Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

Abstract

National Center for Child Traumatic Stress Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-informed perspective in their practices to enhance the quality of care for these children. This includes making sure that children and adolescents are screened for trauma exposure; that service providers use evidenceinformed practices; that resources on trauma are available to providers, survivors, and their families; and that there is a continuity of care across service systems. This article reviews how traumatic stress impacts children and adolescents' daily functioning and how various service systems approach trauma services differently. It also provides recommendations for how to make each of these service systems more trauma informed and an appendix detailing resources in the National Child Traumatic Stress Network that have been produced to meet this objective.

Trauma is a public health issue

“…Similar practices and policies are underway in other systems around the world; however, integration of mental health and trauma-informed services remains the exception and not the rule in many communities. Many suggest that a true public health approach requires mental health integration beyond primary care to include sectors such as education, justice, welfare, and labour through partnerships with government, non-governmental organizations, and the faith-based community (Collins, Insel, Chockalingam, Daar, & Maddox, 2013; Ko et al, 2008),…”

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

“…Lack of referral resources for patients identified as being at risk compounds the problem as mental health resources, particularly those tailored to child and adolescent patients, are scarce in many LMICs (Kakuma et al, 2011; Kieling et al, 2011). In addition to improving knowledge, reducing systemic barriers is an important step in creating trauma-informed health care systems, which requires organizations to be committed to addressing the impact of trauma on children and families (Kassam-Adams, 2014; Ko et al, 2008; Marsac et al, 2015; Petersen et al, 2017). Further, as time constraints were frequently identified as a barrier to providing trauma-informed care, training programmes that are developed for staff in these regions should aim to be brief and time efficient.…”

“…It is important to note that medical and nursing staff would not be expected to replace mental health workers but rather provide routine medical care in a way that acknowledges the impact of trauma and minimizes distress, thus altering the subjective experience of the event and the immediate aftermath (Kazak et al, 2006; Marsac et al, 2014; Price et al, 2015). Several preventative approaches including the DEF protocol (Stuber, Schneider, Kassam-Adams, Kazak, & Saxe, 2006) which provide evidence based guidelines on implementing trauma-informed care and information provision (Kenardy et al, 2008) are designed to be incorporated into routine care and add little burden on time (in the Medical Traumatic Stress Toolkit: Kassam-Adams, 2014; Kenardy et al, 2008; Ko et al, 2008; Marsac et al, 2015). …”

“…This approach can be incorporated into acute medical care and when provided in the immediate aftermath of paediatric injury aims to change the subjective experience of the potentially traumatic event. This is achieved by reducing pain and distress, providing emotional support and promoting both physical and psychological recovery, thus minimizing the risk of the development of paediatric medical traumatic stress (Ko et al, 2008; Marsac, Kassam-Adams, Hildenbrand, Kohser, & Winston, 2011; Marsac et al, 2015). As such, trauma-informed care, provided by emergency staff, is indicated as a low-cost, low-intensity preventative measure for targeting paediatric medical traumatic stress in LMICs (Ko et al, 2008; Marsac et al, 2015).…”

“…This is achieved by reducing pain and distress, providing emotional support and promoting both physical and psychological recovery, thus minimizing the risk of the development of paediatric medical traumatic stress (Ko et al, 2008; Marsac, Kassam-Adams, Hildenbrand, Kohser, & Winston, 2011; Marsac et al, 2015). As such, trauma-informed care, provided by emergency staff, is indicated as a low-cost, low-intensity preventative measure for targeting paediatric medical traumatic stress in LMICs (Ko et al, 2008; Marsac et al, 2015). Despite being the recommended approach, research is needed to examine the effectiveness of trauma-informed care as a preventative approach for paediatric medical traumatic stress (De Young & Kenardy, 2017; Marsac, Hildenbrand, & Kassam-Adams, 2017; Marsac et al, 2015).…”