MCFD Trauma-Informed Practice Guide: Healing Families, Helping Systems
The Healing Families, Helping Systems guide begins with a section on Understanding Trauma, noting:
“Trauma arises from many forms of neglect, abuse, violence, loss, witnessing of violence and other overwhelming life events. Individuals react to and cope with these potential sources of trauma in different ways….
A 2008 survey of 10,000 Canadian youth revealed high rates of trauma: 21% of girls and 31% of boys reported physical abuse, while 13% of girls and 4% of boys reported sexual abuse….
In a 2013 BC Adolescent Survey, students were asked to report on stress, despair, sadness, self-harm and suicide attempts. Of those youth who reported self-harm, 43% also reported using substances to “manage stress” compared to 14% of all students who tried substances….
In a review if 31 cases of critical injury or death of children in care reported to the Office of the Representative for Children and Youth in BC for the period of 2010-2011, all had experienced trauma earlier in their lives. Early traumatic experiences within the family of origin included physical abuse by a family member, sexual abuse by a family member, neglect by their family, exposure to domestic violence, and/or exposure to problematic substance use in the family.”
“The experiences and effects of trauma among children and youth are different based on sex and gender identity.
Boys are more likely to experience physical assault, physical bullying, and physical threats, and are slightly more likely to have witnessed violence. One study found that boys reported significantly greater exposure to both interpersonal and non-interpersonal traumatic life events…
Girls are more likely to experience sexual victimization, psychological and emotional abuse, internet harassment, and emotional bullying. One study found that girls were more likely than boys to have experienced sexual abuse and to report greater clinical levels of PTSD symptoms and disassociation symptoms.”
“Some children and youth are more likely to experience traumatic events than others. Vulnerable groups include:
Children and youth living on a low income
Children and youth living with a parent with mental illness or their own unresolved trauma histories…
Lesbian, gay and bisexual youth…
Transgender children and transsexual children and youth, including two-spirit youth
Children and youth with disabilities..
Youth with hearing loss report greater and more severe physical abuse than other youth…
Rates of sexual and physical abuse and maltreatment (both in the home and in institutional settings) are much higher among deaf children and youth, and the communication barriers that these youth experience may prevent disclosure and/or exacerbate trauma.”
The guide provides a summary section on the Effects of Trauma, looking at:
The centrality of trauma to development
Factors affecting an individual’s trauma response
Range of negative effects of trauma
Neurobiological contributions to our understanding of trauma
The distinction between acute trauma and complex trauma
Post-traumatic stress disorder
Parents with trauma responses
The authors of the guide note: “When working with children and families we may notice and understand trauma responses in children, but not recognize or accept them so readily in parents. Unresolved trauma responses over time can become adaptive behaviours and reactions that we see in adults but are otherwise mislabelled or stigmatized. This stigmatization may be particularly directed to families impacted by chronic and multiple adversities, which can contribute to multi-generational challenges….A parent who is in a ‘fight, flight or freeze response” … may be labelled as ‘avoidant and non-compliant’, having ‘anger management problems’ or be perceived to have ‘limited capacity’ to understand issues or manage their behavior. Overall, trauma-related issues such as problematic substance use, depression, anger problems, fear of intimacy or authority, hypervigilance, and emotional numbing can impact emotional regulation, and interfere with parents’ ability to make accurate assessments of risk and safety. This, in turn, impacts parenting skills and disrupts family connection and stability, setting up the potential for intergenerational transmission of trauma.”
“People impacted by trauma are typically active in their resistance to distress, even if that resistance isn’t always adaptive in the long term. For example, some youth and adults living with trauma histories use psychoactive substances as a coping strategy to help self-regulate emotions, numb hyper-arousal symptoms, reduce intrusive memories, and combat feelings of helplessness and depression. However, what begins as a coping strategy can result in substance use problems and addition.”
In wrapping up the section, the authors note that “responses to trauma are complicated because the both influence and are influenced by numerous factors including personal characteristics such as age, developmental stage, and temperament; gender; culture and family life; life circumstances and histories. Responses to trauma and loss, therefore, encompass a wide range of reactions with varying degrees of onset, duration and intensity, which can be mitigated by preventative and protective factors. Having good self-esteem, an array of coping skills, and a positive attachment to a caregiver or caregiving system can protect against adverse trauma effects. Recognizing the signs of trauma and responding appropriately not only mitigates the effects but enhances the resilience of children and families and those who support them.”
The guide reviews Trauma-informed Principles and looks at the distinction between “trauma-informed” and “trauma-specific”, noting the importance of understanding the difference between the two terms, with the following examples:
• Everyone working in child- and youth-serving systems contributes to embedding a trauma-informed approach into the everyday practices of their organization. The administrative staff, custodial staff and other people who are part of the organization’s day-to-day work are important participants, as are the organization’s executive leadership. Knowledge of trauma-informed approaches is relevant to all.
