Transcript Engaging Fathers in Child Welfare Cases

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Polyvictimization and Child Trauma:
Identifying and Addressing Client Needs
Howard Davidson, JD
[email protected]
Lisa Conradi, PsyD
[email protected]
Lisa Pilnik, JD, MS
[email protected]
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Presentation Agenda
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Background on Polyvictimization
Child Trauma Causes and Symptoms
Screening Tools and Interventions
Practice Tips for Attorneys
Additional Resources
Questions?
The materials in this presentation is for informational purposes only and is not meant to
constitute legal advice. Please consult an attorney for opinions regarding specific facts, cases or
legal issues.
National Survey of
Children’s Exposure to Violence
“Children’s exposure to violence, whether as
victims or witnesses, is often associated with
long-term physical, psychological, and
emotional harm. Children exposed to violence
are also at a higher risk of engaging in criminal
behavior later in life and becoming part of a
cycle of violence.”
Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., and Kracke, K. 2009. Children’s
Exposure to Violence: A Comprehensive National Survey. Bulletin. U.S. Department
of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency
Prevention
• Children exposed to violence are more likely to
abuse drugs and alcohol; suffer from depression,
anxiety, and post-traumatic disorders; fail or
have difficulty in school; and become delinquent
and engage in criminal behavior.
• 60 percent of American children were exposed
to violence, crime, or abuse in their homes,
schools, and communities.
• Almost 40 percent of American children were direct
victims of two or more violent acts, and one in ten were
victims of violence five or more times.
• Children are more likely to be exposed to violence and
crime than adults.
• Almost 15 percent of children experienced an assault
with a weapon and were injured as a result.
• Almost 1 in 10 American children saw one family
member assault another family member, and more than
25 percent had been exposed to family violence during
their life.
• 10 percent suffered some form of child maltreatment.
• A child’s exposure to one type of violence increases the
likelihood that the child will be exposed to other types of
violence and exposed multiple times.
Advocating for Victimized Youth
• preventing further victimization and trauma;
• treating the underlying child and family
vulnerabilities
• broadening what child protective and child
welfare services agencies should be providing to
these children; and
• advocacy for building the supervision and
protective capabilities of those adults who are, or
will be, caring for them.
Recommendations
• Every child advocacy legal training should now be
including a section on recognizing and responding to
traumatized children, regardless of what part of the
juvenile court they’re involved in.
• Look at childhood victimization more broadly –
how to identify and address it – even if it appears
unrelated to the incident that brought the child client
before the court.
• Court appointed child advocates should be more aware
of their clients’ victimization and trauma history
-- and most importantly how they can effectively
advocate for services their clients need to address the
adverse consequences of that history.
What does the word “trauma”
mean?
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A traumatic experience . . .
 Threatens the life or physical integrity of a
child or of someone important to that
child (parent, grandparent, sibling)
 Causes an overwhelming sense of terror,
helplessness, and horror
 Produces intense physical effects such as
pounding heart, rapid breathing, trembling,
dizziness, or loss of bladder or bowel control
Types of Trauma
Acute trauma:
A single event that lasts for a limited time
Chronic trauma:
The experience of multiple traumatic events, often
over a long period of time
Complex trauma is used to describe a specific kind of
chronic trauma and its effects on children:
 Multiple traumatic events that begin at a very
young age
 Caused by adults who should have been caring for
and protecting the child
How Children Respond to Trauma
Long-term trauma can interfere with healthy
development and affect a child’s:
 Ability to trust others
 Sense of personal safety
 Ability to manage emotions
 Ability to navigate and adjust to life’s changes
 Physical and emotional responses to stress
How Children Respond to Trauma
(Continued)
A child’s reactions to trauma will vary depending on:
• Age and developmental stage
• Temperament
• Perception of the danger faced
• Trauma history (cumulative effects)
• Adversities faced following the trauma
• Availability of adults who can offer help,
reassurance, and protection
Long-Term Effects of Childhood Trauma
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In the absence of more positive coping strategies,
children who have experienced trauma may engage in
high-risk or destructive coping behaviors.
