in Child Welfare - The Trauma Center

12 CW360 o Trauma-Informed Child Welfare Practice • Winter 2013The Emergence of Trauma-Informed Child Welfare SystemsCharles E. Wilson, MSSWOverviewOver the last 30 years, society’s understandingof the effects of traumatic stress has increasedsignificantly and more recently we have begunto recognize the interaction between traumaticstress and the service systems we put in placeto support vulnerable populations. Nowhereis this connection between trauma and thesystem more striking than in the nation’s childwelfare systems. Almost all children servedby the child welfare system report chronicand complex trauma histories, complicatedby system-imposed stresses such as removaland multiple foster care placements. Childrenwith such experiences often require supportof a skillful and well trained mental healthprofessional, but treatment alone is notenough. Over the last six years, it has becomeclear to many working in the National ChildTraumatic Stress Network 1 (NCTSN) thatmeaningful treatment of children in thechild welfare system must be matched withsystem supports. Essentially, the entire childwelfare system needs to be transformed into a“trauma-informed system.”What is a trauma-informed system?The term first appeared in substance abuseliterature to recognize that many seriouslyaddicted individuals had experienced majortraumas, and those traumatic events hadshaped their lives in sometimes disastrousways (see Conradi & Wilson, 2010 for a fullreview of this topic). By 2004, NCTSN wasapplying similar concepts to child traumavictims and that work led to a variety ofproducts and services developed withinthe Network. One definition of a traumainformedsystem has been advanced by theChadwick Trauma-Informed Systems Project(CTISP), with support of a national advisorycommittee. CTISP defines a trauma-informedchild welfare system as a system “in which allparties involved recognize and respond to thevarying impact of traumatic stress on children,caregivers and those who have contact with thesystem. Programs and organizations within thesystem infuse this knowledge, awareness andskills into their organizational cultures, policies,and practices. They act in collaboration, usingthe best available science, to facilitate andsupport resiliency and recovery” (ChadwickTrauma-Informed Systems Project, 2011).There are key phrases in this definitionthat are worth pointing out. First, thedefinition applies to the wider child welfaresystem not just the public child welfareagency. Second, the definition focuses notonly on child trauma victims but also theircaregivers and the workforce who seek tosupport them. All three of these groupsare affected by traumatic events, includingprimary traumatic experiences that threatentheir own or their loved one’s lives or physicalintegrity as well as vicarious trauma fromwhat they see, hear, and experience whenworking intimately with traumatized children.The definition stresses the “varying impactof trauma,” indicating that each child andadult is unique and reacts to trauma in hisor her own way. Some children and adultshave great resilience and may not requireclinical intervention while others exposedto similar levels of trauma are devastatedand require skillful intervention. Thedefinition emphasizes that it is not enoughto be knowledgeable about trauma but alsoasserts that the system must act to makeuse of that knowledge by integrating it intoeveryday interactions with families and theirorganizational cultures.To undertake this effort, the child welfaresystem needs a framework, and the NCTSNoffers one in its “Essential Elements of atrauma-informed child welfare system.”The NCTSN Child Welfare Committeeis currently in the process of refining theessential elements, first introduced in 2006.What emerges are the following sevenessential elements (Child Welfare Committee,personal communication, March 7, 2012).1. Maximize Physical andPsychological Safety for theChild and FamilyWhile child welfare has always had a focuson physical safety, a trauma-informedsystem must go further and recognizethat psychological safety is importantto the child’s long-term recovery andsocial and emotional well-being and hasdirect implications for physical safetyand permanence. Psychological safety isa sense of safety or the ability to feel safewithin one’s self and safe from externalharm and is critical for functioning aswell as physical and emotional growth.A lack of psychological safety can impactchildren’s interactions with all otherindividuals, including those trying tohelp them, and can lead to a variety ofmaladaptive strategies for coping withthe anxiety associated with feeling unsafe.These “survival strategies” often includea range of symptoms and behaviorsfrom substance abuse to self-mutilation.Children and/or adults may continue tofeel psychologically unsafe long after thephysical threat has been removed or theyhave been relocated to a physically safeenvironment, such as a relative or fosterhome.The system should offer universal screening for traumatic historyand traumatic stress responses, which will assist the workers inunderstanding the history of a child or family.Even after the child or adults gainssome degree of security, people, places,and events may unexpectedly remind themof past traumas and draw their attentionback to intense and disturbing memoriesoverwhelming their ability to cope again.At times, a seemingly innocuous eventor sensory stimuli such as smells, sights,sounds, touches, or objects may triggersubconscious reminders of the traumathat produce a strong physiologicalresponse wherein the biochemical systemsof the body react as if the trauma werehappening again. A trauma-informedchild welfare system understands thatthese pressures may help to explain achild or parent’s behavior and can use thisknowledge to help them better managetriggers and to feel safe.2. Identify Trauma-Related Needsof Children and FamiliesThe child welfare workforce should beeducated on trauma and how it affects anindividual at any stage of developmentand intersects with his/her culture. Thesystem should offer universal screeningfor traumatic history and traumatic stressresponses, which will assist the workersin understanding the history of a child orfamily. The screening will help identifypotential triggers and will create a guide1Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) is a unique collaboration of academic and communitybasedservice centers whose mission is to raise the standard of care and increase access to services for traumatized children and theirfamilies across the United States.