A statewide introduction of trauma-informed care in a child welfare system

Most children in the care of the child welfare system have been exposed to multiple traumas in addition to the stressor of being removed from their home. Because the risk for mental health problems following exposure to trauma is high, a critical need exists to introduce trauma-informed practices into the child welfare system. The purpose of this study is to evaluate initial stages of a trauma-informed training program for the Arkansas Division of Child and Family Services (DCFS). In Phase 1, 102 (75%) of DCFS area directors and supervisors participated in 10 regional, two-day workshops modeled after the National Child and Traumatic Stress Network (NCTSN) trauma-informed training for child welfare. Pre- and post-training evaluations demonstrated significant improvements in participants' knowledge of trauma-informed practices. A three-month follow-up with directors and supervisors indicated that use of trauma-informed practices increased significantly and that such changes were correlated with pre- versus post-training improvement in knowledge. Most participants were able to partially implement action steps established at the time of training; however, a number of barriers were cited as preventing full implementation, including time constraints, heavy caseloads, lack of staff, and limited resources. Results are discussed in light of plans under way for Phase II training for all DCFS front-line staff.     

Program evaluation of trauma-informed yoga for vulnerable populations

BackgroundTrauma is highly prevalent among vulnerable populations, including those who are incarcerated, in treatment for substance use, or seeking mental health services. Trauma-informed yoga seeks to create a safer yoga practice for individuals with a trauma history and may improve emotional and physical wellbeing. Thus, we conducted an evaluation of a trauma-informed yoga program to gain insight into participant experiences.MethodsTrauma-informed yoga classes were led by trained volunteers and held in three sectors that work with vulnerable populations: corrections and reentry, substance use treatment and recovery, and community and mental health. Data were collected via anonymous survey using a retrospective pre-post design. The survey instrument captured reasons for student participation and perceived effects of yoga on emotional and physical wellbeing.ResultsStudents were motivated to participate in yoga classes by expectations of physical, mental, and spiritual benefit. Students reported perceived improvements in emotional and physical wellbeing and greater use of self-regulation skills after starting yoga.ConclusionOur findings suggest trauma-informed yoga is perceived as beneficial by vulnerable individuals, especially those in the correctional system or recovering from substance use. Our results support the value of offering trauma-informed yoga in institutionalized and community settings. Improvements in emotional and physical wellbeing warrant formal study.     

Development and Evaluation of the Trauma-Informed System Change Instrument: Factorial Validity and Implications for Use

In this paper, we present the process of developing and evaluating an instrument designed to measure the extent to which a complex community system has changed as a result of a community initiative, and for purposes of this research, doing this within the content area of developing local trauma-informed child welfare systems in specific communities in Michigan. The instrument was designed for the Southwest Michigan Children’s Trauma Assessment Center’s (CTAC) Substance Abuse and Mental Health Services Administration (SAMHSA)-funded initiative to bring a trauma-informed perspective to professionals working with children in child welfare. The Trauma Informed System Change Instrument was developed with the input of experts in trauma-informed system change. Two parts of the instrument were analyzed separately using confirmatory factor analysis. A two factor model was fit for Community Characteristics and a three factor model for Individual Characteristics. Although adequate factorial validity was obtained for the instrument, specific items on the instrument that were problematic in fitting the model were identified, and suggestions for revising the instrument for improved functionality are offered, as are other potential uses of the instrument.     

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N = 114) towards evidence-based practices. Implementation outcomes include rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.     

The Value of Hate in the Countertransference

The author looks at the experience of hate in the countertransference and develops the idea that hate can be of particular value to the treatment process. He begins with an exploration of the therapist’s needs and discusses how unmet self-regulatory needs sometimes lead to feelings of frustration and rage toward the patient. The author explores these ideas as they are connected to Winnicott’s (1949, 1971) work on aggression and Jessica Benjamin’s (1992) work on recognition and destruction. The author espouses a difference between rage and hate, where rage is seen as indicative of unmet needs, and hate is seen as a force that can emancipate the therapist from the encumbrance of unmet needs. Case examples are provided to show the utility of this perspective. Laurence Green, M.S.W., Psy.D. is on the faculty and a member of the Institute of Contemporary Psychoanalysis. He is Co-chair of the History Committee of the International Federation of Psychoanalytic Education. He is in private practice in Los Angeles, California working with children, adolescents and adults.     

Why do larger families reduce parental investments in child quality, but not child quality per se?

