Acf Strategic Plan Promote Safety and Well-being of Children, Youth, and Families

Children who are exposed to traumatic life events are at significant risk for developing serious and long-lasting problems beyond multiple areas of development.[i],[two],[3],[4] Nevertheless, children are far more likely to exhibit resilience to childhood trauma when kid-serving programs, institutions, and service systems understand the bear on of childhood trauma, share common means to talk and think about trauma, and thoroughly integrate effective practices and policies to address it—an arroyo frequently referred to as trauma-informed care (TIC).[5]

TIC is not the sole responsibility or purview of mental wellness professionals. While bear witness-based trauma treatment tin play a pregnant role in the healing process for children who need information technology, at that place are many other ways to implement TIC. In fact, every programme and service system that touches the lives of children can play an important office.

This brief summarizes current research and promising practices for implementing TIC to support the well-being of children exposed to trauma and help them reach their total potential. The cursory begins with an overview of the nature, prevalence, and impact of childhood trauma, followed past a discussion of related risk factors associated with poor child outcomes and protective factors that support resilience. In add-on, we present a framework for understanding and implementing trauma-informed care in programs and service systems for children and their families.

Childhood trauma

Babyhood trauma occurs when a child experiences an actual or threatened negative outcome, series of events, or gear up of circumstances that cause emotional pain and overwhelm the child'due south power to cope.[6],[7],[8] Childhood trauma is widespread and can take many forms (come across Figure 1 for mutual types of childhood trauma).[9],[x]

Trauma exposure ofttimes begins early in life. Young children are at the highest risk for exposure to trauma and are well-nigh vulnerable to its adverse furnishings.[11] An estimated half of all children in the United states of america—approximately 35 one thousand thousand—are exposed to at least i type of trauma prior to their eighth birthday.[12] For case, child corruption and neglect are most common among children younger than age three.[13] Children under age five are near probable to incur injuries from falls, choking, and poisoning,[14] and represent the majority of children who witness domestic violence.[fifteen] Children from sure racial and ethnic groups too are more probable to experience adversities that can cause trauma. For example, exposure to childhood adversity is more common among blackness and Hispanic children than amid white children, even when accounting for the role of income.[16]

Impact of babyhood trauma

Childhood trauma is strongly linked to mental and physical health problems over the lifespan. Information technology negatively impacts brain evolution, cognitive development, learning, social-emotional development, the ability to develop secure attachments to others, and concrete wellness; information technology is also associated with a shortened lifespan[17],[18],[19],[20] (come across Effigy 2 for additional information on the bear on of babyhood trauma). A considerable body of research demonstrates that children endure the most astringent, long-lasting, and harmful furnishings when trauma exposure begins early in life, takes multiple forms, is severe and pervasive, and involves impairment by a parent or other main caregiver—often referred to every bit complex trauma.[21]

Childhood trauma is more than likely to lead to post-traumatic stress disorder (PTSD) than trauma that occurs in adulthood.[22] Children exposed to several dissimilar forms of trauma are more likely to showroom PTSD (e.g., anxiety, depression, anger, assailment, dissociation) than children with chronic exposure to a single type of trauma.[23] Children and youth with PTSD may re-experience the traumatic event through intrusive memories, nightmares, and flashbacks; avert situations or people that remind them of the trauma; and feel intense anxiety that disrupts their everyday lives. In improver, they may appoint in aggressive, cocky-subversive, or reckless behavior; have trouble sleeping; or remain in a land of hypervigilance, an exaggerated state of sensation and reactivity to their environments.[24] Still, at that place is no typical reaction to trauma. The vast majority of children show distress immediately post-obit a traumatic consequence, but about render to their prior level of performance.[25]

Generally, children's reactions to trauma differ based on the nature of the trauma; the kid's individual, family, and neighborhood characteristics; and the overall residuum of risk and protective factors in their lives. Information technology also depends on their historic period and developmental phase.[26],[27]

Young children who feel trauma may:

• Have difficulties forming an attachment to caregivers
• Experience excessive fear of strangers or separation anxiety
• Take trouble eating and sleeping
• Exist particularly fussy
• Testify regression after reaching a developmental milestone (due east.yard., sleeping through the night, toilet grooming)

School-age children who experience trauma may:

• Appoint in aggressive behavior
• Go withdrawn
• Fixate on their ain safety or the safety of others
• Re-enact the traumatic effect through play
• Have frequent nightmares
• Exhibit difficulty concentrating in schoolhouse

Adolescents who feel trauma may:

