A statewide introduction of trauma-informed care in a child welfare system

Most children in the care of the child welfare system have been exposed to multiple traumas in addition to the stressor of being removed from their home. Because the risk for mental health problems following exposure to trauma is high, a critical need exists to introduce trauma-informed practices into the child welfare system. The purpose of this study is to evaluate initial stages of a trauma-informed training program for the Arkansas Division of Child and Family Services (DCFS). In Phase 1, 102 (75%) of DCFS area directors and supervisors participated in 10 regional, two-day workshops modeled after the National Child and Traumatic Stress Network (NCTSN) trauma-informed training for child welfare. Pre- and post-training evaluations demonstrated significant improvements in participants' knowledge of trauma-informed practices. A three-month follow-up with directors and supervisors indicated that use of trauma-informed practices increased significantly and that such changes were correlated with pre- versus post-training improvement in knowledge. Most participants were able to partially implement action steps established at the time of training; however, a number of barriers were cited as preventing full implementation, including time constraints, heavy caseloads, lack of staff, and limited resources. Results are discussed in light of plans under way for Phase II training for all DCFS front-line staff.     

Trauma-informed forensic child maltreatment investigations

Trauma-informed child welfare systems (CWSs) are the focus of several recent national and state initiatives. Since 2005 social work publications have focused on systemic and practice changes within CW which seek to identify and reduce trauma to children and families experiencing child maltreatment or other distressing events, as well as to the agency personnel working with these clients. Within the body of trauma-informed literature, little attention has been devoted specifically to the initial investigative response and its role in controlling for system induced trauma to the child, family, and caseworker. Training child protection services (CPS) workers on the impact of trauma in child maltreatment forensic investigations and the worker's role in anticipating and mitigating the effects of trauma during the investigative process is rarely addressed in the trauma-informed literature. This article reports on a training strategy to infuse trauma information into an existing forensic child maltreatment investigation curriculum with the goal of enhancing CPS caseworker's knowledge, skills, and values concerning the importance of viewing investigations and their associated tasks through a trauma lens.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups.MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects.ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff.ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.     

KVC's Bridging the Way Home: An innovative approach to the application of Trauma Systems Therapy in child welfare

This article presents implementation study findings from a large-scale evaluation of an intervention model for children in foster care, aimed to improve care within the services system. This Bridging the Way Home Initiative, funded by the Anne E. Casey Foundation, and conducted under the auspices of KVC Kansas (KVC) in Kansas created processes by which a defined trauma-informed intervention model (Trauma Systems Therapy-TST) could inform the work of all those involved in the care of a foster child (i.e., clinical and non-clinical providers, and foster parents). This study focuses on how effectively TST was integrated into the full continuum of care at KVC, an organization that provides out-of-home care to children served by the Kansas Department for Children and Families in the Kansas City Metropolitan and East Kansas regions. The implementation study helps explain findings from a complementary outcomes study—covered in a separate article also submitted for review. We found the process of implementing and expanding TST demanding, iterative and complex, yet ultimately TST was implemented across levels. The majority of staff and foster parents completed training in TST, and fidelity measures showed progress in TST use over time. KVC's implementation of TST provided both the knowledge and the tools necessary for foster parents to better care for the children in their homes. KVC's efforts show it is possible to infuse trauma-informed care into a large child welfare organization across all levels of care.     

Barriers and facilitators for access to mental health services by traumatized youth

Polytrauma is a highly prevalent public health problem in the U.S. with even higher rates in urban areas. Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. Providers within these child-serving systems have potential to serve as gatekeepers to trauma services by linking youth with trauma-informed treatments and supports that promote recovery. The purpose of our study was to assess the perspective of providers who participated in a nine-month, trauma-informed care (TIC) training intervention on 1) their capacity to make referrals to trauma-specific services following the training, and 2) factors external to the training intervention that supported or hindered their ability to link traumatized youth with services. A subset of sixteen participants from the TIC training completed individual interviews. These participants were predominantly female, African American, and based in the social services sector. The constant comparative method was used to derive three thematic domains related to participant perceptions regarding youth referrals: 1) Organizational and provider capacity to provide trauma treatment or to make referrals to trauma-specific services, 2) Barriers to youth accessing trauma services, and 3) Suggestions for improving coordination of care and referrals. Our study highlights the influence of contextual factors on whether a TIC training can improve the capacity of agencies and individual providers to support traumatized youth in accessing appropriate services. The development of a structure that formally connects youth-serving agencies and providers with specialists trained in addressing traumatized youth is recommended.     

