Agenda

1
Agenda
830 Registration Angela Rodgers 900 Introduct
ions/Project Overview Meeting Objectives Acknowl
edgements 915 Understanding Emotional
Trauma Angela Rodgers Parent Story Ian
Finch 1015 Break 1030 Biology of Trauma Ally
Jamieson 1115 Policy, Practice and Trauma Linda
Bello 1200 Lunch 1245 Facilitated Group
Discussion Katharine Cahn 230 Concluding
Thoughts Group
2
T.I.P.S.Trauma Informed Practice Strategies

• Understanding and Minimizing the Trauma to
  Children during Child Abuse Investigations and
  Out-of-home Placements

3
Project Objectives

• Define and understand the nature of the trauma to
  children associated with investigation of abuse
  and neglect and initial out-of-home placement.
• Identify effective practices for reducing the
  trauma to children during these events.
• Facilitate collaboration between the various
  systems to create a plan of action to provide
  information, education and training to implement
  effective practices.
• Disseminate this information to members of the
  various systems involved in investigation and
  placement through training, education, or other
  strategies to be identified.

4
Todays Objectives Overview

• Present our ideas for curriculum components and
  examples of materials available for full
  development of a curriculum.
• Get your feedback
• Plan for next steps
• Curriculum development (one or several?)
• Dessemination, training in the various
  professional systems

5
Acknowledgements

• National Child Traumatic Stress Network
• Child Welfare Committee
• Kids, Cops and Domestic Violence
• Website www.nctsn.org
• Local NCTSN Task Force led by Leslie Brown at the
  Childrens Relief Nursery
• Zero to Three National Center www.zerotothree.org
• DHS Child Welfare Policies and Procedure Manual
• Focus Group and Interview Participants
• Caseworkers, tribal workers, foster parents,
  educators school counselors, police officers,
  child welfare trainers, CARES NW doctors,
  juvenile court staff, mental health providers,
  Foster Club All Stars
• Many experts, researchers and authors in the area
  of child welfare and child traumatic stress
• California State Library, California Research
  Bureau
• Arizona Behavioral Health Services Division of
  Children, Youth Families

6
Statistics

• 60,746 calls in 2006 (10.2 increase from 2005)
• 20 from police
• 17 from schools
• 10 from medical
• 28 from other mandated reporters
• 20 from nonmandated reporters
• 5 from parents
• 25,606 referred for investigation
• (Status of the Children, 2006)

7
Statistics (cont)

• 12,043 validated child abuse victims
• (7 increase from 2005)
• 28.6 physical abuse
• 20.2 neglect
• 14 sexual abuse
• 8.9 mental injury
• 3.5 threat of harm
• 5,294 children entered foster care

8
Systems Involved in Investigation, Removal and
Placement

• Child Welfare
• Law Enforcement
• Courts
• Tribes
• Foster Care

• Education
• Medical
• Mental Health
• Parents

9
Understanding Trauma and Its Effects on Children

• Angela Rodgers

10
What Is Emotional Trauma?

• An experience of perceived threat, harm or
  danger in which a person is overwhelmed beyond
  their coping resources.

Childs drawing from Darfur
11
What is Child Traumatic Stress?

• Child traumatic stress refers to the physical and
  emotional responses of a child to events that
  threaten the life, safety, or physical integrity
  of the child or of someone critically important
  to the child (such as a parent or sibling).
• Traumatic events overwhelm a childs capacity to
  cope and elicit feelings of terror,
  powerlessness, and out-of-control physiological
  arousal.

12
What is Child Traumatic Stress?

• A childs response to a traumatic event may have
  a profound effect on his or her perception of
  self, the world, and the future.
• More in handouts

13
Types of Emotional Trauma

• Acute trauma
• Chronic trauma
• Complex trauma

14
Types of Trauma

• Acute trauma is a single traumatic event that is
  limited in time.
• Children go through a variety of feelings,
  thoughts, and physical reactions that are
  frightening in and of themselves and contribute
  to a sense of being overwhelmed.

15
Types of Trauma

• Chronic trauma refers to the experience of
  multiple traumatic events.
• Events may be varied (e.g., domestic violence,
  serious car accident, community violence) or
  longstanding, such as physical abuse, neglect, or
  war.
• The effects of chronic trauma are often
  cumulative, as each event serves to remind the
  child of prior trauma and reinforce its negative
  impact.

