Children's services practice notes : for North Carolina's child welfare workers

              Volume 17, Number 2
May 2012
This publication for child
welfare professionals is pro-duced
by the North Carolina
Division of Social Services and
the Family and Children’s Re-source
Program, part of the
Jordan Institute for Families
within the School of Social
Work at the University of North
Carolina at Chapel Hill.
In summarizing research, we try
to give you new ideas for refin-ing
your practice. However, this
publication is not intended to re-place
child welfare training, reg-ular
supervision, or peer consul-tation—
only to enhance them.
Let us hear from you!
To comment about something
that appears in Practice Notes,
please contact:
John McMahon
Jordan Institute for Families
School of Social Work
UNC–Chapel Hill
Chapel Hill, NC 27599-3550
jdmcmaho@unc.edu
Newsletter Staff
Mellicent Blythe
Lane Cooke
John McMahon
Laura Phipps
Tiffany Price
Special thanks for help with
this issue goes out to
George Ake, III
Holly McNeill
Jeanne Preisler
Visit Our Website
www.practicenotes.org
TRAUMA-INFORMED CHILD WELFARE PRACTICE
Recent research has given us a richer un-derstanding
of just how maltreatment and
other traumas hurt children. As Tullberg
(2011) summarizes, studies have revealed
trauma can negatively affect children’s:
• Brain development
• Sense of personal safety
• Ability to trust others
• Sense of the future
• Behavior and social relationships
• Ability to navigate life changes, and
• Learning and school performance.
Trauma’s footprint can be huge. Success
or failure in these domains profoundly af-fects
the trajectories of children’s lives.
Children are also affected when par-ents
are traumatized. Tullberg cites a study
of child welfare-involved mothers in New
York in which 92% had experienced at least
one type of traumatic event (e.g., domes-tic
violence); 35% of these mothers thought
trauma symptoms affected their parenting
or their relationship with their child. Trau-ma
stress reactions—symptoms can in-
BASICS ON CHILDREN AND TRAUMA
Traumatic Experience
• Threatens the life or physi-cal
integrity of a child or
someone important to that
child (parent, grandparent,
sibling)
• Causes an overwhelming
sense of terror, helpless-ness,
and horror
• Produces intense physical
effects such as pounding
heart, rapid breathing,
trembling, dizziness, or loss
of bladder or bowel control
Three Types
Acute: a single event that
lasts for a limited time
Chronic: multiple events,
often over a long period
Complex: multiple events
beginning at a very young
age; caused by adults
who should have been
caring for/protecting child
Trauma Adds Up
It is cumulative—each new
traumatic event compounds
the last.
clude difficulty concentrating, detachment,
anger, and others—can
make it hard for parents to
engage with the child welfare
system.
If we want to be effective
as child welfare profession-als
and make a lasting dif-ference
to families and children, we must
ensure our work is guided by what we know
about trauma and how to respond to it.
We’d like to support you and your agen-cy
as you seek to learn about and engage
in trauma-informed child welfare practice.
Therefore, this issue includes information
about how trauma affects the developing
brain, identifies trauma-informed concepts
and practices that are already part of child
welfare policy in North Carolina, describes
the way trauma affects our work with birth
parents, and offers concrete steps you can
take to make your work with families more
trauma-informed and therefore more ef-fective.

Neglect Counts
Failure to provide for basic
needs is seen as a trauma
by infants or young children,
who depend on adults to
survive. Neglect also opens
door to other traumatic
events, and may reduce a
child's ability to recover from
trauma.
Reactions Vary Widely
Based on the child’s level of
exposure to trauma, access
to supportive caregivers,
previous history of traumatic
Source: Tullberg, 2011 events, and other factors
How we think
about and
respond to
trauma matters
a great deal.
2
HOW TRAUMA AFFECTS CHILD BRAIN DEVELOPMENT
The sheer volume of research on trau-ma,
brain development, and outcomes
for children can be daunting. Fortu-nately,
understanding and applying
key concepts to child welfare practice
doesn’t have to be complicated.
TRAUMA AND THE BRAIN
“The human brain is designed to
sense, process, store, perceive, and act
on information from the external and
the internal environment. All of these
complex systems and activities work to-gether
for one overarching purpose—
survival” (Goldstein, 1995 cited in Per-ry,
et al., 1995).
Neurons are the building blocks of
the brain. During development, neu-rons
create networks that link to cre-ate
systems. These systems are how the
brain regulates all functions. Brain
functions are organized from the most
simple to the most complex. The de-velopment
of these functions is sequen-tial,
meaning prior events impact fu-ture
development.
A key fact that child welfare profes-sionals,
judges, and others who work
with child welfare-involved families
should know is that there are critical
developmental times when neural
pathways are being formed that can
be significantly altered by traumatic
events (Perry, 1995, 2009).
EARLY CHILDHOOD
Brain development in infancy and early
childhood lays the foundation for all
future development. Neural pathways
form at great speed and depend on
the repetition of experiences. Experi-ences
teach the brain what to expect
and how to respond.
