use of trauma-informed interventions in youth permanency practice erika tullberg, mpa, mph assistant...

Use of Trauma-Informed Interventions in Youth Permanency Practice

Erika Tullberg, MPA, MPHAssistant Research ProfessorNYU Child Study Center

November 27, 2012

Workshop Overview

• What does trauma look like in older youth?

• What challenges does trauma present in permanency planning?

• What trauma-informed strategies can be employed to better serve our youth and families?

2Use of Trauma-Informed Interventions in Youth Permanency Practice

Hat #1: Trauma “Expert”

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• Faculty at NYU Child Study Center

• Member of National Child Traumatic Stress Network


Hat #2: Child Welfare Professional

• 11 years working for public child welfare agency

• Mentor to “rookie” foster care caseworkers


Hat #3: Foster Parent

• Parent of a 22-year-old alumna of foster care


Traumatic Stress

Traumatic event

Re-experiencing trauma

Avoidance

Intense Arousal

Numbing

Consciousness shifts

Relationship difficulties

Affect Dysregulation

Self problems

Harmful behavior

Saxe, 2012


Trauma and Older Youth in Foster Care

Urgency around

transition planning/preparatio

n

Impact of trauma

on develop

ment


Opportunities and Challenges

Positive youth development* – providing youth with opportunities to build on strengths, develop positive relationships, direct life planning can help to “rewire” brain development

Trauma can lead youth to disconnect, be more present-and threat-focused, have a foreshortened sense of the future


* From The Adolescent Brain, Jim Casey Youth Opportunities Initiative, 2011


Building social capital* – connecting youth with family, other caring adults and their community helps prepare them for adulthood, provides needed support past discharge from foster care

Trauma can make building positive relationships difficult, make negative relationships feel more “normal.” Youth may get conflicting messages from people in their support network




Engaging youth in decision-making* can provide a safe opportunity to learn and practice adult tasks, allow for youth ownership over their plans

Trauma can affect youths’ development, readiness to take on adult tasks, and ability to fully understand or recognize the consequences of their decisions



The Foster Care “Bubble” and Magical Thinking

• Adolescence is a time of risk-taking, but also a time of consequence-acquisition – not always possible in foster care setting

• Limited freedom – life of appointments, workers, plans• Unlimited second chances – sensitive to trauma-related needs

of kids, but unrealistic preparation for the future• Belief that things will just “work out”

• How to balance support vs. over-reliance

• Knowing that if you don’t help youth with something it won’t happen, but that if you do they may not learn how to do it on their own


Strategies

From Advancing a Trauma-Informed Collaborative System for Emerging Young Adults Transitioning from Foster Care to Adulthood in Maryland (Family Center at Kennedy Krieger Institute, 2012):

1. Developing knowledge of trauma and transition to adulthood issues and approaches

2. Engaging and partnering with emerging young adults and their adult allies

3. Life planning and provision of individualized supports and services4. Collaborating across child and adult systems related to trauma

and transition needs5. Ensuring organizational support and capacity for implementation

and sustainability


Strategies, continued

1. Developing knowledge of trauma and transition to adulthood issues and approaches

• Knowledge of the effects of trauma for emerging young adults, caregivers, providers and partners• Importance of psychoeducation and concrete, individualized

strategies for identifying and managing triggers• Be explicit about the link between effects of trauma and specific

transition-related tasks

• Challenges around discussing impact of trauma on development

with youth

• Challenges around confidentiality



3. Life planning and provision of individualized supports and services

• Youth-driven life planning; individualized life success planning

• Minimal intrusion • Efforts are coordinated, meet youths’ identified needs, are not

overwhelming

• Keep impact of trauma in mind • Does this task/service match the youth’s developmental level?• What psychoeducation and/or adaptation is needed?• Can we be more flexible?



4. Collaborating across child and adult systems related to trauma and transition needs

• Mutual cross-training and collaboration• Challenges in educating and engaging adult-serving systems

around needs of youth leaving care• Accountability – to systems, to families, to youth• Challenges around information-sharing, confidentiality

• Are the right services really there? If not, how can existing services be modified, and/or new services be developed?


Impact on Staff

• Secondary traumatic stress (STS) is a documented risk for child welfare staff, and is thought to be a contributing factor to high turnover in the field

• STS reactions are similar to those following primary exposure to trauma, can result in:

• Negative bias, pessimism• Loss of critical thinking skills• Threat focus• Decreased self-monitoring• Feeling helpless, overwhelmed

• Unaddressed STS can impact the quality of case practice

• Parents and other youth supports are also at risk


Re-experiencin

g

Arousal

Avoidance

Impact on Staff, continued

• Working with older youth in care may be particularly challenging, given the high stakes and urgent timeframes

• Frustration from working with youth who have negative or counter-productive reactions, or do not follow through with their case plans

• Helplessness may be heightened by lack of appropriate resources, other systems’ lack of responsiveness

• Child welfare agencies should have systems in place to educate staff, supervisors and administrators about STS and build resilience-related skills at all levels of the agency


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What can we do to better support transitioning youth?

• As system leaders?

• As agency administrators?

• As frontline staff?

• As family members?


Discussion


Contact Information

Erika Tullberg

NYU Child Study Center

646-754-5107

[email protected]


use of trauma-informed interventions in youth permanency practice erika tullberg, mpa, mph assistant...

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