This issue of CBX highlights how trauma-informed approaches can help to mitigate the effects of the adverse experiences children involved with child welfare often face. Read a message from Jerry Milner, Associate Commissioner of the Children's Bureau, and David Kelly, special assistant to the Associate Commissioner, that emphasizes the importance of strengthening families and making sure they have the supports they need during times of adversity to help prevent trauma. The issue also includes a variety of resources and publications for professionals and families related to trauma-informed care and adverse childhood experiences.
- Preventing Adverse Experiences in Child Welfare
Written by Jerry Milner and David Kelly
As a field, when we most commonly think about and discuss trauma-informed care, we usually think in terms of adverse experiences that have already occurred. We are trained on how to recognize trauma and how to provide clinical interventions to parents and children who have experienced trauma at some point in their lives. This approach of looking back to understand how to move forward has helped us to become more conscientious and effective in working with individuals who have experienced trauma so that we are less likely to compound it. Such efforts have helped us make some progress in developing more effective ways to serve and support people who have experienced adversities and the trauma that so often follows.
All of this is helpful, and all such efforts are clearly relevant to our work in child welfare.
However, we should be equally, if not more, committed to thinking about how we can be proactive in going after the sources of trauma and adversity to prevent them from happening in the first place. We can apply our knowledge about prevalent causes of adversity and trauma that lead children and families to the child welfare system and organize ourselves with strength of purpose to address those causes.
A truly trauma-informed system should be one that looks forward to preventing trauma as well as looks backward at trauma that has already occurred.
Screening and scoring adverse childhood experiences (ACEs) is an area that receives considerable energy in the field. We know that the ACEs scores for many, if not most, of the parents and children that make contact with child welfare are likely to be high. While some ACEs are beyond the scope of child welfare and may be unavoidable (e.g., the death of a parent), many are brought about by the lack of protective capacities of parents in caring for their children.
When we, as a broad child and family serving system—not only the child welfare agencies—work together to create environments and conditions where families can thrive and children are free from harm, we work in support of building and strengthening protective capacities. And when we strengthen the protective capacities of parents, we create the potential for fewer ACEs in the lives of children that require "fixing" through clinical interventions.
For example, when we universally link parents and newborn infants with home visiting programs from the beginning, we have incredible opportunities to help those children avoid traumatic experiences and enable parents to not be unduly affected by their own adversity. When we make community-based family resource centers available to all families in a community, we have opportunities to support them before avoidable traumatic events overtake them. But when we remove children from their families—even when necessary for safety reasons—we often create additional adversity that is compounded when children move from home to home and remain in care for extended periods of time. Inadequate parent-child contact while a child is in out-of-home placement is an additional source of adversity and trauma, as is emancipating after years of foster care without the connections, relationships, and skills to make it in the world. These things may not be officially on the list of ACEs, but they comprise sources of avoidable trauma for so many in the child welfare system. We have to go on the offensive against the sources of adversity and trauma if we expect to have a true trauma-informed or trauma-oriented system.
Over the past 2 years, we have visited family resource centers, family enrichment centers, and family support centers in multiple states and have seen the range of supports they provide families. We have heard directly from families that speak to how these community resources have helped them in times of need to remain healthy, enhance their skills, and decrease their social isolation.
We have also had the pleasure to go on home visits with visiting programs and watched as young mothers asked questions and received support in their own homes. We have witnessed the strength of relationships between visitors, like Summer in Albany and Faith in South Carolina, and young parents trying to raise their children safely.
Until we organize around and commit to strengthening families—all families—to gain resiliency and the protective capacity needed to care for their children safely as well as provide families with the supports they need to make it through difficult times, adversity, trauma, and ACEs scores will continue to be high. If we are serious about being trauma informed, we have to be serious about reducing adversity in the first place not just scoring and trying to fix it after it has happened.
- Adverse Childhood Experiences: The Time for Prevention Is Now so Every Child Can Thrive
Written by Christopher M. Jones, PharmD, DrPH, MPH, CAPT, U.S. Public Health Service, director of strategy and innovation, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
In our neighborhoods and communities, we don't always know what is behind the faces we see. We don't know the experiences that adults or children may have had—abuse or neglect, growing up around substance misuse, or witnessing violence in their home or communities.
We also don't realize that these potentially traumatic experiences, referred to as adverse childhood experiences, or ACEs, are more common than people think. In fact, a recent study from the Centers for Disease Control and Prevention (CDC) showed that 62 percent of adults surveyed across 23 states had experienced at least one ACE, and nearly 25 percent had experienced three or more ACEs. This is concerning because research tells us that ACEs can disrupt healthy brain development, compromise immune systems, and lead to substance use and other unhealthy behaviors. ACEs are also linked to chronic health conditions and other negative health outcomes later in life. At least 5 of the top 10 leading causes of death are linked to ACEs, including cancer, diabetes, heart disease, and suicide. Beyond the impacts on health, ACEs also negatively affect life opportunities, like educational and occupational achievement. The effects of ACEs add up over time, which means as the number of ACEs a person has increases, so does their risk for negative outcomes. We need to address these patterns or they could continue into adulthood, potentially affecting both this generation and the next.
