Trauma Informed Practice: Supporting Children, Youth and Families Impacted by Abuse and Neglect

WHY IT MATTERS

While moderate, short-lived stress responses can promote growth, “toxic stress” is the strong, unrelieved activation of the individual’s stress management system in the absence of protective adult support.

Children involved in the child welfare system have been exposed to traumatic situations. Many have developed neurologically in the context of ongoing instability, danger, and lack of attachment. Additionally, systems-imposed stressors, such as removal from the home, can compound pre-existing stressors and re-traumatize children who already may be carrying significant burdens. Learning how to cope with adversity is an important part of healthy development. While moderate, short-lived stress responses can promote growth, toxic stress is the strong, unrelieved activation of the individual’s stress management system in the absence of protective adult support. Without caring adults and targeted interventions to mitigate the effect of these experiences for children, the unrelenting stress caused by extreme poverty, neglect, abuse or severe maternal depression can weaken the architecture of the developing brain, with long-term consequences for learning, behavior and both physical and mental health.1

Untreated adverse childhood events (ACES) worsen over time if they aren’t addressed. Undiagnosed and untreated complex trauma can manifest in symptoms and behaviors that parallel Attention Deficit Hyperactivity Disorder and Oppositional Defiance Disorder. Children are often labeled with these diagnoses and inappropriately medicated. Untreated trauma in adolescence for example, has been shown to manifest itself in destructive ways. Adolescents with multiple adverse early childhood events are more likely to find themselves placed in juvenile facilities, more likely to have mental health and substance abuse challenges and more likely to be behind the academic curve.2 Untreated adverse early childhood events increase the likelihood that as an adult, individuals will experience a number of physical and mental health issues including psychiatric problems, drug and alcohol addiction, criminal involvement, heart disease, adult onset diabetes and even early death.3

Systems that are trauma informed are better prepared to help the children and families they serve, and staff and volunteers are better able to recognize their own vulnerability to secondary trauma. According to the U.S. Department of Health and Human Services4, service improvements as a result of becoming trauma-informed include more children receiving trauma-informed screening, assessment, and evidence-based treatments, which may impact outcomes, such as: fewer children requiring crisis services; decreased use of psychotropic medications; fewer foster home placements, disruptions, and reentries; reduced length of stay in out-of-home care; and improved child functioning and increased well-being. While these recommendations are directed to child welfare systems, all systems that engage with vulnerable children and families should strive to become trauma informed. CASA programs and their volunteers often find themselves on the “front line” with children and families who have and are experiencing trauma. Being equipped with the knowledge, skills and strategies to engage productively with these challenging circumstances is critical. Lastly, being trauma informed means having the ability to recognize when you or your staff and volunteers are being impacted by secondary trauma and how to manage possible burn-out.

Trauma Defined

According to the National Child Traumatic Stress Network, trauma is defined as, “extreme events that are threatening to physical safety or bodily integrity of oneself or loved one.” Acute trauma is a single event that is limited in time such as a car crash or a terrorist attack. Chronic trauma refers to multiple traumatic events occurring over time. Complex trauma is the exposure to a traumatic event and the subsequent development of a trauma reaction. Complex trauma can also be magnified by the trauma having been perpetrated or abetted by caregivers charged with protecting and caring for a child. A trauma reaction is a response to a traumatic event, which leaves the person feeling terrified and powerless to respond. When this reaction becomes generalized to other situations, their normal response to danger becomes overwhelmed. Their response to this perceived danger is to first flee to avoid the situation, and if that’s not possible the fight reaction is implemented in self-defense. The last reaction is a freeze response – a type of neurological collapse or playing dead to stay alive.

ADVOCATES IN ACTION

Trauma can affect children’s brains, bodies, behavior, and ways of thinking — It can also be treated.

  • Become trauma informed by participating in training and ongoing educational opportunities. This topic is a fast growing one with new information coming to light every day. Encourage your CASA program to host regular trainings that cover all the different facets of trauma including: the neurobiology of trauma, toxic stress, resilience, historical trauma, and executive functioning and compassion fatigue.
  • Learn how the systems that interconnect with the children and families you serve are trauma informed. Encourage cross-systems integration of trauma informed practices and capacity building efforts. Responding to trauma in a uniformed way will help families and children and it will relieve the burden of one system/agency taking it on by themselves.
  • Ask if child welfare professionals are using trauma informed screening and assessments for children who come to the attention of child welfare agencies. Encourage their use as both an initial assessment and as an intervention planning tool.
  • Encourage and ensure that there is an array of evidence-based, trauma-informed treatments for children and families.
  • Ask how your program knows if it is trauma informed? What actions, policies, and outcomes can support the claim that your program is trauma informed?
  • Check to see if you’re local CASA program has policies and practice models to ensure alignment with trauma-informed care. Let staff at National CASA know if you need help putting these things in place.
  • Recognize when you are starting to feel the impacts of secondary trauma or burn-out. Let your supervisor or other colleagues know how you are feeling. Take time to care for yourself and each other. Remember that the work you do every day is incredibly important and can also be incredibly demanding and draining. Taking time to recharge will help you and the children and families you support.