When experiences are traumatic, the
pathways getting the most use are those
in response to the trauma; this reduces
the formation of other pathways need-ed
for adaptive behavior. Trauma in
early childhood can result in disrupted
attachment, cognitive delays, and im-paired
emotional regulation. Also, the
overdevelopment of certain pathways
and the underdevelopment of others
can lead to impairment later in life (Per-ry,
1995).
By age three, the brain is almost
80% of its adult size; by age five it is
90% (zerotothree.org). Although this
creates a sense of urgency regarding
intervention, it is also important to
know that the brain has the most plas-ticity
in infancy and early childhood,
meaning there is the most opportunity
for change. This is both the reason that
prolonged trauma in early childhood
can be so devastating, but also a win-dow
of opportunity for interventions
that can alter the brain in positive ways
(CWIG, 2011).
CHILDREN AND TEENS
Brain development continues in the
school-age years, but more slowly.
During this stage neural pathways are
pruned or eliminated to increase effi-ciency.
In addition, the brain coats neu-ral
pathways to protect and strength-en
them (Shonkoff & Phillips, 2000).
This process allows the school-age
child to master more complex skills,
including impulse control, managing
emotions, and sustaining attention.
Trauma during this stage of develop-ment
can have significant impact on
learning, social relationships, and
school success (NCTSN, 2008).
The impact of trauma at this age
also depends on the onset. If trauma
continues into the school-age years
from early childhood, the impact is
greater on overall functioning. There
is some evidence that trauma that be-gins
during the school-age years will
have a different impact than trauma
that begins in early childhood. Specif-ically,
school-age onset seems to re-sult
in more externalizing behaviors
(acting out) whereas early childhood
onset results in more internalizing be-haviors
(withdrawal, depression, self-blame)
(Manly, 2001; Kaplow, 2007).
In adolescence the brain goes
through another period of accelerat-ed
development. The pruning of un-used
pathways increases, similar to
early childhood. This process makes
the brain more efficient, especially the
part of the brain that supports atten-tion,
concentration, reasoning, and
advanced thinking. Trauma during ad-olescence
disrupts both the develop-ment
of this part of the brain and the
strengthening of the systems that al-low
this part of the brain to effectively
communicate with other systems. This
can lead to increased risk taking, im-pulsivity,
substance abuse, and crimi-nal
activity (NCTSN, 2008; Chamberlin,
2009; Wilson, 2011; CWIG, 2009).
WHAT YOU CAN DO
Addressing the impact of trauma re-quires
a comprehensive and collabo-rative
approach. Awareness and un-derstanding
of the issue is the first step
towards trauma informed practice. For
more practical applications see “Essen-tial
Trauma-Informed Activities for
Child Welfare Staff in this issue.” 
TRAUMA’S POTENTIAL IMPACT ON BRAIN DEVELOPMENT
Exposure to chronic, prolonged traumatic experiences has the potential to alter
children’s brains, which may cause longer-term effects in areas such as:
• Attachment: Trouble with relation-ships,
boundaries, empathy, and so-cial
isolation
• Physical Health: Impaired sen-sorimotor
development, coordination
problems, increased medical prob-lems,
and somatic symptoms
• Emotional Regulation: Difficulty
identifying or labeling feelings and
communicating needs
• Dissociation: Altered states of con-sciousness,
amnesia, impaired
memory
• Cognitive Ability: Problems with focus,
learning, processing new information,
language development, planning and
orientation to time and space
• Self-Concept: Lack of consistent sense
of self, body image issues, low self-esteem,
shame and guilt
• Behavioral Control: Difficulty control-ling
impulses, oppositional behavior,
aggression, disrupted sleep and eat-ing
patterns, trauma re-enactment
Source: Cook, et al. 2005
3
WHAT DOES A TRAUMA-INFORMED SYSTEM LOOK LIKE IN PRACTICE?
Billy is a 6-year-old boy placed with his maternal
grandmother by the child welfare system. Although his
mother stated that she never used drugs while she was
pregnant, Billy was born prematurely. His mother did not
have a home or regular income, and they moved from place
to place for several years. Billy slept wherever he could find
a spot, and he ate only sporadically. Billy did not cause much
trouble because he rarely spoke.
After Billy was removed from his mother’s care due to
abandonment, he was placed in foster care until his grand-mother
could be located. Billy’s grandmother became con-cerned
about his behavior and development while caring for
him over the last 6 months. Billy hid food in his pockets and
in his room, and his teacher reported he was stealing food at
school. Billy also slept on the floor. Because he was so quiet,
it took some time for Billy’s teacher to notice he had difficulty
speaking and interacting in school.
Billy’s grandmother asked for help from his caseworker,
who referred him to a mental health therapist for evaluation.
After letting Billy speak openly about his past experiences,
the therapist determined Billy’s tendencies to steal food and
sleep on the floor were adaptive behaviors he developed while
living with his mother—skills that helped him survive but are
no longer appropriate given his current, more stable situa-tion.