So, what can be done? How we can address the trauma and early adversity that children are currently facing? We can recognize the signs of distress that children and youth may be experiencing, like displaying "acting-out" behaviors, struggling with school, or participating in risky behaviors (e.g., alcohol or drug use, high-risk sexual behavior).
Health-care providers can help reduce these behaviors and turn things around for individuals in the following ways:
- Anticipating and recognizing current risk in children and history of ACEs in adults and referring them to effective, trauma-informed services
- Connecting children and adults to victim-centered services, such as housing support, social support, and community resources
- Recommending effective therapeutic treatments that address depression, anxiety, posttraumatic stress disorder, and other symptoms of distress
- Linking children and adults to family-centered treatment approaches that address parental substance use and offer a range of preventive services, including parenting education and training
By intervening and breaking the cycle of adversity, we can ensure that ACEs are not passed on to future generations.
While advancing trauma-informed care for children and adults is essential, it is only one component of comprehensive ACEs prevention. There are also things we can do to prevent ACEs from happening in the first place. We know that all children and families face challenges. We can shift the focus from individual responsibility to community solutions in the following ways:
- Strengthening economic supports to families
- Promoting social norms that protect against violence and adversity, such as those that support parents and positive parenting and those that foster connectedness and healthy relationships
- Ensuring a strong start for children with home visitation programs and high-quality child care to build a foundation for future learning and opportunity
- Teaching skills to parents and youth to help them handle stress, manage emotions, and tackle everyday challenges
- Connecting youth to caring adults and activities to improve their future outcomes and buffer against difficulties at home, school, or in the community
So, while we don't always know what is behind the faces we see, we can create neighborhoods, communities, and a world in which every child can thrive.
For more information about the CDC's National Center for Injury Prevention and Control's ACEs prevention effort, visit https://www.cdc.gov/violenceprevention/pdf/preventingACES-508.pdf.
- Getting to the Roots of Trauma
Written by Melissa T. Merrick, Ph.D., president and CEO, Prevent Child Abuse America
I am a clinical psychologist by training. That means I am very comfortable helping one child, one family at a time, and that will always be critically important work in our quest for providing trauma-informed services. I also received 9 years of on-the-job training in public health and population-level best practices at the Centers for Disease Control and Prevention (CDC), and for 7 of those years I served as the lead scientist for the adverse childhood experiences (ACEs) portfolio of work. At the CDC, we focused our work on building and disseminating the best available evidence for preventing early adversity like child abuse and neglect before it begins, prioritizing primary prevention solutions. And now, in this new role as the president and CEO of our nation's oldest nonprofit focused on preventing child abuse and neglect, I realize that our collective efforts as a multidisciplinary, multisystem field have not gotten deep enough into the roots of what breeds trauma and its many ugly, unhealthy outcomes.
Just last week, Prevent Child Abuse America held its national conference, with nearly 1,000 practitioners, researchers, and policymakers in attendance from our nearly 600 Healthy Families America sites and affiliates and our nationwide state chapter network, with a guiding theme of "Moving Upstream." With more than 100 symposia, workshops, poster presentations, and other sessions, we were intentional to call for a new narrative—that child abuse and neglect and other ACEs could be prevented in the first place through comprehensive approaches and trauma-informed systems. We intentionally acknowledged that prevention can only happen in partnership and that we all have a role to play in stopping early adversity before it begins. All of that is true, and we are so proud of the energy and conversations that took place in support of thriving children, families, and communities. But I think my biggest lesson of the week came unintentionally, during the last session of the conference.
What we had planned as a sharing session on policy and practice considerations that our home visiting network and state chapters have been experiencing turned into an overwhelming and courageous sharing of the breadth of traumatic experiences children and families are facing every day in our country. For example, family support specialists detailed how helping a family that fears deportation to apply and secure passports for their young children is often the most immediate need for the achievement of family emotional stability and security; or how it is hard to recommend nutritious foods or connect families with social support in their communities when some families fear being racially profiled while at the grocery stores and parks in their communities; or how family support specialists themselves, members of the communities in which they serve families, are subject to these sorts of fears and discrimination, too. It was a sobering conversation that will bind everyone in that room forever because it turned our evidence-based practices and trauma-informed approaches on their heads.
