21, No. 3
Building a Trauma-Responsive Child Serving System in North Carolina
Project Broadcast was launched in October 2011 with a five-year grant from the U.S. Administration for Children and Families (#90CO1058) to help our child welfare system become more trauma-informed. Almost five years later, even though funding is coming to an end, the project's mission will remain a key component to child welfare services in North Carolina.
Why Focus on Trauma?
In fact, there is a "dose-effect" for childhood trauma. As Figure 1 shows, the more ACEs you have, the more likely you are to experience mental health disorders. As Figure 2 shows, ACEs have a dose-effect for physical health outcomes as well. (Figures reprinted from Putnam, et al. 2015, which is available at www.canarratives.org.)
Trauma can have a huge impact, but fortunately its effects can be mitigated if we identify trauma early and intervene effectively.
Screening for Trauma
These one-page tools help identify potential trauma exposure and functional impairments often associated with trauma, and they help workers decide whether to refer youth for a comprehensive, trauma-informed clinical assessment. The screening form for children age six and older includes four questions the social worker specifically asks the child about physical abuse, sexual abuse, domestic violence and other traumatic events.
These tools have been used widely in Project Broadcast counties. Over the course of 36 months (Jan. 2013 to Dec. 2015), child welfare workers in 12 NC counties completed 9,714 trauma screenings. Because some children were screened more than once, the total number of children screened was 6,651. On average, children screened were 8.39 years old. Slightly more than half (51%) were male. Thirty-nine percent were white, 39% were black, and 13% were Hispanic.
Twenty percent of the children screened were found to have had three or more adverse childhood experiences. That's more than 1,300 children who are 6x more likely to attempt suicide in their lifetime. This is why the work we do is so important. After we ensure children are safe, we must tend to their well-being so they can become productive, successful adults. We want them to live long enough to know their grandchildren some day.
Among the children screened by Project Broadcast the most common trauma experience was exposure to domestic violence (48%), followed by exposure to drug/substance abuse or related activity (42%).
Children's trauma varied by case type. For example, 54% of CPS in-home and 48% of foster care cases had experienced trauma, compared to 23% for children involved in CPS assessments/investigations. Overall, 30% of children screened had experienced some type of trauma. Of these, 56% were referred for further assessment. (Most of the remaining 44% were already in treatment.)
When children older than six were asked directly about their history, 15% indicated they had experienced physical abuse, 22% had been exposed to domestic violence, 10% had been sexually abused, and 2% had another traumatic event occur. The trauma screening revealed previously unknown information about 113 children. Thanks to trauma screening, we can provide them with services and psychoeducation to help them heal.
The Future of Project Broadcast
We are using learning communities to spread Project Broadcast. The current learning community is training representatives from 12 counties to lead efforts to make their agencies more trauma-informed. This learning community, though it is a year-long process, is only the beginning: becoming trauma-informed is a culture shift for all agencies.
Using learning communities is an exciting new step for the Division of Social Services as well. This is a promising approach to rolling out training and implementing new initiatives. We hope to offer another trauma-focused learning community in spring 2017.
Other Child-Serving Systems
Today many entities in our state are focused on trauma:
You are part of this exciting time. You can be part of the healing process.
For more information about Project Broadcast or trauma-informed services in North Carolina, please contact Jeanne.Preisler@dhhs.nc.gov.