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These behaviors place them at risk for a range of serious
mental and physical health problems, including:
▫ Alcoholism
▫ Drug abuse
▫ Depression
▫ Suicide attempts
▫ Sexually transmitted diseases (due to high risk activity with multiple
partners)
▫ Heart disease, cancer, chronic lung disease, skeletal fractures, and
liver disease
Source: Felitti et al. (1998). Am J Prev Med;14(4):245-258.
The Adverse Childhood
Experiences Study (ACE)
Trauma and Behavior Problems in
Children
• Children who have been traumatized stay in
chronic states of fear and anxiety leading to
hypervigilance and a heightened sense of threat
• Traumatized children often misinterpret the
behavior of others as hostile and respond with
aggression
• Past victimization can lead to survival strategies
that are often anti-social and/or self-destructive
• Adolescents may respond to their experience
through dangerous reenactment behavior or
recklessness.
Common Diagnoses
• Some common diagnoses for children experiencing
traumatic stress include:
▫ Posttraumatic Stress Disorder
▫ Reactive Attachment Disorder
▫ Attention Deficit Hyperactivity Disorder
▫ Oppositional Defiant Disorder
▫ Bipolar Disorder
▫ Substance Abuse
▫ 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.
How does trauma  Acting out?
Victimization
Survival Coping
Victim Coping
Loss of personal
integrity and
control
Dysregulation of
emotions and
info processing;
Rigid, distrustful,
callous on outside;
Damaged, hopeless,
empty inside
Taking any means
necessary to avoid
revictimization;
Loss of empathy and
impulse control;
Diminished sense of
future
Defiance as a desperate attempt to redress injustice
and regain sense of control (Ford, Chapman, Mack, & Pearson,
2006)
Screening and
Assessment
Psychological
Evaluation
*Designed to answer a specific referral
question
Trauma Assessment
*If a child has a history of trauma and is
currently displaying trauma symptoms,
referral for a trauma mental health
assessment is warranted
Trauma Screening
*Universally administered to
determine a child’s trauma history and
related symptoms
Trauma Screening
• Trauma-informed screening refers to a brief,
focused inquiry to determine whether an individual
has experienced specific traumatic events or
reactions to trauma and if they need traumafocused mental health treatment.
• Done by front-line workers, such as Child Welfare
and, in some cases, mental health.
• Usually includes questions regarding a child’s
exposure to trauma and his/her symptoms
Trauma-Informed Assessment
• Trauma assessment is a more in-depth exploration of
the nature and severity of the traumatic events, the
impact of those events, current trauma-related symptoms
and functional impairment.
• Usually done by a mental health provider to drive
treatment planning.
• A good trauma assessment usually occurs over at least 2-3
sessions of therapy and includes a clinical interview, use of
objective measures, behavioral observations of the child,
and collateral contacts with family, caseworkers, etc.
• Domains covered include:
▫ Basic demographics
▫ Family history
▫ Trauma history (comprehensive, including events experienced
or witnessed)
▫ Developmental history
▫ Overview of child problems/symptoms.
Who Needs Trauma-Focused
Treatment?
• Children who have experienced extreme trauma, such as a
penetrating injury (gun shoot, stabbing, etc) or sexual
assault
• Children who are “re-experiencing” the traumatic events
in their nightmares, in flashbacks, repetitive play, or those
who react strongly to reminders of their trauma
• Children who are actively avoiding reminders (people,
places, sounds, smells, etc) of the trauma
What are the Core Components of
Evidence-Based Trauma
Treatment?
• Building a strong therapeutic relationship
• Psycho-education about normal responses to
trauma
• Parent support, conjoint therapy, or parent
training
• Emotional expression and regulation skills
• Anxiety management and relaxation skills
• Cognitive processing or reframing
Core Components of
Trauma-Focused Treatment,
cont’d
• Opportunity for trauma integration
• Strategies that allow exposure to traumatic
memories and feelings in tolerable doses so that
they can be mastered and integrated into the child’s
experience
• Personal safety training and other important
empowerment activities
• Resilience and closure
How Do These Core Components
Fit Together to Create EvidenceBased Practices?