If we are to ever be truly trauma informed in our care, we must first get to the roots of trauma. The last time I checked, fear of immigration raids and being racially profiled and discriminated against were not items on the ACE scale, nor were growing up in poverty or without access to affordable high-quality child care and education. Yet, our kids and families are increasingly exposed to these types of traumatic experiences that set them on trajectories for poor health and decreased productivity and prosperity in and of themselves—never mind the exacerbating impact these unmeasured, unspoken adversities have on ACEs. It struck us all in that room that even our most tested and rigorously researched prevention efforts cannot begin to take effect until the immediate needs of families are met, and I would argue we can never truly meet those immediate needs until we make our work about getting to the roots of trauma—the roots of discrimination, racism, income inequality, poverty, historical trauma and oppression, and other structural and social determinants of health and prosperity.
A trauma-informed approach, therefore, requires that we identify and address the many barriers to thriving communities, families, and children that exist and repeat across generations. And we must do this trauma-informed work together, across sectors and disciplines and all party lines. We know that children, families, and communities can be resilient and can thrive if we create the conditions and context for such resilience and prosperity. Prevention is possible if we work in partnership, not only with other professionals and sectors but with families and communities so that their lived experiences are reflected in our interventions and prevention approaches.
Until we get to the roots of trauma, we cannot be truly trauma informed.
- Unnecessary Removals: The Most Unjust Adverse Childhood Experience
Written by Christopher Church, staff attorney for the CHAMPS Clinic, University of South Carolina School of Law
Just over 100 years ago, President Taft appointed Julia Lathrop to lead the newly established Children's Bureau—the first federal agency devoted to the welfare of children. In establishing the agency's priorities, Director Lathrop focused on data-driven strategies to promote children's health and well-being, such as measuring infant mortality and funding strategies to reduce it. Director Lathrop also framed her priorities through a social justice lens, noting the Children's Bureau was "an expression of the nation's sense of justice, and the justice of today is born out of yesterday's pity."
Using data and justice as North Stars, I am filled with curiosity as to what Director Lathrop would think about the state of child welfare today. The Children's Bureau now uses a nearly $8 billion annual budget to strengthen families and prevent child maltreatment, to protect children when maltreatment has occurred, and to ensure that every child has a safe and legal connection to a caring adult. They promote these priorities through, among other activities, monitoring of state and tribal child welfare systems, funding research and innovation to build an evidence base of programs and practices, and providing technical assistance and training to local child welfare professionals. But has this activity expressed our nation's sense of justice? This issue's spotlight on trauma-informed care and adverse childhood experiences pulls me to think about the child welfare system's own infliction of adverse childhood experiences. In the spirit of Julia Lathrop, I want to examine the involuntary separation of children and families for the purpose of protection in foster care through a data-driven justice lens.
Removal is child welfare's most drastic and most protective safety intervention. It should be a last resort for state agencies charged with protecting children from harm. While there is a strong legal basis underpinning removal's limited use, there are also clinical reasons to invoke it sparingly. Dr. Monique Mitchell's research, as discussed in Does Anyone Know What is Going On? Examining Children's Lived Experience of the Transition into Foster Care, documents the ambiguity and loss that children suffer the moment they are separated from their parents and how this threatens child well-being. At removal, children can experience structural ambiguity (e.g., What is foster care?), placement reason ambiguity (e.g., Why am I in foster care?), relationship ambiguity (e.g., Who is this case manager? Who are these foster parents?), temporal ambiguity (How long will this last?), and ambiguous loss (e.g., Why can't I see my parents?). These are questions that haunt children moment by moment as they are physically separated from their parents. The research on the harm inflicted by separating children from their parents is so unambiguous that Harvard Professor of Pediatrics, Dr. Charles Nelson, told the Washington Post, "If people paid attention at all to the science, they would never do this." But we do this as a matter of routine in the name of child protection—more than 250,000 times per year.
I am not here to suggest that children should never be separated from their parents in the name of child protection. Removal is a critically important safety intervention for child welfare professionals. However, the data we routinely collect on children and families involved in the child welfare system raise the possibility that our system is not appropriately calibrated to minimize harm by removing children from their parents only when absolutely necessary.
First, the variance in removal rates across geographies is concerning. During the 2017 federal fiscal year (FFY), the rate at which Virginia (the state with the nation's lowest removal rate) and neighboring West Virginia (the state with the nation's highest removal rate) removed children for purposes of foster care placement differed by a factor of 10. I am not sure what the correct number of removals is for any jurisdiction, but I do not believe our nation's child welfare system should be designed to allow one state to remove 10 times as many children as another. To the extent your mind is drawn to explanatory variables such as child poverty or opioid use, I assure you the relationship between foster care removal rates and poverty or caretaker drug use rates does little to explain differences of this magnitude. Our child welfare system is far too complicated to be explained by a handful of simple correlations.
Second, removal to foster care is only supposed to take place if a judicial officer finds it would be contrary to the welfare of the child to remain in the home and that reasonable efforts were made to prevent the need for removal. The Children's Bureau requires states to submit biannually a wealth of demographic and programmatic data regarding the children and families in foster care. In these data, there is no requirement to document a contrary-to-the-welfare finding or the reasonable efforts the state agency made to prevent a removal. If preventing removals were a priority, our system would require states to report how often, and by what means, they achieve it.
