Presentation on theme: "Trauma-Informed Child Welfare Practice"— Presentation transcript:
1Trauma-Informed Child Welfare Practice TN CAC Connecting for Children’s Justice ConferenceNovember 2014Nashville, TNMelissa L. Hoffmann, Ph.D.UT Center of Excellence for Children in State CustodyUniversity of Tennessee Health Sciences CenterMemphis, TN
3Objectives Participants will: 1) Understand the different types of trauma2) Learn about the effects of trauma exposure on children3) Become familiar with the Essential Elements of a Trauma-Informed Child Welfare SystemMuch of the information presented here is drawn from the National Child Traumatic Stress Network (NCTSN) website and resources. Go to for a wealth of information.
4Trauma-Informed Child- and Family-Service Systems A trauma-informed child- and family-service system is one in which all parties involved:Recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers;Infuse and sustain trauma awareness, knowledge, and skills into their organizational cultures, practices, and policies;Act in collaboration with all those who are involved with the child, using the best available science, to facilitate and support the recovery and resiliency of the child and familyThis refers to the broader system, not just DCS/child welfare
5Utilization of trauma-informed practices will assist in attaining the goals of: SafetyPermanencyWell-BeingWhat impact does trauma have on these goals?
6Child Welfare Trauma Training Toolkit NCTSN productVersion 2.0released in 201314 modulesThis presentation is a summary of the Toolkit
7In a trauma-informed child welfare system, the child welfare worker: Understands the impact of traumaCan integrate that understanding into planning for the child and familyUnderstands his or her role in responding to child traumatic stress
8The Essential Elements of a Trauma-Informed Child Welfare System 1 - Maximize Physical and Psychological Safety for Children and Families2 - Identify Trauma-Related Needs of Children and Families3 - Enhance Child Well-Being and Resilience4 - Enhance Family Well-Being and Resilience5 - Enhance the Well-Being and Resilience of Those Working in the System6 - Partner with Youth and Families7 - Partner with Agencies and Systems that Interact with Children and Families
9The Essential Elements Implementation of each Essential Element must:Take into consideration the child’s developmental level andReflect sensitivity to the child’s family, culture, and language
10What is Child Trauma?Witnessing or experiencing an event that poses a real or perceived threatThe event overwhelms the child’s ability to cope and causes feelings of fear, helplessness or horror, which may be expressed by disorganized or agitated behavior
13Acute TraumaEvents that occur at a particular time and place and are short-lived, and involve:(1) experiencing a serious injury to yourself or witnessing a serious injury to or the death of someone else, or(2) facing imminent threats of serious injury or death to yourself or others, or(3) experiencing a violation of personal physical integrity.During an acute event, children go through a variety of feelings, thoughts, and physical reactions that are frightening in and of themselves and contribute to a sense of being overwhelmed.
14Chronic TraumaChronic trauma refers to the experience of multiple traumatic eventsMay be multiple and varied events (car accident and domestic violence), or longstanding, repeated events (ongoing sexual abuse)The effects of chronic trauma are often cumulative
15Complex TraumaComplex trauma describes both exposure to chronic trauma and the impact of such exposure on the child.The chronic trauma is usually caused by adults entrusted with the child’s careChildren who have experienced complex trauma have endured multiple interpersonal traumatic events from a very young ageComplex trauma has profound effects on nearly every aspect of a child’s development and functioning
16Other Types of TraumaHistorical traumaChild traumatic grief
18What is Child Traumatic Stress? Child traumatic stress occurs when:children and adolescents are exposed to traumatic events or traumatic situations, andthis exposure overwhelms their ability to cope with what they have experienced, eliciting feelings of terror, powerlessness, and out of control physiological arousalChild traumatic stress refers to the physical and emotional responses of the childA child’s response to a traumatic event may have a profound effect on his or her perception of self, others, the world, and the futureTraumatic events may affect a child’s trust and sense of safety, and may make them more vulnerable to current and future stressors
19Responses to Stressors and Traumatic Events A child’s response to a potentially traumatic event depends on:Age and developmental stagePerception of the danger facedWhether the child was the victim or a witnessRelationship to the victim or perpetratorPast experience with traumaAdversities faced after the traumaPresence or availability of adults who can offer help and protection
20Effects of Trauma Exposure AttachmentBiologyMood regulationDissociationBehavioral controlCognitionSelf-conceptDevelopment
21Maladaptive Coping Strategies Sleeping, eating, elimination problemsHigh activity levelsIrritability, acting outEmotional detachment, unresponsiveness, numbnessHyper-vigilanceUnexpected and exaggerated response when told “no”
25Growth of Human Brain from birth to 20 years WHOLE BRAIN WEIGHT IN GRAMS0-7 = 93% of brain growth (volume) has occurred.. We are learning more about the possibility of regeneration of the brain…
26Child maltreatment reports Note how neglect is prominent; Note that the early age group is prominent. Ages 0-7 comprise the majority, with the 0-3 the largest group affected.3 million kids per year on maltreatment reports from 1989-present
27Alters the Organized Brain Experience in Adulthood….Alters the Organized BrainExperience in Childhood….Organizes the Developing Brain
28Neural Imprinting What Fires Together Wires Together The brain develops and modifies itself in response to experience. Neurons and neuronal connections (i.e., synapses) change in an activity-dependent fashion.The more an event occurs, the more a neural path is fired and traveled, and the more permanent the message or new learning becomesSo, when you activate and repeatedly practice specific brain activity you are wiring or rewiring the brain.Neural imprinting: when an event occurs over and over, Long term potentiation occurs that causes synapses to strength in their connection to one another. LTP blazes a new trail along a series of neurons making it easier for subsequent messages to fire and travel along the same path. The more it is fired, the more permanent the new path becomes.