• Get anxious or depressed
• Engage in gamble-taking or self-destructive behaviors (e.g., drug and alcohol misuse, dangerous driving, sexual promiscuity, unprotected sex, self-harm, illegal action)
• Feel intense guilt, anger, or shame
• Adopt a negative view of people and order
• In some cases, have persistent thoughts about suicide or seeking revenge

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Resilience to Childhood Trauma

When parents, service providers, and programs employ a resilience framework to childhood trauma, they empathise there are always opportunities to support positive developmental trajectories among children, even if they have experienced trauma. Resilience has been defined equally "a dynamic process encompassing positive accommodation inside the context of meaning adversity."[28] Resilience is not a personal trait that individuals do or exercise not possess (thus, the term "resiliency" is best avoided because it connotes an individual characteristic),[29] but rather a product of interacting factors—biological, psychological, social, and cultural—that determine how a child responds to traumatic events.[thirty]

Resilience to trauma can be divers in several ways: positive child outcomes despite exposure to trauma, prevention of trauma recurrence despite loftier risk for further exposure, or avoidance of traumatic experiences altogether in the face of meaning risk. All iii of these conceptualizations of resilience are based on an ecological approach.

Ecological approach to resilience. Using an ecological approach to promote resilience in development amid children who experience trauma is useful because it assumes that at that place are multiple levels of influence on a child's development—the private, parent, family unit, schoolhouse, customs, and culture—which may increase or decrease a child'southward gamble for and response to experiencing trauma. These various influences are frequently referred to equally risk and protective factors.[31]

Gamble factors. Take chances factors are circumstances, characteristics, weather condition, events, or traits at the private, family, community, or cultural level that may increase the likelihood a person volition experience adversity (e.k., childhood trauma, re-traumatization, or negative outcomes due to trauma).[32],[33] Chance factors for specific types of trauma may vary, only commonly include living in poverty, a lack of social supports, and prior history of trauma.[34],[35] Additionally, children who identify equally lesbian, gay, bisexual, transgender, or queer (LGBTQ)[36] and children in military families[37] are at an increased risk for experiencing trauma. Nonetheless, the presence of risk factors or membership in a high-hazard group does not necessarily mean that a child will experience trauma or its most adverse effects.[38] Protective factors tin buffer children from risk and improve the odds of resilient functioning.

Protective factors. Protective factors are characteristics, conditions, or events that promote good for you development and minimize the take chances or likelihood a person will experience a particular illness or event, or its related negative outcomes.[39] Research shows that the strongest protective factor linked with resilience to childhood trauma is the reliable presence of a sensitive, nurturing, and responsive adult.[xl] The presence of such a figure tin assist children by restoring a sense of safety, predictability, and control; giving them the feeling of rubber; providing them a mode to process traumatic events; protecting them from re-traumatization; supporting their development of self-regulation; and helping them heal.[41], [42],[43],[44]

In addition, the National Child Traumatic Stress Network highlights the following protective factors that promote resilience to childhood trauma:[45]

• Support from family, friends, people at school, and members of the community
• A sense of condom at home, at school, and in the community
• Loftier self-esteem and positive sense of self-worth
• Self-efficacy
• Spiritual or cultural beliefs, goals, or dreams for the future that provide a sense of pregnant to a child's life
• A talent or skill in a particular area (e.1000., excelling in school or in a sport)
• Coping skills that can be practical to varying situations

Finally, resilience to childhood trauma depends largely on the supports bachelor to a kid and his or her family. Family members, teachers, mental health providers, child welfare workers, and other customs service providers tin work together to ensure that children and families receive the emotional and concrete supports (eastward.thou., food, shelter, financial stability) they need.[46] This system of care approach is also a cornerstone of TIC.[47]

Trauma-informed Care

The context in which children alive, larn, and grow shapes both their firsthand and long-term well-being.[48] Accordingly, children who experience trauma are more than likely to exhibit resilience when their environments are responsive to their specific needs. Families, schools, community-based programs and services, and the individuals caring for children can increment the chances of resilience following childhood trauma when they go aware of the affect of childhood trauma, provide a sense of safety and predictability, protect children from further adversity, and offer pathways for their recovery. In other words, children benefit when these entities provide them with trauma-informed care (TIC).[49]

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Implementing TIC with child-serving programs, institutions, and systems

Despite its focus on trauma, TIC is inherently a strengths-based perspective that emphasizes resilience instead of pathology.[l] TIC has been divers and implemented in a number of means, but the Substance Abuse and Mental Health Services Assistants has identified four key elements—the Four Rs (see description of each "R" beneath)—that can be used broadly beyond programs, institutions, and services.[51]