Third, removals often fall into the class of emergencies: a late-night call from law enforcement, or a situation where time would not allow the agency to seek judicial authority prior to the removal. Existing removal data call that narrative into question. Removal data from 18 states, spanning more than 237 aggregate years' worth of data, reveal that 93 percent of removals occur during the business week, with only 7 percent occurring on the weekend. Nearly two-thirds of the removals during the 2017 FFY implicated neglect as a reason for removal, the most commonly cited removal reason. For whatever situation or context neglect is serving as a proxy, it conjures up less of a sudden onset of a severe condition requiring immediate action and more of a chronic, long-standing environmental stressor.
Finally, for at least a decade, roughly 1 out of 10 children removed to foster care were discharged within 30 days of removal. During the 2017 FFY, most of these children spent about 2 weeks in care—an unfamiliar environment—before ultimately being returned to a family member. Is it not likely that some portion of those 22,000 children that spent less than a month in foster care never needed to be separated from their parents? What safety threat could be so imminent and impervious to remediation through reasonable efforts but otherwise cured within a couple weeks of their removal?
Based on what we know about the harm of removal—the grief and loss suffered the moment children are separated from their families—local child welfare professionals should seriously consider whether their removal gate is carefully calibrated to make sure no child unnecessarily passes through it. The data suggest that our systems are not so carefully calibrated. When child welfare professionals consider the decision to remove a child from their parents, they must carefully balance the harm of removal against the risks of staying in the home. They must not "err on the side of caution," as is oft repeated, especially if that means removing the child from their parent. There is nothing cautious about blithely making such a decision.
Sometimes removing a child from their parents' custody is absolutely necessary. I am reminded of one of the early lines in Justice Blackman's dissent in DeShaney v. Winebago: "Poor Joshua!" he lamented. Joshua was one such child where removal was necessary. But the progeny of DeShaney does not justify abdicating responsibility for using removal as an intervention of last resort. Long before Justice Blackman penned his DeShaney dissent, Director Lathrop reminded us children need justice, not pity. Justice requires objective assessments of child safety, thorough exploration of the best alternatives to removal, and careful scrutiny by judicial officers prior to effectuating a removal. In the absence of those elements occurring, we will contribute to the number of adverse childhood experiences our nation's most vulnerable children suffer.
Spotlight on National Adoption Month
Spotlight on Creating a More Equitable Child Welfare System
News From the Children's Bureau
Read about trauma-informed approaches aimed at serving fathers during reentry, preventing teen pregnancy, and promoting self-regulation, as well as information on a newly updated toolkit for child welfare professionals about substance use and co-occurring disorders among families involved with child welfare. Also included are the latest updates to the CB website.
- Literature Review of Trauma-Informed Approaches for Programs Serving Fathers in Reentry
Many fathers who are incarcerated have experienced some form of trauma in early life. These past traumatic experiences can affect how these men reenter society and how they reconnect with and support their families. A report released by the Office of Planning, Research and Evaluation within Administration for Children and Families of the U.S. Department of Health and Human Services discusses trauma and reentry and how responsible fatherhood programs should take a trauma-informed approach to the services they offer to ensure positive outcomes for fathers and their families.
Researchers conducted a literature review that included 40 full-text journal articles as well as unpublished literature, such as project reports, white papers, and government reports, published between 2000 and 2016. They also conducted an environmental scan and identified 41 programs that seemed to take a trauma-informed approach or provide trauma-specific services. Of those programs, researchers selected six that serve recently incarcerated fathers and held 1-hour interviews with the program directors to gain an understanding of how the programs implemented trauma-informed approaches and the challenges and barriers they face.
The study produced the following findings:
- There is a prevalence of trauma among fathers who are reentering society.
- Trauma can hinder positive outcomes for fathers participating in fatherhood programs.
- Healing can occur through interactions with sympathetic and empathetic individuals, not just clinical professionals.
The report also provides the following important key steps to making sure fatherhood programs are trauma informed:
- Commit to taking a systematic trauma-informed approach throughout the entire organization's policies and procedures.
- Make sure all staff are trained in recognizing and responding to trauma.
- Screen all program participants for signs of trauma.
- Refer fathers in need of clinical treatment for their trauma to gender and culturally appropriate services.
To read the report, Trauma-Informed Approaches for Programs Serving Fathers in Re-Entry: A Review of the Literature and Environmental Scan, visit https://www.acf.hhs.gov/sites/default/files/opre/pact_rf_tic_lit_review_final_508.pdf (531 KB).
- CB Website Updates
The Children's Bureau website hosts information on child welfare programs, funding, monitoring, training and technical assistance, laws, statistics, research, federal reporting, and much more.
