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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
and will learn regulation in the daily processof care and coaching from their parents orfoster parents. By accepting this wisdom,outpatient therapists can play a key rolein teaching, supporting and nurturing thetargeted process between children and theircaregivers as a means of maximizing success.Much more powerful outcomes are achievedwhen the parent/foster parent—child dailylife process becomes the locus of change.Key learning #3 reflects an appreciationfor the significant prevalence of childhoodtrauma and how that understanding isapplied. The general conclusion from childwelfare staff is that nearly all children inthe child welfare system have at least beenexposed to trauma, often resulting in otherdifficulties. The application of this concept iswhere child welfare systems can see significantgain. Understanding how adjustment totrauma impacts children’s behaviors is oftenthe best and, arguably, first path to explore.CW360 o Trauma-Informed Child Welfare Practice • Winter 2013 35Child welfare staff are encouraged to askthemselves for every child they encounter“Does trauma have a part in this child’spresentation?” Starting with this questionwill likely help the entire team reach the rightconclusions regarding needed interventions,which can provide relief to both the child andthe entire team.Key learning #4 is arguably themost significant. It is the notion that allstakeholders providing care are constantlyensuring that they approach the work andclients they serve from a place of optimalhealth and well-being. This is especiallysignificant in child welfare circles where thecontext of practice is extremely challenging.One only has to experience the process oftaking a child away from a screaming parentor to support a child through a medical examchecking for abuse to have those experiencesindelibly etched into memory. In light ofthese challenges, there are some resourcefriendly interventions that agencies can useto help (i.e. effective supervision, groupor individual de-briefings, spontaneousteam lunch events that encourage peerconnections).The need to better understand the impactof trauma on the children and families weserve is likely only going to increase overthe coming years. While the scope andsignificance of the challenge can be daunting,there is always hope that well-informed andcoordinated systems of care can rise to meetthe challenge. We are trying to do just that atSt. Aemilian-Lakeside (http://www.st-al.org/)in Milwaukee.Ann Leinfelder Grove, MSM is VicePresident of Strategy and Innovation St.Aemilian-Lakeside, Inc. in Milwaukee,Wisconsin. She can be reached ataleinfelder@st-al.org.PerspectivesAmbit Network provides insights for therapists and frontline mental healthworkers who serve children impacted by trauma. The research and knowledgeof Ambit Network is actively refined by closely monitored field work.Ambit Network benefits organizations through training,technical assistance and case consultation.Navigating research and practice in child trauma efficiently is vital;Ambit Network champions development of a new standard of care,particularly evidence-based practices.Learn the latest at www.ambitnetwork.orgor sign up for news by visiting the Contact Us pageon our website!
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