Child Trauma and the Prefrontal Cortex

Source:
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
U.S. Department of Health and Human Services

Trauma is the Norm for Youth in Systems

Source:
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
U.S. Department of Health and Human Services

The Link Between Relationships and Resilience

Source:
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
U.S. Department of Health and Human Services


* * *
Speaking as a former foster youth, another way to express this truth might be that:

• Pain came into our lives through relationships
• Healing can enter our lives that way, too

Lisa

Safety, Permanence and Well-Being

Child welfare agencies are rated by the CSFR on how well they provide foster care youth with Safety, Permanency and Well-Being.

Currently, the federal government is thoughtfully considering: 

• What exactly does "Well Being" look like? 

•  How can it be measured?

Source:
Bryan Samuels
Commissioner, Administration on Children Youth and Families
U.S. Department of Health and Human Services

The Difference Between Physical And Emotional Safety

Tips for Foster Parents:

• Limit stimulation - be patient and take a slower pace in introducing newness ("welcome to your new foster home, there are all the rules, now let's meet everybody in the household"), because this speed of incoming data can be cognitively understood, but is emotionally overwhelming.
• Follow the lead of the child. 
• Follow the pace of the child.

Tips for Caseworkers:

• Be aware that Transition Points are emotional hot spots
• The internal alarm goes off, signaling danger
• Child welfare has a tendency to try to make moves as quick as possible -- this is not in the best interest of the child, in terms of making them feel safe

Goal:

• To create a place of safety for the child / teenager
• To avoid re-traumatizing the child through further abrupt disruption
• To create a place of order, rather than chaos.
• To create a sense of control, rather than instability.
• To teach the child self-regulation.

Source:
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
U.S. Department of Health and Human Services

Why is Fear so Exhausting?

According to the National Institute for Trauma and Loss in Children:

• Understanding the physiology of the fear response may help provide you with some insight about why youth exposed to trauma are often complaining of being tired or having little energy. This knowledge can be shared with parents, teachers and others who get frustrated with youth’s behavior that appears to be driven by lack of care or motivation. Instead, we can explain that there is a real physical response happening following acute and chronic exposure to scary experiences.

• Fear is first detected in the brain’s sensory cortexes, something we see, hear or smell. It is then filtered through the thalamus, which sends a signal to the amygdala. This is what many call the “smoke detector” of our brain, which causes you to freeze before you’re even aware of the threat.

• The nervous system then releases chemicals such as cortisol, which in turn helps glucose to be released in our bodies getting us ready to fight or flee. The cortisol also helps to speed up our breathing and heart rate, which pumps oxygen into our muscles.

• Our brain then floods with opiods that mask any pain we might feel at the moment. It won’t be felt until hours or days later when the opiods wear off.

• Once the fear is past, the autonomic nervous system swings into action and calms our bodies. It often overshoots because of the intense stress it is trying to balance. This often leaves us feeling extremely exhausted and with little energy.

Social and Emotional Well-Being of Foster Care Youth

The purpose of this Information Memorandum is to explain the Administration on Children, Youth and Families priority to promote social and emotional well-being for children and youth receiving child welfare services, and to encourage child welfare agencies to focus on improving the emotional and social-emotional outcomes for children who have experienced abuse and/or neglect.

Helping Children Transition Into Adoption

Even after foster care children and teens are connected with a forever family, they often still experience loss and the aftermath of trauma.

This resource was designed to recognize and support the experiences of young people.

What You Might Not Know About Young Homeless Mothers

Did you know that young mothers who are homeless differ from the older homeless population?

Young Mothers Who Are Homeless:

• Are exposed to homelessness 10 years earlier than their older counterparts.
• Are pregnant and parenting approximately 3 years earlier than older homeless mothers.
• Are nearly 3 times more likely to have spent time in foster care.
• Have limited support networks.

(Medeiros and Vaulton, 2010)

Learn more by reading: Developing a Trauma-Informed Approach to Serving Young Homeless Families.

Posttraumatic Growth

Joseph, Stephen, PhD. What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth. New York :  Basic Books,  2011.

Quote:  “People’s coping strategies vary according to their appraisal of the situation. Those who believe that their situation will not change unless they do something about it, that change is desirable, and that they have control over their situation, tend to deal with their trauma by task-focused coping, whereas those who believe their situation cannot be changed tend to resort to avoidance as a way of coping.”

• Avoidance coping: Avoidance is a common reaction to trauma, especially when a stressful situation is perceived to be unchanging and uncontrollable. Short-term avoidance can be a survival technique, but long-term avoidance can preclude the possibility of moving on from trauma.
• Task-focused coping: Practical strategies to be solved after trauma (do something about it, one step at a time, try to come up with a strategy, seek advice from others)
• Emotion-focused coping: Strategies to confront and manage emotions (i.e. physical exercise, relaxation, talking with others, actively focusing on the positive – list of things grateful for – research shows that people who are more appreciative have more adaptive ways of coping)
• Seeking Social  Support from Others: Retreat to the safety of our community for protection
• People have a compelling need to talk after trauma – like a fever after infection – the mind’s way of healing itself
• Storytelling: What we tell ourselves and others, and the way we choose to understand events in our lives shapes the way we behave (victim vs. survivor). Stories that construct meaning and retain hope will lead towards growth.

Bringing Trauma-Informed, Resilience-Focused Care to Children, Adolescents, Families, Schools and Communities

This white paper by the National Institute for Trauma and Loss in Children highlights a developmental perspective and experiential approach to trauma-informed care.

