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10 CW360 o Trauma-Informed Child Welfare Practice • Winter 2013OverviewThe Impact of Traumatic Stress on Parents Involvedin the Child Welfare SystemErika Tullberg, MPH, MPAThomas is a new caseworker supervising avisit between his client, Denise, age 25, andher three children, Christopher, Jr., age 5,Tanya, age 3, and Damon, age 2. This visithas already been rescheduled twice – it wassupposed to happen after the agency’s weeklydomestic violence group, which Denise ismandated to attend as part of her service plan,but she keeps missing the meetings. Thomaswants to talk to Denise about how she needsto come to these groups if she wants her kidsback, but he has seen her temper and doesn’twant to do anything to make today’s visit gobadly so decides to let it go.Damon has not said anything sincearriving at the agency; he is still strappedinto his stroller and since coming intothe visitation room has been whining andreaching up to Denise, but she keeps tellinghim to “behave” while she tries to get hissiblings to settle down. After a few minutesof running around Christopher trips on hisshoelaces and starts bleeding from his head –Tanya shrieks when she sees the blood, andDenise yells at Christopher saying that he’sruined the visit and is always out of control,just like his father. Thomas goes to comfortTanya, who has started to shake and cryuncontrollably, but Denise steps in front ofhim saying that she can handle her kids andthat they don’t need his help.The child welfare system has becomeincreasingly attuned both to the traumathat children and youth in the systemhave experienced and to the importance ofaddressing such trauma as part of ensuringtheir safety, permanence and well-being(Kisiel, Fehrenbach, Small, & Lyons, 2009).Research on the impact of trauma on fostercare placement stability in the short term,and long-term health outcomes over thelifespan, has helped to spur increased trainingon trauma for staff, resource parents, andother system stakeholders and availability ofevidence-based interventions for children andyouth (Landsverk, Garland, Reutz, & Davis,2011).However, we know that for children in thechild welfare system, the trauma they haveexperienced has often happened at home:abuse or neglect from a caretaker, exposureto domestic violence, or separation from aparent due to homelessness, incarceration orother family stressors. For parents who grewup under similar circumstances, or who haveexperienced traumatic events in adulthood, itmay be difficult to provide their own childrenwith support and structure if their owntrauma remains unaddressed. Research hasdemonstrated, in fact, that a parent’s traumahistory may increase his or her children’srisk of maltreatment (Banyard, Williams, &Siegel, 2003; Cohen, Hien, & Batchelder,2008), and that the parent’s trauma-relatedsymptoms and ability to respond in aprotective manner to his or her children isa predictor of a child developing traumasymptoms following exposure to a traumaticevent (Chemtob, Nomura, & Abramovitz,2008). If parents do not feel safe, they will beless able to keep their children safe.Anecdotal evidence and growing researchsuggests that trauma is very common amongparents receiving child welfare services. InNew York City, the ACS-NYU ChildrenTrauma Institute’s Safe Mothers, SafeChildren program is addressing traumaexperienced by mothers receiving child welfarepreventive services. During project planninginterviews conducted in 2008, East Harlempreventive service program directors reportedconcerns about trauma experienced by theirclients, citing related problems with theirability to have patience with, empathy for,and express affection towards their children.During subsequent screenings with mothersreceiving services from a subset of theseagencies, 92 percent reported at least oneprior traumatic experience with the averagebeing 2.6 categories of traumatic events. Fiftyfourpercent of mothers met probable criteriafor post-traumatic stress disorder, 62 percentmet probable criteria for depression, and 49percent met probable criteria for both PTSDand depression (Chemtob, Griffing, Tullberg,Roberts, & Ellis, 2011).Research has shown that parents withhistories of trauma can be harder to engagein services and have difficulty trusting serviceproviders (Kemp, Marcenko, Hoagwood,& Vesneski, 2009; Dawson & Berry,2002). Despite this and the prevalence oftrauma among parents in the child welfaresystem, our experience is that it is relativelyFor parents who grew up under similar circumstances, or who haveexperienced traumatic events in adulthood, it may be difficult