the impact of trauma on children and families implications for child welfare and the court system...

The Impact of Trauma on Children and

Families

Implications for Child Welfare and the Court

System

Presented byC. Lynne Edwards, LCSW

CASA State Conference, 2012

Myths

#1: The effects of abuse/neglect, removal and other traumas to young children will “vanish” as long as they are in a loving home.

#2: If a child has no cognitive memory of a loss, then they don’t grieve and have no long lasting effects.

Presented by C. Lynne Edwards, LCSW

Myths and Realities

#3: There is nothing that parents or anyone can do to change the impact of their child’s early traumatic experiences.

#4: Behavior can best be managed by rules and consequences.


What We Now Know

Feeling safe positively affects the nervous system and provides stimulation for healthy development.

Presented by C. Lynne Edwards, LCSW 4

Child Traumatic Stress

The physical and emotional responses of a child to events that threaten the life or physical integrity of the child or someone important to the child.

Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out of control physiological arousal.


Types of Trauma

ACUTE

CHRONIC

COMPLEX


Complex Trauma

•Multiple, chronic and prolonged, developmentally adverse events

•Often of an interpersonal nature with early life onset

•Effects are cumulativePresented by C. Lynne Edwards, LCSW 7

Response to Trauma Affected by…

Child’s chronological age and developmental stage

Child’s perception of the danger Whether the child was a victim or

witness Child’s past experience with trauma Child’s relationship to the perpetrator Presence/availability of adults to help


Experience of Trauma

Trauma is experienced through the body, mind and spirit and has a long term impact.


Impact on Children and Parents

• Adverse Childhood Experiences StudyAdverse childhood experiences: are a major health issue result in social, emotional and cognitive

impairment linked to higher risks for medical conditions

(heart disease, severe obesity, COPD) linked to higher risk for substance abuse,

depression and suicide attemptsPresented by C. Lynne Edwards, LCSW

Impact on “Our” Kids

Studies with antisocial youth have found self-reported trauma exposure ranging from 70% to 92% (Greenwald, 2002)

Antisocial youth have a high rates of Post Traumatic Stress Disorder (Greenwald, 2002)

Research suggests that anger and violent acting out often are symptoms of PTSD (Chemtob, Novaco, Hamada, Gross, & Smith, 1997)

Study of Foster Care Alumni revealed higher levels of PTSD in the alumni than in war veterans.


Biology

Movement and sensation Hypersensitivity/insensitivity Coordination, balance and body

tone Unexplained physical symptom Increased medical problems

Brain Development

• Children are born with “instincts” that are the result of pre-programming in the brain

• Other parts of the brain are not pre-programmed

• Neurological pathways or patterns that begin to form are based on what infants SEE, HEAR, SMELL and FEEL

Mood Regulation

Difficulty knowing and describing their feelings

Brain can shift from feeling to thinking

State dependent responses to experiences

Cognition and Learning

Focusing on and completing tasks Anticipating and planning for future

events Absence of cause and effect

thinking Range of learning difficulties Adaptive development impaired

Behavioral Control

Poor impulse control Self-destructive

behavior/aggression Sleep disturbances/eating disorders Fear driven responses A behavior problem is a relationship

problem

Memory

Lack cognitive memory of events Memory of trauma stored in the

senses, the body State dependent memory

Self-Concept and World View

Lack of a continuous, predictable sense of self

World is not a safe place to be I’m a bad child; everything bad is my

fault People who love you, hurt you and/or

abandon you My feelings don’t matter

Attachment

rooted in biologymutual psychological process

learned after birth


Trauma and Attachment

Both research and psychoanalytic theory have both demonstrated

a clear connection between physical, emotional, sexual abuse, neglect, multiple losses and other traumatic events during childhood and

negative changes in a child’s neurological, biological, and emotional development and on the ability to form healthy attachments.

Presented by C. Lynne Edwards, LCSW20

The Attachment Cycles

Initiating Positive Interactions

Parent Initiates Positive Interaction

Gratification Parent Responds

Gratification Child Responds


Positive Interactions

Structure


Symptoms of Traumatic Stress

Reexperiencing the trauma Avoiding trigger situations or people Reduced range of emotions Trouble concentrating and impulsive Feelings of powerlessness and helplessness Attachment challenges Increased range of emotions (fear, anxiety,

depression, self-harm, addictions, oppositional behaviors)

What this looks like in children…

Pervasive feelings-Fear and anxiety Core issues-grief, loss, rejection,

attachment, control, guilt, identity Internalized beliefs-I’m a bad kid, I can’t

trust adults, people who say they love you, hurt and/or leave you, the world is not a safe place to be, etc.