Their premise is  that it is not the situation, but how the situation is experienced that induces trauma.

Page 17 is particularly intriguing, as it outlines the Experience of Recovery and Resilience.

Secondary Trauma and the Child Welfare Workforce

The Center for Advanced Studies in Child Welfare recently released a publication on Secondary Trauma and the Child Welfare Workforce.

ABC to handling secondary traumatic stress:

Awareness involves knowing one’s own “trauma map” and triggers, and how trauma work is impacting one’s life and perspective.

Balance refers to allowing one’s self to fully experience emotional reactions, creating and maintaining healthy boundaries between work and personal life, setting realistic goals, practicing time management skills, seeking out new leisure activities, and recognizing and avoiding negative coping skills.
 
Connection means avoiding professional isolation, seeking out and listening to feedback from friends and colleagues, developing support systems and opportunities for debriefing, seeking training to learn new skills and build competence, and maintaining connection to one’s spirituality.

Quotes from Time Magazine about Overmedication of Foster Youth

Source: Szalavitz, Maia. Why Are So Many Foster Care Children Taking Antipsychotics?
Time Magazine, November 29, 2011.

• "The influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving anti-psychotic medications in the study were given atypical anti-psychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised.

• "All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.

• "The main condition that antipsychotics are approved to treat —schizophrenia — is extremely rare in children. The rate of schizophrenia in children under 12 is an estimated 2 cases per 1 million children; it affects fewer than 1% of older teens. Anti-psychotics are also approved to treat bipolar disorder, a diagnosis that is highly controversial in children. Some studies suggest that it affects 0.2% to 0.4 % of children, and up to 1% of adolescents.

• And yet, between 1994 and 2003, rates of bipolar diagnoses in youth under 19 rose by a factor of more than 40, according to the National Institute on Mental Health. It seems unlikely to be a coincidence that this rise occurred during the period when atypical anti-psychotics were being illegally marketed for children."

• "Indeed, most of the anti-psychotics used in foster-care youth were for conditions that the drugs were not approved to treat. Fifty-three percent of prescriptions were written for attention deficit/hyperactivity disorder (ADHD), a condition that is ordinarily managed with drugs that have the opposite pharmacological effects as anti-psychotics. The stimulant medications like Adderall and Ritalin, widely used for ADHD, tend to increase levels of dopamine, while anti-psychotics tend to decrease it."

"This study confirms the need for developmentally and trauma-informed practices in the vulnerable foster-care population," says Dr. Bruce Perry, founder of the ChildTrauma Academy. "Misunderstanding the pervasive effects of abuse and neglect leads to the mislabeling of behavioral and emotional symptoms in these children and then to overmedication."

Overmedication of foster youth continues....

A new study, Antipsychotic Treatment Among Youth in Foster Care, examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth.

They found that:

• More than a third of youth in foster care without disabilities had multiple anit-psychotic prescriptions lasting longer than 90 days
• Children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care.

In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. 

In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the utilization of psychotropic medication for children in foster care.

In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.

Valuing and Asserting Personal Worth vs. Maintaining Abusive Relationships

 "Describing how the brain changes in response to a child's experience, Bruce Perry wrote, 'Children are not resilient, children are malleable.' Trauma, neglect and abuse influence how synapses develop pathways, how neurons fire, how we translate incoming information...

"The baby learns how the caretaker will respond to his emotional needs, and from this, the baby begins generalizing his experiences and defines the world.

"The failure to consistently meet the infant's needs (emotional or biological) impacts the child's sense of self long before the pain influences her perception of the outside world. 'Unfortunately, the child will interpret this as a product of its own inadequacy,' J. Konrad Stettbacher notes.

"Dependent upon others for survival, the child believes that the cause of pain is his own self and he tries to adapt (they must be right; therefore, he is wrong). In response, he minimizes or relabels his own pain: 'It's not so bad.' Pain is always a signal that something has to change - how we respond to that pain reflects what we've learned early on.

"Similarly, the victim of emotional abuse things, 'If I were better, they wouldn't do this to me,' rather than, 'This other person is causing me pain and if she doesn't stop, she has to exit my life.'

"No infant has the ability to make that distinction - they blame themselves in order to hopefully fit the caregiver, alleviate the pain, and preserve that bond.

"Acknowledging pain is the vital first step in any self-defense. Acknowledging what 'hurts' identifies the boundaries that define each one of us... If a victim can decide whom to trust and then act on this decisions, (he or she will have) the resiliency to emotionally to defend himself...

"Resiliency acknowledges that there will be a cost. The former victim may lose a 'friend...'

"Doing so lifts the burden the victim assigned himself, but also presents a hard decision. To define one's self, there is a cost."

~ Heart Transplant by Andrew Vachss and Frank Caruso

New Federal Requirements for States re: Foster Children, Trauma and Monitoring Medications

President Obama recently signed the Child and Family Services Improvement and Innovation Act (H.R. 2883) into law.

Among other stipulations, this new law:

• Requires States to address emotional trauma in foster children, adopt protocols for using and monitoring psychotropic medications, and describe how they both address the developmental needs of young children in the child welfare system and reduce their length of stay in foster care.

National Clearinghouse on Families and Youth

The National Clearinghouse on Families and Youth recognizes that most homeless youth have experienced multiple traumatic events both before becoming homeless and once on the street. This underscores the importance of trauma-informed practice:

• They suggest that several homeless shelters might need a trauma-informed transformation, considering such details as the need to put a lock on the shower door at a shelter in order to ensure physical safety and emotional security.

