Advancing Trauma-Informed Care
in Child Welfare Practice
Today’s Presenters:
Jennifer Marple, MSSA, LISW
– Lorain County Children Services
– Continuous Quality Improvement Manager
Mark R. Groner, MSSA, LISW-S
– Beech Brook
– Vice President of Clinical Services & Clinical Director
Kathryn Biddle, MSSA, LISW-S
– Beech Brook
– Assistant Vice President of Clinical Services
– Program Leader for Center of Excellence for
Trauma-Informed Care
Lorain County Children Services
Mission Statement:
In partnership with the community, the
staff, foster parents and volunteers of
Lorain County Children Services are
committed to the safety and wellbeing of abused, neglected, and
dependent children and will provide
the highest quality protection,
permanency, and prevention services
for children and families.
Mission Statement:
To advance the emotional well-being and
self-sufficiency of children, youth, and
families by providing effective, innovative
behavioral health, permanency,
educational and related services, and by
serving as a strong voice for children,
youth and families.
Other Key Stakeholders
• Lorain County Mental
Health Board
• Lorain County Child
Advocacy Center
• Other Provider
Agencies
• Consumers
• Nord Family
Foundation
History of the Project
• Unfunded Federal Grant co-authored by Lorain County
Integrated Partnership, Lorain County Children
Services, Lorain County Mental Health Board and
Beech Brook
• Successful Application for a Local Grant of a scaleddown project awarded in March, 2012, with
implementation planning started immediately
• Expansion to other child- and family-serving systems
envisioned
Community Context
National Council of Community Behavioral
Healthcare’s Trauma-Informed Care
Learning Community
• Lorain County Children Services is a
current participant in this year’s learning
community
• Beech Brook participated last year
– Shared vision for trauma informed care
– Shared strategies for Continuous
Performance Improvement
– Shared language
Consideration: This is a change
process!
• Change often starts with
denial
• Resistance typically follows
• Aim is to achieve
adaptation, meaning
employees develop an
understanding of the
change and reflect a
positive perception about it
– Process involves mourning
that which is lost from the
past, bringing only the best of
the past forward, all the while
fully embracing the “new”
Goal of the Nord-Funded Initiative
Promotion of trauma-informed child welfare service
delivery for:
• Enhanced child safety
• Permanency,
• Child well-being (i.e., CFSR outcomes)
• Through trauma-informed care principles,
practices, and approach.
What is trauma-informed care
child welfare practice?
• Child welfare professionals are educated about:
– The impact of trauma on the development and behavior of
children
– When and how to intervene directly in a trauma-sensitive
manner and to make strategic referrals to trauma-informed
mental health practices, when indicated
– The importance of access to timely, quality, and effective
trauma-focused interventions and case planning process that
supports resilience in long-term healing and recovery
• Aim is to improve upon Child and Family Services
Review goals of: child safety, permanency, and child
well-being
Key Principles
1.
Trauma awareness: This includes establishing a philosophical shift, with
the overall system taking a different perspective on the meaning of
symptoms and behaviors. Staff training, consultation and supervision are
important aspects of organizational change to incorporate trauma
awareness. Practices should include changes, such as screening for
trauma history, facilitating access to trauma specific services, and
promotion of staff self care.
2.
Emphasis on Safety: Because trauma survivors are often sensitized to
potential danger, trauma informed services work towards building physical
and emotional safety for consumers and providers. The system should be
aware of potential triggers and strive to avoid retraumatization. Emphasis
on appropriate boundaries, Privacy, confidentiality and mutual respect are
important in developing emotional safe environment. Diversity is
accepted and respected.
Key Principles
3. Opportunities to rebuild control and empower: Because control is often
taken away in traumatic situations, trauma-informed service settings emphasize
the importance of choice and empowerment of consumers. Predictable
environments that allow consumers a sense of efficacy and personal control
over their lives are essential. Consumers are involved actively in the design and
evaluation of services.
4. Strengths based-approach: Trauma-informed care is strength based as
opposed to punitive. Consumers are assisted in identifying their own strengths
and developing coping skills. Trauma-informed systems are future-focused, and
utilize skill building to advance resiliency.
