Douglas County Juvenile Court Judge Peggy Walker is an activist judge for the children of Georgia – the children she loves who do not get what they need for healthy, successful lives. She’s seen how the children are failed when they come back to court again and again. Now she’s doing something about it. When she takes over later this year as the president of the National Council of Juvenile and Family Court Judges, she’ll have a national platform to promote changes in polices and practices to prevent and treat childhood trauma. For now, she is spreading the word around the state of Georgia through conferences in four different regions, with the first one held January 10 at the Carter Center in Atlanta.
Woven into Judge Walker’s Georgia Summit on Complex Trauma keynote address to more than 400 participants — including judges, their staffs, child and family services professionals, and advocates — was a description of a painful case from her work as a judge. She began her presentation on what science tells us to do for children who have experienced complex trauma with a photo of herself (shown above) holding “Dalton.” He was the first drug-free child in the court’s family drug treatment program; his mother “Tonya” was a participant (both names are pseudonyms).
During the 10 years that “Tonya” had been in and out of her court, Judge Walker did not know her story. When she found out, she learned that “Tonya’s” mother was alcoholic, emotionally abusive, and manipulative. At age seven, “Tonya” was raped by a 50-year-old neighbor who was later incarcerated but freed after three years. She tried drug treatment in
three different places without success and attempted suicide several times. “Dalton” and her other children were removed from her care after the limits of her judgment and cognition were demonstrated – she put the four children in the trunk of her car because the car was too small to accommodate four car seats.
Other life stories emerged from Judge Walker’s court, leaving her “stunned by the degree of violence that these parents have experienced in their very young lives and the impact it has had on them and the children that they bear.”
Over years, Judge Walker and other Georgia judges who participated in a court improvement group grew increasingly frustrated with the lack of progress being made as the result of the courts’ interventions that were too little, too late. According to the executive staff of the group, attorney Michelle Barclay, the judges continued their conversations as they gathered more information on effective treatments: They read Dr. Bruce Perry’s book about what the traumatized child can teach us. They studied evidence that was introduced in court about trauma. They listened to experts in the field, such as the former U.S. Health and Human Services Child and Family Services Commissioner Bryan Samuels (See the Resources section on the Georgia Summit website). As a fellow with the organization Zero to Three, Judge Walker’s understanding of the impact of trauma deepened and her knowledge of what children need for healthy development grew.
As this educational process continued, another resource became a became available to the group in the form a letter dated July 11, 2013 from the heads of three agencies within the U.S. Department of Health and Human Services (HHS) to state directors of child welfare, Medicaid, and mental health. The letter highlighted the landmark Adverse Childhood Experiences (ACE) Study and detailed the federal resources and funding streams available to combat childhood trauma and improve child wellbeing.
While the letter did not contain new requirements or announce new funding sources for state and local programs, it did provide an exhaustive overview of existing federal programs and requirements to address complex trauma within health and human services. The three HHS leaders said their agencies “are engaged in an ongoing partnership to address complex interpersonal trauma and improve social-emotional health among children known to child welfare systems.” States and tribal governments were encouraged to build upon the important work that resulted from the federal partnership to address trauma.
In a statement about the letter, HHS Secretary Kathleen Sebelius said, “Far too many children – especially those known to the child welfare system – have experienced trauma related to neglect.” Taking a broader view, the same could be said of those “known to the juvenile justice system,” with the strong likelihood that significant numbers of children are in both systems – systems that are unlikely to share information or coordinate in any way. For this reason, it is significant that the leadership for the Georgia summit came from the judiciary rather than child services, and that conference participants represented the numerous systems with responsibility for child wellbeing, including schools and juvenile justice, as well as health and welfare.
Two hours of the three-hour program (video of the entire program is available on the summit site) were devoted to a panel of state agency leaders showcasing how the executive branch is applying scientific knowledge about trauma to practice. The top leadership in juvenile justice, public health, behavioral health and developmental disabilities, Medicaid, child and family services, and education addressed agency-specific initiatives as well as cross-agency collaborations.
The panel moderator, attorney Karlise Grier, asked the panelists to share something significant in their backgrounds that they bring to their positions to the benefit of children. The responses included being:
- a foster and adoptive parent to boys eleven years or older;
- a survivor of complex trauma;
- a pharmacist with experience in curtailing the gross overuse of prescription drugs;
- raised by a grandmother who took in other children for long or short periods when their parents were incapable of responsible parenting;
- mentored and encouraged to pursue higher education after dropping out of school;
- and a physician whose mission is caring for infants and their mothers.
