Nurturing Healing: Trauma-Informed Care for Children in Mental Health Settings

By Kecia L. Ellick, Ph.D.
MFP Training/Technical Assistance Lead, The MayaTech Corporation

The prevalence of adverse childhood experiences has led to an increase in studies to explore the impact of trauma on childhood outcomes. Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood (ages 0-17) that encompass various forms of distress, such as exposure to abuse, domestic violence, and living in a household where mental health issues or substance abuse are present. These experiences can lead to toxic stress, which may alter brain development and influence the body's stress response mechanisms. Additionally, ACEs have been associated with an increased risk of developing chronic physical ailments, mental health disorders, and a propensity for substance abuse in later life.^1,2 Sixty-four percent of adults reported experiencing at least one type of ACE during their childhood.²

Responses to traumatic stress can manifest as a blend of psychological and physical symptoms, which may include re-experiencing, avoidance, heightened arousal, and shifts in cognition and mood. Individuals might experience persistent, unwanted thoughts about the traumatic event, actively avoid reminders related to the incident, feel emotionally numb or disconnected, engage in self-blame, or blame toward others, and struggle with disruptions in sleep, appetite, or concentration.²

Implementing Trauma-Informed Practices

Trauma-informed care (TIC) is an approach in mental health services that acknowledges the widespread impact of trauma and seeks to understand paths for recovery. In pediatric settings, it's vital to recognize that trauma can profoundly affect a child's development, behavior, and overall mental health. TIC is essential to address children's unique needs sensitively and effectively. Providers may utilize the 4 R's approach as guidance: realize, recognize, respond, and resist re-traumatization.³

1. Realize:^4,5
   
   • Acknowledge the extensive impact of trauma on child development and long-term health.
   • Shift the perspective from "what is wrong with you?" to "what happened to you?" to understand the child's experiences and their influence on behavior and health.
2. Recognize:^4,5
   
   • Identify signs of trauma in children, which can vary in presentation, including disordered eating, sleep disturbances, and social withdrawal.
   • Be alert to critical signs like suicidality or self-injurious behavior, considering trauma as a potential underlying cause.
3. Respond:^4,5
   
   • Implement trauma-informed practices in healthcare settings, incorporating them into clinical protocols, procedures, and policies.
   • Ensure referral systems and coordination for trauma-based care are in place, supporting both the child and the family.
4. Resist Re-Traumatization:^4,5
   
   • Adapt clinical approaches to prevent triggering past trauma, being mindful of the patient's reactions during interactions and examinations.
   • Ensure referral systems and coordination for trauma-based care are in place, supporting both the child and the family.
   Support healthcare staff through training and policies that acknowledge the risks of vicarious traumatization.

Effective trauma-informed practices in pediatric settings involve specialized assessment and screening tools and comprehensive staff training and create a supportive environment that includes family involvement.²

Screening and Assessment Tools

• Utilize tools like the Child and Adolescent Needs and Strengths (CANS) assessment to identify the impact of trauma on children's mental health.
• Conduct regular screenings to monitor the progress and tailor interventions accordingly.

Training and Education

• Invest in regular training programs for mental health professionals to stay updated on the latest trauma-informed practices.
• Encourage a culture of learning and adaptability within mental health facilities.

Family Involvement

• Engage families as active partners in the treatment process.
• Provide resources and support to help families understand and effectively respond to their child's trauma-related needs.

Trauma-informed practices in pediatric mental health settings include not only a clinical approach but also a fundamental shift in how clinicians and other providers perceive and respond to children's mental health needs. By embracing these principles and practices, mental health professionals can significantly contribute to the healing and well-being of children who have experienced trauma.

SAMHSA has resources for professionals seeking to implement trauma-informed practices in pediatric settings:

• The National Child Traumatic Stress Initiative improves treatment and services for children, adolescents, and families who have experienced traumatic events.
• Understanding Child Trauma
• Recognizing and Treating Child Traumatic Stress

References

1. Felitti, Vincent J., et al. "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study." American journal of preventive medicine 14.4 (1998): 245-258.
2. National Center for Injury Prevention and Control, Division of Violence Prevention. Vital signs fact sheet: Adverse Childhood Experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/aces/index.html.
3. Goddard, A. Adverse childhood experiences and trauma-informed care. Journal of Pediatric Health Care, 35(2) (2021): 145-155.
4. SAMHSA's concept of trauma and guidance for trauma informed approach. HHS publication no. (SMA) 14-4884. Substance Abuse and Mental Health Services Administration, Rockville, MD (2014).
5. Substance Abuse and Mental Health Services Administration Programs. (2018). Retrieved from https://www.samhsa.gov/nctic/trauma-interventions.