Trauma Informed Care for Child Welfare Professionals

Transcription

1 Trauma Informed Care for Child Welfare Professionals Edward Turner, RN, MA SOURCE: NATIONAL CHILD TRAUMATIC STRESS NETWORK (NCTSN) TRAUMA TRAINING TOOLKIT AND WEB BASED RESOURCES FROM NCTSN.ORG Goals of This Training Educate child welfare professionals about the impact of trauma Assure that all children and families in the child welfare system will have a case planning process that supports resilience in long term healing and recovery Assist child welfare workers in utilizing trauma informed practices to attain the Child and Family Services Review (CFSR) goals: Safety Permanency Well being This is the first step toward helping Louisiana to become a Trauma Informed Child Welfare System, the goal of the Louisiana Child Welfare Training Academy. Prevalence 1. One in four children experience at least one trauma prior to their 16th birthday. 2. Almost one half of all middle school students in urban schools report having seen a stabbing or a shooting. 3. Four out of ten children state they have witnessed violence. These numbers are for an average child. As you know, foster children have endured many more traumas such as abuse, neglect and frequent moves. 1

2 Definition of Trauma: An Informed Child and Family Service System A trauma informed child and family service system is one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers. Programs and agencies within such a system infuse and sustain trauma awareness, knowledge, and skills into their organizational cultures, practices, and policies. They act in collaboration with all those who are involved with the child, using the best available science, to facilitate and support the recovery and resiliency of the child and family. Why Focus on Trauma Trauma affects the child s behaviors, feelings, relationships and view of the world in profound ways. Traumatized children also often have physical problems. Trauma impairs learning. Research Supports Trauma Informed Training: Adults must develop a compassionate and trauma informed framework for understanding traumatized children and their behavior. They must be able to interpret the challenging and perplexing behavior of traumatized children not as willful disobedience, but as survival strategies acquired through adaption to toxic social environment (Henry et al., 2007; Perry, 2006). Adults must understand the role of relationships and connections in bringing healing to children who ve experienced trauma, emphasizing children s needs for felt safety, connections and self regulation (Bath, 2008; Dozier et al., 2008; Hoffman et al, 206; Juffer et al., 2013; Purvis et al., 2013; Siegel, 2012). Relationship based traumas demand relationship based caregiving and services (Cross, 2016). 2

3 Focus On The Child The research is clear that the experience of abuse or neglect leaves a particular traumatic fingerprint on the development of children. Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the negative impacts of early fear learning. The child s memory retains those learned links, and such thoughts and memories are sufficient to elicit ongoing fear and make a child anxious. Children bring their traumas with them everywhere: into the foster homes, schools, churches, stores physicians and dental offices etc. Trauma & Relationships Children experience their world through family relationships. Being separated from an attachment figure, especially during traumatic and confusing circumstances, may add to the child s trauma. Research shows that support from caregivers is significant in facilitating the healing from the child s trauma history. The child s trauma history can affect the professional by: compassion fatigue, bringing up painful memories etc. These same issues arise in the foster homes and may disrupt placements What is Child Traumatic Stress? Physical and emotional responses of a child to threatening events. These are also events that threaten the life or safety of someone close to them. Trauma causes an overwhelming sense of helplessness, terror and horror. Trauma produces intense physical effects such as: pounding heart, rapid breathing, trembling etc. making it hard for children to cope. This causes the child to feel terrified, powerless and out of control. 3

4 Possible Effects of Child Traumatic Stress The powerful effect of trauma may influence the way the child sees themselves, the world and their future. Trauma may affect a child s: Feelings of safety Ability to trust others The ability to adapt to what life throws their way 911 Call (Lisa) {Sound recording} 911 Call (Lisa) continued How did you feel during this call? What reactions did your own body produce during this recording? What other events may produce these same reactions? What happened to Lisa? 4

5 Types of Trauma Acute trauma is a single traumatic event that is limited in time. During an acute event, children go through a variety of feelings, thoughts, and physical reactions that are frightening. Types of Trauma continued Chronic trauma refers to the experience of multiple traumatic events. These may be multiple and varied events, such as: the child s being exposed to domestic violence, involved in a serious car accident, and then becoming a victim of community violence, or longstanding trauma such as physical abuse, neglect, or war The effects of chronic trauma are often cumulative. Types of Trauma continued Complex trauma describes both exposure to chronic trauma usually caused by adults entrusted with the child s care and the impact of such exposure on the child. Children who have experienced complex trauma have endured multiple interpersonal traumatic events from a very young age. Complex trauma has profound effects on nearly every aspect of a child s development and functioning. 5

6 Types of Trauma continued Historical trauma is a personal or historical event or prolonged experience that continues to have an impact over several generations. Examples include: Slavery Removal from homelands Relocation Massacres, genocides, or ethnocide Cultural, racial, and immigrant oppression Forced placement in boarding schools Types of Trauma continued System related Trauma unintentionally caused trauma that occurs by the very nature of being involved in the child welfare system. Removal Multiple placements Experiences in foster homes/group homes/hospitals/residential treatment facilities Feelings related to being placed in detention facilities Movement of siblings that do not live with the child Lack of communication about the case plan or changes in the case plan Types of Trauma continued Medical Trauma (related to ongoing or chronic illness or injury) is a special concern for children in foster care due to their higher rates of chronic health conditions. Medical illness, injury, and treatment can be traumatic. Medical exams can be invasive and may trigger past traumas or uncover conditions requiring painful or prolonged treatment. 6

