What does Trauma Have to Do with It? Strategies for Making Child Welfare Systems more Trauma-Informed

1. What does Trauma Have to Do with It? Strategies for Making Child Welfare Systems more Trauma-Informed Lisa Conradi, Psy.D. CTISP Project Manager Chadwick Trauma-Informed Systems Project Chadwick Center for Children and Families Rady Children’s Hospital – San Diego

2. Objectives • Participants will be able to describe each of the essential elements of a trauma-informed child welfare system. • Participants will identify how multiple child welfare jurisdictions across the country are transforming their systems to become more trauma-informed. • Participants will be able to describe three concrete ways they can change their practice so it is more trauma-informed.

3. Chadwick Trauma-Informed Systems Project • SAMHSA funded (2010-2013) as Category II NCTSN Site • Goals • Provide leadership in identifying effective treatments and developing specialized service delivery models to children in the public child welfare system who have been victims of abuse and/or domestic violence • Support the evolution of public child welfare agencies into trauma-informed organizations and agents of change in their communities • Transform the wider child welfare system into a multi-dimensional, trauma-informed, evidence-based system

4. Origins of Trauma-Informed Child Welfare We were actually doing it before we know what to call it • Good Child Welfare practice • Understanding of adult PTSD • Child Advocacy Center movement • Trauma Mental Health • Evidence Based Practice • Substance Abuse Treatment

5. Definition of 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.       - CTISP National Advisory Committee

6. What is a Trauma-Informed Child-Serving System? A Trauma-Informed Child-Serving System understands: 1) The potential impact of childhood and adult traumatic stress on the people served by the system 2) How the system can either help mitigate the impact of trauma or inadvertently add new traumatic experiences;

7. Emotional Chain of Custody

8. What is a Trauma-Informed Child-Serving System? 3) how to promote factors related to child and family resiliency after trauma; 4) the potential impact of the current and past trauma on the families with whom we interact; 5) how adult trauma may interfere with adult caregivers’ ability to care and support their child; 6) the impact of vicarious trauma on the service system workforce; 7) that exposure to trauma is part of the job in many public and provide service system

9. Weaving Trauma-Informed Systems into Fabric of Child Welfare Safety & Risk Permanency Well-being Developmentally-Informed Culturally-Informed Evidence- Informed Trauma-Informed

11. Essential Elements of Trauma-Informed Child Welfare Practice Maximize the child’s sense of safety. Concept of triggers Utilize comprehensive assessment of the child’s trauma experiences and their impact on the child’s development and behavior to guide services when appropriate. Assist children in reducing overwhelming emotion. Address any impact of trauma and subsequent changes in the child’s behavior, development, and relationships Help children make new meaning of their trauma history and current experiences. 11

12. Essential Elements of Trauma-Informed Child Welfare Practice • Coordinate services with other agencies. • How and when to apply the right evidence based treatments • Support and promote positive and stable relationships in the life of the child. • Provide support and guidance to child’s family and caregivers. • Recognize many of the adults caregivers you interact with are trauma victims as well-trauma in childhood, trauma last week • Manage professional and personal stress.

13. Call for Trauma-Informed Child Serving Systems • What realistic and practical actions can be taken at all levels of the system to understand and address trauma to make it better for the children, families, and workforce? Artwork courtesy of the International Child Art Foundation (www.icaf.org)

14. Going from Good Practice toTrauma-Informed Practice Slides Courtesy of Erika Tullberg, MPH

15. Trauma-Informed Staff Preparation • Training about traumatic stress, impact on behavior and development (child and adult) • Training about secondary traumatic stress, systems in place to reduce its impact, promote self-care • Training on trauma screening and identification • Training/guidance on how to work with foster parents on identifying child’s triggers, understanding and managing challenging behavior • Helping children and parents understand their reactions/behaviors • Others?

