Session Two:

Impact of Child Traumatic Stress on Permanency

Session Two: Impact of Child Traumatic Stress on Permanency

The session will explore strategies for using trauma-informed child welfare practice to enhance the safety, permanency, and well being of children and families who are involved in the child welfare system. Using a trauma informed lens, students will learn about assessing for, intervening with and practicing with children, youth and parents who have experienced trauma.

Session Two Competencies Knows and understands the power and complexities of trauma informed child welfare practice for children, youth, and families.

Session Two Objectives Explain how stress and trauma affect children, youth and families in the child welfare system. Describe how various types of trauma (e.g., abuse, neglect, institutionalization) impacts foster/adopted children. Explain the tools and techniques to support recovery from adverse beginnings. Demonstrate using trauma tools and techniques with children, youth and families.

What is Trauma?

• Acute Trauma-a single traumatic event that is limited in time.– Community Violence– Physical or Sexual Assault– Sudden or Violent Loss of a Loved One

What is Trauma?

• Chronic Trauma-the experience of multiple traumatic events.– Exposure to Domestic Violence– Prolonged Exposure to Physical Abuse, Neglect or

War– Often Cumulative

What is Trauma?

• Complex Trauma-exposure to both chronic trauma (usually caused by caretakers) and the impact of such exposure.

• It has profound effects on nearly every aspect of a child’s development and functioning including:– Attachment– Biology– Mood Regulation– Dissociation– Behavioral Control– Cognition– Self-concept

Impact of Trauma

• The impact depends on several factors:– The age and developmental stage of a child– The child’s perception of the danger faced– Whether the child was a victim or a witness– The child’s relationship to the victim or perpetrator– The child’s past experience with trauma– The adversities the child faces following trauma– Social and cultural realities– The presence/availability of adults who can offer help

and protection

Child Traumatic Stress

• Refers to physical and emotional responses of a child to events that threaten the life or physical integrity of the child or a loved one.

• Traumatic Events:– Elicit feelings of terror, powerlessness and out of

control physiological arousal. • Overwhelming emotion may delay the development of

age appropriate self-regulation• Trauma may be stored in the body as a form of tension

or health complaints

Child Traumatic Stress Cont.

– Affect a child’s ability to trust others• Poor relationships with peers, caretakers, other family

members and workers.

– Affect a child’s ability to sense personal safety• Leads to a variety of survival strategies for coping• A sense of safety is essential in physical and emotional

growth• Safety is first experienced at sensory (embedded in the deep

mid-brain)

– Affect a child’s ability to effectively navigate life changes. • Can lead to placement instability

Impact on Brain Development

• The brain is organized into 4 areas:– Brainstem-mediates our regulatory functions

(heart rate, temperature, respiration and blood pressure).

– Diencephalon and Limbic system handles emotional responses that guide our behavior.

– Cortex-regulates speech and language, abstract thinking, planning and deliberate decision making.

Hierarchy of Brain Function

CortexSpeech, Language, Complex Thinking, Planning and Deliberate

Decision Making

Limbic Emotional Life, Memory, Attachment and Sexual

Behavior

Diencephalon Motor Regulation, Touch

Perception, Senses

BrainstemBody Temperature, Heart

Rate, Respiration and Blood Pressure

Impact on the Brain

• Trauma impacts a child’s normal brain development, brain chemistry and nervous system.

• Trauma induced alterations in the biological stress system can adversely effect brain development, cognitive and academic skills, and language achievement.

• There are changes in the levels of stress hormones that affect the way a child or adolescent responds to future stress in their lives, and may also influence their long-term health.

Impact on the Brain

• Trauma can reduce the size of the cortex.– The cortex is responsible for many complex functions,

including memory, attention, perceptual awareness, thinking, language and consciousness.

Trauma impacts the development of the brain region that would help school aged children:– Manage fears, anxieties, and aggression– Control impulses– Develop problems solving skills – Focus on learning

Impact on the Brain

• In adolescents, trauma can interfere with the development of the prefrontal cortex. Resulting in :– Reckless and risk-taking behavior– School failure– Poor choices– Aggressive or delinquent activities

Memory and Triggers

• Trauma is the inability to move the sensory memories of a traumatic experience from implicit to explicit memory where the child can reframe the memories in ways he can now manage.

• Because the experience of trauma is sensory, a sight, noise or smell can remind the child of the trauma and will trigger a survival response.

• The experience of trauma is one of terror. Therefore, a traumatized child’s behavior, when triggered, will seem illogical. It is the child’s attempt to regain power and control over the who and what in their life that is perceived to be a threat.

Memory and Triggers

• Can you think of a memory that triggers trauma for you?

• How have you seen trauma manifest itself in children, youth and parents with whom you have worked?

What Can We Do?• Gather complete trauma histories from the

parents and children• Listen and acknowledge the child’s traumatic

experience.• Use trauma informed language– What happened to you? Verses – What is wrong with you?– Provide the child with age appropriate information

that led to child welfare involvement.

What Can We Do?

• Support the child in the development of a life book

• Refer the child to trauma focused therapy• Provide support to the foster parents and

birth parents– Allowing them to vent– Helping to reframe behaviors

What Can We Do?

