Michael W Corrigan Ed.D.

Kids Being Kids

Trauma

Thank You, Child Welfare First Responders!

…where every day is a “hurricane” and a constant state of trauma.

Posted Sep 28, 2017

Co-authored with Fellow Psychology Today Blogger Dr. Robert Foltz

From southeast Texas to Florida, the Keys, Virgin Islands and most recently Puerto Rico, the shocking images from Hurricanes Harvey, Irma, and Maria have been beyond difficult to watch. Seeing the devastation of families and children losing their homes, pets, belongings, precious keepsakes, and, for some, their life and loved ones, serves as a harsh reminder of just how unexpectedly traumatic this thing called life can become. Thanks to all of the citizens and first responders who have risked their lives to help. We sincerely hope the residents of these hurricane-riddled areas quickly get the support and assistance they need. But today we also want to send out a big sincere THANK YOU to a few first responders who too often are overlooked.  

In many ways, every day in the world of child welfare and juvenile justice is similar to experiencing a hurricane. For the dedicated workforce serving our nation’s most vulnerable youth and families, 365 days a year are filled with a constant state of trauma and crisis. And for those committed to riding out the daily storms associated with such care and services, rest assured millions of Americans are very grateful for your efforts.

You are truly a blessing to kids and families who too often have no safety net or support, and for this, you deserve an ample amount of long overdue respect and extra support. So in honor of you, let’s start by shining some light on the challenges and trauma those providing child welfare services, and the millions of children and families receiving such care, experience on a daily basis, regardless of the weather.

Cloudy with a 100 Percent Chance of Category 5 Chaos and Challenges

With limited funding and staffing, the proud and persevering individuals working throughout the child welfare systems of care try their best to achieve what seems at times the impossible. Unfortunately, the success of supporting a family, calming a child in crisis, or completing a complicated placement or treatment plan on any given day is later that same day quickly overshadowed by yet another emergency call to an abuse hotline, hospitalization of a child, or reports of more families in dire need. And with the plates of those working in child welfare already full, we can only imagine the current level of increased chaos for those working in our country’s hurricane-damaged and flooded areas.

But for the selfless workers continually trying to keep their heads above water while saving others from drowning, these hurricanes are just the next in a never-ending flow of crisis to manage. The challenges to care for our most vulnerable youth and families has been increasing for decades, and we would like to bring attention to what these folks who have dedicated their careers to this admirable calling are up against, and what they need to overcome the obstacles.  

Challenge #1: Mega-Millions of Traumatized Kids & Families in Need

Annually in the USA, an estimated 10 million or more kids and families with great needs utilize child welfare-related care and services. Due to issues such as poverty, malnutrition, child abuse, domestic violence, and the high level of drug addiction and crime plaguing so many homes and communities, most youth entering child welfare have experienced unimaginable and numerous traumatic events related to neglect and abandonment.

The Adverse Childhood Experiences (ACEs) study revealed that for youth who experienced four or more adverse experiences before the age of 18, they also were more likely to encounter extensive mental and physical health effects, including higher rates of depression, suicidal ideation, substance abuse, high-risk behaviors, cardiovascular complications, and dramatic reductions in life expectancy (Anda et al., 2006). Unfortunately for the vast majority of youth and families in the child welfare systems of care, having four or more ACEs—traumatic experiences—is not uncommon.

As a result, no matter if a youth enters the systems of care through Child Protective Services (CPS), children services, foster care, residential treatment, or the juvenile justice system, beyond often needing food, clothes, and safe shelter, they also need a whole lot of medical and psychological care plus love and direction. Let’s call it “life support.”

Challenge 2: Not Enough Staff, Experts, and Resources to Go Around

To make matters worse, with so many kids and families in need and rather limited staffing, facilities, and agencies available, the workload is unfathomable. For example, when emergency CPS cases are assigned, the initial responsibility of care is often placed on caseworkers. These individuals are expected to somehow supervise 10 to 45 at-risk kids at any given time. Such caseloads make it rather difficult to give the daily personal attention so many of these kids need. Due to lack of time, often caseworkers are forced to devote the majority of their attention to the most elevated crisis situations, hoping “no news is good news” from their other crisis cases—until there is bad news, which may then be too late. We should note that probation officers in juvenile justice often experience similar dilemmas and even heavier caseloads.

Additionally, in child welfare facilities such as residential treatment centers, it is not unheard of to find mental health clinicians juggling therapy for sometimes upwards of two dozen kids. Considering the hours needed for each therapy session and the paperwork associated with each session, as well as the time needed to organize the additional services for each youth’s personalized treatment protocol, this makes it very hard to monitor their well-being and physically see each youth more than once a week. Such efforts are not nearly enough to truly provide successful intensive holistic care and mental health treatment protocols capable of producing consistent positive outcomes.

Meanwhile, for kids just entering child welfare and in need of placement, where agencies are typically challenged by not having a modern system to evaluate the availability, expertise, safety, and climate of an appropriate environment, states are constantly scrambling to find available beds in the overcrowded facilities and limited foster homes. Luckily, there are volunteers who provide help from organizations such as CASA (Court Appointed Special Advocates) and the Dave Thomas Foundation for Adoption. But without Harry Potter materializing and casting a growth charm to magically multiply the number of volunteers and foreseeable future federal dollars needed to build more facilities and hire more staff, as well as fix the shortage of muggle foster parents, more help, modern technology, and better approaches are in great need.