Building on the therapist’s advice and taking Billy’s
unique situation into consideration, the caseworker helped
his grandmother establish regular routines, such as meal-times
and bedtimes, and gave her ideas for activities Billy
and his grandmother could share to enhance the bond be-tween
them. The caseworker also connected the grandmoth-er
to a support group where she could meet other grandpar-ents
raising their grandchildren.
To address Billy’s problems in school, his caseworker
sought the help of the school’s psychologist as well as a speech
pathologist. Initial tests indicated Billy had attention-deficit/
hyperactivity disorder (ADHD); with parental consent, Billy
was prescribed medicine to address the issue. The speech
pathologist also began working with
Billy and gave his grandmother ex-ercises
to do with him at home. Sev-eral
months later, when Billy’s grand-mother
and teacher felt the medicine
was not “working,” Billy’s mental
health therapist was consulted again.
The therapist advised that Billy’s
problems are more likely caused by symptoms of posttrau-matic
stress disorder (PTSD) resulting from his earlier trau-matic
experiences. Under the therapist’s supervision, Billy
stopped taking the medicine, and his treatment plan was re-vised
to include more trauma-focused therapies, to help Billy
work through his feelings.
To improve communication and avoid overlapping efforts,
Billy’s caseworker scheduled a multidisciplinary team meet-ing
for the adults in Billy’s life. The long-term plan that result-ed
from the meeting included a number of action items:
• Billy’s therapy sessions will continue; his grandmother
will attend on occasion to support his progress and learn
new activities and exercises to do with him at home.
• At school, Billy’s teacher will follow the newly created
individual education plan (IEP) to help him succeed
academically and will create a weekly progress report.
Billy’s speech pathologist scheduled several more
sessions to track his improvements.
• Billy’s grandmother will continue to attend monthly
grandparent support meetings to make connections and
receive support from other community members.
• Billy’s caseworker will help his grandmother become a
foster parent and seek financial support while she cares
for Billy. If Billy’s father or mother is unwilling or unable
to care for him, the grandmother will apply for
subsidized guardianship to give Billy a more permanent
home.
Billy’s Story
Adapted from Supporting Brain Development in Traumatized Children and Youth (Child Welfare Information Gateway, 2011)
Source: Child Welfare Information Gateway. Available at http://www.childwelfare.gov/pubs/braindevtrauma.cfm
According to Tullberg (2011), a trauma-informed child
welfare system should have the capacity to translate trau-ma-
related knowledge into meaningful action, policy, and
practice changes. Furthermore, this system and those who
work in it should understand:
• the potential impact of traumatic stress on children
served by the child welfare system;
• how the system can either help mitigate the impact of
trauma or inadvertently add new trauma;
• the potential impact of current and past trauma on the
families with whom we interact;
• how adult trauma may interfere with caregivers’ abili-ty
to care for and support their children;
• how to promote factors related to child and family re-silience;
• the impact of secondary trauma on the child-serving
workforce;
• that trauma shapes the culture of child welfare the same
way trauma shapes the world view of victims; and
• that a traumatized system will find it hard to identify
clients’ past trauma or mitigate/prevent future trauma.
The following case example illustrates what some of these
principles might look like in practice as families, child wel-fare
services, and related professionals address the effects
of trauma on children’s behavior and development. 
4
NINE TRAUMA-INFORMED ACTIVITIES FOR CHILD WELFARE
The National Child Traumatic Stress Network (2008)
highlights nine essential activities in serving children
who have experienced trauma. These activities form
the core of a Child Welfare Trauma Training Toolkit and
a two-day training developed by the Network. To move
your agency forward with trauma-informed practice,
visit the Network’s website at http://bit.ly/HWCkVq.
Below are examples of ways you can engage in each
of the essential activities, along with additional ques-tions
you might explore for each activity. To integrate a
more trauma-informed perspective into your practice
and case planning, start by asking questions. Some of
the recommendations apply to the child’s caregiver,
whether that is a birth family member or foster care
provider. Work in partnership with children, their fam-ilies,
and therapists to ensure that everyone is informed
and taking a comprehensive approach.
1. Maximize safety.
• Children need to feel physically and psychologi-cally
safe. To feel psychologically safe, children
need consistency and predictability. Remind par-ents
that helping kids to know they are safe may
take some time.
• Help caregivers provide predictable and consistent
environments including routines, clear expectations,
consistent feedback, and positive reinforcement.
• Listen to the child. Pay attention to possible trig-gers,
which may be people, places, or things that
make the child feel threatened.
• Increase awareness of behaviors that are reactions
to triggers. It may not always be clear to you what
the threat is, but the threat is real to the child.
• Reassure the child with specific information about
how everyone is working to keep her safe.
KEY QUESTIONS: What are people, places, and activi-ties
that make this child feel safe and secure? What
makes her feel unsafe or unsupported?
2. Help children manage overwhelming
emotions.
• Frequent, intense and overwhelming emotions are
triggered by reminders of traumatic events.
• Help the child label his emotions; make it clear
these emotions are understandable.
• Teach relaxation skills; encourage the child to par-ticipate
in activities that allow for positive expres-sion
of emotions (physical exercise, art, music, etc.).
