This week, you will construct a “3 2 1” response to all of the assigned materials for this Module.
A 321 Response is a “micro-paper” concept devised to make it easier to respond to readings, discussions, workshops, activities, etc. As a micro-paper, the complete response should be about 300 to 500 words.
The 321 Response goes as follows:
Write about three things you learned, grasped, or got out of the assigned content you feel were most important or useful. It’s a great idea to include references to specific content in this part of your post and address them directly. In other words, support your comments or questions.
Write about two aspects of the assigned readings/videos that you didn’t fully understand, you think need to be further clarified, you are uncertain about, or you completely disagree with. As above, be sure to specifically address why you included what you included.
Write one good question or provocation related to the assigned content for further discussion to finish your response; it should be something you want to pursue further or in greater depth. This is a great place to connect your response to your community, the larger world, or other issues that have come up for you in child-welfare related courses. Try to make your question (or questions, you don’t need to limit this to one) so good that readers cannot help but add comments or answers to your post.
First, in order to understand how the child welfare system can be more responsive to trauma, read the first article on developing a trauma-informed child welfare system (attached to module or accessible through this link: https://www.childwelfare.gov/pubPDFs/trauma_informed.pdf (Links to an external site.))
Note: This article presents some overlapping information with Klika & Conte Ch. 17 but gives a broader overview of some of the strategies in developing a more responsive child welfare system; whereas, Ch. 17 will give you some statewide strategies for more specific examples of how states are addressing the issue of trauma and developing trauma-informed systems of care
Second, read Klika & Conte Ch. 17 (Trauma-Informed Care: Definitions and Statewide Initiatives) in order to develop an understanding of how federal initiatives toward trauma-informed care turn into statewide projects
Third, watch this Ted Talk by a child welfare practitioner and administrator as she discusses her perceptions of providing trauma-informed care:
The paradox of trauma-informed care | Vicky Kelly | TEDxWilmington (https://www.childwelfare.gov/pubPDFs/trauma_informed.pdf.)
https://www.youtube.com/watch?v=jFdn9479U3s
Children’s Bureau/ACYF/ACF/HHS
800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov
ISSUE BRIEF
May 2015
Developing a Trauma-Informed
Child Welfare System WHAT’S INSIDE
Trauma and its effects
Implementing traumainformed practice in
child welfare systems
Cross-system
collaboration
Conclusion
References
Acknowledgments
The effects of child abuse and neglect are as varied
as the children affected. Some children who have
experienced trauma are resilient and show few,
if any, lasting effects. Others experience intense
trauma, which may affect many aspects of their
lives and last well into adulthood. It is essential
that child welfare professionals are prepared to
provide appropriate support to all children and
families who experience trauma as a result of
child abuse, neglect, or other acts of violence.
This issue brief will discuss the steps that may
be necessary to create a child welfare system
that is more sensitive and responsive to trauma.
Every child welfare system is different, and
each State or county child welfare system will
need to conduct its own systematic process of
assessment and planning, in collaboration with
key partners, to determine the best approach.
After providing a brief overview of trauma and
its effects, this issue brief discusses some of the
primary areas of consideration in that process,
including workforce development, screening and
assessment, data systems, evidence-based and
evidence-informed treatments, and funding.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
2
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Although partnerships are emphasized throughout
the document, we end with a more indepth discussion
of the importance of collaboration in creating a
successful, trauma-informed child welfare system.
The field is still in the beginning stages of gathering
evidence about what is required to implement a traumainformed approach to child welfare, and what the
outcomes of such an approach may be. For this reason,
some of the content for this issue brief has been
influenced by interviews with Children’s Bureau grantees
and other thought leaders in the field who are among the
first to implement and evaluate such an approach. This
includes grantees funded through the Integrating TraumaInformed and Trauma-Focused Practice in Child Protective
Service Delivery (HHS-2011-ACF-ACYF-CO-0169; http://
www.acf.hhs.gov/hhsgrantsforecast/index.
cfm?switch=grant.view&gff_grants_forecastInfoID=29079),
Initiative to Improve Access to Needs-Driven, EvidenceBased/Evidence-Informed Mental and Behavioral Health
Services in Child Welfare (HHS-2012-ACF-ACYF-CO-0279;
http://www.acf.hhs.gov/hhsgrantsforecast/index.
cfm?switch=grant.view&gff_grants_forecastInfoID=40944),
and Promoting Well-Being and Adoption After Trauma
(HHS-2013-ACF-ACYF-CO-0637; http://www.acf.hhs.gov/
hhsgrantsforecast/index.cfm?switch=grant.view&gff_
grants_forecastInfoID=64839) grants.
Trauma and Its Effects
According to the Substance Abuse and Mental
Health Services Administration (SAMHSA), “Individual
trauma results from an event, series of events, or set
of circumstances that is experienced by an individual
as physically or emotionally harmful or life threatening
and that has lasting adverse effects on the individual’s
functioning and mental, physical, social, emotional,
or spiritual well-being” (SAMHSA, 2014). If trauma
follows a single event that is limited in time (such as
a car accident, shooting, or earthquake), it is called
acute trauma. When children are exposed to multiple
traumatic events over time that are severe, pervasive,
and interpersonal in nature (such as repeated abuse and
neglect), and they experience long-term consequences
from these experiences, this is called complex trauma
(National Child Traumatic Stress Network, 2014).
