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Website: Casey/Why Should child protection agencies be trauma-informed?

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Website: Casey/Why Should child protection agencies be trauma-informed?

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Introduction

Over the last two decades, there has been an intense focus on the impact of trauma on children and how it affects a child's development into and throughout adulthood. ¹ We now know that even babies can be affected by exposure to traumatic events. ² Research indicates that most of the adverse effects of trauma, including child maltreatment, manifest themselves in a child's behavior, interpersonal relationships, and emotional and mental health. ³ Challenges that develop in these areas often have negative effects across the lifespan, limiting a person's chances to succeed at school, work, and home.

Youth in foster care have particularly high rates of trauma exposure and also are significantly more likely than the general population to have directly experienced violence, specifically abuse and/or neglect. ⁴ Perhaps no other child-serving system encounters a higher percentage of children and parents with trauma histories than child protection agencies. ⁵

The adverse effects of trauma, however, can be mitigated - or even reversed - with the right services and supports. ⁶ As a result of the increased understanding of trauma's prevalence and connection to physical and behavioral health and well-being, a growing number of organizations and service systems are developing Trauma-Informed Systems (TIS) to make their services more responsive to people who have experienced trauma. ⁷ Integrating these findings into policies, programs, and practices is a logical next step for child protection agencies seeking to develop a more comprehensive and holistic approach to improving outcomes for children and their families. ⁸

Trauma-informed practices and interventions can assist parents and caregivers who have experienced trauma to provide nurturing and safe homes for children. Additionally, trauma-informed foster and kinship parents are more aware of the connection between a child's exposure to trauma and the child's behavior, and are better equipped to provide children with protective and coping skills to mitigate the impact of being removed from their homes.

In fact, research indicates that when child protection agencies infuse trauma-informed care into everything they do, children experience fewer placements and fare better in foster care. ¹⁰ Trauma-informed service improvements to enhance resilience and well-being, such as ensuring that more children receive trauma screening, assessment, and evidence-based treatment, may lead to improved outcomes, such as: ¹¹

Fewer children requiring crisis services

Decreased use of psychotropic medications

Fewer foster home placements, disruptions, and re-entries

Reduced length of stay in out-of-home care, and

Improved child functioning and increased well-being.

Regardless of whether children are in their homes of origin or in out-of-home care, when the trauma-related needs of children and families are identified, child and family well-being and resilience improve. ¹²

What are trauma-informed systems?

To treat the consequences of trauma, trauma-informed systems use evidence-based and best practice treatment models to directly address the impact of trauma on an individual's life and to facilitate trauma recovery. ¹³ While these treatment models are key, they are just some of the components in a trauma-informed system, which is less about "what" a system is doing and more about "how" the system is doing it. ¹⁴

Looking at how a system is functioning requires administrators and staff to be aware of all the ways in which the system's interactions with children and families might inadvertently make them feel unsafe, either physically or emotionally. Therefore, a trauma-informed child protection agency is both an organizational structure and a treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. ¹⁵ The Substance Abuse and Mental Health Services Administration (SAMHSA) lists the key components of establishing a trauma-informed system as: ¹⁶

Realizing the widespread impact of trauma and understanding potential paths for recovery.

Recognizing the signs and symptoms of trauma in families, staff, and others involved with the system.

Responding by fully integrating knowledge about trauma into policies, procedures, and practices.

Seeking to actively resist re-traumatization.

- Aces Connection

Considering the impact of trauma on families

To effectively support children and families, the child protection agency and service providers need to understand the trauma history of both the children and their parents/caregivers, as there is an interrelation between trauma and symptoms of trauma (such as substance abuse, eating disorders, depression, and anxiety), which can affect both child and parent. ¹⁷ Studies have found that children and families in the child welfare system have experienced high rates of trauma and associated behavioral health problems, ¹⁸ which makes it even more vital to develop a trauma-informed system to address these issues.

In a trauma-informed system, child protection agencies and service providers partner with each other and the families they serve to approach every interaction with an understanding of and sensitivity to the effects of trauma on those interactions. ¹⁹ For example, San Diego County: ²⁰

Initiated a countywide trauma training adapted from the National Child Traumatic Stress Network

Trained staff on safety-organized practice

Increased cross-system collaboration

Developed and disseminated trauma-informed tools

Increased agency focus on and dialogue about trauma

Built the capacity of trauma treatment providers

Trained resource families and community service providers on caring for children who have experienced trauma, and

Incorporated child and birth parent voices in all assessments, giving them as many choices in case planning and services as possible and appropriate.

