Strengthening Families to Prevent Child Abuse and Neglect

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					    Understanding Childhood Trauma
its Lifelong Effects – A Systems Approach

Healthy People
     Stable Families
           Strong Communities
                                        Joanne Mooney and Carole Wilcox
                          Child Safety and Permanency Division, MNDHS
            Overview of Presentation

 Adverse effects on healthy development due to toxic stress
  and trauma

 Approaches to improving the odds

 Development of a trauma informed Minnesota public child
  welfare system

 Building hope from resiliency

What do we hope for our children?
        MN Public Child Welfare System
             Hope for Children

 Based on the child welfare practice model built form
 lessons learned over the last decade of reforms

 Shift from “Family Bubble” or “Deficit Oriented
 Models” to Models that focus on strengths, health, &

 We work with parents and partners to ensure that children and
 families are supported to achieve equitable optimal development
 regardless of race, ethnicity, socioeconomic status or tribal status
Positive Adaptation – A Focus on Well-Being

Child Well-Being includes:

    Healthy social emotional functioning
    Safe, secure and responsive environments for families
    Conditions that allow children to be successful during
     childhood and into adulthood

This means no child in Minnesota should ever
experience extended hunger, be homeless, live in
poverty or go without health care.
Equality or Parity?
        Timing is Everything…
  When it Comes to Brain Development

Health trajectories!
Our healthy path is particularly affected during critical or
sensitive periods. Early programming is key.

   Critical or Sensitive Periods. While adverse events
    and exposures can have an impact at any point in a
    person’s life course, the impact is greatest at specific
    critical or sensitive periods of development.
   Early Programming. Early experiences can “program”
    an individual’s future health and development.
         Our Past Stays With Us

Today's Experiences  Tomorrow's Health

The lifecourse is an integrated continuum of
 risk and protective exposures, experiences
 and interactions

Health pathways or trajectories are built –
 and modified– over the lifespan
    Trauma and Early Brain Development

 During the early period of life, a baby’s brain is forming
  700 neural connections every second. The experience of
  trauma during this stage impacts healthy development.

 Trauma is the experience of an event by a person that is
  emotionally painful or distressful which often results in
  lasting mental and physical effects.

 Growing scientific knowledge links childhood toxic stress
  with disruptions of the developing nervous,
  cardiovascular, immune, and metabolic systems.
    Trauma and Early Brain Development

 These disruptions can lead to lifelong impairments in
 learning, behavior, and both physical and mental

 Disruption in Neural Development that concern child
  Failure to expose youth to appropriate experiences
   at the critical times (Neglect)
  Overwhelming the brain’s alarm system (Abuse)
            Adverse Childhood Experiences
            Change How Our Brains Work

Toxic stress video:
                     Impact of Trauma

Short Term                           Long Term
 Eating
                                      Depression
 Sleeping
 Toileting                           Anxiety
 Attention & Concentration           PTSD
 Withdrawal
                                      Personality
 Avoidance
 Fearfulness                         Alcohol or Other Drug
 Re-experiencing/                     Problems
 Flashbacks
                                      Becoming Violent
 Aggression; Turning passive into
  active                               Towards Others
 Relationships
 Partial memory loss
Trauma-informed worldview
            Now Add…Child Poverty …
Based on 3-year averages from the American Community Survey (ACS) for Minnesota 2007-2009
                       (children for whom poverty status is determined)

                         Poverty and Neglect

 There is a relationship between neglect and poverty. Neglect is defined
  as the failure to provide for a child’s basic needs “when reasonably able
  to do so.” Disproportionate referrals occur by community reporters to
  the public child welfare system.
     The Fourth National Incidence Study found families under the poverty level to be
      reported at 7 times the rate of families over the poverty level.

 Conditions of poverty can create circumstances of a child being
  neglected due to parents’ lack of financial resources. When this occurs,
  public child welfare agencies should work to improve the conditions
  that influence neglect and meet protective needs while making no
  determination of maltreatment.

 Families of color are more likely to be in poverty as an artifact of
  historical racism.

 Therefore higher neglect rates of families of color can be tied in large
  part to higher poverty rates.
                            Historical Trauma

 HISTORIC TRAUMA is the collective emotional and psychological
  injury both over the life span and across generations, resulting from a
  cataclysmic history of genocide.
 Genocide is the intent to destroy a national, ethnic, racial or religious
  group (1948 Geneva Convention)
 Historical trauma has a layering effect and is the "cumulative
  emotional and psychological wounding over the life span and across
  generations, emanating from massive group trauma."
 Historical or intergenerational trauma is similar to that suffered by
  the Jewish people as a result of the Holocaust, Native Americans, the
  Japanese Americans interned in California at the beginning of World
  War II and African Americans suffering the aftermath of slavery.