BRIGHT SPOT

Courthouse Facility Dogs CASA of Chaves County New Mexico  

Anna, 14, wanted to be in court to talk to the judge but was terrified of her drug addicted, physically abusive mother, who would also be present.  Anna had panic attacks before previous hearings and could never walk in the courtroom. So Emma, a Golden Retriever facility dog met Anna several times before her court date to provide her with support and comfort through the process.  Emma then accompanied Anna to her hearing.  Anna was able to speak to the judge regarding her concerns, holding Emma’s leash throughout the process. Anna was empowered to speak up about her abuse and her placement choices.

As more information comes out about the devastating impact of trauma on children, there is increased recognition that coming to court for a hearing can be re-traumatizing for many children. A growing number of judges and personnel recognize the need to provide a safe and secure environment in their courtrooms for victims of abuse and neglect. One successful intervention has been the use of “facility dogs.” Courthouse facility dogs are professionally trained dogs whose purpose is to provide emotional support to victims, witnesses and children.  To date, there are now over 180 facility dogs working in 35 states and in Chile and Canada in a program called Courthouse Facility Dogs.

In 2010, members of the New Mexico Children’s Justice Act advisory group learned about the use of facility dogs in the courtroom and realized how helpful they could be to promoting trauma informed practices by providing vulnerable children and families with supports in a “manner that limits additional trauma to victims.” These specially trained dogs (and their handlers) help children and youth impacted by trauma in a variety of ways: in forensic interviews, in supervised visitations, transition to new homes, in court and more. Programs such as Chaves County CASA, now employ five working facility dogs. This program and others like it have paved the way for other CASA/GAL programs to apply for a facility dog. Currently there are CASA/GAL facility dog programs in:

  • Osceola County GAL, Florida
  • Guardian ad Litem Program of Hillsborough County Florida
  • Monroe County CASA, Bloomington, Indiana
  • Delaware County CASA Program, Muncie, Indiana
  • Elkhart County CASA Program, Elkhart, Indiana
  • Albuquerque CASA New Mexico
  • CASA of Chaves County New Mexico
  • Williamson County CASA Tennessee
  • CASA of Titus, Camp and Morris Counties Texas
  • CASA of Lea County New Mexico

 

The mission of the Courthouse Dogs Foundation is “to promote justice with compassion through the use of professionally trained facility dogs to provide emotional support to everyone in the justice system.” Founded as a 501 (c)(3) nonprofit organization, staff educate members of the legal profession and the public about the use of facility dogs, along with supporting assistance dog organizations, and promoting scientific research in this field. A facility dog is a professionally trained assistance dog. While there are many different types of assistance dogs, a facility dog works alongside a professional in a service capacity to assist people. When speaking to the experts in this area, it is important to note that these dogs are different from “therapy” dogs who are not qualified to work in this professional level. Facility dogs are highly trained and bred for this specific purpose. Since 80% or so of a dog’s temperament is due to their genetic makeup, the breeding of assistance dogs is one of art and science. Just as children have sensitive periods of development, so do dogs and it is important that their “training” begins as soon as they are born.  

However, while it is understood that the dogs need to be specially trained for their role, so do their handlers. Consequently, handlers of facility dogs need training to be trauma-informed so that they do not say or do anything that will re-traumatize or victimize the very individuals that benefit from having the dogs present. In this regard, having a program like Courthouse Dogs means more opportunity to educate and train others about trauma informed practices and how and why facility dogs can help mitigate a child’s trauma and enhance their resiliency.

For more information contact training@casaforchildren.org

To learn more:  https://courthousedogs.org/dogs/dogs-at-work/casa-programs/

SELECTED RESOURCES

Child Welfare Information Gateway, Developing a Trauma-Informed Child Welfare System 6

The issue brief provides and overview of  trauma and its effects, and discusses some of the primary areas of consideration in the assessment and planning process, including workforce development, screening and assessment, data systems, evidence-based and evidence-informed treatments, and funding.

Child Welfare Information Gateway, Treatment for Traumatized Children, Youth and Families 7

This web site identifies evidence-based resources to help professionals identify and implement treatment programs to meet the needs of children, youth, and families affected by trauma.

Georgetown National Technical Assistance Center for Children’s Mental Health, Trauma Informed Care: Perspectives and Resources – A comprehensive web-based, video-enhanced resource tool 8

This tool is comprised of issue briefs, video interviews, and resource lists designed to tell a story of implementation of trauma-informed services and provide guidance and resources to support leaders on their implementation journey.

National Center on Substance Abuse and Child Welfare, Trauma Informed Care 9

This resource provides strategies for systems and agencies that work with children and families for avoiding triggering or unintentional re-traumatization for both parents and children.  They state, “In a trauma-informed organization, every part of the organization – from management to service delivery – has an understanding of how trauma affects the life of an individual.”

The National Child Traumatic Stress Network, Trauma Assessments 10

This site contains a comprehensive list of evidence-based trauma assessments and checklists for children 0-18 years of age.

US Department of Health & Human Services, Guide to Trauma-Informed Human Services 11

The Administration for Children and Families, the Substance Abuse and Mental Health Services Administrations, the Administration for Community Living, the Offices of the Assistant Secretary for Health and the Assistant Secretary for Planning and Evaluation at HHS co-created this guide as a “road map” to relevant trauma-informed strategies and resources.

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