Considering the impact of trauma on staff

While a trauma-informed system emphasizes physical, psychological, and emotional safety for the children and families served, it also recognizes the effects of trauma on staff. Working in child protective services can be dangerous, with caseworkers confronting threats or violence in their daily work and dealing with a highly traumatized population. ²¹ Because they often are exposed to traumatic events, child welfare staff experience higher rates of vicarious trauma (also known as secondary traumatic stress, or STS), workplace stress, and compassion fatigue, when compared to staff in other social services. ²² These, in turn, affect staff well-being, which has an impact on both employee turnover and effectiveness of services. ²³

Some support interventions that agencies can offer to prevent or respond to STS include one-on-one supervision, critical stress debriefings, and use of Employee Assistance Programs (EAPs). ²⁴ One model, called a Clinical Risk Management Team (CRMT), helps staff to work more effectively with traumatized families. CRMT uses structure and support from colleagues to allow workers to express their feelings about traumatic cases in a validating, safe, and normalizing environment. ²⁵

1 National Child Traumatic Stress Network. (2010). Early childhood trauma. Retrieved from 20 Zanders-Willis, D. (n.d.) Development of trauma-informed practice in San Diego. Retrieved from https://www.nctsn.org/sites/default/files/resources/early_childhood_trauma.pdfThe Centers for Disease Control and Prevention-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and later-life health and well-being and the first to really look at the effects. See Department of Health and Human Services, Centers for Disease Control and Prevention. (2016). Adverse childhood experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/acestudy/index.html
2 National Child Traumatic Stress Network, 2010.
3 U.S. Department of Health and Human Services, Administration for Children and Families, Children's Bureau. (2012, April 17). ACYF-CB-IM-12-04: Promoting social and emotional well-being for children and youth receiving child welfare services. Retrieved from https://www.acf.hhs.gov/sites/default/files/documents/cb/im1204.pdf4 Dorsey, S., Burns, B. J., Southerland, D. G., Cox, J. R., Wagner, H. R., & Farmer, E. M. Z. (2012). Prior trauma exposure for youth in treatment foster care. Journal of Child and Family Studies, 21(5), 816-824. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667554/ , para. 2
5 Susan, J., Kassam-Adams, N., Wilson, C., Ford, J. D., Berkowitz, S. J., Wong, M., ... & Layne, C. M. (2008). Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice. Retrieved from https://www.researchgate.net/profile/Christopher_Layne/publication/232516164_Creating_Trauma-Informed_Systems_Child_Welfare_Education_First_Responders_Health_Care_Juvenile_Justice/links/0fcfd50e8be0b79a95000000.pdf , p. 397
6 U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2014). Preventing and mitigating the effects of childhood violence and trauma. Retrieved from https://innovations.ahrq.gov/perspectives/preventing-and-mitigating-effects-childhood-violence-and-trauma
7 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. Retrieved from https://store.samhsa.gov/system/files/sma14-4884.pdf8 U.S. Department of Health and Human Services, Administration for Children and Families, Children's Bureau. (2012, April 17).
9 Stevens, J. (2015). SD County trauma-informed guide team sets county on solid path to resilience. Retrieved from http://www.acesconnection.com/blog/sd-county-trauma-informed-guide-team-sets-county-on-solid-path-to-resilience-1
10 Annie E. Casey Foundation. (2017). When child welfare systems embrace trauma-informed care. Retrieved from http://www.aecf.org/blog/when-child-welfare-systems-embrace-trauma-informed-care/
11 U.S. Department of Health and Human Services. (2013). Letter to state Medicaid directors. Retrieved from https://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-13-07-11.pdf
Child Welfare Information Gateway. (2015). Developing a trauma-informed child welfare system. Retrieved from https://www.childwelfare.gov/pubPDFs/trauma_informed.pdf
12 Chadwick Trauma-Informed Systems Dissemination and Implementation Project. (n.d.-a).
13 Alameda County Behavioral Health Care Services. (2013). Trauma informed care vs trauma specific treatment. Retrieved from https://alamedacountytraumainformedcare.org/trauma-informed-care/trauma-informed-care-vs-trauma-specific-treatment-2/
14 U.S. Department of Health and Human Services, Administration for Children and Families. (n.d.). Resource guide to trauma-informed services. https://www.acf.hhs.gov/trauma-toolkit?utm_source=blog&utm_medium=blog#chapter-6
