Transcript Worldforum 2010 Palisades, NY November 2010 Finding and

Welcome to the Webinar

Welcome to Trauma Informed Child Welfare: What Does This Mean for Your
Work. This webinar is scheduled to begin at 12:00 PM Eastern, 11:00 AM
Central, 10:00 AM Mountain and 9:00 AM Pacific. We will begin shortly.

This is a listen only webinar but questions can be asked by typing in the textbox
provided on your screen.

If you have any technical difficulties, go to this link to view solutions to common
connection problems:
http://support.citrixonline.com/en_US/GoToMeeting/help_files/GTM140010?title
=Test+Your+GoToMeeting+Connection

1
The Webinar ID is: 591-244-752
Trauma Informed Child Welfare :
What Does This Mean for Your
Work?
July 23rd, 2013
Julie Collins, MSW, LCSW
Director of Standards for
Practice Excellence, CWLA
2
What we will cover
•
•
•
3
•
•
•
Definition of trauma-informed child welfare
Cover the basics
• Trauma and the types of trauma
• Impact of trauma
• Culture and trauma
• Secondary Traumatic Stress (STS)
What a trauma-informed child welfare system looks
like
Implications for your work
Resources
Q and A
Definition of Trauma-informed

Different definitions but similar key
elements that include the following:
– a basic understanding of how trauma
affects the life of an individual
– understand the vulnerabilities or
triggers of trauma survivors that
traditional service delivery
approaches may exacerbate
– assess what can be done to be more
supportive, build resilience, and avoid
re-traumatization
– using the “Trauma Lens”
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, families, 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.
5
(as defined by the Chadwick Trauma-Informed Systems Project National Advisory
Committee in 2011, Chadwick Trauma-Informed Systems Project, 2013, p. 11).
Essential Elements for Being
Trauma-Informed in Child Welfare







6
Maximize physical and psychological safety for children
and families
Identify trauma-related needs of children and families
Enhancing child well-being and resilience
Enhancing family well-being and resilience
Enhance the well-being and resilience of those working
in the child welfare system.
Partnering with youth and families
Partnering with child-serving agencies and systems
Adapted from NCTSN
What is Child Trauma?
 Witnessing
or experiencing an
event that poses a real or
perceived threat to the life or wellbeing of the child or someone
close to the child.
Adapted from NCTSN
7
Situations that can be Traumatic







8
Child abuse - such as physical, sexual,
emotional abuse
Neglect
Witnessing or experiencing community violence
Death or loss of a loved one
Abandonment, betrayal of trust
Life-threatening natural disasters
Acts or threats of terrorism
Adapted from NCTSN
Situations that can be Traumatic
For Immigrants and Refugees:
• War and persecution
• Displacement from their home
• Flight and migration
• Poverty
• Family/Community Violence
9
Child Traumatic Stress
10

Child traumatic stress refers to the physical and
emotional responses of a child to events that
threaten the life or physical integrity of the child or
of someone critically important to the child (such
as a parent or sibling).

Traumatic events overwhelm a child’s capacity to
cope and elicit feelings of terror, powerlessness,
and out-of-control physiological arousal.
Adapted from NCTSN
Child Traumatic Stress

A child’s response to a traumatic event may
have a profound effect on his or her
perception of self, the world, and the future.

Traumatic events may affect a child’s:
–
–
–
11
Ability to trust others
Sense of personal safety
Effectiveness in navigating life changes
Adapted from NCTSN
Types of Traumas



12
Acute trauma is a single traumatic event that
is limited in time.
Chronic trauma refers to the experience of
multiple traumatic events.
Complex trauma describes both exposure to
chronic trauma—usually caused by adults
entrusted with the child’s care—and the
impact of such exposure on the child.
Adapted from NCTSN
Types of Traumatic Stress


Historical trauma is a personal or historical event or
prolonged experience that continues to have an
impact over several generations.
Neglect as trauma is considered a complex trauma
that has profound effects on nearly every aspect of a
child’s development and functioning.
Adapted from NCTSN
13
Effects of Trauma Exposure
14

Attachment. Children that have been traumatized feel that the
world is uncertain and unpredictable. They can become
socially isolated and can have difficulty relating to and
empathizing with others.