• Youth workers need to provide trauma-informed care, seeking to understand each young person’s emotional triggers, build supportive relationships, and give youth opportunities to rebuild control in their lives.

• Individuals who have experienced homeless express the need for expectations and empowerment, and hope that staff members are willing to look beyond external behavior, and recognize the underlying trauma beneath.

Federal Partners Committee on Women and Trauma

According to a recently released report by Federal Partners Committee on Women and Trauma:

• Due to the spiraling number of people impacted and the wide range of consequences, trauma is now believed to be a public health crisis.

•  Violence is gendered: While men are most likely to experience violence from strangers, women and girls are most likely to be hurt by people they know intimately: For women in the military, the greatest risk of harm is from fellow soldiers; for an adolescent girl, it is from a person whom she loves.

• One in five girls and one in ten boys are sexually abused before adulthood. Adolescent girls between the ages of 16-19 are four times more likely than boys to be a victim of rape, attempted rape, or sexual assault.

• Women are twice as likely as men to experience depression, and 54% of depression in women can be attributed to childhood abuse.

Not surprisingly, according the SAMSA's 1998-2003 research study on women and violence:

"The most effective interventions are gender-responsive – they reflect an understanding of the realities of the lives of women and girls, respond to their strengths and challenges, and use knowledge about female socialization and development to guide all aspects of program and system design."

Helping Foster Children Handle Transitions

The Indiana University School of Medicine has developed a one-page tip sheet for Helping Your Child in Foster Care Handle Transitions.

Helping Children Who Have Experienced Traumatic Events

In conjunction with Children’s Mental Health Awareness Day, The Substance Abuse and Mental Health Services Administration (SAMHSA) released their 2011 Short Report on Helping Children and Youth Who Have Experienced Traumatic Events.

and

American Humane Association — along with Zero to Three, the Center for the Study of Social Policy, the Child Welfare League of America and the Children's Defense Fund — recently released A Call to Action On Behalf of Maltreated Infants and Toddlers.

Community System of Care Improves Behavioral Health of Children Affected by Trauma

"Childhood exposure to traumatic events is a major public health problem in the United States. Traumatic events can include witnessing or experiencing physical or sexual abuse, violence in families and communities, loss of a loved one, refugee and war experiences, living with a family member whose caregiving ability is impaired, and having a life-threatening injury or illness. It is estimated that 26% of children in the United States will witness or experience a traumatic event before the age of 4 years."

Children and youth affected by traumatic events improve their functioning when they can access effective community-based programs and supports, according to a study by the Substance Abuse and Mental Health Services Administration (SAMHSA).

This report shows that after 12 months of accessing services within a community-based system of care, 44 percent of children and youth improved their school attendance, 41 percent improved their grades, and youth suicide attempts fell by 64 percent. In addition, the number of youth reporting arrests in the past 6 months fell by 36 percent.

Similarly the report shows that children and youth receiving trauma specific services experienced a 20 percent drop in the number experiencing problems at school, a 59 percent drop in the number with problems with suicidality, and a 57 percent drop in number of children engaging in delinquent behavior after 6 months of service.

Stay tuned for future blog entry on "Hidden Rules"

Free Training on Trauma in Children and Families

Recognizing and Addressing Trauma in Infants, Young Children, and Their Families is an online tutorial for professionals who work with young children that explains the developmental context of trauma in early childhood, and expands professionals' knowledge for intervention through consultation. The tutorial also provides valuable links to a range of resources for further learning and exploration, and includes concrete take home messages.

Those who complete the tutorial will be able to:

• Define trauma, describe two types of trauma, and list common yet diverse types of traumatic experiences

• Describe the impact of trauma on infants, toddlers, and young children from a developmental perspective

• Identify trauma signs and symptoms in infants, toddlers, and young children

• Recognize and understand the role of the consultant in addressing trauma in the early care and education setting

The free tutorial takes between 30 and 40 minutes to complete. It is the sixth in a series for mental health consultants and was funded by the Office of Head Start and developed by the Center for Early Childhood Mental Health Consultation (ECMHC).

The entire series of tutorials are housed on the ECMHC website: www.ecmhc.org/tutorials/trauma/index.html

Trauma and Immigrant Families in the Child Welfare System

A Social Worker's Tool Kit for Working With Immigrant Families – Healing the Damage: Trauma and Immigrant Families in the Child Welfare System (September 2010)

Written by the Migration and Child Welfare National Network, this tool kit provides guidelines for integrating child welfare practice with trauma-informed care and trauma-specific services. The tool kit contains answers to frequently asked questions illustrated by case examples, as well as website links and other resources.

Direct link: http://www.americanhumane.org/protecting-children/programs/child-welfare-migration/tool-kits.html

Trauma and Homeless Youth

•  Fact Sheet on Trauma and Homeless Children
• Trauma Among Homeless Youth 
• Videoconference on Working With Runaway and Homeless Youth
• Fostering Resilience in Displaced, Traumatized Families
• Fostering Resilience in Homeless Youth

 Visit the National Child Traumatic Stress Network for more resources on homeless youth.

Trauma and the Juvenile Justice System

Trauma and Justice:

• Traumatic victimization often results in negative behaviors that bring both youth and adults into the criminal justice system.

• Studies of people in jail and prison reveal high rates of mental and substance use disorders and personal histories of trauma.

