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Second Thought

by Angela Dotson, LMFT, Program Director, Bilingual English-Spanish Early Interventionist
mom feeds baby food with spoon

We cannot provide early intervention to underserved families without addressing their powerlessness at the level of basic needs. The pandemic provides a chance to fundamentally change ourselves and the way that early intervention services are delivered. ABC Special Start in Marin County, California, strives to provide early intervention services and to meet the basic needs of families, including food, tablets, cookware, blankets, clothing, and developmental toys and activities. Simultaneously, we strive to support the advancement of bilingual and bicultural early interventionists.

Selma Fraiberg, often considered the mother of infant mental health, wrote and lectured extensively about the importance of concrete support. She asserted that we cannot truly treat families without providing for basic needs. Children and caregivers cannot engage in therapy when they are hungry or cold. They cannot attend sessions held from 9 to 5 Monday through Friday when they have to work at that time. They cannot get to group treatment locations without transportation or attend virtual sessions without access to the internet and a tablet. They cannot communicate with interventionists who do not speak their language. They cannot fully focus on their babies when they are wondering if a knock at the door is signaling deportation. Especially during the pandemic, they can be preoccupied with worry that illness could cause them to miss work and not be able to pay rent.

...we cannot truly treat families without providing for basic needs.

In Marin County, California, a majority of families have adequate resources. The 2019 census survey reported that the yearly median household income in Marin was $110,843, which was $30,343 over the California median household income for the same year. Over half of households in the ABC Special Start community are headed by day laborers and domestic workers earning around $15 dollars per hour, with no benefits. That income may seem substantial to people living outside of the Bay Area, but rent for a 1-bedroom apartment in Marin costs from$2,500 to $3,000 per month, and gas prices hover around $5 per gallon. The minimum total cost to a two-worker family that sends their child to an early childhood education center is around $4900 per month*, even with free or low-cost health care. Expenses exceed the earnings of a full-time day laborer/domestic worker couple by at least $100 per month.
This estimate doesn't account for days when no work is available because of rain or when employers call off domestic work for fear of catching COVID-19. These families live on the edge, where a COVID infection or busted car radiator can signal homelessness on the horizon.

Fortunately, the Bay Area privileged tend to be generous, and there are organizations, such as Canal Alliance, that aid the immigrant community by providing free food, legal aid, and emergency funding for families in need. A branch of the Child Trauma Research Program, founded by Alicia Lieberman, provides therapy to address traumas sustained in the countries of origin, during migration, and here, in the United States.

As a privileged person, I have learned some about the limitations caused by my implicit biases. I'm ashamed to admit it, but I have thought, “Why don't our ABC parents learn English and educate themselves?” Many immigrants from Guatemala don't even speak Spanish when they arrive. Their native language is Kiche, and many were never taught to read or write. They first struggle to learn enough Spanish to get by in the Spanish-speaking community. I have the privilege of being able to have a second thought, one that is not about shifting blame but taking personal responsibility for my ignorance. Out of pure luck, I do not have to do this while also being cold, hungry, and scared.

I have the privilege of being able to have a second thought...

Recently, I worked with a mother from Guatemala and her 2-year-old who was underweight and a picky eater. She reported that her son would only eat a few chicken nuggets and a little bit of spaghetti. “No quiere comer” (He doesn’t want to eat), she told me. Once we were successful in making and eating tortillas together and she smiled luminously. Next, I sent her muffin mix, muffin tins, and a Spanish video about how to incorporate pureed vegetables into the recipe. She didn’t log in on video chat for our planned meeting, or the next one. I was frustrated and I judged her for not being interested enough in her son’s progress to log in for the session. When we did meet again, I tried to stay curious, wondering if I was missing a part of the picture. I asked her if she had an oven. She let me know that she had one, but she didn’t know how to use it. In Guatemala, her family cooked on a stone heated by a flame in the middle of her 10-foot by 10-foot grass hut. If I had persisted in blaming this mother and not been more curious, we would not have been able to progress the treatment.

What does this work of curiosity, humility, recognition, and response mean in the context of early intervention at ABC Special Start? It starts with outreach to route underserved individuals into Early Start, finding ways to get donations from the privileged for basic needs, and dedicating a portion of our agency profit to this work. We partner with other organizations to provide for families’ concrete needs and pay educational stipends to interventionists who represent the communities they serve. We challenge our internal judgments and evolve more integrated second thoughts. We strive to be accountable for learning about community needs, even when our interventionists are in tears from the intensity of what they have witnessed. Providing compassionate, psychologically informed support and reflective supervision is essential. We are still not sure how else we need to evolve, so we are staying curious.