29During traumatic experiences children’s brains are in a state of activation (due to fear, fight or flight).Chronic activation of this adaptive fear response can result in the persistence of a fear state:HypervigilanceIncreased muscle toneFocus on threat-related cuesAnxietyBehavioral Impulsivity
30The neurohormones released during times of stress are good for short periods – but can become harmful when in the system for long periods of time.Trauma exposed children and adolescents display changes in levels of stress hormones similar to those seen in combat veterans.Young children who are neglected or maltreated have abnormal patterns of cortisol production that can last even after the child has been moved to a safe and loving home.
31Normal Stress Response All affective energy mobilized in the limbic system (red).Higher Cortical areas less active (blue).Red and blue need to be able to talk with each other in order to process whether or not the stressor creates a survival emergency or not. Kids with good affect regulatory development will be able to use their connections that got wired together to work back and forth regarding these decisions. Is it time to run or can I settle back down?
32Survival Mode vs. Consultation Mode CORTEXTHALAMUSThalamus is the relay station… do I process this as an emergency and send the signal down to the amygdala for a survival response (fight, flight, freeze?) or can I use my cortex to figure out my next move and to decide how I will manage the stressor?Survival Mode vs. Consultation ModeThe path to thinking is longer than the path to actionIn times of danger/stress, chemicals are released that block the signal from going to the cortex – adaptive, makes reactions automaticWith enduring danger/stress/trauma, the brain becomes hard-wired from the thalamus to the amygdala so the child is vigilant, over-reacts, or freezes
33Brain Development in Infancy During the first few months after birth, only the brainstem and midbrain are sufficiently developed to sustain and alter basic bodily functions and alertnessThe primitive structures regulate the autonomic nervous system, mobilizing arousal (sympathetic branch) and modulating arousal (parasympathitic branch)Early deprivation of responsive caregiving (neglect, maltreatment) can lead to lifelong reactivity to stress – even mild stress later in life can elicit severe reactivity and dysfunctionGunnar & Donzella, 2002
34Brain Development in Early Childhood In toddlerhood and early childhood the brain actively develops areas responsible for1. Filtering sensory input to identify useful information2. Learning to detect and respond defensively to potential threats3. Recognizing information or environmental stimuli that comprise meaningful contexts4. Coordinating rapid, goal-directed responsesIn early childhood, trauma can be associated with reduced size of the cortexThe cortex is responsible for many complex functions, including memory, attention, perceptual awareness, thinking, language, and consciousness
35Early ChildhoodDuring this time there is a gradual shift from right (feeling and sensing) to left (language, abstract reasoning, planning) hemisphere dominanceThe young child learns to attend to both the external and internal environment, rather than responding reflexively to stimuliTrauma interferes with the integration of left and right hemisphere brain functioningUnder stress, traumatized children’s analytic capacities (left brain) disintegrate, and their emotional reactions (right brain)take over, resulting in uncontrolled emotionsProper categorizing of experiences is inhibited, resulting in fight-or-flight reactions to non-threatening stimuliThese changes may affect IQ and can lead to increased fearfulness and a reduced sense of safety and protection
36Trauma and the Brain: School-Age Children In school-age children, trauma undermines the development of brain regions that would normally help children:Manage fears, anxieties, and aggressionSustain attention for learning and problem solvingControl impulses and manage physical responses to danger, enabling the child to consider and take protective actionsAs a result, children may exhibit:Sleep disturbancesNew difficulties with learningDifficulties in controlling startle reactionsBehavior that shifts between overly fearful and overly aggressive
37Trauma and the Brain: Adolescents In adolescents, trauma can interfere with development of the prefrontal cortex, the region responsible for:Consideration of the consequences of behaviorRealistic appraisal of danger and safetyAbility to govern behavior and meet longer-term goalsAs a result, adolescents who have experienced trauma are at higher risk for:Reckless and risk-taking behaviorsUnderachievement and school failurePoor choicesAggressive or delinquent activity
38The Good NewsThe brain is very plastic and therefore capable of changing in response to experiences, especially repetitive and patterned experiences.Early identification and intervention with abused and neglected children has the capacity to modify and influence development
39Posttraumatic Stress Reactions Now that you understand why children react to trauma the way they do, let’s talk about what those reacts may be
40Children who have experienced trauma often find it difficult to: Trust other peopleFeel safeUnderstand and manage their emotionsAdjust and respond to life’s changesPhysically and emotionally adapt to stress
41Posttraumatic Stress Reactions: Young Children Become passive and quietEasily alarmedLess secure about being provided with protectionBecome generally more fearful, especially in regard to separations and new situations
42Posttraumatic Stress Reactions: Young Children May respond to very general reminders of the trauma, like the color red or the sounds of another child cryingRegression – begin wetting the bed, baby-talkBecause a child's brain does not yet have the ability to quiet down fears, the preschool child may have very strong startle reactions, night terrors, and aggressive outbursts.