to providetheir own children with support and structure if their own traumaremains unaddressed.uncommon for parents to receive traumaspecificscreening, much less trauma-informedmental health services – and many childwelfare staff are not trained to recognizetrauma symptoms and how trauma canimpact parenting and child safety. As a result,child welfare staff may be more likely toregard parents like Denise as non-compliant,disengaged, detached from their children,angry and defensive.How else could Thomas understandDenise, the decisions she’s making, and howshe responds to her children? How can he usethat knowledge to help her? With the benefitof a “trauma lens,” the above scenario couldbe reframed as follows:• Ask questions. Caseworkers are oftenworried that asking clients detailedquestions about their past traumaticexperiences may cause their clients to
CW360 o Trauma-Informed Child Welfare Practice • Winter 2013 11become anxious or distraught, but afterbeing trained to conduct trauma screeningsby Safe Mothers, Safe Children projectclinicians, caseworkers said they learnedhelpful information while reporting lowlevels of distress for themselves and theirclients (Dawson & Berry, 2002). Askingmay also help ease the shame associatedwith clients’ past experiences and result intheir feeling more supported and less alone.• Anticipate trauma triggers. The domesticviolence between Denise and her children’sfather was likely a traumatic experiencefor both her and her children, and thefact that she is not attending domesticviolence groups may be due to avoidance,a common trauma symptom. Denisemay be more likely to attend visits withher children if they were scheduled at adifferent time than these groups. Likewise,if Thomas approached Denise’s nonattendancewith this understanding andempathy, helping to explore the impact ofher past experiences on her current actions,rather than by using a punitive approach,he could be more successful in engagingher in services.• Understand the impact of trauma onparent-child relationships. Trauma cancause parents to have a negative worldview and, in particular, develop negativeattributions regarding their children’sbehavior. Their child’s actions, or eventheir appearance, may trigger themresulting in them reacting in an overlyharsh or punitive way. Helping parents tounderstand that their reactions may be aresult of their trauma, and are not the faultof their children, can help them respondmore positively to their children.• Understand the impact of traumaon children’s development andmental health. Children who have alsoexperienced trauma, such as exposureto domestic violence, may have theirown trauma symptoms—such as Tanya’sextreme reaction to her brother’s fall andher mother’s harsh response—whichcan in turn be triggering for the parent.Children’s development can also beimpacted by trauma, and concerns suchas Damon’s potential speech delay maynot be recognized by the parent becausehe or she is overwhelmed and/or does nothave information about expected childdevelopment. When working with a parentor family that has experienced trauma,child welfare staff should be attuned to howit may have impacted each of the children.• Recognize and manage traumareactions. Thomas’s past experiences withDenise’s anger and defensiveness have ledhim to avoid addressing an important partof Denise’s service plan and Christopher,Tanya and Damon’s safety. He may also befrustrated by what he perceives to be herlack of concern for her children and lackof urgency around her service plan goals.Using a “trauma lens” could help Thomasbetter understand Denise’s behavior towardsher children and how he (as a man and asa person in a position of authority) couldbe triggering for her, and provide strategiesfor working together with her rather thanfeeling like they are at cross-purposes. Thiscould help Thomas depersonalize Denise’sreactions towards him, regulate his ownemotions, and feel less frustrated puttinghim in a better position to approach heropenly and with compassion.Trauma can impact parents in many waysincluding their ability to keep their childrensafe. As described above, using a “traumalens” can help child welfare staff moreeffectively partner with families, workingtogether to ensure both their physical andpsychological safety.Erika Tullberg, MPH, MPA, isAdministrative Director of the ACS-NYUChildren’s Trauma Institute at NYULangone Medical Center. She can bereached at erika.tullberg@nyumc.orgOverviewSchool of Social WorkPreparing professionalsto be leaderswww.cehd.umn.edu/sswfor a just and caring society
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