The first years of a person’s life form the foundation for everything to follow. Those years of early childhood development can set the stage for later mental health and well-being or, unfortunately, the opposite.
For clinical psychologist Jenessa Deleault Psy.D., working with children is more than a career, it is a calling, one that spoke to her from an early age when she worked for her mother’s daycare center.
Trained in empirically-supported Child Parent Psychology (CPP), she currently works with Counseling Associates of MA and NH in their Bedford, NH, office where she specializes in children from birth to age six and childhood trauma.
Deleault spoke with New England Psychologist’s Catherine Robertson Souter about her work, how she sees the field changing and the dearth of providers for young children.
For you, why was it important to work with children?
Children are traditionally underserved. It has come a long way in the past 10 years, but 25-30 years ago, it wasn’t even thought that children could express symptoms or signs of distress.
It was thought that children didn’t really have emotions and that always bothered me. I wanted to make sure children were served in the best capacity possible.
How has the field changed in recent years?
I think more and more people are starting to understand that with something like anxiety or depression, if we look at a kid’s history more likely than not there has been trauma, whether it is a loss or an attachment disruption or medical trauma.
We are finally understanding that young children who maybe had a medical procedure at age three or four and may have done well for a number of years but now they are experiencing anxiety in elementary school.
The understanding of behavioral disorders from a different perspective is shifting the field a bit. If we look at a kid’s history and there is adversity or chronic stress in childhood, we are understanding that the current behavior may not be a disorder but it could be an expression of chronic stress in childhood.
Another big area that is finally coming to the forefront is an understanding of the neurobiology of trauma and toxic stressful childhood events from a biological standpoint.
So, when we engage in these treatments we need to look at it from a much more holistic perspective for the child.
That comes from the dissemination of all the new research on how the brain and body work together and the impact of chronic stress in childhood and that will only continue to inform treatment.
Finally, this may not be new, but there seems to be greater understanding of attachment that is finally coming into the mainstream. We now understand that kids heal in context of their relationships and so without supporting the family system, we are not going to see the outcomes that we want to see.
Outside of the therapy room, do you think children face different stressors now than even 10 years ago?
I think the pace at which kids experience life has sped up tremendously and so even for kids who have not experienced trauma, a lot of the anxiety or discomfort can come from trying to keep up with a world that moves much faster than it did in the past.
Parents and teachers are seeing that, more and more, the kids don’t have the language or emotional identification that they used to. Being able to identify emotions is the first step to being able to regulate emotions.
Also, they don’t know what to do with downtime or how to be bored or sit in their body. I think screen time comes up frequently with that.
Working in New Hampshire, have you dealt with children affected by the opioid crisis? Are those numbers still increasing?
I have worked in community mental health where there were some parents in recovery and I have worked with kids who were in kinship or guardianship situations who have either lost a parent to overdose or the parent is actively using so they may be living with a grandparent.
What we also see with the opioid epidemic is a new understanding about parent absence, whether that is physical, emotional, or psychological. We are now being able to help folks understand that just because a caregiver is there physically, their emotional reciprocity and how they respond to kids can be impacted by substance abuse.
I don’t think the number of kids in need has increased so much since I began doing CPP in 2013 but I do know that we have significant workforce shortages in the state of New Hampshire.
So, although my caseload hasn’t increased, I do know that I simply don’t have enough capacity to see the number of kids who need the support. The waitlist is quite long for kids.
Why do you think that there is a shortage in professionals to treat children in New Hampshire?
I think there are a couple of different concerns. We have a really good network that trains people in this state in terms of social work and doctoral level programs but people don’t tend to stay once they are trained. It could be that compensation is better in Massachusetts or other parts of the country.
The cost of the degree is one thing that a lot of programs are looking at. At the current rate of compensation, just to stay in the field, it is hard to recoup your costs.
Another piece is the burnout that happens because of the shortage and folks have to pull back on caseloads sooner than they may otherwise want to.
There has been a lot of conversation around low reimbursement rates affecting the profession. Do you see that changing?
For one thing, the more people who trained in empirically-supported treatments, the more you can negotiate higher rates from insurance companies because they honor that in terms of your expertise and specialty.
In New Hampshire, in particular, there is a huge investment in early childhood and a big focus on children right now which is very promising.
I will give the government a nod that a big initiative came from the spotlight on children’s mental health needs and in particular early childhood needs.
The downside is the lack of support for parents, especially related to the opioid epidemic. I don’t know that the number of kids needing treatment will decrease. I don’t see that happening unfortunately.
For yourself, where do you see your career path taking you?
Over the past couple of years, I have started to find myself in a really cool place where I have a private practice and I can do direct care with families but I am also doing trauma response and doing more consultation with systems around how adversity impacts children.
Helping support those care systems has been really powerful. So I see pretty similar stuff in the next 10 to 15 years for me.
Unless, you know, something more sparkly comes along.