Trauma-Informed Practices With Children and Adolescents

by William Steele

In fact, trauma reactions in children may be inaccurately identified as depression, attention deficit problems, oppositional defiant disorder (ODD), conduct disorder, anxiety disorders, separation anxiety, or reactive attachment disorder (Cook,

Trauma-informed care is an approach to engaging people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.

the principles of trauma-informed care include:

1. Understanding Trauma and Its Impact:

2. Promoting Safety:

3. Ensuring Cultural Competence:

4. Supporting Consumer Control, Choice, and Autonomy:

5. Sharing Power and Governance:

6. Integrating Care:

7. Healing Happens in Relationships:

8. Recovery Is Possible:

Trauma-specific interventions are designed specifically to address the consequences of trauma in the individual and to facilitate healing.

Treatment programs using a trauma-informed approach generally: recognize that survivors need to be respected, informed, connected, and empowered; help to reinforce hope in the recovery process; emphasize the interrelation between trauma and symptoms of trauma (e.g., substance abuse, eating disorders, depression, and anxiety); and encourage collaborative work with survivors, their family and friends, and other human services agencies.

trauma-informed practice integrates neurodevelopmental knowledge and sensory intervention, such as art and play therapy and other experiential approaches, in trauma intervention.

In general, a trauma-informed approach must take into consideration, but is not limited to, the following: (1) how the mind and body respond to traumatic events, (2) recognition that symptoms are adaptive coping strategies rather than pathology, (3) emphasis on cultural sensitivity and empowerment, and (4) helping to move individuals from being not only survivors, but ultimately to becoming thrivers through skill building, support networks,

and resilience enh...

When experienced in childhood, trauma produces neurobiological impacts on the brain, causing dysfunction in the hippocampus, amygdala, medial frontal cortex and other limbic structures.

The healing journey is now seen to include biological as well as psychological transformation.

successful care must address the biological, physiological, neurological, and psychological aspects of trauma.

practitioners’ education, commitment, and understanding of trauma reactions as well as their own vulnerability to secondary trauma reactions can make a difference in successful trauma-informed care.

To be trauma-informed means that assessment and intervention are based on principles that are supported by best practices and research in trauma-informed care. There is general agreement that these principles include, but are not limited to, the following:

Restore a sense of safety, empowerment, and self-regulation

Apply trauma-informed assessment through an understanding of neuro-sequential development and sensory-based trauma reactions.

Capitalize on interventions that address the right hemisphere of the brain

Develop trauma-informed relationships between child clients and therapists, parents/caretakers, teachers, and other helping professionals and significant adults to establish posi...

Create trauma-informed environments that support internal locus of control, positive social interact...

Promote trauma integration to help individuals reach a new meaning for trauma events and capabili...

Encourage posttraumatic growth an...

and positive affective e...

Recognize that no one intervention fits every situation and that in the course of intervention, trauma integration results from the timely and developmentally appropriate application of sensory-based, soma...

Develop and include interventions that respect and support ...

Empower children and adolescents and their families/caretakers to become active participants in i...

Intervene earlier rather than later to achieve greater and more sustainable gains

Apply psychoeducational parenting interventions to improve social and family relationships and educational achievement

Ethnically match the professional to the client whenever possible and when not possible, use and supervise ethnically matched parapro...

Provide support services to children to assist with accul...

Avoid using children to interpret...

Facilitate connections to ethnically matched support groups d...

Always determine what is and is not culturally acceptable regarding recommendations and/o...

Determine the expectations all clients (adults, families, and children) have regar...

Attempt to assess what change will mean in that individual’s or family’s cultural context and evaluate...

Obtain the intergenerational history of trauma and its impact on behavior and psychological factors. Understand that even within a specific culture, trauma experiences may dif...

Any discussion related to conducting a comprehensive trauma-informed assessment must address the importance and validity of evaluating children’s reactions, behaviors, and thought patterns that preceded traumatic events.

Trauma-informed practices also dictate a multidimensional approach to assessment in order to adequately evaluate children’s reports of how they have survived their traumatic ordeals and what kind of relationships and circumstances gave them the strength to survive. In addition, the roles the environment and interpersonal relationships play are key to understanding young clients’ responses to trauma.

Trauma-informed assessment reflects the growing knowledge of how trauma impacts the brain in multiple ways to clarify why behaviors and reactions are occurring.

For this reason, it is essential that trauma assessment incorporates ecological and developmental approaches that include the various biological, physiological, neurological, behavioral, and affective processes throughout early childhood and throughout adolescence.

ultimately, a behavioral health assessment should “enable clinicians to individualize … intervention approaches in response to the child-and-family-specific question: ‘what is the best approach for a given child and family?’ Answering the child- and family-specific question makes it possible for clinicians to tailor the approach to the child, rather than fit the child to the program”

trauma-informed assessments must include attention to strengths as well as deficits and the full range of developmental variables associated with trauma—biology, physiology, neurology, ecology, behavioral, affective, and cognitive processes. Furthermore, trauma-informed care must be developed and governed by the outcomes of trauma-informed assessment, that today go beyond traditional psychiatric evaluations.

The TAP model defines a multifaceted assessment process to enable clinicians to appropriately screen clients and then, if appropriate for the treatment setting, to gain an in-depth understanding of the child; developmental level; traumatic experiences; and the family, community, and cultural system in which the child lives.

Within the TAP model, strategies are presented to help the clinician make sense of the information gathered during the assessment process. Information is organized into four general domains: (1) trauma history, (2) symptom presentation, (3) relevant contextual history, and (4) developmental history.