Applying TIC to real-world settings begins with a child'south first contact with a program, institution, or service system. It requires a comprehensive and multi-pronged endeavour involving the many adults in children'due south lives. For example, in a school or afterschool program, TIC means increasing trauma-related knowledge and skills amidst program facilitators, school administrators, double-decker drivers, food service workers, classroom administration, authoritative staff, volunteers, teachers, leadership, special pedagogy professionals, schoolhouse social workers and psychologists, families, and anyone else who comes into contact with children. However, increasing trauma cognition is only one aspect of TIC, which besides ways that the individuals who intendance for children must be able to:

1. Realize the widespread nature of childhood trauma and how it impacts the child's emotional, social, behavioral, cerebral, brain, and physical development, as well as their mental health. In addition, adults must be enlightened of the influence of trauma on family members, first responders, service providers, and others who may experience secondary stress (trauma-related reactions to exposure to another person'south traumatic feel).[52],[53] In some instances, adults endure the same traumatic events or circumstances as the child (e.k., a natural disaster, community violence, death of a community member) and may benefit from similar supports.
2. Recognize the symptoms of trauma, including how trauma reactions (i.e., symptoms of posttraumatic stress) vary by gender, historic period, type of trauma, or setting. In addition, the adults in children's lives must understand that a child's challenging behaviors are normal, cocky-protective, and adaptive reactions to highly stressful situations, rather than viewing that child as intentionally misbehaving. Children's trauma reactions are understood to exist adaptive efforts to protect themselves in response to traumatic events. For example, a child may be hypervigilant to an adult's anger or disapproval because, in the past, he or she experienced concrete abuse by a parent. Or, a child may disassociate or fantasize as a learned response that enables them to avoid feeling or thinking about a traumatic experience.[54] In improver, TIC ways recognizing that trauma may influence a kid's engagement in activities and services, interactions with peers and adults, and responsiveness to rules and guidelines.[55]
3. Respond past making necessary adjustments, in their own language and behavior, to the kid'due south surroundings; and to policies, procedures, and practices to back up the child'due south recovery and resilience to trauma.[56]
4. Resist re-traumatization by actively shaping children'south environments to avoid triggers (sounds, sights, smells, objects, places, or people that remind an individual of the original trauma) and protect children from further trauma, which tin exacerbate the negative impacts of trauma and interfere with the healing process.[57],[58]

Preparation and professional development on child trauma is an of import start stride in TIC. Providing adults (staff, leadership, families, and community partners) with preparation and professional development on childhood trauma is an important component of implementing TIC.[59] It is essential that adults go aware of the prevalence and impact of trauma, and larn to utilise a "trauma lens" (i.e., gain the chapters to view children's difficulties in beliefs, learning, and relationships as natural reactions to trauma that warrant understanding and sensitive care).[60] In improver, adults can learn key strategies to manage trauma-related problems in childhood. These include creating environments that feel physically and emotionally safe; teaching children self-regulation, language and communication skills, and how to build healthy relationships; learning each child'due south trauma triggers and how both the kid and adults can limit, anticipate, and cope with them; and supporting the development of salubrious attachments with parents and other caregivers, too as positive relationships with peers. Evaluations of TIC initiatives likewise indicate that when parents, service providers, and programs share a mutual linguistic communication and view of trauma, they are better able to work together to run into children'due south needs.[61]

Training and professional development opportunities are also important for increasing the capacity of adults to attend to other aspects of TIC, including family engagement; practices that are responsive to civilisation, gender, and sexual orientation; collaboration with community service providers (e.chiliad., mental health providers who can screen for childhood trauma and provide evidence-based treatment); developing and integrating emergency and crisis response protocols; and establishing trauma-informed policies that support positive youth development despite exposure to trauma. Edifice chapters and maintaining an ongoing commitment to TIC efforts are disquisitional to sustainability.[62], [63] However, although it is a critical component of TIC, preparation staff and parents on the impact of childhood trauma is not sufficient and does non in and of itself constitute TIC. TIC must likewise include comprehensive, ongoing professional development and education for parents, families, school staff, out-of-school program staff, and community service providers on jointly addressing babyhood trauma.