16
Chronic Trauma
Drawing by a 4-year-old physically-abused boy 
The large image is his father and he is the
mouth-less face in the upper left hand corner.
17
Types of Trauma

• Complex Trauma involves multiple or prolonged
  traumatic events, is chronic, usually caused by
  adults entrusted with the childs care, and
  begins in early childhood.
• It results in emotional dysregulation, loss of
  safety, direction, and the ability to detect or
  respond to danger cues.
• More info in handouts

18
The Experience of Trauma for Children of
Different Ages

• What a traumatic situation is like for a Young
  Child
• What a traumatic situation is like for a
  School-age Child
• What a traumatic situation is like for an
  Adolescent
• (See handout)

19
Variability in Responses to Traumatic Events

• The impact of a potentially traumatic event is
  determined by both
• The objective nature of the event
• The childs subjective response to it
• Something that is traumatic for one child may not
  be traumatic for another.

19
20
Variability (cont)

• The impact of traumatic events depends on
• Age and developmental stage
• Perception of the danger faced
• Being a victim or witness
• Relationship to the victim or perpetrator
• Past experience with trauma
• Adversities faced following the trauma
• The presence/availability of adults who can offer
  help and protection

21
Audio Clip Lisas 9-1-1 Call

• Preparation
• Note while youre listening
• Her changing emotions as the threat changes
• Her efforts to regulate her emotions
• What was going on internally, in her brain, her
  body, her thoughts and fears
• How your own bodies and minds were reacting to
  the audio even knowing that you were not
  threatened, it happened long ago, and no one was
  seriously injured

22
Effects of Complex Trauma
A childhood laced with abuse, neglect, and/or
on-going, different, and unpredictable placements
is primed for complex trauma symptomology.
23
Effects of Trauma on Children

• Trauma can affect many areas of development and
  functioning
• Attachment
• Biology
• Mood Regulation
• Cognition Learning
• Behavioral Control
• Dissociation
• Self-Concept/Identity
• See Handout

24
Traumatic Stress Child Welfare

• Data from the Child Abuse and Neglect System
  (CANS)

25
Trauma Experiences When Entering Child Welfare
26
Traumatic Stress Symptoms When Entering Child
Welfare
27
Emotional/Behavioral Needs When Entering Child
Welfare
28
Summary of Major Findings

• See handout for
• Significant Group Effects in
• Childhood(6-12 years old)
• Early to Middle Adolescence (12-15 years)
• Late Adolescence to Early Adulthood (16-23
  years)
• Also see handout The Incidence and Impact of
  Trauma on Children in the Child Welfare System
  (From Child Welfare Trauma Training Toolkit)

29
Long-Term Effects of Childhood Trauma

• Lack of positive coping strategies may engage in
  high-risk or destructive coping behaviors.
• These behaviors place them at risk for a range of
  serious mental and physical health problems,
  including
• Alcoholism
• Drug abuse
• Depression
• Suicide attempts
• Sexually transmitted diseases
• Heart disease, cancer, chronic lung disease,
  skeletal fractures, and liver disease
• More in Handouts
• 
  

29
Source Felitti et al. (1998). Am J Prev
Med14(4)245-258.
30
Trauma and the Brain

• Trauma can have serious consequences for the
  normal development of childrens brains, brain
  chemistry, and nervous system.
• The biological stress of trauma can adversely
  effect brain development, cognitive and academic
  skills, and language acquisition.
• Changes in the levels of stress hormones in
  traumatized children and adolescents are similar
  to those seen in combat veterans.
• See handouts for more info

1. Pynoos et al. (1997). Ann N Y Acad
Sci821176-193
30
31
Influence of Culture on Trauma

• Social and cultural realities strongly influence
  children's risk for, and experience of trauma
• Many children who enter the child welfare system
  are from groups that experience discrimination,
  negative stereotyping, poverty, and high rates of
  exposure to community violence.
• The background of those who interact with these
  children can influence their perception of child
  trauma and how to intervene.
• Some components of trauma response are common
  across diverse cultural backgrounds, Other
  components vary by culture. (E.g., shame)
• See handouts for more info

32
The Trauma of Investigation, Removal Placement

• Seeing parents distressed, arrested
• Surprise, shock, chaos (e.g. drug bust)
• Separation and loss of parent/caregiver
• Powerlessness, helplessness
• Sense of guilt or responsibility for not
  protecting parents or siblings, or its my fault
• Fear of the unknown
• Loss of all things familiar - places (school,
  home, neighborhood), people (friends, siblings),
  pets, routines, possessions/comfort objects
• Summary of Focus Group Data