• Identify and avoid reminders that trigger intense
emotions. Help the child understand what is hap-pening
when reminders occur.
• Remember—and help caregivers remember—not to take
it personally when children experience or express their
emotions. Talking to other adults can help caregivers prob-lem-
solve and identify trauma-informed ways to respond.
KEY QUESTIONS: What are possible triggers that make this child
feel threatened or remind him of traumatic events? What is
being done in therapy and at home to help minimize or man-age
those triggers? Are there relaxation or stress manage-ment
skills that the child is learning that I can remind him of
and reinforce?
3. Help children make new meaning of their trauma
history and current experiences.
• Listen to the child tell her story; acknowledge emotions.
• Support the child and caregiver in developing a Life Book.
• When appropriate, provide information about traumatic
events to help the child gain a different perspective and
reduce self-blame.
KEY QUESTIONS: What is the best way for me to respond to the
child’s comments or questions about her trauma history? Am I
able to listen empathically without shifting to an investigative
or problem-solving mode?
4. Address the impact of trauma and subsequent
changes in the child’s behavior, development, and
relationships.
• Identify areas of concern as early as possible and take
necessary steps to ensure the child is safe and that devel-opmental
needs are being met.
• Educate families about key developmental milestones and
ways they can increase brain development through inter-actions
with children.
THE NC CHILD TREATMENT PROGRAM
Effective Mental Health Treatment for Children and Families
Established in 2006, the NC Child
Treatment Program serves children,
adolescents, and families coping with
serious psychological trauma or loss. Its faculty
has trained a network of community-based mental health
clinicians to provide effective, evidence-based treatments.
One such treatment, Trauma-Focused Cognitive Behavior-al
Therapy (TF-CBT), is designed to:
• Reduce negative emotions and behaviors especially those
related to Post Traumatic Stress Disorder (PTSD), depres-sion,
and sexual reactivity
• Correct unhelpful thoughts that impede healing
• Provide caregivers with support and skills to help children
move past the trauma and loss.
To learn more or to find a therapist in your area, go to
www.ncchildtreatmentprogram.org.
5
• Remind parents to avoid saying to children that they
are “bad” or their behavior is “bad.” This can rein-force
negative behavior. What’s more, this might shame
the child, which would be inappropriate, since the be-havior
is related to feelings of fear or anxiety.
• Work with schools and others to ensure the child has
support in reaching academic, social, and behavioral
goals.
KEY QUESTIONS: What behaviors, symptoms, or situations is
the child experiencing? How might they relate to his his-tory
of trauma? What support or information can we offer
him and his caregivers to understand and respond appro-priately?
5. Coordinate services with other agencies.
• Share information with caregivers and service provid-ers.
General information about a child’s trauma his-tory
may legally be shared with foster parents and other
members of the professional team when it is essential
to providing quality services.
• With the family’s permission, invite service providers
to child and family team meetings (CFTs).
• Be mindful of the family’s involvement with other agen-cies
when developing Family Service Plans.
• Provide concrete support and encouragement for get-ting
the child to the appointments that may be neces-sary
for full assessment and treatment.
KEY QUESTIONS: What other agencies or providers are serv-ing
this family? What expertise might they offer or what
information might they need to ensure the entire team is
helping the family heal from trauma?
6. Use a comprehensive assessment of the child’s
trauma experiences and their impact on the child
to guide service provision.
• Gather trauma history from the child, family members,
collaterals, and agency case records.
• Recognize that developmental delays and behavior
problems may be related to trauma. A full develop-mental
and medical assessment is needed to identify
the appropriate treatment.
• Refer the child for further assessment and treatment
as needed (health, mental health, education, etc.). Ask
providers about their level of training and experience
in trauma-focused treatment.
KEY QUESTIONS: What can we do to individualize our ser-vices
to this child and her caregivers, based on her spe-cific
history, developmental level, and strengths and needs?
What are things that make this child and her situation
unique, and how are we addressing that in our conversa-tions
and case planning?
7. Support and promote positive
and stable relationships in
the child’s life.
• Use genograms, Life Books,
and conversation to identify
people who are important to the
child.
• Review the case file; find peo-ple
who have played a role in
the child’s life in the past but
have lost contact.
• Teach caregivers ways to develop healthy interactions
and attachments with children of different ages.
• When considering placement and visitation recommen-dations,
be sure to consider ways to maintain or
strengthen the child’s current attachments.
• Remember that DSS workers may be an important at-tachment
for the child. Minimize changes in case work-ers
as much as possible.
KEY QUESTIONS: Who is important to this child? What posi-tive,
stable relationships has he had in his life? What can
I do to maintain, strengthen, or re-establish those con-nections?
8. Provide support and guidance to the child’s
family and caregivers.
• Provide training and information to caregivers about
the effects of trauma.
• Encourage caregivers to participate in therapy, both to
support the child’s recovery and to increase their own
support network.
• Address respite needs of birth and foster families.
• Strengthening the family’s support system is critical.
