Transcript Strengthening Families to Prevent Child Abuse and Neglect

Understanding Childhood Trauma
and
its Lifelong Effects – A Systems Approach
Healthy People
Stable Families
Strong Communities
Joanne Mooney and Carole Wilcox
Child Safety and Permanency Division, MNDHS
Overview of Presentation
 Adverse effects on healthy development due to toxic stress
and trauma
 Approaches to improving the odds
 Development of a trauma informed Minnesota public child
welfare system
 Building hope from resiliency
Orientation
What do we hope for our children?
MN Public Child Welfare System
Hope for Children
 Based on the child welfare practice model built form
lessons learned over the last decade of reforms
 Shift from “Family Bubble” or “Deficit Oriented
Models” to Models that focus on strengths, health, &
thriving.
We work with parents and partners to ensure that children and
families are supported to achieve equitable optimal development
regardless of race, ethnicity, socioeconomic status or tribal status
Positive Adaptation – A Focus on Well-Being
Child Well-Being includes:
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Healthy social emotional functioning
Safe, secure and responsive environments for families
Conditions that allow children to be successful during
childhood and into adulthood
This means no child in Minnesota should ever
experience extended hunger, be homeless, live in
poverty or go without health care.
Equality or Parity?
Timing is Everything…
When it Comes to Brain Development
Health trajectories!
Our healthy path is particularly affected during critical or
sensitive periods. Early programming is key.
Critical or Sensitive Periods. While adverse events
and exposures can have an impact at any point in a
person’s life course, the impact is greatest at specific
critical or sensitive periods of development.
 Early Programming. Early experiences can “program”
an individual’s future health and development.
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Our Past Stays With Us
Today's Experiences 
Tomorrow's Health
The lifecourse is an integrated continuum of
risk and protective exposures, experiences
and interactions
Health pathways or trajectories are built –
and modified– over the lifespan
Trauma and Early Brain Development
 During the early period of life, a baby’s brain is forming
700 neural connections every second. The experience of
trauma during this stage impacts healthy development.
 Trauma is the experience of an event by a person that is
emotionally painful or distressful which often results in
lasting mental and physical effects.
 Growing scientific knowledge links childhood toxic stress
with disruptions of the developing nervous,
cardiovascular, immune, and metabolic systems.
Trauma and Early Brain Development
 These disruptions can lead to lifelong impairments in
learning, behavior, and both physical and mental
health.
 Disruption in Neural Development that concern child
welfare
 Failure to expose youth to appropriate experiences
at the critical times (Neglect)
 Overwhelming the brain’s alarm system (Abuse)
Adverse Childhood Experiences
Change How Our Brains Work
Toxic stress video:
http://developingchild.harvard.edu/resources/multimedia/videos/three_core_conc
epts/toxic_stress/
Impact of Trauma
Short Term
Long Term
 Eating
 Depression
 Sleeping
 Toileting
 Anxiety
 Attention & Concentration
 PTSD
 Withdrawal
 Personality
 Avoidance
 Fearfulness
 Re-experiencing/
 Flashbacks
 Aggression; Turning passive into
active
 Relationships
 Partial memory loss
 Alcohol or Other Drug
Problems
 Becoming Violent
Towards Others
Trauma-informed worldview
Now Add…Child Poverty …
Based on 3-year averages from the American Community Survey (ACS) for Minnesota 2007-2009
(children for whom poverty status is determined)
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Poverty and Neglect
 There is a relationship between neglect and poverty. Neglect is defined
as the failure to provide for a child’s basic needs “when reasonably able
to do so.” Disproportionate referrals occur by community reporters to
the public child welfare system.

