Taking a Trauma First Approach in Policy,
Programs, and Practice
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
Interpersonal Trauma
“[Complex trauma – also referred to as “developmental trauma disorder”
or “chronic interpersonal trauma”] refers to children’s experiences of multiple
traumatic events that occur within the caregiving system – the
social environment that is supposed to be the source of safety and stability in a
child’s life. Typically, complex trauma exposure refers to the simultaneous
or sequential occurrences of child maltreatment—including
emotional abuse and neglect, sexual abuse, physical abuse, and witnessing
domestic violence—that are chronic and begin in early childhood.
Moreover, the initial traumatic experiences (e.g., parental neglect and emotional
abuse) and the resulting emotional dysregulation, loss of a safe base, loss of
direction, and inability to detect or respond to danger cues, often lead to
subsequent trauma exposure (e.g., physical and sexual abuse, or
community violence).”
Southerland, D; Casaneuva, CE; & Ringeisen, H. (2009). Young adult outcomes and mental health problems among transition age youth investigated for
maltreatment during adolescence. Children and Youth Services Review. 31(9):947.
September 21, 2012
ATTACh Conference
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Impact of Trauma on Healthy
Development
September 21, 2012
Abusive or Neglectful
Parenting
Insecure Attachments,
Emotional
Dysregulation, Negative
Internal Working
Models
Poor Social-Emotional
Functioning,
Disturbed/Negative
Relationships
Maladaptive Coping
Strategies
Psychological Distress
Poor Adult
Functioning/Outcomes
ATTACh Conference
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Maltreatment Impacts How Youth
Form Relationships with Adults
• Child maltreatment represents an extreme form of child–parent
relationship disruption (Harden, 2004; Milan & Pinderhughes, 2000).
• Child maltreatment can be defined as a chronic interpersonal
trauma, to which the child is exposed on a daily basis(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 (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).
Apr. 2, 2012
Ntl. Forum on Youth Violence Prevention
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Relational Functioning as Well-being?
Correlates of Resilience to Adult Psychopathology
Stable relationship history
53%
Quality adult friendships
44%
Supportive first intimate partner
40%
62%
Caring relationship w/ either parent
Normal peer relationships
53%
Age at onset of abuse (<10 years)
25%
Duration of abuse (>1 year)
20%
Sexual or Severe Physical abuse
11%
0%
10%
20%
30%
40%
50%
60%
70%
Collishaw, S; Pickles, A; Messer, J; Rutter, M; Shearer, C & Maughan, B. (2007). Resilience to adult psychopathology following childhood maltreatment: Evidence from a community
sample. Child Abuse and Neglect. 31:211.
Apr. 2, 2012
Ntl. Forum on Youth Violence Prevention
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Relationships as Protective Factors
ISLE OF WIGHT STUDY
• Study showed child abuse is linked with difficulties in interpersonal
relationships.
• Adolescent psychiatric difficulties showed strong continuity of difficulties
into adulthood.
• However, 45% of abused individuals reported no mental health problems
in adult life.
• Half of those reporting abuse in adulthood had been rated as showing
significant abnormalities in interactions with peers in adolescence.
• At the same time, peer relationships in adolescence emerged as one of the
strongest predictors of no mental health problems in adult life.
• Some individuals in the abused resilient group showed evidence of isolated
difficulties, but rates of difficulties were lower than for the rested of abused
group.
Collishaw, S; Pickles, A; Messer, J; Rutter, M; Shearer, C & Maughan, B. (2007). Resilience to adult psychopathology following childhood maltreatment: Evidence from a community
sample. Child Abuse and Neglect. 31:211.
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September 21, 2012
ATTACh Conference
“DSM-IV psychiatric disorder connects with relationship
functioning domains: high parental care; normal adolescent
peer relationships; good adult friendships; supportive first
partner, stable relationship history).”