Becker’s Quantity–Quality model (Becker in Demographic and economic change in developed countries, Princeton University Press, Princeton, pp 209–240, 1960; Becker and Lewis in J Polit Econ 81(2): S279–S288, 1973; Becker and Tomes in J Polit Econ 84(4): S143–S162, 1976) suggests a trade-off between family size and parental investments in children. To date, only Cáceras-Delpiano (J Hum Resour 41(4): 738–754, 2006) tests this theory by considering private school enrolment. This study extends this work by using a unique data set containing a broader range of parental investments that are arguably linked to parental intentions for producing higher quality children, such as overall and non-sectarian private school enrolment, the number of computers in the home per child, and saving for the child’s education. Both studies find that fertility reduces parental investments. However, the literature generally finds that fertility has no impact on child outcomes. The study offers three potential explanations for this ‘puzzle’.     

Trauma-informed care training in a child welfare system: Moving it to the front line

The use of trauma-informed practices in the child welfare system is critically important to prevent system-induced trauma and encourage timely assessment, triage and referral for care when indicated. Ultimately, such measures have the potential over time to decrease the risk for mental health problems in children exposed to a trauma. This study evaluates an initiative in Arkansas to train child welfare front-line staff members in trauma-informed care practices. We evaluated the impact of the training on knowledge and use of trauma-informed care practices among three types of child welfare staff (Caseworkers, Program Assistants and Other front-line staff). Results suggest that this training process was highly successful in improving knowledge of trauma-informed care practices, especially among staff with the least formal education and training. We also found a significant increase in staff use of trauma-informed care practices at the three-month follow-up with little difference observed across staff groups. Barriers that may prevent staff from full implementation of training concepts are described and strategies to address barriers are proposed.     

A trauma-informed social work framework for the abortion seeking experience

ABSTRACT

This purpose of this article is to discuss the abortion seeking experience in relation to stress, trauma, and trauma-informed care. Definitions of stress and trauma are provided, and potential points of stress during the abortion seeking experience will be discussed in the areas of unintended pregnancy, policy barriers, provider access, and the external clinic environment. Abortion stigma will also be discussed in relation to individual stigma, mass media stigma, community stigma, social work practitioner stigma, and the impact of stigma on the abortion seeking experience. Next, we discuss a trauma-informed lens for considering the abortion seeking experience in the United States, and a trauma-informed social work framework for interacting with clients during the abortion experience is presented as a practice approach for reducing and eliminating trauma and trauma triggers. We then present the potential benefits of this approach. The article concludes with some additional recommendations for a trauma-informed approach to aspects of social work advocacy.     

Trauma Without Borders: The Necessity for School-Based Interventions in Treating Unaccompanied Refugee Minors

This article explores migration trauma among Mexican and Central American unaccompanied refugee minors (URM) with the purpose of developing an understanding of migration as a tripartite process consisting of: pre-migration exposure to traumatic stressors, in-journey stressors, and post-migration stressors. The migration experience of these youth may be subjectively different depending on a wide range of factors. The complexities of migration are explored as a traumatic, tripartite process. These three salient components of migration may act as precursors, often resulting in psychological sequelae such as: post-traumatic stress disorder (PTSD), anxiety, and depression. Of all migrant groups, URM are more likely to develop psychiatric symptoms. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Behavioral Intervention for Trauma in Schools (CBITS), and Mental Health for Immigrants Program (MHIP) are among the most effective interventions in the treatment of PTSD, anxiety, and depression in refugee minors. Social workers in schools are in unique positions to provide mental health services to URM. A case example illustrating a cultural adaptation of TF-CBT in an urban public high school is included. Clinical implications of culturally responsive and trauma-informed treatment of URM in schools will be discussed. Additionally, this article will emphasize the importance of bridging the gap between research and culturally responsive, trauma-informed interventions for URM in schools.     

Cross-sectoral collaboration working with perinatal women who use substances: outcomes and lessons from HerWay Home

ABSTRACT

HerWay Home is a multi-service drop-in and outreach program women for with substance use issues and who also may be affected by mental illness, trauma, and/or violence. Philosophical foundations of the program include harm reduction and being relationship-based and trauma-informed. This article presents the program’s evaluation findings related to cross-sectoral service collaborations and outcomes for service partners as well as for women and families, including prevention of children going into care. For service partners, HerWay Home provided peace of mind, knowing that vulnerable women’s needs would be met and also led to increased understanding about substance-using women and best practice approaches.     

