in Child Welfare - The Trauma Center

34 CW360 o Trauma-Informed Child Welfare Practice • Winter 2013Using a Trauma-Informed Lens To Create A PerspectiveShift in Child Welfare Practice: One Organization’s JourneyAnn Leinfelder Grove, MSMPerspectivesSt. Aemilian-Lakeside (SAL) is a Milwaukee,Wisconsin based organization that hasintroduced trauma-informed care into childwelfare practice with positive results. Overthe past five years SAL has developed a modelfor trauma-informed philosophy and practiceacross its entire organization. Foster care,education, and mental health services are thecore business lines that annually serve 3,000+children, families, and adults throughoutSoutheastern Wisconsin. Since 2009 SALhas had the contract to provide ongoing casemanagement and intensive in-home servicesfor the Bureau of Milwaukee Child Welfare.This contract gave SAL the opportunity toinfuse its emerging success with traumainformedcare into child welfare practice.SAL’s transformation to a traumainformedperspective originated in 2007 witha goal to reduce the use of physical restraintand decrease critical incidents, but the visionquickly expanded to become an agency-wideparadigm shift that continues to evolve today.Via staff training, a focus on organizationalculture and changes in treatment deliverymomentum grew. A major milestone wasthat the agency’s clinical staff completedcertification in the use of the NeurosequentialModel of Therapeutics, an assessmentapproach developed by Dr. Bruce Perry andthe Child Trauma Academy.SAL’s journey was representative of thefact that while attention to the concepts oftrauma-informed care has grown immenselyChild welfare staff are encouraged to ask themselves for every childthey encounter “Does trauma have a part in this child’s presentation?”Starting with this question will likely help the entire team reach the rightconclusions regarding needed interventions, which can provide relief toboth the child and the entire team.in traditional “clinical” circles (outpatienttherapy, residential care systems, etc.), it isstill catching fire in core child welfare arena.SAL’s initiative was developed and nurturedin our residential, treatment foster care andday treatment programs and was introducedwithin our child welfare subsidiary two yearslater. It was in that introduction, however,that the larger system of care (Child ProtectiveServices staff working with foster parents,outpatient clinicians, etc.) truly began totransform and produce the kinds of outcomesthat the initiative is capable of delivering.This article summarizes some key learningour agency has experienced in its infusion oftrauma-informed care into core child welfarepractice.Key learning #1 reinforces a core systemicvalue that all parts of the system need to havea shared understanding for the entire systemto function effectively. Systems of care thatpersist in the belief that the entire system canbecome trauma-informed without includinga key component of that system run the riskof poor outcomes. Conversely, when all thekey stakeholders in a child and family’s lifeare trauma-informed, remarkable outcomesare possible. We have experienced numerousexamples of our child welfare staff, fosterparents, clinicians and other stakeholdersbeing on the same page regarding traumainformedpractice, producing inspiring stories.One example is Jenni’s story. Jenni is a16 year old girl served by SAL’s child welfareprogram, whose life was turned around by thecollaborative, trauma-informed efforts of hercaregiver aunt and other family members, herchild welfare case manager, and the therapistand staff at the residential facility where shewas placed due to suicidal behaviors. Theentire team understood the importance ofthe trauma-informed lens that asks “what hashappened to you “ rather than “what is wrongwith you.” and they worked together toacknowledge Jenni’s significant trauma historyof sexual abuse and to introduce interventionsthat helped guide her treatment, includingsensory activities that helped her regulate heremotions and behavior. One year later, Jenninow lives with her aunt and reports that sheis “just a normal teenager,” quite a remarkableexpression of healing.Key Learning #2 centers on a recognitionthat effective practice involves a combinationof trauma treatments by trained cliniciansand the actions of trauma-informed caregivers(parents, foster parents, service providersetc,). Historically, outpatient therapists wereviewed in the child welfare system as a keydriver in the process. Things got off trackwhen the outpatient therapist and broaderteam believed that the change process tookplace only in the weekly therapy session(s).Key neurobiological learnings regarding howthe learning and change process happensuggest that the outpatient process as thelocus of change is an incomplete model formany kids who have experienced significanttrauma. A child with significant dysregulationissues generally won’t learn how to regulatethe stress response process through conceptualtechniques taught in weekly session(s) but can