Rate of Adult Psychiatric Disorder
100%
90%
Abuse
80%
No Abuse
70%
60%
50%
40%
30%
20%
10%
0%
1
2
3
4
Number of Domains of Successful Relationship Functioning
Collishaw, S; Pickles, A; Messer, J; Rutter, M; Shearer, C & Maughan, B. (2007). Resilience to adult psychopathology following childhood maltreatment: Evidence from a community
sample. Child Abuse and Neglect. 31:211.
September 21, 2012
ATTACh Conference
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Relationships as Protective Factors
ISLE OF WIGHT STUDY
• Study supports view:
– impairments in interpersonal relationships are of crucial
importance for understanding the effects of child abuse on mental
health outcomes.
– positive relationships should not be seen as good fortune arising
from chance encounters with a supportive friend, peer or partner,
but rather as an ongoing process of developing the competencies
necessary to form, maintain and benefit from supportive interpersonal
relationships.
– individuals with good relationship experiences across different
domains and across childhood, adolescence and adulthood who were
particularly likely to demonstrate healthy adult outcomes.
– understanding the processes whereby relationship competencies
are developed and maintained constitutes an important goal for
future research and target for clinical interventions.
September 21, 2012
ATTACh Conference
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Older Youth Entry into Foster Care - 2011
84,518 out of 252,320 Entries are Adolescents
11 Years
8,118
9,141
12 Years
10,741
13 Years
13,132
14 Years
15,878
15 Years
16,288
16 Years
11,220
17 Years
Data Source: Adoption and Foster Care Analysis and Reporting System (AFCARS), U.S. Department of Health and Human Services
September 21, 2012
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“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.edu
December 9, 2011
ZERO TO THREE National Training Institute
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Programmatic Elements of TraumaFirst Approach
Addressing
secondary trauma
Build capacity to
deliver EBPs;
contract for
externallydelivered EBPs
Traumainformed
screening and
mental health
assessment
Knowledge
building for staff
and foster
parents
Developmentally
specific approach
September 21, 2012
TraumaFirst Child
Welfare
Approach
ATTACh Conference
Cross-system
partnerships and
collaboration
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Practice Elements of Trauma-First
Approach
Promotion of healthy
relationships
Monitor progress for
reduced symptoms and
improved child/youth
functioning
Focusing on child- and
family-level outcomes
(as opposed to process
outcomes alone)
September 21, 2012
Proactive approach to
addressing social and
emotional needs
TraumaFirst Child
Welfare
Approach
ATTACh Conference
Trauma-informed case
planning and
management
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Multi-Level Strategy to Address Trauma and
Promote Well-Being
Policy
Program
Practice
Promoting Safe and Stable
Families – Trauma
Screening and Treatment
FOA: Screening,
Assessment, and Services
Array
Permanency Innovations
Initiative – Illinois
Information Memoranda:
Well-Being, Psychotropics,
CQI
FOA: Regional Partnership
Grants
Collaboration with
SAMHSA
IM: Title IV-E Child Welfare
Waiver Demonstration
Projects
Protective Factors across
Populations
Waiver Demonstrations in
6 States
CMS: Early and Periodic
Screening, Diagnosis, and
Treatment
Ending Youth
Homelessness (USICH)
FOA: Integrating Trauma
into Child Welfare Services
Workforce
USAID
FOA: Supportive Housing
and Child Welfare
Neuroscience and Child
Maltreatment
September 21, 2012
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Feeling safe and
stable in the
living
environment
Able to manage
emotions and
regain
equilibrium
when upset
Belonging and
social
connectedness
(permanency)
WELLBEING
Able to sustain
positive
interpersonal
relationships
Self-efficacy
based on
developing
competencies
Adapted from Impact Youth Services, 2011;
http://impactyouthservices.com/goals.htm
Has a positive
self image
September 21, 2012
A More
Complete
Picture of
WellBeing
ACYF-CB-IM-12-04:
http://www.acf.hhs.gov/programs/cb/laws_p
olicies/policy/im/2012/im1204.pdf
ATTACh Conference
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