Recent additions to the site include the following:
- IM-19-03: Engaging, Empowering, and Utilizing Family and Youth Voice in All Aspects of Child Welfare to Drive Case Planning and System Improvement: https://www.acf.hhs.gov/cb/resource/im1903
- IM-19-04: Evaluation Plan Development Tip Sheet: https://www.acf.hhs.gov/cb/resource/im1904
- Tribal Federal Medical Assistance Percentage Reference Table for Fiscal Year 2020: https://www.acf.hhs.gov/cb/resource/tribal-fmap-reference-fy2020
- Child and Family Services Reviews (CFSR) Round 3 Statewide Data Indicator Data Dictionary: https://www.acf.hhs.gov/cb/resource/cfsr-round3-sdi-data-dictionary-2019
- CFSR Round 3 Statewide Data Indicator Syntax Zip File: https://www.acf.hhs.gov/cb/resource/cfsr-round3-sdi-syntax-zip-2019
- Instructions to Run Data Quality (DQ) Checks and Observed Performance Syntax for Statewide Data Indicators: https://www.acf.hhs.gov/cb/resource/cfsr-round3-sdi-dq-instructions-2019
- CFSR Technical Bulletin #10: https://www.acf.hhs.gov/cb/resource/cfsr-technical-bulletin-10
- Child and Family Services Reviews Update Volume 13, Issue 3, July 2019: https://www.acf.hhs.gov/cb/resource/cfsr-update-volume-13-issue-3
- Five Steps for Stronger Child Welfare Workforce [Podcast]: https://www.acf.hhs.gov/cb/resource/child-welfare-podcast-five-steps
Visit the Children's Bureau website often to see what's new.
- Trauma-Informed Intervention Designed to Prevent Teen Pregnancy, Promote Self-Regulation
The U.S. Department of Health and Human Services' Office of Adolescent Health (OAH) has launched a resource designed to help youth understand the impact of adverse childhood experiences on self-regulation, sexual decisionmaking, healthy relationships, and personal safety. The Practice Self-Regulation (PS-R) program is a therapeutic, trauma-informed intervention that is part of the OAH Policy and Research Group's federal grant program—Teen Pregnancy Prevention (TPP) program—designed to help prevent teen pregnancy. TPP focuses on at-risk populations to reduce disparities in teen pregnancy and birth rates.
PS-R is being implemented in eight cities across five states to treat youth ages 14 through 19 who are eligible to receive individual counseling services in outpatient clinics or with independently licensed mental health clinicians. PS-R consists of 10 one-on-one therapeutic and educational sessions on sexual health with a licensed clinical facilitator who discusses how an individual's prior trauma and his or her goals and values can affect sexual health and well-being. The program includes workbook exercises and factsheets to help youth develop constructive strategies for self-regulation, sexual decisionmaking, personal safety, and healthy relationships. The program includes multisensory activities, such as art therapy, guided visualizations, and breathing exercises to help participants integrate key concepts, practice skills, and improve decision-making.
Between July 2016 and July 2018, 148 youth were enrolled in PS-R, and 84 percent reported that the intervention gave them skills to help regulate their emotions and that they planned to use their newfound knowledge to help them prevent pregnancy and sexually transmitted diseases.
For more information, see the OAH TPP's Successful Strategies factsheet on PS-R at https://www.hhs.gov/ash/oah/sites/default/files/tpp-ss-policy-and-research-2018.pdf (284 KB).
- Child Welfare Training Toolkit
The National Center on Substance Abuse and Child Welfare (NCSACW) offers a toolkit to educate child welfare professionals about substance use and co-occurring disorders among families involved with child welfare.
The training is intended to help child welfare professionals understand substance use and its effects, determine if substance use is a factor in a child welfare case, learn strategies for engaging parents and families, and realize the importance of collaboration within systems of care.
The course consists of seven modules, each approximately 2 hours in length:
- Module 1: Understanding the Multiple Needs of Families Involved With the Child Welfare System
- Module 2: Understanding Substance Use Disorders, Treatment, and Recovery
- Module 3: Understanding Co-Occurring Substance Use Disorders, Mental Health/Trauma, and Domestic Violence
- Module 4: Engagement and Intervention With Parents Affected by Substance Use Disorders and Mental Health/Trauma
- Module 5: Case Planning, Family Strengthening, and Planning for Safety for Families With a Substance Use Disorder
- Module 6: Understanding the Needs of Children of Parents With Substance Use or Co- Occurring Disorders
- Module 7: Collaborating to Serve Parents With Substance Use Disorders
On September 5, 2019, the Substance Abuse and Mental Health Services Administration, NCSACW, and the Children's Bureau held a webinar to talk about updates to the toolkit as well as provide an overview of the topics in the toolkit and strategies for adapting content for use in organizations or agencies.
The toolkit is available at https://ncsacw.samhsa.gov/training/toolkit/.
