Promoting a Trauma Informed Lens when Assessing the Well-Being of Children in the Child Welfare System

Racquel EllisMental Health Counseling InternLong Island University, Brooklyn Campus

Manhattan/Staten Island Division of Child ProtectionMay 1, 2015

DEFINITION OF TRAUMA

A traumatic event with a set of characteristic symptoms

Event that is life threatening, can lead to serious injury or rape

Vicarious experience of trauma (witness reactions or learning of an event)

Client need not “feel” traumatized at event

Chronic trauma refers to repeated assaults on the child’s body and mind e.g., chronic sexual or physical abuse, exposure to ongoing domestic violence, emotional or physical neglect(Cook et al.,2005).

American Psychiatric Association,2013

RELEVANCE

There is an increasing body of literature affirming that trauma, including neglect, has a significant impact on brain development, particularly during the sensitive periods, such as infancy or adolescence(Child Welfare Information Gateway, 2011).

Children involved in the child welfare system are usually not exposed to a single traumatic event. Rather, they experienced multiple chronic and additive types of trauma that negatively impact their brain development. For families where there is intergenerational involvement in the system, the birth parents may also have been impacted in the same .

The National Child Traumatic Stress Network

RELEVANCE

Mismanagement of trauma reduces the likelihood of reunification (Rubin, O’Reilly, Luan & Localio, 2007), increases placement instability (Hartnett, Leathers, Falconnier & Testa, 1999), results in the application of increasingly more restrictive placements (Pecora et al., 2005), increases the likelihood of administration of strong psychotropic medicines (Raghavan et al., 2005), and increases the likelihood that the child will carry on an intergenerational cycle of abuse or neglect upon becoming a parent (Fang & Corso, 2007).

MIND

BODY

SOUL

EFFECTS

How Do Children Experience Trauma ?

Children are at increase vulnerability when compared to adults for developing negative outcomes after trauma.

Separation and loss are not life threatening but maybe perceived as so to children especially very young children.

Child traumatic stress may manifest in destructive and maladaptive ways that can impair their ability to self regulate.

Self regulation maybe underdeveloped as a result the child may have difficulty controlling his/her emotions and behaviors.

A child is also affected by his/her proximity to the event and the event’s personal significance for him/her.

A child response to trauma are shaped by the extent to which his/her support system is disrupted during or after the trauma, which can often affect the child’s reaction.

National Child Abuse and Neglect Database(NCANDS)

The Impact of Trauma on the Brain

A child who has experienced chronic and complex trauma endures an overwhelming amount of stress that impacts his/her brain’s ability to develop along a normal course.

Child Welfare Information Gateway,2011

Types and Prevalence of Child Trauma

The Prevalence of Child Trauma in Child Protection Citywide(NYC)

NYC Administration for Children's Services Flash Report, March 2015

Trauma and the Child Welfare System

Children involved in the child welfare systems are particularly vulnerable to traumatic events.

Separation from a caregiver maybe considered a traumatic event for younger children.

For many individuals contact with the child welfare system may serve as a trigger a traumatic event and bring back memories of prior personal family experiences.

Trauma also often results in ruptured relationships. Within child welfare systems there are likely to be both ruptures and conflicts among family members who are seeking to care for a child.

Child Welfare Information Gateway,2011

Theoretical Framework

Adults play an important role in children’s emotional development and emotional regulation. One key is the development of a trusting relationship and secure attachment (Frost,Wortham, & Reifel, 2008).

Intergenerational transmission theory postulates that being a victim of physical abuse or witnessing the abuse of the other family members, teaches boys to become violent. With continued exposure to violence, learning occurs through both observational learning and positive reinforcement in the form of approval for violent behavior (Craig & Sprang, 2007).

Attachment is the most complex and crucial emotional bond that develops between the child and caring adults during the early years of life. Children take their behavioral cues from caring adults’ complementary and responsive demeanors. These strong, affectionate bonds then become a secure base—an emotional scheme or set of expectations—that will ultimately create the blueprint for future relationships and social competency (Tanyel,2009).

