Healing our children

A pioneer in early childhood psychology expands programs for young children impacted by trauma

By Ann Christenson

The girl from Milwaukee’s north side was only 4, an age when childhood development models say she is just beginning to learn the concepts of counting and sharing with others. This little girl, however, is getting a lesson in something no 4-year-old should learn — terror.

She witnesses her father physically abusing her mother. When her mother decides enough is enough and the family unit severs, the parents engage in a two-way tug-of-war with the girl’s hands and feet. For the 4-year-old, the trauma goes beyond scratches and bruises.

Fortunately the child lands in the hands of the Behavior Clinic, a nationally recognized partnership of Marquette University College of Education and Milwaukee’s Penfield Children’s Center. The clinic specializes in serving children ages 5 and under experiencing serious behavior problems — including those resulting from trauma — matching them with the family-based, in-home treatment sessions pioneered by the center’s founder and consulting psychologist, Dr. Robert Fox.

According to Fox, a professor of counselor education and counseling psychology, this child actually showed classic symptoms of post-traumatic stress disorder, including nightmares, staring into space and wetting herself when a man was nearby.

After nine months of weekly sessions tailored to her needs, in consultation with family members and caregivers, Fox says the child was symptom-free. Although those months were not setback-free, her story ended encouragingly because of the clinic’s groundbreaking treatment — custom-fit to a child of the preschool population once assumed by counseling and psychology professionals to be too young for treatment.

Those perceptions began changing in the 1980s, but research into pediatric behavior issues didn’t really take off until the early 2000s, says Fox, who arrived at Marquette and saw his career path simultaneously trace and accelerate this evolution in the counseling field.

A budding child-behavior specialist early in his career, he offered parenting classes to middle-class families before shifting his focus to families on the poverty line. The following decades have been busy, productive and influential for this unassuming scholar, the author of more than 100 peer-reviewed articles and 11 books — a record that earned him the 2016 Lawrence G. Haggerty Faculty Award for Research Excellence, Marquette’s highest research honor.

Founded in 2003, the Behavior Clinic continues to grow in impact and influence. In September, Fox and Penfield secured a five-year $1.93 million grant from the federal Substance Abuse and Mental Health Services Administration that will enable the clinic to expand its trauma-focused treatment by serving 400 young children annually in Milwaukee County. It also gives a welcome boost to Early Pathways, the online course Fox launched in 2014 to train mental health professionals in the Behavior Clinic’s assessment and treatment methods.

The course also addresses the effects of living in poverty, says Fox. A coup for Fox and his team, the grant secures the Behavior Clinic’s staying power and green lights Fox and his graduate students for more research addressing pediatric mental health needs, including those of Latino families.

“We are conducting a trauma trial now with Latino children as one of my student’s dissertations,” says Fox, who recently published findings in the Journal of Latina/o Psychology on a randomized controlled trial involving treatment based on a version of the Early Pathways course culturally adapted for Latino children in poverty.

Genetic disorders are one cause of behavior problems experienced by very young children. The Behavior Clinic specializes in in-home treatments customized to address the needs of these young children in partnership with their families.

With the Early Pathways model proving to be “the most effective program available for young children in poverty,” the next step in Fox’s goal fulfillment is for it to be embraced on a regional or national level. To this point, the program’s reach has been limited mostly to Wisconsin, says its creator, but recent requests, numbering in the hundreds from around the world, call for adaptations supporting a more “broadly disseminated” program. “That is our next plan,” he says.

The benchmark Behavior Clinic approach of working in the homes of young children with behavior problems isn’t widely practiced. “I recently heard of one child having 147 play-therapy sessions in a clinic with no change in the mother’s original concerns about her child’s behavior,” says Fox. “This type of ineffective therapy needs to rethink what it’s doing.”

Dr. Bob Fox (center left) and Heather Rotolo, representing Penfield Children’s Center, accept Marquette’s inaugural Community Engaged Partnership Award in 2016, with Dan Bergen,executive director of the Office of Community Engagement, and Provost Daniel Myers.
This story was adapted from the 2017 issue of Discover, Marquette’s annual research and innovation magazine. Read the entire issue online and the cover story here.