Maria Yellow Horse Brave Heart, Research Associate Professor, Graduate School of Social Work,
University of Denver
                 Effects of Historic Trauma

 First Generation
     Post Traumatic Stress Disorder

 Subsequent Generations – Historical Unresolved Trauma Survivor
     Guilt, Depression, Anger
     Psychic numbing
     Victim identity/death identity
     Thoughts of suicide
     Nightmares
     Preoccupation with trauma
     Relational problems
     Physical symptoms including diabetes and other disease associated with high
      stress hormones that wear out the body.
What is ACE?
    High Individual and Public Costs of Trauma

 Alcoholism and alcohol abuse        Risk for intimate partner
 Chronic obstructive pulmonary          violence
    disease (COPD)                      Multiple sexual partners
   Depression                          Sexually transmitted diseases
   Fetal death                          (STDs)
   Health-related quality of life      Smoking
   Illicit drug use                    Suicide attempts
   Ischemic heart disease (IHD)        Unintended pregnancies
   Liver disease                       Early initiation of smoking
                                        Early initiation of sexual activity
                                        Adolescent pregnancy
(Graphic: R. Anda, 2011)
Slide from R. Anda (2011), used with
Slide from R. Anda (2011), used with
    OF THE
A large portion of many
health,     safety   and
prosperity conditions is
attributable to Adverse
Childhood Experience.

ACE reduction reliably
predicts a decrease in all
of    these    conditions
               “Ten Tribes” Study
          Adverse Childhood Exposures
 Boarding School, Foster Care and Adoption perspectives added.
 Cultural variables assessed.
 86% participants experienced one or more categories of exposure
 33% reported four or more categories.
 Strong relationship between childhood sexual abuse and
  subsequent drinking problems among the general population
  similar in Native American population.
 Combined sexual and physical abuse increased alcohol dependence
  for men.
 Combined sexual abuse and boarding school attendance were
  significant for women.

Source: Koss, M., Polacca, M., Yuan N., et al “Adverse Childhood Exposures and
Alcohol Dependence Among Seven Tribes” American Journal of Preventative
Medicine, 2003, pp. 238‐244
              States Collecting ACE Data

                                                           18 States

    No data      2009         2010           2011

Source: Behavioral Risk Factor Surveillance System, CDC.

 Children are vulnerable to risk – but also
  amenable to intervention
 Human brains have the capacity to change -
 Focus for children must be on relationships that
 •   Nurturing
 •   Stable
 •   Engaging
                 Resilience and Relationships

   “Resilience rests, fundamentally,
           on relationships”
 None of us is perfect
 Resilience is complex
 We have the capacity to adapt
 Resiliency and protective factors help during adversity
 Recovery is individual and environmentally influenced

Conclusion of SuniyaLuthar, in: Resilience in development: A synthesis of research across five decades. (2006, p. 780)
            Key Components of Resilience

   How is your
 nurturing these
three components
  for resilience
 throughout the

 How is your community nurturing these
 three components for resilience throughout
 the lifespan of the people you serve?

 What do you need to do more of?

 With whom?
    Building Upon the Strengths of Families:
             The Protective Factors

• Concrete Supports in Times of

• Social Connections

• Parental Resilience

• Knowledge of Parenting and
  Child Development

• Children’s Social and
  Emotional Competence
                  Embracing Culture

 Culture is a system of shared
  actions, values and beliefs that
  guide behavior of families and
 Recognizing importance and
  strength of cultural norms
  supports families and
  communities and helps them to
 Establishing shared leadership
  with diverse parents and
  caregivers improves supports
  and services for families and

           Protective Factor Card

How does this protective factor present itself
           in your personal life?

How does this protective factor present itself
        in your professional life?
System Approach to Trauma

                        Alcohol &
          Education    Other Drugs
 Child                   System
             Trauma            Care
           Community       Criminal
            Violence        Justice
PEDIATRICS Volume 129, Number 1, January 2012
    Working Across Systems in Partnership

Primary Prevention            Secondary                       Tertiary Prevention
•   Positive early care and   •   Mentoring                   •   Mental Health Services
    education                 •   Mental health services      •   Substance Abuse
•   Positive social and       •   Substance abuse services        Services
    emotional development     •   Family support services     •   Domestic Abuse Services
•   Parenting skills          •   Domestic Abuse services     •   Successful re-entry
•   Quality after-school      •   Conflict interruption and
    programming                   street/community
•   Conflict resolution           outreach
•   Youth leadership
•   Quality education
•   Social connections in
•   Economic development
            Discussion Questions

 How is the system you work within traumatizing
 children and families?