Include extended family, church, or neighborhood con-nections
as much as possible. Consider ways to offer
peer-to-peer support for families.
KEY QUESTIONS: What connections, information, or resources
will help this child and her family engage in trauma-in-formed
treatment? What barriers exist to treatment, and
how can I help the family to overcome them?
9. Manage professional and personal stress.
• Take care of your own need for a healthy lifestyle and
support system.
• Help create a supportive environment in your unit by
recognizing the emotional toll of this work on your co-workers.
Even small tokens of appreciation and un-derstanding
make a difference.
• Seek continuing education on the effects of trauma.
KEY QUESTIONS: What symptoms of stress and secondary
trauma am I experiencing? What can I do to add more
healthy stress management to my daily life? What can we
do on our team to take care of each other?
Sources: NCTSN, 2008; Cook, et al., 2005; Pease, 2012
Help caregivers
provide predictable
environments
including routines,
clear expectations,
consistent feedback,
and positive
reinforcement.
6
TRAUMA-INFORMED PRACTICE AND NC CHILD WELFARE POLICY
The increasing emphasis on being trauma-informed can feel like pressure to add another complex dimension to
child welfare practice. However, child welfare policy in North Carolina already emphasizes a number of practices
that are in line with research recommendations about minimizing the effect of trauma. With the introduction of
Multiple Response System (MRS), and with new federal laws passed in recent years, child welfare practice has
increasingly emphasized partnering with families, listening to the voices of children and youth, and building and
maintaining healthy connections. These are all trauma-informed activities and approaches. They’re also already
part of your everyday practice with families. The table below highlights North Carolina policies that align with key
trauma-informed child welfare activities. 
Activity Related NC Policies* Trauma-Informed Implementation
Maximize
child’s
sense of
safety
Safety Planning
Coordinate
services
with other
agencies
Child and Family
Team Meetings
Permanency
Planning
Action Teams
Use
comprehensive
assessment of
child’s trauma
history to guide
services
CME/CFE
Strengths/Needs
Assessment
Individualized case
planning
Support
and promote
positive,
stable
relationships
Provide support
and guidance to
child’s family/
caregiver
Involving family in
case planning
Individualized foster
parent training and
development
Child welfare staff are strongly encouraged to involve parents and their
children in safety planning, and to ask questions that help the child describe
their concerns and fears as well as the things that help them feel safe.
“Seeking first to understand” and taking the “not knowing stance” are also
part of understanding the safety needs and protective factors in families.
CFTs are one of the most important techniques we have for coordinating
services. Time spent preparing families, community partners, and others
for CFTs is essential. Talk early and often about CFTs; have conversations
about who will be helpful to have on the team. DSS agencies should be
proactive about educating community partners about CFTs on an ongoing
basis. This can help spread System of Care (SOC) values, which in turn
ensure communities know what the needs are and can get them met.
NC policy requires us to engage children as part of assessments during
the provision of CPS services and throughout their involvement with DSS.
Particularly in family assessments, the focus should be on getting the big
picture, which includes the child’s history. One county DSS finds it helpful
to consistently ask children a few simple questions to ensure that their
trauma histories are fully explored and appropriate services are provided.
Child Medical and Child/Family Evaluations also gather trauma history
information to guide supportive interventions for children and families.
Placement priorities
Visitation plans
Sibling placement
and visits
Family notification
Reunification efforts
Shared Parenting
LINKS goal
Use of Life Books
Identifying and supporting positive, stable relationships for children is a
theme that runs throughout NC policy, from looking diligently for absent
parents, to placing priority on placements and frequent visitation with
siblings and other kin, to the LINKS goal of ensuring that young people
leaving foster care have a personal support system of at least five caring
adults in addition to professional relationships.
It is possible to do the Safety Assessment in the family’s presence without
doing it “with” them. The “to, for and with” frame taught in courses such as
CPS Assessments effectively engages and empowers all family members to
take part in the planning for their own safety and well-being.
Involvement of foster parents and other substitute caregivers in CFTs
and shared parenting is an excellent way to ensure they have the information
they need to meet the needs of children in their care. Creating and actively
supporting individualized foster parent training and development plans is
another way to ensure they see children’s behaviors through a “trauma
lens” and have the skills they need to respond appropriately.
*This is not a comprehensive list. NC’s full child welfare policy can be found at <info.dhhs.state.nc.us/olm/manuals/>.
7
PROJECT BROADCAST
Disseminating Trauma-Informed Practices to Children in the NC Child Welfare System
The NC Division of Social Services (NCDSS) has been
awarded grant funding for Project Broadcast: Disseminat-ing
Trauma-Informed Practices to Children in the North
Carolina Child Welfare System. This project provides the
state $640,000 each year for five years (through Septem-ber
2016). Its aim is to help provide children with services
and practices to address the trauma caused by past abuse
or neglect before that mistreatment leads to mental health
problems or chronic disorders later in the child’s life.
