in Child Welfare - The Trauma Center

14 CW360 o Trauma-Informed Child Welfare Practice • Winter 2013By What Yardstick Should We Measure Success in Child Welfare Policy?Janice L. Cooper, PhD, MPA and Yumiko Aratani, PhDOverviewThe last decade has seen a tremendouschange and progress in child welfare. This isparticularly true of child welfare policy. Thefocus on permanency, led to increases in thepercentage of foster care children adoptedfrom 17% to 21% between 2000 and 2010(U.S. Department of Health and HumanServices Administration for Children andFamilies, 2011). There was a 26% decreasein the child welfare rolls from 552,000to 408,000 during the same period (U.S.Department of Health and Human ServicesAdministration for Children and Families,2011). The rates of children being victimized(a child with maltreatment dispositionsubstantiated, indicated, or having alternativeresponse by the child welfare agencies) havedeclined from 12.2 to 10 per 1000 (U.S.Department of Health and Human Services,2002, 2012). Conditions of foster care alsoimproved, such as reduced average lengths ofstay from 32 months to 26 months, marginalincreases in kinship care (from 24% to 25%)and in non-relative foster care (from 47%to 48%), and reductions in the use of grouphomes and/or institutions from 18% to 15%(U.S. Department of Health and HumanServices Administration for Children andFamilies, 2011). During the same period,there were increases in child welfare fundingsuch as the Child Abuse Prevention andTreatment Act, State grants, and adoptionincentive payments (American HumaneAssociation, 2012). Also significant was anarrowing in disparities marked by reductionsin the proportion of African-Americanchildren in foster care from 39% to 29%(American Humane Association, 2012). Onthe other hand, the period also saw setbacks.More young children (ages 0-5), enteredfoster care, increasing from 29% to 36%(American Humane Association, 2012).This article focuses on the impact ofpolicy on the child welfare system (CWS)using another measure: the extent to whichinfusing a trauma-informed care frameworkhas taken hold. While not every child inthe CWS will experience trauma, previousresearch shows different estimates of theprevalence of post-traumatic stress disorder(PTSD) among children in the CWS, rangingfrom 19% to 55% (Annie Casey Foundation,2011; Grasso, et al., 2009; Greeson, et al.,2011; Jackson, O’Brien, & Pecora, 2011;Kolko, et al., 2010). Nearly 12% of childrenin child welfare who remained at home alsoexperienced PTSD (Kolko, et al., 2010).Risk factors for PTSD include multipleexposures to maltreatment. Over 70%of children in foster care had two or moretrauma experiences (Greeson, et al., 2011).Children with multiple trauma exposures tendto experience other mental health problemsincluding depression and externalizingconditions (Kolko, et al., 2010; Richardson,2001). Trauma experiences have a long-termdetrimental effect on health and mental healthand susceptibility to re-traumatization(Dube,2001; Felitti, et al., 1998; Widom, Czaja, &Dutton, 2008).Trauma-informed care and atrauma-informed frameworkTrauma-informed refers to the process ofengagement with a parent, child or familycharacterized by intentional efforts to ensurethat no action is taken that further causesharm. It creates an environment that enablesthe victimized child or person to feel safe andpromotes the ability of the victim to cope andto increase resiliency. A trauma-informedframework refers to embedding up-to-daterobust knowledge on trauma in policy andpractice such as how to prevent trauma,address its consequences, and ensure thesystem does not contribute to re-traumatizing.Operationally, this would suggest policiessuch as funding and supporting effectivesystems for prevention and intervention,beginning with evidence-based (EB) andculturally-normed screening and assessmentof trauma, ensuring the widespread adoptionof EB treatment and engagement strategies,support for training within and across childservingsystems, and requiring accountabilitythroughout systems.The way forwardA 2007 National Center for Children inPoverty report presented the adverse impactof the child serving systems in America andtheir failure systematically to adopt a traumainformedperspective in policy (Cooper,Masi, Dababnah, Aratani, & Knitzer, 2007).It addressed the need to include the useof EB screening and treatment for traumaand related mental health conditions in thechild welfare system. It called for increasedWe offer the following recommendations to support improved practice andbetter outcomes.• Mandate EB trauma screening at all entry points into child welfare and atdischarge• Require that child and adolescent trauma histories are integral to theirconfidential records available at all entry points to the care delivery systemand that individualized care planning address the child and family needs in atrauma-informed manner• Ensure that trauma-informed care is integrated into the pre-service trainingand continuing education for all child welfare professionals and paraprofessionals• Set up systems to better identify and match staff suitable for working in theCWS, reward and support them appropriately and recognize the need for thehuman resource development plan to be trauma-informed.• Increase funding and tie it not only to reduction in child welfare rolls butimproved outcomes such as child and family health and mental health.• Develop guidelines for regulations and/or certification pertaining to traumaexpertise.• Fund initiatives that support staff who work with children and youth whoexperienced trauma and reduce secondary trauma associated with traumarelatedwork.• Partner with tribal and other colleges that target specific populations todevelop workforce capacity in evidence-based practices for both tribal andnontribal communities.