33
Ians Story
34
Reflection What is the relevance and
applicability of this to your work?
35
Physiology of the Brain

• Attachment Theory Neuroscience
• Ally Jamieson

36
The Human Brain Paper or Plastic?

• September 13, 1948 Phineas Gage. 13 lbs
• tampering iron blasted through his head in
• work accident.
• The rod had been propelled with such force
• that it was said to have landed some 80 feet
  
• away.
• Amazingly, Gage spoke within a few minutes,
• walked with little or no assistance, and sat
  
• upright in a cart for the 3/4-mile ride to
  town.
• Though physicians found him weak from
• hemorrhage, he had a regular pulse of about
• 60 and was alert and coherent.

37
Traumatology Affects of Trauma on the Brain
38
How fast do our brains think?

• A human being has about 100 billion brain cells.
• It is estimated that a neuron can fire about 200
  times a second (once every 5 milliseconds).
• Each neuron connects to 1000 other neurons
• Brains total firing 20 million billion
  calculations per second.
• If we were to lay out each neuron in our brain,
  the distance in length would be approximately 2
  million miles!

39
Three Major Sections of the Brain
Limbic System
Prefrontal Cortex
Reptilian Brain
40
Prefrontal Cortex
Thoughts, problem-solving, planning,
organizing, time management, and contemplation,
among other things.
41
Limbic System

• Feeling emotions
• and emotional
• regulation.
• Works with prefrontal
• cortex and brain stem.

42
Brain Stem the Reptilian Brain

• Heart rate, breathing,
• blood pressure, appetite,
• temperature, etc.
• Integrates with emotions
• and thoughts to adjust
• internal responses
• Can make some internal
• states conscious (hunger,
• pain, fatigue, etc.)

43
What is a neuron?
Multiple Neuronetworks
Humans unable to replicate electric/chemical
transmission
Complete Neuron
Neuron connecting to neuron
Synapse between two neurons
44
Video Clip 1

• Helping Babies from the Bench
• Chapter 3
• Effects of Trauma on the Brain

45
Cells that fire together, wire together
Within this zone, a person can contain and
experience affects, sensations, and thoughts and
can process information effectivelywithout
disrupting the functioning of the system.
Ogden Minton (1999)
Poor tolerance for arousal is characteristic of
traumatized individuals. (Van der Kolk, 1987)
46
Neurotransmitters

• Chemicals that tell the brain what to think,
  feel, and do.
• Serotonin
• Dopamine
• Epinephrine
• (adrenalin)
• Norepinephrine
• Oxytocin

47
What is Cortisol and what does it do for us?

• Cortisol
• (stress hormone)
• Cortisol protects the body
• Proper glucose metabolism
• Regulation of blood pressure
• Insulin release for blood sugar maintenance
• Immune function
• Inflammatory response

• Can too much Cortisol harm the body?
• With extreme and consistently high stress
  levels, the body experiences
• Impaired memory and thought
• processes
• Widespread cell death
• Decreased developmental capacity
• Physical ailments such as
• Suppressed thyroid function
• Blood sugar imbalances
• Higher blood pressure
• Lowered immunity

48
Trauma Center The Mighty Amygdala
The amygdala houses all unconscious traumatic
memories and is where fight or flight is
decided. The amygdala signals the rest of the
body to respond through high levels of cortisol.
49
Strongest Memories Smell
Smell activates our neurons first, with the
olfactory bulb (smell processor) located at the
very front of the frontal lobe.
50
Left Brain Right Brain
Disconnection can result in unknown and
reactionary emotional states, depression and
anxiety disorders, and memory limitations (to
name a few).
Trauma or sustained high stress in childhood
damages the corpus callosum, which connects the
left brain from the right brain.
51
Brain Development

• Age Brain Weight (BW)
• Male (grams) BW
• Birth 380
• Age 1 970
• Age 2 1,120
• Age 3 1,270
• Age 10 -12 1,440
• Age 19 21 1,450

Female (grams) BW Birth 360 Age 1
940 Age 2 1,040 Age 3 1,090 Age
10 12 1,260 Age 19 21 1,310
(Data from Dekaban, A.S. and Sadowsky, D.,
Changes in brain weights during the span of human
life relation of brain weights to body heights
and body weights, Ann. Neurology, 4345-356,
1978)
52
Early Childhood Brain Development