Theoretical Framework

It is commonly believed that a parent with history of childhood maltreatment is at risk of abusing and or neglecting their own child (ren). Consistent evidence has been found for the intergenerational transmission of physical punishment based on social learning models, even after controlling for alternative explanatory models (Lunkenheimer, Kittler, Olson, & Kleinberg, 2006).

The first evidence for the intergenerational transmission of child abuse comes from case histories of families in which abuse has occurred in many generations (Ertem, Leventhal, & Dobbs, 2000). Traumatic experiences are cumulative and if one generation does not heal, problems are transmitted to subsequent generations.

Enhance Family Well-Being and Resilience

Enhance the Well-Being and Resilience of those Working in the System

Partner with Youth and Families

Recommendations

Maximize Physical and Psychological Safety for Children and Families

Identify Trauma-Related Needs of Children and Families

Enhance Child Well-Being and Resilience

Partner with Agencies and Systems that Interact with Children and Families

Proposal for the Department of Child Protection

Continued encouragement of child protective staff to incorporate trauma assessments when working with families(which is done when we assess for well-being).

Advocate for trauma informed services which may help with the decrease of repeated maltreated cases.

Learn about the service providers in the community that offer trauma informed services and partner with them to help the families we service.

Continued training of child protective team on trauma and how it affect the children and families we work with.

References American Psychiatrist Association(APA).

(2013). Diagnostic and Statistical manual of mental disorder. Washington, DC.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390-398.

Craig, C. D., & Sprang, G. (2007). Trauma exposure and child abuse potential: Investigating the Cycle of Violence. American Journal of Orthopsychiatry, 296-305.

Ertem, I. O., Leventhal, J. M., & Dobbs, S. (2000). Intergenerational continuity of child physical abuse: How good is the evidence? The Lancet, 814-819.

Fang, X., & Corso, P. S. (2007). Child maltreatment, youth violence, and intimate partner violence: Developmental relationships. American Journal of Preventive Medicine, 33(4), 281-290.

Frost, J. L., Wortham, S. C., & Reifel, S. (2008). Play and child development. Upper Saddle River, NJ: Merrill Prentice Hall.

References Child Welfare Information Gateway. (2011). Brain/cognitive development. Retrieved from http://www.childwelfare.gov/can/impact/development/brain.cfm Hartnett, M. A., Leathers, S., Falconnier, L., & Testa, M. (1999). Placement stability study. Urbana, IL: Children and Family Research Center.. Lunkenheimer, E. S., Kittler, J. E., Olson, S. L., & Kleinberg, F. (2006). The Intergenerational Transmission of Physical Punishment: Differing Mechanisms in Mothers' and Fathers' Endorsement? Journal of Family Violence, 509-519.

NYC Administration for Children’s Services. Flash Report , March 2015

National Child Traumatic Stress Network, Child Welfare Committee(2011). Birth parents with trauma histories and child welfare system: A guide for child welfare staff. Los Angeles and Durham: National Center for Child Traumatic Stress.

References

Pecora , P. J., Kessler, R. C., Williams, J., O'Brien, K., Downs, A. C., English, D., et al. (2005). Improving family foster care : Findings from the Northwest Foster Care Alumni Study. Seattle: Casey Family Programs.

Raghavan, R., Zima, B. T., Anderson, R. M., Leibowitz, A. A., Schuster, M. A., & Landsverk, J. (2005). Psychotropic medication use in a national probability sample of children in the child welfare system. Journal of Child and Adolescent Psychopharmacology, 15(1), 97-106.

Rubin, D. M., O'Reilly, A. L., Luan, X., Localio, A. R. (2007). The impact of placement stability on behavioral well-being for children in foster care. Pediatrics , 119(2), 336-344.

Tanyel, N. E. (2009). Emotional Regulation: Developing Toddlers' Social Competence. Dimensions of Early Childhood, 10-15.