The Child Welfare Trauma Training Toolkit: An Overview Alison Hendricks, LCSW Chadwick Trauma-Informed Systems Project Chadwick Center for Children and Families Rady Children’s Hospital – San Diego Alison

Objectives Participants will be able to: Define a trauma-informed child welfare system Learn about the Child Welfare Trauma Training Toolkit, training activities, and resources Identify the 9 Essential Elements of Trauma-Informed Child Welfare Practice Describe practical applications of the Essential Elements in casework practice

What is a Trauma-Informed Child Welfare System? A Trauma-Informed Child Welfare System (TICW) 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 Alison Rule 1 of a Trauma-Informed System: Don’t Make It Worse

What is a Trauma-Informed Child Welfare 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 Alison

About the Child Welfare Trauma Training Toolkit A product of the Child Welfare Committee of the National Child Traumatic Stress Network Toolkit includes a Trainer’s Guide and a Comprehensive Guide as well as training slides, handouts, and activities with a CD-Rom Goal of training is to educate child welfare professionals about childhood trauma and its impact and how to intervene in a trauma-responsive manner

Toolkit Training Modules Module 1: Introduction to the Essential Elements (1 hour) Module 2: What is Child Traumatic Stress? (2.5 hours) Module 3: The Impact of Trauma on Children’s Behavior, Development, and Relationships (2 hours) Module 4: Assessment of a Child’s Trauma Experiences (2 hours) Module 5: Providing Support to the Child, Family, and Caregivers (1.5 hours) Module 6: Managing Professional and Personal Stress (1 hour) Module 7: Summary (1 hour)

Essential Elements of Trauma-Informed Child Welfare Practice 1. Maximize the child’s sense of safety Traumatic stress overwhelms a child’s sense of safety and can lead to a variety of survival strategies for coping Safety implies both physical safety and psychological safety A sense of safety is critical for functioning as well as physical and emotional growth While inquiring about emotionally painful and difficult experiences and symptoms, workers must ensure that children are provided a psychologically safe setting Alison - I bulleted numbers 2 and 4 to make the points more concise but would make this 3-4 points per page – not 5-6

What a Child Welfare Worker Can Do When facilitating the placement of children, ask specifically about any worries that they have about being safe, and reassure them with information about how they are being kept safe Help children who have trauma histories identify ways in which adults in their life protect them and review these points in each meeting with the children Prepare children in advance for placement changes and legal proceedings by describing what will happen and addressing any questions or concerns they may have

2. Assist children in reducing overwhelming emotion Trauma can elicit such intense fear, anger, shame, and helplessness that the child feels overwhelmed Overwhelming emotion may delay the development of age- appropriate self-regulation Emotions experienced prior to language development maybe be very real for the child but difficult to express or communicate verbally Trauma may be “stored” in the body in the form of physical tension or health complaints

What a Child Welfare Worker Can Do Teach children and caregivers strategies for coping with strong emotions, such as relaxation techniques, meditation, dance, art, music, yoga, and physical exercise Inform all prospective foster parents of any applicable trauma history of potential foster children, while simultaneously respecting the children’s confidentiality   Provide information to resource parents about the links between trauma reminders and the overwhelming emotions children may experience and help them identify trauma reminders for the children in their care

3: Help children make new meaning of their trauma history and current experiences Trauma can lead to serious disruptions in a child’s sense of safety, personal responsibility, and identity Distorted connections between thoughts, feelings, and behaviors can disrupt encoding and processing of memory Difficulties in communicating about the event may undermine a child’s confidence and social support Child welfare workers must help the child feel safe, so he or she can develop a coherent understanding of traumatic experiences

What a Child Welfare Worker Can Do   Help a child with a trauma history create a Life Book If removal of children from their home of origin is necessary, review with the children and families the true reasons for removal and correct any misconceptions

4. Address any impact of trauma and subsequent changes in child’s behavior, development, and relationships Traumatic events affect many aspects of the child’s life and can lead to secondary problems (e.g., difficulties in school and relationships, or health-related problems) These “secondary adversities” may mask symptoms of the underlying traumatic stress and interfere with a child’s recovery from the initial trauma Secondary adversities can also lead to changes in the family system and must be addressed prior to or along with trauma- focused interventions Alison

What a Child Welfare Worker Can Do Ask the child and caregiver at each point of contact whether the child has been experiencing signs of trauma such as nightmares, bedwetting, emotional outbursts, or changes in behavior or apparent developmental level at home or at school When a caregiver expresses concern with a child’s behavior that appears related to a trauma history, help the caregiver to understand the child’s conduct in a non-judgmental way and provide ideas for coping strategies When children show behavioral indicators of trauma, assess the issue and make referrals to other professionals as needed

5. Coordinate services with other agencies Traumatized children and their families are often involved with multiple service systems, and child welfare workers are uniquely able to promote cross-system collaboration Service providers should try to develop common protocols and frameworks for documenting trauma history, exchanging information, coordinating assessments, and planning and delivering care Collaboration enables all helping professionals to view the child as a whole person, thus preventing potentially competing priorities

What a Child Welfare Worker Can Do   Organize quarterly meetings with other service providers, to discuss common cases (while respecting confidentiality) and to develop a trauma-informed “common language” and shared framework regarding child traumatic stress Promote continuity in helping relationships for the child and family by making calls to other service providers involved with the family and checking in about the child’s progress

