Understanding and Addressing Trauma
within Systems:
Key Issues and Ways to Support TraumaInformed Practices
Cassandra Kisiel, Ph.D.
Center for Child Trauma Assessment and Service Planning
Northwestern University Feinberg School of Medicine
The National Child Traumatic Stress Network (NCTSN)
www.nctsn.org
• Mission: To raise the standard of care and increase access to services for
traumatized children and their families across the US
• Established by Congress in 2000
• National collaboration of multiple academic and community-based service
centers
• Serves as a national resource for disseminating evidence-based
interventions, trauma-informed services, and public and professional
education
• Emphasis on transforming trauma-focused services throughout childserving systems of care across the U.S.
• Currently comprised of 176 member centers - including 79 currently
funded Centers and 98 affiliate members
Prevalence and Impact of Trauma
• More than 67% of children/adolescents experience at least one
potentially traumatic event before the age of 16.
• 4 out of 10 U.S. children report witnessing violence; 8% report a lifetime
prevalence of sexual assault; 17% report being physically assaulted.
• The majority of traumatized children experience multiple, co-occurring,
and often chronic forms of trauma or adverse experiences.
• More than 60% of American males and 51% of females report lifetime
exposure to one or more traumatic events; about 1 in 3 women will
experience sexual assault in their lifetime.
• Trauma impacts a broad range of areas for youth and adults: emotional,
behavioral, interpersonal, physiological, and cognitive functioning.
• Chronic interpersonal trauma in childhood has a differential impact on
adults compared to acute or interpersonal traumas in adulthood.
• Strengths have an important role in buffering the effects of trauma.
A Common Theme for Systems
Education
Child Welfare
Trauma
Mental and Physical
Health
Juvenile
Justice
Substance
Abuse
The Impact of Trauma within Systems
• Rates of maltreatment are significantly higher in juvenile
detention and child welfare than in the general population.
• Many youth and adults with trauma histories and current
symptoms are never assessed or fully assessed.
• Many youth with trauma symptoms never receive appropriate
treatment.
• Children and adults in both systems are sometimes “blamed”
or labeled as “bad” = potential stigma
• Both systems are largely comprised of already oppressed
individuals who are often exposed to several other ongoing
stressors.
50
45
Significant Traumatic Experiences for Youth
entering Illinois Child Welfare (N=16,474)
40
35
30
25
20
15
10
5
0
Based on Kisiel et al. (2009). J Child and Adoles Trauma, 2:143-160
Complexly Traumatized Youth Entering IL Child Welfare
Frequency of Significant Clinical Needs (N = 16,474)
Single/Non-CG Trauma
25
Complex Trauma
20
15
10
5
0
*Complex Trauma Exposure =
2 or more significant caregiver
traumas on the CANS
All differences sig. at p=.000
Based on Kisiel et al. (2009). JCAT, 2:143160
Placement Disruptions by Type of Trauma Exposure:
Two Years Following Entry into CW System (N=14, 264)
26%
15%
5%
Single Type (Violent)
Single Type (Non-Violent)**
Illinois child welfare system, Incident Rate Ratios, **=p<.001
Kisiel et al., 2012
Multiple/Complex
Trauma**
Children’s Posttraumatic Reactions:
Risk for Misdiagnosis and Mislabeling
Children presenting with posttraumatic symptoms are at risk of
being misdiagnosed with a variety of disorders and functional
difficulties particularly when a trauma assessment is not conducted
 ADHD
 Depressive Disorders
 Oppositional Defiant Disorder
 Conduct Disorder
 Reactive Attachment Disorder
 Psychotic Disorders
 Specific Phobias
 Learning/ academic difficulties
 Juvenile Delinquency
Challenges in the Assessment of Trauma Responses and
within Service Systems- Misunderstood or Mislabeled?
Willful
defiance/noncompliance
Intensely
Reactive
behaviors/
Sexually
aggressive
behaviors
Psychotic
Symptoms
Trauma:
A Missing
Link?
Conduct
Disorder/
‘Sociopathic’
behaviors
Problems
with
Attention
and
Learning
What is a Trauma-Informed Service System?
• All programs/providers involved in a particular system
recognize and respond to the impact of traumatic stress
on all those who have contact with their system.
