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©
2005 Jordan Institute
for Families
Vol.
10, No. 3
June 2005
A Child Welfare Response to Traumatized Children
To improve mental health outcomes for children and families, professionals in all service areas within departments of social services—including those in Work First and economic services—should have the following core knowledge and skills:
- Understand PTSD and traumatic stress
- Be able to identify events and experiences likely to cause trauma
- Be able to recognize the range of trauma reactions in children of different ages and cultural backgrounds, and in adults
- Know how and when to document and pass on to others in the agency information about a child or family struggling with traumatic stress
- Be able to obtain appropriate and timely mental health services for children and adults
- Understand the consequences of a child’s lifetime trauma history for his or her current behavior
We hope the articles in this issue, including the discussion below, will help you develop some of this knowledge. For additional learning resources, consult Training Matters, v. 6, n. 3 (www.trainingmatters-nc.org).
Enhancing Worker-Child Interactions
Interviewing. McNally and colleagues (2003) advise us to respect a trauma survivor’s wishes about whether to talk about the trauma, and we know that most victims of child maltreatment, especially sexual abuse, can be retraumatized by interviews (Faller, 1993). Yet to ensure child safety and well-being—and do their jobs—child welfare workers must interview children, even those who have been traumatized.
To minimize the harm caused to traumatized children, professionals should reduce the number of interviews whenever possible by conducting joint interviews with law enforcement and by ensuring that interview practices are informed by policy, research, and practice guidelines (Faller, 1993). For example, proper use of the Stepwise Interview, a structured interview process, permits the child to state information in his or her own words as much as possible, which may reduce retraumatization (Flick & Woodcock, 2002b). To learn more about this interview process, attend the in-service training Introduction to Child Sexual Abuse (to register, go to www.ncswtrain.org). Practice Notes v. 8, n. 1 also discusses interviewing.
Using Trauma Assessment Tools. The National Child Traumatic Stress Network (NCTSN) encourages professionals to use tools such as the Trauma Symptom Checklist for Children and the Trauma Symptom Checklist for Young Children to help identify traumatic stress and PTSD in children (Taylor & Siegfried, 2005). The NCTSN explains that these tools, which are multiple item instruments that take approximately 20 minutes to administer, will help ensure workers have the information they need to meet children’s needs. These tools are relatively inexpensive and available online at <www3.parinc.com>.
Collect Information on a Child’s History. The NCTSN also believes that workers can support traumatized children by collecting more thorough information about a child’s history. Children with a history of multiple foster placements often lack a sense of continuity about their lives. By gathering information about a child’s history, relationships, strengths, and accomplishments, workers and foster parents can help organize the child’s life and help the child structure his or her thoughts and memories into a coherent narrative. Therapists and caretakers can also benefit from more thorough information about a child’s trauma history. Trauma history profiles help clinicians and caretakers form a more comprehensive and appropriate treatment plan and address underlying causes of emotional and behavioral problems.
Promoting Recovery and Resiliency. The following may help traumatized children:
Provide Information. Explain to children that it is very normal for people to have symptoms of PTSD after a traumatic event (McNally et al., 2003). Send the message that the emotions they are experiencing are normal, their reactions will not last forever, and that you accept what they are feeling. “Resist the temptation to talk a child out of fear, sadness, anger, embarrassment, guilt, or shame to avoid your own discomfort” (Levine & Kline, 2002).
Maintain/Establish that One Key Relationship. Children do well, even under terrible conditions, when they have a relationship with at least one adult who is extremely supportive and accepting, who frequently spends time with them, is concerned about their welfare, and provides them with guidance, discipline, and information (Goodman, 2002).
Teach Calming Techniques. “Give children the opportunity to relax through play, talk, art activities, music, or physical comforting. Exercise, muscle relaxation techniques, deep breathing exercises, and using calm mental images are techniques proven to reduce stress. Talk to a professional to learn more about these methods. Teenagers should be advised to avoid unhealthy means of stress reduction such as smoking or using alcohol or drugs” (Goodman, 2002).
Monitor Environmental Stressors. In addition to being vulnerable to “triggers” that remind them of the specific traumatic event they experienced, children in the child welfare system are more vulnerable to the psychological effects of other traumatic events or potentially stressful incidents, such as school violence and terrorist attacks. Be prepared to support them (BPNP, 2002).
See and Build Strengths. Though her behaviors may be difficult, see the child as a tough survivor whom you are helping to recover and thrive (Pitonyak, 2002). Remember these behaviors are not the child’s fault, nor something she can control (Flick & Woodcock, 2002a).
Improving Placement
The Northwest Foster Care Alumni Study (Pecora et al., 2005) found that child welfare agencies can help prevent PTSD and other negative mental health outcomes for foster children by improving placement stability—that is, by reducing the number of placements, shortening length of stay in care, reducing the number of placement moves a child experiences each year, etc. While this study validates the emphasis North Carolina already puts on placement stability, it should also inspire workers and agencies to redouble their efforts. To improve placement, child welfare and family support agencies and practitioners should consider the suggestions made in the article "Strategies for Agencies and Workers."
Conclusion
Agencies do not have full control over what happens to children exposed to traumatic events, but they have an extremely important role to play. If they take appropriate action in the areas of training, policy, and practice, and if they have strong collaborative relationships with foster parents, mental health, the schools, and others, agencies will strengthen their ability to help trauma-exposed children recover and achieve positive life outcomes.