Impact of Trauma on Ability to Parent

The Birth Parent Subcommittee of the National Child Traumatic Stress Network has created a series of fact sheets to highlight the importance of understanding the serious consequences that trauma histories can have on birth parents, and the subsequent impact on their parenting.

How can trauma impact parenting?

•                Parents’ ability to make appraise danger and make appropriate judgments about their own/their child’s safety can be compromised --  risk of being over/under-protective

•                Parent might have difficulty forming and maintaining secure trusting relationships -- leading to disconnection and/or disruption in their children's lives 

•                Parent might personalize the child’s negative behavior -- resulting in ineffective or inappropriate discipline. 

•                Lack of ability to regulate emotion

•                Maladaptive coping strategies -- such as substance abuse or abusive intimate relationships that parents maintain because of a real or perceived lack of alternatives. 

Direct link to this resource: http://nctsn.org/sites/default/files/assets/pdfs/birth_parents_trauma_history_fact_sheet_final.pdf

Excellent article by Gary Stangler

Finding Hope After Trauma: The Remarkable Recovery of the Adolescent Brain
Gary Stangler, Executive Director of Jim Casey Youth Opportunities Initiative

Young people who have experienced trauma are extraordinarily resilient. Whether it's a child in a homeless shelter who discovers the joy of reading or newly minted college graduates who overcame poverty - their ability to recover from traumatic events is nothing short of remarkable.

Nowhere is this clearer than among the population of young people who have been in foster care.

Having spent the last three decades working for improvements to foster care in the U.S., I am constantly inspired by the resilience I see in young people disproportionately affected by trauma. And yet, we are not doing all we can to support them.

For young people in foster care, that support network is essential, especially when you consider how significantly this population is impacted by traumatic events. In fact, a 2005 study conducted by Casey Family Programs found rates of PTSD in young people formerly in foster care to be more than twice that of U.S. war veterans.

Trauma comes in all forms, and whether the trauma young people in foster care experience is defined by physical or sexual abuse, moving from place to place, being separated from siblings and other loved ones, or living in a disjointed system -- its impact can be devastating. Without access to a supportive family or network, young people in foster care -- especially those who abruptly age out of the foster care system -- don't have the same opportunity to recover and move on.

And yet, it is precisely during that window of their young lives -- between ages 14 and 25 -- that young people have the most potential for recovery and resilience. New advances in neuroscience tell us that the brain is not "done" by age six, as previously thought. Instead, the adolescent brain continues to develop, providing a "use it or lose it" timeframe similar to that which exists in early childhood. Even after significant trauma, the brain can indeed rewire itself -- meaning that the physiological consequences of trauma can be reversed.

Systems that support young people must seize this window of opportunity.

For those in foster care, especially those placed in care following a traumatic experience, maintaining stable relationships with responsible and caring family members, teachers, or other mentors provides a critical sense of support and rootedness. Child welfare systems should encourage and create opportunities for these relationships to develop and thrive.

We must also help young people who have experienced trauma forge healthy connections with support networks that are important to their ongoing well-being. Specifically, gaining experiences that encourage them to stay in school and navigate their way to college or technical training, such as internships and part-time jobs and community-based activities, like after-school sports or music groups. These connections help build young people's self-confidence, help them see what is possible, and often provide the springboard for achieving important life goals like renting an apartment or securing a job. Through my own career working with youth leadership groups dedicated to young people in foster care, I have seen individuals emerge from quiet and reserved to articulate spokespeople on complex policy issues that have direct meaning in their lives.

Navigating through the challenges of adolescence is not easy for any young person, let alone a young person who has experienced significant trauma. Because of this, we must extend foster care beyond the age of 18. We do not assume that our own children have every support they will ever need by the time they turn 18; transitioning into adulthood is not a one-day event. We must advocate for the inclusion of supportive, age-appropriate social services for young people in foster care that more closely mirror the experiences of young people in supportive, intact families.

In an ideal world, no young person would ever experience trauma. But until that happens, let's make sure that all young people have the support necessary to rewire and recover. They deserve nothing less.

Tips to Promote Social-Emotional Health Among Young Children

Tips to Promote Social-Emotional Health Among Young Children This publication from the American Academy of Pediatrics provides tips and resources for parents, early education and child care providers, and pediatricians to promote social-emotional health among young children. It also includes a list of resources from the American Academy of Pediatrics. http://www2.aap.org/commpeds/dochs/mentalhealth/docs/SE-Tips.pdf

Measure Outcomes, Not Services

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

Living in Chaos is a High Risk Factor for Losing Parental Custody

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

Source of graph:
Simmel, C. (2010. Why do adolescents become involved in with the child welfare system? Exploring risk factors that affect young adolescents. School of Social Work, Rutgers University, New Brunswick NJ.

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