The Fourth National Incidence Study found families under the poverty level to be
reported at 7 times the rate of families over the poverty level.
 Conditions of poverty can create circumstances of a child being
neglected due to parents’ lack of financial resources. When this occurs,
public child welfare agencies should work to improve the conditions
that influence neglect and meet protective needs while making no
determination of maltreatment.
 Families of color are more likely to be in poverty as an artifact of
historical racism.
 Therefore higher neglect rates of families of color can be tied in large
part to higher poverty rates.
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Historical Trauma
 HISTORIC TRAUMA is the collective emotional and psychological
injury both over the life span and across generations, resulting from a
cataclysmic history of genocide.
 Genocide is the intent to destroy a national, ethnic, racial or religious
group (1948 Geneva Convention)
 Historical trauma has a layering effect and is the "cumulative
emotional and psychological wounding over the life span and across
generations, emanating from massive group trauma."
 Historical or intergenerational trauma is similar to that suffered by
the Jewish people as a result of the Holocaust, Native Americans, the
Japanese Americans interned in California at the beginning of World
War II and African Americans suffering the aftermath of slavery.
Maria Yellow Horse Brave Heart, Research Associate Professor, Graduate School of Social Work,
University of Denver
Effects of Historic Trauma
 First Generation
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Post Traumatic Stress Disorder
 Subsequent Generations – Historical Unresolved Trauma Survivor
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Guilt, Depression, Anger
Psychic numbing
Victim identity/death identity
Thoughts of suicide
Nightmares
Preoccupation with trauma
Relational problems
Physical symptoms including diabetes and other disease associated with high
stress hormones that wear out the body.
What is ACE?
High Individual and Public Costs of Trauma
 Alcoholism and alcohol abuse
 Risk for intimate partner
 Chronic obstructive pulmonary
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disease (COPD)
Depression
Fetal death
Health-related quality of life
Illicit drug use
Ischemic heart disease (IHD)
Liver disease
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violence
Multiple sexual partners
Sexually transmitted diseases
(STDs)
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual activity
Adolescent pregnancy
(Graphic: R. Anda, 2011)
Slide from R. Anda (2011), used with
permission
Slide from R. Anda (2011), used with
MAGNITUDE
OF THE
SOLUTION
A large portion of many
health,
safety
and
prosperity conditions is
attributable to Adverse
Childhood Experience.
ACE reduction reliably
predicts a decrease in all
of
these
conditions
simultaneously.
“Ten Tribes” Study
Adverse Childhood Exposures
 Boarding School, Foster Care and Adoption perspectives added.
 Cultural variables assessed.
 86% participants experienced one or more categories of exposure
 33% reported four or more categories.
 Strong relationship between childhood sexual abuse and
subsequent drinking problems among the general population
similar in Native American population.
 Combined sexual and physical abuse increased alcohol dependence
for men.
 Combined sexual abuse and boarding school attendance were
significant for women.
Source: Koss, M., Polacca, M., Yuan N., et al “Adverse Childhood Exposures and
Alcohol Dependence Among Seven Tribes” American Journal of Preventative
Medicine, 2003, pp. 238‐244
States Collecting ACE Data
2009-2011
18 States
No data
2009
2010
2011
Source: Behavioral Risk Factor Surveillance System, CDC.
HOPE
 Children are vulnerable to risk – but also
amenable to intervention
 Human brains have the capacity to change Plasticity
 Focus for children must be on relationships that
are:
•
•
•
Nurturing
Stable
Engaging
Resilience and Relationships
“Resilience rests, fundamentally,
on relationships”
 None of us is perfect
 Resilience is complex
 We have the capacity to adapt
 Resiliency and protective factors help during adversity
 Recovery is individual and environmentally influenced
Conclusion of SuniyaLuthar, in: Resilience in development: A synthesis of research across five decades. (2006, p. 780)
Key Components of Resilience
CAPABILITY
How is your
community
nurturing these
three components
for resilience
throughout the
lifespan?
COMMUNITY,
CULTURE,
SPIRITUALITY
• Intellectual & employable skills
• Self regulation – self control,
executive function, flexible
thinking
• Ability to direct & control
attention, emotion, behavior
• Positive self view, efficacy
ATTACHMENT
& BELONGING
• Bonds with parents and/or
caregivers
• Positive relationships with
competent and nurturing
adults
• Friends or romantic partners
who provide a sense of
security & belonging
• Faith, hope, sense of meaning
• Engagement with effective
orgs – schools, work, pro-social
groups
• Network of supports/services
& opportunity to help others
• Cultures providing positive
standards, expectations,
rituals, relationships &
supports
Discussion
 How is your community nurturing these
three components for resilience throughout
the lifespan of the people you serve?
 What do you need to do more of?
 With whom?
Building Upon the Strengths of Families:
The Protective Factors
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• Concrete Supports in Times of
Need
• Social Connections
• Parental Resilience
• Knowledge of Parenting and
Child Development
• Children’s Social and
Emotional Competence
Embracing Culture
 Culture is a system of shared
actions, values and beliefs that
guide behavior of families and
communities
 Recognizing importance and
strength of cultural norms
supports families and
communities and helps them to
flourish
 Establishing shared leadership
with diverse parents and
caregivers improves supports
and services for families and
communities
Discussion
Protective Factor Card
How does this protective factor present itself
in your personal life?
How does this protective factor present itself
in your professional life?
System Approach to Trauma
Child
Welfare
Education
Trauma
Mental
Health
Community
Violence
Alcohol &
Other Drugs
System
Health
Care
Criminal
Justice
PEDIATRICS Volume 129, Number 1, January 2012
Working Across Systems in Partnership
Primary Prevention
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•
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•
•
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•
Positive early care and
education
Positive social and
emotional development
Parenting skills
Quality after-school
programming
Conflict resolution
Youth leadership
Quality education
Social connections in
neighborhoods
Economic development
Secondary
Prevention
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Mentoring
Mental health services
Substance abuse services
Family support services
Domestic Abuse services
Conflict interruption and
street/community
outreach
Tertiary Prevention
•
•
•
•
Mental Health Services
Substance Abuse
Services
Domestic Abuse Services
Successful re-entry
Discussion Questions
 How is the system you work within traumatizing
children and families?
 What will your system do to shift away from these
policies, practices, or procedures?
Child Welfare System Perspective
What has Minnesota’s Public Child Welfare
System done to…
Become trauma-informed?
Improve the odds for children and their
families?
Minnesota Public Child Welfare System
Context
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 State-supervised/County-
administered (87 counties)
 Eleven federally recognized Tribes –
2 American Indian Child Welfare
Initiative Tribes
 State with highest share of local
property taxes for child welfare
MN Children in Out-of-home Care per 1,000 in the
Child Population by Race/Ethnicity, 2001–2010
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94.1
92.6
89.2
86.9
88.7
83.9
82.5
77.8
78.7
Children in care per 1,000
72.8
48.0
45.7
42.7
37.4
35.9
35.8
34.9
32.4
33.6
29.8
17.3
25.9
17.3
9.4
21.5
24.1
15.3
14.5
8.0
7.4
9.1
7.0
7.7
2001
2002
5.9
2003
20.1
19.7
20.3
19.3
14.7
14.5
14.1
13.5
7.9
7.7
7.6
6.7
5.4
4.9
2004
2005
6.2
2006
5.2
2007
5.0
2008
17.2
25.0
16.9
11.5
10.3
5.7
5.8
3.8
2009
3.7
2010
African American/Black
American Indian
Asian/Pacific Islander
White
Two or more races
Hispanic ethnicity–any race
What We Now Know
 Relationships cause change
 Leaders and partnerships impact change
 Flexibility and adaptability
 Employ strengths and engage capacities
 Assure continuity of care and connections
 Focus on well-being
 Rely on professional, familial, community and cultural
wisdom
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Building Upon the Strong Foundation
 Minimize trauma when a child enters the CW system
–
Engage parents as partners in safety planning
–
–
–
–
–
If placement is necessary, make every effort to place children with
relatives/kin
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–
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Parent Support Outreach Program
Family Assessment Response
Signs of Safety
Family Group Decision Making
Conduct relative/kin searches early on
Continue to pursue available relative/kin resources
When placing children
–
–
–
–
keep them close to their homes
keep siblings together
maintain cultural connections and school stability
ensure frequent and quality visits with parents and children
Building Upon the Strong Foundation
 Implement a systemic approach to creating trauma-
informed child welfare system
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Screen for trauma upon entrance to out of home care
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–
Examine potential to integrate screening items into existing
screening and/or assessment instruments.
Expand learning and training opportunities
–
–
Build knowledge of brain development and trauma-informed
practice integrated into foundation training for social workers
Provide training to resource family providers
Building Upon the Strong Foundation
 Improve capacity, access and availability for
therapeutic services that are culturally sensitive and
relevant
–
–
–
Coordinate with Children’s Mental Health Division and MN’s
Ambit Network to build capacity for trauma-informed mental
health practitioners
Encourage child welfare workers to make trauma-centered
referrals to providers
Include parent leaders to inform policy, program and practice
enhancements
Relationships Are the Difference
 Trauma can be created by disruption in healthy
relationships
 Trauma can be healed by development of healthy
relationships
 Keep the focus on relationships for children that are:
•
•
•
Nurturing
Stable
Engaging
Building Hope:
Resiliency and Change
 How will YOU use your opportunities for integration
and change?
Links to Sources

