What does trauma-informed mean to foster youth?

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Alisa Santucci

By Alisa Santucci

For three decades, I have listened in awe to the brave voices of children, youth and families who have shared, in anguish, their past experiences — experiences that anyone would objectively call “adverse” and ones that can have lasting effects on health and well-being.

The seminal CDC-Kaiser Permanente Adverse Childhood Experiences Study opened my eyes to how pervasive their stories were and how these findings might influence the development of effective interventions and treatment, especially for system-involved young people.

In 1998, the Centers for Disease Control and Prevention and Kaiser Permanente released the first publication about the ACE Study, one of the largest studies of childhood abuse and neglect and their connections to later-life health risks. The study’s results, as well as subsequent related studies, have, in part, hastened the spread of “trauma-informed” approaches that have permeated into the nomenclature and delivery of human service today.

This research matters. It links childhood experiences of abuse, neglect, violence, substance use, mental illness and incarceration to risky health behaviors, chronic health conditions, low life potential and even early death. Almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more. A 2009 report funded by the U.S. Department of Justice corroborates the ACE Study findings, showing that almost 60 percent of children (ages 17 and younger) have been exposed to violence within the past year, either directly (as victims) or indirectly (as witnesses). The most recent child welfare data shows that approximately 702,208 children were victims of maltreatment in 2014.

Trauma-informed approaches offer frameworks grounded in an understanding of trauma, which provide safe spaces for engaging youth, delivering services and creating opportunities for individuals to  successfully rebuild their lives. Embodied in the approach is a need to help youth heal, to pivot toward resiliency and ensure their voices are heard. As the literature base grows in trauma-informed approaches and what works in trauma-specific treatments, an important but often forgotten element is the role youth (and adult) clients play in shaping their effectiveness.

A 2015 exploratory study from Riebschleger, Day and Damashek exposes this need. The authors interviewed young people to discuss traumas experienced before, during and after placement in the foster care system and asked how they thought trauma-informed systems could be improved. Young people interviewed shared six important recommendations:

  • Earlier intervention: Young people recommended enhanced supports for families struggling with poverty, substance abuse and mental illness. They also called for earlier interventions while they were in care — to “inspect [foster] homes for signs of trouble and abuse.”

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8 ways people recover from post childhood adversity syndrome

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Cutting-edge research tells us that experiencing childhood emotional trauma can play a large role in whether we develop physical disease in adulthood. In Part 1 of this series we looked at the growing scientific link between childhood adversity and adult physical disease. This research tells us that what doesn’t kill you doesn’t necessarily make you stronger; far more often, the opposite is true.

Adverse Childhood Experiences (ACEs)—which include emotional or physical neglect; verbal humiliation; growing up with a family member who is addicted to alcohol or some other other substance, or who is depressed or has other mental illness; and parental abandonment, divorce, or loss — can harm developing brains, predisposing them to autoimmune disease, heart disease, cancer, depression, and a number of other chronic conditions, decades after the trauma took place.

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7 ways childhood adversity changes a child’s brain

 

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If you’ve ever wondered why you’ve been struggling a little too hard for a little too long with chronic emotional and physical health conditions that just won’t abate, or feeling as if you’ve been swimming against some invisible current that never ceases, a new field of scientific research may offer hope, answers, and healing insights.

Childhood trauma leads to lifelong chronic illness — so why isn’t the medical community helping patients?

ADonnaDadWhen I was twelve, I was coming home from swimming at my neighbor’s dock when I saw an ambulance’s flashing lights in our driveway. I still remember the asphalt burning my feet as I stood, paralyzed, and watched the paramedics take away my father. It was as if I knew those flashing lights were a harbinger that my childhood was over.

At the hospital, a surgeon performed “minor” elective bowel surgery on my young dad. The surgeon made an error, and instead of my father coming home to the “welcome home” banners we’d painted, he died.

The medical care system failed my father miserably. Then the medical care system began to fail me.

At fourteen, I started fainting. The doctors implied I was trying to garner attention. In college I began having full seizures. I kept them to myself, fearful of seeming a modern Camille. I’d awaken on the floor drenched in sweat, with strangers standing quizzically over me. Then, I had a seizure in front of my aunt, a nurse, and forty-eight hours later awoke in the hospital with a pacemaker in my chest.

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Violence is just one part of childhood trauma. So why are we focusing so much on childhood violence?

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Whac-A-Mole players (photo by Laura)

Many people and organizations focus on preventing violence with the belief that if our society can stop violence against children, then most childhood trauma will be eradicated.

However, research that has emerged over the last 20 years clearly shows that focusing primarily on violence prevention – physical and sexual abuse, in particular – doesn’t eliminate the trauma that children experience, and won’t even prevent further violence.

“Although violence can beget violence, it’s hardly the only cause of violence,” says Dr. Vincent Felitti, co-principal investigator of the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking epidemiological research that showed a direct link between 10 types of childhood trauma and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among many other consequences.

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The single best medical appointment of my life was when a nurse practitioner asked about my adverse childhood experiences (ACEs)

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Heidi Aylward spent much of 2015 going to doctor’s appointments for back and joint pain, dizziness, swelling of the legs and feet, high blood pressure, elevated platelets, heart palpitations and extreme fatigue.

2016 isn’t looking much better. She’s worn a heart monitor, had a bone marrow biopsy and continues to have blood work. She holds down a job as a full-time project manager, tends to her daughters, home and pets.

But she feels like her body is falling apart.

“I’m not going to make it to 60,” she said, “Why do I even contribute to my retirement savings account?”

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Time and again: This time, Orlando, and again more pertinent questions must be asked

Mourners in Orlando. Photo credit: Sam Hodgson for The New York Times

Mourners in Orlando. Photo: Sam Hodgson for The New York Times

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For those of us who know that childhood adversity can lead to chronic disease, mental illness, and violence, among other consequences, the questions about Omar Mateen, the man who killed 49 people and wounded 53 others in an Orlando night club early Sunday morning, aren’t answered yet. In fact, most of the questions that would address the roots of his violent actions — and our successful efforts to prevent other mass shootings — haven’t even been asked.

There are a couple of hints. According to this New York Times article, “Mr. Mateen had a chilling history that included talking about killing people, beating his former wife and voicing hatred of minorities, gays and Jews…”

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