Complex trauma may interfere with a child’s ability to
form secure attachments to caregivers and many other
aspects of healthy physical and mental development.
Historical trauma affects populations that have
experienced cumulative and collective trauma
over multiple generations. Affected groups in
the United States include American Indians,
African-Americans, immigrant groups, and
families experiencing intergenerational poverty.
Children within these families may exhibit signs
and symptoms of trauma—such as depression,
grief, guilt, and anxiety—even if they have not
personally experienced traumatic events.
Traumatic experiences overwhelm children’s natural
ability to cope. They cause a “fight, flight, or freeze”
response that affects children’s bodies and brains.
Chronic or repeated trauma may result in toxic stress
that interferes with normal child development and cause
long-term harm to children’s physical, social, emotional,
or spiritual well-being. These adverse effects can include
changes in a child’s emotional responses; ability to think,
learn, and concentrate; impulse control; self-image;
attachments to caregivers; and relationships with others.
Across the life span, traumatic experiences have been
linked to a wide range of problems, including addiction,
depression and anxiety, and risk-taking behavior—these
in turn can lead to a greater likelihood of chronic ill
health: obesity, diabetes, heart disease, cancer, and even
early death. For more information about the long-term
effects of child abuse and neglect and other traumatic
experiences, see the Adverse Childhood Experiences
study (ACE Response, http://www.aceresponse.org/
who_we_are/subpage.cfm?ID=43) and Longitudinal
Studies of Child Abuse and Neglect (LONGSCAN,
http://www.unc.edu/depts/sph/longscan/). Child
Welfare Information Gateway also produced a factsheet
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
3
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
that explains the long-term physical, psychological,
behavioral, and societal consequences of child abuse
and neglect. Read Long-Term Consequences of Child
Abuse and Neglect at https://www.childwelfare.
gov/pubs/factsheets/long-term-consequences.
Not all children will experience all of these effects.
Children’s responses to traumatic events are unique
and affected by many factors, including their age at
the time of the event, the frequency and perceived
severity of trauma, and the child’s innate sensitivity,
as well as protective factors such as the presence
of positive relationships with healthy caregivers,
physical health, and natural coping skills.
Trauma of all kinds is extremely common among children
involved with child welfare. Studies show that as many
as 9 out of 10 children in foster care have been exposed
to some form of violence (Stein et al., 2001). Entry into
the child welfare system causes additional trauma due
to separation from family, school, neighborhood, and
community, as well as fear and uncertainty about the
future. In addition, children who enter the child welfare
system are more likely than others to have experienced
multiple traumatic events and to exhibit more complex
symptoms (Chadwick Trauma-Informed Systems
Project, 2013). For example, one study showed that
nearly half of youth who were subjects of maltreatment
reports had emotional or behavioral problems that
were clinically significant (Burns et al., 2004).
Professionals who work within child-serving systems
must be aware of a child’s trauma history and its
effects, or their actions and responses to the child
may inadvertently trigger trauma memories, worsen
symptoms, or further traumatize the child. When child
welfare professionals are mindful of a child’s history
of trauma, they are better positioned to connect that
child to appropriate, trauma-informed, evidence-based
services for support. With awareness and knowledge of
how to address and treat children’s trauma histories, the
child welfare system can become a place of healing.
Implementing Trauma-Informed
Practice in Child Welfare Systems
The National Child Traumatic Stress Network
(NCTSN, n.d.) adopted the following definition of a
trauma-informed system:
A trauma-informed child- and family-service
system is one in which all parties involved
recognize and respond to the impact of traumatic
stress on those who have contact with the system,
including children, caregivers, and service
providers. Programs and agencies within such a
system infuse and sustain trauma awareness,
knowledge, and skills into their organizational
cultures, practices, and policies. They act in
collaboration with all those who are involved with
the child, using the best available science, to
facilitate and support the recovery and resiliency
of the child and family.
In other words, trauma-informed child welfare practice is
not a discrete task but rather involves the day-to-day
work of the system as a whole. Child welfare systems that
are trauma informed are better able to address children’s
safety, permanency, and well-being needs. Service
improvements include more children receiving the
trauma screening, assessment, and evidence-based
treatment they need. These improvements, in turn, may
produce better outcomes, including:
Fewer children requiring crisis services, such as
emergency department visits or residential treatment
Decreased use of psychotropic medications
Fewer foster home placements, placement
disruptions, and reentries
Reduced length of stay in foster care
Improved child functioning and increased well-being
(U.S. Department of Health and Human Services, 2013)
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
4
Use of Psychotropic Medications
Studies consistently show that children involved
with child welfare are prescribed psychotropic
medications at higher rates than the general
population (Children’s Bureau, 2012).
Effective screening and assessment for trauma
can help child welfare systems more effectively
identify and treat psychological symptoms and
behaviors resulting from trauma. Addressing
trauma symptoms with appropriate, evidencebased psychosocial treatment may decrease the
need for psychotropic medications.