We highlight a study about the effectiveness of a trauma-informed initiative aimed at improving the social-emotional well-being and developmentally appropriate functioning of children and families as well as a study on the impact of a training for resource parents on their sensitivity to children's trauma-related behavioral and emotional issues.
- Study on the Effectiveness of a Trauma-Informed Care Initiative
An article in the journal Child Maltreatment discusses a study conducted as part of New Hampshire's Partners for Change project, a trauma-informed 5-year initiative funded by the Children's Bureau from 2012 to 2017 to improve the social-emotional well-being and developmentally appropriate functioning of children and families served by the New Hampshire Division for Children, Youth and Families (DCYF). New Hampshire was also one of 20 grantees tasked with implementing trauma-informed care in their state or tribal child welfare systems.
The project's objectives included the following:
- To implement universal screening for trauma exposure, posttraumatic symptoms, and well-being needs of all children and youth involved with child protective services and the juvenile justice system
- To use data-driven case planning informed by trauma-screening results
- To enhance progress monitoring through rescreening and increased coordination between child welfare and mental health providers
- To increase trauma-focused competencies among child welfare staff
- To increase collaboration between child welfare and community-based behavioral health services
- To monitor the use of psychotropic medication
- To assist mental health providers in using evidence-based trauma treatments
- To realign service array strategies
The study focused on DCYF child protective services and juvenile justice staff and supervisors in 10 district offices. Participants in each district office were randomly assigned to either the early intervention group or the late intervention group. The survey covered the domains of trauma screening, case planning, mental health and family involvement, progress monitoring, collaboration, and perceptions of the state's overall system performance.
The following are some key findings of the study:
- Prior to the intervention, most of the domains were moderately intercorrelated, suggesting that the behaviors and attitudes associated with trauma-informed care are part of a broader grouping of trauma-informed skills and knowledge.
- Case-planning practices were positively related, although only modestly, to frequency of progress monitoring and trauma screening.
- Trauma-screening practices were modestly associated with more positive attitudes toward system performance and higher mental health referral/family involvement practices.
The article also discusses future directions and study limitations.
"Effectiveness of a trauma-informed care initiative in a state child welfare system: A randomized study," by M. Kay Jankowski, Karen E. Schifferdecker, Rebecca L. Butcher, Lynn Foster-Johnson, and Erin R. Barnett (Child Maltreatment, 24), is available at https://journals.sagepub.com/doi/pdf/10.1177/1077559518796336.
- Study Assesses Impact of Training on Resource Parents' Sensitivity to Children's Trauma Symptoms
A study looking at the impact of specialized training—the Resource Parent Curriculum (RPC)—on the sensitivity of new resource parents to children's trauma-related behavioral and emotional issues found that such training helps parents identify child posttraumatic stress symptoms (PTSS) and reduce related parenting stress. Resource parents were shown to be more knowledgeable about PTSS after participation in the training, which was developed by the National Child Traumatic Stress Network.
The study was designed to address the effects of the RPC on how parents face the challenges of caring for children who struggle with emotional and behavioral health issues due to exposure to trauma. When resource parents lack awareness about the mental health repercussions of trauma and the proper tools for addressing it, foster placements risk disruption. Resource parents need to know how to care for chronically traumatized children to limit the disruption of foster placements. When they understand the effects of trauma on a child's development, resource parents are better equipped to help their foster or adopted children heal from the trauma and form healthy attachments.
The RPC features eight modules to improve resource parents' knowledge and skills related to caring for traumatized children. Module topics include the types of trauma and their effects, the importance of building a safe place, feelings and behaviors related to trauma, advocacy, the importance of connections and healing, and self-care. Training was provided in eight 2.5-hour sessions by two health-care professionals, with a follow-up session 6 months after the last training.
"Increasing resource parents' sensitivity towards child posttraumatic stress symptoms: A descriptive study on a trauma-informed resource parent training," by Maj R. Gigengack, Irma M. Hein, Robert Lindeboom, and Ramón J. L. Lindauer (Journal of Child & Adolescent Trauma, 12), is available at https://link.springer.com/article/10.1007/s40653-017-0162-z (383 KB).
This section of CBX offers publications, articles, reports, toolkits, and other resources that provide either evidence-based strategies or other concrete help to child welfare and related professionals.
- Toolbox Helps Primary Care Practices Understand, Recognize Effects of Childhood Trauma
Healthy Foster Care America developed a trauma toolbox to help primary care physicians recognize and understand the effects of adverse childhood experiences (ACEs) on children and families. Referred to as the Trauma Toolbox for Primary Care, the kit is designed for those who may not be familiar with ACEs and/or the process of asking families about prior or potential exposure to ACEs.