This project has three broad areas of focus:
(1) Providing training and professional development for
resource parents (i.e., foster, adoptive, kinship) using
the National Child Traumatic Stress Network's (NCTSN)
Resource Parent Curriculum; child welfare profession-als
will also use the NCTSN’s Child Welfare Toolkit;
(2) Increasing access to trauma-informed, evidence-based
treatments for children and youth by training more cli-nicians
in these interventions:
— Structured Psychotherapy for Adolescents
Responding to Chronic Stress (SPARCS)
— Attachment and Biobehavioral Catch-up (ABC)
— Trauma-Focused Cognitive Behavioral Therapy
(TF-CBT)
— Parent-Child Interaction Therapy (PCIT)
(3) Creating systemic changes so that the training and in-terventions
offered to the 9 demonstration counties can
eventually be expanded to all 100 counties.
“This grant opportunity will help to provide tools that
increase the capacity of the division and local departments
of social services to serve children and families in our child
welfare system,” said Sherry Bradsher, director of NCDSS.
“Incorporating trauma-informed practices into our child
welfare services allows for a more holistic approach to
meeting the needs of children.”
In adopting trauma-informed, evidence-based practic-es,
the child welfare system will take steps to adapt its ser-vice
delivery system to include a better understanding of
how trauma affects the lives of the children being served.
Trauma-informed programs and services are based on an
understanding of the vulnerabilities or triggers of trauma
survivors so that these services and programs can be more
supportive and meet the needs of the individual child. Trau-ma-
specific interventions are designed specifically to ad-dress
the consequences of trauma in the individual and to
facilitate healing.
“Children who have been abused or neglected have
been in and felt many negative experiences in their lives,”
said Bradsher. “We owe it to them and their futures to have
a system in place that acknowledges those experiences,
understand their traumas, deals with its impact, and pre-vents
future occurrences.”
This grant is funded through the U.S. Department of
Health and Human Services, Administration for Children
and Families, Children’s Bureau (grant #90C01058/01).
NCDSS is partnering on this project with the Center for
Child and Family Health, a leader of the National Child
Traumatic Stress Network, as well as the University of North
Carolina at Chapel Hill—proven national leaders in de-veloping
effective programs and resources in this area.
The goals of Project Broadcast are to:
• Coordinate system-level changes across the system of
care in the nine demonstration counties (Buncombe,
Craven, Cumberland, Hoke, Pender, Pitt, Scotland,
Union, and Wilson);
• Develop trauma-informed child welfare workforces and
systems across the nine demonstration counties, ad-dressing
service needs across the practice continuum
from prevention to post-adoption care;
• Increase local capacity and access to trauma-specific
evidence-based mental health treatments for children
and youth in the nine demonstration counties; and
• Plan to incorporate these practices statewide.
For more information, contact Jeanne Preisler with the NC
Division of Social Services (Jeanne.Preisler@dhhs.nc.gov;
336/209-5844). 
New Law Requires Screening for Trauma
On September 30, 2011, Congress
passed the Child and Family Services
Improvement and Innovation Act (P.L.
112-34). Among other things, this new
law requires states to describe in their
health care oversight plans:
• How they will screen for and treat
emotional trauma associated with
maltreatment and removal for chil-dren
in foster care;
• The protocols in place or planned to oversee and moni-tor
the use of psychotropic medications among chil-dren
in foster care.
North Carolina anticipates Project Broadcast will help it
meet both these requirements. As the article on this page
makes clear, there is a clear connection between trauma
screening and this project.
The connection to psychotropic medication use is indi-rect
but still strong. The hope is that if children in foster
care receive trauma-informed, evidenced-based treatments,
we will see a reduction in use of psychotropic medications
in this population.
8
ENGAGING AND SUPPORTING FAMILIES WHO HAVE EXPERIENCED TRAUMA
Many parents involved with the child welfare system have
trauma histories. Whether trauma is a past experience, a
current reality, or both, it can shape a person’s behaviors,
feelings, and decisions. The more we learn about trauma,
the more we can modify our practices and agency envi-ronments
to support and engage birth parents.
As the information below from the National Child Trau-matic
Stress Network indicates, a history of traumatic ex-periences
can impede parents’ ability to keep their chil-dren
safe and to work effectively with child welfare agen-cies
and others. However, it’s important to remember that
each person is an individual. Any description of trauma’s
impact will not necessarily “fit” each person who has ex-perienced
trauma, but it can help develop general aware-ness
for those who work with families.
At any point in an agency’s involvement with a family,
birth parents may experience trauma triggers. Consider
the mother who, when asked about the child’s absent fa-ther
as a possible caregiver, feels overwhelming fear—her
heart pounding fiercely as memories of spousal abuse race
forward. Another birth parent, removed from his home as
a youth, can’t bear the thoughts that his own children are
now in foster care, and therefore avoids visitation.
In these situations, a social worker knowledgeable about
trauma responses might understand the intensity with which
the mother demands the children’s father not be contact-ed.
She might set aside judgment of the father’s avoidant
behavior and seek to better understand his experiences
and help him work through his pain toward a goal of re-
Trauma-Informed Practice
Trauma Can Affect Parents by...
