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Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleAn Invisible Struggle: The Presence ofIntergenerational Trauma in Child WelfareRachel Winters, MAHelen Cahalane, PhD, ACSW, LCSW7th Annual Pennsylvania Infant Mental Health ConferenceMonroeville, PAOctober 16, 2015Background/Relevance Roughly 1/3 of children 0-3 referred formaltreatment have developmental concernsthat qualify for EI services Studies show routine developmentalscreening among children in foster careimproves detection of problems IDEA and CAPTA were amended to requirereferral of all children 0-3 substantiated formaltreatment to EI when developmentalproblems are detectedDevelopmental & Social-EmotionalScreenings State mandate-Who is being screened?- Every child under the age of 3 withsubstantiated abuse screened within 30 days ofacceptance for services-Any child under 3 placed by child welfare into aresidential facility specializing in developmentaldelays, disabilities, or other serious healthconditions-Any child under 3 who is homeless andaccepted for child welfare services1
10/16/15PA-AIMH Conference- MonroevilleCahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child WelfareDevelopmental & Social-EmotionalScreeningsState highly recommends thebest practice approach ofevery child with an open childwelfare case under the age of5 receive the screening!Screening GoalsChild age 0-3Referred to child welfareImproved identification,decreasing biasScreen using the ASQIncreased access to servicesamong underserved groupsEarly intervention servicesFamilies receivehelp, support,servicesFewer children needspecial educationservicesFewerchildrenplaced outof home?55Who is Referred to Child Welfare?2
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleChild Welfare PopulationsCounties with most childrenreceiving in-home servicesCounties with most childrenreceiving foster care servicesCounty% of ChildPopulationCounty8.4%Philadelphia 6,0371.8%2,6321.1%# ChildrenServed2011-2012Philadelphia 28,939# ChildrenServed2012-2013% of ancaster4,8673.8%Luzerne7291.2%Study Design3-phase study funded by the PA Department of PublicWelfare, Office of Children, Youth & FamiliesFocusSourcePhase IWhat policies and procedures doagencies put in place to implementscreening?Phone surveyinterviews withCW and EI*Phase IIWhat are children’s needs?Statewidedatabase ofchildren screenedPhase IIIHow do caregivers experiencescreening and do children in needreceive services?Interviews withcaregivers andlink to state EIdatabase*Child Welfare (CW); Early Intervention (EI)8Research Questions(1) How many child welfare-involved young childrenshow clinical levels of trauma symptomology?(2) Is there a relationship between maternalchildhood history of child welfare involvement andchild trauma symptoms?(3) Among children receiving child welfare services,which child, maternal, and maltreatment-relatedcharacteristics predict trauma symptomology?3
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleMeasures Caseworker reports of key characteristics enteredinto Screening Database Caregiver Interview Trauma Symptom Checklist for Young Children(TSCYC; Briere, 2002) Brief Michigan Alcoholism Screening Test (BriefMAST; Selzer, 1971) Drug Abuse Screening Test (DAST; Skinner, 1982) Brief Patient Health Questionnaire (Brief PHQ;Kroenke, et al., 2001) Project-developed questionsMeasures ASQ (Squires, et al., 1999)– Assesses developmental skills among children 4-60months– Five areas assessed (communication, gross motor, finemotor, problem-solving, personal-social skills) ASQ:SE (Squires, et al. 2003)– Complements ASQ among children 3-66 months toassess behavioral difficulties or socio-emotionalconcerns– Three areas assessed (interaction, empathy, emotionalregulation)What is trauma?APA’s definition:Terrible EventShockDenialEmotional ResponseLong Term Effects: UnpredictableEmotions Flashbacks StrainedRelationships Physical Symptoms4
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleACE StudyACE stands for:DVERSEHILDHOODXPERIENCEACE’s Defined: Abuse (Emotional, Physical, Sexual)Neglect (Emotional, Physical)Interpersonal ViolenceSubstance AbuseMental IllnessParental Separation/DivorceIncarcerated Household MemberCheck Your ACE’s5
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleThe ACE PyramidNumber of ACESNumber ofAdverseChildhoodExperiences(ACE Score)01234 or .69.236.126.015.99.512.5Health Risks Based on ACESNumberof ACESPrevalence/Risk6
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleHealth Risks Based on ACESSuicide AttemptsInjected Drugs4 or moreACE’sAlcoholicPrevalence/RiskUsed Illicit DrugsDepressed MoodStress ContinuumPositiveTolerableToxic is a normal and essential partof healthy development, activates the body’s alertsystems to a greater degree can occur when a childexperiences strong, frequent,and/or prolongedDefinitions and graphic provided by: http://developingchild.harvard.edu/topics/science of early childhood/toxic stress response/Toxic Stress7