See the following resources for more information:
Use of Psychotropic Medications web section
(resources for professionals, collected by Child
Welfare Information Gateway): https://www.
childwelfare.gov/topics/systemwide/
mentalhealth/effectiveness/psychotropic/
Making Healthy Choices: A Guide on
Psychotropic Medications for Youth in Foster
Care (a guide for professionals to use when
working with youth, produced by the Children’s
Bureau): https://www.childwelfare.gov/pubs/
makinghealthychoices/
Key elements of a transition to a trauma-informed child
welfare system may include workforce development;
routine screening and assessment for trauma history
and related symptoms; changes to data systems;
implementation of trauma-informed, measurementdriven case planning and referral to evidence-supported
treatment; and new approaches to funding for services.
For more information and resources on implementation,
see the Trauma-Informed Practice section of the
Information Gateway website at https://www.
childwelfare.gov/topics/responding/trauma/.
Workforce Development Considerations
The workforce is a critical element in the trauma-informed
child welfare system. The workforce includes staff at all
levels of the agency (receptionists, frontline staff,
caseworkers, supervisors, managers, administrators, and
other staff), as well as foster and adoptive parents.
Many consider development of a trauma-informed
workforce to be a necessary step before other
components of a trauma-informed system can be
implemented effectively. In order to become more trauma
informed, professionals and resource families may need to
make significant shifts in thinking and behavior while
performing jobs that are stressful already. It will be
important to integrate a trauma perspective throughout
the system’s day-to-day activities as much as possible so
that staff view this as an essential element of their work,
rather than as simply another new initiative that may fade
quickly.
Shifts in Thinking
Moving from a traditional child welfare approach to one
that is more trauma informed requires members of the
workforce at all levels to make certain paradigm shifts.
These may include the following:
A “trauma lens.” In the past, trauma was thought to
result from a single, catastrophic event. We now know
that chronic neglect, abuse, or any incident of
separation, loss, or grief—even a sudden move or
placement change—can be traumatic for children.
Developing a trauma lens includes reinterpreting
behaviors that were previously seen as being caused
by a mental illness or behaviors exhibited by a “bad
kid” as the potentially reversible consequences of
trauma.
In general, becoming a trauma-informed
child welfare system involves a shift from
asking, “What’s wrong with you?” to asking,
“What happened to you?”
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
5
Shift in goals. The focus of child welfare services is
often on substantiating a defined occurrence of child
maltreatment and ensuring children’s physical safety. In
a trauma-informed system, the focus broadens to
include healing the impact of trauma and improving
children’s social and emotional well-being, along with
the more traditional goals of safety and permanency.
Importance of collaboration. To achieve the goal of
enhancing well-being, many child welfare agencies find
they must significantly deepen their collaboration with
other service systems, including enhancing
communication, planning and working toward joint
goals, sharing robust data about the families they
serve, and strategically blending or braiding funding
streams.
Focus on early intervention. A growing body of
research demonstrates the long-term effects of trauma
on children’s physical, social, and emotional well-being.
A trauma-informed child welfare system reflects the
understanding that by focusing more resources on
identification of trauma and early intervention services,
we may prevent or mitigate some of those long-term
effects.
Approach to families. In making this shift, it is
important to be clear with families about the boundary
between their involuntary participation in the child
welfare system (substantiation of maltreatment) and
what may be their voluntary participation in services to
promote healing from trauma.
Awareness of intergenerational trauma. It also is
important to understand that family members are likely
to have experienced their own trauma. Like their
children, caregivers’ challenging behaviors may be
most productively viewed as maladaptive responses to
their own trauma.
Role of child welfare professionals. With the shift in
attention toward well-being and healing, the child
welfare professional’s role changes. Staff will spend
more time screening for trauma, facilitating effective
mental health treatment, and following up to ensure
appropriate progress is being made toward those
treatment goals, including monitoring the use of
psychotropic medication.
Awareness of secondary traumatic stress. Hearing
about children’s trauma histories may result in
secondary traumatic stress among professionals and
caregivers. Left untreated, this can decrease
effectiveness and lead to excessive burnout or
turnover. Being trauma informed requires attention to
trauma’s effects on all participants in the system,
including children, caregivers, and service providers.
Staff Training
Trauma training should be introduced from the beginning
of each staff member’s employment at the agency. Topics
may include:
Trauma basics: What trauma is, its impact on the brain,
nd how it affects children (including the role of
riggers/reminders)
a
t
How to screen children for trauma
Children’s need for physical and psychological safety
Resiliency case planning: Looking beyond risk to
explore how services can build children’s resilience and
sense of competency
When, how, and where to refer children for evidencebased trauma treatment
How to work with parents who have been traumatized
The National Child Traumatic Stress Network
(NCTSN) offers the Child Welfare Trauma Training
Toolkit, which is available at http://www.nctsnet.
org/products/
child-welfare-trauma-training-toolkit-2008.
NCTSN also offers a guide for administrators on
using a trauma-informed lens to transform child
welfare systems. It is free and can be accessed
after creating an account and logging in at http://
www.surveygizmo.com/s3/1769592/
Access-to-Creating-TICW-Systems-A-Guide-forAdministrators-CTISP-DI.
