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What Happened to You? A Strength-Based Approach to Trauma Informed Care

  • 11/1/2013 8:52:00 AM
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Sexualized behavior in a first-grader might evoke shock or frustration in some caregivers. Six-year-old Kay’s* maternal aunt recognized a cry for help. Kay was removed from her parents’ home by Child Protective Services at age 3 and placed in her aunt’s custody at age six. Kay’s biological parents had a history of substance abuse and she had witnessed significant domestic violence. Her mother struggled with serious mental illness and her father was incarcerated. Concerned about Kay’s behavior at home and possible past sexual abuse, Kay's aunt sought help.

Staff at the Youth Advocate Programs’ (YAP) Morris Sussex Outpatient Clinic supported Kay using Trauma Focused Cognitive Behavioral Therapy. TF-CBT, is an evidenced-based treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques . A trauma assessment indicated Kay’s history of physical, emotional, and sexual abuse. YAP’s clinician guided Kay through her trauma narrative, detailing her past abuse. Kay was able to feel safe and share her "trauma book" with her aunt. Within a few months of TF-CBT sessions, reports of sexualized behaviors at school, day care, and home lessened and soon ended. Kay's aunt reports that there have been no reported issues with Kay’s behaviors.

*name changed for confidentiality.

When YAP began serving youth involved with the juvenile justice and child welfare systems in the early 1970’s, the effects of traumatic events were being studied primarily among war veterans. Current research reveals that combat is but one of many potentially traumatic events that can have long-term effects on emotional, behavioral and physical health. Current findings also confirm what many youth workers have long suspected: That exposure to potentially traumatic events has the same implications for children and youth as for adults.

Traumatic events come in many forms. The ACE (Adverse Childhood Experiences) Study, conducted jointly by the Centers for Disease Control (CDC) and Kaiser Permanente’s Health Appraisal Clinic in San Diego, identified 10 forms of traumatic experience: physical, emotional and sexual abuse; physical and emotional neglect; and household dysfunction that includes a mother treated violently, household substance abuse, household mental illness; parental separation or divorce, and the incarceration of a household member. Rape has been added as a traumatic event in the American Psychiatric Associations latest Diagnostic and Statistical Manual (DSM-V).

The vast majority of Juvenile Justice and Child Welfare involved youth have experienced significant trauma (abuse, neglect, exposure to domestic violence, etc.). According to the U.S. Department of Justice, more than 1.6 million children and adolescents were involved in the juvenile justice system in 2008. A recent report by SAMHSA cites, “Children and youth involved in these systems are more likely to have been previously exposed to potentially traumatic events, such as witnessing or experiencing physical or sexual abuse, bullying, violence in families and communities, loss of loved ones, refugee and war experiences, or life-threatening injuries or illnesses. Children and youth involved in the juvenile justice or child welfare system who have serious emotional challenges are especially vulnerable. However, when services are uniquely tailored to help these children and youth, the savings in terms of cost and suffering are substantial.”

YAP provides trauma-informed care for young children like “Kay” in the story above as well as older children and adolescents who routinely experience violence and other traumatic events in some of this country’s poorest and most dangerous neighborhoods including those in Chicago’s south and west sides.

"We’ve seen trauma that is unimaginable—like one of our many Chicago Public Schools students who at age 15 literally watched his best friend die in his arms in the middle of the street from a gunshot wound." Gary Ivory, M.Div, YAP’s Southwest President/National Director of Program Development, in Testimony Before Attorney General Eric Holder’s “Defending Childhood Initiative’s Task Force on Children Exposed to Trauma

It is important to note that individuals of all ages who are exposed to traumatic events will respond differently, some more successfully than others. However, studies consistently show that high numbers of Juvenile Justice and Child Welfare system-involved children and youth have been exposed to traumatic events. When these youth are referred to YAP, they are typically bouncing from placement to placement, being held in secure detention, returning to their communities from placement and at risk of recidivism, or aging out of the system without the support they need. In areas such as Las Vegas, NV, commercially sexually exploited young people are being held on charges of prostitution.

“We had our reasons for running, but instead of dealing with those reasons, they decided to lock us up” (Caged Birds Sing). This is a common theme across the juvenile justice system, at least where girls are concerned. Instead of dealing with the abuses, traumas, and problems that put girls in a perfect storm, the system tries to lock them away. We are ignoring the root problems.
http://dayofthegirl.org/2013/06/girls-in-the-juvenile-justice-system/

Consistent with SAMHSA and evidence-based research, YAP’s focus with these young people is not on “What is Wrong with You?” but rather on “What happened to you?”, “What do you need?” and “How Can we help?” The successful outcomes achieved with this strength-based approach to trauma-informed care are improving lives, saving dollars and reducing costly long-term dependence on public systems resulting from unmet emotional, behavioral and physical health needs.

The cost of one case of abuse or neglect is estimated at more than $200,000 over a lifetime. The cost of incarcerating a juvenile is estimated at over $94,000 per year. The costs of lost potential and suffering of children and youth who are not helped to heal are inestimable. This is why trauma informed care is an essential element of YAP’s model and why we so strongly believe that “What is wrong with you?” is a question no child or youth should ever be asked.

Trauma Informed Care Fact Sheet

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