Three Branch Institute on Child

Social and Emotional Well-Being:

Moving Toward a Trauma-Informed

System

Jane Halladay Goldman, PhD

Director, Service Systems Program

National Center for Child Traumatic Stress

NSTSN: Changing the Course of Children’s

Lives by Changing the Course of their Care

• Traumatic events are common in the lives of America’s children

• Child traumatic stress is one of our most under-recognized public

health problems

• Child traumatic stress can derail a child’s healthy development

• The effects of childhood trauma reach into adulthood

• Child traumatic stress is one of the most treatable

mental health problems of childhood

• NCTSN brings a singular and comprehensive

focus to child trauma

• NCTSN works to bring a trauma perspective to

the systems that serve children

NCTSN Structure

• Community Treatment and Services Centers (Cat 3)

• Treatment and Services Adaptation Centers (Cat 2)

• National Center for Child Traumatic Stress (NCCTS)

– UCLA-Duke Collaborative

– Develops and maintains Network structure, provides technical

assistance to grantees, oversees resource development and

dissemination, coordinates national education and training efforts.

– Programs: Service Systems, Military Families, Training and

Implementation, Education in Evidence Based Practices, Data and

Evaluation, Terrorism and Disasters, Site Integration

Addressing Trauma Requires an

Integrated Approach

• Trauma has biological and psychological effects

that impact behavioral, social, and emotional

domains.

• The impact of trauma can hinder development

and interfere with children’s functioning in

relationships, school, and life.

• Complex challenges of children who have

experienced trauma may not be addressed by the

system and services as they are currently

designed.Source: U.S. Department of Health and Human Services (DHHS), Administration for Children Families, Administration on Children, Youth and Families, Children’s

Bureau. (2012). Information memorandum (Log No: ACYF-CB-IM-12-04). Available from

http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf

Essential Elements of a

Trauma-Informed Child Welfare System

Essential Elements of a

Trauma-Informed Child Welfare System

1. Maximize physical and psychological safety for children

and families.

2. Identify trauma-related needs of children and families.

3. Enhance child well-being and resilience.

4. Enhance family well-being and resilience.

5. Enhance the well-being and resilience of those working in

the system.

6. Partner with youth and families.

7. Partner with agencies and systems that interact with

children and families.

Essential Elements of a

Trauma-Informed Child Welfare System

The Essential Elements:

• Are the province of ALL professionals who work

in and with the child welfare system

• Must, when implemented, take into consideration

the child’s developmental level and reflect

sensitivity to the child’s family, culture, and

language

• Help child welfare systems achieve the CFSR

goals of safety, permanency, and well-being

Essential Elements are Consistent with

Child Welfare “Best Practices”

• Trauma-informed child welfare (TICW) practice

mirrors well-established child welfare priorities.

• Implementation does not require more time, but

rather a redirection of time.

• TICW means applying the trauma lens to

everyday practice and weaving the trauma

perspective into what workers already do.

Child Welfare: Trauma-Informed Child Welfare

Practice Breakthrough Series Collaborative

• Goal: develop and promote trauma-informed policies and practices related

to foster care placement, thereby increasing placement stability and

promoting a sense of permanency among children in care.

• Process: 9 teams, partnerships of mental health and child welfare

practitioners and consumers were selected to participate in 4 Learning

Sessions

• The teams implemented trauma-informed practices such as improved

communication between foster and birth families, more systematic

screening and assessment for trauma, trauma-informed training for child

welfare workers and foster parents

• At baseline, most teams averaged 50% - 70% move requests per month

(8/10). Towards the end of the series (4/12), teams vacillated between 0-

30% move requests per month, thereby greatly improving placement

stability after implementing trauma-informed practices.

Child Welfare Trauma Training Toolkit (Revised 2013)

Target Audience Child welfare professionals

Description Designed to teach basic knowledge,

skills, and values about working with

children who are in the child welfare

system and who have experienced

traumatic stress

Format Trainer’s manual

Participant manual

Comprehensive PowerPoint slides

– CD-ROM

Maximize Physical and Psychological

Safety for Children and Families

• Psychological safety vs. physical safety

• Trauma Reminders

• CW BSC Practice Strategies:

– Providing information about child to

caregivers (All About My Child/All About Me)

– Facilitating connections between birth and

foster parents

Identify Trauma-Related Needs of

Children and Families

• Screening and Assessing for Trauma

– NCCTS role in modernizing approach to

trauma screening and assessment

– CW BSC Practice Strategies:

• Customizing screening process for individual

agencies

• Gathering clear and specific mental health

information to share with case workers and courts

Enhance Child Well-Being and

Resilience

• Access to evidence-based, trauma-

informed treatments and services

– Supporting public policies related to access to

and research in trauma-informed treatment

– CW BSC Practice Strategies:

• Increasing capacity of mental health providers to

deliver evidence-based treatment

Enhance Family Well-Being and

Resilience

• Addressing Birth Parent Trauma

• Resource Parent workshop

• Essential Elements of Trauma-

informed Parenting

• Evidence-based trauma-Informed

treatment for caregivers

Birth Parents with Trauma Histories in the

CW System Fact Sheet Series

Series of five fact sheets highlighting

importance of understanding the

serious consequences that trauma

histories can have for birth parents,

and the subsequent potential impact

on their parenting, created for the

following audiences:

Resource Parents

Parents

Mental Health Professionals

Judges and Attorneys

Child Welfare Staff

Caring for Children Who Have Experienced

Trauma: A Workshop for Resource Parents

Target Audience

Foster, adoptive, and kinship

caregivers

Description

Helps resource parents understand

the link between trauma and their

children's behavior, feelings, and

attitudes.

Format

Facilitator’s Guide

Participant Handbook

Slide Kit

1. Recognize the impact trauma has had on your child.

2. Help your child to feel safe.

3. Help your child to understand and manage overwhelming emotions.

4. Help your child to understand and modify problem behaviors.

5. Respect and support positive, stable, and enduring relationships in the life of

your child.

6. Help your child to develop a strength-based understanding of his or her life

story.

7. Be an advocate for your child.

8. Promote and support trauma-focused assessment and treatment for your

child.

9. Take care of yourself.

The Essential Elements of Trauma-Informed Parenting

Source: Grillo, C. A., Lott, D. A., & Foster Care Subcommittee of the Child Welfare Committee, National Child Traumatic Stress Network. (2010). Caring for children who have experienced trauma:

A workshop for resource parents—Facilitator’s guide. Los Angeles, CA And Durham, NC: National Center for Child Traumatic Stress. Retrieved from http://nctsn.org/products/caring-for-children-

who-have-experienced-trauma

Enhance the Well-Being and

Resilience of those

Working in the System

• Create an environment of care that

addresses and minimizes Secondary

Traumatic Stress

• CW BSC Practice Strategies:

– Secondary traumatic stress groups for staff

– Supporting wellness activities

– Integrating resilience skill-building into

practice

Secondary Traumatic Stress Resources

Guide to promoting resilience and reducing STS among child welfare staff

Fact sheet on Secondary

Traumatic Stress for child-serving professionals

Speaker series providing foundation

of knowledge on STS, including

cultural implications of STS (English and

Spanish)

Partnering with Youth and

Families

• Youth and families should be given choices and an active voice in

decision-making on an individual, agency, and systemic level.

• Youth and family members who have been in the system have a

unique perspective and can provide valuable feedback.

• Partnerships with youth and families should occur at all levels of the

organization.

• Practice Strategies:

– Conducting inclusive team meetings

– Funding/contracts for youth/former youth/family participation

Family Partnership

Pyramid

Least Participation

Family Involvement

Goal: Involve families

at every step of the

service delivery and evaluation

process.