Adapting CBITS and SSET to Support Foster Care Youth

Toolkit for Adapting Cognitive Behavioral Intervention for Trauma in Schools (CBITS) or Supporting Students Exposed to Trauma (SSET) for Implementation with Youth in Foster Care  (Dana Schultz, Dionne Barnes-Proby, Anita Chandra, Lisa H. Jaycox, Erin Maher, Peter Pecora)

The purpose of this toolkit is to assist school-based mental health professionals, school personnel, and child welfare social workers in adapting these interventions for use with youth aged 10-15 who are in foster care:

• CBITS was developed for use by school-based mental health professionals for any student with symptoms of distress following exposure to trauma. 
• SSET was adapted from CBITS for use by any school personnel with the time and interest to work with students affected by trauma.

The authors note that delivering a school-based mental health program to youth in foster care has many challenges, including collaboration between the child welfare and education systems, confidentiality and information sharing policies regarding youth in foster care, and identification of these youth.

The toolkit was designed to help understand these challenges and provide strategies for addressing them. It is made up of three parts:

• Background Section
• Overview of CBITS and SSET
• Step-By-Step Guide to Implementing and Adapting CBITS/SSET for Foster Care Youth

Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense

The Justice Policy Institute has issued a brief examining the relationship between childhood trauma and youth justice system involvement.

The brief, Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense, notes that of the more than 93,000 children who are currently incarcerated nationwide, between 75 percent and 93 percent have experienced at least one traumatic experience, including sexual abuse, war, community violence, neglect, and maltreatment, which can have long-term effects such as emotional problems and negative impacts on youth brain development.

According to the brief, the U.S. justice system does not meet the needs of traumatized youth and may in fact increase trauma through its use of incarceration. Youth who receive treatment in their communities have better outcomes than those placed in correctional facilities, which indicates the need for trauma exposure to be considered in youth placement decisions.

When Helping You Is Hurting Me

When helping you is hurting me

View more presentations from Lisa Dickson.

Rewriting the scripts in a child's life

What the movie Martian Child teaches about trauma and food hoarding

Boy in a Box: What the movie Martian Child teaches about responding to child trauma

Foster Care Youth and Chosen Family

"Family isn't whose blood you carry,

it's who you love and who loves you"

~ Jackie Chan as Bob Ho from The Spy Next Door

Stress Hormones Predict Trouble for Kids Left in Abusive Homes

Stress Hormones Predict Trouble for Kids Left in Abusive Homes'
Business Week, May 5, 2010.

Specific hormonal pattern tied to later psychological problems, researchers say...

Children who live with their parents after local child protective services agency enters their lives have worrying levels of a stress hormone compared to those who end up in foster care.

Researchers at the University of Delaware at Newark studied 339 children aged 3 months to 31 months, 155 of whom lived with their birth parents and 184 who landed in foster care, all after child protective services became involved with the families.

The researchers analyzed levels of the hormone cortisol in the children for two days, and found that those who remained with their parents had flatter slopes.

"A blunted pattern of cortisol production appears to confer risk for later psychiatric disorders, most especially psychopathy and substance abuse problems," study author Kristin Bernard and her colleagues wrote. "Although it is premature to suggest specific implications for neglected children, the findings are concerning."

The authors concluded that "foster care may have a regulating influence on children's cortisol among children who have experienced maltreatment."

The findings were published May 3 in the Archives of Pediatrics and Adolescent Medicine.

Youth-Centered Approach to Achieving Permanency

In 2005, the Children's Bureau funded nine demonstration projects through an Adoption Opportunities grant.

Interviews with youth shed light on their feelings about family and permanency:

• The level of commitment an adult brings to the relationship with a youth is what constitutes family—not blood.

• Permanency is a process of building trust, and finding a family is almost always worth the risk.

• Permanency work is not just about finding a home but includes restoring family connections that have been lost. Sibling relationships have been significant to older youth in the project.

• Youth are proud of their self-reliance and their ability to overcome adversity.

For more information about the Dumisha Jamaa Project, visit the National Resource Center for Adoption website.

Understanding the Effects of Maltreatment on Brain Development

Another tool for understanding the emotional, mental, and behavioral impact of early abuse and neglect in children who come to the attention of the child welfare system:

This Child Welfare Information Gateway brief provides basic information for professionals on brain development and the effects of abuse and neglect on that development.

SAMHSA Evidence-Based Practice Kits

The Substance Abuse and Mental Health Services Administration (SAMHSA) is offering a new series of Evidence-Based Practice KITs. The KITs were developed to help move the latest information available on effective behavioral health practices into community-based service delivery.

The KITs contain information sheets, introductory videos, practice demonstration videos, and training manuals.

Currently, five KITs are available:

• Assertive Community Treatment
• Integrated Treatment for Co-Occurring Disorders
• Supported Employment
• Family Psychoeducation
• Illness Management and Recovery

These new KITs are available online and in CD-ROM/DVD format.

Reaching Out to Connect Teens and Young Adults With Resources

REACHOUT.com is an information and support service using evidence based principles and technology to help teens and young adults facing tough times and struggling with mental health, substance abuse and other issues.

All content is written by teens and young adults, for teens and young adults, to meet them where they are, and help them recognize their own strengths and use those strengths to overcome their difficulties and/or seek help if necessary.

NAMI Launches Social Networking Site for Young Adults

The National Alliance on Mental Illness (NAMI) has launched StrengthofUs.org, a new online community where young adults living with mental health concerns can provide mutual support in navigating unique challenges and opportunities during the critical transition years from ages 18 to 25.