15 American Academy of Pediatrics. (2018). Becoming a trauma-informed practice. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/Becoming-a-Trauma-Informed-Practice.aspx
16 U.S. Department of Health and Human Services, SAMHSA. (2015). Trauma-informed approach and trauma-specific interventions. Retrieved from https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf, para. 2.
17 U.S. Department of Health and Human Services, SAMHSA, 2015.
18 U.S. Department of Health and Human Services, SAMHSA, 2014, p. 2.
McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychopathology in the National Comorbidity Survey Replication (NCS-R) III: Associations with functional impairment related to DSM-IV disorders. Psychological Medicine, 40(5), 847-859.
Conradi, L., & Wilson, C. (2010). Managing traumatized children: A trauma systems perspective. Current Opinion in Pediatrics, 22(5), 621-625.
19 Chadwick Trauma-Informed Systems Dissemination and Implementation Project. (n.d.-a). Essential elements of a trauma-informed child welfare system. Retrieved from https://ctisp.wordpress.com/essential-elements-of-a-trauma-informed-child-welfare-system/https://web.archive.org/web/20170513115434/http://muskie.usm.maine.edu/helpkids/tele_pastdetail.htm#11151221 Wilson, C. E. (2013, Winter). The emergence of trauma-informed child welfare systems. In CW360º Trauma-Informed Child Welfare Practice, pp. 12-13. Retrieved from https://cascw.umn.edu/wp-content/uploads/2013/12/CW360-Ambit_Winter2013.pdf22 Miller, J. J., Donohue-Dioh, J., Niu, C., & Shalash, N. (2018). Exploring the self-care practices of child welfare workers: A research brief. Children and Youth Services Review, 84, 137-142. Retrieved from https://psycnet.apa.org/record/2018-00249-019, p. 1.
Salloum, A., Kondrat, D., Johnco, C., & Olson, K. (2015). The role of self-care on compassion satisfaction, burnout and secondary trauma among child welfare workers. Children and Youth Services Review, 49, 54-61
23 Miller et al. (2018).
24 McGuiness, A. R. (2015). Organizational supports for child welfare social workers experiencing secondary traumatic stress. Retrieved from https://web.archive.org/web/20181103045736/http:/scholarworks.csustan.edu/bitstream/handle/011235813/871/McGuiness.AR.spring2015.pdf?sequence=125 Geller, J. A., Madsen, L. H., & Ohrenstein, L. (2004). Secondary trauma: A team approach. Clinical Social Work Journal, 32(4), 415-430. Retrieved from https://doi.org/10.1007/s10615-004-0540-5
26 Chadwick Trauma-Informed Systems Dissemination and Implementation Project. (n.d.-b). Using a trauma-informed lens to help transform the child welfare system. Retrieved from https://web.archive.org/web/20180212051756/https://ctisp.org/

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Trauma-Informed Child Protection - Casey Family Programs

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Over the last two decades, there has been an intense focus on the impact of trauma on children and how it affects a child's development into and throughout adulthood. 1 We now know that even babies can be affected by exposure to traumatic events.

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To provide trauma-informed care to children, youth, and families involved with child welfare, professionals must understand the impact of trauma on child development and learn how to effectively minimize its effects without causing additional trauma. This section provides information on building trauma-informed systems, assessing and treating trauma, addressing secondary trauma in caseworkers, and trauma training. It also offers trauma resources for caseworkers, caregivers, and families.

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To provide trauma-informed care to children, youth, and families involved with child welfare, professionals must understand the impact of trauma on child development and learn how to effectively minimize its effects without causing additional trauma. This section provides information on building trauma-informed systems, assessing and treating trauma, addressing secondary trauma in caseworkers, and trauma training.

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Website: National Child Traumatic Stress Network

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Website: National Child Traumatic Stress Network

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The National Child Traumatic Stress Network

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Children and families become known to the child welfare system because of suspected abuse or neglect, experiences which can result in traumatic stress reactions.