Control issues-children feel so out of control they try to control everything in whatever way they can


What this looks like in children…

Sensory issues-sensitive to touch, loud noises,

Delayed adaptive development Regulation of emotions-their brains can

not shift from their emotions to their thought processes

Pull/Push-come close, now go away; afraid of getting close

High risk behaviors


What this looks like in parents…

All of the above PLUS: Parents’ ability to appraise danger is

compromised Trauma reminders presented in children’s

behaviors trigger extreme reactions. Tendency for parents to personalize their

children’s negative behavior which challenge attachment and can lead to ineffective or inappropriate discipline.


What this looks like in parents…

Parents’ capacity to regulate their emotions is impaired.

Parent’s executive functioning is impaired which results in poor decision-making, problem solving or planning.

Parent is more vulnerable to other life stressors.

Parents have a negative view of themselves as parents and unhealthy interpersonal relationships.


The brains of children who experience

trauma are wired differently.

Presented by C. Lynne Edwards, LCSW29

Trauma Informed Care (TIC)

“Trauma-Informed Care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment.” (Hopper, Bassuk, and Olivet 2009, p. 133)

Trauma Informed Child Welfare System

“A trauma informed child welfare system is one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers, and those who have contact with the system. Programs and organizations within the system infuse this knowledge awareness and skills into their organizational cultures, policies and practices. They act in collaboration, using the best available science to facilitate and support resiliency and recovery.” (Hendricks, Conradi, & Wilson, 2011, p.189)

Implications

CASA volunteers, attorneys, GALs and judges can help youth and create a trauma-informed system by…


Implications

…learning about trauma…helping parents and children

receive appropriate services and treatment;

…using what we now know to make better informed decisions; and,

…advocating for trauma training across systems and with providers


Implications

First do no harmPrevent → Protect → Repair →

RestoreThe earlier the intervention

occurs, the greater the opportunity for the brain to be repaired


Implications

Interventions require the use of relational rather than confrontational approaches to behavior change


Implications

Trauma related factors are often at the heart of placement disruptions.

Each time a child moves his opportunities to form healthy attachments are jeopardized

Understand and respond to the impact of trauma on parents


Implications

Birth/Foster/Adoptive parents need to learn strategies for developing healthy attachments and healthy brains and reducing traumatic stress

Focus on strengths and resilience increases positive outcomes for children and families


Implications

Use Protective Factors as the framework for services Parental Resilience Knowledge of child development/parenting Concrete supports Social connections Parent-child relationship/nurturing Social and emotional competence of

children


Implications

All systems of care for children who have experienced trauma and their families need to reflect trauma informed practice and address the five protective factors through…

Trauma screening Gathering thorough trauma history Referring families for comprehensive,

trauma informed clinical assessment


Internal Working Model

Inner Working

Model

PhysiologySensory integration

NeurologyDevelopment

Trauma/Loss

Nurturing, Structure,

Engagement

Adaptive behaviors

Genetic

Predispositions

Special Needs

Attachment Figures

Number of Caregivers


What you can do

CASA volunteers, attorneys, GALs and judges can help youth and create a trauma-informed system by…


What you can do

…learning about trauma…helping parents and children

receive appropriate services and treatment;

…using what we now know to make better informed decisions; and,

…advocating for trauma training across systems and with providers


What you can do

Raise the question “Will this action add to traumatic stress?” If the answer is yes, What services and support are in place to

reduce the stress for parents and children? Request that parents and caregivers

receive trauma informed services. Support children maintaining safe

connections with family and caregivers.


What you can do

Raise the question “How will this action add promote a child’s emotional and psychological safety as well as his physical safety?”

Review the results of any trauma screening and assessments and use them to guide recommendations.

If there has not been a trauma informed assessment, request one.


What you can do

Learn about the resources available and how they address trauma and build protective factors.

Whenever possible, allow children to live with parents and other adults with whom they are connected rather than in a foster or group home or detention facility.


Resources

Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth http://www.childwelfare.gov/pubs/braindevtrauma.cfm

National Child Traumatic Stress Network-newsletter and developed the Child Welfare Trauma Training Toolkit. http://www.nctsnet.org/ nctsn.org/products/child-welfare-trauma-training-toolkit-2008

Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators http://www.chadwickcenter.org/CTISP/images/CTISPTICWAdminGuide.pdf


Resources

Adverse Childhood Experiencescds.gov/ace/pyramid.htm

Child Welfare Trauma Referral Tool http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008#q4

Trauma Symptom Checklist for Children www.johnbriere.com/tsc.htm

Resources

SAFESTART Center www.SAFESTARTCenter.org

Center for the Study of Social Policy www.cssp.org

Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth www.childwelfare.gov/pubs/brain devtraums.cfm

National Child Traumatic Stress www.nctsnet.org

Contact Information

C. Lynne Edwards, LSCWTrauma and Attachment Therapist

Prevention [email protected]

804-726-7807

What we do today can help improve others’ tomorrow.


the impact of trauma on children and families implications for child welfare and the court system...

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