A Shared Developmental Approach: Meeting Well-Being Needs and Addressing Trauma to Promote Healthy Development CLARE ANDERSON, DEPUTY COMMISSIONER ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES

MALTREATMENT IS PERVASIVE AMONG CHILDREN AND YOUTH IN MANY SYSTEMS Miller, EA; Green, AE; Fettes, DL; & Aarons, GA., 2011. Data come from a representative sample of 1,715 youths aged 6–18 who received services from one or more of five San Diego County public sectors of care.

DOMAINS OF IMPAIRMENT IN CHILDREN AND ADOLESCENTS WITH DEVELOPMENTAL TRAUMA DISORDER Cognitive Attention Regulation & Executive Functioning Problems Processing Novel Information & Learning Difficulties Problems Understanding Own Contribution to What Happens Physical Sensorimotor Developmental Problems & Hypersensitivity to Physical Contact Somatization Medical Problems Social Attachment & Interpersonal Difficulties Difficulty Attuning to Others’ Emotional States Boundary Problems, Distrust, and Suspiciousness Emotional/Behavioral Difficulty with Emotional Regulation & Poor Modulation of Impulses Difficulty Understanding and Complying with Rules & Oppositional Behavior Difficulty Describing Feelings and Internal Experience Adapted from Complex post-traumatic stress disorder: a useful diagnostic framework? (Busuttil 2009)

Trauma/Victimization The Trauma to Violence Process: Points of Interventions to Promote On-Target Development & Well-Being INTERVENTION Trauma/Victimization Developmental Impact Maladaptive Coping Anger & Aggression (Delinquency) Violence Healthy Development

DEVELOPMENTAL FRAMEWORK FOR WELL-BEING Physical Health and Development Cognitive Functioning Environmental Supports Personal Characteristics Emotional/ Behavioral Functioning Social Functioning Developmental Stage (early childhood, latency, adolescence)

A DEVELOPMENTAL FRAMEWORK FOR WELL-BEING Intermediate Outcome Domains Well-Being Outcome Domains Environmental Supports Personal Characteristics Cognitive Functioning Physical Health and Development Emotional/Behavioral Functioning Social Functioning Infancy (0-2) Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Temperament, cognitive ability Language development Normative standards for growth and development, gross motor and fine motor skills, overall health, BMI Self-control, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms Social competencies, attachment and caregiver relationships, adaptive behavior Early Childhood (3-5) Language development, pre-academic skills (e.g., numeracy), approaches to learning, problem-solving skills Self-control, self-esteem, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms Middle Childhood (6-12) family social capital, social support, Identity development, self-concept, self-esteem, self-efficacy, cognitive ability Academic achievement, school engagement, school attachment, problem-solving skills, decision making Normative standards for growth and development, overall health, BMI, risk-avoidance behavior related to health Emotional intelligence, self-efficacy, motivation, self-control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms Social competencies, social connections and relationships, social skills, adaptive behavior Adolescence (13-18) Academic achievement, school engagement, school attachment, problem solving skills, decision making Overall health, BMI, risk-avoidance behavior related to health Social competence, social connections and relationships, social skills, adaptive behavior Social and Emotional Well-Being Domains

Tiered Approach for Promoting Healthy Development & Well-Being, Addressing Exposure to Violence, and Reducing Crime On-Target Development & Healing and Recovery Socioeconomic and Community Factors Assessment drives individualized treatment plan with trauma-informed evidence-based interventions; Use of incarceration rarely, fairly and to the benefit of the youth and includes evidence-based treatment Intensive Intervention Targeted Social and Emotional Supports Safe, Supportive and Responsive Relationships NURTURING ENVIRONMENTS Knowledgeable and Effective Organizations and Workforce Systematic approaches to trauma needs established; Social and emotional skill and coping strategy development supports are available and targeted to meet identified needs Safe and supportive relationships promote healthy development including social and emotional skills; responsive to trauma related needs Collective responsibility for promoting and supporting optimal developmental outcomes Adapted from Technical Assistance Center on Social Emotional Intervention for Children and the Center on the Social and Emotional Foundations for Early Learning

Tiered Approach for Promoting Healthy Development & Well-Being, Addressing Exposure to Violence, and Reducing Crime On-Target Development & Healing and Recovery Assessment drives individualized treatment plan with trauma-informed evidence-based interventions; Use of incarceration rarely, fairly and to the benefit of the youth and includes evidence-based treatment Intensive Intervention Targeted Social and Emotional Supports Safe, Supportive and Responsive Relationships NURTURING ENVIRONMENTS Knowledgeable and Effective Organizations and Workforce Systematic approaches to trauma needs established; Social and emotional skill and coping strategy development supports are available and targeted to meet identified needs Safe and supportive relationships promote healthy development including social and emotional skills; responsive to trauma related needs Collective responsibility for promoting and supporting optimal developmental outcomes Adapted from Technical Assistance Center on Social Emotional Intervention for Children and the Center on the Social and Emotional Foundations for Early Learning

MATCHING POPULATIONS, OUTCOMES, & APPROACHES Children, 8-17 Children, 13-17 Children, 2-7 Screening & Assessment UCLA PTSD Index Strengths & Difficulties Questionnaire Child & Adolescent Needs & Strengths Trauma Symptoms Checklist for Young Children Infant Toddler Emotional Assessment Child Behavior Checklist EBIs Trauma-Focused Cognitive Behavioral Therapy Multisystemic Therapy Parent–Child Interaction Therapy Outcomes Reduced behavior problems Reduced PTS symptoms Reduced depression Reduced delinquency/drugs Reduced peer problems Improved family cohesion Reduced conduct disorders Reduced parent distress Improved parent–child interaction In earlier discussions, we noted that this slide could be potentially helpful, but we would need to rephrase the outcomes to reflect the desired outcomes we wanted to achieve.

ACHIEVING BETTER OUTCOMES context: therapeutic, responsive, & supportive settings & relationships Validated Screening Clinical Assessment Functional Assessment Case Planning for Safety, Permanency, and Well-Being Outcomes: Safety, Permanency, Well-Being Evidence-Based Intervention(s) Progress Monitoring social–emotional functioning

Policy: Social and Emotional Well-Being http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf