Child Welfare Trauma Training Toolkit

Transcription

1 Child Welfare Trauma Traiig Toolkit Traier s Guide 1st Editio March 2008 From the Natioal Child Traumatic Stress Network This project was fuded by the Substace Abuse ad Metal Health Services Admiistratio (SAMHSA), US Departmet of Health ad Huma Services (HHS). The views, policies, ad opiios expressed are those of the authors ad do ot ecessarily reflect those of SAMHSA or HHS. Established by Cogress i 2000, the Natioal Child Traumatic Stress Network (NCTSN) is a uique collaboratio of academic ad commuity-based service ceters whose missio is to raise the stadard of care ad icrease access to services for traumatized childre ad their families across the Uited States. Combiig kowledge of child developmet, expertise i the full rage of child traumatic experieces, ad attetio to cultural perspectives, the NCTSN serves as a atioal resource for developig ad dissemiatig evidece-based itervetios, trauma-iformed services, ad public ad professioal educatio.

2 Ackowledgmets This Traier s Guide was adapted by Miriam Wolf, LCSW, of the Califoria Social Work Educatio Ceter (CalSWEC) from materials developed by the Natioal Child Traumatic Stress Network (NCTSN). It forms part of a larger project, the Trauma-Iformed Child Welfare Traiig roject, a collaboratio with: Rady Childre s Hospital, Chadwick Ceter for Childre ad Families, Child ad Family olicy Istitute of Califoria (CFIC), ad Califoria Istitute for Metal Health (CIMH). Others who provided guidace ad assistace o this project iclude: Jae Berdie, Bill Carter, Lisa Coradi, Arlee Fisher, James Hery, Roby Igelma, Barrett Johso, Susa Ko, Jeifer Maze, Lye Marseich, Stuart Oppeheim, Cythia arry, Kare Riguette, Barbara E. Rya, Christie Siegfried, Cally Sprague, atricia Va Hor, Charles Wilso, ad Leslie W. Zeitler. Suggested Citatio Child Welfare Collaborative Group, Natioal Child Traumatic Stress Network & The Califoria Social Work Educatio Ceter. (2008). Child welfare trauma traiig toolkit: Traier s guide (1st ed.). Los Ageles, CA & Durham, NC: Natioal Ceter for Child Traumatic Stress. 2 The Natioal Child Traumatic Stress Network

3 Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio Cotets Materials Checklist...4 Goals ad Learig Objectives...6 Sample Daily Ageda, Day 1 of Sample Daily Ageda, Day 2 of Lesso la, Day Lesso la, Day Module 1: Creatig Trauma-Iformed Child Welfare ractice: Itroductio to the Essetial Elemets...26 Module 2: What Is Child Traumatic Stress?...35 Module 3: The Impact of Trauma o Childre s Behavior, Developmet, ad Relatioships...48 Module 4: Assessmet of a Child s Trauma Experieces...59 Module 5: rovidig Support to the Child, Family, ad Caregivers...73 Module 6: Maagig rofessioal ad ersoal Stress...80 Module 7: Summary...89 Appedix A: Optioal Follow-Up 1 3 Moths After The Traiig...95 Appedix B: Additioal Case Vigettes...96 Appedix C: Refereces ad Resources Appedix D: About the NCTSN ad Califoria arters Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March 2008

4 Materials Checklist Traier Note: Materials are listed i the order they appear throughout the Traier s Guide. Laptop ad LCD projector Flip chart ad stad (ost-it type preferred) Markers Supplemetal Hadouts, icludig pritouts of oweroit slides, for each participat. It may be best to prit them out i differet colors by module so participats ca easily see which hadout is i use. NCTSN Child Welfare Trauma Traiig Toolkit: Comprehesive Guide, oe for each participat Yellow highlighters, oe for each participat ost-it otes (2 -square size, approximately 20 for each participat) Audio clip of LISA (icluded o accompayig CD) Speakers (if usig the LCD to project video ad audio clip) 2 twist-top bottles of seltzer water, uopeed 1 twist-top bottle of seltzer, opeed, emptied, ad refilled with plai water (Label this bottle i some way so that you ca later distiguish it from the other uopeed seltzer bottles.) aper towels, approximately oe roll Blak white paper, approximately 100 sheets rizes (optioal) Extra pes/pecils DVD player ad TV (optioal) DVDs (optioal) Digital Stories: Choose from More Tha a Case File (2006), I Our Ow Voices (2002), or What Made a Differece? (2003). Order from the Youth Traiig roject, Bay Area Academy, Sa Fracisco State Uiversity, 4 The Natioal Child Traumatic Stress Network

5 Multiple Trasitios: A Youg Child s oit of View o Foster Care ad Adoptio (1997). Order from the Ifat-aret Istitute, CD with relaxig music NCR paper (i.e., carboless copy paper) or carbo paper (optioal) Costructio paper, assorted colors icludig black, approximately 50 pages (optioal) Glue sticks (optioal), oe for each participat Koosh Ball (optioal) Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March 2008

6 Goals ad Learig Objectives GOALS To educate child welfare professioals about the impact of trauma o the developmet ad behavior of childre To educate child welfare professioals about whe ad how to itervee directly i a trauma-sesitive maer ad through strategic referrals To esure that all childre i the child welfare system will have access to timely, quality, ad effective trauma-focused itervetios ad a case plaig process that supports resiliece i log-term healig ad recovery To support the Child ad Family Services Review (CFSR) goals of safety, permaecy, ad well-beig by icreasig skills ad motivatio of child welfare workers to effectively serve childre ad families (biological ad resource) i the child welfare system that have experieced traumatic stress Kowledge LEARNING OBJECTIVES K1. articipats will be able to recogize the importace of trauma-iformed practices i achievig safety, permaecy, ad well-beig. K2. articipats will be able to defie the Essetial Elemets of trauma-iformed child welfare practice. K3. articipats will be able to uderstad the term child traumatic stress ad kow what types of experieces costitute childhood trauma. K4. articipats will be able to uderstad the relatioship betwee a child s lifetime trauma history ad his or her behaviors ad resposes. K5. articipats will be able to uderstad how traumatic experieces affect brai developmet ad memory. K6. articipats will be able to uderstad how cultural factors ifluece how childre may idetify, iterpret, ad respod to traumatic evets. K7. articipats will be able to uderstad how traumatic experieces affect developmet. 6 The Natioal Child Traumatic Stress Network

7 K8. articipats will be able to recogize how child traumatic stress is exacerbated by ogoig stressors (icludig separatio from/loss of caregivers, ad/or foster placemet) i a child s eviromet ad withi the child welfare system. K9. articipats will be able to distiguish betwee geeral metal health practitioers ad those who specialize i treatig trauma, to facilitate effective referrals. K10. articipats will be able to describe the core compoets of evidece-based trauma treatmet. K11. articipats will be able to idetify copig resposes, stregths, ad protective factors that promote positive adjustmet amog traumatized childre. K12. articipats will be able to uderstad the impact of secodary traumatic stress (STS) o child welfare workers. K13. articipats will be able to idetify techiques for self-care. Skills S1. articipats will be able to recogize, idetify, ad assess symptoms of traumatic stress withi a developmetal ad cultural cotext. S2. articipats will be able to idetify potetial strategies to support childre who have experieced traumatic evets. These strategies cosist of stadard child welfare practice tools, additioal resources available through referral or cosultatio, ad immediate ad practical itervetio assistace. S3. articipats will be able to idetify strategies for implemetig the Essetial Elemets i their ogoig practice. S4. articipats will be able to accurately distiguish betwee behaviors that do ot require curret metal health treatmet vs. those that require referrals for immediate stabilizatio, trauma-specific itervetios, ad/or geeral metal health services. S5. articipats will be able to idetify strategies to support ad promote positive ad stable relatioships i the life of a child. S6. articipats will be able to idetify strategies to support ad guide a child s family ad caregivers. S7. articipats will be able to practice techiques for self-care. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

8 Values V1. articipats will be able to appreciate how the impact of traumatic stress ca be preveted ad/or mitigated by trauma-iformed resposes of child welfare workers ad child welfare systems. V2. articipats will be able to value the developmet of ad eed for trauma-iformed professioals ad multi-discipliary teams. V3. articipats will be able to value the importace of referrig childre with a trauma history for a thorough trauma assessmet ad trauma-specific metal health services. V4. articipats will be able to appreciate the eed for improved services ad supports to traumatized childre i the child welfare system ad to their biological ad resource families. V5. articipats will be able to appreciate the challegig role that resource parets (i.e., foster parets, relatives, legal guardias, ad adoptive parets) face i carig for childre who have experieced trauma. V6. articipats will be able to value their role i helpig traumatized childre i the child welfare system. 8 The Natioal Child Traumatic Stress Network

9 Sample Daily Ageda Day 1 of 2 8:30 am 9:00 am Registratio 9:00 am 9:10 am Welcome, Overview ad Itroductios (10 miutes) 9:10 am 9:25 am What Impact Does Trauma Have o the Goals of Safety, ermaecy, ad Well-Beig? (15 miutes) 9:25 am 9:40 am Itroductio to Trauma-Iformed Child Welfare ractice ad the Essetial Elemets (15 miutes) 9:40 am 10:05 am Itroductio to Strategies for Implemetig the Essetial Elemets (25 miutes) 10:05 am 10:30 am What Is Child Traumatic Stress? (25 miutes) 10:30 am 10:45 am BREAK (15 miutes) 10:45 am 11:15 am How Does Trauma Affect Childre? (30 miutes) 11:15 am 11:35 am What Is the Ifluece of Culture? (20 miutes) 11:35 am 12:00 oo What Is the Ifluece of Developmetal Stage? (25 miutes) 12:00 oo 1:00 pm LUNCH BREAK (60 miutes) Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

10 1:00 pm 1:45 pm Case Vigette Tommy (45 miutes) 1:45 pm 1:55 pm What Child Welfare Workers Ca Do (10 miutes) 1:55 pm 2:10 pm BREAK (15 miutes) 2:10 pm 2:30 pm Lecture ad Small Group Discussio o Essetial Elemet 1: Maximize the Child s Sese of Safety (20 miutes) 2:30 2:50 pm Large Group Discussio o Essetial Elemet 2: Assist Childre i Reducig Overwhelmig Emotio (20 miutes) 2:50 pm 3:00 pm Lecture o Essetial Elemet 3: Help Childre Make New Meaig of Their Trauma History ad Curret Experieces (10 miutes) 3:00 pm 3:40 pm Case Vigette Adrew (40 miutes) 3:40 pm 4:10 pm Summary of Essetial Elemets 1, 2, ad 3 (30 miutes) 4:10 pm 4:15 pm Summary of Day 1 ad Day 1 Traiig Evaluatio (5 miutes) 10 The Natioal Child Traumatic Stress Network

11 Sample Daily Ageda Day 2 of 2 8:30 am 9:00 am Registratio 9:00 am 9:15 am Welcome Back, Leftover Questios, ad Eergizer (15 miutes) 9:15 am 9:25 am Lecture o Essetial Elemets 4, 5, ad 6: Address the Impact of Trauma ad Subsequet Chages i the Child s Behavior, Developmet, ad Relatioships; Coordiate Services with Other Agecies; Utilize Comprehesive Assessmet of the Child s Trauma Experiece ad Its Impact o the Child s Developmet ad Behavior to Guide Services (10 miutes) 9:25 am 9:35 Lecture: What Is Trauma Assessmet? (10 miutes) 9:35 am 9:50 am Lecture: What Does Trauma-Iformed Assessmet ad Treatmet Look Like? (15 miutes) 9:50 am 10:00 am Trauma-Iformed Bigo Game ad Discussio of Local Resources (Optioal Activity) (10 miutes) 10:00 am 10:15 am Child Welfare Trauma Referral Tool (15 miutes) 10:15 am 10:30 am BREAK (15 miutes) 10:30 am 11:05 am Case Vigette Joshua (35 miutes) Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

12 11:05 am 11:20 am Summary of Essetial Elemets 4, 5, ad 6 (15 miutes) 11:20 am 11:25 am Lecture o Essetial Elemet 7: Support ad romote ositive ad Stable Relatioships i the Life of the Child (5 miutes) 11:25 am 11:30 am Lecture o Essetial Elemet 8: rovide Support ad Guidace to the Child s Family ad Caregivers (5 miutes) 11:30 am 12:00 oo Discussio or Video Exercise (Optioal Activity) (30 miutes) 12:00 oo 1:00 pm LUNCH BREAK (60 miutes) 1:00 pm 1:35 pm Case Vigette Chris (35 miutes) 1:35 pm 1:50 pm Summary of Essetial Elemets 7 ad 8 (15 miutes) 1:50 pm 2:00 pm Lecture o Essetial Elemet 9: Maage rofessioal ad ersoal Stress (10 miutes) 2:00 pm 2:15 pm Case Vigette Mary (15 miutes) 2:15 pm 2:30 pm What Ca Help revet or Mitigate Secodary Traumatic Stress (STS)? (15 miutes) 2:30 pm 2:45 pm BREAK (15 miutes) 2:45 pm 2:55 pm Relaxatio Exercises (10 miutes) 2:55 pm 3:10 pm Summary of Essetial Elemet 9 (15 miutes) 12 The Natioal Child Traumatic Stress Network

13 3:10 pm 3:25 pm Strategizig Activity (15 miutes) 3:25 pm 3:55 pm Summary of Essetial Elemets 1 Through 9 (30 miutes) 3:55 pm 4:10 pm Art Summary Activity, Koosh Ball Summary Activity, Read Summary Quote (Choose 1 or more Optioal Activities) (15 miutes) 4:10 pm 4:15 pm Traiig Evaluatio (5 miutes) Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

14 Lesso la Day 1 TOIC LEARNING OBJECTIVE METHODOLOGY Day 1, Module 1 Activity 1A: 10 miutes 9:00 am 9:10 am Welcome, Overview, ad Itroductios Day 1, Module 1 Activity 1B: 15 miutes 9:10 am 9:25 am What Impact Does Trauma Have o the Goals of Safety, ermaecy, ad Well-Beig? Day 1, Module 1 Activity 1C: 15 miutes 9:25 am 9:40 am Itroductio to Trauma- Iformed Child Welfare ractice ad the Essetial Elemets Itroductio to the Goals ad the Learig Objectives for the 2-day traiig. K1. articipats will be able to recogize the importace of trauma-iformed practices i achievig safety, permaecy, ad well-beig. K2. articipats will be able to defie the Essetial Elemets of trauma-iformed child welfare practice. Traier s Itroductio Review goals ad objectives. T Slides 1 4 Lecture ad Small Group Discussio Coect CFSR goals to ew kowledge of child traumatic stress. T Slide 4 Lecture Traier itroduces participats to the Essetial Elemets, which will be the framework for the remaider of the traiig cotet. T Slides The Natioal Child Traumatic Stress Network

15 TOIC LEARNING OBJECTIVE METHODOLOGY Day 1, Module 1 Activity 1D: 25 miutes 9:40 am 10:05 am Itroductio to Strategies for Implemetig the Essetial Elemets Day 1, Module 2 Activity 2A: 25 miutes 10:05 am 10:30 am What Is Child Traumatic Stress? Day 1, Module 2 Activity 2B: 30 miutes 10:45 am 11:15 am How Does Trauma Affect Childre? K2. articipats will be able to defie the Essetial Elemets of trauma-iformed child welfare practice. K3. articipats will be able to uderstad the term child traumatic stress ad kow what types of experieces costitute childhood trauma. BREAK (15 miutes) 10:30 am 10:45 am K4. articipats will be able to uderstad the relatioship betwee a child s lifetime trauma history ad his or her behaviors ad resposes. K5. articipats will be able to uderstad how traumatic experieces affect brai developmet ad memory. Small Group Discussio Apply the Essetial Elemets to participats ow practice. Lecture Use Lisa audio clip. Facilitate large group discussio. T Slides Lecture T Slides Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

16 TOIC LEARNING OBJECTIVE METHODOLOGY Day 1, Module 2 Activity 2C: 20 miutes 11:15 am 11:35 am What Is the Ifluece of Culture? Day 1, Module 2 Activity 2D: 25 miutes 11:35 am 12:00 oo What Is the Ifluece of Developmetal Stage? Day 1, Module 2 Activity 2E: 45 miutes 1:00 pm 1:45 pm Case Vigette K6. articipats will be able to uderstad how cultural factors ifluece how childre may idetify, iterpret, ad respod to traumatic evets. K7. articipats will be able to uderstad how traumatic experieces affect developmet. LUNCH (60 miutes) 12:00 oo 1:00 pm S1. articipats will be able to recogize, idetify, ad assess symptoms of traumatic stress withi a developmetal ad cultural cotext. Lecture ad Discussio Itroduce framework of Lisa Aroso Fotes as example of how culture ca support or exacerbate the experiece of trauma. Case sharig. T Slides Lecture T Slides Case Vigette Tommy Idetify history of traumatic evets, areas of stregth ad resiliece, curret behaviors ad domais i which he is havig difficulty, potetial areas for assessmet, case maagemet ad plaig, short-term ad log-term outcomes, child welfare worker (CWW) roles. 16 The Natioal Child Traumatic Stress Network

17 TOIC LEARNING OBJECTIVE METHODOLOGY Day 1, Module 2 Activity 2F: 10 miutes 1:45 pm 1:55 pm What Child Welfare Workers Ca Do Day 1, Module 3 Activity 3A: 20 miutes 2:10 pm 2:30 pm Essetial Elemet 1: Maximize the Child s Sese of Safety Day 1, Module 3 Activity 3B: 20 miutes 2:30 pm 2:50 pm Essetial Elemet 2: Assist Childre i Reducig Overwhelmig Emotio K8. articipats will be able to recogize how traumatic stress is exacerbated by ogoig stressors i a child s eviromet ad withi the child welfare system. V1. articipats will be able to appreciate how the impact of traumatic stress ca be preveted ad/or mitigated by trauma-iformed resposes of CWWs ad child welfare systems (CWSs). BREAK (15 miutes) 1:55 pm 2:10 pm K1. articipats will be able to recogize the importace of trauma-iformed practices i achievig safety, permaecy, ad well-beig. K8. articipats will be able to recogize how traumatic stress is exacerbated by ogoig stressors i a child s eviromet ad withi the child welfare system. Lecture ad Discussio What CWWs ca do to support traumatized childre i the CWS. T Slides Lecture ad Small Group Discussio Distiguish betwee physical ad psychological safety, ad what CWWs ca do. T Slides Lecture ad Large Group Discussio Simulate childre s emotios usig seltzer bottles, ad what CWWs ca do. T Slides Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

18 TOIC LEARNING OBJECTIVE METHODOLOGY Day 1, Module 3 Activity 3C: 10 miutes 2:50 pm 3:00 pm Essetial Elemet 3: Help Childre Make New Meaig of Their Trauma History ad Curret Experieces Day 1, Module 3 Activity 3D: 40 miutes 3:00 pm 3:40 pm Case Vigette Day 1, Module 3 Activity 3E: 30 miutes 3:40 pm 4:10 pm Summary of Essetial Elemets 1, 2, ad 3 Day 1, Module 3 Activity 3F: 5 miutes 4:10 pm 4:15 pm Summary of Day 1 ad Day 1 Traiig Evaluatio K4. articipats will be able to uderstad the relatioship betwee a child s lifetime trauma history ad his or her behaviors ad resposes. S2. articipats will be able to idetify potetial strategies to support childre who have experieced traumatic evets. These strategies cosist of stadard child welfare practice tools, additioal resources available through referral or cosultatio, ad immediate ad practical itervetio assistace. S3. articipats will be able to idetify strategies for implemetig the Essetial Elemets i their ogoig practice. Lecture Essetial Elemet 3: Help Childre Make New Meaig of Their Trauma History ad Curret Experieces. T Slides Case Vigette Adrew Evaluatio Activity articipats idetify ad record strategies to help them implemet the Essetial Elemets. Summarize Day 1 Allow opportuities for ligerig questios. 18 The Natioal Child Traumatic Stress Network

19 Lesso la Day 2 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 4 Activity 4A: 15 miutes 9:00 am 9:15 am Welcome Back, Leftover Questios, ad Eergizer Day 2, Module 4 Activity 4B: 10 miutes 9:15 am 9:25 am Essetial Elemets 4, 5, ad 6: Address the Impact of Trauma ad Subsequet Chages i the Child s Behavior, Developmet, ad Relatioships; Coordiate Services with Other Agecies; Utilize Comprehesive Assessmet of the Child s Trauma Experiece ad Its Impact o the Child s Developmet ad Behavior to Guide Services K2. articipats will be able to be able to defie the Essetial Elemets of trauma-iformed child welfare practice. V2. articipats will be able to value the developmet of ad eed for traumaiformed professioals ad multidiscipliary teams. Traier elicits leftover questios. As Eergizer, participats write dow as may thigs as they ca remember from the day before. Lecture Brief review of Essetial Elemets 4, 5, ad 6: Address the Impact of Trauma ad Subsequet Chages i the Child s Behavior, Developmet, ad Relatioships; Coordiate Services with Other Agecies; Utilize Comprehesive Assessmet of the Child s Trauma Experiece ad Its Impact o the Child s Developmet ad Behavior to Guide Services T Slides Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

20 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 4 Activity 4C: 10 miutes 9:25 am 9:35 am What Is Trauma Assessmet? Day 2, Module 4 Activity 4D: 15 miutes 9:35 am 9:50 am What Does Trauma- Iformed Assessmet ad Treatmet Look Like? Day 2, Module 4 Activity 4E: 10 miutes 9:50 am 10:00 am Trauma-Iformed Bigo ad Discussio of Local Resources (Optioal Activity) V3. articipats will be able to value the importace of referrig childre with a trauma history for a thorough trauma assessmet ad trauma-specific metal health services. K9. articipats will be able to distiguish betwee geeral metal health practitioers ad those who specialize i treatig trauma. K10. articipats will be able to be able to describe the core compoets of evidece-based treatmet, icludig Trauma- Focused Cogitive Behavioral Therapy. V2. articipats will value the developmet of ad eed for trauma-iformed professioals ad multidiscipliary teams. Lecture Trauma Assessmet is defied. T Slides Lecture Traier defies ad distiguishes betwee geeral therapists ad trauma-iformed therapists ad evidecebased treatmets. Discuss worker role i obtaiig such treatmet for childre i the CWS. T Slides Bigo Game ad Discussio articipats play Trauma-Iformed Bigo to review cotet ad lear about local resources from fellow participats. 20 The Natioal Child Traumatic Stress Network

21 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 4 Activity 4F: 15 miutes 10:00 am 10:15 am Child Welfare Trauma Referral Tool Day 2, Module 4 Activity 4G: 35 miutes 10:30 am 11:05 am Case Vigette Day 2, Module 4 Activity 4H: 15 miutes 11:05 am 11:20 am Summary of Essetial Elemets 4, 5, ad 6 K4. articipats will be able to uderstad the relatioship betwee a child s lifetime trauma history ad his or her behaviors ad resposes. K9. articipats will be able to distiguish betwee geeral metal health practitioers ad those who specialize i treatig trauma to facilitate effective referrals. BREAK (15 miutes) 10:15 am 10:30 am S4. articipats will be able to accurately distiguish betwee behaviors that do ot require curret metal health treatmet vs. those that require referrals for immediate stabilizatio, traumaspecific itervetios, ad/or geeral metal health services. S3. articipats will be able to idetify strategies for implemetig the Essetial Elemets i their ogoig practice. Lecture Itroduce Child Welfare Trauma Referral Tool usig T slides ad hadout samples of the tool. T Slides Case Vigette Joshua Evaluatio Activity articipats idetify ad record strategies to help them implemet Essetial Elemets 4, 5, ad 6. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

22 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 5 Activity 5A: 5 miutes 11:20 am 11:25 am Essetial Elemet 7: Support ad romote ositive ad Stable Relatioships i the Life of the Child Day 2, Module 5 Activity 5B: 5 miutes 11:25 am 11:30 am Essetial Elemet 8: rovide Support ad Guidace to the Child s Family ad Caregivers Day 2, Module 5 Activity 5C: 30 miutes 11:30 am 12:00 oo Discussio or Video Exercise (Optioal Activity) V4. articipats will be able to appreciate the eed for improved services ad supports to traumatized childre i the CWS ad to their biological ad resource families. V5. articipats will be able to appreciate the challegig role that resource parets (i.e., foster parets, relatives, legal guardias, ad adoptive parets) face i carig for childre who have experieced trauma. K11. articipats will be able to idetify copig resposes, stregths, ad protective factors that promote positive adjustmet amog traumatized childre. LUNCH (60 miutes) 12:00 oo 1:00 pm Lecture Why supportig ad promotig positive ad stable relatioships i the life of the child is essetial. T Slides Lecture Why providig support ad guidace to the child s family ad caregivers is essetial. T Slide 102 Videotape, Hadout, ad Discussio articipats view Digital Stories or Multiple Trasitios ad discuss what CWWs ca do to support Essetial Elemets 7 ad The Natioal Child Traumatic Stress Network

23 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 5 Activity 5D: 35 miutes 1:00 pm 1:35 pm Case Vigette Day 2, Module 5 Activity 5E: 15 miutes 1:35 pm 1:50 pm Summary of Essetial Elemets 7 ad 8 Day 2, Module 6 Activity 6A: 10 miutes 1:50 pm 2:00 pm Essetial Elemet 9: Maage rofessioal ad ersoal Stress Day 2, Module 6 Activity 6B: 15 miutes 2:00 pm 2:15 pm Case Vigette S5. articipats will be able to idetify strategies to support ad promote positive ad stable relatioships i the life of a child. S6. articipats will be able to idetify strategies to support ad guide a child s family ad caregivers. S3. articipats will be able to idetify strategies for implemetig the Essetial Elemets i their ogoig practice. K12. articipats will be able to uderstad the impact of secodary traumatic stress o CWWs. K12. articipats will be able to uderstad the impact of secodary traumatic stress o CWWs. Case Vigette Chris articipats use the case vigette to idetify strategies to maximize stability ad support the caregivers i Chris s life. Evaluatio Activity articipats idetify ad record strategies to help them implemet Essetial Elemets 7 ad 8. Lecture Secodary traumatic stress (STS) is defied. T Slides Case Vigette Mary Traier reads a vigette to the group to idetify symptoms of STS as well as prevetio ad self-care strategies for workers. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

24 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 6 Activity 6C: 15 miutes 2:15 pm 2:30 pm What Ca Help revet or Mitigate Secodary Traumatic Stress? Day 2, Module 6 Activity 6D: 10 miutes 2:45 pm 2:55 pm Relaxatio Exercises Day 2, Module 6 Activity 6E: 15 miutes 2:55 pm 3:10 pm Summary of Essetial Elemet 9 Day 2, Module 7 Activity 7A: 15 miutes 3:10 pm 3:25 pm Strategizig Activity K13. articipats will be able to idetify techiques for self-care. BREAK (15 miutes) 2:30 pm 2:45 pm S7. articipats will be able to practice techiques for self-care. S3. articipats will be able to idetify strategies for implemetig the Essetial Elemets i their ogoig practice. S2. articipats will be able to idetify potetial strategies to support childre who have experieced traumatic evets. These strategies cosist of stadard child welfare practice tools, additioal resources available through referral or cosultatio, ad immediate ad practical itervetio assistace. Large Group Discussio articipats braistorm ideas to prevet or mitigate STS ad to practice self-care. T Slide 107 Relaxatio Exercises Traier leads a relaxatio exercise, or may substitute oe suggested by a participat. Or a participat may lead oe. Evaluatio Activity articipats idetify ad record strategies to help them implemet Essetial Elemet 9. Small Group Activity articipats apply the Essetial Elemets to cases withi their ow couty. 24 The Natioal Child Traumatic Stress Network

25 TOIC LEARNING OBJECTIVE METHODOLOGY Day 2, Module 7 Activity 7B: 30 miutes 3:25 pm 3:55 pm Summary of Essetial Elemets 1 Through 9 Day 2, Module 7 Activity 7C, 7D, or 7E: 15 miutes 3:55 pm 4:10 pm Art Summary Activity, Koosh Ball Summary Activity, or Read Summary Quote (Optioal Activities) Day 2, Module 7 Activity 7F: 5 miutes 4:10 pm 4:15 pm Traiig Evaluatio S3. articipats will be able to idetify strategies for implemetig the Essetial Elemets i their ogoig practice. K11. articipats will be able to idetify copig resposes, stregths, ad protective factors that promote positive adjustmet amog traumatized childre. V6. articipats will be able to value their role i helpig traumatized childre i the child welfare system. Evaluatio Activity articipats idetify ad record strategies to help them implemet the Essetial Elemets. Activity Traier selects a cocludig activity. Traiig Evaluatio T Slides Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

26 MODULE 1 Creatig Trauma-Iformed Child Welfare ractice: Itroductio to the Essetial Elemets Key Learig oits Traiig Time: 65 miutes (1 hour 5 miutes) 1. Childre s exposure to traumatic evets ad their subsequet reactios affect child welfare workers ability to achieve the CFSR goals of safety, permaecy, ad well-beig. Trauma-iformed child welfare practice supports efforts to reach these goals. 2. The Essetial Elemets describe a trauma-iformed child welfare practice model that addresses ad best respods to the eeds of childre who have bee maltreated ad traumatized. This module details each of the Essetial Elemets ad itroduces participats to the Comprehesive Guide. 3. The Essetial Elemets are cosistet with best practice i child welfare, ad some mirror well-established child welfare priorities, such as maximizig safety. Icorporatig the Essetial Elemets ito oe s practice does ot require more worker time, but rather, a redirectio of time. 4. While the Essetial Elemets are the provice of all professioals, such as metal health ad educatio professioals, who work i ad with childre i the child welfare system, it is the child welfare worker who coordiates with other systems to esure that these elemets are preset. 5. For each Essetial Elemet, there are three types of strategies available for child welfare workers: Child Welfare Tools, Resources ad Supports, ad ractical Assistace. 26 The Natioal Child Traumatic Stress Network

27 ACTIVITY 1A Welcome, Overview, ad Itroductios Activity Time: 10 miutes Materials Needed oweroit Slides 1 4 Flip chart (ost-it type preferred) ad stad Markers Traier Activities Cover the followig i your brief itroductio: Thak participats for attedig the traiig. Itroduce traier(s), ad give a syopsis of traier backgroud. rovide logistical iformatio, e.g., locatios of bathrooms, phoes, coffee ad food, sig-i sheets, Cotiuig Educatio Uits (CEUs), begiig ad edig times, schedules of breaks, etc. Briefly review oweroit Slides 3 ad 4, which iclude CFSR goals ad specific objectives of this traiig. Make sure to emphasize that this traiig is ot iteded to icrease the workload for child welfare workers. Rather, the traiig will help workers reshape what they are already doig to make services more trauma-iformed. Use oe to two miutes to ask participats for specific questios they have related to child trauma, ad ote their questios o the flip chart. Let participats kow whe durig the 12-hour traiig their questio will be addressed. If there wo t be time, do your best to provide a referece or resource where the participat ca get more iformatio. If time allows, have participats itroduce themselves, ad ask them to iclude their couty, assigmet, ad years workig i the field of child welfare. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

28 TRAINER TI: Optioal Exercise: As participats itroduce themselves ad the umber of years workig i the field, the traier ca quietly tally the umber of years of experiece i the room, ad provide the sum total to the group whe itroductios are complete. This device hoors the wisdom ad experiece i the room whe a traiig audiece icludes vetera workers. The traier ca the state that he/she looks forward to hearig ideas ad wisdom from participats, as well as fresh ideas from ewer workers. A fu twist o this exercise is to ask participats to lie up aroud the room i order of years of experiece, ad have the group tally the total years of experiece. ACTIVITY 1B SMALL GROU DISCUSSIONS What Impact Does Trauma Have o the Goals of Safety, ermaecy, ad Well-Beig? Materials Needed Comprehesive Guide, pp oweroit Slide 4 Flip chart Markers Traier Activities Activity Time: 15 miutes Leave oweroit Slide 4 o the scree. Divide the group ito three smaller groups, with five to six participats per group. (If you have a large group, you ca divide ito six or ie small groups, as eeded.) Distribute blak flip chart sheets ad markers to each group. Assig each of the three groups oe of the CFSR goals: SAFETY, ERMANENCY, WELL-BEING. (If there are six small groups, assig two groups to SAFETY; if there are ie groups, assig three groups to SAFETY, etc.) 28 The Natioal Child Traumatic Stress Network

29 Istruct each group to select a scribe ad a spokesperso. Each group should braistorm ad write o the flip chart sheet their aswers to the questio: From what you kow about trauma, how might a child s exposure to traumatic evets ad his or her subsequet reactios affect child welfare workers ability to achieve the goal assiged to your group? rovide a example for each goal, drawig from the ideas i the bullet poits below. Give participats approximately five to seve miutes to braistorm, ad ask the spokesperso to be prepared to give a report-back to the larger group. Ask spokespeople to provide the report-backs to the larger group. As groups report, you may add ay of the followig poits that may ot have bee metioed i the report-backs. Safety: Traumatic stress ca adversely impact the child s ability to protect himself or herself from abuse or for the agecy to do so, i the followig ways. The child s iability to regulate moods ad behavior may overwhelm or ager caregivers to the poit of icurrig icreased risk of abuse or placig other childre at risk. The after-effects of trauma may impair a child s ability to describe the traumatic evets i the detail eeded by ivestigators. The child s lack of trust may lead him or her to provide ivestigators or the courts with icomplete or iaccurate iformatio about abuse experieced or witessed. Traumatic reactios may dull the child s emotios i ways that make some ivestigators skeptical of the veracity of the child s statemets. The child s altered world view may lead to behaviors that are self-destructive or dagerous, icludig premature sexual activities. ermaecy: The child s reactio to traumatic stress ca adversely impact the child s stability i placemets. The child s iability to regulate his or her moods ad behavior may lead to behaviors that edager or threate stable placemets, reuificatio, ad/or adoptive placemet. The child s lack of trust i the motivatios of caregivers may lead to rejectio of possible carig adults or, coversely, lead to superficial attachmets. The child s early experieces ad attachmet problems may reduce his or her atural empathy for others, icludig foster or adoptive family members. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

30 A ew foster paret or adoptive paret, uaware of the child s trauma history or of what remiders are liked to strog emotioal reactios, may iadvertetly trigger strog remiders of trauma. Well-Beig: Traumatic stress may have both short- ad log-term cosequeces for the child s metal health, physical health, ad life trajectory. The child s exposure to trauma may have produced cogitive effects that iterfere with his or her ability to lear, to progress i school, ad to succeed i the classroom ad the commuity (ad later i the workplace). The child s iability to regulate emotios may iterfere with his or her ability to fuctio i a family, i a traditioal classroom, ad with peers i the commuity. The child s mistake feeligs of guilt ad self-blame for the egative evets i his or her life may lead to a sese of hopelessess that impairs his or her ability ad motivatio to succeed i social ad educatioal settigs. A child s traumatic experieces may alter his or her worldview so that the child ow sees the world as utrustworthy ad isolates himself or herself from family, peers, ad social ad emotioal support. Without more positive copig strategies, the child may egage i high-risk or destructive copig behaviors ragig from reckless behavior to substace abuse, smokig, ruig away, eatig issues, sexual actig-out, ad self-cuttig. Summarize the discussio. 30 The Natioal Child Traumatic Stress Network

31 ACTIVITY 1C LECTURE Itroductio to Trauma-Iformed Child Welfare ractice ad the Essetial Elemets Materials Needed oweroit Slides 5 19 Supplemetal Hadout: The Essetial Elemets of Trauma-Iformed Child Welfare ractice Traier Activities Activity Time: 15 miutes Cover the followig cotet i lecture format, usig oweroit Slides 5 9: The trauma-iformed child welfare worker uderstads the impact of trauma o a child s behavior, developmet, relatioships, ad survival strategies, ad ca itegrate that uderstadig ito plaig for the child ad family. The traumaiformed child welfare worker also uderstads his or her role i respodig to child traumatic stress. The Essetial Elemets describe a trauma-iformed child welfare practice model that addresses ad best respods to the eeds of childre who have bee maltreated ad traumatized. The Essetial Elemets are the provice of all professioals who work i ad with the child welfare system. They spa ivestigatio, service provisio ad coordiatio, court decisio-makig, ad permaecy. Implemetatio of each Essetial Elemet must take ito cosideratio the child s developmetal level ad must reflect sesitivity to the child s family, culture, ad laguage. Systems grouded i the Essetial Elemets will be better able to achieve goals of the Adoptio ad Safe Families Act safety, permaecy, ad child well-beig. Refer participats to the Supplemetal Hadout: The Essetial Elemets of Trauma-Iformed Child Welfare ractice. This hadout ca be used as a referece throughout the traiig. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

32 Itroduce the Essetial Elemets: 1. Maximize the child s sese of safety. 2. Assist childre i reducig overwhelmig emotio. 3. Help childre make ew meaig of their trauma history ad curret experieces. 4. Address the impact of trauma ad subsequet chages i the child s behavior, developmet, ad relatioships. 5. Coordiate services with other agecies. 6. Utilize comprehesive assessmet of the child s trauma experieces ad their impact o the child s developmet ad behavior to guide services. 7. Support ad promote positive ad stable relatioships i the life of the child. 8. rovide support ad guidace to the child s family ad caregivers. 9. Maage professioal ad persoal stress. The Essetial Elemets are cosistet with best practice i child welfare. Trauma-iformed child welfare practice mirrors well-established child welfare priorities such as supportig stable relatioships i a child s life. Implemetig the Essetial Elemets ad doig trauma-iformed child welfare work do ot require ay more time from the child welfare worker tha good-quality child welfare work already takes. Rather, they require a redirectio of time. NOTE TO TRAINERS: This poit is especially importat for seasoed workers who are likely to be skeptical of ew ideas or practices, ad who may believe that ew practices may place more time ad work demads o workers who may already feel overburdeed. Explai why each of the Essetial Elemets is cosidered essetial, utilizig oweroit Slides Traier Tip: The descriptio of each Essetial Elemet o Slides should be viewed as brief sapshots of the Essetial Elemets. The remaider of the traiig will go much more i-depth ito each oe. Additioally, Activity 1D allows participats to become more familiar with each Essetial Elemet. 32 The Natioal Child Traumatic Stress Network

33 Activity 1D SMALL GROU DISCUSSION Itroductio to Strategies for Implemetig the Essetial Elemets Activity Time: 25 miutes Materials Needed Comprehesive Guide, pp Yellow highlighter pes (oe per participat) ost-it otes (2 -square size, eough for 20 ost-it otes per participat) Flip chart (ost-it type preferred) Markers Traier Activities Assig participats to three small groups. Distribute yellow highlighters ad ost-it otes to each participat. Istruct participats to refer to the Comprehesive Guide, pp , The Essetial Elemets of Trauma-Iformed Child Welfare ractice. For each Elemet, the Guide describes i greater detail tha the Activity 1C lecture why each Elemet is essetial ad provides cocrete strategies for child welfare workers. As participats work withi their small groups, ecourage them to highlight parts of the material that they feel are the highlights of this sectio of the Guide. While participats are workig, write each of the Elemets o a flip chart sheet (oe Elemet per sheet). Istruct participats to jot dow o ost-it otes how they have already bee implemetig each Elemet i their work i the field. Let them kow that they ca post ideas that they are already doig which they read about i the Comprehesive Guide (that s NOT cheatig!) ad ecourage them to write other ideas that they may be doig which are t metioed i the Guide. Whe they are fiished, they should stick their ost-it otes o the Elemets page that best matches their otes. Whe each group has completed the task ad has posted its ost-it otes, read aloud a few from each Elemet with the whole group. If time permits, ask participats to describe how they have used the Elemets with actual cases they have/had. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

34 TRAINER TI: This activity reviews ad affirms what participats are already doig, exposes them to ew ideas that are beig utilized by others i the field, ad uderscores the poit that trauma-iformed child welfare practice, with implemetatio of the Essetial Elemets, does ot require spedig more time o their work. Rather, it is a reframig or redirectio of their time. Further, the activity may demostrate that the trauma-specific Essetial Elemets are less emphasized tha other Essetial Elemets (e.g., maitaiig safety) that are already stadard practice for child welfare workers. If this is the case, poit that out. 34 The Natioal Child Traumatic Stress Network

35 MODULE 2 What Is Child Traumatic Stress? Key Learig oits Traiig Time: 155 miutes (2 hours 35 miutes) 1. Child trauma comes i various forms, ad may childre eterig the child welfare system have experieced may differet types of trauma. These experieces rage from abuse ad eglect, to witessig violece or the traumatic loss of a loved oe, or to ivolvemet i accidets or commuity violece that may be urelated to the reaso the child comes to the attetio of the child welfare system. 2. Child traumatic stress should be uderstood utilizig a developmetal ad cultural framework. Trauma ca derail attachmet ad developmet ad requires differet strategies ad resposes depedig o the child s developmetal stage. 3. Most childre who come to the attetio of the child welfare system have likely had multiple exposures to trauma. 4. Trauma ca be cumulative, with multiple traumatic evets buildig upo oe aother i a egative way. Sustaied, chroic, or multiple exposures to trauma have a impact o childre s developmet ad o their ability to form attachmets ad relatioships, to self-regulate, ad to lear. 5. Without help ad support, childre ofte develop a variety of egative copig resposes to traumatic stress. A child s respose to traumatic stress may maifest across multiple domais of fuctioig ad developmetal processes, icludig emotioal, behavioral, iterpersoal, physiological, ad cogitive fuctioig. 6. The realities of the child welfare system ca ad ofte do exacerbate a child s traumatic respose by itroducig eve more stressors ito the child s eviromet (icludig separatio/loss of caregivers, foster placemet stress, etc.). Fortuately, childre ofte have a variety of copig resposes, stregths, ad protective factors that promote positive adjustmet. Child welfare workers ca idetify these stregths ad support their developmet ad use. 7. Trauma ca chage childre s worldviews, their sese of safety, ad how they iterpret the meaig of the behavior of others icludig people who are tryig to help them. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

36 8. Childre ofte have multidimesioal trauma histories, ad adults should ot assume that they kow what was most traumatic for the child. The evet(s) that led to child welfare ivolvemet may ot be the child s most sigificat trauma experiece. ACTIVITY 2A LECTURE, OWEROINT SLIDES, AND AUDIO CLI What Is Child Traumatic Stress? Materials Needed Comprehesive Guide, pp. 5 9 oweroit Slides Audio clip of Lisa call (icluded o accompayig CD) Speakers (if usig the LCD to project video ad audio clip) Activity Time: 25 miutes TRAINER TI: Because of the volume of iformatio i this module, it relies more heavily o cotet cotaied i the oweroit slides. lease review the slides ad the Comprehesive Guide i detail prior to coductig a traiig. You may adapt the lecture/oweroit format to be more iteractive with the group. For example, prior to presetig the material o types of trauma, you ca ask the group for examples of commo types of trauma experieced by childre they may ecouter i the child welfare system. You ca the use the slides to add aythig that was ot covered i the participats aswers. Traier Activities Usig lecture format, preset the material i oweroit Slides The cotet covered icludes iformatio o types of traumatic stress, prevalece of trauma i the Uited States, prevalece of trauma i child welfare populatios, ad other sources of ogoig stress. 36 The Natioal Child Traumatic Stress Network

37 If available, you may wat to substitute prevalece statistics for your state or couty i this sectio (oweroit Slide 30). lay the audio clip of Lisa TRAINER TI: This audio clip is a actual call made to Sa Diego emergecy services by a youg girl who was witessig a domestic violece icidet betwee her parets. The audio clip is quite itese ad may be difficult for some participats to liste to, especially those who have persoally experieced or witessed domestic violece. Before you play the recordig, you should alert participats to this ad tell them that they may step out of the room if they wish. After you play the recordig, allow time for geeral reflectios ad resposes. This is importat due to the itesity of the material. The amout of time eeded to discuss reactios to the clip may vary depedig o the group. If participats eed more time to process their reactios to the clip, feel free to cut out some of the followig suggestios for debriefig o the clip. Next, ask the group to describe what they imagied was goig o physically i the child s home. The ask them what was goig o iterally with the child i her brai, her body, ad i her thoughts ad fears. Be sure to ecourage commets about Lisa s efforts to regulate her emotios ad her chagig emotios as the threat chaged. Next, ask participats to describe how their ow bodies ad mids were reactig to this audio, which was recorded log ago ad i which they were ot threateed persoally. Explai that while o oe was actually seriously ijured that ight (cofirmed by Sa Diego 9-1-1), the traumatic stress was quite obvious ad real. Ask participats to braistorm other types of evets that might produce the same itese reactios. Look for aswers such as: physical abuse/assault, sexual abuse, life-threateig violece i the house or commuity/school, auto accidets, atural disasters, etc. IF RESENTING THIS TRAINING IN TWO FULL DAYS, TAKE A 15-MINUTE BREAK HERE. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March

38 ACTIVITY 2B LECTURE How Does Trauma Affect Childre? Activity Time: 30 miutes Materials Needed Comprehesive Guide, pp. 5 8, oweroit Slides Traier Activities Usig lecture format, preset the material i oweroit Slides This material covers iformatio about the variability of childre s resposes to stressors ad traumatic evets ad ca be foud i the Comprehesive Guide, pp Use the Comprehesive Guide, pp. 7 8 ad pp , ad the bulleted poits below to augmet the iformatio o oweroit Slides 34 37: Childre with histories of complex trauma, icludig multiple or prologed traumatic evets, may demostrate impairmet i may of the followig areas: Attachmet. Traumatized childre feel that the world is ucertai ad upredictable. Their relatioships ca be characterized by problems with boudaries, as well as distrust ad suspiciousess. As a result, traumatized childre ca become socially isolated ad have difficulty relatig to ad empathizig with others. Biology. Traumatized childre demostrate biologically based challeges, icludig problems with movemet ad sesatio, hypersesitivity to physical cotact, ad isesitivity to pai. They ca have problems with coordiatio, balace, ad body toe, as well as uexplaied physical symptoms ad icreased medical problems (e.g., asthma, ski problems, ad autoimmue disorders). Mood regulatio. Childre exposed to trauma ca have difficulty regulatig their emotios, as well as difficulty kowig ad describig their feeligs ad iteral states. They ca have difficulty appropriately commuicatig wishes ad desires to others. 38 The Natioal Child Traumatic Stress Network

39 Dissociatio. Some traumatized childre sometimes experiece a feelig of detachmet or depersoalizatio, as if they are observig somethig happeig to themselves that is ureal. They ca also withdraw from the outside world or demostrate amesia-like states. Behavioral cotrol. Traumatized childre ca demostrate poor impulse cotrol, self-destructive behavior, ad aggressio agaist others. Sleep disturbaces ad eatig disorders ca also be maifestatios of child traumatic stress. Cogitio. Childre exposed to trauma ca have problems focusig o ad completig tasks i school, as well as difficulty plaig ad aticipatig. They sometimes have difficulty uderstadig their ow cotributio to what happes to them. Some traumatized childre demostrate learig difficulties ad problems with laguage developmet. Self-cocept. Traumatized childre ca experiece the lack of a cotiuous, predictable sese of self. They ca suffer from disturbaces of body image, low self-esteem, shame, ad guilt. Use the bulleted poits below to augmet the iformatio o oweroit slides 38 39: osttraumatic stress disorder (TSD) is defied i the DSM-IV (AA, 2000) as: The precipitatig evet(s) ivolve actual or threateed (perceived) death or serious ijury, rape, or child sexual abuse, to self or others. The evet causes itese subjective resposes, such as fear, helplessess or horror (i childre, this may be expressed istead by disorgaized or agitated behavior). The evet(s) ca be acute (duratio of symptoms less tha three moths), chroic (duratio of symptoms is three moths or more), or with delayed oset (oset of symptoms is six moths or more after the evet). Key symptoms i childre: ersistet re-experiecig of the traumatic evet: itrusive, distressig recollectios of the evet; flashbacks (feelig as if the evet were recurrig while awake); ightmares (ca ivolve the evet or mosters, or ca be a frighteig dream without recogizable cotet); exaggerated emotioal ad physical reactios to remiders of the evet (e.g., a child who starts hittig the pizza delivery guy who remids him of the suspect with the gu); trauma-specific re-eactmet or repetitive play, i which themes or aspects of the trauma are expressed. Child Welfare Trauma Traiig Toolkit: Traier s Guide 1st Editio March