From Prevention Action
June 11, 2015
Complex, multi-faceted problems faced by abused and neglected children demand well-considered, multi-faceted solutions. Expert help and care are essential, but no single activity is likely to prove sufficient in itself.
Recognizing this, social work and other professionals in the US State of Massachusetts are attempting an ambitious transformation of services for children whose “complex trauma” threatens their life chances through poor mental health.
The problems being confronted relate to children removed from their homes in extreme circumstances who not only undergo separation from a parent, but often also experience further separation when residential and foster-care placements break down. After being castigated for poor performance regarding foster placement stability in 2011, the Massachusetts Department of Children and Families (MA DCF) convened a group of experts from different professions to step back and see what was needed to improve children’s outcomes in the future.
They began by considering what workers and carers at all levels in a child protection system need to know to make a better job dealing with problems when they arise. This, they hoped, would produce a culture change that would permeate the whole of child welfare service, not only benefitting children, but also reducing the risks of “burn out” among stressed professionals.
The cornerstones of the new practice model are: positive engagement and empowerment of families; progressive understanding of families’ needs and strengths; building capacity of parents to effectively parent their children and consolidating and sustaining gains. Underpinning mantras devised for the new approach are that casework should be “safety-organized”, “trauma-informed” and “solution-focused”.
More specific practice goals set for the initiative are to improve the identification and assessment of children exposed to complex trauma and encourage trauma-sensitive practices among agencies. Relevant training is being made widely available for professionals and caregivers with the aim of improving links as well as referral rates to evidence-based treatments and other help.
The training has been delivered in two layers. The first focuses on improving the way that DCF staff and carers recognise and respond to child trauma. The second works towards the establishment of local Leadership Teams in area offices to direct policy and practice towards desired aims.
The curriculum includes modules on understanding the impact of trauma on children’s development and behavior, and on when and how to intervene. Participants are advised on how to ensure children and carers have access to timely, evidence-based interventions and on the adoption of a case planning process that supports resilience and recovery. They are also encouraged to pay attention to their own “self-care” in response to working with traumatised children.
Extensive efforts have been made to disseminate information and training about three particular interventions for children with complex trauma: Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT), Child-Parent Psychotherapy (CPP) and Attachment, Self-regulation and Competency (ACC). The effectiveness of first two is supported by positive trial data.
Although yet to be tested using a randomized-controlled trial, ARC is reported to have produced reductions in behavioral problems and post-traumatic stress symptoms comparable to those achieved by TF-CBT.
The emphasis throughout planning and implementation in Massachusetts has been on ensuring that new approach achieves a cultural shift, and is not dismissed as a passing fad or on the outside of mainstream child protection practice.
Emphasis on Implementation
While introduction of the initiative continues, the emphasis in its evaluation is on implementation. Data collected so far confirms that the project began from a low base where there was no specialist trauma service available and knowledge among staff was limited.
Basic training has already been provided for more than a thousand DCF workers and the new-style leadership teams have been progressively introduced in area offices. The championing role of the Area Office Manager has emerged as critical for success, not least when reorganization plans have run into political and financial resistance.
In the first year, 298 children were helped by the new approach.
The next evaluation phase will be more difficult: to discover whether the new approach improves outcomes for children and provides value for money. But whatever emerges, the steps taken to date accord with knowledge from beyond the bounds of children’s services on what it takes to tackle complex social problems.
In road safety, for instance, deaths from accidents in the U.K. have fallen by two-thirds in the last twenty years, not because of one single initiative but because of the combined contributions of material scientists, road designers, vehicle engineers, police patrols, driving test examiners and others, backed by increasingly sophisticated technology.
Achieving necessary cultural change takes time and can be confounded by professional resistance, administrative complications and, sometimes, disappointing early results. Yet the eventual outcome, as with road safety in the U.K., can be a dramatic improvement.
Fraser, J.G., Griffin, J.L., Barto, B.L., Lo, C., Wenz-Gross, M., Spinazzola, J., Bodiam, R.A., Nisenbaum, J.M. and Bartlett, J.D (2014). Implementation of a workforce initiative to build trauma-informed child welfare practice and services: Findings from the Massachusetts Child Trauma Project. Children and Youth Services Review, 44, 233-242. doi.10.1016/j.childyouth.2014.06.016.