For more training resources, visit the NCTSN
website at http://www.nctsnet.org/resources/
training-and-education.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
6
Effective training for trauma-informed child welfare
practice will require more than a single workshop or class
session. Staff need to be actively engaged in changes to
the system; soliciting their input will be critical to creating
buy-in and successful implementation. Adult learners also
need to hear messages many times, and in a variety of
ways, before they are likely to change their behavior.
Training can be conducted separately for child welfare
professionals, but it may have more impact if child welfare
staff are cross-trained with other professionals in partner
agencies and systems. After initial training, follow-up
training and technical assistance can be provided in some
or all of the following formats:
Supervision, including case review, fidelity monitoring,
and accountability
Coaching and mentoring
In-house “trauma consultants” or “trauma champions”
Learning collaboratives
Periodic “booster” trainings (face to face or via
webinars)
Newsletter tips and reminders about trauma
symptoms, behaviors, and impact
Education and Support for Resource Families
In a trauma-informed child welfare system, information
about child traumatic stress is a central part of the initial
training required to become a foster or adoptive parent.
Current resource parents can be trained separately or
engaged in joint trainings with child welfare staff. This
training also should be offered to kinship caregivers, as
well as to birth parents who are reuniting with their
children. It should include the basics of trauma and its
impact on children, the significance of trauma triggers,
how to recognize and respond appropriately to traumarelated behaviors, how foster and kinship caregivers can
work effectively with birth parents, and the importance of
self-care.
Education is an ongoing process. After initial training, a
trauma-informed perspective can be infused in work with
resource parents in additional ways, including the
following:
Regularly include tips or articles about child trauma in
resource parent newsletters. (See the Information
Gateway factsheet Parenting a Child Who Has
Experienced Trauma, which can be found at https://
www.childwelfare.gov/pubs/factsheets/child-trauma.)
Connect foster parents or kinship caregivers with birth
parents soon after placement, and collect information
from birth parents to share with caregivers regarding
the child’s trauma history, triggers, and behaviors.
Conduct child-focused team meetings that engage
birth parents and kinship caregivers or foster parents in
collective planning and problem solving. Include a
trauma consultant on these teams to provide early
intervention to children who display troubling
behavioral symptoms in placement.
Implement placement disruption prevention meetings
when needed.1
1 Some of the training suggestions for professionals and resource
families are derived from the National Child Traumatic Stress Network
(2013).
Caring for Children Who Have Experienced Trauma: A
Workshop for Resource Parents, by the National Child
Traumatic Stress Network, is a training resource that may
be useful when working with resource parents, see http://
www.nctsnet.org/products/
caring-for-children-who-have-experienced-trauma.
Secondary Traumatic Stress
Working with children and families who have experienced
trauma is undeniably difficult. As professionals screen and
assess children and families for trauma, and resource
parents receive more information about children’s
histories, they may be vulnerable to secondary traumatic
stress (STS)—traumatic stress as a result of exposure to
others’ experiences. (Secondary traumatic stress is
sometimes referred to as vicarious trauma or compassion
fatigue.) Left untreated, STS can lead to decreased
effectiveness and morale and high rates of burnout and
turnover.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
7
A trauma-informed child welfare agency recognizes the
need to invest in the health, well-being, and resilience of
its workforce. Some suggestions for helping to prevent
and address STS (and attend to primary stress
experienced on the job) include the following:
Begin trauma trainings with a discussion of STS. This
can help professionals make a personal connection to
the topic and build buy-in for the training, while
validating staff experience.
Create peer-to-peer support groups to give staff and
resource families opportunities to learn about STS,
share their experiences, and discuss coping strategies.
Build “resident expert teams” of 6 to 10 staff members
charged with identifying and assessing STS and its
effects and helping to build a system to better support
affected staff.
Offer health and wellness activities (e.g., mindfulness,
yoga, dance, art) in the office and at foster parent
trainings or gatherings to encourage resilience.
Integrate resilience skill-building into training, staff
meetings, and supervision.
Offer Psychological First Aid to staff and resource
families who work with a child or family involved in a
tragic accident, incident of violence, or death.2
2 Psychological First Aid is an evidence-informed approach for assisting
children, adolescents, adults, and families in the aftermath of disasters,
see http://www.nctsn.org/content/psychological-first-aid.
Take time during supervision and/or case staffing to
address how cases are impacting the child welfare
professional personally and what support is needed
from peers.
Find more information about STS on the Child Welfare
Information Gateway website at https://www.childwelfare.
gov/topics/responding/trauma/secondary/.
Screening and Assessment
A trauma-informed child welfare system relies heavily on
initial and ongoing screening and assessment to identify
children’s trauma-related needs and assess their progress
(U.S. Department of Health and Human Services, 2013).
The goals of trauma screening and assessment include
the following:
Trauma screening to learn about a child’s trauma
history, to identify current symptoms and functional
delays, and to identify children who need further
assessment and possible treatment. Screening should
be brief and should be administered to all children
entering child welfare, as part of or in addition to
regular, comprehensive screenings already conducted
by child welfare professionals, such as safety and risk
assessment, family assessment, placement tools, and
collection of prenatal and parents’ medical history.
Screening should be repeated periodically thereafter,
including after stressful events, such as a change in
placement.
