Transcript The nuts and bolts of trauma-informed care in an integrated

Erika McElroy, Ph.D.
Associate Director of Behavioral Health Services
Kempe Center for the Prevention and Treatment of Child Abuse and Neglect
University of Colorado
Objectives
Learners will be able to define basic
understanding of trauma-informed
integrated healthcare
 Learners will be able to identify one way
in which trauma can impact child
development
 Learners will understand the impact that
child maltreatment has on psychosocial
functioning, and identify one intervention
for use in their practice

Types of traumatic experiences
Child abuse
 Child neglect
 Domestic violence
 Dog bites
 Car accidents
 School and community violence
 Other examples?

AAP Definition
“A trauma informed practice is defined as
an organizational structure and treatment
framework that involves understanding,
recognizing, and responding to the effects
of all types of trauma.
 Trauma Informed Practice emphasizes
physical, psychological and emotional
safety for patients, providers, and helps
survivors rebuild a sense of control and
empowerment.”

NCTSN Definition

“A trauma-informed system is one in which all
parties involved recognize and respond to the
impact of traumatic stress on those who have
contact with the system including children,
caregivers, and service providers. The system
infuses and sustains trauma awareness,
knowledge, and skills into their organizational
cultures, practices, and policies. They act in
collaboration with all those who are involved with
the child, using the best available science, to
facilitate and support the recovery and resiliency
of the child and family.”
NCTSN Definition (cont.)
A service system with a trauma-informed perspective is one in which
programs, agencies, and service providers:
 (1) routinely screen for trauma exposure and related symptoms;
 (2) use culturally appropriate evidence-based assessment and
treatment for traumatic stress and associated mental health
symptoms;
 (3) make resources available to children, families, and providers on
trauma exposure, its impact, and treatment;
 (4) engage in efforts to strengthen the resilience and protective
factors of children and families impacted by and vulnerable to
trauma;
 (5) address parent and caregiver trauma and its impact on the
family system;
 (6) emphasize continuity of care and collaboration across childservice systems;
 (7) maintain an environment of care for staff that addresses,
minimizes, and treats secondary traumatic stress, and that
increases staff resilience.
Is Your SBHC a
Trauma-Informed System?
Behavioral
Health
DDHS
Legal
School
Family
Child
Medical/
Dental
Law
Enforcement
Trauma & Child Development
Impact of Trauma on Physical
Development
Fight or flight response can be constant
 Brain abnormalities

 Brain becomes wired to be hypervigilant
 Brain can misread environmental cues

Challenges with self-regulation that can
become chronic
Impact of Trauma on Mental
Health Development
Depression
 Anxiety
 PTSD
 Aggression
 School problems
 Sleeping and eating dysregulation

Impact of Trauma on
Social/Emotional Development
Poor attachment with caregivers
 Poor socialization
 Poor self-efficacy

Child Maltreatment

Acts of Commission (Child Abuse)
 Physical Abuse
 Sexual Abuse
 Emotional Abuse/Psychological
Maltreatment
Child Maltreatment

Acts of Omission (Child Neglect)
 Physical neglect
 Emotional neglect
 Medical neglect
 Educational neglect
 Inadequate supervision
 Exposure to violent environments
Consequences of Child
Maltreatment in children


Disruptions in attachment, behavior, social skills,
emotional and psychological functioning
Children in foster care
 Large percentage have a diagnosable emotional disorder
and/or a substance abuse problem
 Nearly a third have severe behavioral, emotional, or
developmental problems
 Many suffer from posttraumatic stress disorder (PTSD)

Maltreated children may have learning disorders
requiring special education more than other children
Adverse Childhood Experiences
(ACE)


The ACE study was conducted on more than 17,000
adults in the 1990’s who were undergoing a
comprehensive physical examination and chose to
provide information about childhood experience of
abuse, neglect, and family dysfunction
Seven categories of ACE: psychological, physical, or
sexual abuse; violence against mother; or living with
household members who were substance abusers,
mentally ill or suicidal, or ever imprisoned
Impact of Adverse childhood
experiences on adults
Examples of health outcomes
Health quality of life
 Chronic obstructive pulmonary disease (COPD)
 Liver Disease
 Ischemic heart disease
 Smoking, including early initiation of smoking
 Adolescent pregnancy
 Severe obesity

Impact of Adverse childhood
experiences on adults
Examples of mental/behavioral health
outcomes
Sleep difficulties
 Depression
 Suicide attempts
 Risk for intimate partner violence
 Substance Use
 Alcoholism and alcohol abuse
 Illicit drug use

Protective Factors for Child
Maltreatment
According to the CDC, protective factors buffer children
from being abused or neglected.
There is scientific evidence to support the following
protective factors:
 Supportive family environment
 Supportive social networks
Community Protective Factors
 Communities that support parents and take responsibility for
preventing abuse
Protective Factors for Child
Maltreatment
Research is ongoing to determine whether the following family
factors buffer children from maltreatment
 Nurturing parenting skills
 Stable family relationships
 Household rules and child monitoring
 Parental employment
 Adequate housing
 Access to health care and social services
 Caring adults outside the family who can serve as role models or
mentors
Take- Away
Tools
Strengths and Protective Factors
Very often there is too much of a focus
on pathology – how the trauma
“damaged” a child/family
 What does the family do well?
 What supports do they have in place?

Our Wellness & Health
Service professionals need to be a
priority too!
 Secondary Trauma/Vicarious
Trauma/Burnout
 What is one thing currently in place in
your SBHC that supports wellness,
health and positivity?

On-Line Resources & Training
American Academy of Pediatrics:
www.aap.org
 International Society for Traumatic
Stress Studies: www.istss.org
 Centers for Disease Control and
Prevention: www.cdc.org
 National Child Traumatic Stress
Network: www.nctsn.org