Major Project Components
• Training on Trauma
• Development of a System to Screen for Trauma
on Child Welfare Cases and a Referral Process
• Case Consultation on Concerning Cases
• Support to Staff Exposed to Secondary Trauma
Component 1: Trauma Training
• Half-Day
ACE and Complex Trauma
Workshop for All Lorain
County Children Services
staff
• Two-Day Child Welfare
Trauma Toolkit Training
for Direct Care Staff and their
Supervisors
ACE and Complex Trauma
Exercises
NCTSN Trauma Toolkit
Exercises
Program Component 2: Screening
and Referral
• Installation of screening system using the Child Events Trust Survey to
identify children and adolescents adversely impacted by trauma
Use of results to:
• Inform case planning
• Improve making appropriate referrals to community-based mental health
services
• Targeting with the best trauma-informed evidence-based practices
Childhood Trust Events Survey
(CTES)
• 26-Item survey for assessing
exposure to traumatic events
• Children age 8 and older
complete the Child and
Adolescent Version
• The Caregiver Version is
completed for children younger
than age 8
• English and Spanish versions
Referrals for Trauma-Informed
Care
Evidence-Based
Model
Agency Provider(s)
Caring for Children Who
Have Experienced Trauma
Beech Brook, Bellefaire JCB
Parent-Child Interaction
Therapy (PCIT)
Firelands
Trauma-Focused CBT ‘(TFCBT)
Applewood, Beech Brook, Bellefaire JCB,
Firelands, Guidestone, Nord Center
Alternatives for Families
CBT (AF-CBT)
Beech Brook
Trauma-Grief Component
Therapy for Adolescents
Beech Brook
Child-Parent Psychotherapy Guidestone
(CPP)
Program Component 3:
Case Consultation on Youth with Trauma
• Scheduled every week for an hour
independent of other meetings
• Scheduled as part of routine unit meetings
• Case Example: Karla
Program Component 4:
Attention to Secondary (Vicarious) Trauma
• Training on importance of reaching out for support
• Availability of outside help upon request
• Use of UIR system to identify employees exposed to
vicarious trauma and reaching out to them
• Advancing the existing organizational climate of mutual
support
Desired Outcomes
• LCCS staff members will deepen their
knowledge of trauma-informed child welfare
practice
• LCCS’s ability to indentify trauma in children will
increase
• LCC’s traumatized children will be referred to
trauma-informed mental health treatments in the
community
• LCCS staff members impacted by vicarious
trauma will be supported
• Long-term, the percentage of children
experiencing safety, permanency, and wellbeing will improve
Results to Date:
Achievements
•
Training on trauma, complex trauma, and trauma-informed child welfare
and mental health practices has been provided and received favorably
•
A screening process and protocol have been created, and staff members
have been trained on them, including use of the Child Trust Events Survey
•
Case consultations have occurred and used to facilitate appropriate case
planning and referrals
•
Attention to vicarious trauma has begun
•
Baseline data has been collected on the Professional Quality of Life Scale,
a tool that measures compassion satisfaction and compassion fatigue (i.e.,
burnout and secondary traumatic stress)
•
Project activities have been supported by several teams (i.e., an Advisory
Team, a Screening Team, and a Training Team) not envisioned in the
original grant.
Results to Date: Key Challenges
• Because of the pace, not all child
welfare workers have had the
opportunity to participate in the
NCTSN Trauma Toolkit Training
• State-mandated requirements make
it hard for child welfare workers to
find time to screen for trauma and
attend case consultations
• Self-referral for attention to
secondary trauma is slow to occur
Lessons Learned
• Staff from all levels of agency need to be included in
introducing this model
~ Need finger on the pulse of staff concerns with
agenda like introducing more assessments or training
• Vicarious trauma: a) will be present from before, b)
needs to be taken into consideration at the start, and c)
needs to be openly addressed
• Must recognize context and pressures with which staff
members are coping in order to elicit genuine
engagement
~ Case gone bad with media coverage