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GAO report on challenges that states face in addressing child trauma


The Government Accountability Office (GAO) released a report on May 22 on the challenges that states face in their efforts to support children affected by trauma. The findings were based in part on interviewing state and local officials in six states (Colorado, Massachusetts, North Carolina, Ohio, Washington, and Wisconsin) along with questionnaires to 16 states.

The request for the report was made by two Illinois members of Congress, U.S. Senator Dick Durbin and Congressman Danny Davis, and was accepted by GAO in August 2017 (for an ACEs Connection post with background on the GAO report, click here). The report’s conclusions will inform the development of legislation to be introduced next month, according to a press release from Sen. Durbin’s office about ongoing efforts to develop legislation on a bicameral, bipartisan basis. This proposed legislation builds on trauma provisions in a law passed in 2018 to address the opioid crisis. That bill was H.R. 6, SUPPORT for Patients and Communities Act, signed by the President on 10-24-18 (SUPPORT = Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment). Those provisions were based on the 2017 bill, Trauma-Informed Care for Children and Families Act, proposed by Senators Durbin and Heitkamp but not enacted.  

Here are the highlights, as reported by the GAO:

The Department of Health and Human Services (HHS) and the Department of Education (Education) provide grants, disseminate information, and fund training and technical assistance to help state and local agencies support children affected by trauma. HHS's Administration for Children and Families and Substance Abuse and Mental Health Services Administration (SAMHSA) have awarded discretionary grants specifically to address childhood trauma. In addition, state and local officials reported making use of other discretionary grants from HHS and Education—as well as formula funds meant for broad purposes like mental health, substance abuse, child welfare, and education—to support their work with children affected by trauma. In terms of non-financial support, state and local officials in six selected states all referred to the National Child Traumatic Stress Network, which is funded by SAMHSA, as an important resource for information, training, and technical assistance. Both HHS and Education have also made other guidance and informational resources available to states.

Officials in child welfare and education agencies in the six selected states reported using a range of approaches to help children affected by trauma, including training staff, screening children, and providing services and support systems. To train child welfare workers, educators, and birth and foster parents to understand trauma and its effects on children, agencies in the six selected states used various approaches, such as learning communities, which include in-person learning and coaching, and online courses. Several state child welfare agencies also used learning communities to train clinicians in trauma-focused therapies. In addition, child welfare and education agencies in five states used screening tools to identify children exposed to and exhibiting symptoms of trauma. Children identified as experiencing trauma are referred for a trauma-informed mental health assessment. Also, to help children affected by trauma, child welfare and education agencies in five of the six states provide support and services. For example, in one state, caseworkers provide specialized services, including weekly visits, to children and families.

Officials in the six selected states reported facing various challenges in their efforts to support children affected by trauma, and they emphasized the importance of engaged leadership in establishing and sustaining support for these children. In three states, officials said that a lack of such leadership hindered their efforts, and they described cases that included delayed, incomplete, or unsuccessful implementation of initiatives. Officials in all six states also talked about limitations on their agency's capacity to support children affected by trauma, including:

  • high rates of staff turnover, especially in child welfare;
  • limited staff time to dedicate to trauma initiatives;
  • lack of clinicians trained in trauma-focused therapies; and
  • insufficient funding to support trauma initiatives.

Officials in some states reported strategies they have used to help address these challenges, including providing additional support to employees and coordinating with partner agencies to jointly leverage resources, expertise, and data.

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