Creating trauma-informed child welfare systems using a community assessment process

This article describes a community assessment process designed to evaluate a specific child welfare jurisdiction based on the current definition of trauma-informed child welfare and its essential elements. This process has recently been developed and pilot tested within three diverse child welfare systems in the United States. The purpose of the assessment is to identify strengths and barriers related to trauma and child welfare in each site, to make tailored recommendations to help the sites better understand, and to address the impact of trauma on the families served and on the child welfare system itself. The specific components of the assessment process will be explained, and a summary of some of the findings that were common across sites will be provided. Recommendations for future work will also be discussed.     

A grassroots prototype for trauma-informed child welfare system change

The development of trauma-informed child welfare systems (TICWSs) that advance individual agency practice to target transformation of the system as a whole has been conceptualized but not documented. A grassroots effort to build a TICWS with key participants (e.g., Department of Human Services, Community Mental Health, Family Court, schools) in nine Michigan communities provides a field tested model for implementation. This article described what emerged as the core elements for a TICWS, which includes (1) development and support of a project champion, (2) trauma identification, (3) comprehensive assessment of traumatic impact, (4) evidence based trauma treatment, (5) establishing a common trauma language, and (6) trauma-informed decision-making. Several new instruments for assessing aTICWS are identified. Lessons learned are highlighted for consideration of communities seeking to develop TICWSs.     

Social Work Intervention in Child Abuse—An Ever-Widening Net?

This paper considers some of the issues concerning the social work response to child protection which are currently being debated by professionals involved in this field. In particular, the paper considers where there is an imbalance in the system, with too much emphasis being placed on child protection at the expense of child welfare. It describes how one authority has sought to focus its child protection investigation system. This has been achieved firstly through the use of management information to measure performance and make comparisons between different areas. This information was then used as the basis of training, encouraging staff to renew their practice and ensure that an appropriate response is made to child care referrals and that children are not drawn into the child protection net inappropriately but are dealt with within a child welfare framework. Examination of a sample of child protection investigations showed that where welfare needs were investigated, attempts were made to use available resources to meet these needs.     

Use of data to assess performance and promote outcome achievement by public and private child welfare agency staff

Despite the emphasis on evidence-based practice in the literature, little is known about the extent to which child welfare workers routinely use data to assess the effectiveness of their practice, or consider an array of evidence informed practices such as peer record review, supervisory sessions or program evaluation as useful in improving their performance. This study, conducted as a part of the planning phase for a larger research and demonstration project measured frontline staff perceptions in both the public and private sectors in one state regarding these and other outcome-focused activities. Statistically significant differences were noted between public and private agency staff. In addition, the relationship between staff's use of data and their assessment of their own skill and the support provided by their agency for an array of out-of-home care practice activities are described. Implications for building the use of evidence-informed practice in child welfare are discussed.     

New roles for families in child welfare: Strategies for expanding family involvement beyond the case level

This paper examines the strategies and approaches child welfare agencies used to integrate meaningful family involvement into their service delivery systems, under the Children's Bureau Improving Child Welfare Outcomes Through Systems of Care demonstration initiative. Through a series of retrospective interviews with child welfare agency staff, systems of care project staff, family members actively involved in implementing the systems of care initiative, and local program evaluators, researchers investigated the family involvement planning and capacity building activities of child welfare agencies during the initiative's implementation. Findings indicate that child welfare agencies' capacity building efforts primarily centered on human resource development, focusing on three areas: program staffing, family engagement, and agency buy-in. These findings illustrate the importance of developing the capacity of child welfare agency staff and family members before fully implementing family involvement programs and activities. Although more research is needed to document the impact of family involvement, the lessons learned from these grant communities' experiences provide critical information and can inform development of policies and practices to help child welfare and other child- and family-serving systems promote and implement meaningful and sustainable family involvement.     