Developed by young adults, StrengthofUs.org is a user-driven social networking community where members can connect with peers, share personal stories, creativity and helpful resources by writing and responding to blog entries, engaging in discussion groups and sharing videos, photos and other news.

The site offers resources on issues important to young adults, including:

• Healthy relationships
• Family and friends
• Campus life
• Independent living
• Finances
• Employment
• Housing
• Mental health issues

"Young adulthood is an exciting challenge, but also a confusing and stressful time for anyone," said Michael Fitzpatrick, NAMI executive director. "Life can throw things at you fast."

"Mental illness affects everyone. StrengthofUs.org is intended not just for young adults who have a mental illness, but for anyone entering adulthood that has a friend, parent or other family member facing a mental health problem."

"Most of all, StrengthofUs.org is an interactive, fun space where young adults can share experiences and other information to empower each other, build relationships and offer peer support."

Resiliency Ohio Recently Launched

The website http://www.resiliencyohio.org/ is designed to help children and youth with mental and emotional health challenges and their families learn about and embrace resiliency.

The concepts, and website materials were developed by Resiliency Leadership Ohio, which is comprised of youth experiencing mental health issues and their family members.

Resiliency is defined as an inner capacity that when nurtured, facilitated, and supported by others empowers children, youth, and families to successfully meet life's challenges with a sense of self-determination, mastery, hope, and well-being.

The website includes a video of Ohio youth and families speaking about the role of resiliency in their lives and the importance of having a resiliency perspective for mental wellness.

Whose Permanency Is It, Anyway?

Voices From the 2008 National Convening on Youth Permanence

More than 30 youth and alumni from foster care attending the 2008 National Convening on Youth Permanence participated in an impromptu session facilitated by the Annie E. Casey Foundation's Family to Family Youth Engagement Team. Participants shared their experiences and provided recommendations about improving the foster care system.

What concerned these young people the most were issues of trust; they felt unable to trust the concept and the process of permanency planning. Most youth also reported that they had not been included in the process of identifying permanent connections for themselves.

Youth recommended the following important steps in developing a trusting partnership:

• Redefine permanence to include emotional connections.
• Address the disparities in permanency outcomes for older youth and youth of color.
• Continue the permanency search beyond emancipation.
• Involve youth in planning for future Convenings.

To read the full Recommendations of Youth and Young Adults From the 2008 National Convening on Youth Permanence, please visit:

www.youthpermanence.org/_pdf/materials/mat_2008/recommendations-of-youth.pdf

The California Permanency for Youth Project (CPYP) emphasizes the importance of (1) involving youth in their own permanency planning and (2) using technology to help youth find family connections.

They work with California counties to ensure that youth leave foster care with some kind of permanent connection with a caring adult.

The Emancipated Youth Connections Project involved 20 young adults (ages 17-39) who had exited foster care with no permanent connections. Services were provided to help them make those connections.

To learn more, read the Emancipated Youth Connections Project Final Report/Toolkit, available at:

www.cpyp.org/Files/EYCP-ReportToolkit.pdf

The August 2008 Destination Future: National Youth Leadership Development Conference brought together youth leaders in foster care or formerly in care from around the country to discuss their experiences in foster care and their hopes for the future. This conference was sponsored by the National Child Welfare Resource Center for Youth Development (NRCYD) and supported by the Children's Bureau.

The 94 youth and 74 adults in attendance were divided among eight groups, each with a focus topic for discussion:

• Engaging youth in the National Youth in Transition Database (NYTD) implementation
• Extending the Federal foster care program payments to age 21
• Ensuring youths' success in their academic endeavors
• Meeting youths' cultural needs while in foster care
• Involving youth in the court case review process
• Developing and maintaining youths' connections to family members
• Ensuring that youth who do not go to college can still find a good-paying job
• Ensuring that youths' mental health services needs are met

The conference slogan "Nothing about us without us" reflects the desires of foster youth to take an active role in the decisions that affect their lives and develop ways to influence programs and policies. This theme was raised in all of the small-group discussions.

To read the full report of the conference, Destination Future: National Youth Leadership Conference Report, by Jacqueline Smollar, please visit:

www.nrcys.ou.edu/yd/resources/publications/pdfs/df08rep_w.pdf

Mental Health Practices Toolkit

The REACH Institute, Casey Family Programs and the Annie E. Casey Foundation have worked together to develop a Mental Health Practices in Child Welfare Guidelines Toolkit.

It covers:
* Screening and assessment
* Interventions
* Medication
* Parent support
* Youth empowerment

This toolkit provides suggestions and resources for putting the guidelines into action in child welfare agencies.

Question for Readers: What Do You Think of This Model?

This is new to me...

The Intergenerational Trauma Treatment Model is "a revolutionary trauma treatment for 3-18 year olds and their adult caregivers. It consists of a comprehensive and robust, 21-session manualized program that is informed by trauma theory, attachment theory and advanced CBT techniques. ITTM effectively trains practitioners across all professional designations."

WHAT: The ITTM is a model that works to resolve the impact of trauma on a child through the caregiver.

HOW: The ITTM heals unresolved impact in the caregiver's history first and then re-positions the caregiver in treatment sessions to be the primary impact healer for the child.

WHO: The ITTM empowers caregivers to retain and regain their position as their child's most important and influential support.