Biology. Children that have been traumatized may experience
problems with movement and sensation, including
hypersensitivity to physical contact and insensitivity to pain.
They may exhibit unexplained physical symptoms and
increased medical problems.

Mood regulation. Children exposed to trauma can have
difficulty regulating their emotions as well as difficulty knowing
and describing their feelings and internal states.
14
Effects of Trauma Exposure cont’d
15

Dissociation. Some children that have been
traumatized experience a feeling of detachment
or depersonalization, as if they are “observing”
something happening to them that is unreal.

Behavioral control. Children that have been
traumatized can show poor impulse control,
self-destructive behavior, and aggression
towards others.
15
Adapted from NCTSN
Effects of Trauma Exposure cont’d

Cognition. Traumatized children can have
problems focusing on and completing tasks,
or planning for and anticipating future events.
–

16
Some exhibit learning difficulties and problems
with language development.
Self-concept. Traumatized children
frequently suffer from disturbed body image,
low self-esteem, shame, and guilt.
Adapted from NCTSN
Effects on the Brain
Permanent changes in neurochemistry that
continue into adulthood can be caused by:
 early trauma
 prolonged separation
 insecure attachment to caregiver(s)
(Van der Kolk, 1987)
17
Emotional/Behavioral Regulation
Regulated
Definition
Maintain Affect, Awareness, Action (3 A’s)
over a usual range of stressors
Dysregulation of Emotion
Definition
Shift in Affect, Awareness, Action (3 A’s)
over usual range of stressors. Shift in Action
does not involve risky/dangerous behavior
Dysregulation of Behavior (and Emotion)
Definition
Shift in Affect, Awareness, Action (3 A’s)
over usual range of stressors. Shift in Action
does involve risky/dangerous behavior
Adapted from Heidi Ellis Trauma Systems Webinar Dec 2012
Why it is Important to Address

If we don’t look for or acknowledge trauma in
the lives of children and adolescents, we end
up chasing behaviors and limiting the
possibilities for change

The behavioral and emotional adaptations
that children who have been maltreated
make in order to survive are brilliant, creative
solutions, and are personally costly.
Childhood Trauma and Other
Diagnosis

Common diagnoses for children in the child welfare system
include:

Reactive Attachment Disorder

Attention Deficit Hyperactivity Disorder

Oppositional Defiant Disorder

Bipolar Disorder

Conduct Disorder

These diagnoses generally do not capture the full extent of the
developmental impact of trauma.

Many children with these diagnoses have a complex trauma
history.
20
Long Term Consequences
of Unaddressed Trauma








Homelessness
Prostitution
Delinquency, violence and criminal behavior
Long-term use of services such as health, behavioral
health, correctional, and social services systems
Inability to sustain employment
Re-victimization
Inability to parent
Inter-generational transmission of abuse
Adapted from NCTSN
21
Variability in Responses to
Stressors and Traumatic Events

The impact of a potentially traumatic event is
determined by:
–
–

22
The objective nature of the event
The child’s subjective response to it
Something that is traumatic for one child may
not be for another
Adapted from NCTSN
Variability in Responses Cont’d
The impact of a potentially traumatic event depends on
several factors, including:
23
–
The child’s age and developmental stage
–
The child’s perception of the danger faced
–
Whether the child was the victim or a witness
–
The child’s relationship to the victim or perpetrator
–
The child’s past experience with trauma
–
Adversities the child faces following trauma
–
Presence/availability of adults who can offer help and protection
Adapted from NCTSN
23
What are Trauma Triggers?





