A Complex Trauma Informed Approach to Children in Foster - PowerPoint Presentation

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A Complex Trauma Informed Approach to Children in Foster Care

Judge Michael Key, Troup County Juvenile Court Michelle Barclay, EsqStaff to Supreme Court of Georgia’s Committee on Justice for Children

Adoption and Foster Parent Association of Georgia, Jekyll Island Conference, 2.20.2015

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Today, our child welfare system is doing better on keeping children safe and finding permanency for those who come into foster careBut we have to do even more…we have to look out for their well-beingThat is where all our law and policy is going next

the Big Picture2Slide3

Easier to tell you what it does not meanWe are not to remove a child based on his best interest. Harm or risk of imminent risk of harm is still the standard for removalAnd we know removal (even when necessary) is frightening to a child and can harm their well-being

What does that mean?3Slide4

Blueprints Conference4

“Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the negative impacts of early fear learning. There is no doubt that children in harm’s way should be removed from a dangerous situation. However, simply moving a child out of immediate danger does not in itself reverse or eliminate the way that he or she has learned to be fearful. The child’s memory retains those learned links, and such thoughts and memories are sufficient to elicit ongoing fear and make a child anxious.”National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved fromwww.developingchild.harvard.eduSlide5

We must as a system become better educated on brain development and what trauma does to little brainsWe must use that knowledge to better support the children and families in our system or even just touched by our system.Because this is our only chance to break the cycle of trauma and to help a child become a well functioning adult.

So, what do we do?5Slide6

Impact of Maltreatment on Brain DevelopmentHealthy development depends on the quality and reliability of a child’s relationships with the important people in his or her life, both within and outside the family. Even the development of a child’s brain architecture depends on the establishment of these relationships.Heightened stress has been shown to impair the development of the prefrontal cortex, the brain region that, in humans, is critical for the emergence of executive functions—a cluster of abilities such as making, following, and altering plans; controlling and focusing attention; inhibiting impulsive behaviors; and developing the ability to hold and incorporate new information in decision-making.

National Scientific Council on the Developing Child, 20106Slide7

Brain DevelopmentAlarm System as a Survival MechanismTrauma damages the alarm systemPost trauma, the alarm system is too easily triggered and too slow to shut down

After TraumaChild is on Constant AlertChild over-interprets signs of dangerChild overreacts to normal situationsChild has difficulty with attachment and trusting others, particularly authority figuresThe Impact of Maltreatment: Trauma, Alarm, and Triggers

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Most Common Mental Health Diagnoses among Children in Foster Care Receiving Psychotropic MedicationsZito, JM; et al. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics. 121(1): e157.Slide9

Safety and Permanency are Necessary but not Sufficient to Ensure Well-Being

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Maltreatment Impacts How Youth Form Relationships with AdultsMaltreatment affects a child's health and well-being as well as the quality of his or her relationships.

Child maltreatment represents an extreme form of child–parent relationship disruption (Harden, 2004; Milan & Pinderhughes, 2000).Child maltreatment can be considered as a chronic interpersonal trauma, to which the child is exposed on a daily basis within the context of the caregiver-child relationship (Perry, 2008; van der Kolk, 2005). Children’s capacity to adequately cope with stress depends largely on the nature of the stress and on the

attachment figure’s capacity to diminish or counter the effects linked to the stressor (Lyons-Ruth et al., 1999). The

developmental stage of the child at the onset of the abuse

and neglect will influence the type and severity of the consequences (

Frederico

, Jackson & Black 2005; Perry 1995).

For many maltreated children, nurturing and supportive parental behavior was

inconsistent or unavailable

, resulting in children who

lack confidence to explore new environments and relationships

(

Bretherton

, 2000;

Sorce

&

Emde

, 1981).

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Path of Maltreatment’s Impact on Relationships throughout Life

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Focusing on Social & Emotional Well-Being:UNDERSTANDING IMPACT OF MALTREATMENT, ANTICIPATING CHALLENGESAn understanding of the impact maltreatment has had on children when they come to the attention of the child welfare system allows providers to be more proactive, knowing what to look for and anticipating the services that may be needed. This capacity is necessary at the caseworker-level, but also at the level of administrators who are making decisions about the array of services needed internally or through contracts.

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A Child Welfare System that Focuses on Improving Social and Emotional Well-Being:Reviews assessment tools to ensure that they are valid, reliable, and sensitive enough to distinguish trauma and mental health symptomsScreens children for trauma when their cases are opened

Delivers services that have been demonstrated to improve parenting capacities and children’s social-emotional functioning to in-home caregiversProvides ongoing training to staff and foster parents on issues related to trauma and mental health challenges that are common among youth being served by the systemConducts assessments at regular intervals to determine whether services being delivered to children and youth are improving functioningUtilizes independent and transitional living programs to support youth’s development of self-regulation and positive relational skills13Slide14

TRAUMA INFORMED COURTSA COURT LED COMMUNITY RESPONSE TO TRAUMA -So, what does this have to do with us as foster parents, adoptive parents and other caregivers?