For more information on the Intergenerational Trauma Treatment Model, please visit www.theittm.com

Foster Care and PTSD

• Foster Care Alumni and Post Traumatic Stress Disorder
• PTSD and Children in the Child Welfare System
• How Children and Adolescents React to Trauma
• Responding to a Child's Acute PTSD Reaction
• Effective Treatment for PTSD
• A Child Welfare Response to Traumatized Children
• Strategies for Agencies and Workers
• Preventing PTSD in Children
• Traumatic Stress and Child Welfare Workers
• Assessing Worker Distress
• Ways Supervisors Can Help Caseworkers Deal With Secondary Trauma
• References

Mental Health Needs of Foster Children and Children At-Risk for Removal

A recent issue of Virginia Child Protection Newsletter focused on the mental health needs of children entering foster care and children at risk to enter care.

The article explores:
- The range of mental health needs
- Ways to address those needs using evidence-based practices
- Ways to work with the children
- Methods for parent and foster parent training

http://psychweb.cisat.jmu.edu/graysojh/volume%2085.pdf

Emotional Resiliency Resources while pursuing Higher Ed

Addressing the Mental Health Needs of Former Foster Youth in Campus Support Programs,

December 2, 2008.

Download the PowerPoint presentation

California College Pathways conducted a web seminar to provide ongoing learning opportunities and resources for professionals working with current and former foster youth. Mental health experts from Cal State Fullerton and UC Riverside discussed the relationship between mental health support and educational attainment for foster youth in higher education. They shared their evidence-based approach to addressing the mental health needs of former foster youth on campus.

Information provided in the training included:
- Issues foster youth present when transitioning into college.
- Strategies for working with foster care with mental health needs (e.g. medication management, therapy).
- Signs and symptoms of depression and anxiety.
- How to refer a student psychological services.
- Types of counseling and support resources are available on college campuses

A sense of home in exile

Quote from the article A Sense of Home in Exile by Sandra Dudley:

"Materializing exile"

Displacement inevitably complicates and changes people's relationships with objects and places, as well as with each other. In order to live as 'normally' as possible within a new place, Karenni refugees seek to make it familiar in material ways...

-They are attempting to connect two points in space and time.

-They affirm their connections through the ritual of food, clothing and everyday activities.

-They are re-creating a sense of home.

Thoughts on Easter 2009

“Our scars have the power to remind us that the past was real.” – Red Dragon

Thoughts on the shift from victim to survivor

"The 'big click' for survivors comes after seeing a purpose for the pain, and a venue to help others. When pain seems meaningless, folks fall into despair."

~ Lisa Dickson

After Abuse, Changes in the Brain

After Abuse, Changes in the Brain
By Benedict Carey, NY Times, Feb. 23, 2009.

For years, psychiatrists have known that children who are abused or neglected run a high risk of developing mental problems later in life, from anxiety and depression to substance abuse and suicide.

The connection is not surprising, but it raises a crucial scientific question: Does the abuse cause biological changes that may increase the risk for these problems?

Over the past decade or so, researchers at McGill University in Montreal, led by Michael Meaney, have shown that affectionate mothering alters the expression of genes in animals, allowing them to dampen their physiological response to stress. These biological buffers are then passed on to the next generation: rodents and nonhuman primates biologically primed to handle stress tend to be more nurturing to their own offspring, Dr. Meaney and other researchers have found.

Now, for the first time, they have direct evidence that the same system is at work in humans. In a study of people who committed suicide published Sunday in the journal Nature Neuroscience, researchers in Montreal report that people who were abused or neglected as children showed genetic alterations that likely made them more biologically sensitive to stress.

The findings help clarify the biology behind the wounds of a difficult childhood and hint at what constitutes resilience in those able to shake off such wounds.

The study “extends the animal work on the regulation of stress to humans in a dramatic way,” Jaak Panksepp, an adjunct professor at Washington State University who was not involved in the research, wrote in an e-mail message.

He added that the study “suggests pathways that have promoted the psychic pain that makes life intolerable,” and continued, “It’s a wonderful example of how the study of animal models of emotional resilience can lead the way to understanding human vicissitudes.”

In the study, scientists at McGill and the Singapore Institute for Clinical Sciences compared the brains of 12 people who had committed suicide and who had had difficult childhoods with 12 people who had committed suicide and who had not suffered abuse or neglect as children.

The scientists determined the nature of the subjects’ upbringing by doing extensive interviews with next of kin, as well as investigating medical records. The brains are preserved at Douglas Hospital in Montreal as part of the Quebec Suicide Brain Bank, a program founded by McGill researchers to promote suicide studies that receives brain donations from around the province.

When people are under stress, the hormone cortisol circulates widely, putting the body on high alert. One way the brain reduces this physical anxiety is to make receptors on brain cells that help clear the cortisol, inhibiting the distress and protecting neurons from extended exposure to the hormone, which can be damaging.

The researchers found that the genes that code for these receptors were about 40 percent less active in people who had been abused as children than in those who had not. The scientists found the same striking differences between the abused group and the brains of 12 control subjects, who had not been abused and who died from causes other than suicide. “It is good evidence that the same systems are at work in humans that we have seen in other animals,” said Patrick McGowan, a postdoctoral fellow in Dr. Meaney’s lab at McGill and the lead author of the study.

His co-authors, along with Dr. Meaney, were Aya Sasaki, Ana C. D’Alessio, Sergiy Dymov, Benoît Labonté and Moshe Szyf, all of McGill, and Dr. Gustavo Turecki, a McGill researcher who leads the Brain Bank.

