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Vol.
21, No. 3
June 2016
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?
National studies have shown that adverse childhood experiences (ACEs) lead to increased use of health and human services, poor health outcomes, and early death. In fact, with an ACE score of three (out of ten), at some point in your life you are 2x more likely to become a smoker and 6x more likely to attempt suicide. With an ACE score of four, you are 7x more likely to become an alcoholic and 12x more likely to try suicide at some point.
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
Project Broadcast developed two trauma screening tools for use by child welfare professionals: one for children under age six and one for children age six and older.
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
The NC Division of Social Services and its partners want to expand Project Broadcast to all NC counties. We want to ensure our entire child welfare workforce has the knowledge and skills they need to identify and respond to child trauma. We also want to make sure all child welfare agencies attend to the secondary traumatic stress needs of employees and have effective working relationships with the mental health community. We want to provide the support needed to make every agency's culture trauma-informed.
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
When it comes to our state's vision for making other child-serving systems more trauma-informed, the word "synergy" comes to mind. Synergy is the interaction or cooperation of two or more organizations to produce a combined effect greater than the sum of their separate effects (Oxford, 2016).
Today many entities in our state are focused on trauma:
- The Division of Medical Assistance is embedding trauma-informed information into the mental health service definitions;
- The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services is funding the NC Child Treatment Program, which is training hundreds of new clinicians each year (visit www.ncchildtreatmentprogram.org often; new clinicians are added monthly);
- The Department of Public Instruction is leading a School Mental Health Initiative;
- The Department of Public Safety/ Division of Juvenile Justice have implemented trauma-informed assessments, treatment, practices, and policies in their Youth Development and Youth Detention Centers;
- The Department of Health and Human Services is investing in Mental Health First Aid (www.mentalhealthfirstaid.org) which could have a tremendous impact on our entire system; and
- The Governor's Task Force for Mental Health and Substance Use issued many trauma-informed recommendations in May 2016.
Conclusion
It's an exciting time in our state. If we can realize how prevalent trauma is, recognize the signs and symptoms, respond with trauma-informed skills and practices, and avoid re-traumatizing children and families, we will be well on our way to mitigating trauma's negative effects. We can build resilience in children and families, promote protective factors, and heal those who have experienced 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.