• Children learn how to regulate emotional
  responses to people and life events through
  perception of caregivers behavior.
• Secure Attachments child is able to rely on
  caregiver to help regulate responses to stress
  over time, child learns how to self-regulate.
• Unsecure Attachments child not able to rely on
  caregiver due to inappropriate, inconsistent, or
  ineffective interactions from caregiver in
  severe cases, the child fails to develop
  self-regulating capabilities, such as
  self-soothing
• Prolonged exposure to stress hormones can
  conceivably change the physical structure of the
  brain, if it occurs during the critical period of
  development for that specific brain region
  (Schore, 1996).
• Halfon, N., Schulman, E., Hochstein, M. (2001).
  Brain Development in Early Childhood. UCLA Center
  for Healthier Children, Families and Communities

53
Trauma and the Developing Brain

• Healthy hippocampus
• Memory and learning

• Decreased hippocampal
• volume in traumatized brain

54
Nature Needs Nurture
Neurons that fire together wire together
Hebbs Hypothesis If you dont use it, youll
lose it. Every bilingual speaker youll
met The more we use neurons (thoughts, feelings)
the stronger their connections become.
If a neuron were a person hiking through a forest
and similar hikers followed suit, eventually a
noticeable path would form. If all of sudden no
one walked on that path, the forest would grow
over the path and it would eventually disappear.
55
Reflection What is the relevance and
applicability of this to your work?
56
Section 3Policies and Trauma Informed Practice
Strategies

• Linda Bello

57
Objectives

• Describe child welfare policies and procedures
  that influence child safety during child abuse
  investigations and initial placement into
  substitute care.
• Identify strategies that can be used by
  professionals that serve to lessen the traumatic
  impact of child abuse investigations and initial
  out-of-home placement of children.

58
Child Abuse Defined (ORS 419B.005)

• Assault or physical injury caused by other than
  accidental means
• Mental injury
• Rape
• Sexual abuse
• Sexual exploitation
• Negligent treatment or maltreatment
• Threatened harm
• Buying or selling
• Specific exposure to methamphetamine
  manufacturing
• Unlawful exposure to a controlled substance

59
Cross Reporting

• When a report of child abuse is received
• by DHS, DHS shall notify law
• enforcement within the county where the
• report was made.
• When a report of child abuse is received
• by law enforcement, law enforcement
• shall notify the local office of DHS within
  
• the county where the report was made.

60
County Multidisciplinary Child Abuse Teams (MDT)

• Law Enforcement
• DHS Child Protective Service
• School Officials
• County Health Department
• County Mental Health
• Child Abuse Intervention Center
• Juvenile Department
• Others

61
Determine the Response

• 24 hour response
• 5 day response

62

• Police have served a search warrant and find
  children living in a household where their
  parents are manufacturing methamphetamine.

24 hours?
5 days?
24 hours
63

• Parents have taken their toddler to the
  emergency room with head injuries and report the
  child fell off the couch. Medical staff report
  the explanation is not consistent with the injury
  and the injury is suspicious for child abuse.

24 hours?
5 days?
24 hours
64

• A child is reported to have been abused by a
  relative in a home they were visiting. The
  reporting party is the caregiver of the child who
  states they will not allow contact between the
  child and the alleged perpetrator until the
  allegations can be assessed by CPS.

24 hours?
5 days?
5 days
65
Child Welfare Assessment Placement Practices

• Assessment Protocols
• Placement Practice
• Visitation Procedures

66
CPS Assessment Initial Contact Protocols

• Determine if a safety threat exists
• Determine child vulnerability to the safety
  threat
• Determine if the parent can or cannot and will or
  will not protect
• Implement a protective action when child safety
  is at risk

67
Placement Practice

• Emergency certification
• Family Foster Care
• Placement Priorities
• Professional and Emergency Shelter Care
• Family Group Home Care
• Therapeutic Foster Care
• Psychiatric Residential Treatment

68
Assess the Childs Needs

• Safety
• What circumstances required out-of-home placement
  and how do they affect the child?
• Permanency
• Are there clear indications initially that the
  child will need permanent placement?
• Well-being
• Are there services available to meet the childs
  educational, mental health, and physical health
  needs?