• Within a trauma-informed system there will be those who provide direct services to children and youth, and their families. These service providers will typically have a role that includes the provision of information, support for developing coping skills, sensitive monitoring of potential trauma-related behaviour, and referral to trauma-specific services if these are desired and required.
• Trauma-specific interventions are provided by mental health professionals, and are intended for those with a known trauma history.
This section also provides link for further reading including:
• Concept of Trauma and Guidance for a Trauma-Informed Approach: Introduces a concept of trauma and offers a framework for how an organization, system, service sector can become trauma-informed. Includes a definition of trauma (the three “E’s”), a definition of a trauma-informed approach (the four “R’s”), 6 key principles, and 10 implementation domains. http://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884
• Trauma-Informed Practice Guide: The TIP Guide, developed on behalf of the BC Provincial Mental Health and Substance Use Planning Council, supports the translation of trauma-informed principles into practice. Included are concrete strategies to guide the professional work of practitioners assisting clients with mental health and substance use concerns. http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf
• Addressing the Healing of Aboriginal Adults and Families within a Community-owned College Model: This report contributes to understanding of the impacts of historic trauma on learning and how incorporating culture in the learning environment through circle approaches and related strategies can foster respect, relationship building, trust and empowerment, all of which are connected to trauma-informed practice. https://www.nccahccnsa.ca/495/Addressing_the_Healing_of_Aboriginal_Adults_and_Families_within_a_Community-owned_College_Model.nccah?id=143
The guide reviews the Principles of Trauma-Informed Practice, including:
Emphasis on safety and trustworthiness
Opportunity for choice, collaboration, and connection
Strengths based and skill building
The section on Implementing trauma-informed approaches stresses that “change should be made from both the top-down and bottom-up perspectives” (Conradi, L., et al), noting that “For traumatized children involved with the child welfare system, a consensus is mounting around several core areas of knowledge and practice change as reflecting trauma-informed practice (Fraser, et al – Findings from the Massachusetts Child Trauma Project, page 235):
An understanding about the impact of trauma on the development and behaviour of children and youth,
Knowledge about when and how to intervene directly in a trauma- and culturally-sensitive manner through strategic referrals,
Ensuring access to timely, quality, and effective trauma-focused intervention,
A case planning process that supports resilience in long term healing and recovery, and
Attention to self-care in response to working with traumatized children.”
The guide notes, “Five ways in which trauma-informed principles can be seen in practice at the individual level with children and youth [include]:
Clear information and predictable expectations about support are provided.
Welcoming intake procedures are used, and they include a physically and emotionally safe environment.
Challenging behaviours are notices and responded to, based on an understanding of trauma responses and an acceptance for a range of emotions.
A focus is placed on building relationships, acknowledging that because of trauma responses this can be difficult.
Skills for recognizing triggers, calming, centering and staying present are taught and modeled.”
The guide provides best practices for professionals dealing with children and youth:
Maximize children’s and young people’s sense of safety; assist them in managing their emotions and in making meaning of their current coping strategies and trauma histories. Provide emotional safety for children/youth to talk about trauma and safety if they choose to.
Include the perspectives of children and youth in defining what is triggering for them and what creates safety and learning. Involve them as appropriate in focus groups, roundtables and other methods for evaluating and improving services.
Recognize how age and developmental trends impact the experience and effects of trauma for children and youth. Provide responses that are appropriate for their culture, age and cognitive, physical, and emotional developmental stages.
Recognize how gender affects the types of trauma experienced and the expression of its effects, openness to discussing and truth-telling about trauma. Provide gender responsive options for support.
Recognize how historical trauma affects Aboriginal children and youth, and involve Aboriginal youth, parents, aunts and uncles, Elders and communities in bringing holistic wellness and other culturally competent practices to trauma-informed approaches with Aboriginal children and youth.
Continuously explain and clarify to children and youth the agency processes, next steps, and measures being taken to ensure their safety and wellness.
Make the physical environment of service settings welcoming and safe. Signal through the physical environment and informational materials that talking about and getting support on trauma is welcome and available in the setting.
Understand and map the supports and treatments available for children and youth experiencing trauma and build relationships with the provider agencies to facilitate appropriate and timely referrals.
Use trauma-informed universal screening and other methods to understand the level of trauma a child/ youth is experiencing, as well as other adverse experiences in their lives. This can inform referrals for other supports and services, such as trauma-specific interventions or cultural connections. In child welfare, it can also inform appropriate placements and guard against multiple placements.
Support and promote positive and stable relationships in children’s and young people’s lives.
Recommendations for best practices in dealing with families include:
Understand that all children and families with histories of trauma have areas of strength and resilience, and support workers need to identify not only risk factors, but also to foster and build protective factors for each child, youth and family.
Provide training to families of all types (birth, adoptive, blended, foster, kinship, respite, families of choice etc.) on: bringing a trauma lens to understanding what factors may be affecting a child/youth’s behaviour, managing conflict and displaying empathy, and teaching coping and resilience strategies.
Provide opportunities for families of all types who are parenting children and youth to enhance their own self-care and where relevant to access support/ treatment for their own experiences of trauma.
