Presentation key points:
Leading Practice Conference “Growing Capacity, Creating Opportunities, Strengthening Outcomes for Children, Families and Communities”
28th - 30th July 2014, Novotel Rooty Hill.
Name / Rosemary Signorelli, STARTTS
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Biography / Rosemary Signorelli is aMusic Therapist, Psychotherapist and former Occupational Therapist. She has extensive experience, across the lifespan, in the fields of trauma, early childhood, special needs, mental health, and wellness. She has been engaged in the ongoing development of the STARTTerS Early Childhood Programme in several locations, serving families with 0-6 year olds from refugee backgrounds. She has also engaged in community based participative research with specific refugee communities, to explore their early childhood and parent support needs and to explore opportunities for collaborative culturally appropriate service design and implementation.
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Key points from Presentation
Complexities of early childhood work with families of refugee background:
Research based principles of early childhood trauma
  • Brain development is use dependent and has critical periods(Cozolino, 2006)
  • Attachment and affect are critical for development
  • Trauma changes the structure and function of the developing brain (NSDC 2005, 2007B, 2008)
  • Trauma also affects the body (Van Der Kolk, 1994)
  • Even very young children can remember sensations and emotions associated with traumatic experiences (Azarian et al, 1999)
  • Early intervention can reverseunwanted brain changes and repair disruptions in attachment
  • Early intervention can prevent later post traumatic symptomsand/or other neuropsychiatric symptoms (Van der Kolk, 2010)
  • Early intervention, and a growth enriching environment, can help the child from a refugee background to catch up in his/her development (CDCH, 2007, 2010, 2011)
The theoretical basis for the work is derived from the development work of Bruce Perry (2006), Stanley Greenspan (ICDL, 2011), Allan Schore (2001 , 2003), Daniel Siegel (2009); and the trauma recovery work of Judith Herman (1994) Bessel Van Der Kolk (1991, 1994, 2010), Kinniburgh e al (2005), Steven Porges (2011) and Pat Ogden et al (2006).
The context of traumatic experiences, and recovery environment for the child
The child’s trauma can arise form:
  • prenatal traumas and deprivation
  • direct sensory experiences
  • the hazardous trip to safety, period of displacement, detention, loss and separation
  • In addition the attachment with the parent may be disrupted by the parent’s trauma
  • The parent’s possibleinability to engage emotionally with, nurture or protect the child, or stimulate the child’s development
  • domestic violence, other violence and child protection issues
  • The parent may have difficulty protecting the child, with resultant guilt feelings, setting limits and boundaries as the child’s reactions may trigger the parent’s traumatic memories
Assessment and ongoing observation involves exploring the impact of traumatic experiences on all areas of development – physical, sensorimotor, regulation, social, emotional, language and communication, symbolic and interactive play and learning. The counsellor refers the child, as appropriate, for medical and paediatric assessment. The counsellor screens for safety issues, and explores the parents’ physical and emotional health, settlement issues, social supports, as they affect their engagement with the child.
Family centred assessment tools include
  • the STARTTerS Early Childhood Screening tool (Signorelli and Coello)
  • social-emotional growth chart (Greenspan)
  • Infant-toddler checklist (De Gangi)
  • Sensorimotor History questionnaire for preschoolers (De Gangi)
  • Edinburgh Postnatal Depression scale if appropriate
  • Parent pre- and post- survey (QUT)
  • Observations of Interactions (QUT)
  • observations during play
  • biofeedback or Neurofeedback if appropriate
The goals for therapy include
  • enhancing trauma recovery process
  • stimulating development
  • enhancing the parent role
  • strengthening the parent-child relationship
  • providing information and support for the parents
  • facilitating the parents’ recognition of their skills arising from their cultural background
  • facilitating the expression of those skills, traditions and knowledge towards the goals.
The objectives for therapyinclude:
For the child:
  • safety
  • symptom reduction
  • emotional and behavioural regulation
  • skills development
  • processing of trauma
  • building of resilience
  • development of whole child
  • readiness for pre-school and school
/ For the parent:
  • affect regulation
  • emotional availability
  • parenting skills and confidence
  • psychoeducation, information and referral

For the parent-child dyad
  • strengthening attachment and social nervous system
  • co-regulation

Evidence-based strategies for healing and prevention:
  • reduce the number of adverse experiences
  • growth facilitating environment
  • reciprocal interactions
  • appropriate sensory input
  • activities which use the brain pathways
  • relationships
  • consistency, routine
  • play therapy
  • lullabies, play songs
Participants in the session – engagement of child, parent, interpreter, counsellor, others:
The sessions involve enhancing engagement of all these participants, aspects of the cultures represented in the room, and at times engagement of the community.
Interventions involve integration of several modalities, such as music and movement, sensorimotor activities, play therapy, dramatic play, CBT, mindfulness, narrative therapy, EMDR, and biofeedback, as well as psychoeducation for the parents, including support for long-distance parents whose family remains in the country of origin or some other country.