When practice and policy collide: Child welfare workers' perceptions of investigation processes

This qualitative study examines variability in practices surrounding Child Protective Services (CPS) investigations regarding the allegations of child maltreatment. Working under the auspices of a community-research collaboration with Department of Human Services officials, university researchers conducted a series of focus groups with CPS caseworkers in a state that was under court-ordered consent decree to improve child welfare investigations. Focus groups with caseworkers sought to better understand caseworkers' common investigative practices and their perceptions of best practices in conducting child welfare investigations. Two main areas were noted for improvement: (1) the need for ongoing training of CPS workers, particularly at the stage of initial intake of the allegations of maltreatment, and cross-training of police and hospital staff who regularly work with CPS, and (2) implementation of an improved risk assessment tool. These recommendations are discussed in detail.     

A new paradigm: Bringing a historical and sociopolitical trauma lens to the training for welfare practitioners working with Aboriginal families

This article argues that child protection agencies must provide mandatory training about the Aboriginal experience within the welfare state and the resultant trauma that exists in Australian Indigenous communities. This article highlights the areas of curriculum to be included in training for welfare practitioners working with Aboriginal families in the New South Wales child protection system. The training content explores the Stolen Generations’ trauma experiences of child loss and examines the dichotomy between past child welfare laws and present child protection laws and intergenerational racism. Another key component of the training comprises information about the impacts of trauma on brain development.     

Does formal integration between child welfare and behavioral health agencies result in improved placement stability for adolescents engaged with both systems?

National survey data were used to assess whether child welfare agency ties to behavioral health care providers improved placement stability for adolescents served by both systems. Adolescents initially at home who were later removed tended to have fewer moves when child welfare and behavioral health were in the same larger agency. Joint training of child welfare and behavioral health staff was negatively associated with numbers of moves and numbers of days out of home.     

Exploring the self-care practices of child welfare workers: A research brief

Child welfare workers experience higher rates of vicarious trauma, workplace stress, and compassion fatigue, when compared to other social service workers. Increasingly, social service agencies, in general, and child welfare agencies, specifically, recognize the importance of self-care in assuaging these problematic employee outcomes. However, research that explicitly examines the self-care practices of child welfare workers in nominal. This study brief explores the self-care practices of child welfare workers (N = 222) in one southeastern state. Results reveal that child welfare workers only engage in self-care at moderate levels. Additionally, data suggests that variables such as health status, current financial status, and relationship status significantly impact personal and professional self-care practices, respectively. After a terse review of relevant literature, this brief will explicate findings associated with this study, and identify salient discussion points and implications for child welfare training, practice, and research.     

Challenging implicit bias: preparing students to practice with African American families

ABSTRACT

The disparity of African American families in the foster care system is a concern in the field of child welfare services and the social work profession. African American families experience unique challenges related to discriminatory practices and implicit biases in the child welfare system and by mandated reporters. To address these inequalities, state and local agencies have implemented prevention and intervention services to support minority families. Additionally, child welfare agencies have invested in professional development training for their workers to alleviate possible intolerant practices. This article describes implicit biases and considers how they could contribute to the disparity of African American families involved in the child welfare system. Furthermore, the article presents approaches to help social work students to identify and challenge their implicit biases to support culturally sensitive practices while working with African American families. It concludes with implications for social work education.     

Do child welfare job preview videos reflect evidence on retention and turnover?

To maintain a well-trained, competent work force and reduce turnover, child welfare agencies must use effective recruitment and retention practices. Many states use realistic job preview videos to recruit and retain appropriate, well-matched staff. The purpose of this study is to assess the content of child welfare realistic job preview videos to determine whether the content reflects current evidence on child welfare retention and turnover, and the mechanisms through which realistic job previews are most effective. The study involves content analysis of realistic job preview videos posted at the Child Welfare Information Gateway. A comparison of video content to findings from research on child welfare retention and turnover, and to research on realistic job preview effectiveness reveals some ways that the content of child welfare recruitment and retention efforts could be strengthened.     

Bridging refugee youth and children's services: a case study of cross-service training

Bridging Refugee Youth and Children's Services(BRYCS), a public-private partnership between the federal Office of Refugee Resettlement, Lutheran Immigration and Refugee Service, and the United States Conference of Catholic Bishops, provides national technical assistance to public child welfare. After a series of "community conversations," BRYCS identified a lack of knowledge among child welfare staff about newcomer refugees, negative stereotypes, and a fear of child protective services among refugees. BRYCS initiated a number of technical assistance initiatives, including a pilot cross-service training project in St. Louis to strengthen collaboration between child welfare and refugee-serving agencies. This article details the lessons learned from this training and recommends changes in policy and practice.