Mindfulness and Cognitive Therapy in Depression Relapse Prevention: A Case Study

Depression is the most commonly diagnosed mental illness in the United States with relapse rates as high as 80–90% in some circumstances (Chen et al. in Res Soc Work Pract 16(5): 500–510, 2006; Mintz et al. in Arch Gen Psychiatry 49: 761–768, 1992; Teasdale et al. in J Consult Clin Psychol 68(4): 615–623, 2000). Cognitive therapy (CT) and psychopharmacology have been the mainstays of treatment for depression and relapse prevention, yet relapse remains a significant risk of this mental illness (DeRubeis et al. in Arch Gen Psychiatry 62: 409–416, 2005; Meyer and Scott in Behav Cogn Psychother 36: 685–693 2008; Rush et al. in Cognit Ther Res 1: 17–37, 1977). The literature review, case illustration and analysis examines the rationale for integrating mindfulness practice, and demonstrates the application of this practice in conjunction with cognitive therapy to reduce the risk of relapse in Major Depression.     

Children’s Deliberate Control of Facial Action Units Involved in Sad and Happy Expressions

Few attempts have been made since the pioneer work of Ekman et al. (1980) to examine the development of the deliberate control of facial action units in children. We are reporting here two studies concerned with this issue. In Study 1, we investigated children’s ability to activate facial action units involved in sadness and happiness expressions as well as combinations of these action units. In Study 2, we examined children’s ability to pose happiness and sadness with their face, without telling them which action unit to activate. The children who took part in this study were simply asked to portray happiness and sadness as convincingly as possible. The results of Study 1 indicate a strong developmental progression in children’s ability to produce elementary facial components of both emotions as well as in their ability to produce a combination of the elements in the case of happiness. In agreement with prior research in motor development, several non-target action units were also activated when children performed the task. Their occurrence persisted throughout childhood, indicating limitations in the finer motor control achieved by children across age. The results obtained in Study 2 paralleled those obtained in Study 1 in many respects, providing evidence that the children used the technique of deliberate action to pose the two target emotions.     

The role of child care in supporting the emotion regulatory needs of maltreated infants and toddlers

Infants and toddlers who experience physical abuse and/or neglect are at a severe risk for disruptions to emotion regulation. Recent prevention and treatment efforts have highlighted center-based child care as an important setting for providing support to the needs of these children, as child care centers are already an existing point of entry for reaching high-risk families. Guided by ecological theory, this review draws on the maltreatment and child care literatures to consider the opportunity for child care centers, specifically teacher-child interactions within the classroom, to support the unique regulatory needs of maltreated infants and toddlers. Existing research on the effects of child care for children facing other types of risk, as well as research with maltreated preschool children, provides a foundation for considering the role child care may play for infants and toddlers, whose emotion regulation skills are just emerging. More research is needed regarding teachers' roles in facilitating effective emotional experiences in the classroom that meet the unique needs of maltreated children. Additionally, early childhood teacher training that focuses on infant/toddler mental health and a trauma-informed perspective of care, as well as structuring child care centers as communities of support for high risk families, all may aid child care centers in better serving this vulnerable population.     

Sociology’s <Emphasis Type="Italic">Suicide</Emphasis>: A Forensic Autopsy?

For decades Durkheim’s theory of suicide has been tested and found wanting. Yet, rather than being consigned to the dust-bin of history, it lives on and is pointed to as an exemplar of the powers of sociological theory and research. If this rationalizing and/or dismissal of so many falsifications of the theory were an isolated phenomenon, it might be evidence of some lemming-like propensity for suicide or a disciplinary death-wish, among a few sociologists. But it appears to be a much more widespread and common occurrence. In this paper we explore some possible explanations of this ‘falsification denial’—‘The Social Misconstruction of Reality’ (Hamilton 1996), ‘When Prophecy Fails’ (Festinger et al. 1956), ‘Underdetermination’ (Duhem 1954; Quine Journal of Philosophy 67:178–183, 1970, Erkenntnis 9:313–328, 1975; Lakatos 1970), and ‘Boundary Maintenance’ (Erikson 1966), and we outline some of the more important and pernicious consequences of this falsification denial for the discipline and future of sociology.     