Here are some highlights from the panel:
The chief of the Medicaid Division in the Department of Community Health, Jerry Dubberly, emphasized the importance of Medicaid’s “Early and Periodic Screening, Diagnostic and Treatment (EPSDT)” benefit to encourage early intervention, avoid deep-end services and improve outcomes for children and youth who have experienced complex trauma. He also addressed efforts to reduce overuse of psychotropic drugs and promote the use of electronic medical records. He spoke enthusiastically about a managed care contract with Amerigroup that will begin in March to provide comprehensive services, including a trauma assessment, for all children in the custody system.
Dr. Sharon Hill, director of the Division of Child and Family Services, emphasized the importance of inter-agency communication and information sharing. She said the new contract with Amerigroup should make more vital information available and improve care and service coordination for children in multiple systems. She also addressed the overuse of psychotropic drugs in very young children.
Dr. Brenda Fitzgerald, commissioner of the Department of Public Health, described research findings on the negative impact of late preterm births – as little as two weeks early – on standardized tests given to children in the third grade. Elective early births have been dramatically reduced in Georgia due in part to a public-private collaborative involving the state of Georgia, physicians, hospitals, and advocates. A new policy that began last October in which Medicaid stopped paying for non-medically necessary inductions or cesarean deliveries, also had an impact, said Dubberly.
Fitzgerald said that 50 percent of babies born in Georgia come through the WIC (Women, Infants, and Children) nutrition program. The high participation in the WIC program presents opportunities to look for depression and domestic violence in mothers and intervene when they are identified. It also creates an opening to provide “language nutrition” as well as standard nutrition education. She cited research that shows children from impoverished homes are exposed to 30 million fewer words by age three, putting them at a distinct disadvantage compared to other children when starting school.
Fitzgerald reported that the state is working with the Harvard University Center on the Developing Child to make improvements for at-risk children. A 5-minute video from the Center, “Building Adult Capabilities to Improve Child Outcomes: A Theory of Change,” was shown at the conference.
Dr. Christy Doyle of the Department of Juvenile Justice reported that trauma-informed systems of care are replacing the negative interventions of the past – restraint, injection, and incarceration. Evidence-based practices such as SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress) are gaining traction. She recommended a clinical guide for treating children with traumatic stress by Dr. Damion Grasso at the University of Connecticut (Clinical Exercises for Treating Traumatic Stress in Children and Adolescents: Practical Guidance and Ready-to-use Resources).
Dr. Linda Henderson-Smith, of the Department of Behavioral Health and Developmental Disabilities said her agency provides crisis stabilization services and has been training leadership and frontline staff in trauma-informed practices. She spoke of the need to continue working with sister agencies to improve services to children.
Dr. Garry McGiboney, deputy superintendent of the Department of Education said the department is implementing PBIS (Positive Behavioral Interventions and Supports) to improve school climate and bring down the high number of suspensions in the state (Georgia is ranked 10th in the number of students suspended from school). He expressed the desire to shut down the school-to-prison pipeline, and addressed the importance of recognizing when behavior is symptomatic rather than defiant.
The summit was sponsored by the Carter Center, the Supreme Court of Georgia Committee on Justice for Children, the Georgia Administrative Office of the Courts, Casey Family Programs, and Goshen Valley Boys Ranch. The $8,000 cost of the summit was funded by sponsorships, participant donations and a grant from the federal court improvement program. Georgia Supreme Court Justice P. Harris Hines, who opened the summit, chairs the committee that guides the work of the grant and related programs. The Carter Center donated the meeting space. The second meeting in the series of four will be held April 25 in Savannah.
In his welcoming remarks, Dr. Thomas H. Bornemann, director of the Carter Center Mental Health Program, observed that now is a time of dynamic change in the state of Georgia, and he cited constructive changes in the adult mental health system that have arisen from tragic and contentious circumstances. He described his intense reaction to the stark and dramatic findings of the CDC’s ACE Study and commented on the power of the courts to engender change. These observations set the stage for the summit proceedings that followed and for the three future events around the state of Georgia.