Mental health assessment for children whose screen
indicates a trauma history combined with
psychological symptoms and/or functional delays. A
positive screen warrants referral to a specialist. This
more indepth clinical evaluation by a mental health
professional may include a diagnostic interview in
addition to standardized mental and behavioral health
assessment tools. The mental health assessment forms
the basis for treatment planning.
Functional assessment or periodic and holistic
evaluation of a child’s social and emotional functioning.
In the case of functional assessment, measurement
tools are used not to reach a diagnosis but to gather
data about individual children’s strengths and needs,
measure improvement in skills and competencies, and
inform ongoing case planning. Many evidence-based
treatment models incorporate this within service
delivery.
Outcome measurement. At a child level, outcomes
are measured to ensure that services are achieving
desired effects and to inform changes to the treatment
plan. At the system level, this process can help identify
changes needed to improve the effectiveness of the
service array as a whole.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
8
These goals are not mutually exclusive—a single
instrument, in the right context, may be used for multiple
purposes. For example, functional assessment measures
may be administered as part of the mental health
assessment and may also serve the role of outcome
measurement. (For a more detailed discussion, see
Conradi, Landsverk, & Wotring, 2014.)
Selecting Screening and Assessment Measures
The following are some considerations that child welfare
agencies and their partners might weigh when selecting
trauma screening and assessment instruments:
Length. Keeping an initial screening as brief as possible is
critical, in light of other activities that must be completed
by child welfare professionals upon children’s entry to the
system. Children whose initial trauma screens are positive
should receive a more thorough follow-up assessment by
a clinical mental health provider.
Content. Most screening tools seek to assist busy child
welfare professionals in quickly identifying trauma
exposure and/or symptoms. There tend to be different
screening tools for older and younger children, and some
tools employ language and cultural adaptations for
different populations. A follow-up assessment should
more fully explore the child’s trauma history and current
symptoms. Symptoms may include internalizing and
externalizing behaviors, as well as moods, cognitive
issues, school difficulties, trauma triggers, and relational
skills, among others.
Connections Between Trauma Exposure and
Symptoms. Some tools have the potential to help
professionals see important connections between a
child’s exposure to traumatic events and his or her
present functional difficulties. An instrument that makes
these connections explicit may help prevent staff from
misinterpreting behavior and may facilitate more
appropriate referrals.
Cost. Costs to consider include the initial purchase of the
instrument, training required to implement it, and
expenses for data collection and/or analysis.
Ease of Administration and Data Sharing. Agencies
and partners may need to ask the following questions: Is it
a paper/pencil screening, or can it be administered via
computer, with results linked automatically into the
existing data system? Is the instrument self-scoring?
Where will the necessary information come from (the
parent/caregiver, the child, other sources such as case
records and third-party reports)?
Psychometric Properties. How accurately does the tool
measure what it purports to measure? How many false
positives and/or negatives will it produce (e.g., sensitivity
and specificity)?
For more potential screening and assessment tools, visit
the following websites:
National Child Traumatic Stress Network Measures
Review Database: http://www.nctsn.org/resources/
online-research/measures-review
SAMHSA, Screening Tools for Trauma: http://www.
integration.samhsa.gov/clinical-practice/
screening-tools#TRAUMA
Data System Needs
Selecting appropriate screening and assessment tools is
important, but it is equally important to consider how the
data will be used—individually, on a systems level, and
across systems. Currently, the research base does not
exist to say what approaches to data collection and
sharing are most effective. The field is just beginning to
explore what data a trauma-informed child welfare agency
needs to collect and how those data should be used.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
9
The following are some questions for child welfare
agencies to consider as they assess their own data
systems’ strengths, needs, and gaps, and develop
processes for filling those gaps:
On a child level, how might critical data (for example,
screening and assessment results) be captured as a
child moves throughout the system? Could these data
be used to prompt a caseworker to follow up with
further assessments or treatment, or could the data
system help track an individual child’s progress and
drive case planning by comparing results over time?
On a systems level, how can aggregated data be
used to understand what is happening to children in
the child welfare system? For example, what types of
children are improving, based on functional
assessment scores? What services are they using?
Which children are not improving or are getting worse?
Across systems, how could data be made accessible
to all service providers who are involved with a child,
including those working in systems such as mental
health and Medicaid, while taking into consideration
confidentiality concerns and privacy guidelines where
applicable? Likewise, could the results of assessments
completed by mental health professionals and
Medicaid claims data (for example, data related to
prescriiption and dosage of psychotropic medications)
be accessible within the child welfare data system to
inform case planning?
Evidence-Supported Practices for Trauma
Treatment
To recover from trauma, children and families often
require treatment delivered by skilled child welfare staff
and mental health therapists. Children are well served
when interventions are effective and appropriate for their
needs, gaps and duplication are eliminated from the
service array, and funders work together to coordinate
services and reimburse providers for treatment.
Selecting Evidence-Based/Evidence-Informed
Interventions
To ensure an appropriate array of evidence-based and
evidence-informed services for children who have
experienced trauma, child welfare systems must first
assess the needs of their population and the services that
currently exist within their communities.
Children and youth should be reevaluated periodically to
identify any new symptoms that have emerged and to
assess treatment progress. Data about children’s
improvement (or lack thereof) over time, gathered from
functional assessments and outcomes measurement, can
be used to continuously monitor individual children’s
progress and guide case planning.