In the fall of 2019, one of our leading early interventionists, Sandivel Torres Garcia, started a master's of social work program at the University of California at Berkeley. She received a stipend from the Latinx Center for Excellence, and she agreed to do work in the future to advance child welfare in return. As the program director, I chose to allocate to her tuition a portion of a generous training budget paid for by our parent organization, The Association of Behavior Consultants. Sandivel had already provided years of exemplary professionalism and leadership, and it was time to give back to her. I had no idea then that her pursuits would help provide a solid foundation for work during the pandemic.

Sandivel’s master's program allowed her to continue to work for ABC Special Start as a paid intern doing social work. We decided together to reach out to chronically underserved families, mostly Latinx families, offering a supported intake process to the Early Start system, or re-routing them to appropriate educational opportunities if they did not qualify for Early Start. We held monthly events offering developmental activities guided by bilingual interventionists, served lunch, and gave out free books. Sandivel followed up with each family, performed developmental assessments as necessary, and routed families to the Golden Gate Regional Center, school districts, or community partners. Our agency benefitted from finding families with typically developing children who attended our weekly developmental playgroups as peer models. Some of those families still attend our developmental playgroups today.

Sandivel formed strong relationships with community partners, such as Canal Alliance, Aprendiendo Juntos (Learning Together), and the Marin Community Clinic Health Hub. These organizations had been providing concrete support to families for years in the form of food, emergency rental assistance, legal aid, and early learning opportunities. When the pandemic hit, we were already in contact with people who could help our early population meet some basic needs. The onset of the pandemic challenged us to provide other basic needs, such as tablets to stay connected to our early intervention program, vegetables and fruits that were lacking from other food donation sites, cookware, blenders, toaster ovens, blankets, coats, heaters, diapers, dishes, silverware, holiday dinners, and developmental toys and activities. Donations from privileged individuals helped us meet those needs. Donors have expressed gratitude for the sense of purpose they feel by helping those in need.

Sandivel left our agency to fulfill her responsibilities to The Latinx Center for Excellence, and she now serves families through the State of California Child Protective Services. Another ABC Special Start leader, Rose Meadows, continues Sandivel’s work. Rose has been instrumental in helping us secure private donations to deliver organic fruits and vegetables to the doorsteps of our underserved individuals. Rose has deepened our partnerships with organizations like Canal Alliance, which has added rapid COVID testing and free vaccinations to the services they offer the community. Two of our other interventionists, Jessica Lewin and Naomi Sosa, help us to communicate with the families about available support programs, and they have assisted by delivering tablets and tablet training to families. A network of community relationships makes our early intervention work possible.

We have gained more compassion for our early intervention families and built more internal strength. We could not have deepened these capacities without being involved in the struggle of our families at the level of basic needs. We did not know that most of our families grew up without ovens in their homes, or that many of our families’ parents were never taught to read and write. We did not know that one of our families was missing sessions because they were tired and sore from sleeping without a mattress until we agreed to witness their struggles. Our interventionists have shown openness and receptivity in recognizing these painful realities.

We now know that early intervention is not only educational activities for babies...

Under the mentorship of Barbara Kalmanson, who worked with Selma Fraiberg at the Infant-Parent Program in San Francisco, we have learned to check in with each other, sharing our experiences frequently. Barbara has helped us value co-regulation and parallel processes. Being calm, alert, and reflective provides an essential foundation for our ability to support the ABC families and learn with them. We now know that early intervention is not only educational activities for babies. It is also our capacity to grieve with a mother who may lose her home next week. Sometimes our work is just to listen to a person who is in need. We are evolving to be more empathic and less judgmental.

We want to find more ways to prioritize the basic needs of our families as an integral part of our work and to foster the advancement of young professionals like Sandivel, Naomi, and Jessica. We are searching for ways to make that vision sustainable through donations, by deepening our community partnerships, and by implementing a more formal plan for the professional development of our early interventionists. This work starts with the co-regulation of interventionists and parents using reflective practices and is strengthened through our humility and empathy. We hope to find pathways for making this depth of work reproducible in other communities with needs.

This cost estimate is based on rent of $2,750 per month, full-time daycare at the Marin County average rate of $812 per month (as reported by Care Lulu data), $600 per month for food costs, and $700 per month for transportation costs, including $250 per month for a car payment, $300 per month for gas, and $150 per month for car insurance.

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