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleTrauma in the Child Welfare PopulationWhat is the prevalence of PTSDsymptoms in a child welfare population?11.7%Contributors to heightened posttraumatic stresssymptoms: Younger age Non-biological parent perpetrator Violence victimization in home Child depressionTrauma in the Child Welfare PopulationComplex TraumaTwo or more of the following: Sexual Abuse Physical Abuse Emotional Abuse Neglect Domestic ViolenceACE STUDYTrauma in the Child Welfare PopulationComplex TraumaEffects: Internalizing Behavior Problems Posttraumatic Stress Having at least 1 clinical diagnosisWhat groups should interventions target?8
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleEarly trauma is associated with arange of negative outcomesincluding: Delinquency Substance Abuse Re-victimizationChildhood Symptoms of TraumaCognitiveBehavioralPhysiologicalCurrent Study 337 Caregivers Interviewed Majority Female, White, Under 35 Interviews conducted by 11 trainedinterviewers Caregivers compensated9
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleCounty Sample for CaregiverInterviewsCaregiver Risk FactorsCaregiver Child WelfareExperience 40% of the sample was involved in childwelfare as children 22% had spent time in foster care 19% reported that their siblings hadspent time in foster care10
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleEvidence of Trauma in Child WelfarePopulationCaregiver Trauma as Reported on the Brief PHQ: 44% of caregivers acknowledged being bothered bysomething bad that happened recently (19.9%bothered a little, 24.4% bothered a lot). 38.7% of caregivers said they were thinking ordreaming of something bad that happened to them inthe past (22% bothered a little, 16.7% bothered a lot).Evidence of Trauma in Child WelfarePopulation 10% of caregivers report that the child’s otherbiological parent is incarcerated. 1% of caregivers report that the child’sbiological parent is deceased. 1% of caregivers report that the child’s otherbiological parent is in rehab, a halfway houseor an institution. Over 20% of children showed traumasymptomology on TSCYC.Examining Trauma TSCYC normed with children 3-12. 100 children from caregiver sampleselected, based on age Four of nine clinical scales used instudy Caregivers asked to rate how often childhas shown behaviors in past month11
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleTrauma Symptomology of Children Over theage of 3 Involved in Child Welfare ServicesChild demographicsTotal %Child age (mean, in months)41.8 (1.0)Male53.6African American16.2White77.5Biracial6.3**Living situation: In-home89.2Foster care7.8*Kinship care3.0Significant Findings Regarding ter-personalViolenceSignificant Findings Regarding TraumaSymptomologyMothers with childhood CPS involvementwere 33% less likely to have children withTSCYC scores that fell within the clinicallysignificant range.12
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleImplications of Trauma Research Biracial children and their families mayneed more support in their communities Children with a history of neglect maybe at greater risk for mental healthproblems Exposure to IPV poses significant risksto healthy child developmentImplications of Trauma ResearchMaternal FindingShare your thoughts Our analysis: Maternal finding was unexpected Mothers’ childhood involvement in CWS mayfunction as a protective factor for their children These mothers may also underreport traumasymptomologyTreating Trauma Alternatives for Families: A Cognitive BehavioralTherapy for Preschoolers (AF-CBT) Attachment, Self-Regulation and Competency (ARC) Child-Parent Psychotherapy (CPP) Parent-Child Interaction Therapy (PCIT) Preschool PTSD Intervention Trauma Focused Cognitive Behavioral Therapy (TFCBT)13
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleTrauma and Developmental/SocialEmotional ConcernsReports in Service GapsEIChild rvice Utilization14
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevillePoints of InterventionMaking that referralEngagementEducationCoachingClip: Caregiver Perception ofDevelopmental ConcernsUsed with permission from the University of Pittsburgh, Office of Child Development; 2011University of Pittsburgh, Office of Child Development.Points of Intervention-ContinuedStep 1: EmpathyStep 2: Make the referralStep 3: Continued engagement to promote buy-inIDEAS?15
Cahalane & Winters, University of Pittsburgh:Invisible Struggle: Trauma in Child Welfare10/16/15PA-AIMH Conference- MonroevilleParting Thoughts from ourInterviewersContact Information:Rachel Winters, MA, Senior Evaluation Coordinator:[email protected] Cahalane, Ph.D., ACSW, LCSWPrincipal Investigator Child Welfare Education andResearch Programs:[email protected] Fusco, Ph.D., ASQ Principal Investigator:[email protected]: http://www.pacwrc.pitt.edu/ASQ.htm“Like” us on Facebook:http://www.facebook.com/#!/PADevScreen16
Cahalane & Winters, University of Pittsburgh: Invisible Struggle: Trauma in Child Welfare 3 10/16/15 PA-AIMH Conference- Monroeville Child Welfare Populations Counties with most children receiving in-home services County # Children Served 2011-2012 % of Child Population Philadel
