Introduction to Trauma-Informed Systems

1. Introduction to Trauma-Informed Systems

2. Overview Part I: Trauma and its impacts Part II: Trauma-informed child serving systems Part III: Key elements of Trauma-informed system change

3. Part I What is Trauma?

4. Event Experience

5. Child Traumatic Stress(Experience) • The physical and emotional responses of a child to events that threaten the life or physical integrity of the child or of someone critically important to the child (such as a parent or sibling) • Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal • Trauma is experienced as a series of traumatic moments each penetrating deep in the child’s psyche

6. Situations That Can Be Traumatic(Events) • Physical or sexual abuse • Abandonment, betrayal of trust (such as abuse by a caregiver), or neglect • The death or loss of a loved one • Life-threatening illness in a caregiver • Witnessing domestic violence • Automobile accidents or other serious accidents • Bullying • Life-threatening health situations and/or painful medical procedures • Witnessing or experiencing community violence (e.g., drive by shooting, fight at school, robbery) • Witnessing police activity or having a close relative incarcerated • Life-threatening natural disasters • Acts or threats of terrorism

7. Trauma Trajectories • After exposure to a traumatic life event, short term distress is almost universal • Children and adolescents vary in the nature of their response to traumatic experiences • Developmental level • Ethnicity/cultural factors • Available resources • Preexisting child and family problems • Over time, most children return to their prior levels of functioning

8. Who Develops Post Traumatic Stress? • 1/3 of children who experience a traumatic event will go on to develop PTSD • Sources of resilience • Temperament • Social-emotional supports • Learned social-emotional skills • Risk Factors • Temperament • Developmental delays • Limited social-emotional skills • Previous trauma exposure • Preexisting psychopathology • Low social support

9. Children Vary in Their Response to Traumatic Events(Experience)The impact of a potentially traumatic event depends on many factors including: • The child’s genetic makeup • The child’s age and developmental stage • The child’s perception of the danger faced • Whether the child was the victim or a witness • The child’s relationship to the victim or perpetrator • The child’s past experience with trauma • The adversities the child faces following the trauma • The response to the events of the child’s close caregivers • The presence/availability of adults who can offer help and protection • CULTURE

10. Types of Trauma • Acute trauma is a single traumatic event that is limited in time • Chronic trauma refers to the experience of multiple traumatic events • Complex trauma describes both exposure to chronic trauma—usually caused by adults entrusted with the child’s care—and the impact of such exposure on the child

11. What Does Trauma Look Like in Children? BEHAVIORAL IMPACTS • Avoidance, hyperarousal, hypervigilance EMOTIONAL IMPACTS • Emotionally dysregulated, fear, anger, sadness COGNITIVE IMPACTS • Inaccurate beliefs, negative self-image RELATIONAL IMPACTS • Isolation, trouble maintaining healthy relationships SPIRITUAL IMPACTS • Crisis of faith

12. Trauma-Informed Child Serving Systems Part II

13. Trauma-Informed Systems • The idea of trauma-informed systems sprang from the empirical research on the efficacy of trauma-focused interventions for children and families • A trauma-informed system is a wider system impacting children and families, with multiple components designed to meet the varying needs of traumatized individuals who are receiving services.

14. Defining Trauma-Informed Care • As a field, we have a good understanding of what TIC is. • There are several prevailing definitions that overlap in their conceptualization.

15. A Trauma-Informed System A trauma-informed child- and family-service system is one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers. Programs and agencies within such a system infuse and sustain trauma awareness, knowledge, and skills into their organizational culture, practices, and policies. They act in collaboration with all those who are involved with the child, using the best available science, to maximize physical and psychological safety, facilitate the recovery of the child and family, and support their ability to thrive– NCTSN (2019)

16. A Trauma-Informed System • Understands the impact of childhood traumatic stress on children and families • Understands how the system can help mitigate the impact of trauma or can add new traumatic experiences • Understands how trauma has shaped the culture of the system, the same way trauma shapes the world view of child victims • Has realistic and practical actions that can be taken at all levels of the system to make things better for children, families, and the workforce

17. Essential Elements of aTrauma-Informed System of Care • Are the province of ALL professionals who work in and with the child-serving system • Must, when implemented, take into consideration the child’s developmental level and reflect sensitivity to the child’s family, culture, and language • Help the system of care to achieve the goals of safety, permanency, well being and trauma resolution

18. What is a Trauma-Informed Child-Serving System? A Trauma-Informed Child-Serving System understands: 1) The potential impact of childhood traumatic stress on the children served by the system How the system can either help mitigate the impact of trauma or inadvertently add new traumatic experiences How to promote factors related to child and family resiliency after trauma

19. What is a Trauma-Informed Child-Serving System? The potential impact of the current and past trauma on the families with whom we interact How adult trauma may interfere with adult caregivers’ ability to care for and support their child The impact of vicarious trauma on the child-serving workforce That exposure to trauma is part of the job of protecting kids

20. From Defining to Implementing • While the various definition of TIC have similar aims, the strategies for becoming a TI system are varied • We do not yet have a gold standard model for creating and maintaining trauma-informed systems

22. ACTS: Trauma-Informed System Change • The ACTS project has consolidated what we know about TIC from the existing empirical literature, and created a framework to guide implementation of TIC within systems. • First, our TIC Menu represents the key elements of a TI system, organized into three categories.