Parents and service providers who work with children who experience trauma require self-intendance to prevent and mitigate the effects of secondary traumatic stress. TIC too means attending to the psychological and physical safety and well-existence of the adults who intendance for children who have experienced trauma.[64], [65] Professionals, parents, and other caregiving adults may suffer secondary traumatic stress (trauma-related reactions to exposure to another person's traumatic feel).[66],[67] Psychoeducation (helping others understand the touch of trauma, both on affected individuals and on their service providers, also as pathways toward recovery),[68] skills training, loftier-quality supervision, and self-care (e.g., residue, exercise, social back up, mindfulness and other stress reduction activities, engaging in pleasurable activities and hobbies, psychotherapy) are disquisitional to ensuring adult well-existence and providing sufficient personal resource to work finer with children who are exposed to trauma. Encounter Figure iv for specific strategies recommended by the National Child Traumatic Stress Network to combat secondary traumatic stress and reduce related staff burnout and turnover.[69]

Farther research is needed on TIC in child-serving programs, institutions, and systems to develop a sufficient evidence base of operations to inform policy and practice. TIC is a relatively new framework for working with individuals who feel trauma, and the evidence base of operations in support of its effectiveness is in the early stages of development. Nevertheless, a number of promising TIC initiatives in early care and instruction, schools, child welfare, and behavioral wellness have demonstrated improvements in trauma-related noesis and skills among service providers, foster parents, and family members; reductions in children's posttraumatic stress symptoms and problem behaviors; and increases in children'due south strengths and protective factors.[seventy],[71],[72],[73],[74] In addition, a growing number of clinical treatment models—including Trauma-Focused Cognitive Behavioral Therapy,[75],[76] Child-Parent Psychotherapy,[77],[78] Attachment and Biobehavioral Catch-upwards,[79],[80] and Parent-Kid Interaction Therapy,[81],[82]—accept undergone rigorous evaluation and shown positive outcomes for children from infancy to late adolescence. However, TIC is non express to mental health professionals. Each child-serving programme, institution, or service system can play a role in TIC, including referral to clinical handling and follow-up with families.

Conclusion

Trauma-informed programs, institutions, and service systems are critical to promoting and fostering resilience in all children, and especially those who accept experienced trauma. TIC requires comprehensive, multi-pronged support from adults in all aspects of children's lives. It includes increasing adults' noesis of babyhood trauma and helping them recognize the symptoms, as well as giving them the resources to support and refer children who have experienced trauma to appropriate services. Additionally, every bit programs make their services more than trauma-informed, information technology is important that they promote self-intendance to foreclose or address secondary trauma among adults working with children who have experienced trauma.

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Endnotes

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[2] Enlow, M., Blood, E., & Egeland, B. (2013). Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early on life. Journal of Traumatic Stress, 26(6), 686–694.

[3] Lieberman (2004). Traumatic stress and quality of zipper: Reality and internalization in disorders of babe mental health. Infant Mental Health Journal, 25(4), 336–351.

[four] National Child Traumatic Stress Network. (2003). Complex trauma in children and adolescents: White paper from the National Child Traumatic Stress Network Complex Trauma Task Force. Los Angeles, CA and Durham, NC: National Center for Child Traumatic Stress. Retrieved on February 3, 2017 from https://www.nctsn.org/sites/default/files/resources//complex_trauma_in_children_and_adolescents.pdf

[5] Substance Abuse and Mental Health Services Administration. SAMHSA's concept of trauma and guidance for a trauma-informed arroyo. HHS publication no. (SMA) 14-4884. Rockville, Md: Substance Abuse and Mental Health Services Administration.

[6] International Gild for Traumatic Stress Studies. (n.d.). What is babyhood trauma? Retrieved June eight, 2018 from http://www.istss.org/public-resource/remembering-childhood-trauma/what-is-babyhood-trauma.aspx

[7] Substance Corruption and Mental Health Services Administration-Health Resources & Services Administration. (n.d.). Adverse childhood experiences (ACES), trauma, & Mail service Traumatic Stress Disorder (PTSD). Retrieved June 8, 2018 from https://www.integration.samhsa.gov/clinical-practice/trauma#ACE_Trauma_PTSD_Resources

[viii] The National Child Traumatic Stress Network. (n.d.). What is child trauma? Retrieved June 8, 2018 from https://world wide web.nctsn.org/what-is-child-trauma

[9] National Child Traumatic Stress Network (northward.d.). Trauma types. Retrieved on June 8, 2018 from https://world wide web.nctsn.org/what-is-child-trauma/trauma-types

[x] National Survey of Children'due south Health. (2011/12). Data query from the Child and Adolescent Wellness Measurement Initiative, Data Resource Center for Child and Adolescent Health website. Retrieved June eight, 2018 from world wide web.childhealthdata.org.

[11] U.South Department of Health & Human being Services Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2019). Child maltreatment 2017. Washington, DC: Children's Bureau. Retrieved June eight, 2018 from https://world wide web.acf.hhs.gov/cb/resources/child-maltreatment-2017

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[13] U.S. Department of Wellness & Man Services Administration for Children and Families, Assistants on Children, Youth and Families, Children'due south Bureau. (2019).

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Source: https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma

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