24
This is something that reminds the person of a traumatic
memory. Sometimes referred to as stressors or stimulus
These reminders are not frightening or traumatic.
These are very diverse – could be a person, a smell, a
persons posture, tone of voice, color or type of clothes,
object, a movie or scene from a movie, etc.
These are often very subtle and hard to detect or
anticipate.
The person has an automatic response to the trigger –
could be emotional, physical, mental, behavioral.
Adapted from NCTSN
What are Trauma Triggers?

Often the person is not aware they are being
triggered
–

Often these responses seem irrational
–
–

25
Rather, they just feel the intense response – fight,
flight or freeze arousal, emotional dysregulation
Overreactions
Respond as if happening now
The person can become overwhelmed with
their own response
Adapted from NCTSN
The Influence of Culture on Trauma





26
Social and cultural realities strongly influence children’s risk for – and
experience of – trauma.
Children with minority backgrounds are at increased risk for
trauma exposure and subsequent development of PTSD.
Lesbian, gay, bisexual, transgender, or questioning (LGBTQ)
adolescents contend with violence directed at them in response
to suspicion about or declaration of their sexual orientation and
gender identity.
Immigrant and refugee families often face additional traumas
and stressors, especially when they are undocumented.
Children’s, families’ and communities’ responses to trauma
Adapted from NCTSN
The Influence of Culture cont’d




Varied trauma response by culture
Necessity to respond to trauma is universal in terms
of the physiological and the social responses
Strong cultural identity and community/family
connections can enhance a child’s resiliency
Cultural beliefs and values can help or hinder in
regard to the child’s reaction to trauma
–
27
For example, shame is a culturally universal response to
child sexual abuse, but the victim’s experience of shame
and the way it is handle
Adapted from NCTSN
Historical Trauma



Collective and cumulative emotional
wounding across generations.
Cumulative exposure to traumatic events that
not only affects an individual but continues to
affect subsequent generations.
The trauma is psychological injury held
personally and transmitted over generations.
Adapted from NCTSN
28
Historical Trauma cont’d


29
Cultural trauma: an attack on the fabric of a
society, affecting the essence of the
community and its members.
Multigenerational/Intergenerational trauma:
occurs when trauma is not resolved,
subsequently internalized, and passed from
one generation to the next.
Adapted from NCTSN
Impact of Historical Trauma
30
Definition: The collective emotional and psychological injury both
over the life span and across generations, resulting from a
cataclysmic history of genocide Dr. Maria Yellow Horse Brave Heart
 Effects: Unsettled trauma, Increase of child abuse and domestic
violence
 Coping Strategies
– Psychological - Depression
 Suicide: 2x National rate
– Behavioral - Alcohol
 5.5x National rate
– Medical - Heart disease
 2x National rate
http://www.opi.mt.gov/pdf/indianed/Ottenbacher.pdf
Resiliency: Coping and Protective
Factors (Cook, Blaustein, Spinazzola, Van der Kolk, 2003)
Parental and social support are key mediating
factors in determining adaptation to
victimization



31
Believing and validating child’s experience
Tolerating child’s affect
Managing your own emotional response
Resiliency: Coping and Protective
Factors Cont’d
Other Protective Factors
 Positive attachments and connections to
emotionally supportive adults
 Cognitive and self regulation abilities
 Positive belief about oneself
 Intelligence
 Disposition/temperament
 External attributions of blame
32
What is Secondary
Traumatic Stress?
33
Secondary Traumatic Stress
(STS)


Results from exposure to trauma experienced by
others, often in the workplace
STS symptoms are often indistinguishable from
those experienced directly as a response to trauma
–
–
–
–

34
Re-experiencing
Avoidance
Hyperarousal
Distress and impairment
STS is often described as an occupational hazard
Other terms used for STS



35
Compassion Fatigue – conceptually identical to
STS – seen as a less stigmatizing term
Vicarious Traumatization – transformation of inner
experience of the therapist that comes about as a
result of empathic engagement with traumatic
material
Burnout – prolonged response to chronic emotional
and interpersonal stressors on the job, determined
by the dimensions of exhaustion, cynicism, and
inefficacy.
http://www.cehd.umn.edu/ssw/cascw/events/SecondaryTrauma/PDFs/BrianBride_PPT.pdf
Burnout vs. STS/VT/CF
Burnout