24. ACTS: Trauma-Informed System Change Second, we created a model for implementing TI system change….

26. Key Elements of Trauma Informed System Change Part III

28. Systems Collaboration

29. Collaboration, service coordination, and information sharing among professionals from within and outside an organization is associated with more effective and efficient services for children, youth, and families impacted by traumatic stress.

30. Key Elements • Many children and families that are affected by trauma are served my multiple systems such as child welfare, schools, law enforcement, courts and health care. • These systems have individual mandates, priorities, and demands that impact how they intervene with children and families. • Trauma-informed cross-system partnership involves collaboration, service coordination and information sharing among professions in the different systems working with children and families.

31. Advancing Systems Collaboration: • Being knowledgeable of the major voices for children and youth exposed to trauma within your community (e.g., child protective service leaders, trauma-informed treatment leaders) • Working relationships with the systems that serve the children and families your organization works with. • Establishing/continuing regular communication with the systems that serve the children and families your organization works with. • Procedures in place for sharing pertinent information and data with those outside and within your organization • Multidisciplinary teams that are knowledgeable and aware of the impact of child trauma • Cross systems/multidisciplinary training to familiarize providers with other systems

32. Physical and Psychological Safety

33. A sense of psychological and physical safety facilitates emotion regulation, creates an environment of trust, and helps children, youth, and families be present and engaged in services.

34. Key Elements • Safety is often a construct that is lacking in traumatized children’s environments • With structure, consistency, and predictability one can build rapport and increase a child and family’s comfort level and sense of safety. • Children and youth can learn safety skills to increase emotion regulation; however, caregiver involvement is key to success

35. Advancing Physical and Psychological Safety : • Having a physical environment that promotes a sense of safety, calming, and de-escalation for children, youth, and families • Recognizing and addressing aspects of the physical environment that may be re-traumatizing and work with families on developing strategies to deal with this. • Having physical safety and crisis protocols in place that are regularly practiced • Knowing how to develop safety and crisis prevention plans. • A workforce that is knowledgeable in differentiating trauma responses and challenging behavior, and able to respond to both • Procedures focused on working with caregivers to model emotion regulation and de-escalation for children and youth

36. Partnering with Children, Youth, & Families

37. Collaborative partnerships between staff and consumers based on mutual respect and a common commitment to healing leads to increased engagement, retention, and successful outcomes for children, youth, and families.

38. Key Elements • Authentic partnerships begin with the acknowledgement and appreciation of the unique expertise and experiences of the children, youth, and families involved with the child welfare system. • Child welfare practitioners who actively engage and empower families, including resource parents and kinship caregivers during the planning can better address trauma-related needs.

39. Advancing Partnerships with Children, Youth, and Families: • Organizational policies and decisions that are conducted with transparency, with the goal of building and maintaining trust among children, youth, and families • Understanding from the workforce that healing happens in the meaningful sharing of power and decision-making (e.g., assessment and treatment results are shared with the child and family and discussed as a team) • Children, youth, and family’s strengths are recognized, built on, and validated • Strengthening the experience of choice for children, youth, and family members

40. Organizational Policies

41. Trauma-informed system change is driven and sustained by organizational policies and procedures that are championed and supported by leadership.

42. Key Elements • Senior leaders should be positioned within the organization to effectively provide oversight, guidance, and support to trauma-informed change initiatives • Hiring processes should ensure that new employees align with trauma-informed values and approaches to care • Written policies explicitly include and support trauma informed principles

43. AdvancingOrganizational Policies: • Senior leaders that have basic knowledge of implementation principles, and have capacity and skills to facilitate implementation of trauma-informed change • A high level, clearly identified point of responsibility within the organization for trauma-informed administrative practices • Policies or protocols for workforce orientation, training, support, and job standards that are related to trauma • A self-assessment to evaluate the extent to which current organizational policies are trauma-informed

44. Culture, Diversity, and Trauma

45. To understand how trauma affects children, youth, and families, we must first understand how life experiences and cultural backgrounds serve as key contextual elements for trauma and resilience

46. Key Elements • Cultural trauma: Is an attack on the fabric of a society, affecting the essence of the community and its members. • Multigenerational/Intergenerational trauma: Occurs when trauma is not resolved, and is subsequently internalized and passed from one generation to the next. • Social and cultural realities strongly influence children’s risk for—and experience of—trauma. • Children from minority backgrounds are at increased risk for trauma exposure and subsequent development of PTSD.

47. Advancing Culture, Diversity, and Trauma • Workforce development/training that addresses the ways identity, culture, community, and oppression can affect a person’s experience of trauma, access to supports, and opportunities for safety • Workforce knowledge and awareness on how culture influences the interpretation and meaning of traumatic events, the acceptability of support, and help seeking behaviors. • Incorporating attention to culture and trauma in organizational operations and quality improvement processes • Recognizing and addresses historical trauma • Institutionalizing cultural knowledge within the organization

49. Trauma Training and Awareness

50. Knowledge about traumatic stress is a critical first step for staff to effectively understand, support, and serve those impacted by it.