Eventually, this data also may be aggregated to help
agencies assess the appropriateness of the service array
for all children and for particular subgroups. Using that
information, the service array can be further reconfigured
to best meet the measured needs of children, as part of
the agency’s continuous quality improvement (CQI)
process. (For more information about CQI in child
welfare, see the Children’s Bureau Information
Memorandum on Establishing and Maintaining
Continuous Quality Improvement Systems in State Child
Welfare Agencies, http://www.acf.hhs.gov/sites/default/
files/cb/im1207.pdf, and the Information Gateway web
section on Approaches to Quality Improvement at https://
www.childwelfare.gov/topics/management/practiceimprovement/quality/approaches/.)
Following are some evidence-based and evidenceinformed programs that are being used to help children,
youth, and families who have experienced trauma.
The research base for these treatments varies; the
inclusion of a program in this issue brief should not be
viewed as an endorsement by the Children’s Bureau.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
10
For more information about evidence-based
treatments, visit the following websites:
California Evidence-Based Clearinghouse for
Child Welfare, Trauma Treatment (Child &
Adolescent): http://www.cebc4cw.org/topic/
trauma-treatment-for-children/
National Child Traumatic Stress Network
Empirically Supported Treatments and
Promising Practices: http://www.nctsn.org/
resources/topics/treatments-that-work/
promising-practices
SAMHSA’s National Registry of Evidencebased Programs and Practices: http://www.
nrepp.samhsa.gov/
Evidence-based treatments are those that are supported
by scientific research as being effective in improving
outcomes for children and families. They have strong
research design, evidence of significant positive effects,
sustained effects, and capacity for replication.
A strong evidence base supports the following practices,
according to the California Evidence-Based
Clearinghouse:
Trauma-Focused Cognitive-Behavioral Therapy
(TF-CBT) is one highly popular and well-researched
intervention shown to help children and adolescents
who have experienced trauma. It is designed to reduce
negative emotional and behavioral responses by
addressing distorted beliefs and attributions related to
the trauma. For more information about TF-CBT, visit
http://tfcbt.musc.edu/ or read Information Gateway’s
Trauma-Focused Cognitive Behavioral Therapy for
Children Affected by Sexual Abuse or Trauma at
https://www.childwelfare.gov/pubs/trauma/.
Parent-Child Interaction Therapy (PCIT) is a familycentered treatment approach proven effective for
abused and at-risk children ages 2 to 8 and their
caregivers. During PCIT, therapists coach parents while
they interact with their children. For more information,
visit http://www.pcit.org/ or read Information
Gateway’s Parent-Child Interaction Therapy With
At-Risk Families at https://www.childwelfare.gov/
pubPDFs/f_interactbulletin.pdf.
Eye Movement Desensitization and Reprocessing
(EMDR) has been validated as an effective treatment
for trauma victims. It integrates a number of different
therapeutic approaches, including cognitivebehavioral therapy and the use of eye movements to
decrease emotional distress related to traumatic
memories. For more information about EMDR, visit
http://www.emdr.com/.
Evidence-informed practices make use of the best
available research and practice knowledge to guide
program design and implementation within the context of
the child, family, and community characteristics, culture,
and preferences.
The following are some of the available trauma-focused
treatment models supported by research or practice
knowledge:
Alternatives for Families: A Cognitive-Behavioral
Therapy (AF-CBT): http://www.afcbt.org/
Attachment and Biobehavioral Catch-up (ABC):
http://www.infantcaregiverproject.com/#!about_us/
cjg9
Attachment, Self-Regulation, and Competency
(ARC): http://www.traumacenter.org/research/ascot.
php
Child and Family Traumatic Stress Intervention
(CFTSI): http://www.nrepp.samhsa.gov/
ViewIntervention.aspx?id=305
Child-Parent Psychotherapy (CPP):
http://preview.childtrauma.ucsf.edu/resources-0
Cognitive-Behavioral Therapy for Posttraumatic
Stress Disorder (CBT for PTSD): http://www.ncbi.nlm.
nih.gov/pmc/articles/PMC3083990/
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
11
Modular Approach to Therapy for Children with
Anxiety, Depression, Trauma or Conduct Problems
(MATCH-ADTC): http://www.practicewise.com/
portals/0/MATCH_public/index.html
Prolonged Exposure Therapy for Adolescents:
http://www.med.upenn.edu/ctsa/certification.html
Real Life Heroes: http://reallifeheroes.net/
The Sanctuary Model: http://sanctuaryweb.com/
sanctuary-trauma.php
Structured Psychotherapy for Adolescents
Responding to Chronic Stress (SPARCS):
http://sparcstraining.com/
Trauma Affect Regulation: Guide for Education and
Therapy (TARGET): http://www.advancedtrauma.com/
Services.html
Trauma Systems Therapy (TST): http://www.
aboutourkids.org/traumasystemstherapy/
Selecting Interventions
Before meaningful changes to the service array can be
made, there must be buy-in at all levels of the childserving system, as well as collaboration across systems,
including Medicaid, mental health, juvenile justice,
education, and health care. Administrators and decisionmakers must fully understand the effects of trauma and
embrace the need to develop and fund evidence-based
treatments.