The toolbox, also available in Spanish, features the following six parts:
- "Adverse Childhood Experiences and the Lifelong Consequences of Trauma"
- "Addressing Adverse Childhood Experiences and Other Types of Trauma in the Primary Care Setting"
- "The Medical Home Approach to Identifying and Responding to Exposure to Trauma"
- "Bring Out the Best in Your Child"
- "When Things Aren't Perfect: Caring for Yourself and Your Children"
- "Protecting Physician Wellness: Working With Children Affected by Traumatic Events"
The project was funded by a grant from the Maternal and Child Health Bureau of the Health Resources and Services Administration within the U.S. Department of Health and Human Services .
The Trauma Toolbox for Primary Care is available at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Trauma-Guide.aspx#trauma.
- Beyond Strategic Planning: Engaging Families in Plan Implementation
Written by the Children's Bureau's Capacity Building Center for States
States have recently submitted their Child and Family Services Plans (CFSPs) to the Children's Bureau for review and approval. These plans are the result of strategic planning that required a broad array of stakeholders, including youth, parents, and extended families. As recipients of services, family stakeholders bring a critical perspective to child welfare strategic planning. They shine a light on what is working well, gaps in services, and inconsistencies in service delivery. They also bring innovative ideas about how to improve services based on their lived experience. So, how can agencies continue to engage family voice while implementing the CFSP? This article offers tips for getting started and keeping the momentum going.
Implementing a CFSP is a process. The plan outlines a state's or tribe's vision and goals to strengthen its child welfare system over the next 5 years. Plans include initiatives, activities, programs, and services to promote the safety, permanency, and well-being of children and families. Just as family voice adds value to the development of CFSPs, it also adds value as agencies begin bringing their plans to life. As teams move toward implementation, they should consider several things:
- Include youth and family voice across implementation planning. Do not cherry pick projects for youth and family participation. Every aspect of child welfare directly or indirectly impacts the children and families served. Engage families at all levels of agency implementation.
- Set expectations for continued youth and family involvement in CFSP implementation. Reach out to youth and families that participated in developing the CFSP and solicit their interest in joining an implementation team for a potential program, practice, or innovation.
- Prepare youth and family stakeholders to contribute effectively. Let them know ahead of time what to expect during the implementation process, including their expected time commitment and specifics about how they can contribute, so they can make informed decisions about their participation.
- Celebrate the milestones. Once the CFSP is approved, reconvene the planning team to celebrate its hard work and begin planning next steps. This is when the real work begins!
- Make the process open and welcoming. Have the group develop "working agreements" on how the group will function and communicate. During this process, the facilitator should be specific about what it means to create a safe space and everyone's role in creating and maintaining it. Post these working agreements at each meeting and add to them as necessary.
- Keep families in the communication loop. Make sure families and all stakeholders are kept informed about the status of the CFSP they contributed to creating. If there is no new information, let families know the CFSP is still under review and the expected return date, if known.
Keep the Momentum Going
So, how can agencies keep youth and family stakeholders involved throughout the process?
- Break it down into smaller steps. Because an implementation process can be long, it can be difficult to see the progress along the way. As a group, identify the interim goals that will indicate the project is on track. What will the project look like in 3 months, 6 months, and 18 months? By checking in along the way, the group can monitor progress, celebrate milestones, and make course corrections, if needed.
- Communication is vital at all points along the implementation process. If there are multiple initiatives, programs, or services being implemented, communicate across the workgroups. Hearing what other workgroups are doing and how their contributions are making a difference can be rewarding for youth and family stakeholders.
- Learn from the process. On a regular basis, gather feedback from youth and family stakeholders on the implementation process and their role. Do they feel heard and valued? Are they receiving regular communication from their implementation team? What could improve their engagement? Checking in regularly gives agencies an opportunity to address any issues that may arise, correct those issues, and learn from the process.
When agencies carry family engagement and family voice throughout the implementation process, they are ensuring that their voice is reflected not only in the plan but in the resulting programs and processes. In doing so, an agency is modeling partnership and open communication and is valuing the contributions of the families they serve.
From the Capacity Building Center for States
Becoming a Family-Focused System: Strategies for Building a Culture to Partner With Families
Strategies for Authentic Integration of Family and Youth Voice in Child Welfare
Strategic Planning in Child Welfare: Strategies for Meaningful Stakeholder Engagement (PDF - 270 KB)
Change and Implementation in Practice
From Child Welfare Information Gateway
- Building Protective Factors to Support Resilience to Childhood Trauma
A brief from Child Trends looks at current research and practice surrounding trauma-informed care (TIC) and how to implement TIC to promote resilience in trauma-exposed children. The brief examines childhood trauma-related risk factors associated with poor outcomes and protective factors that can support resilience. It also includes a framework for implementing trauma-informed care for children and families.
