Vol. 17, No. 2
May 2012

Nine Trauma-Informed Activities for Child Welfare

The National Child Traumatic Stress Network (2008) highlights nine essential activities in serving children who have experienced trauma. These activities form the core of a Child Welfare Trauma Training Toolkit and a two-day training developed by the Network. To move your agency forward with trauma-informed practice, visit the Network’s website at http://bit.ly/HWCkVq.

Below are examples of ways you can engage in each of the essential activities, along with additional questions you might explore for each activity. To integrate a more trauma-informed perspective into your practice and case planning, start by asking questions. Some of the recommendations apply to the child’s caregiver, whether that is a birth family member or foster care provider. Work in partnership with children, their families, and therapists to ensure that everyone is informed and taking a comprehensive approach.

1. Maximize safety.

Children need to feel physically and psychologically safe. To feel psychologically safe, children need consistency and predictability. Remind parents that helping kids to know they are safe may take some time.
Help caregivers provide predictable and consistent environments including routines, clear expectations, consistent feedback, and positive reinforcement.
Listen to the child. Pay attention to possible triggers, which may be people, places, or things that make the child feel threatened.
Increase awareness of behaviors that are reactions to triggers. It may not always be clear to you what the threat is, but the threat is real to the child.
Reassure the child with specific information about how everyone is working to keep her safe.

Key Questions: What are people, places, and activities that make this child feel safe and secure? What makes her feel unsafe or unsupported?

2. Help children manage overwhelming emotions.

Frequent, intense and overwhelming emotions are triggered by reminders of traumatic events.
Help the child label his emotions; make it clear these emotions are understandable.
Teach relaxation skills; encourage the child to participate in activities that allow for positive expression of emotions (physical exercise, art, music, etc.).
Identify and avoid reminders that trigger intense emotions. Help the child understand what is happening when reminders occur.
Remember—and help caregivers remember—not to take it personally when children experience or express their emotions. Talking to other adults can help caregivers problem-solve and identify trauma-informed ways to respond.

Key Questions: What are possible triggers that make this child feel threatened or remind him of traumatic events? What is being done in therapy and at home to help minimize or manage those triggers? Are there relaxation or stress management skills that the child is learning that I can remind him of and reinforce?

3. Help children make new meaning of their trauma history and current experiences.

Listen to the child tell her story; acknowledge emotions.
Support the child and caregiver in developing a Life Book.
When appropriate, provide information about traumatic events to help the child gain a different perspective and reduce self-blame.

Key Questions: What is the best way for me to respond to the child’s comments or questions about her trauma history? Am I able to listen empathically without shifting to an investigative or problem-solving mode?

4. Address the impact of trauma and subsequent changes in the child’s behavior, development, and relationships.

Identify areas of concern as early as possible and take necessary steps to ensure the child is safe and that developmental needs are being met.
Educate families about key developmental milestones and ways they can increase brain development through interactions with children.
Remind parents to avoid saying to children that they are “bad” or their behavior is “bad.” This can reinforce negative behavior. What’s more, this might shame the child, which would be inappropriate, since the behavior is related to feelings of fear or anxiety.
Work with schools and others to ensure the child has support in reaching academic, social, and behavioral goals.

Key Questions: What behaviors, symptoms, or situations is the child experiencing? How might they relate to his history of trauma? What support or information can we offer him and his caregivers to understand and respond appropriately?

5. Coordinate services with other agencies.

Share information with caregivers and service providers. General information about a child’s trauma history may legally be shared with foster parents and other members of the professional team when it is essential to providing quality services.
With the family’s permission, invite service providers to child and family team meetings (CFTs).
Be mindful of the family’s involvement with other agencies when developing Family Service Plans.
Provide concrete support and encouragement for getting the child to the appointments that may be necessary for full assessment and treatment.

Key Questions: What other agencies or providers are serving this family? What expertise might they offer or what information might they need to ensure the entire team is helping the family heal from trauma?

6. Use a comprehensive assessment of the child’s trauma experiences and their impact on the child to guide service provision.

Gather trauma history from the child, family members, collaterals, and agency case records.
Recognize that developmental delays and behavior problems may be related to trauma. A full developmental and medical assessment is needed to identify the appropriate treatment.
Refer the child for further assessment and treatment as needed (health, mental health, education, etc.). Ask providers about their level of training and experience in trauma-focused treatment.

Key Questions: What can we do to individualize our services to this child and her caregivers, based on her specific history, developmental level, and strengths and needs? What are things that make this child and her situation unique, and how are we addressing that in our conversations and case planning?

7. Support and promote positive and stable relationships in the child’s life.

Use genograms, Life Books, and conversation to identify people who are important to the child.
Review the case file; find people who have played a role in the child’s life in the past but have lost contact.
Teach caregivers ways to develop healthy interactions and attachments with children of different ages.
When considering placement and visitation recommendations, be sure to consider ways to maintain or strengthen the child’s current attachments.
Remember that DSS workers may be an important attachment for the child. Minimize changes in case workers as much as possible.

Key Questions: Who is important to this child? What positive, stable relationships has he had in his life? What can I do to maintain, strengthen, or re-establish those connections?

8. Provide support and guidance to the child’s family and caregivers.

Provide training and information to caregivers about the effects of trauma.
Encourage caregivers to participate in therapy, both to support the child’s recovery and to increase their own support network.
Address respite needs of birth and foster families.
Strengthening the family’s support system is critical. Include extended family, church, or neighborhood connections as much as possible. Consider ways to offer peer-to-peer support for families.

Key Questions: What connections, information, or resources will help this child and her family engage in trauma-informed treatment? What barriers exist to treatment, and how can I help the family to overcome them?

9. Manage professional and personal stress.

Take care of your own need for a healthy lifestyle and support system.
Help create a supportive environment in your unit by recognizing the emotional toll of this work on your co-workers. Even small tokens of appreciation and understanding make a difference.
Seek continuing education on the effects of trauma.

Key Questions: What symptoms of stress and secondary trauma am I experiencing? What can I do to add more healthy stress management to my daily life? What can we do on our team to take care of each other?

Sources: NCTSN, 2008; Cook, et al., 2005; Pease, 2012

References for this and other articles in this issue