The following are some questions for agencies to consider
to help assess the fit of a particular therapeutic model for
a community’s needs:
What level of evidence is available to support claims
of effectiveness?
Is the practice effective with a broad spectrum of
children and families (including various ages and
cultural settings)?
Has the practice been proven effective specifically with
children and families who have experienced
trauma?
Is the practice a good fit for the needs of the target
population?
What kind of implementation support is offered for
the treatment model (including fidelity management)?
Are there ongoing trainings and support, or is training
delivered in a single session?
Can the model be delivered in an outpatient setting?
Does it include a caregiver component?
Who administers the therapy? What level of education
and training is required?
How much will it cost to implement and sustain the
practice?
Who owns and supports the treatment model?
How readily available is the model, and how
accessible is training and support?
Is the model a good fit with agency and partner
needs, values, workforce capacity, and other
resources?
Can the model be adapted as needed while
maintaining adequate fidelity?
Funding
The field has yet to reach consensus on whether
developing a trauma-informed child welfare system will
require additional funding and what a successful
approach to funding this work will entail. (While it seems
clear that implementing evidence-based practices will
require significant investments to train staff and maintain
fidelity, these costs may be offset by savings in other
areas within a fully trauma-informed system.) Because
every child welfare jurisdiction is different, States and
counties will lead the way in developing what works best
for them.
Agencies may wish to begin by exploring opportunities to
leverage current, existing funding streams to support
trauma-informed training, screening and assessment,
interventions, and data systems. This will likely include
working closely with systemic partners—for example,
working with the State Medicaid system and managed
care organizations to fund evidence-based, traumainformed treatments for children. However, the available
resources and policies guiding the use of these funding
streams will vary by State.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
12
The Information Gateway Funding for Program Areas web
section lists resources for specific types of programs,
including mental health. It can be found at https://www.
childwelfare.gov/topics/management/funding/
program-areas/.
For information and resources about Medicaid funding,
see the web section on using Medicaid to fund prevention
services at https://www.childwelfare.gov/topics/
management/funding/program-areas/prevention/federal/
nondedicated/medicaid/.
Agencies may also want to review the guidance provided
in the following joint Center for Medicaid and CHIP
Services (CMCS) and SAMHSA Informational Bulletin on
coverage of behavioral health services for children, youth,
and young adults with significant mental health conditions
(a category that is likely to include many children who
have experienced trauma) at http://www.medicaid.gov/
federal-policy-guidance/downloads/CIB-05-07-2013.pdf.
Cross-System Collaboration
To serve traumatized children and families effectively, the
entire child-serving system—at the agency, local, and
State levels—needs to understand trauma and create
policies and practices that support more effective
treatment. In a trauma-informed system, child welfare,
mental health, Medicaid, juvenile justice, the courts,
health care providers, and schools work together with a
common purpose of helping children and families heal.
Collaboration is not without challenges. Some of the
difficulties experienced by Children’s Bureau grantees
interviewed for this brief include the following:
Different understandings of what trauma is and how it
affects children and families
Conflicting goals or priorities
Funding constraints
Policies and practices that limit the time available to
help children and families heal from trauma
Lack of a universal consent form or other confidentiality
concerns
Despite these challenges, some strategies have shown
promise in building collaboration across child-serving
systems. Building relationships across systems as a matter
of course and maintaining these relationships through
regular contact have been found to be more effective
than waiting for a crisis to force systems to work together.
Some strategies for initiating stronger cross-disciplinary
relationships include the following:
Cross-disciplinary trauma training. When
professionals from various child-serving disciplines
attend trauma training together, they develop a shared
vocabulary, commitment, and understanding of trauma
and have the opportunity to develop norms, values,
and procedures for how teams will work together to
support children and families.
Collaborative system mapping. In this process,
representatives from multiple disciplines work together
to create a flow chart for how children and families
move through each system. This can help staff and
administrators alike learn more about how other
systems work. Identifying points of intersection
between systems can lead to deeper discussions
about infrastructure, case/treatment plans, referrals,
data sharing, and communication (e.g., when there is
court involvement or a threat of disruption).
Shared STS trainings. All child-serving professionals
have stressful jobs and experience the difficulties of
working with children and families who have trauma
histories. Sharing experiences of secondary trauma
may build understanding across disciplines and “break
the ice” for systems to work toward partnership in
other areas, as well.
Case conferencing. Talking about specific children
and families can be another way to build investment
and relationships across systems. Working together to
solve problems and promote healing for a specific
child, about whom all participants share concern,
fosters communication and relationships that may carry
over into work on other cases in the future.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
13
Funding. Funding can be used in various ways to
encourage and support cross-system collaboration to
better serve children’s trauma needs. This is happening
at a Federal level among the Administration for
Children and Families, Centers for Medicaid and
Medicare Services, and SAMHSA (for more
information, visit http://www.medicaid.gov/FederalPolicy-Guidance/Downloads/SMD-13-07-11.pdf). At a
local level, this might include strategies such as
providing incentive payments to encourage mental
health clinics to provide evidence-based trauma
treatment services to children in the child welfare
system, or funding a cross-disciplinary trauma learning
collaborative.