16. Trauma-Informed Stakeholder Preparation • Introduction to child traumatic stress and elements of a trauma-informed system • Training on trauma assessment and service planning for mental health providers (child and adult) • Training on evidence-based trauma interventions for mental health providers (child and adult) • Collaborating with other service systems (e.g., substance abuse treatment) to ensure that services integrate “trauma lens” • Others?

17. Trauma-Informed Foster Parent Preparation and Support • Training about traumatic stress, impact on behavior and development • Training about secondary traumatic stress, how to reduce its impact, promote self-care • Commitment to avoid placement disruptions whenever possible, reduce additional traumas to child • Ongoing support around identifying triggers and managing challenging behavior • Others?

18. Trauma-Informed Initial Foster Care Placement • Foster parent and caseworker get information on child’s past traumatic experiences • Foster parent provided with information needed to make the child feel psychologically safe, ideally directly from birth parent • Assist foster parent and birth parent to develop partnership around supporting the child’s physical and psychological safety • Minimize disruptions to child’s social systems (e.g., school, existing services) • Others?

19. Trauma-Informed Family Service Plan Development • Child is screened for trauma by child welfare staff, if appropriate receives trauma assessment through mental health provider/system • Comprehensive information about child’s trauma history/exposure gathered from family, past and current service providers, etc., shared between child welfare and mental health staff • Comprehensive information about parent’s trauma history/exposure is gathered, shared between child welfare and mental health staff • Develop service plan to meet specific needs of child and family • Others?

20. Trauma-Informed Service Provision • Children should be referred to trauma-informed mental health services when appropriate and available • Parents should be referred to trauma-informed mental health services when appropriate and available • Other services (e.g., tutoring, mentoring, vocational preparation) provided to child should recognize their developmental stage(s) and needs • Services provided to parents (e.g., parent management training) should address issues around child and parent trauma • Foster care staff should be responsive to concerns raised by foster parent, intervening early and effectively • Others?

21. Trauma-Informed Visitation • Prepare child for visitation, what will and won’t happen (e.g., won’t be going home with parent today) • Prepare parent for visitation, how to manage their reactions and their children’s reactions • Prepare foster parent for children’s reactions post-visitation • Others?

22. Trauma-Informed Reunification Planning • Parents should understand how child’s trauma history and experience of being in care may impact their behavior with parent • Parent and child should get support during and after the transition back home • Others?

23. How Can we Create a More Trauma-Informed Child Welfare System? • Materials and resources • Child Welfare Trauma Training Toolkit • Resource Parent curriculum • Bridging the gap between child welfare and mental health • Core components of trauma treatment • Questions to ask MH professionals • CW Breakthrough Series Collaborative • Chadwick Trauma-Informed Systems Project • State and National Initiatives

24. Child Welfare Trauma Training Toolkit Artwork courtesy of the International Child Art Foundation (www.icaf.org)

25. Child Welfare Training Toolkit Overview • Developed by the Child Welfare Committee of the National Child Traumatic Stress Network, CALSWEC and CFPIC • Goals of the Toolkit: • To educate child welfare professionals about the impact of trauma on the development and behavior of children • To educate child welfare professionals about when and how to intervene directly in a trauma-sensitive manner and through strategic referrals • To assure that all children in the child welfare system will have access to timely, quality, and effective trauma-focused interventions and a case planning process that supports resilience in long-term healing and recovery

26. Child Welfare Trauma Training Modules • Creating a Trauma-Informed Child Welfare Practice: Introduction to the Essential Elements • What is Child Traumatic Stress? • The Impact of Trauma on Children’s Behavior, Development, and Relationships • Assessment of a Child’s Trauma Experiences • Providing Support to the Child, Family, and Caregivers • Managing Professional and Personal Stress • Summary

27. Child Welfare Training Toolkit Overview • Teaches child welfare workers how to use knowledge about child trauma to achieve the Child and Family Services Review (CFSR) goals: • Safety • Permanency • Well-Being • Full toolkit can be downloaded from http://www.nctsn.org/nccts/nav.do?pid=ctr_cwtool

