Childhood trauma is common. More than two thirds of children in the United States experience a traumatic event or circumstances—such as abuse or neglect, death of a loved one, or community violence—by the time they turn 16. Young children (birth to age five), in particular, are disproportionately exposed to traumatic events and circumstances.
While many children return to normal functioning after a traumatic event, others show symptoms of posttraumatic stress. These children are more likely to suffer harmful long-term consequences, including serious impairments in mental and physical health, when not met with understanding and trauma-appropriate responses from adults.
Trauma-informed care (TIC) encompasses a variety of approaches to working with children exposed to traumatic events or conditions. Research suggests that TIC is associated with considerable benefits for children and their families, including reductions in children’s behavior problems and posttraumatic stress. The Substance Abuse and Mental Health Services Administration identified four key assumptions of a trauma-informed approach; the approach should:
Below, we highlight five ways TIC supports children’s healthy development.
Each child reacts to trauma differently, but experiencing some form of distress is nearly universal. Children exposed to trauma may display heightened aggression, poor social skills, and impulsivity, struggle academically, and engage in risk-taking behaviors with serious consequences (e.g., substance abuse, risky sexual behavior). Given these challenges, it is not surprising that youth who experience trauma are overrepresented in the juvenile justice system. Parents, service providers, and other caregivers trained in TIC learn effective ways to interact with these children, such as helping them cope with trauma reminders (“triggers”), supporting children’s emotion regulation skills, maintaining predictable routines, and using effective behavior management strategies. TIC also promotes adults’ capacity to identify childhood trauma and to make appropriate referrals for screening, assessment, and evidence-based treatment.
Having a shared language helps create a collective understanding of trauma and effective ways to address its impact. It also is a powerful tool for developing common goals and strategies. For instance, Trauma Systems Therapy promotes widespread understanding among caregivers in the home, school, and community that a child’s inability to regulate emotions or behavior does not mean the child is “bad,” but rather that the social environment is not meeting the needs of the child in some way. This simple change in language enables adults to focus on what is most important–for example, what is triggering the child, and how to help the child self-regulate. Findings from a large-scale evaluation conducted by Child Trends, to be released later this year, will provide insight into how Trauma Systems Therapy was implemented in a child welfare setting, and its positive effects on child well-being. Similarly, Trauma-Focused Cognitive Behavioral Therapy, another evidence-based intervention, helps children develop a trauma narrative, allowing parents, service providers, and other caregivers to provide appropriate support through a shared understanding of the child’s unique experience with trauma.
TIC is a key component of behavioral health services delivery, but mental health providers are not the only people who are essential to TIC. Caregivers, early childhood educators, teachers, medical staff, judges, child welfare workers, juvenile justice workers, first responders, and other community service providers all play an important role in buffering the negative effects of childhood trauma and in preventing it from occurring in the first place. As the adage goes, “It takes a village,” and TIC requires collaboration to embrace an approach to care that is consistent with the best available evidence on how to promote resilience to adversity.
Many parents and other caregivers have a history of trauma themselves, which may compromise their ability to be sensitive caregivers. For example, up to one-third of parents abused or neglected in childhood maltreat their own children. Similarly, service providers who have a history of trauma, or who suffer from severe stress as a result of working with people who are exposed to trauma, may become either distanced or overly involved with children and families, experience burnout, or have difficulty tolerating their emotions. Accordingly, TIC attends to the needs of adults by helping them identify and work through their own reactions to trauma. Self-care (e.g., exercise, good nutrition, mindfulness), psychotherapy, reflective supervision, and psycho-education are a few techniques that help individuals cope with their own responses to trauma.
Legislators and other policymakers increasingly recognize the importance of implementing TIC across systems of care. For example, states are required to develop and implement a plan for meeting the physical and mental health needs of foster children, including addressing the issue of trauma. A number of child welfare systems have trauma-informed training requirements. In Texas, the Department of Family Protective Service is legislatively mandated to provide trauma-informed training for caseworkers, foster parents, adoptive parents, and kinship caregivers. TIC also has been implemented in school systems. Other policies have focused on TIC in healthcare (including mental health) and juvenile justice. Several multi-sector approaches have been developed, such as legislation established in Washington state—the Adverse Childhood Experiences Public-Private Initiative—which is aimed at reducing children’s exposure to trauma, as well as its consequences.