Family Partnership

Goal: Partner with families by valuing and

utilizing their input on par with the providers within agencies.

Families have equal voice and input into processes that may

continue after they have left services.

Most Participation

Family

Engagement

Goals: Engage

Families in services &

Improve service utilization.

Benefits of Involving Youth and Families in

Programming

• Greater family involvement in service delivery leads to:

– Increased collaboration among systems and professionals

– Greater understanding of the challenges facing families

– Increased family satisfaction with services

– Enhanced job satisfaction for providers

– Services that are more culturally relevant and competent

– A sense of ownership and empowerment among youth and families

– Quality improvement

– Increased public awareness and advocacy regarding child trauma

– Community outreach and mentorship

Pathways to Partnerships with Youth and

Families

Target Audience

Organizations and agencies who

work with children and families who

have experienced trauma

Description

Offers a structure for examining and

expanding the role of youth and

families in organizations on both the

clinical and organizational levels.

methods

Format

Self -assessment tools

Sample goals, objectives & strategies

Practical examples

Partner with Agencies and

Systems that Interact with

Children and Families

• Child welfare agencies need to establish strong

partnerships with other child- and family-serving systems.

• Service providers should develop common protocols and

frameworks.

• Cross-system collaboration enables all helping

professionals to see the child as a whole person, thus

preventing potentially competing priorities and messages.

• Collaboration between the child welfare and mental health

systems promotes cohesive care and better outcomes.

Strategies for Cross-System Collaboration

• Cross-training on trauma and its impact

• Jointly developed protocols regarding child and family trauma and

collaborative services that promote resiliency

• Multi-disciplinary teams

• Family team meetings

• Co-location of staff in community “hubs”

• Cross-system assessment tools

• All systems engaged in shared outcomes

• Technology used for information exchange

• Integrated information sharing systems

Public Policy and Child Trauma:

Key Issues Relevant to the NCTSN Mission

• Integration of trauma-informed services into all child-serving

systems, including health care settings

• Integration of evidence-based treatment into child

trauma/mental health treatment

• Medicaid coverage of child trauma treatment and services

• Trauma treatment and mental health services workforce

development

• Support for research on child traumatic stress

• Peer support for family and youth involvement in

shaping child trauma treatment/services

National Center for Child Traumatic Stress

Workforce Development

Modernizing Trauma Informed

Screening &Assessment

Continuum of Care

Collaboration within and

across Systems and Communities

Functional

Outcomes

Safety ↑Mood regulation

↓ Risky behaviors

↑Disclosure

Permanency↑ Placement Stability

↑Attachments

Well-Being↓School absences

↑ Ability to attend

↑ Health

↓Reckless behaviors

↓ Trauma symptoms

↑Positive coping

• Core Curriculum – training in schools of Social Work and Psychology

• Learning Collaboratives

• Communities of Practices

• Child Welfare Trauma Training

Toolkit

• Resource Parent Curriculum

• Birth Parent Factsheets

• Benchcards for the

Trauma-Informed

Judge

• Tools for

addressing STS

•Identifying children/youth in need of

further assessment

•Systematically collecting detailed

trauma history profile

•Assessing traumatic bereavement/grief

reactions

•Using assessment to drive treatment

selection, case conceptualization,

treatment planning, monitoring

of progress

•Using assessment to

coordinate services and

case planning across

service sectors

• Breakthrough Series

and Lessons Learned

• Roundtables

• Partnering with Youth and Families

• Cross-System tools and partnerships

• Tools for Community Partners

• Child-Parent Psychotherapy (CPP)

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

• Trauma-Grief Component Therapy for Adolescents

(TGCT-A)

• Trauma Affect Regulation: Guide for Education and

Therapy (TARGET)

Jane Halladay Goldman, PhD

Director, Service Systems Program

National Center for Child Traumatic Stress

jhalladay@mednet.ucla.edu

www.NCTSN.org