• Compromising their ability to make
appropriate judgments about
safety. Some parents may be over-protective;
others may not recognize
situations that could be dangerous
for the child.
• Making it hard to form and main-tain
secure, trusting relationships.
This can lead to:
– Disruptions in relationships with
infants, children, and teens, and/
or negative feelings about
parenting; parents may
personalize their children’s
negative behavior, resulting in
ineffective or inappropriate
discipline.
– Challenges in relationships with
caseworkers, foster parents, and
service providers and difficulties
supporting their child’s therapy.
• Impairing their capacity to regulate
their emotions.
• Causing them to develop poor self-esteem
and maladaptive coping
strategies, such as substance abuse
or abusive intimate relationships that
parents maintain because of a real or
perceived lack of alternatives.
• Making them vulnerable to trauma
triggers, which are extreme reactions
to situations that seem benign to oth-ers.
These responses are especially
common when parents feel they have
no control over the situation, such as
facing the demands of the child wel-fare
system. Moreover, a child’s behav-iors
or trauma reactions may remind
parents of their own past traumas or
feelings of helplessness, which can
cause impulsive or aggressive parent
behaviors toward the child. Parents
also may seem dis-engaged
or numb
(in efforts to avoid
trauma reminders),
making engaging
with parents and
addressing the family’s underlying
issues difficult for caseworkers and
others.
• Impairing their ability to make
decisions, making future planning
more challenging.
• Making them more vulnerable to
other life stressors, including pov-erty,
lack of education, and lack of
social support. These stressors can
worsen trauma reactions.
Reprinted from Birth Parents with Trauma
Histories and the Child Welfare System: A
Guide for Child Welfare Staff. National
Child Traumatic Stress Network, 2011.
unification. Having
empathy is impor-tant
for building re-lationships,
so that
even when a social
worker has to follow
a course of action
that is upsetting to
parents but neces-sary
in the best inter-est
of the child, a genuine concern for the parent is evi-dent.
Understanding what a parent is dealing with won’t
necessarily change what you must do, but it can change
how you do it.
In working with birth parents, trauma-informed child
welfare workers ask themselves questions such as:
• How might trauma influence parents’ current abilities
to nurture and care for their child?
• How have parents managed all that’s happened to them?
• How does the parent experience the agency or the work
of the child welfare system?
• How can I minimize trauma triggers for parents and
help them draw on their strengths to increase child
and family safety and well-being?
Using these questions as a guideline can help reduce the
extent to which parents re-experience trauma; it can also
help parents find in the agency’s interactions a source of
hope and healing from the effects of trauma.
According to Pease (2012), “the relationship is the criti-
Resource Families
Resource families, too, may have
trauma histories. In fact, they may
have trauma reactions triggered
by the stuggles of the children in
their homes. This, in turn, can have
an impact on placement stability.
We need to be sure to support
resource families around trauma
as well.
9
cal tool.” Social workers who are empathetic and form part-nerships
with parents lay the foundation for interactions
that assist in trauma recovery. “Workers need to provide a
psychologically safe setting for children and families while
inquiring about emotionally painful and difficult experienc-es”
(NCTSN, 2008). One way to let parents know a social
worker cares about their emotional well-being is to acknowl-edge
the physical environment. One could say, “If there
are things here that make you feel unsafe or uncomfort-able,
let me know…we will try to make things comfortable
and safe…” (Pease, 2012). Another way to assure parents
and reduce triggers is to help them know what to expect
throughout child welfare process; minimize surprises.
Acknowledging culture and language is another impor-tant
aspect of engaging birth parents. Approach families
with an understanding that some cultural groups have ex-perienced
trauma through involvement with child welfare
or government systems. Based on that history, they have
good reason to be wary of child welfare agencies. Appre-ciate
their resilience.
Recognize the challenges that immigration presents to
many families. “When immigrant families come to the
United States, they lose familiar references and routines,
and communication is often difficult because of language
barriers. For those families who have also experienced trau-ma,
even the small details of everyday life add to the stress
and confusion” (NCTSN, 2012). Advocate for multilingual
staffing that meets families’ language needs. Stay informed
about world events and social/political situations in other
countries and consider how these may impact the stress
levels of families here who have loved ones or other ties in
those countries.
Trauma-informed practice includes working alongside
birth parents to find safe housing and living environments
if these are not already in place. Parenting one’s children
while dealing with the effects of trauma is difficult enough;
worrying about personal safety compounds the stress.
Engage parents by providing them with opportunities to
disclose information about their own or their children’s trau-matic
experiences. Strengthen parenting capacity by edu-cating
families about child and adult trauma.
In addition, focus on visitation for birth parents and their
children. Ensuring “frequent and quality visits between
parents and children is essential to reducing overwhelm-ing
emotions associated with trauma and minimizing dis-ruptions
in relationships” (CECMH, 2011). Through visita-tion
parents have an opportunity to nurture their children
and build on the skills they have for providing a safe, lov-ing
home. Referring parents to resources for trauma re-covery
can improve visitation as parents build on relation-ship
and safety skills.