36
Related to the work
environment
Extends to work with
any difficult population
Workload and
institutional stress are
the precipitating
factors
STS



Related to the work
environment
Extends to work with
traumatized populations
Exposure to traumatic
material is the
precipitating factor
http://www.cehd.umn.edu/ssw/cascw/events/SecondaryTrauma/
PDFs/BrianBride_PPT.pdf
Prevalence of STS

Summary of studies show:
–
–
–
37
Most service providers
 experience some symptoms of STS
 have low levels of STS
Significant amount of service providers have
relatively high levels of STS
CHILD WELFARE = the highest rates of
STS
http://www.cehd.umn.edu/ssw/cascw/events/SecondaryTrauma/
PDFs/BrianBride_PPT.pdf
Impact of STS on Staff
Cognitive
effects
Social impact
• Negative bias,
pessimism
• All-or-nothing
thinking
• Loss of perspective
and critical thinking
skills
• Threat focus – see
clients, peers,
supervisor as
enemy
• Decreased selfmonitoring
• Reduction in
collaboration
• Withdrawal and
loss of social
support
• Factionalism
Emotional
impact
• Helplessness
• Hopelessness
• Feeling
overwhelmed
Adapted from 2012 CWLA STS Supersession presentation by
NCTSN
Physical impact
• Headaches
• Tense muscles
• Stomachaches
• Fatigue/sleep
difficulties
System-Level Impact
Distrust
among
colleagues,
supervisors
Impact on
ability to
assess safety
and risk
Decreased
motivation,
increased
absenteeism
Increased
attrition,
poor child
welfare
outcomes
Challenges
managing
clients’
trauma
reactions
Lack of
psychological
safety
Adapted from 2012 CWLA STS Supersession presentation by
NCTSN
What about Supervisors?



40
Not much focus has been given to studying the impact
of STS on this group
Studies of child welfare workers where they showed
lower levels of STS - supervisors were a mediating
factor. Workers reported supervisors used a more
action-oriented approach, offered to help address
problems and provided visible ongoing support
While supervisors can be helpful in minimizing STS
for workers they too need the supports to minimize
STS for them.
http://www.cehd.umn.edu/ssw/cascw/attributes/PDF/publications/CW360_2012.pdf
Essential Elements for Being
Trauma-Informed in Child Welfare







41
Maximize physical and psychological safety for children
and families
Identify trauma-related needs of children and families
Enhancing child well-being and resilience
Enhancing family well-being and resilience
Enhance the well-being and resilience of those working
in the child welfare system.
Partnering with youth and families
Partnering with child-serving agencies and systems
Adapted from NCTSN
Implications for Your Work

Use the trauma lens in your CRP work
–
–
–

42
Reviews
Recommendations
Advocacy
Pay attention to and address STS for CRP
members
Resources




43
http://www.nctsn.org/resources/topics/childwelfare-system
http://surveygizmolibrary.s3.amazonaws.com/libra
ry/113599/TICWAdminGuide2ndEdMarch2013ele
ctronic.pdf
http://surveygizmolibrary.s3.amazonaws.com/libra
ry/113599/GuidelinesApplyingTraumaLens1.pdf
www.cachildwelfareclearinghouse.org
Resources




44
http://www.nctsn.org/sites/default/files/assets/p
dfs/sparcs_cultural.pdf
http://www.nctsnet.org/sites/default/files/assets/
pdfs/age_related_reactions_to_a_traumatic_ev
ent.pdf
http://www.cdc.gov/ace/findings.htm
http://www.childwelfare.gov
A Trauma Survivor
“If I could ask for anything, it would
be for you to listen and be kind.”
45
Contact Information

46
Julie Collins
Director of Standards for Practice
Excellence CWLA
Phone: 202-688-4155
Email: [email protected]