Child Welfare Panel, November 7, 2014, San Francisco, CA
Moderator Charles Wilson of the Chadwick Center for Children and Families opened the session with a brief history on the system, coming from a rescue philosophy. In the 1970’s the focus was on how to make kids safe physically, which primarily involved removal from homes and placement in foster care. In the early 1990’s there was a shift to permanency- how to protect kids and keep families together. It wasn’t until recently that the focus shifted beyond safety and permanence to include social and emotional wellbeing. “The change was driven by the critical importance of the first five years of life, the ACE study, the social determinants of health, the emergence of evidence-based practices, and the impact of trauma on human behavior,” says Wilson.
Trauma was laid out as an event or events, as defined by an individual, with measurable impact (SAHMSA/National Child Traumatic Stress Network). A trauma-informed system looks at the world through a trauma-informed lens. I”t’s not about sending people to a training and checking it off the list. It’s an organizational culture change,” says Wilson. Resources included the Seven Essential Elements of a Trauma-Informed Child Welfare System, and the California Evidence-Based Clearinghouse for Child Welfare.
Deborah Zanders-Willis of the San Diego County Child Welfare Services, focused on how to take the research and knowledge to implement a trauma-informed system and practice. In 2010, San Diego County Child Welfare Services participated in a collaborative with the Chadwick Center, along with six other jurisdictions, to test and implement trauma-informed care. Together they laid the foundation for a county wide two day trauma training, which was later modified to a six hour training.
“One system cannot do it by itself,” says Zander-Willis. “Partners and resources need to be informed.” Trauma champions were identified and brought on board and involved in the process of deciding which tools to develop. Social workers and supervisors were included. Subject matter experts developed tools in the field while providing ongoing support. “It has to be infused and braided in the work,” says Zander-Willis.
An example of a tool developed to engage parents was the All About Me form, for infants, kids, and teens. The form asks parents from whom the child is being removed from about daily routines and any possible scary experiences. This approach recognizes that the parent is the expert on the child, while also helping placement families to know what to reproduce or avoid.
“When I was in child welfare we went in, held up our badge, left our business card, told them what to do- parent classes, drug recovery program- then you’ll get your child back. Now the power has shifted to be shared with families,” says Zander-Willis. “It’s not just about protecting the child, it’s about changing the question from ‘what’s wrong with you’ to ‘what happened to you,’ and to be sensitive and respectful of that.”
Concrete tools are needed to create meaningful dialogue with families that elicit positive responses. Training has to be supported and talked about at all times. “We have coaches out to remind staff of their tools and the dialogues to have with families,” says Zander-Willis.
The San Diego Health and Human Services “super agency” now has a county-wide trauma focus. “We’ve done this in child welfare- how do we do this for other disciplines? It’s just as traumatic when we send families to another department to be shuffled around.”
Brent Crandal of the Chadwick Center for Youth and Families, covered the tools and implications of identifying kids for trauma and related mental health issues. Out of ten teens, six will experience a traumatizing event and of them one (13%) will have mental health needs. 48% of teens in child welfare have significant mental health needs, yet only one out of three are getting treatment (see Katie A).
Identification includes screening, which can be administered broadly and relatively easily with effective tools. Assessment is more complicated. The precursor for identifying trauma includes an event, whereas identifying PTSD includes behavior problems. A number of validated tools were reviewed, including the Children Revised Impact of Event Scale (CRIES-8), the Brief Assessment of Anxiety and PTS Symptoms (SCARED), the Pediatric Symptom Checklist (PSC-17), and the Strengths and Difficulties Questionnaire (SDQ).
The Chadwick Center’s Tulare County pilot program identified 1,000 kids in care using the SCARED Brief Assessment and the Strengths and Difficulties Questionnaire, a total of 29 items, in English and Spanish, completed by caregivers and youth, not CPS workers. Preliminary results- of 725 youth, there was a 44% overall need (37% general mental health need and 22% trauma-specific need). The goal- create a better cock pit for the workers through the use of screening tools. “When armed with better tools, workers find that better conversations are started,” says Crandal.
Stephan Betz of the Solano County Child Welfare Department covered the ways in which his work is contributing to building a trauma-informed community including how child welfare is partnering with other agencies to forge a community wide approach and policy. “A multidisciplinary team approach is needed, including ACE scores and resilience scores, such as the UCLA PTSD score, the TESI score, the CANNS score, and the cumulative impact of recurring ACEs on your life,” says Betz.
“Assessments need to be concurrent with treatment.” Betz is working with Kaiser Napa/Solano to identify residents and assess school requirements. They are helping teachers identify out of character behaviors among kids, in order to make successful referrals to school based health centers and community resources. Instead of sending kids out, classrooms also invite child welfare, mental health, and student teams into classrooms to provide support.
In the city of Vallejo, the community response includes collaboration between full service schools and the Solano Positive Youth Justice Initiative. Through the leadership of Dr. Romona Bishop, Vallejo City Unified School District Superintendent, they assessed high need crossover youth, piloted restorative practices, saw graduation rates go up, and referrals for discipline go down by 81%.
The Solano County women’s Reentry Achievement Program (WRAP), followed guidance by formally incarcerated woman and developed a fair shot for them to reunite with their children. Through the program, recidivism was reduced from 48% to 21%, a 56% reduction. Two million dollars were saved in justice costs, and the program is currently being evaluated as a national model to treat adults and kids of offenders.