Treatment Triage: Examples of
Evidence-Based Treatments for
Children
• Trauma-Focused Cognitive Behavioral Therapy
(TF-CBT)
• Child-Parent Psychotherapy (CPP)
• See www.cebc4cw.org for more information on
other modalities that exist
• There are many different evidence-based trauma-focused
treatments. A trauma-informed mental health professional
should be able to determine which treatment is most
appropriate for a given case.
Practice Tips
• Ensure children and youth receive appropriate
screenings, assessments and treatments for
traumatic stress as appropriate
• Ask about follow-up and request that ongoing
assessments, where appropriate.
• Request that parents and caregivers receive
services as well, when appropriate.
Practice Tips (cont.)
• Ensure that biological and foster families learn
about the effects of victimization and warning
signs for dangerous symptoms of traumatic
stress.
• Help youth stay in the least restrictive setting
possible. (e.g., their own homes, when safe and
possible, or therapeutic or family foster homes,
rather than group facilities, when necessary).
Practice Tips (cont.)
• Help build long-term sustaining relationships
(e.g., connecting youth to mentoring
organizations or faith-based groups, supporting
relationships with extended family members)
• Ensure the child or youth is both physically and
psychologically safe (e.g., working with a
provider who is respectful, non-judgmental, and
allows the youth to explore his/her history in a
safe and supportive manner)
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New Resources Coming Soon
Resources being developed by the Safe Start Center,
ABA Center on Children and the Law and Child & Family Policy Associates
• Issue Brief on Trauma Informed Legal Advocacy
• Identification Tool and Resource Guide on
Polyvictimization and Trauma among CourtInvolved Youth
Will be available at www.safestartcenter.org
or e-mail [email protected] to receive when available
Issue Brief:
Trauma-Informed Advocacy
• Part of Safe Start Center’s “Moving from
Evidence to Action” series
• Prevalence and impact of exposure to violence
• Symptoms of traumatic stress
• Evidence-based assessments and interventions
• Practice tips for attorneys and others
• State/local initiatives
• Special considerations/ethical issues
• Policy recommendations
Identification Tool and Resource Guide
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“Information Integration Tool”
Questions about experiences and symptoms
No “score”  Flowchart on referrals for services
Guidance on how to use the tool, understanding
child trauma, policy/practice considerations
• Resources on prevalence/impact, traumafocused assessments and intervention, and
trauma-informed advocacy
Other Resources
Polyvictimization: Children’s exposure to multiple types of
violence, crime, and abuse
www.unh.edu/ccrc/pdf/jvq/Polyvictimization%20OJJDP%20bulletin.
pdf
Understanding Children's Exposure to Violence
http://safestartcenter.org/pdf/IssueBrief1_UNDERSTANDING.pdf
National Child Traumatic Stress Network Child welfare
trauma training toolkit
www.nctsn.org/products/child-welfare-trauma-training-toolkit-2008
Other Resources cont.
Birth parents with trauma histories and the child welfare
system: A guide for judges and attorneys
www.nctsn.org/sites/default/files/assets/pdfs/birth_parents_trauma
_guide_judges_final.pdf
CAC directors’ guide to mental health services for abused
children
www.nctsnet.org/sites/default/files/assets/pdfs/CAC_Directors_Guid
e_Final.pdf
Healing invisible wounds: Why investing in traumainformed care for children makes sense
www.justicepolicy.org/images/upload/1007_REP_HealingInvisibleWounds_JJ-PS.pdf
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Questions?
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Contact
• Howard Davidson, JD
ABA Center on Children and the Law
[email protected]
• Lisa Conradi, PsyD
Chadwick Center/Rady Children’s Hospital
[email protected]
• Lisa Pilnik, JD, MS
Child & Family Policy Associates
[email protected]