The following resources on Child Welfare were developed by the NCTSN.

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In any given year, approximately one million children come to the attention of the U.S. child welfare system. Many are victims of abuse or neglect, live with caregivers who are impaired, and/or deal with school and community violence as a fact of life.

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Printable: Implementing Trauma-Informed Practices in Child Welfare

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Printable: Implementing Trauma-Informed Practices in Child Welfare

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Printable: The Importance of a Trauma-Informed Child Welfare System

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Printable: The Importance of a Trauma-Informed Child Welfare System

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Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others

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Amazon.com: Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (Audible Audio Edition): Laura van Dernoot Lipsky, Connie Burk, Laura van Dernoot Lipsky, Berrett-Koehler Publishers: Books

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"Essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society." (Alexander McFarlane, director of the Centre for Traumatic Stress Studies) A pioneering researcher transforms our understanding of trauma and offers a bold new paradigm for healing in this New York Times best seller.
Trauma is a fact of life. Veterans and their families deal with the painful aftermath of combat; one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence. Dr. Bessel van der Kolk, one of the world's foremost experts on trauma, has spent more than three decades working with survivors. In The Body Keeps the Score, he uses recent scientific advances to show how trauma literally reshapes both body and brain, compromising sufferers' capacities for pleasure, engagement, self-control, and trust. He explores innovative treatments - from neurofeedback and meditation to sports, drama, and yoga - that offer new paths to recovery by activating the brain's natural neuroplasticity. Based on Dr. van der Kolk's own research and that of other leading specialists, The Body Keeps the Score exposes the tremendous power of our relationships both to hurt and to heal - and offers new hope for reclaiming lives.

Cover image: 2020 Succession H. Matisse / Artists Rights Society (ARS), New York Courtesy of the Archives Henri Matisse, All rights reserved.

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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

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Amazon.com: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (Audible Audio Edition): Sean Pratt, Bessel A. van der Kolk, Penguin Audio: Audible Books & Originals

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The Drama of the Gifted Child: The Search for the True Self

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Amazon.com: The Drama of the Gifted Child: The Search for the True Self (Audible Audio Edition): Alice Miller, Suzanne Toren, Hachette Audio: Audible Books & Originals

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"[Oprah Winfrey and Bruce D. Perry] are both capable, likable narrators who are sincerely engaged with their subject matter...The performances of these two humanitarians make this a must-hear for anyone recovering from their traumatic past." (AudioFile Magazine)

This program is read by the authors.

Our earliest experiences shape our lives far down the road, and What Happened to You? provides powerful scientific and emotional insights into the behavioral patterns so many of us struggle to understand.

"Through this lens we can build a renewed sense of personal self-worth and ultimately recalibrate our responses to circumstances, situations, and relationships. It is, in other words, the key to reshaping our very lives." (Oprah Winfrey)

This audiobook is going to change the way you see your life.

Have you ever wondered "Why did I do that?" or "Why can't I just control my behavior?" Others may judge our reactions and think, "What's wrong with that person?" When questioning our emotions, it's easy to place the blame on ourselves; holding ourselves and those around us to an impossible standard. It's time we started asking a different question.

Through deeply personal conversations, Oprah Winfrey and renowned brain and trauma expert Dr. Bruce Perry offer a groundbreaking and profound shift from asking "What's wrong with you?" to "What happened to you?"

Here, Winfrey shares stories from her own past, understanding through experience the vulnerability that comes from facing trauma and adversity at a young age. In conversation throughout the audiobook, she and Dr. Perry focus on understanding people, behavior, and ourselves. It's a subtle but profound shift in our approach to trauma, and it's one that allows us to understand our pasts in order to clear a path to our future - opening the door to resilience and healing in a proven, powerful way.
A Macmillan Audio production from Flatiron Books

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What Happened to You?: Conversations on Trauma, Resilience, and Healing

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Amazon.com: What Happened to You?: Conversations on Trauma, Resilience, and Healing (Audible Audio Edition): Oprah Winfrey, Bruce D. Perry, Bruce D. Perry, Oprah Winfrey, Macmillan Audio: Audible Books & Originals

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The Repair of Early Trauma: A Bottom Up Approach