Support for long-distance relationships involves encouraging use of opportunities such as:
  • Email, internet, phone, social media
  • use of stories and songs over the phone
  • use of scrap books, photos
  • planning for reunion
Strength-based approach includes:
  • recognising shared objectives for the child’s safety and wellbeing
  • strengths, resilience, survival
  • benefit of early intervention
  • increasing skills, empowerment of the parent
  • collaboration of experts – parent and provider are both experts
  • ARC model – parent already has the tools to help the child
Observed and reported outcomes for the child include:
  • improvement in eating, sensory tolerance, regulation and attention, language, relating, enjoyment, socio-emotional development
  • reduction in aggressions and to a lesser extent nightmares
Observed and reported outcomes for the parent include:
  • improvement in engagementin the “here and now”, enjoyment, coping strategies, somecarry over of skills
  • some improvement in setting limits where appropriate
Observed and reported outcomes for the parent-child dyad include:
  • increase in shared play, back and forth communication and play
Psychoeducation and strengths based parent support covers post-traumatic stress disorder symptoms and signs and symptoms of early childhood trauma, normal stages of development, role of attachment, benefits of play and playing with the child, suitable activities for healing and development, and referral of the as appropriate to a counsellor, or referral for the family to other relevant services. Resources are in the form of CDs of suitable and therapeutic children’s songs, and fact sheets. Parents are encouraged to identify and manage triggers that exist for both parent and child. Parents and children are also shown techniques that can help them to stay within their window of tolerance (Siegel, 1999; Ogden et al, 2006).
Managing triggers for child and parent:
  • Need to recognise triggers in both – arising from implicit /somatic memories, explicit/declaratory memories
  • Grounding techniques can restore balance of arousal levels and return the child and/or parent to being within their window of tolerance
Suggestions for trauma informed modification of parenting programmes include:
  • Consistent use of interpreters and translated material
  • Use of grounding techniques at the beginning of sessions, to help parents function within their window of tolerance (and hence be able to access the language and cognitive areas of the brain)
  • acknowledgement of cultural differences
  • willingness for the facilitator to learn about the family’s culture and work with elements of that
  • More sessions and more follow up between sessions, through phone calls or home visits
  • Cross-referral, case conferencing and collaboration between services
  • Sensitivity to cultural transition and cultural differences in parenting.
A systemic approach to working with refugee families and communities involves:
  • working with child and parent together
  • home visits where appropriate and acceptable to the family
  • consideration of cultural variations and support for cultural transition (Reebey et al, 2013; Kaur 2012)
  • collaboration, joint programmes, referral and case conferencing with other service providers
  • community based participatory research with specific refugee communities (Signorelli, 2013)
  • collaborative service development with those communities
  • training of community members to run their own playgroups with ongoing support from STARTTS
  • dissemination of research and practice
Service-based versus place-based interventions:
There will be some reflection/ discussion, with the participants, about the comparative strengths and challenges of service-based and place-based interventions.
Azarian A.G. , Lipsitt L.P., Miller T.W., and Skriptchenko-Gregorian (1999) Toddlers Remember Quake Trauma. Chapter 23 in Williams L.M. and Banyard V.L. (1999) Trauma & Memory. Sage Publications, Thousand Oaks.
CDCHU (2007) Center on the Developing Child at Harvard University A Science-Based Framework for Early Childhood Policy – Using Evidence to Improve outcomesin Learning, Behavior, and Health for Vulnerable Children. Accessed online on 24.09.11, at
CDCHU (2010) Center on the Developing Child at Harvard University; The Foundations of Lifelong Health Are Built in Early Childhood.Accessed online on 24.09.11, at
CDCHU (2011)Center on the Developing Child at Harvard University Building the Brain’s “Air Traffic Control” System: How Early Experiences Shape the Development of Executive Function: working Paper no. 11. Accessed online on 24.09.11, at
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Herman J. (1997) Trauma and Recovery – the aftermath of violence – from domestic abuse to political terror. Basic Books: New York
ICDL – Interdisciplinary Council on Development and Learning Disorders (undated) Clinical practice Guidelines –Chapter 3 – Overview and Recommendations), provided as online course materials 2011 for the Basic Course on The Greenspan Floortime Approach, at
Kaur J. (2012) Cultural Diversity and Child Protection – a Review of the Australian research on the needs of culturally and linguistically diverse (CALD) and refugee children and families. JK Diversity Consultants.
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NSCDC (2005) National Scientific Council on the Developing Child Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3, accessed online on 24.09.11 at
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Schore A.N. (2003) Affect Dysregulation and Disorders of the Self. W.W.Norton & Company, New York
Schore A.N. (2003) Affect Regulation and the Repair of the Self. W.W.Norton & Company, New York
Siegel D (1999) The Developing Mind. The Guildford Press. New York.
Siegel D (2009) Healing Trauma: The Central Role of integration in Working with the Mind, Brain and Human Relationships. One day workshop auspiced by STARTTS Sydney
Signorelli R (2013) A Pilot Research Project: to Explore the perceptions of the Sydney Karen and Mandaean refugee communities of the impact of refugee and resettlement trauma on their 0-5 year olds, and to explore those communities’ help-seeking pref3rences, for the children and caregiver. Theses for Masters of Counselling and Applied Psychotherapy course. Jansen Newman Institute, Sydney, Unpublished.
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