28. Caring for Children Who Have Experienced Trauma: A Workshop for Resource Parents • NCTSN Training curriculum for foster, kinship, and adoptive parents • Co-facilitated by mental health professional and foster parent • Incorporates case studies and interactive learning exercises • Goals: • To help resource parents understand link between trauma and child’s behavior, feelings, and attitudes • To provide practical tools for resource parents to help children with coping skills and support their recovery from trauma • To help resource parents recognize and reduce impact of child’s trauma on themselves and how to find support

29. Caring for Children Training Modules • Introductions • Essential Elements of Trauma-Informed Parenting • Trauma 101 • Types of trauma, reactions to trauma • Understanding Trauma’s Effects • Building a Safe Place • Dealing with Feelings and Behaviors • Connections and Healing • Becoming an Advocate • Taking Care of Yourself

30. Caring for Children Training Materials • Facilitator’s Guide, Participant Handbook, slide kit, and handouts available: • Free to download from NCTSN web-site: www.nctsn.org/rpc • Bound copies can be purchased through Castle Press

31. Using Trauma-Informed Child Welfare Practice to Improve Placement Stability: A Breakthrough Series Collaborative (BSC) • Sponsored by the National Center for Child Traumatic Stress with funding from SAMHSA • Includes 9 sites from across the country (NH, NC, Mass, FL, OK, TX, CO, Los Angeles and San Diego) • Lead agency is Child Welfare but consists of a partnership between Child Welfare jurisdictions and their partner MH sites

32. Goal of the Child Welfare BSC • To develop and promote trauma-informed policies and practices related to foster care placement, thereby increasing placement stability and promoting a sense of permanency among children in care.

33. BSC teams are focusing intensively on the following areas:

34. Knowledge Building and Developing PracticePDSA: Increase knowledge of the impact of trauma on children among resource parents

35. Trauma-Informed Mental Health AssessmentPDSA: Identification of children in foster care requiring a mental health assessment

36. Case Planning and ManagementPDSA: Identify information needed by the foster parent to facilitate a collaborative and trauma-informed placement

37. Child Welfare Systems, Cross-System Partnerships and System Collaboration PDSA: Increase the child welfare worker knowledge on the impact of secondary traumatic stress

38. Externally Delivered Trauma-Informed ServicesPDSA: Assess and treat trauma in children

39. Chadwick Trauma-Informed Systems Project (CTISP) • National Advisory Committee to: • Guide process • Assist with identifying key issues, challenges, and resources • Provide input and feedback on CTISP Products • Chaired by Howard Hendrick • Members from CWLA, Casey, State Government, Advocacy Groups, Universities, ICFSA

40. CTISP Products • Policy Guide for Trauma-Informed Child Welfare • Desk Guide on Trauma-Informed Services for Child Welfare Supervisors • Trauma-Informed Casework Practice Model/Guidelines • Trauma-Informed Policy Toolkit

41. Laboratory Sites • Oklahoma • New Hampshire • San Diego • CTISP to provide assessment, consultation, training, technical assistance, and resources to sites • Sites will test CTISP products and provide feedback • CTISP products and services to be disseminated to 20 states during year 3 (2012-2013)

42. Resources • www.cebc4cw.org - Online evidence-based practice resource designed for child welfare professionals - with support from California Department of Social Services • www.nctsn.org and http://learn.nctsn.org - National Child Traumatic Stress Network, includes NCTSN Learning Center for Child and Adolescent Trauma • www.ChadwickCenter.org - Chadwick Center • www.musc.edu/tfcbt/ - TF-CBT on-line training

43. Contact Information • Lisa Conradi, Psy.D. • CTISP Project Manager • Chadwick Center of Rady Children’s Hospital • 3020 Children’s Way, MC 5131 • Ph: (858)576-1700 x 6008 • E-mail: lconradi@rchsd.org