1. Use of Trauma-Informed Interventions in Youth Permanency Practice Erika Tullberg, MPA, MPH Assistant Research Professor NYU Child Study Center November 27, 2012

2. 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? 2 Use of Trauma-Informed Interventions in Youth Permanency Practice

3. Hat #1: Trauma “Expert” 3 Faculty at NYU Child Study Center Member of National Child Traumatic Stress Network Use of Trauma-Informed Interventions in Youth Permanency Practice

4. Hat #2: Child Welfare Professional 11 years working for public child welfare agency Mentor to “rookie” foster care caseworkers 4 Use of Trauma-Informed Interventions in Youth Permanency Practice

5. Hat #3: Foster Parent Parent of a 22-year-old alumna of foster care 5 Use of Trauma-Informed Interventions in Youth Permanency Practice

6. Traumatic Stress T raumatic event R e-experiencing trauma A voidance I ntense Arousal N umbing C onsciousness shifts R elationship difficulties A ffect Dysregulation S elf problems H armful behavior Saxe, 2012 6 Use of Trauma-Informed Interventions in Youth Permanency Practice

7. Trauma and Older Youth in Foster Care Urgency around transition planning/preparation Impact of trauma on development 7 Use of Trauma-Informed Interventions in Youth Permanency Practice

8. 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 8 Use of Trauma-Informed Interventions in Youth Permanency Practice * From The Adolescent Brain, Jim Casey Youth Opportunities Initiative, 2011

9. Opportunities and Challenges 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 9 Use of Trauma-Informed Interventions in Youth Permanency Practice * From The Adolescent Brain, Jim Casey Youth Opportunities Initiative, 2011

10. Opportunities and Challenges 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 10 Use of Trauma-Informed Interventions in Youth Permanency Practice * From The Adolescent Brain, Jim Casey Youth Opportunities Initiative, 2011

11. 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 11 Use of Trauma-Informed Interventions in Youth Permanency Practice

12. 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 services 4.Collaborating across child and adult systems related to trauma and transition needs 5.Ensuring organizational support and capacity for implementation and sustainability 12 Use of Trauma-Informed Interventions in Youth Permanency Practice

13. 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 13 Use of Trauma-Informed Interventions in Youth Permanency Practice

14. Strategies, continued 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? 14 Use of Trauma-Informed Interventions in Youth Permanency Practice

15. Strategies, continued 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? 15 Use of Trauma-Informed Interventions in Youth Permanency Practice

16. 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 16 Use of Trauma-Informed Interventions in Youth Permanency Practice Re- experiencing ArousalAvoidance

17. 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 17 Use of Trauma-Informed Interventions in Youth Permanency Practice

18. 18 What can we do to better support transitioning youth? As system leaders? As agency administrators? As frontline staff? As family members? Use of Trauma-Informed Interventions in Youth Permanency Practice

19. Discussion 19 Use of Trauma-Informed Interventions in Youth Permanency Practice

20. Contact Information Erika Tullberg NYU Child Study Center 646-754-5107 Erika.Tullberg@nyumc.org 20 Use of Trauma-Informed Interventions in Youth Permanency Practice