Although collaboration can be challenging, the benefits
to children and families are great as communities move
from a fragmented approach to a cross-system approach
that treats each child as a whole person.
Conclusion
Increased attention to childhood trauma within child
welfare agencies across the country reflects a growing
understanding of the significant impact that trauma can
have on children’s well-being and the community as a
whole. Left untreated, trauma may have serious, complex
consequences for children throughout their lifespan.
Addressing trauma effectively is more than an isolated
practice; it requires a coordinated, system-wide approach.
Working together, staff at all levels of the child welfare
system and related agencies—as well as resource
families—can implement the screening, assessment, and
treatment practices needed to better help the children
and families in their care heal from trauma.
For more information and resources, see the Treatment
and Trauma-Informed Care section of the Child Welfare
Information Gateway website at https://www.childwelfare.
gov/topics/responding/trauma/.
References
Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P.,
Kolko, D. J. Campbell, Y., & Landsverk, J. (2004). Mental
health need and access to mental health services by
youths involved with child welfare: A national survey.
Journal of the American Academy of Child &
Adolescent Psychiatry, 43(8), 960–970.
Chadwick Trauma-Informed Systems Project. (2013).
Creating trauma-informed child welfare systems: A
guide for administrators (2nd ed.). San Diego, CA:
Chadwick Center for Children and Families. http://
www.chadwickcenter.org/CTISP/images/
CTISPTICWAdminGuide2ndEd2013.pdf
Children’s Bureau, Administration on Children, Youth and
Families, Administration on Children and Families, U.S.
Department of Health and Human Services. (2012).
Information Memorandum (ACYF-CB-IM-12-03).
Retrieved from http://www.acf.hhs.gov/sites/default/
files/cb/im1203.pdf
Conradi, L., Landsverk, J., & Wotring, J. R. (2014).
Screening, assessing, monitoring outcomes, and using
evidence-based interventions to improve the wellbeing of children in child welfare. Washington, DC:
Children’s Bureau. http://www.nrcpfc.org/is/
downloads/WP-ScreeningAssesingAndMonitoring.pdf
National Child Traumatic Stress Network. (n.d.). Creating
trauma-informed systems [Webpage]. Retrieved from
http://www.nctsn.org/resources/topics/
creating-trauma-informed-systems
National Child Traumatic Stress Network. (2013). Using
trauma-informed child welfare practice to improve
placement stability: Breakthrough series collaborative
[Practice cards]. Retrieved from http://www.nctsn.org/
sites/default/files/assets/pdfs/using_ticwp_bsc_
practicecards_final.pdf
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information
Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov
National Child Traumatic Stress Network. (2014). Complex
trauma: Facts for caregivers. Retrieved from http://
www.nctsn.org/sites/default/files/assets/pdfs/
complex_trauma_caregivers_final.pdf
Substance Abuse and Mental Health Services
Administration. (2014). SAMHSA’s concept of trauma
and guidance for a trauma-informed approach. HHS
Publication No. (SMA) 14-4884. Rockville, MD:
SAMHSA. Retrieved from http://store.samhsa.gov/shin/
content//SMA14-4884/SMA14-4884.pdf
Stein, B., Zima, B., Elliott, M., Burnam, M., Shahinfar, A.,
Fox, N., et al. (2001). Violence exposure among schoolage children in foster care: Relationship to distress
symptoms. Journal of the Academy of Child and
Adolescent Psychiatry, 40(5), 588–594.
U.S. Department of Health and Human Services. (2013,
July 11). [Letter to State Medicaid Directors]. Retrieved
from http://www.medicaid.gov/Federal-PolicyGuidance/Downloads/SMD-13-07-11.pdf
Acknowledgments:
This issue brief was developed by Child Welfare
Information Gateway and based in part on interviews with
Children’s Bureau grantees funded through the
Integrating Trauma-Informed and Trauma-Focused
Practice in Child Protective Service Delivery (HHS-2011-
ACF-ACYF-CO-0169), Initiative to Improve Access to
Needs-Driven, Evidence-Based/Evidence-Informed
Mental and Behavioral Health Services in Child Welfare
(HHS-2012-ACF-ACYF-CO-0279), and Promoting WellBeing and Adoption After Trauma (HHS-2013-ACFACYF-CO-0637). Information Gateway wishes to
acknowledge the valuable input of Becci Akin, Chad
Anderson, Linda Bass, Sharri Black, James Caringi, Marilyn
Cloud, Pamela Cornwell, James Henry, Kevin Kelley, Alice
Lieberman, Patricia Long, Susana Mariscal, Kelly
McCauley, Vickie McArthur, Kathryne O’Grady, Sherry
Peters, Jeanne Preisler, Cheryl Rathbun, and Jim Wotring.
The conclusions discussed here are solely the
responsibility of the authors and do not represent the
views of grantees or the official views or policies of the
funding agency.
Suggested citation:
Child Welfare Information Gateway. (2015). Developing a
trauma-informed child welfare system. Washington, DC:
U.S. Department of Health and Human Services,
Children’s Bureau.
U.S. Department of Health and Human Services
Administration for Children and Families
Administration on Children, Youth and Families
Children’s Bureau
