Creating Trauma-Informed Child Welfare Systems

Lisa Conradi, Psy.D.

Chadwick Trauma-Informed Systems Project

Chadwick Center for Children and Families

Rady Children’s Hospital – San Diego

1

What realistic and practical actions can be taken at all levels of the system to understand and address trauma to make it better for the children, families, and workforce?

2

Call for Trauma-Informed Child Welfare Systems

Artwork courtesy of the International Child Art Foundation (www.icaf.org)

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

3

Definition of Trauma-Informed Child Welfare System

The research is clear that the experience of abuse or neglect leaves a particular traumatic fingerprint on the development of children that cannot be ignored if the child welfare system is to meaningfully improve the life trajectories of maltreated

children, not merely keep them safe from harm.

Bryan Samuels, Commissioner for the Administration on Child, Youth and Families

Testimony to House Ways and Means Subcommittee on Human Resources, Congress 4

Why is this Important?

“Simply removing a child from a dangerous environment will not

by itself undo the serious consequences or reverse the negative

impacts of early fear learning. There is no doubt that children in

harm’s way should be removed from a dangerous situation.

However, simply moving a child out of immediate danger does not

in itself reverse or eliminate the way that he or she has learned to

be fearful. The child’s memory retains those learned links, and such

thoughts and memories are sufficient to elicit ongoing fear and

make a child anxious.” May 4, 2012

NAPCWA All-State Webinar

5

National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved fromwww.developingchild.harvard.edu.

5

May 4, 2012

NAPCWA All-State Webinar

6

We need an integrated approach to addressing

the impact of maltreatment

Child Welfare

Relational Impact

Trauma

Mental Health

Psychotropic Medication

Behavioral Impact

Neurological Impact

“Emerging evidence demonstrates that these biological and psychological effects are concentrated in behavioral, social, and emotional domains. These effects can keep children from developing the skills and capacities they need to be successful in the classroom, in the workplace, in their communities, and in interpersonal relationships. As a result, this can hinder children’s development into healthy, caring, and productive adults and keep them from reaching their full potential. Children involved with child welfare have a set of complex challenges; these challenges may not be addressed by the system and services as they are currently designed” (ACYF-IM-CB-12-04).

Maximize Physical and

Psychological Safety for the

Child and Family

Identifying Trauma-related

Needs of the Children and ,

Families

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 Child-Serving Agencies and

Systems

7

Essential Elements of a Trauma-Informed Child-Welfare System

1. Maximize physical and psychological safety for the child, family, and child welfare workforce.

2. Identify trauma-related needs of children, families, and the workforce.

3. Enhancing child well-being and resiliency.

4. Enhancing family well-being and resiliency.

5. Enhancing the well-being and resiliency of those working in the system.

6. Partnering with youth and families.

7. Partnering with child-serving agencies and systems.

Essential Elements of a Trauma-Informed Child Welfare System

8 8

Trauma-informed child welfare (TICW) practice mirrors well-established child welfare priorities.

Implementation does not require more time, but rather a redirection of time.

TICW means applying the trauma lens to everyday practice and weaving the trauma perspective into what workers already do.

9

Essential Elements Are Consistent With Child Welfare “Best Practices”

Psychotropic Medication Issues for Children in Custody

Lisa Conradi, Psy.D.

Chadwick Center for Children and Families

Rady Children’s Hospital – San Diego

10

Higher rates of psychotropic medication use among children in the child welfare system compared to the general population

Higher rates of medication among older children, boys, those with behavior problems, and children in group homes. (Raghavan et al., 2005).

Children with complex needs may be prescribed multiple medications and/or higher than recommended dosages with the potential for adverse effects (side effects, drug interactions, altering metabolism and nervous system development), despite lack of evidence that polypharmacy is effective.

Increased rates of psychotropic use with young children, especially those in foster care. (U.S. Government Accountability Office, 2011).

11

Trauma and Psychotropic Medication among Children in Child Welfare

Risk of Social-Emotional Problems and Use of Psychotropic Medications among Children Known to CPS, by Age Group

May 4, 2012

NAPCWA All-State Webinar

20.5%

49.5%

57.2%

1.5%

19.6%

16.0%

0%

10%

20%

30%

40%

50%

60%

70%

1.5-5 Years 6-10 Years 11-17 Years

Perc

en

t o

f C

hil

dre

n R

ep

ort

ed

to

Ch

ild

Pro

tecti

ve S

erv

ices

Age Group

Risk of Social-Emotional Problems Current Use of Psychotropic Medication

Data Source: National Survey of Child and Adolescent Well-Being II (NSCAW II). NSCAW II is a Congressionally required study sponsored by the Office of Planning, Research and Evaluation,

Administration for Children and Families (ACF), U.S. Department of Health and Human Services (DHHS).

Citation: Casaneuva, Ringeisen, Wilson, Smith, & Dolan, 2011

Risk of social-emotional problems was defined as scores in the clinical range on any of the following standardized measures: Internalizing, Externalizing or Total Problems scales of the Child

Behavior Checklist (CBCL: administered for children 1.5 to 18 years old), Youth Self Report (YSR; administered to children 11 years old and older), or the Teacher Report From (TRF;

administered for children 6 to 18 years old); the Child Depression Inventory (CDI; administered to children 7 years old and older); or the PTSD section Intrusive Experiences and Dissociation

subscales of the Trauma Symptoms Checklist (administered to children 8 years old and older).

12

3 reasons to use medications

Increase Safety

Reduce Suffering

Improve Function

If the medication works, kid is better able to engage in other interventions

13

Trauma and Psychotropic Medication among Children in Child Welfare

Affective arousal

Sleep problems

Fear and anxiety

Depression and sadness

Aggression

Impulsivity and attention problems

Memory problems

14

Target Symptoms of Traumatized Kids and Teens

Over eating

Low patience

Misinterpreting other people’s behavior and intentions

Thrill seeking, risk taking

Substance abuse

Sexual behavior

Daring acts 15

Symptoms That are Hard to Treat with Medications

Medication combinations

Compliance

Co-morbid conditions

Substance use

16

Complications to Safely Medicating Kids and Teens

Resources

• Chadwick Trauma-Informed Systems Project – www.ctisp.org

• California Evidence-Based Clearinghouse for Child Welfare - www.cebc4cw.org

• National Child Traumatic Stress Network - www.nctsn.org and http://learn.nctsn.org

• Chadwick Center for Children and Families – www.ChadwickCenter.org

• Child Welfare Trauma Training Toolkit - http://www.nctsn.org/nccts/nav.do?pid=ctr_cwtool

• Caring for Children who Have Experienced Trauma: A Guide for Resource Parents - www.nctsn.org/rpc

Lisa Conradi, Psy.D.

CTISP Project Manager

Chadwick Center for Children and Families

Ph: 858-576-1700 x 6008

E-mail: lconradi@rchsd.org

Contact Information

18