Vol. 17, No. 2
May 2012

What Does a Trauma-Informed System Look Like in Practice?

According to Tullberg (2011), a trauma-informed child welfare system should have the capacity to translate trauma-related knowledge into meaningful action, policy, and practice changes. Furthermore, this system and those who work in it should understand:

the potential impact of traumatic stress on children served by the child welfare system;
how the system can either help mitigate the impact of trauma or inadvertently add new trauma;
the potential impact of current and past trauma on the families with whom we interact;
how adult trauma may interfere with caregivers’ ability to care for and support their children;
how to promote factors related to child and family resilience;
the impact of secondary trauma on the child-serving workforce;
that trauma shapes the culture of child welfare the same way trauma shapes the world view of victims; and
that a traumatized system will find it hard to identify clients’ past trauma or mitigate/prevent future trauma.

The following case example illustrates what some of these principles might look like in practice as families, child welfare services, and related professionals address the effects of trauma on children’s behavior and development.

* * * * * * * * * * * * * * * * * * * *

Billy’s Story
Adapted from Supporting Brain Development in Traumatized Children and Youth (Child Welfare Information Gateway, 2011)

Billy is a 6-year-old boy placed with his maternal grandmother by the child welfare system. Although his mother stated that she never used drugs while she was pregnant, Billy was born prematurely. His mother did not have a home or regular income, and they moved from place to place for several years. Billy slept wherever he could find a spot, and he ate only sporadically. Billy did not cause much trouble because he rarely spoke.

After Billy was removed from his mother’s care due to abandonment, he was placed in foster care until his grandmother could be located. Billy’s grandmother became concerned about his behavior and development while caring for him over the last 6 months. Billy hid food in his pockets and in his room, and his teacher reported he was stealing food at school. Billy also slept on the floor. Because he was so quiet, it took some time for Billy’s teacher to notice he had difficulty speaking and interacting in school.

Billy’s grandmother asked for help from his caseworker, who referred him to a mental health therapist for evaluation. After letting Billy speak openly about his past experiences, the therapist determined Billy’s tendencies to steal food and sleep on the floor were adaptive behaviors he developed while living with his mother—skills that helped him survive but are no longer appropriate given his current, more stable situation. Building on the therapist’s advice and taking Billy’s unique situation into consideration, the caseworker helped his grandmother establish regular routines, such as mealtimes and bedtimes, and gave her ideas for activities Billy and his grandmother could share to enhance the bond between them. The caseworker also connected the grandmother to a support group where she could meet other grandparents raising their grandchildren.

To address Billy’s problems in school, his caseworker sought the help of the school’s psychologist as well as a speech pathologist. Initial tests indicated Billy had attention-deficit/hyperactivity disorder (ADHD); with parental consent, Billy was prescribed medicine to address the issue. The speech pathologist also began working with Billy and gave his grandmother exercises to do with him at home. Several months later, when Billy’s grandmother and teacher felt the medicine was not “working,” Billy’s mental health therapist was consulted again. The therapist advised that Billy’s problems are more likely caused by symptoms of posttraumatic stress disorder (PTSD) resulting from his earlier traumatic experiences. Under the therapist’s supervision, Billy stopped taking the medicine, and his treatment plan was revised to include more trauma-focused therapies, to help Billy work through his feelings.

To improve communication and avoid overlapping efforts, Billy’s caseworker scheduled a multidisciplinary team meeting for the adults in Billy’s life. The long-term plan that resulted from the meeting included a number of action items:

Billy’s therapy sessions will continue; his grandmother will attend on occasion to support his progress and learn new activities and exercises to do with him at home.
At school, Billy’s teacher will follow the newly created individual education plan (IEP) to help him succeed academically and will create a weekly progress report. Billy’s speech pathologist scheduled several more sessions to track his improvements.
Billy’s grandmother will continue to attend monthly grandparent support meetings to make connections and receive support from other community members.
Billy’s caseworker will help his grandmother become a foster parent and seek financial support while she cares for Billy. If Billy’s father or mother is unwilling or unable to care for him, the grandmother will apply for subsidized guardianship to give Billy a more permanent home.

Source: Child Welfare Information Gateway. Available at http://www.childwelfare.gov/pubs/braindevtrauma.cfm