The Lifelong Effects of Early Childhood Adversity and Toxic Stress – American Academy of Pediatrics
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;129/1/e232.pdf
Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy
– Dr. Jack P. Shonkoff
http://steinhardt.nyu.edu/scmsAdmin/media/users/eez206/srb_conference/Building_a_New_Biodevelopmental_Frame
work_-_J__Shonkoff.pdf


Child Trauma Academy – Dr. Bruce Perry
http://www.childtrauma.org/

Adverse Childhood Experiences – Washington State Family Policy Council http://www.fpc.wa.gov/

Strengthening Families - A Protective Factors Framework – Center for the Study of Social Policy
http://www.cssp.org/reform/strengthening-families

Chapin Hall Child & Family Policy Forum – Public Systems: Responding to Students Affect by Trauma
http://www.chapinhall.org/sites/default/files/documents/Child_Family_Forum_Nov_1.pdf
Zero to Three: Supporting the Development of Infants and Toddlers in the Child Welfare System: A
Call to Action
http://www.zerotothree.org/public-policy/webinars-conference-calls/supporting-the-development-of-infatns-andtoddlers-in-the-chld-welfare-system-a-call-to-action.html

Joanne Mooney
651.431.3879
[email protected]
Carole Wilcox
651.431.4977
[email protected]