The brief discusses the many ways childhood trauma can impact an individual: behavioral health, brain development, cognition, emotional health, relationships, and mental health. The brief emphasizes that knowledge of trauma is only one aspect of TIC and points to "the four Rs" essential to integrating true TIC in practice with children and families:
- Realize the widespread impact of trauma and the potential paths to recovery
- Recognize the signs of trauma
- Respond by integrating knowledge of trauma into policies and practices
- Resist retraumatization
The brief also includes strategies for addressing secondary traumatic stress in adults who care for trauma-exposed children.
How to Implement Trauma-Informed Care to Build Resilience to Childhood Trauma is available at https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma.
This section of CBX provides a quick list of interesting resources, such as websites, videos, journals, funding or scholarship opportunities, or other materials that can be used in the field or with families.
- Video Highlights Child Abuse and Neglect Prevention Strategies
A video from the Centers for Disease Control and Prevention, "We Can Prevent ACEs," looks at the importance of safe, stable, and nurturing relationships and environments in both preventing child abuse and neglect and helping to overcome adverse childhood experiences (ACEs).
The video looks at various protective factors to help communities prevent ACEs—such as making sure parents have access to social connections, career workshops, parenting classes, affordable child care, and after-school activities—and identifies five specific strategies for preventing child abuse and neglect:
- Economic supports
- Changing social norms to support parents and positive parenting
- Quality child care and early education
- Parenting skills education
- Interventions to lessen harms and prevent future risk
The video is available at https://www.youtube.com/watch?v=8gm-lNpzU4g.
- ACEs Connection Website
The ACEs Connection website connects people, communities, organizations, and systems who use trauma-informed/resilience-building practices. The website is an information exchange that offers social networking opportunities for its more than 35,000 members. It is a place where they can help one another with implementation, share best practices, and provide inspiration. ACEs Connection also supports local adverse childhood experiences (ACEs) initiatives in neighborhoods, cities, counties, states, and nations by providing them with free community sites on the main website, guidelines on how to launch and grow local ACEs initiatives, and online tools that help local initiatives measure their progress.
The website also provides a Daily Digest and Weekly Roundup of the latest in ACEs science, trauma-informed and resilience-building news, and research and reports. Its Resources Center has ACE surveys, resilience surveys, and ACEs science presentations available to download.
To stay current on the latest in ACEs and trauma-informed science, visit https://www.acesconnectioninfo.com/.
Find trainings, workshops, webinars, and other opportunities for professionals and families to learn about how to improve the lives of children and youth as well as a listing of upcoming events and conferences.
Upcoming conferences and events on child welfare and adoption include the following:
- ZERO TO THREE Annual Conference 2019
ZERO TO THREE
October 2–4, Ft. Lauderdale, FL
- 31st Annual Association for Treatment and Training in the Attachment of Children (ATTACh) Conference
October 3–5, Scottdale, AZ
- JuST Conference 2019
Shared Hope International
October 15–17, Cincinnati, OH
- 24th Juvenile Detention Alternatives Initiative Inter-Site Conference
The Annie E. Casey Foundation
October 16–18, Seattle, WA
- Beyond Separation: Protecting Cross Border Families
University of Maryland School of Social Work
October 17–18, Baltimore, MD
- 2019 Mandated Reporter Training
October 22, Grand Rapids, MI
- Association of Family and Conciliation Courts Fall Conference
Association of Family and Conciliation Courts
October 31–November 2, Pittsburgh, PA
- 2019 Families Learning Conference
National Center for Families Learning
November 4–6, Louisville, KY
- Together We Can Conference 2019
Pelican Center for Children & Families
November 12–14, Lafayette, LA
- 2019 Nexus Training Conference: Violence Within the Home and Its Effects on Children
Inter-Agency Council on Child Abuse and Neglect (ICAN)
November 20, Universal City, CA
- 2019 Global Youth Justice Conference
Global Youth Justice, Inc.
December 3–5, Las Vegas, NV
- ZERO TO THREE Annual Conference 2019
- Trauma-Sensitive Training Schools
The National Center on Safe Supportive Learning Environments offers a training package that aims to help school and district administrators and staff develop a framework for implementing trauma-informed practices within theirs schools.
The training package includes a variety of training materials and resources, including the following:
- An implementation guide that summarizes the goals of the training, describes its components, and provides guidance on how and when to use the training
- A course on understanding trauma and its impact that includes resources for all school staff about the prevalence of trauma, its impact on children and youth, and implications for schools
- A course about building trauma-sensitive schools that introduces school staff to the concept of this type of school, why it is important to adopt a trauma-sensitive approach, and trauma-sensitive practices for use in the classroom and schoolwide
- A course on leading trauma-sensitive schools intended for school leaders that introduces a framework and process for adopting a trauma-sensitive approach schoolwide, including guidance for how to roll out other package components
The training also features online modules, interactive e-resources, downloadable handouts, and more.
To learn more about Trauma-Sensitive Schools Training Package, visit https://safesupportivelearning.ed.gov/trauma-sensitive-schools-training-package.