Link to, refer to, and collaborate with multi-setting, multi-level, interagency supports and services that optimize child and family resilience.
Involve brokers, liaisons and Elders to bridge trauma-informed and culture- and gender-informed approaches for children, youth and families, communities, and child and youth serving agencies.
Recommendations for best practices in managing worker wellness and safety include:
Understand and recognize the risk of secondary traumatic stress for all staff members, and the agency as a whole.
Provide training on secondary trauma and stress management for all staff, promote self-care and well-being through policies and communications and encourage ongoing discussion among staff and administration.
Create and maintain a work environment that conveys respect and appreciation, that is safe and confidential, and that provides support for continuing education, supervision, collaboration, consultation, and planned mental health breaks.
Support staff development, debriefing after critical incidents, individual/group supervision and related strategies that support worker health. Ideas for various combinations of strategies that workplaces have used to prevent and manage secondary trauma are linked to on the Child Welfare Information Gateway (see link below).
Cultivate a workplace culture that normalizes (and does not stigmatize) getting help for mental health challenges and actively promotes
Recommendations for best practices at an organizational and inter-agency level include:
Conduct organizational level assessments that identify the range of practices and policies that might be initiated and/or enhanced to support trauma-informed practice. See Appendix 2 for examples of self- assessment questions.
Facilitate culture change in the organization towards social learning and agency-wide emotional intelligence.
Identify and map existing trauma-informed practices, which can be built upon and more broadly implemented.
Incorporate trauma knowledge into all practice models.
Integrate safe, respectful, learning-oriented, solution-focused approaches to case review, debriefing of incidents and supervision, paying close attention to language.
Discuss how to address trauma experienced by different system stakeholders (children, parents, workers, Aboriginal communities) and how strategies for building resilience in all these groups can be linked in agency-wide approaches. Attention to the impact of intergenerational trauma is particularly important in such strategic planning for/with workers and communities.
Share trauma-informed resources, and resources reflecting traditional Aboriginal healing practices, across systems.
Integrate alternate forms of information sharing to support trust and ensure understanding between workers and families. For example, a written summary of what was discussed, action points, contact information, etc.
Key areas at the leadership level (relational system change) include:
Valuing of Collective Learning
Involvement of management and leadership together with practice leaders, workers, and youth and families
Learning taking place not only through formal training, but also in cross-agency placements, in virtual communities, and via role modelling and supervision in enabling environments
Recognizing cultural safety as a cornerstone of trauma-informed practice
Broad, open stances of inquiry, critical thinking, appreciative enquiry, mentoring and use of learning collaboratives
Activation of Natural Champions
Recognizing the need to actively support and motivate people to make shifts in practice
Organizational Culture Shifts
Enabling learning cultures at the system, agency and team levels and developing wide-spread accountability for decision-making through collective approaches
Recognizing that, “amid multiple internal and external pressures facing those working in child and youth care systems, that implementation of a trauma lens needs to be intentional, and all implementation strategies need to be linked to creating kind and hospitable organizational systems that foster both organizational and human capacity”
Embracing the values and principles of the APPF in all work and interactions strengthens the implementation of trauma-informed practices
Recognizing that organizational shifts need to affect recruitment and hiring, so there is active recruitment of trauma-informed employees
Focus on Building Partnership, Relational System Change
Establishing constructive working relationships with/amongst children, parents, families, cultural communities and practitioners, and amongst professionals in multiple agencies and systems as a foundation, including “developing common language and frameworks for documenting trauma history, exchanging information, coordinating assessments, and planning and delivering care collaboratively with families and communities”
Supporting culturally safe service provision for Aboriginal families by gaining understanding of the complex history of Aboriginal communities in Canada, in particular the intergenerational impacts of the medical system on Aboriginal peoples, and creating partnerships with Aboriginal peoples in the care of children and youth.
Recommendations for best practice at the leadership level include:
Build a system-wide learning culture about trauma. Provide forums for training all staff, as well as providing co-learning opportunities with families, on types of trauma, common reactions to traumatic events, short- and long-term impact of trauma, and principles of trauma-informed practice.
Identify leaders who can serve as TIP champions to promote change within their workplaces. Cultural advisors and Elders may also take such leadership roles.
Link leaders in all six services areas, provincial programs, contracted agencies and Delegated Aboriginal Agencies (DAAs), in learning together and discussing and acting on trauma-informed approaches.
Link leaders in child protection, mental health, education, youth justice, victim services, police, crown attorneys, community agencies, youth and family advocacy groups, Peer Support Agencies/Programs and other systems to collectively take a trauma-informed approach to their work with children, youth and families.
Discuss with other systems the benefits of a trauma-informed approach and the importance of interagency collaboration when creating safe environments, learning about trauma and adapting practice and policy, and creating a trustworthy service net/network of support and treatment. This advocacy with leadership in other systems needs to include systems interacting with adults who are parents and/or caregivers, those working on cultural wellness interventions, gender-informed interventions, etc.