• Cross-system collaboration• Build a strong relationship with the child– Some of the most therapeutic interventions don’t

take place in therapy but rather in a natural healthy relationship.

• Minimize power imbalance• Be empathetic, respectful, genuine,

consistent, predictable, non shaming and non blaming

What Can We Do?

• Work hard to minimize placement disruptions and move towards timely permanency.– When children are placed with familiar capable

care-givers they tend to recover more easily.– Healing and recovery are impossible even with the

best medications and therapy without the lasting, caring connections to others.

• Develop a personal plan to take care of yourself.

Birth Parents and Trauma

• Knowing the birth parent’s trauma history is essential in helping the family to grow and succeed.

• Surrendering a child/removal of a child is a traumatic event.

• Birth parents who are involved in the child welfare system typically have a history of childhood trauma.

• Their past trauma can make it very difficult for child welfare to work with them. – The system can be a trigger– Court, case planning meetings, visitations can all be triggers .

Birth Parents

• “The Resistant Birth Parent”-as workers we often label birth parents impacted by trauma as resistant.

• Typical behaviors displayed by a birth parent impacted by trauma:– Verbally aggressive– Shut down– Avoidant– Poor coping skills that result in substance abuse or

abusive relationships.

Practices in Working with Birth Parents

• Obtain trauma history and specific trauma symptoms

• Educate them about trauma and the impact trauma has on them and their families

• Refer for a trauma assessment and treatment• Include their trauma needs in a case plan• Help them to understand their child’s trauma needs.• Support them in the role of parents “make them

feel important”

Practices in Working with Birth Parents

• Model direct and honest communication. Share observations not opinions

• Be consistent and follow through with what you say you are going to do

• Prepare them for meetings, court hearings and visits.• Be aware of your voice tone, body language and eye

contact during stressful situations. • Build mutual trust• Facilitate a relationship between the birth parent and

the foster/adopt parent.

Adoptive Parents and Trauma

• Understanding the adoptive parent’s trauma history is important when placing children in their homes.

• Reproductive Stories-conscious and unconscious mental narratives about themselves as parents. – People’s identity as parents begins long before they have

children. This identity is influenced by childhood experiences, culture and the developmental tasks of adulthood.

– When someone’s reproductive story is impacted the loss is perceived as a trauma that can affect adult development and all areas of one’s life.

Adoptive Parents and Secondary Trauma

• Common side effects associated with parenting a child experiencing traumatic stress:– Overwhelmed– Anxiety– Intrusive thoughts– Physical illness (nausea, headaches)– Forgetfulness– Anger– Poor sleep– Helplessness– Isolation

Adoptive Parents

• Our role in preparing adoptive parents for children who are impacted by trauma is critical– Education: We must educate them about trauma and

the impact it has had on the child they are seeking to adopt.

– Support: We must listen and provide guidance when no one else will.

– Resources: We must supply them with resources (books, groups, therapy).

– Consistency: We must be consistent in our communication

Trauma Informed Care

• Trauma Informed Care is a system that recognizes, understands and appropriately responds to trauma and its effects on children and their families.

• To achieve safety, permanency and well-being all activities by the child welfare workforce are focused on strengthening the family, promoting resiliency, enhancing physical, emotional, and social well-being including healing trauma wounds, and reducing or eliminating system activities that further re-traumatize a child and their family.

Child Welfare’s Responsibilities

• Child Welfare’s practice includes the following elements:– A child-focused, family-centered, gender-specific

and culturally sensitive, strengths-based approach. – Highly individualized assessments and care that

identifies and acts on the child/caregiver/family and social/environmental risk and protective factors.

Best Practice

• Maximize the child and family’s sense of physical and psychological safety.

• Identify the trauma-related needs of the child and family.

• Enhance the child’s and family’s well-being and resiliency.

• Partner with families and system agencies.• Enhance the well-being and resiliency of the

child welfare workforce.

Responsibilities Cont.

• A relationship characterized by respect, dignity, compassion, listening and being present in the moment and validation.

• A relationship that is based on a partnership with families, supports families, and promotes empowerment.

• A recognition and appreciation of the high prevalence of traumatic experiences by those children, youth and families served.

Responsibilities Cont.

• An understanding of the profound neurological, biological, psychological, cognitive and social effects of trauma and violence on the child and family.

• Planned, purposeful, anticipatory and proactive actions that reduce or eliminate the potential for harm or re-traumatizing.

• An inclusive, collaborative approach with community partners that are involved in the child and caregiver’s lives.

References• Steele, William, PsyD, MSW (2009). Trauma Informed Care: A History of

Helping: A History of Excellence Lessons Learned Since 1990. Retrieved June 8, 2015, from www.starr.org/research/trauma-informed-care.

• Jaffe, J. & Diamond, M. (2011). Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients. Retrieved June 15, 2015, from www.the-iacp.com/book-reviews.

• National Child Traumatic Stress Network, Child Welfare Committee. (2011). Birth parents with trauma histories and the child welfare system: A guide for resource parents. Los Angeles, CA, and Durham, NC: National Center for Traumatic Stress.

• National Child Traumatic Stress Network, Child Welfare Committee. (2013). Child Welfare Trauma Training Toolkit. http://www.nctsnet.org/