7 Types of Trauma continued Medical Trauma continued For children in foster care, medical trauma may become layered onto previous traumatic experiences: Children are at risk for additional traumatic stress reactions related to their healthcare experience. The same risk factors for persistent traumatic stress in ill and injured children are particularly relevant for children in foster care who: Experience severe levels of pain during illness or injury Are exposed to scary sights and sounds in the hospital Are separated from parents or caregivers during treatment Have experienced prior medical trauma or had previous trauma reactions Potentially Traumatizing Events in Juvenile Detention and Other Residential Settings Seclusion Restraint Routine room confinement Strip searches and pat downs Placement on suicide watch Witnessing physical altercations Fear of being attacked by other youth Separation from family and community What About Neglect? Failure to provide for a child s basic needs Perceived as trauma by an infant or young child who is completely dependent on adults for care Opens the door to other traumatic events May interfere with a child s ability to recover from trauma Is neglect different based on the child s age or stage of development? 7

8 Child Traumatic Grief When someone important to the child dies in a sudden or violent manner that is perceived as traumatic to the child. Child s trauma symptoms interfere with his/her ability to grieve. Symptoms of child traumatic grief include: Being overly preoccupied with how the loved one died Reliving or re enacting the traumatic death Showing signs of emotional and/or behavioral distress when reminded of the loss The child can also experience significant grief with regard to the disruption of the family unit. Removal When a child is removed: Children lose their nuclear family dysfunctional or not, this is the normal for the child and all they know. The Child may lose their sense of community neighbors, church family, school friends, that favorite teacher Often they are separated from their siblings. They are separated from important possessions pets, favorite doll, clothing If the removed child was the caretaker/parent figure they lose the control of taking care of the family and therefore may become focused on the well being of siblings placed in separate foster homes, parents and the former household. Sources of Ongoing Stress Poverty Discrimination Lack of communication with parents and siblings Frequent moves Academic Problems both from organic and inorganic issues Loss of peer support as they are placed throughout the child welfare system Lack of positive role models Fear Refugee and immigrant experiences 8

9 Effects of Trauma Exposure When the trauma is the result of failing to protect and nurture it has serious long term effects on the child s life. It is especially harmful when the person or people that are expected to protect the child are the very ones causing the trauma. This may lead to issues with: Attachment traumatized children feel that the world is unsafe, have trouble forming or maintaining relationships and may have difficulty understanding the feelings of others. Biology these children may have difficulty with movement and sensation. They may be hypersensitive to physical contact buy not feel pain as expected. They may have unexplained symptoms or increased medical problems. Effects of Trauma Exposure continued Mood issues traumatized children may have trouble controlling their emotions. They experience difficulty expressing, understanding, describing or labeling their feelings. Disassociation often traumatized children experience a feeling of being disconnected from themselves. It is as if they are observing what is happening and therefore it does not feel real. Behavioral control when these children want to do something they have difficulty holding back. Because of this they often have behaviors that may unintentionally harm themselves or others. Effects of Trauma Exposure continued Cognition there may be problems focusing on tasks or completing tasks. They may also have problems planning for future events. Many have challenges learning or with language. Self concept traumatized children often suffer with a distorted body image, low self esteem, shame and guilt. (often from both issues prior to coming into care and then emotional issues from being in care) 9

10 Long Term Effects of Childhood Trauma Traumatized children that do not receive help often assume risky or destructive coping mechanisms. These behaviors often place the children at risk for: Alcoholism Substance abuse Depression Suicide attempts Sexually transmitted diseases Heart disease, liver disease and cancer Trauma And The Brain In a traumatized child there can be a serious impact on brain development and chemicals in the brain and nervous system can be altered. Changes in the ways that our bodies handle stress may cause harm to a developing brain. This may cause delays in both learning and language. Traumatized children show changes in stress hormones that are similar to war veterans. These changes may affect the way that their brains respond to future stress in their lives and negatively impact their health for years to come. Trauma And The Brain continued In early childhood development trauma exposure can lead to reduced brain size This reduction can cause impairment with complex brain functioning including speech development, memory, attention and learning capability. Trauma may impede the ability of the left and right hemispheres of the brain to communicate. This impaired communication is believed to lead to lower IQ and the inability to control emotions. This may then lead to the belief that the world is not safe, increasing fearfulness. 10

11 Diagnoses Associated With Childhood Trauma Post Traumatic Stress Disorder Attention deficit hyperactivity disorder Oppositional defiant disorder Conduct disorder Bipolar disorder Reactive attachment disorder These diagnoses generally do not capture the full extent of the developmental impact of trauma. The symptoms leading to these diagnoses may in fact be a child's reaction to a trauma reminder, which can result in withdrawn, aggressive, reckless or selfinjurious behaviors. What Can the Child Welfare Professional Do? Understand that children can react to trauma in different ways. View the child s reactions and behaviors through a trauma lens and help other service providers and caregivers to do the same. Refer appropriate children for trauma treatment to reduce long term impacts. If you are concerned that a child is being overly or unnecessarily medicated, advocate for a second opinion. Assure that medications are only used as part of a comprehensive treatment plan. What can you begin doing right away? Questions/Comments Edward Turner, RN, MA Louisiana Child Welfare Training Academy (985) James.turner 2@selu.edu 11

12 Thank You 12