Psychiatric News May 6, 2005
Volume 40 Number 9
© 2005 American Psychiatric Association
p. 10
Agencies Often Overlook Need To Assess Trauma in Children
Eve Bender
The mental health needs of children who have experienced trauma and are
in the child welfare system require consistent, ongoing attention of all the
agencies involved.
A number of public agencies charged with serving youth who have experienced
trauma fail to gather information systematically about those traumatic
experiences, including factors that trigger responses related to past
trauma.
An additional shortcoming appears to be a failure to assess children
consistently for posttraumatic stress disorder (PTSD), according to a report
released in March by the National Child Traumatic Stress Network.
The report, titled "Helping Children in the Child Welfare System Heal
From Trauma: A Systems Integration Approach," found that children who
have been removed from their homes due to abuse and neglect and placed in the
public system "have an extremely high risk for mental health problems,
especially traumatic stress."
To obtain the information for the report, members of the network's Systems
Integration Working Group conducted interviews in 10 states with
representatives of 53 mental health, child health, and foster care agencies;
schools; and family/dependency courts.
The agencies were not randomly selected, but chosen on the basis of
proximity and familiarity to members of the work group, so the data presented
are not generalizable.
Respondents answered questions about the type and amount of information
they request from agencies that refer children to them, the type of
information they collect while the child is under their care, and the
information they communicate to staff from other agencies who also are working
with a particular child.
"Many organizations working with traumatized children focus only on
addressing traumatic reactions, such as anger or irritability, or symptoms
such as avoidance," the report stated. "They fail to address the
underlying trauma that gives rise to problematic behavior and the trauma
reminders that can trigger posttraumatic reactions."
Agencies surveyed reported that they gather information on the duration and
number of traumatic episodes for about 69 percent of children, on average. For
just 47 percent of children do agencies gather information on factors that
trigger a particular child's trauma (see chart).
On average, survey respondents indicated that they screened for PTSD in
only about half (54 percent) of children with known trauma histories.
The data suggest that the agencies surveyed are not systematically
gathering crucial information on trauma, according to Lisa Amaya-Jackson,
M.D., M.P.H., and as a result, many children who have experienced trauma and
who come into contact with these agencies are left untreated for the
consequences of that experience.
Amaya-Jackson served on the work group that issued the report. She is
associate director of the UCLA-Duke University Center for Child Traumatic
Stress and an associate professor of psychiatry and behavioral sciences at
Duke University Medical Center.
"We not only have the ability to assess children for trauma exposure
and trauma-specific consequences, but we also have empirically supported
treatments to offer children and families," she told Psychiatric
News.
The survey also showed that less than half (44.7 percent) of the agencies
train staff about evidence-based treatments for children with trauma
histories, and 61 percent said they train staff on how to assess for trauma in
children.
The report issued a number of recommendations for members of the work group
and other groups within the National Child Traumatic Stress Network. They
include the following:
- To work with national child welfare and dependency court organizations to
develop and promote training about child trauma.
- To promote the use of appropriate standardized assessment measures for
child trauma within the service systems, including public, child welfare, and
court systems.
- To promote the dissemination of evidence-based practices within public
child-serving systems.
"Child trauma and its repercussions are a major public health
concern," Amaya-Jackson said. "Information about empirically
supported treatments.. .can and should be shared between agencies."
The report, "Helping Children in the Child Welfare System Heal
From Trauma: A Systems Integration Approach" is posted online at
<www.nctsnet.org>.
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