Ultimately, helping a birth parent who is hurting from
traumatic experiences benefits both the parent and the child.
Simply by reserving judgment, learning, asking and inter-acting
positively with parents we communicate our desire
to be trusted partners. 
Suggestions for Trauma-Informed Practice with Families
Child welfare professionals cannot undo parents’ traumatic experiences, but they can:
• Understand that parents’ anger,
fear, or avoidance may be a reac-tion
to their own past traumatic ex-periences,
not to the caseworker
him/herself.
• Assess parents’ history to understand
how past traumas may inform cur-rent
functioning and parenting.
• Motivate parents by approaching
them in a non-judgmental, non-blaming,
strengths-oriented way.
• Build on parents’ desire to keep their
children safe and reduce children’s
challenging behaviors.
• Help parents understand the impact of
past trauma on current functioning and
parenting, while still holding them ac-countable
for maltreatment. Many par-ents
are empowered and motivated
when they learn there is a connection be-tween
their past experiences and their
present reactions and behavior.
• Pay attention to how trauma plays out
during CFTs, home visits, visits to chil-dren
in foster care, and court hearings.
Help parents anticipate their possible re-actions
and develop different ways to
respond to stressors and trauma triggers.
• Refer parents to trauma-informed ser-vices
whenever possible. Generic in-terventions
that do not take into ac-count
parents’ underlying trauma is-sues
may not be effective.
• Become knowledgeable about evi-dence-
supported trauma interventions
to include in service planning.
• Advocate for the development and use
of trauma-informed services in your
community.
Reprinted from Birth Parents with Trauma Histories and the Child Welfare System: A Guide for Child Welfare Staff. National Child
Traumatic Stress Network, 2011. http://nctsn.org/sites/default/files/assets/pdfs/birth_parents_trauma_history_fact_sheet_final.pdf
RESOURCES FOR FAMILIES
Birth Parents with Trauma Histories in the Child
Welfare System: A Guide for Birth Parents (2012)
www.nctsnet.org/sites/default/files/assets/pdfs/
birth_parents_trauma_history_birth_parents.pdf
Birth Parents with Trauma Histories and the
Child Welfare System: A Guide for Resource Parents
(2011) www.nctsnet.org/sites/default/files/assets/
pdfs/birth_parents_trauma_resource_parent_final.pdf
10
References (Children’s Services Practice Notes, vol. 17, no. 2)
Center for Excellence in Children’s Mental Health, University
of Minnesota. (March, 2011). Creating Trauma-Informed
Systems of Child Welfare. eReview. http://
www.cmh.umn.edu/ereview/cmhereviewMar11.html
Chamberlain, L. B. (2009). The amazing teen brain: What
every child advocate needs to know. Child Law Practice,
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Child Welfare Information Gateway. (August 2011).
Supporting brain development in traumatized children and
youth. www.childwelfare.gov.
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Understanding the effects of maltreatment on brain
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Cook, A., Spinazzola, P., Ford, J., Lanktree, C., Blaustein, M.,
Cloitre, M., et al. (2005). Complex trauma in children
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782.
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welfare trauma training toolkit: The essential elements
of trauma-informed child welfare practice. http://
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National Child Traumatic Stress Network. (Spring, 2012).
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manuals.aspx?dc=dss
Pease, T. (2012). Developing trauma-informed practices
and environments: First steps for programs. Webinar
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Domestic Violence, Trauma & Mental Health. http://
www.nationalcenterdvtraumamh.org/trainingta/
webinars-seminars/
Perry, B. D. (2009). Examining child maltreatment through a
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neurosequential model of therapeutics. Journal of Loss
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15325020903004350
Perry, B., Pollard, R., Blakley, T., Baker, W., & Vigilante, D. (1995).
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(Teleconference). Presented November 16, 2011 by the
National Resource Center for Permanency and Family
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11-16/Addressing_Trauma_in_the_CW_System.pdf.
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main.zerotothree.org/site/
PageServer?pagename=ter_key_brainFAQ#question
A MEMO WORTH READING
In April the Administration for Children and Families (ACF)
issued an information memorandum entitled “Promoting
Social and Emotional Well-Being for Children and Youth
Receiving Child Welfare Services” (ACYF-CB-IM-12-04). In
this document, ACF urges child welfare systems nation-wide
to do more to attend to children’s behavioral, emo-tional,
and social functioning—those skills, capacities, and
characteristics that enable young people to understand and
navigate their world in healthy, positive ways.
In explaining why this is such an important area of empha-sis,
this information memorandum presents ACF’s official
framework for child well-being and describes in a very clear
way trauma’s effects on children in six key areas:
• Neurological impact
• Traumatic impact
• Behavioral impact
• Relational competence
• Mental health, and
• Psychotropic
medication.
A MUST READ
Reading this memo will give
you a clearer sense of what
the federal government is
thinking about trauma-in-formed
practice, the use of
evidence-based practices, and much more. You can find it
online at http://1.usa.gov/J0zL1r, or click on the image
above. 