43Posttraumatic Stress Reactions: School-age Children A wider range of intrusive images and thoughts, including what could have stopped the event from happening and what could have made it turn out differently. These thoughts can show up in "traumatic play”Respond to very concrete trauma reminders: someone with the same hairstyle as an abuser; the monkey bars on a playground where a child got shot.May develop intense specific new fears associated with the traumatic event and "fears of recurrence" that result in the child avoiding doing things they would usually like to do.
44Posttraumatic Stress Reactions: School-age Children May go back and forth between shy or withdrawn behavior and unusually aggressive behavior.Normal sleep patterns may be disturbed, with restless movements and vocalizations.The lack of restful sleep can interfere with daytime concentration and attention, making studying more difficult due to remaining on alert for things happening around them.
45Posttraumatic Stress Reactions: Adolescents May interpret their own reactions as regressive or childlike, or feel they are "going crazy," weak, or different from everyone else.May be embarrassed by bouts of fear and exaggerated physiological responses.May believe that they are unique in their pain and suffering, resulting in a sense of isolation.May be very sensitive to the failure of family, school, or community to protect or carry out justice.
46Posttraumatic Stress Reactions: Adolescents May respond to their experience through dangerous reenactment behavior, such as reacting with too much "protective" aggression for a situation.Response to reminders may involve reckless, dangerous behavior or extreme avoidant behaviorMay try to get rid of emotions and physical responses through the use of alcohol and drugs.
47The Influence of Culture Children and adolescents from minority backgrounds are at increased risk for trauma exposure and subsequent development of PTSDLesbian, gay, bisexual, transgender, or questioning (LGBTQ) adolescents contend with violence directed at them in response to suspicion about or declaration of their sexual orientation and gender identityImmigrant and refugee families often face additional traumas and stressors related to migration and/or traumas in country of origin
48The Influence of Culture Child welfare workers should work to understand that social and cultural realities can influence children’s risk, experience, and description of trauma;Recognize that strong cultural identity can also contribute to the resilience of children, their families, and their communities;Assess for historical trauma and events that may have occurred in the family’s country of origin;Work with qualified interpreters
50Essential Element 1: Maximize Physical and Psychological Safety for Children and Families A sense of safety is critical for functioning as well as physical and emotional growthSafety implies both physical and psychological safetyWhen asking about emotionally painful and difficult experiences and symptoms, workers must ensure that children are provided with a psychologically safe settingChildren and families should be helped to feel safer during transitions
51Maximize Physical and Psychological Safety for Children and Families Let children and families know what will happen next.Give children control over some aspects of their lives.Help children maintain connections.Give a safety message.
52Maximize Physical and Psychological Safety for Children and Families When it is necessary to facilitate the removal of a child, ask the child what personal items he or she would like to bring from home.Provide the child and parents with as much information as possible about the new placement.Obtain information about the child’s schedules and preferences from the birth parent and share this information with substitute care providers.Be aware of how some practices in residential care settings can be triggering and/or traumatizing and work to minimize triggers.
53Essential Element 2: Identify Trauma-Related Needs of Children and Families One of the first steps in helping trauma-exposed children and families is to understand how they have been impacted by trauma.Utilize trauma screening practices to identify children who need trauma-focused therapy. Gather a full picture of trauma exposure and impact.Identify immediate needs and concernsAssess the functioning of the caregiving system, including the impact of parent traumaDoes anyone here use trauma screening measures? Which ones?