6. Utilize comprehensive assessment of the child’s trauma experiences and their impact on the child’s development and behavior to guide services Thorough assessment can identify a child’s reactions and how his or her behaviors are connected to the traumatic experience Thorough assessment can also predict potential risk behaviors and identify interventions that will ultimately reduce risk Child welfare workers can use assessment results to determine the need for referral to appropriate trauma-specific mental health care or further comprehensive trauma assessment

What a Child Welfare Worker Can Do   Refer children who have experienced trauma and show or report trauma-related symptoms to a trauma-informed mental health provider who is knowledgeable about assessment instruments appropriate for assessing trauma Develop a list of available social supports within the community, including friends, family and community agencies with experience treating trauma Use the Child Welfare Trauma Referral Tool or other screening tool to identify any urgent trauma-related concerns and to determine if they need a mental health referral (including a possible referral to trauma-specific mental health assessment)

7. Support and promote positive and stable relationships in the life of the child Separation from an attachment figure, particularly under traumatic and uncertain circumstances, is highly stressful for children Familiar and positive figures—teachers, neighbors, siblings, relatives—play an important role in supporting children who have been exposed to trauma Minimizing disruptions in relationships and placements and establishing permanency are critical for helping children form and maintain positive attachments

What a Child Welfare Worker Can Do For traumatized children who are struggling in their foster placements, help their foster parents understand the child’s needs and reactions and provide support and coping skills to the foster parents to increase the likelihood of successful placement   For children removed from their homes, help to maintain existing positive relationships in the child’s life (i.e., teachers, friends, siblings) by making efforts to keep children in their schools and communities and facilitating meetings with those individuals as much as possible

8. Provide support and guidance to child’s family and caregivers Resource families have some of the most challenging roles in the child welfare system Resource families must be nurtured and supported so they, in turn, can foster safety and well-being Relatives serving as resource families may themselves be dealing with trauma related to the crisis that precipitated child welfare involvement and placement Alison

What a Child Welfare Worker Can Do Assist children and families with getting concrete needs met, including shelter, food, medical care, transportation, respite care, etc. Identify parents or other caregivers who are struggling with their own traumatic experiences or secondary adversities. Provide them with support and referrals to trauma-informed providers and link them with other families for mutual support.

9. Manage professional and personal stress Child welfare is a high-risk profession, and workers may be confronted with danger, threats, or violence Child welfare workers may empathize with victims; feelings of helplessness, anger, and fear are common Child welfare workers who are parents, or who have histories of childhood trauma, might be at particular risk for experiencing such reactions

What a Child Welfare Worker Can Do   Practice using stress management techniques such as meditation, prayer, conscious relaxation, deep breathing, journaling, and/or exercise Meet with supervisor for regularly scheduled consultation on cases and meet with a peer to seek support on difficult cases

Case Vignette - Tommy 4-year-old boy Recently witnessed an episode of domestic violence between his parents Neighbors called the police Police arrested his father Ambulance had come to take his mother (bleeding and unconscious) to the emergency room Police called Child Welfare Original text so you can read it: Tommy is a 4-year-old boy who recently witnessed an episode of domestic violence between his parents. During an especially loud argument, neighbors called the police. Police had come and arrested his father and an ambulance had come to take his mother (bleeding and unconscious) to the emergency room. Police called Child Welfare to assess child safety.

Tommy in Foster Care Placed in foster care 8 weeks ago Initially quite withdrawn and resisted soothing or nurturance Wakes up twice a night with or without nightmares, but falls back asleep fairly easily Irritable and fatigued Wets the bed 2-3 times a week Original text: Tommy was placed in foster care 8 weeks ago He was initially quite withdrawn and resisted soothing or nurturance He wakes up twice a night with or without nightmares, but falls back asleep fairly easily He appears irritable and fatigued He wets the bed 2-3 times a week

Tommy in Foster Care (continued) Attends daycare three times per week At high risk to be excluded - intense episodes of aggression towards peers, especially girls Can also be very helpful to others, appears sensitive when they are upset, and attempts to comfort them Typically ignores verbal limits and desperately fights physical restraint, to the point of exhaustion Following visits with his mother, he tends to isolate himself Does not visit with his father who is incarcerated Original text: He attends daycare three times per week, but is at high risk to be excluded because of intense episodes of aggression towards peers, especially girls He can also be very helpful to others, appears sensitive to their upset, and attempts to comfort them He typically ignores verbal limits and desperately fights physical restraint, to the point of exhaustion Following visits with his mother, he tends to isolate himself He does not visit with his father who is incarcerated

Activity: How can we help Tommy during each phase? Support and training for foster parent Visitation Collaboration with other systems Child welfare worker training and support Investigation Risk and needs assessment Removal Placement Mental health services

How Can we Create a More Trauma-Informed Child Welfare System? Materials and resources Child Welfare Trauma Training Toolkit Caring for Children who Have Experienced Trauma: A Workshop for Resource Parents Bridging the gap between child welfare and mental health CW Breakthrough Series Collaborative Chadwick Trauma-Informed Systems Project State and National Initiatives Alison

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 Alison

Contact Information Alison Hendricks, LCSW Operations Manager Chadwick Trauma-Informed Systems Project www.chadwickcenter.org ahendricks@rchsd.org (858)576-1700x2736