Because of individual differences in the genetic machinery that regulates stress response, experts say, many people manage their distress despite awful childhoods. Others may find solace in other people, which helps them regulate the inevitable pain of living a full life.

“The bottom line is that this is a terrific line of work, but there is a very long way to go either to understand the effects of early experience or the causes of mental disorders,” Dr. Steven Hyman, a professor of neurobiology at Harvard, wrote in an e-mail message.

Self Verification

Developed by William Swann, the theory of Self Verification is that once individuals develop firmly held beliefs about themselves, they come to prefer that other people see them as they see themselves - even if their self-views are negative.

Replace traumatic memories with positive ones

Emotional memories engage different brain structures than do normal memories, and are stored in a particularly powerful and lasting way by the brain.

There is evidence for a self-reinforcing "memory loop" whereby the brain's emotional center triggers the memory center, which in turn further enhances activity in the emotional center.

Because of this, traumatic memories can have a powerful effect on human behavior – including placing restrictions in the way that people go about their daily lives.

Survivors may avoid places, smells or objects that remind them of the traumatic experience, because they may trigger severe anxieties.

Learned knowledge may dissipate, but emotional memories still remain.

According to researcher Karsten Baumgärtel, “It is entirely possible for facts to vanish completely from the memory, whereas in extreme cases emotional recollections remain stored for a whole lifetime.”

Isabelle Mansuy, Professor of Cellular Neurobiology explains that, “Emotional memories are not simply erased. Oppressive negative memories need to be actively replaced by positive memories.”

How are you replacing the negative experiences in your life?

Marriage as crucible

My husband's prediction about a mutual friend: "All the issues that she thought were dealt with will come springing back up out of her once she gets that ring on her finger..."

Children, foster care and PTSD

Link to articles about how to help and treat children who have PTSD as a result of abuse: http://hubpages.com/profile/krillco

Child Welfare Trauma Training Toolkit

http://www.nctsnet.org/nccts/nav.do?pid=ctr_cwtool

Some of the many insights available in this valuable resource:
"Trauma can change children’s world views, their sense of safety, and how they interpret the meaning of the behavior of others—including people who are trying to help them...

"Children often have multidimensional trauma histories, and adults should not assume that they know what was most traumatic for the child. The event(s) thatled to child welfare involvement may not be the child’s most significant trauma experience...

"There is a difference between physical safety and psychological safety. Child welfare workers should not only aim to keep a child physically safe but should also provide a psychologically safe setting for children and families when inquiring about emotionally painful and difficult experiences...

"System-Induced Trauma: (def).Traumatic removal from the home, traumatic foster placement, sibling separation, or multiple placements in a short amount of time."

At the Root of Addiction

"Addiction is never really about fun...
It's always about pain."

- A Field of Darkness by Cornelia Read

Psychosocial Trauma and Restitution

Searching for Life: The Grandmothers of the Plaza de Mayo and the Disappeared Children of Argentina

"The concept of “psychosocial trauma” developed by Ignacio Martin-Baro can help us understand the restitution process. He believed that when an injury that affects people has been produced, nourished, and maintained through a certain set of social relations, then individual solutions are not effective.

"The social context responsible for the injury has to be taken into account. A new “social contract” to heal the trauma is needed, incorporating individual and socio-political factors into the equation.

"In the case of the disappeared children, their loss of identity represents a trauma affecting not only their individual lives but also their relationship with society. For this relationship to be restored, the social distortions that took place need to be exposed.

"Restitution brings into focus the trauma’s social dimension, as it provides the wider context for each individual story. Truth and justice must be part of the picture, if the children are to construct a meaningful future for themselves as individuals and as members of society."

This statement makes no sense

Quote from Erick Nicklas, associate commissioner of the Family Permanency Division: "The whole idea of foster care is not to disrupt children's lives."

Foster Care Alumni and Relational Permanence

http://www.chapinhall.org/article_abstract.aspx?ar=1466

Gina Miranda Samuels interviewed 29 young adults who aged out of foster care in order to understand their existing support networks and how they learned to cope with people coming in and out of their lives.

Wearing a Mask to Face the World

http://translucence.multiply.com/journal/item/284/Masks_Repost

"We all wear masks, and the time comes when we cannot remove them without removing some of our own skin.”
- Andre Berthiaume

Abuse, Females and Testosterone Levels

“Trauma, at any age, produces anatomical changes in the brain, and even if those changes do not have an obvious effect on behavior, they can still shape our deepest responses to anxiety.

“A NIMH study (discovered that) abused girls were found to have abnormally high levels of testosterone, increases in immune system abnormalities and abnormal changes in the regulation of heart rate under stress.”

Source: Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Feeling like a "failed anorexic"

Recovery from anorexia comes with a deep sense of shame, because it feels somehow like a failure. Caroline Knapp has referred to this as “the post-anorexic riddle of identity, a sense of wild shapelessness.”

Aimee Lui writes accurately that;
“Eating disorders sabotage identity… You’ve failed to reduce yourself to a perfect object…

“For years you’ll move along just fine, gaining weight, gaining confidence, gaining all the trappings of a thriving life, and then, unexpectedly, a shadow of your past will resurface in the face of a long-lost friend or a moment on revived anxiety, and your bright new self will cringe, yearning for that old mask of perfection.”

Sheila Reindl has valuable insight into this area as well:
“We all have to integrate the light with the dark… the noble and ignoble aspects of ourselves. That’s a normal developmental task. It’s just harder for people with eating disorders.”