69
Assess the Substitute Caregiver

• Does the caregiver have the ability to
• Provide safety for the child
• Support child welfares plan for the child
• Meet the childs physical, emotional, and
  educational needs

70
Visitation Procedures

• Schedule the first visit within a week
• Involve the parents, the substitute caregiver,
  the child and other relevant people in planning
  visits.
• Consider siblings

71
Cultural Considerations

• Determine and respond to ICWA status
• Determine and respond to refugee status
• The Multi-ethnic Placement Act

72
Elements of Effective Mental Health Counseling
Include

• Cognitive behavioral principles
• Education about the impact of trauma
• Help to re-establish a sense of safety
• Techniques for dealing with emotional reactions
• Opportunity to talk in a safe environment
• Involvement of parents in the healing process

73
Video Clip 2

• Helping Babies from the Bench Chapter 10
• Placement and Visitation Policy in Child Welfare

74

• T.I.P.S.Trauma Informed Practice
  StrategiesMinimizing the Trauma to Children
  during Child Abuse\Neglect Investigations
  andOut-of-home Placements forParents

75

• Many parents will want to know ways to help
  their children cope with a traumatic situation.
  This training component will share what the
  literature states about ways parents can
  effectively serve to minimize the trauma their
  children experience.

76
T.I.P.S for Parents

• Learn common reactions
• Consult a mental health professional
• Assure your child of safety
• Reassure child that she/he is not responsible
• Allow expression of fears and fantasies
• Maintain regular routines
• Remain patient

77
T.I.P.S.Trauma Informed Practice
StrategiesMinimizing the Trauma to Children
during Child Abuse\Neglect Investigations
andOut-of-home Placementsfor

• Child Welfare Workers

78

• T.I.P.S.Trauma Informed Practice
  StrategiesMinimizing the Trauma to Children
  during Child Abuse\Neglect Investigations
  andOut-of-home Placements forChild Welfare
  Workers

79
T.I.P.S. for Caseworkers

• Consider all information gathered during the
  assessment to make informed decisions
• Make informed and appropriate placements
• Prepare the children
• Prepare the caregivers
• Prepare other children in the home
• Support children through the transition

80
The Essential Elements of Trauma-Informed Child
Welfare Practice

• Handout

81

• T.I.P.S.Trauma Informed Practice
  StrategiesMinimizing the Trauma to Children
  during Child Abuse\Neglect Investigations
  andOut-of-home PlacementsforEducators

82

• This training component will provide practical
  suggestions that teachers and other educators can
  use to support the student who has been subjected
  to a traumatic experience.

83
T.I.P.S. for Teachers

• Maintain usual routines
• Give children choices
• Increase level of support
• Set clear, firm limits
• Give simple, realistic answers
• Be sensitive to environmental cues
• Warn about changes
• Be aware of others reaction to the child
• Make accommodations, modifications as needed
• Refer for mental health services as appropriate
• Seek support for yourself

84
T.I.P.S.Trauma Informed Practice
StrategiesMinimizing the Trauma to Children
during Child Abuse\Neglect Investigations
andOut-of-home PlacementsforRelative
Caregivers and Foster Parents
85

• This training component will identify concrete
  strategies that relative caregivers, foster
  parents and providers can use to help minimize
  the trauma to children during their transition
  into placement.

86
Handouts

• Things that Help when Children First Arrive in
  your Home
• Sixty-one Helpful Responses for Relative
  Caregivers and Foster Parents to Use with
  Traumatized Children

87
T.I.P.S.Trauma Informed Practice
StrategiesMinimizing the Trauma to Children
during Child Abuse\Neglect Investigations
andOut-of-home PlacementsforLaw Enforcement
88

• This training component will identify concrete
  strategies that law enforcement officers can use
  that will help minimize the trauma to children
  during the initial investigation phase.

89
T.I.P.S. for Law Enforcement

• Try not to interview parents in a childs
  presence
• Avoid making an arrest in a childs presence
• Keep children with known adults Identify someone
  at the scene who can take care of them
• Do not talk badly about either parent in childs
  presence
• Introduce yourself and describe your role in
  simple terms to the child
• Be physically at the childs level
• Acknowledge that something upsetting has happened
• Explain to children why any use of force was
  necessary

90
Video Clip 3

• Kids, Cops and Domestic Violence

91
Reflection What is the relevance and
applicability of this to your work?
92
Contact Info

• Angela Rodgers
• Portland State University
• rodgersa_at_pdx.edu
• 503-725-8022
• Linda Bello
• Portland State University, Salem
• bello_at_chemeketa.edu
• 503-315-4271
• Ally Jamieson
• Portland State University
• jamieson_at_pdx.edu
• 503-725-8063