The embodiment of complex trauma in domestic minor sex trafficking victims and the dangers of misidentification

ABSTRACT

Domestic minor sex trafficking (DMST) victims face many barriers to getting appropriate, trauma-informed treatment. Many of these victims experience childhood trauma by trusted adults or by non-familial perpetrators of abuse. Complex trauma, later defined in depth, captures what many DMST victims endure as the harm that they experience is ongoing and cannot be identified as a singular event. Due to the complex trauma these victims experience, they become dissociated as a tool for survival. As a result of trauma, many DMST victims do not embody protective skills, and attempt to gain control of their lives through maladaptive behaviors that can lead to re-victimization. I begin by discussing the literature around embodiment, trauma and the body, and dissociation to demonstrate why a trauma-informed approach in identification and therapy is important when working with DMST victims. Subsequently, I present a case study to explore an example of how the presentation of trauma, or ways it is masked, can lead to misidentification. This case study will illustrate how social workers can effectively advocate for DMST victims at the early stages of identification and also foster a safe, accepting therapeutic space to assist these clients in trust-building and identify formation. Trauma-informed care needs to be integrated from the first interaction with law enforcement, throughout the development of a treatment plan with providers, and for the duration of the therapeutic relationship.     

Trauma-informed care and elder abuse: a synergistic alliance

ABSTRACT

Elder abuse is a global systemic problem in which one or more traumatic or stressful life experiences directly affect older adults, their families, and communities. Despite its devastating impact, the understanding of—and response to—elder abuse has rarely been explored through a trauma-informed lens. Despite the prevalence of traumatic and stressful life experiences, research and practice are just beginning to target the intersection of elder abuse and life course trauma. This article demonstrates how knowledge about the causes, consequences, and responses to elder abuse can be integrated with the principles of trauma-informed care to improve agency and community responses to preventing or intervening with elder abuse and neglect. In order to address the ongoing problems with detection and treatment of elder abuse, we assert that instilling trauma and elder abuse informed care in organizational services and policies forms a synergistic alliance and would address many of these concerns.     

Polyvictimization in later life: Trauma-informed best practices

ABSTRACT

This article provides a summary of salient trauma findings and conveys the dearth of research pertaining specifically to the trauma of elder abuse. This material, in conjunction with information contained in other articles composing this special issue, lays the foundation for advancing a trauma-informed approach to assisting older adults who have experienced polyvictimization. Informed by the findings presented and their extensive clinical experience with victims of violence, the authors suggest steps for providing a trauma-informed and victim-centered response to older adults who have suffered polyvictimization. These steps are then illustrated with an in-depth late-life polyvictimization case analysis.     

Maternal Self-Efficacy of Mothers of Children with Intellectual Developmental Disabilities,Down Syndrome,and Autism in Kuwait

This study aims to identify the perception of maternal self-efficacy among 95 Kuwaiti mothers of children with Developmental Disabilities (DD) to determine the differences in perception of maternal self-efficacy variables among the mothers based on demographic variables: Child’s age, Gender, Type of disability, Leisure time, and Mother’s age. A survey was conducted using Kandari’s (2005, Unpublished doctoral dissertation, Simmons College, Boston) Arabic version of the Caregiving Self-Efficacy Scale. The mothers were selected from different special education settings in Kuwait. They had 33 children with Intellectual Developmental Disabilities (IDD), 41 with Down Syndrome, and 21 with autistic disorder. The children included both males and females, and ranged between the ages of 6 and 15. The findings showed that (1) mothers of children with DD did not differ in their beliefs about aspects of maternal self-efficacy according to the Child’s age, Child’s gender, and the Mother’s age; (2) mothers of children with IDD, when compared to other mothers, had negative beliefs of all aspects of maternal self-efficacy; (3) mothers of children who did not attend a respite facility for an afternoon had negative beliefs of all aspects of maternal selfefficacy except for the child’s behavioral management; and (4) all mothers’ groups had negative beliefs about their ability to control their child’s behavior and their own emotions. Implications are discussed to provide services for mothers to help them develop their adaptive skills and meet their children’s needs, as well as their own.     

Trauma-informed services for children with incarcerated parents

Children of incarcerated parents have often experienced not only the trauma of family separation, but also other forms of adverse events. Social workers can improve service delivery to this population by incorporating SAMHSA’s components of trauma-informed care (TIC). Translating TIC concepts into practice is an important but challenging goal for social work practitioners. The first half of this article reviews the literature about the effects of parental incarceration on attachment, stigma, physical and mental health, and intergenerational transmission of trauma. The latter half of the article applies principles of TIC by offering specific recommendations for conceptualizing cases through the lens of trauma and utilizing trauma-informed responses with these children.