Improving Outcomes with Effective Trauma-Informed Interventions

Charles Wilson, MSSW Senior Director Sam and Rose Stein Endowed Chair in Child Protection Centers for Developmental and Behavioral Sciences Chadwick Center for Children and Families Rady Children’s Hospital-San Diego

Why is This Relevant to Management of Psychotropic Medication Trauma is all too common for children and youth served in foster care The link between traumatic experience, behavior, and how the system responds The link between our behavior in the system and the child’s response to our efforts

Definition of a Trauma-Informed System A trauma-informed child welfare system is one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers and those who have contact with the system.  Programs and organizations within the system infuse this knowledge, awareness and skills into their organizational cultures, policies, and practices.  They act in collaboration, using the best available science, to facilitate and support resiliency and recovery.  - CTISP National Advisory Committee

Seeing Through a Trauma Lens When we can see the opportunity to minimize trauma reminders/triggers and reduce the need to control mood and behavior with psychotropic medications… …we stop making it worse!

Seeing Through a Trauma Lens The better we can differentiate maladaptive behavior that will respond to psychosocial interventions from pathology that requires psychotropic intervention

In Fact, Many Children in Foster Care Do Receive Mental Health Services   Stambaugh, L.F., Leslie, L.K., Ringeisen, H., Smith, K., & Hodgkin, D. (2012). NSCAW Child Well-Being Spotlight: Children in Out-of-Home Placements Receive More Psychotropic Medication and Other Mental Health Services than Children Who Remain In-Home Following a Maltreatment Investigation. OPRE Report #2012-XX, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Find this report and those on similar topics online at: http://www.acf.hhs.gov/programs/opre/ abuse_neglect/nscaw/

Seeing Through a Trauma Lens The better we can see the opportunity to deploy evidence based or informed psychosocial interventions that can produce positive result - with minimal side effects…. …we will also see the value to strategically combining psychotropic and psychosocial interventions in some cases.

Essential Elements of a Trauma-Informed Child-Serving System Maximize Physical and Psychological Safety for the Child, Family and CW Workforce Identifying Trauma-related Needs of the Child, and Family Enhancing Child Well-Being and Resiliency Enhancing Family Well-being and Resiliency Enhancing the Well-Being and Resiliency of those Working in the System Partnering with Youth and Families Partnering with System Agencies Screening, Assessment Role of Caregivers with Trauma History Evidence Based Treatments

The Keys to Change Are in This Room Expectation from the top leadership for a move to a trauma informed environment - from the receptionist at the front desk to caseworkers and therapists Policy framework to support the transformation Capacity of the workforce to retool to an evidence based approach Financing approach that supports learning and delivering new evidence based practices