• Programs and agencies within this system infuse and
sustain trauma awareness, knowledge and skills to their
organizational cultures, practices and policies
• Programs and agencies act in collaboration with all those
involved (using best available evidence) to facilitate and
support resiliency of the child/adult and family.
www.nctsn.org
Trauma-Informed Practice
The trauma-informed professional:
• Understands the impact of trauma on a child or
adult’s behavior, development, relationships, and
survival strategies
• Can integrate that understanding into planning for
the child, adult, and family
• Understands his or her role in responding to child
traumatic stress
NCTSN Child Welfare Trauma
Training Toolkit, 2008
Resilience
“The
process of, the capacity for, or outcome of
successful adaptation despite challenging or
threatening circumstances.”
(Masten, Best, & Garmezy, 1990)
Protective Factors
Protective factors can:
1. Buffer individuals from exposure to additional
traumas or adversities
2. Increase the likelihood of positive outcomes
following exposure to trauma.
Individual Factors
Protective Factors or
Factors Promoting Resilience
 Developmental Competencies
(language, cognitive skills)
 Personality and temperament
 Positive Beliefs/Self-efficacy
 Internal Locus of Control
 External Attributions for Blame
 Special Talents/Creativity
 Spirituality/Meaning-Making
Environmental Factors
 Ongoing Social Support –
within and outside of family
 Secure Attachments –Positive
attachment with emotionally
supportive adult
 Family Cohesion/Ties to
Extended Family
 Community Involvement
(recreational, religious)
What can I D0 in my work?
Helping to Support TraumaInformed Practices across
Settings
General Guidelines and Implications for Practice:
How to Support Staff, Youth, and Caregivers
• Recognize that exposure to trauma is often the rule, not the
exception, among youth and adults in child welfare and
justice settings.
• Recognize the cumulative effects of trauma – the range of
signs and symptoms stress and how they vary across
different age groups.
• Recognize that an individual’s “bad” behavior is sometimes
an adaptation to trauma or a result of them not having
developed age-appropriate regulation capabilities.
Utilizing a Trauma-informed Perspective:
Practical Recommendations (www.nctsn.org)
1. Routinely screen for trauma exposure and related symptoms
2. Conduct a comprehensive assessment – gathering information on all
traumas and range of reactions to make better-informed decisions.
3. Integrate culturally appropriate and responsive evidence-based practices
4. Engage in efforts to strengthen the resilience and protective factors of
children/families and adults impacted by trauma
5. Address parent trauma and its impact on the family system
6. Enhance communication/share resources with youth, adults, and
providers on trauma exposure, its impact and treatment
7. Promote effective family involvement in counseling/rehab services.
8. Emphasize continuity of care and collaboration and training for ALL
relevant professionals across child or adult service systems
9. Maintain an environment of care that addresses and minimizes
secondary trauma and increases staff resilience
Promoting resilience and building competence in
the context of treatment and services
• Strengthen ties to other adult/community
resources
• Teach flexible problem-solving skills
– Communication skills
– Self-help skills
• Foster independence and responsibility
• Strengthen and support individual
competencies
• Model/reward acts of cooperation and
helpfulness
June is National PTSD Awareness Month
Why take time to learn about PTSD?
• Because taking the step to help someone you care about (even
yourself), or your clients, starts with knowing the basics.
• No matter how much you already know about PTSD and trauma
responses, there is always more to learn.
• Initial step - connect with materials to help you learn more
about PTSD, including the latest research and tools to manage
symptoms
See www.ptsd.va.gov for more information
Provider Resources in Illinois:
Statewide Provider Database (SPD) –
https://illinoisoutcomes.dcfs.illinois.gov
• Program Type
–
–
–
–
–
–
–
Mental Health
Substance Abuse
Domestic Violence
Parenting
Non-clinical
Early Childhood
General Medical
• Target Population
– Deaf/hard-of-hearing
– Developmentally
disabled
– Young Children
– Teen parents
– Sexual offenders
– Trauma survivors
– GLBTQ
– Foster care
Information and Resources on Addressing Trauma:
Helpful Organizations and Websites
• National Child Traumatic Stress Network: www.nctsn.org (child)
• National Center for PTSD: www.ptsd.va.gov (adult)
• International Society for Traumatic Stress Studies: www.istss.org
• American Professional Society on the Abuse of Children
www.apsac.org
• International Society for the Prevention of Child Abuse and
Neglect www.ispcan.org
• Illinois Statewide Provider Database
https://illinoisoutcomes.dcfs.illinois.gov
•
Thank You!
Contact Information:
Cassandra Kisiel, Ph.D.
c-kisiel@northwestern.edu