Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

A big hole with the wind blowing through it: Aboriginal women's experiences of trauma and problem gambling

Although studies have shown a link between social trauma and problem gambling (PG), there is little research involving Aboriginal women in this area, despite Aboriginal women being potentially at higher risk for both social trauma and problem gambling. This article describes the results of a qualitative phenomenology study asking seven Aboriginal women living in Western Canada to describe their experiences of social trauma and gambling problems. Results suggest four main themes, describing: (1) the Aboriginal women's experiences of social trauma (‘the three tigers’); (2) their use of gambling to cope with these experiences (‘a big hole with the wind blowing through it’); (3) their experience of problem gambling (‘I'm somebody today’); and (4) their process of healing from social trauma and gambling problems (‘a letter to John’). Participants described what they felt was a clear link between social trauma and problems with gambling, and how gambling helped to change their mood and block out the past. The results raise the possibility that Aboriginal women with gambling problems may need support to heal from social trauma – including racism and colonization – and that upstream initiatives to reduce the incidence of social traumas may be an important response to problem gambling among Aboriginal women.     

Championing the interface between mental health and child protection: evaluation of a service initiative to improve joint working in northern Ireland

The importance of establishing effective inter‐agency working between adult mental health services and child care services in order to safeguard children has been repeatedly identified by research, policy, inquiries and inspection reports. This article reports on the evaluation of an initiative in one health and social care trust in Northern Ireland that aimed to facilitate joint working and so improve service provision and protection for children and families. The Champions Initiative involved identifying a Champion in each multidisciplinary community mental health team and in each family and child care team that would have responsibility for providing information, promoting joint working and identifying any obstacles to better cooperation. The evaluation of this Initiative assessed levels of experience, training, confidence, understanding and awareness in the Champions and their team members at baseline. The Champions and their Team Leaders were then followed up after six months to obtain their qualitative views of the impact of the initiative. The results include comparisons between mental health and child care staff, and crucially, views about whether the initiative has had any impact on working together. This study also generated recommendations for further service development in this complex and important area of practice. Copyright © 2010 John Wiley & Sons, Ltd.

‘Identifying a Champion in each multidisciplinary community mental health team and in each family and child care team’

Citing Literature

Number of times cited according to CrossRef: 15

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• Nicky Stanley, Khatidja Chantler, Rachel Robbins, Children and Domestic Homicide, The British Journal of Social Work, 10.1093/bjsw/bcy024, 49 , 1, (59-76), (2018). Crossref
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Volume 21 , Issue 3 May/June 2012

Pages 157-172     

A presumption to disclose: new laws on the provision of information about child sex offenders to parents in England and Wales

In England and Wales, agencies managing child sex offenders in the community have long had the power to disclose information on those offenders to other agencies and sometimes to individual members of the public; this process has variously been referred to as ‘discretionary disclosure’ or ‘controlled disclosure’. In 2008, new laws were passed to strengthen this process and allow designated members of the public to request such information and imposed a new duty on agencies considering disclosure to conduct those considerations with a ‘presumption to disclose’. This article looks at the background to the new laws and how they might work in practice. Copyright © 2010 John Wiley & Sons, Ltd.     

“He Survives Everything”: A Latency-Aged Child with Play Disruption in the Face of Trauma and Early Object Loss

It is hypothesized that trauma and early object loss result in the arrest of the normal and healthy progression of a child's development and also disrupts a child's capacity to engage in symbolic play. In therapy, over time, with a constant object, a latency-aged child was able to re-enact early trauma and loss, make substantial gains in development, and begin to play in a symbolic and expressive way.     

Triangulating perspectives to inform the development of a smartphone application for foster,kinship, and adoptive parents

Abstract

This article describes the initial phase of a user-centered, inductive process for informing the development of a smartphone application (app) to complement an in-person trauma-focused knowledge and skills training class for child welfare resource parents (i.e. foster, kinship, and adoptive parents). Based on the participatory design approach for technology development, a qualitative study was designed to capture and triangulate relevant knowledge and opinions from resource parents, training instructors, and parenting education experts. The most prevalent themes emerging among these stakeholder groups included the need for a simple app interface and the potential for the app to (1) cultivate connection, affirmation, and combat resource parent feelings of isolation; (2) reinforce in-class knowledge and support skill practice at home; and (3) monitor resource parent, child, and family progress over time. Detailed findings are presented, including direct quotes from focus group and interview participants and elaboration on the prevalent themes, which may benefit others in the early stages of human services app design and contribute to the creation of guidelines for the development of technology-based human services interventions.     

Re-thinking a systemic approach to child welfare: A critical response to the framework for the assessment of children in need and their families

The Framework for the Assessment of Children in Need was introduced by the Department of Health (England and Wales) in 2000. Offering guidance to social workers in child and family settings, it came as a watershed in three main ways. First, it emphasized the connection between child poverty and developmental delay. Second, it advocated a systemic approach to child welfare by drawing on a number of related theories, including Bronfenbrenner's (1979) model of human development. Third, it overturned a restricted preoccupation with child abuse that had dominated much of child and family social work in the past. These developments aside, the systemic basis of the framework is problematic because it fails to explain how power operates within society. Without this understanding, social workers will not be in a position to tackle the inequalities which the framework rightly targets. This paper seeks to remedy these deficits by drawing on the critical systems theory of Jürgen Habermas.     

A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers

Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists’ contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients’ injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists’ role in elder abuse detection.     

‘..It takes a lot of brain space’: Understanding young carers’ lives in England and the implications for policy and practice to reduce inappropriate and excessive care work

This qualitative study, undertaken in England, explored young carers’ perspectives on the nature of their caring responsibilities. The findings are significant, particularly in the context of England's Care Act 2014, which seeks to prevent children engaging in ‘excessive’ or ‘inappropriate’ caring. Our research placed children at the heart of the debate on what constitutes appropriate care. The findings raise key questions regarding effective implementation of contemporary child policy, duties of care towards children in caring roles and priorities for child protection and family support policy and practices, with the potential to inform thinking around child's well-being in wider contexts.