility, the fact that many students ride the bus to Tennyson Knolls — instead of getting dropped off by their parents — made it harder to connect with parents than organizers anticipated.

The nonprofit’s limited budget was also a factor. Spending on the project was originally set at $250,000 annually, with eventual plans to reach $3 million if it expanded to other schools.

The nonprofit’s actual spending on Blocks of Hope has been around $100,000 a year, said Fox Elwell. In addition, a grant that Growing Home leaders hoped would pay for an evaluation of the project never came through.

“There were some incredible hopes to grow the budget and deeply invest in the community,” she said. “And maybe it was more challenging to fundraise than we anticipated.”

There are still several Blocks of Hope programs at Tennyson Knolls this year, including backpack giveaways, holiday gift and meal help, and two parenting classes. The school also houses a boutique with used children’s clothing and gear.

An after-school tutoring program was discontinued after last school year because it wasn’t effective, leaders said. Another program aimed at grandparents raising grandchildren was slated to launch this spring, but will not because school leaders felt they had too much going on.

A community organizer originally hired to work with Blocks of Hope families to advocate for affordable housing has expanded her territory to include other neighborhoods.

“There’s a lot of need just a little bit south and a little bit east of those (school) boundaries,” said Leslie Gonzalez, a Growing Home board member.

Residents in some of those areas began to assume they were no longer eligible for any of the nonprofit’s services as Blocks of Hope ramped up. That wasn’t true, but the project sent some “unintended negative messages,” she said.

Despite looming questions about the future of Blocks of Hope, leaders at Growing Home and Tennyson Knolls say the project has helped families, sparked welcome changes to the nonprofit’s case management strategy, and built community at the school.

Tennyson Knolls Principal Heather McGuire, who is the school’s third principal since Blocks of Hope began, said the project helped get parents involved at school, whether attending PTA meetings, taking Blocks of Hope classes, or attending “coffee with the principal” meetings.

She credits the project with giving rise to the school’s tagline, “We are TKE,” a reference to the school’s initials.

Gonzalez said, “We don’t view Blocks of Hope as a failure necessarily … Even though there were a lot of challenges, a lot of good came out of it, too, and we were able to meet even more families in that community we serve.”

safe haven

Colorado could get its first 24/7 child care facility for families in crisis

PHOTO: Jamie Grill | Getty Images
Mother rubbing forehead while holding baby son.

Last fall, Lisa Rickerd Mills, a medical social worker in Grand Junction, worked with a single mother who needed inpatient mental health treatment.

The problem was child care. The woman had no one to watch her two small children during her stay and bowed out of treatment.

It’s exactly the kind of scenario a group of advocates hope to prevent with a 24-hour, seven-day-a-week child care facility for families facing emergencies or periods of high stress.

The center, to be called the Grand Valley Crisis Nursery and set to open in late 2018, would provide free care for children 0 to 5 years old for periods ranging from a few days to 30 days. The idea is to give parents a safe place to leave their youngest children when they’re facing a crisis — a period of homelessness, an emergency medical procedure, domestic violence, or the threat of job loss. It’s meant to prevent child abuse and neglect and keep kids out of the foster care system.

While there are around 70 crisis nurseries nationwide, the one planned for Grand Junction would be the first of its kind in Colorado. It could pave the way for a new type of state child care license and perhaps crisis nurseries elsewhere in the state. The project is unfolding amidst a broader push in the western Colorado community to improve child and family outcomes by dramatically expanding child care options over the next three years.

Kaleigh Stover, a former pharmaceutical sales representative who moved to Grand Junction from Sacramento last summer, is leading the charge on the crisis nursery. Prior to her move, the 26-year-old volunteered at the Sacramento Crisis Nursery, which runs two of five crisis nurseries in California and, like many such facilities, relies heavily on volunteers to care for the children.

“I’m like that girl in the grocery store who will offer to hold your baby,” she said. “I have a soft spot for babies and moms and helping those people who are experiencing hard times.”

When she first arrived in Grand Junction, Stover called around to several nonprofit organizations and was surprised to learn there wasn’t a crisis nursery in town.

She said local advocates told her, “We don’t have anything like this … but we need it.”

Child abuse cases — and hotline calls about suspected child abuse — have steadily risen over the last few years in Mesa County. The western Colorado county also faces numerous other challenges: higher than average rates of child poverty, foster care placement, and teen pregnancy.

The community’s transience also means that parents of young children often arrive without a circle of family and friends to help out in a pinch, said Rickerd Mills, a member of the crisis nursery’s board.

That can mean parents leave their kids in the care of people they don’t know well or enlist older siblings to watch them.

In addition to providing licensed overnight care for young children, crisis nurseries have case managers who work to connect parents with community resources and get them back on their feet.

While there are a host of typical housing, job, and medical problems that prompt parents to use crisis nurseries, parents with a child care problem outside the usual list won’t be turned away at the Grand Valley center, Stover said.

“We let families define the crisis,” she said, adding that parents using the center would be required to check in with case managers regularly.

Over the past six months, Stover has steadily made progress on the nursery — holding a community town hall, recruiting board members, and finding a local nonprofit to serve as the nursery’s fiscal sponsor. She’s currently in the process of finding a location for the nine- to 12-bed center and will soon begin fundraising.

Stover expects the first-year costs to be around $455,000 if the group purchases a building, with operations costing $150,000 in subsequent years. About 80 percent of the nursery’s funding will come from individual and corporate donations and 20 percent from grants, she said.

In what might be the nursery project’s biggest victory so far, Stover got a preliminary nod in February from the state’s child care licensing advisory committee, which agreed to consider giving the crisis nursery a waiver from state licensing rules.

If the waiver is granted, it could set the stage for a new kind of child care license in Colorado — a cross between a typical child care center license, which doesn’t allow 24-hour care, and a residential child care facility license, which allows 24-hour care but doesn’t permit care for children under 3 years old.

“Having a new license type is kind of nightmare, but it changes the whole state if we can make it happen,” Stover said.

Ebony White Douglas, program manager at the 22-year-old Sacramento Crisis Nursery, praised Stover’s persistence in pursuing the project. She said she routinely consults with people in other states interested in launching crisis nurseries and has seen many such projects sidelined because of complex licensing logistics or daunting fund-raising requirements.

Rickerd Mills said she was heartened to hear about the positive reception from the state’s licensing advisory committee.

“I think it just goes to show the need in this community and the state,” she said.