Understanding Childhood Trauma and its Lifelong Effects

1
Understanding Childhood Traumaandits Lifelong
Effects A Systems Approach

• Healthy People Stable Families Strong
  Communities

Joanne Mooney and Carole Wilcox Child Safety and
Permanency Division, MNDHS
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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

3
Orientation

• What do we hope for our children?

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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

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Positive Adaptation A Focus on Well-Being

• Child Well-Being includes
• 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.

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Equality or Parity?
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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 persons life course, the impact is
  greatest at specific critical or sensitive
  periods of development.
• Early Programming. Early experiences can
  program an individuals 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

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Trauma and Early Brain Development

• During the early period of life, a babys 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.

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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 brains alarm system (Abuse)

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Adverse Childhood ExperiencesChange How Our
Brains Work
Toxic stress video http//developingchild.harvard
.edu/resources/multimedia/videos/three_core_concep
ts/toxic_stress/
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Impact of Trauma

• Short Term
• Eating
• Sleeping
• Toileting
• Attention Concentration
• Withdrawal
• Avoidance
• Fearfulness
• Re-experiencing/
• Flashbacks
• Aggression Turning passive into active
• Relationships
• Partial memory loss

• Long Term
• Depression
• Anxiety
• PTSD
• Personality
• Alcohol or Other Drug Problems
• Becoming Violent Towards Others

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Trauma-informed worldview
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Now AddChild 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 childs 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

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Effects of Historic Trauma

• First Generation
• Post Traumatic Stress Disorder
• Subsequent Generations Historical Unresolved
  Trauma Survivor
• 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.

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What is ACE?
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High Individual and Public Costs of Trauma

• Alcoholism and alcohol abuse
• Chronic obstructive pulmonary disease (COPD)
• Depression
• Fetal death
• Health-related quality of life
• Illicit drug use
• Ischemic heart disease (IHD)
• Liver disease

• Risk for intimate partner violence
• Multiple sexual partners
• Sexually transmitted diseases (STDs)
• Smoking
• Suicide attempts
• Unintended pregnancies
• Early initiation of smoking
• Early initiation of sexual activity
• Adolescent pregnancy

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(Graphic R. Anda, 2011)
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Slide from R. Anda (2011), used with permission
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Slide from R. Anda (2011), used with permission
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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.
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Ten Tribes StudyAdverse 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

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States Collecting ACE Data2009-2011
18 States
2010
2009
2011
No data
Source Behavioral Risk Factor Surveillance
System, CDC.
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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

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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)

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Key Components of Resilience
How is your community nurturing these three
components for resilience throughout the lifespan?
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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?

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Building Upon the Strengths of FamiliesThe
Protective Factors

• Concrete Supports in Times of Need
• Social Connections
• Parental Resilience
• Knowledge of Parenting and Child Development
• Childrens Social and Emotional Competence

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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

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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?

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System Approach to Trauma
Education
Alcohol Other Drugs System
Child Welfare
Health Care
Trauma
Mental Health
Criminal Justice
Community Violence
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PEDIATRICS Volume 129, Number 1, January 2012
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Working Across Systems in Partnership
Primary Prevention Secondary Prevention Tertiary Prevention
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 Mentoring Mental health services Substance abuse services Family support services Domestic Abuse services Conflict interruption and street/community outreach Mental Health Services Substance Abuse Services Domestic Abuse Services Successful re-entry
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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?

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Child Welfare System Perspective

• What has Minnesotas Public Child Welfare System
  done to
• Become trauma-informed?
• Improve the odds for children and their families?

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Minnesota Public Child Welfare System Context

• 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

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MN Children in Out-of-home Care per 1,000 in the
Child Population by Race/Ethnicity, 20012010
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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
• Parent Support Outreach Program
• Family Assessment Response
• Signs of Safety
• Family Group Decision Making
• If placement is necessary, make every effort to
  place children with relatives/kin
• 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

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Building Upon the Strong Foundation

• Implement a systemic approach to creating
  trauma-informed child welfare system
• Screen for trauma upon entrance to out of home
  care
• 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

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Building Upon the Strong Foundation

• Improve capacity, access and availability for
  therapeutic services that are culturally
  sensitive and relevant
• Coordinate with Childrens Mental Health Division
  and MNs 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

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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

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Building HopeResiliency and Change

• How will YOU use your opportunities for
  integration and change?

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Links to Sources

• The Lifelong Effects of Early Childhood Adversity
  and Toxic Stress American Academy of Pediatrics
  http//aappolicy.aappublications.org/cgi/reprint/p
  ediatrics129/1/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/Build
  ing_a_New_Biodevelopmental_Framework_-_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/docu
  ments/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-inf
  atns-and-toddlers-in-the-chld-welfare-system-a-cal
  l-to-action.html

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JJoanne Mooney651.431.3879joann
e.mooney_at_state.mn.usCarole Wilcox651.431.4977c
arole.wilcox_at_state.mn.us