Essential Bonds: PACT Therapeutic Nursery in Baltimore
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The PACT (Intervention with Parents and Children Together, Inc.) Therapeutic Nursery serves children under age 3 who are living in emergency shelters with their parents. “We have found that there are often major delays in speech and language and play has regressed. There is a link between language and play.” This article gives an overview of the PACT Therapeutic Nursery’s efforts to support families experiencing homelessness.
Visit the HRC Parenting and Homelessness webpage to learn more about the latest research on parenting and homelessness.
A fourteen-month old child who had been living in the homeless shelter system with his mother was aggressive and bit other children with no provocation. This behavior is grounds for removal from the shelter. The boy’s mother, already stressed from the trauma of homelessness, was alarmed. She had no idea how to help her son until she began working with staff at the PACT (Intervention with Parents and Children Together, Inc.) Therapeutic Nursery in Baltimore, Maryland. “Our staff,” explains Director, Kim Cosgrove “is extremely gifted.”
Both mother and child started the program’s “Wee Cuddle and Grow” program, attended “Family Breakfast Traditions” group, and the mother participated in discussion groups with other parents. Staff members were paired with the young boy to help him get through the day. When he was about to bite another child, staff would redirect him and talk to him about the importance of soft touch. They encouraged him to take deep breaths to calm down.
Nursery staff suspected that the boy had been left unattended often as a result of the stress of homelessness. “Over two weeks we saw his biting decrease. He became engaged in more positive play, some parallel play, and was much more engaged in his own play. Now he is verbal, never bites, and is the most gentle child you could ever meet,” explains Kim.
Programs like the PACT Therapeutic Nursery in Baltimore provide support for both the mother and the child. “His mother has earned her GED, received a scholarship for further education, and is incredibly nurturing,” offers Kim.
The PACT Therapeutic Nursery has developed attachment-based therapeutic programming to assist children and parents to connect with each other in a nurturing way. Teaching parents and children to develop these essential bonds has been proven to have a significant impact on children’s social, emotional, and cognitive development.
There are a number of highly effective evidence-based interventions addressing issues presented by parents and children living in emergency shelters. The PACT Therapeutic Nursery’s interventions include “Wee Toddle and Grow,” based on the Nursing Child Assessment Satellite Training Tool and “Family Traditions Breakfast,” based on Dr. Laurel Kiser’s work on Strengthening Family Coping Resources.
The nursery serves children under age 3 who are living in emergency shelters with their families. “We have found that there are major delays in speech and language and play has regressed. There is a link between language and play.” Young children who have experienced the trauma and instability of homelessness typically have separation anxiety that can be extreme in many cases. “There are some children who won’t respond when their parents leave and others that are inconsolable,” explains Kim.
To address separation anxiety, the PACT Therapeutic Nursery has developed a behaviorally based separation practice in which parents and children work with clinicians around departing and returning. The intervention requires that parents say goodbye while the clinician holds the child. Parents walk outside the door and receive coaching from another clinician. They are coached on body and facial language. In the meantime staff will sing a song called “Mommy Comes Back” and show a picture of the parent with the child. Parents are then coached back into the room to console the child.
This process is repeated two to three times to help the child understand that the parent will return. Staff always acknowledge the child’s distress, provide access to photographs of parent and child regularly, and repeat the song “Mommy Comes Back.” Staff members engage in deliberate games of “peek-a-boo” throughout the day to improve the child’s understanding of object permanence. Often, other children who have further developed language skills will join in singing to other children.
All referrals for the PACT Therapeutic Nursery come from emergency shelters in the community. As long as a family is living at an emergency shelter, it is possible to access the services provided by PACT. For families who are in transitional housing or moving to permanent housing, there is another program called Family Roots that provides the same services as the PACT Therapeutic Nursery.
The PACT Therapeutic Nursery and Family Roots programs are bolstered by a number of collaborative partnerships within the community. Baltimore Mental Health Systems has funded these programs for nearly two decades. Eight years ago the nursery partnered with Martin Luther King Early Head Start, which is affiliated with Johns Hopkins University. They also partner with the University of Maryland Center for Infant Study and Mercy Children’s Health Outreach Program. The PACT Therapeutic Nursery is an independent affiliate of the Kennedy Krieger Institute.
A host of private foundations provide additional financial support. In the last eight years, the PACT Therapeutic Nursery has served 4,000 families. The program also provides training to agencies on NCAST as well as other attachment-based interventions.
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