Source: Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Anorexia and Bulemia

According to Shelia Reindl, “With anorexia, the act of losing weight serves as a metaphor for feeling that one is emotionally invisible… (it’s a) disciplined emptiness. So, for her, the message is that you don’t have to be perfect to be loved.

“The bulimic, on the other hand, binges and purges in secret – hiding the beast she knows is in there. The issues of shame are stronger. I think that’s why, when anorexics hit a bulimic patch in recovery or difficulties later in life, they often want to go back to the anorexia. It feels cleaner and tidier – they didn’t have to deal with all these messy feelings and conflicts.”

Reindl’s research has demonstrated that the most enduring obstacle to healing in the aftermath of anorexia and bulimia is vulnerability to a sense of not being enough, not having enough, feeling empty, unlovable, unworthy.”

Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Can You Inherit Anorexia?

“Researchers often say that genetics load the gun of eating disorders, and environment pulls the trigger.”

Aimee Lui believes that genetics make the gun, environment loads it, and that an experience of unbearable trauma is what actually pulls the trigger.

Source: Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

Childhood trauma and emotional maturity

Adults often underestimate what children experience, the extent of their reactions and what they need to know.

Childhood trauma can disrupt child or adolescent development, interfering with the growth of emotional maturity. Repeated exposure to trauma can affect a child's brain and nervous system.

Children suffer a dual response:
- The impact of the trauma on themselves
- The emotional distress of a child's caregiver

Adult support is a strong protective factor. Impacted adults may make at-risk children more vulnerable.

Common trauma responses in children include impaired concentration, difficulty in learning new things, aggression, recklessness, reduced inhibitions, somatic complaints and school refusal.

It is normal for a child who has experienced trauma to:
- Be hypervigilant and constantly alert
- Be jumpy and startled easily by loud sounds and sudden noises
- Feel exhausted
- Have a worsening of chronic medical problems
- Have difficulty concentrating
- Exhibit poor judgment
- Exhibit denial of emotions or lack memory of events

Sometimes children revert to a younger developmental stage (bed-wetting, thumb-sucking, clinging). Teenagers might respond by taking on the role of a parent, acting as an adult and taking charge of the situation. Or, the teen might try to escape in sex, drugs and alcohol.

Children who are traumatized can develop depression, anxiety, mood disorders and/or behavior disorders.

Source: Traumatic Stress in Children, NRCFCPPP, January 8, 2008

To forgive is not to forget

From E.R. Bird's book review of 'I Am Not Joey Pigza' by Jack Gantos:

"I think the important thing about this book is that it makes it clear that forgiveness is different from stupidity. You can forgive someone and remember what they put you through. Forgiveness is not the same as memory loss."

Results of Casey Field Office Mental Health Study

http://www.casey.org/Resources/Publications/CFOMH.htm

The aftermath of child traumatic stress

Child traumatic stress occurs when children and adolescents are exposed to traumatic events or situations, and this exposure overwhelms their ability to cope with what they have experienced.

Traumatic events can include physical and/or sexual abuse, assault, serious accidents or illnesses and the loss of important relationships or caregivers.

The issue of trauma has only recently received attention within the juvenile justice department, and children’s services in general. For this reason, very few agencies routinely screen for trauma or offer trauma-specific treatment interventions for youth in their care.

Severe and/or long-term trauma has a chemical effect on the body which changes the body’s normal stress response into an alarm response.

As a result, young people might internalize their feelings through depression and anxiety, or act out their feelings in the form of aggression, conduct problems and oppositional/defiant behavior.

Young people are faced with the task of dealing with past trauma, recognizing its current impact and learning ways to manage or overcome the emotional and behavioral problems caused by PTSD.

Effective strategies are those that:
- Educate survivors about biochemical reactions associated with PTSD
- Empower survivors with strategies to self-regulate their response to triggers
- Encourage survivors by giving them a safe place to share their story in an atmosphere of acceptance

Source: Ford, J., et al, Trauma among youth in the juvenile justice system. National Center for Mental Health and Juvenile Justice, Research and Program Brief, June 2007.

What do you think?

According to preventative psychologist JoAnn Derek, females are predisposed to experience higher levels of fear and anxiety, and remember painful experiences in greater detail than males.

Source: Keeling, Libby. Writer applies brain research to child development. Sept. 3, 2007.

Stress, Trauma and Support in Child Welfare Practice

This study from the University of Toronto measured the extent to which exposure to stress and trauma impacted social workers.

Results suggested that child welfare workers are exposed to a significant amount of traumatic stimuli and exhibit high levels of post-traumatic stress.

Mental Health First Aid Guidelines Project for Traumatic Events

I have been privileged by the University of Melbourne by being invited to share my insights as an expert panel member for a project titled the Mental Health First Aid Guidelines Project for Traumatic Events.

Panel members are mental health professionals and researchers, people who have experienced traumatic events in the past and who work to help others with handling trauma as part of their careers.

Eating your feelings

"There is not enough fried chicken on the planet to soothe a broken woman."

"I would eat so I didn't have to talk, drink so I didn't have to feel, smoke so I didn't have to be close to another soul."

"Nothing is better for numbing your soul than the sheer, unbridled love of the carbohydrate."

"You can eat your life into submission, or drink it down with so many bottles of wine, or smoke it away on a patio. You can look for love and respect in the eyes of another, and it still will not fill you up. This I have finally learned. Nothing will ever make you whole except you."

- Laurie Perry, Drunk, Divorced and Covered in Cat Hair