 What will your system do to shift away from these
 policies, practices, or procedures?
     Child Welfare System Perspective

What has Minnesota’s Public Child Welfare
System done to…

Become trauma-informed?

Improve the odds for children and their
     Minnesota Public Child Welfare System

 State-supervised/County-
  administered (87 counties)

 Eleven federally recognized Tribes –
  2 American Indian Child Welfare
  Initiative Tribes

 State with highest share of local
  property taxes for child welfare
                             MN Children in Out-of-home Care per 1,000 in the
                              Child Population by Race/Ethnicity, 2001–2010

                               94.1                 92.6
                                                                                                                         89.2         88.7
                                                                                            82.5            83.9
                                                                                                                                                   77.8          78.7
Children in care per 1,000

                                                                             37.4                           35.9
                                                                                            35.8                         34.9
                                33.6                                                                                                  32.4
                                                                                                                                                   25.9              25.0
                                                                     21.5      24.1
                                                                                             19.7             20.1        20.3         19.3
                                                          17.3                                                                                       17.2         16.9
                                                                     15.3       14.5           14.7               14.5      14.1         13.5
                                      9.4                 9.1                                                                                             11.5       10.3
                                                                       8.0          7.4        7.9             7.7              7.6      6.7              5.7         5.8
                               7.0                  7.7                        5.4                                         5.2         5.0
                                                                 5.9                          4.9           6.2                                     3.8              3.7
                               2001                 2002         2003        2004          2005           2006           2007         2008        2009           2010

                                            African American/Black                        American Indian                              Asian/Pacific Islander

                                            White                                         Two or more races                            Hispanic ethnicity–any race
         What We Now Know

 Relationships cause change
 Leaders and partnerships impact change
 Flexibility and adaptability
 Employ strengths and engage capacities
 Assure continuity of care and connections
 Focus on well-being
 Rely on professional, familial, community and cultural

 Building Upon the Strong Foundation

 Minimize trauma when a child enters the CW system

 –   Engage parents as partners in safety planning
     –   Parent Support Outreach Program
     –   Family Assessment Response
     –   Signs of Safety
     –   Family Group Decision Making

 –   If placement is necessary, make every effort to place children with
     –   Conduct relative/kin searches early on
     –   Continue to pursue available relative/kin resources

 –   When placing children
     –   keep them close to their homes
     –   keep siblings together
     –   maintain cultural connections and school stability
     –   ensure frequent and quality visits with parents and children
 Building Upon the Strong Foundation

 Implement a systemic approach to creating trauma-
 informed child welfare system

 –   Screen for trauma upon entrance to out of home care
     –   Examine potential to integrate screening items into existing
         screening and/or assessment instruments.

 –   Expand learning and training opportunities
     –   Build knowledge of brain development and trauma-informed
         practice integrated into foundation training for social workers
     –   Provide training to resource family providers
 Building Upon the Strong Foundation

 Improve capacity, access and availability for
 therapeutic services that are culturally sensitive and
 –   Coordinate with Children’s Mental Health Division and MN’s
     Ambit Network to build capacity for trauma-informed mental
     health practitioners
 –   Encourage child welfare workers to make trauma-centered
     referrals to providers
 –   Include parent leaders to inform policy, program and practice
         Relationships Are the Difference

 Trauma can be created by disruption in healthy
 Trauma can be healed by development of healthy
 Keep the focus on relationships for children that are:

 •   Nurturing
 •   Stable
 •   Engaging
              Building Hope:
           Resiliency and Change

 How will YOU use your opportunities for integration
 and change?
                                Links to Sources

   The Lifelong Effects of Early Childhood Adversity and Toxic Stress – American Academy of Pediatrics;129/1/e232.pdf

   Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy
              – Dr. Jack P. Shonkoff

   Child Trauma Academy – Dr. Bruce Perry

   Adverse Childhood Experiences – Washington State Family Policy Council

   Strengthening Families - A Protective Factors Framework – Center for the Study of Social Policy

   Chapin Hall Child & Family Policy Forum – Public Systems: Responding to Students Affect by Trauma

   Zero to Three: Supporting the Development of Infants and Toddlers in the Child Welfare System: A
    Call to Action
      Joanne Mooney

        Carole Wilcox