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It is critical that you understand trauma, how to recognize the indicators and how to respond to the behaviors.“Ultimately, what determines how children survive trauma, physically, emotionally, or psychologically, is whether the people around them - particularly the adults they should be able to trust and rely upon - stand by them with love, support and encouragement”. Dr. Bruce Perry, in his book, The Boy Who was Raised as

a DogYou are among the firstcritical responders!15Slide16

Factors that Affect how People Respond to Traumatic EventsThe “dosage”, meaning the length, frequency and intensity of the event or events.Natural resiliency- possibly not as strong in children who have experienced chronic neglect or

abusThe environment in which the child is placed post-event.The timeliness, appropriateness and quality of interventions. Others?16Slide17

Impact of Complex TraumaFloods the body with cortisol to induce flight or fight for safetyChanges the brain and the bodyKeeps the body alert and defensive even when danger is no longer presentImpairs the body’s ability to focus on other things like language acquisition, academic progress, growth

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Impact of Complex TraumaExpect children to be alert, defensive, guarded, distrustful of others, fearful, anxiousLook for problems with health, language development, cognitive delays, developmental delays, lack of self confidenceRecognize that attention problems, impulsive behaviors, inability to make decisions, difficulty planning may arise from a history of complex trauma

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Impact of Complex TraumaLook for sleep disturbances, self destructive behavior, eating disordersConsider that lack of boundaries and oppositional behavior may arise from complex traumaObserve and note any behaviors that may reflect the child acting out what they have experienced

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Impact of Complex TraumaNote the child may misread other’s emotional states, expression of emotions or intent.Be aware that children may not have appropriate body image and may experience shame and guilt.Recognize that children may express themselves through behavior when they cannot communicate their wants and needs.

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Impact of Complex TraumaNote any lack of curiosity, lack of ability to process language, and any inability to complete tasks.Recognize that the child may experience impaired memory as a way of coping with extreme abuse.21Slide22

Long Term ImpactImpairs the ability to learnImpairs physical health and growthImpairs the ability to have happy, healthy relationships as an adultPlants the seeds for mental illness, substance abuse and violence

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Trauma Informed CareWere services provided specific to the child’s needs by someone who is trained to provide trauma informed care? Ask for trauma informed cognitive behavioral therapy, child parent psychotherapy, parent and child interactional therapy, eye movement desensitization and reprocessing, and other evidence based therapies designed to address trauma.

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Trauma Informed CareAsk for consistency in the child’s life with placement, education, day care, medical care and counseling.Foster care and the legal system may further contribute to complex trauma with frequent moves, changes in school and day care, and constant introduction of strangers to provide medical and psychological care.

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Trauma Informed CareIs the child engaged with his or her counselor? If there is no rapport, there is not likely to be any trust or any progress.Are appointments kept on a consistent basis by the child’s caretaker and the counselor?Does the child have sufficient contact with parents, siblings and other significant persons in the child’s life to have the child’s emotional needs met?

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Trauma Informed CareCan the child self regulate?Does the child act out rather than express emotions?What is being done to teach the child to self regulate? To express emotions?Does the child’s caretaker have the skills to assist the child with regulation of behavior and expression of emotions?

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Trauma Informed CareIs the caretaker nurturing of the child?Does the caretaker give the child feedback?Can the child use the feedback to incorporate change?Does the caretaker encourage the child and support the child in expressing emotions?Does the child feel that the Court and others know what the child wants?

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Trauma Informed CareDoes the child have opportunities to interact with peers and expand social capacities through peer activities?Does the child have the capacity to make friends and be a friend?Are there age specific services that provide additional support?

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Trauma Informed CareDoes the child have any health problems?Is there any family history of health problems that should be considered?Does the child have physical activity on a regular basis?Does the child have the opportunity for spiritual development?

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Trauma Informed CareAre the caseworkers across agencies communicating to form a case plan consistent across agencies?Is the child progressing in school?Does the child have adequate support for school? Supplies, tutoring, engagement?

Does the child have hopes, dreams, aspirations for the future? Three wishes30Slide31

Trauma Informed CourtWhat is it?What makes a court different than other systems serving children and families in any discipline?The Court is an adversarial system by its very nature.What else?

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The Troup County ProjectA joint project of the Court, the Community, Casey Family Programs and the Barton Child Law and Policy Center at the Emory University School of LawCalled a “Trauma Responsive Court”, but “Court” includes all stakeholders and the community at large

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Trauma Responsive CourtVision Statement For a court and the community within which it operates to work together to minimize trauma and the effects of trauma experienced by its children, adults, and families.

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The Troup County Juvenile Court and other  community members  will work together to prevent , minimize , detect, respond to, and mitigate the impact of trauma exposures and experiences to and  by its children, adults and families, and to meet the needs of those affected by trauma timely, appropriately and effectively.MISSION STATEMENT

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CreditsNational Child Traumatic Stress NetworkCasey Family ProgramsNational Council of Juvenile and Family Court JudgesChadwick Center for Children & FamiliesMassachusetts Advocates for Children in collaboration with Harvard Law School and the Task Force on Children Affected by Domestic Violence

Presentations by the Honorable Peggy Walker35Slide36

Learn MoreAdverse Childhood Experiences Study; www.cdc.gov/ace/index.htm Center for the Developing Child; www.developingchild.harvard.edu

Child Trauma Academy; www.childtrauma.org National Child Traumatic Stress Network; www.nctsn.org Zero To Three; www.zerotothree.org National Council of Juvenile and Family Court Judges; www.ncjfcj.org Justice For Children; www.complextrauma.us36Slide37

The kids we serve.Their belongings in a bag, their hearts on a sleeve, or tucked securely away.

Their futures not their own, but held in the hands of those who do not know them.Their worlds asunder; insecurity and mistrust their constant companions.They come to us looking for answers, for understanding, for hope, for resolution.What we give them will determine who they are and who they will forever be.Equally as important, what they become because of their having passed our way, will define our lives and our place in history. RMK September 24, 200537