54Identify Trauma-Related Needs of Children and Families It is important to consider trauma when making service referrals and service plans.Refer children and families for culturally appropriate therapy and other services as neededAsk questions of mental health providers regarding their experience and training in assessing and treating trauma
55Essential Element 3: Enhance Child Well-Being and Resilience Professionals and caregivers can help children overcome trauma by enhancing their natural strengths and resilience.Positive and stable relationships are vital to children’s ability to overcome traumatic experiences.Children may need assistance to help them cope with overwhelming emotions, begin to make sense out of what happened to them, and express this to others.Trauma-informed treatments and services can effectively reduce trauma impact and enhance child resilience.
56Enhance Child Well-Being and Resilience Resilience is the ability to overcome adversity and thrive in the face of risk.Neuroplasticity allows for rewiring of neural connections through corrective relationships and experiences.Children who have experienced trauma can therefore develop resilience.Factors that enhance resilience:Family supportPeer supportSpiritual beliefsSchool connectednessSelf esteem/self efficacy
57Essential Element 4: Enhance Family Well-Being and Resilience Many birth parents in the child welfare system have their own histories of trauma that can impact their ability to protect and support their children.Resource parents often struggle to understand and manage children’s trauma-related reactions, leading to frustration and possible placement disruption.Providing trauma-informed services to birth and resource parents enhances family and child well-being and resilience.
58Enhance Family Well-Being and Resilience Facilitate partnership between birth and resource parents.Provide trauma education and trauma-informed parenting skills to resource families.Help reframe children’s behaviors as trauma reactions to help resource parents see that it’s not about them.Take the time to listen to resource parents and ask them what they need.Engage resource parents as vital members of the team.Link resource parents to support groups, mentors, and other community services.Ensure that resource parents have access to respite care and encourage them to use it.
59Essential Element 5: Enhance the Well-Being and Resilience of Those Working in the System Child welfare is a high-risk profession in which workers are exposed to trauma indirectly and sometimes directly.Child welfare workers are impacted by exposure to child and family trauma; Secondary Traumatic Stress (STS) reactions including feelings of helplessness, anger, and fear are common.Workers, supervisors, and agencies can implement strategies to build resilience and reduce the impact of STS.
60Sources of Secondary Trauma in Child Welfare The death of a child or adult on the worker’s caseloadInvestigating a vicious abuse or neglect reportFrequent/chronic exposure to children’s detailed and emotional accounts of traumatic eventsPhotographic images of horrific injury or scenes of a recent serious injury or deathHelping to support grieving family members following a child abuse death, including the siblings of the deceased childConcerns about the continued funding and adequacy of resources for their agencyConcerns about being publicly scape-goated for a tragic outcome when they did not have the means or authority to intervene effectivelyAlisonSource: Osofsky, J. D., Putnam, F. W., & Lederman, C. (2008). How to maintain emotional health when working with trauma. Juvenile and Family Court Journal, 59(4),(Osofsky et al, 2008)
61Enhance the Well-Being and Resilience of Those Working in the System Child welfare workers should work to be aware of how trauma work impacts them and know their trauma signsChild welfare agencies can create a culture that acknowledges and normalizes the impact of STSAgencies should engage in regular and reflective supervision to address STSDevelop and utilize self-care plans and advocate for policies that promote self-care
62Essential Element 6: Partner with Youth and Families Youth and families involved with the child welfare system have a unique perspective to be explored, respected, and integrated into service delivery.Partnership provides a voice for families currently and formerly involved in services.Strategies must be employed to engage youth and families in partnerships and decision making.
63Strategies for Partnering with Youth and Families Clear, honest, respectful communicationCommitment to strengths-based, family-centered, and youth-driven practiceShared decision making and participatory planningPraise and recognition for parents (birth, foster, kinship, and adoptive) as resourcesSeeking feedback from youth and families on a regular basisExit interviews with familiesAssessing your own practice and agency self-assessments
64Essential Element 7: Partner with Agencies and Systems that Interact with Children and Families Trauma-exposed children and their families are often involved with multiple service systemsCross-system collaboration enables all helping professionals to see the child as a whole person, thus preventing potentially competing priorities and confusion for families.Service providers should try to develop common protocols and frameworks for documenting trauma history, exchanging information, coordinating assessments, and planning and delivering care.
65Strategies for Cross-System Collaboration Cross-training on trauma and its impactJointly developed protocols regarding child and family trauma and collaborative services that promote resiliencyMulti-disciplinary teamsFamily team meetingsCo-location of staff in community “hubs”Cross-system assessment toolsAll systems engaged in shared outcomesTechnology used for information exchangeIntegrated information sharing systems
66Training in Trauma-Informed Practices NCTSN Child Welfare Trauma Training Toolkit12-hour training for child welfare professionals to educate about trauma, its effect on children, and how child welfare professionals can helpNCTSN Caring for Children Who Have Experienced Trauma: A Workshop for Resource Parents14-hour training for resources parents to educate about trauma, its effect on children, and specific ways resource parents should interact with children in their care