Challenge 3: Limited Data to be Evidence-Driven & Trauma-Informed

With far too many existing child welfare information systems put in place before the dawning of the mobile flip phone, the systems at use often are outdated, slow and incapable of collecting the actionable data needed to connect insightful efforts across agencies. These systems were designed mainly to stockpile data for accountability demands required by SACWIS (Statewide Automated Child Welfare Information Systems), a federal accountability effort implemented two decades ago. Unfortunately, existing SACWIS systems typically do not allow real-time access to essential information, files and clinical records to keep a pulse on each individual youth under care. This is a major challenge because such efforts often require high-quality evidence to inform more effective care and collaboration between CPS, foster care, residential treatment and juvenile justice.

These existing systems typically do not provide the ability to efficiently share information electronically across agencies such as when a child enters via CPS, is placed into residential treatment and then is transferred to foster care, or after release ends up back in juvenile courts. Thus, although important information on past experiences in child welfare, as well as clinical and case files, might exist on a youth not new to the systems of care, many at child welfare agencies and facilities are not provided accessibility to existing or adequate information to truly understand what a child has been through, what has been tried before, what worked and what didn’t work.

Houston… um… Everyone… We Have a Problem

Imagine if today we did not have advanced weather radar tracking technology to monitor the location, strength, or even existence of a storm system such as a hurricane. Similar to the recent tragic earthquakes in Mexico, imagine if on any given day, any given hour, we could be blindsided by a hurricane, monsoon, tsunami, or tornado. Luckily, we have such forecasting technology and alert systems in place to be more informed, prepared, and supported when it comes to weather emergencies. Given the challenges our child welfare workers face, and the critical needs of the millions of traumatized youth and families they serve, doesn’t it seem strange and slightly unfair we don’t have similar efficiency-focused modern technology to empower child welfare?

Think about it. Despite the fact that today we have the technology and statistical ability to provide real-time predictive analytics to guide care for at-risk kids and families, the systems we have in place to support child welfare first responders and those they protect rarely have forecasting capabilities or alert systems. Instead of having a comprehensive electronic history of the trauma and care a child has experienced, while searching for fragmented hard copies of past treatment records, agencies must often re-interview and have youth revisit their past trauma again and again, and hope that the youth, or parent or guardian of the youth, shares all details accurately and honestly. Meanwhile, with little information at all, many in juvenile courts or psychiatric care have to make split-second placement or treatment decisions far too often.

The good news is that we have the technology (cue Six-Million Dollar Man theme music), and we can strengthen or replace these systems to better serve child welfare and inform current challenges. Additionally, there are efforts underway to restructure the outdated child welfare information systems utilized in many states due mainly to a new federal effort called CCWIS (pronounced See-wis and stands for Comprehensive Child Welfare Information System).

The idea of addressing new accountability demands and adopting an even more comprehensive data system capable of collecting higher quality data and empowering sharing across historically disconnected agencies, however, might not sound like good news to those on the front line already stretched way too thin and possibly fighting a slight case of PTSD. But with cloud-based modern mobile systems and more trauma-informed approaches available, there are solutions readily adoptable to help child welfare improve the care and support provided nationwide.

The dilemma currently hovering over the land of child welfare, nonetheless, rests within either staying the course with SACWIS systems or adopting a new comprehensive system offering more efficient and science-based approaches that can be tailored to empower each child welfare sector to care for so many with so little. But for states which pursue such change to help child welfare, rest assured that improving data collection quality and processes can improve the delivery, coordination, and effectiveness of care. And improving care will reduce the length and cost of services needed, simultaneously strengthening the fiber of safety net provided and increasing retention of your dedicated workers.

Decisions, Decisions

As two psychology professors specializing in at-risk youth, and with ample personal and professional experience connected to the child welfare systems of care, we know what you are up against and we have been working diligently to develop such systems to help. Given what we know about the challenges to child welfare care, to accomplish such goals, future efforts might strongly consider moving towards a more trauma-informed systemic approach.

By addressing more of the pieces of a child’s life or family’s environment that are contributing or previously has contributed to the problem, having a comprehensive system that collects and connects information on the many variables challenging our youth and families could revitalize existing team approaches encompassing investigators, caseworkers, clinicians, supervisors, staff, administrators, and community partners. With more modern, modular and mobile technology now available, similar to what we have developed, such an approach can provide a mechanism to finally keep the pulse on each youth in real-time as they progress through the systems of child welfare care and hopefully when possible back to a more stable home with their family.

To truly adopt a more successful technological approach to child welfare, however, many will most likely need to embrace high-level change, do a little soul-searching, and consider taking a slightly different path to the care provided. Because let's face it, with many still using approaches to placement and care which were established long ago and do not necessarily work with today's child welfare challenges, there is more to fix than just the information systems currently utilized.

For example, as many are well aware of, in the mental health world one of the most popular current approaches is often referred to as the bio-model. As this theory hypothesizes, some believe the vast majority of mental health issues are due to brains malfunctioning or a client experiencing a chemical imbalance. As a result of being focused heavily on placing so much responsibility for such behaviors on the biology of the mental health problem, many often overlook the impact that the social and familial environments of the client and one’s traumatic past plays.

Under the bio-model hypothesis, if one shows enough subjectively assessed concerning behaviors (aka symptoms), the client typically is given a diagnosis of a mental disorder and a code number to invoice insurance or Medicaid for the care assigned. And then, often before any therapy sessions are utilized to learn more about the circumstances of the behaviors and create a more holistic treatment plan, or before a thorough trauma history or drug use assessment is administered, mind-altering pharmaceutical drugs (that often come with warnings of being highly addictive) are prescribed to children by a psychiatrist to “treat” the symptoms.  

When it comes to applying this approach to child welfare and juvenile justice efforts, we are taking a big risk. Beyond common sense not being that common anymore, aka giving highly addictive drugs to at-risk children, there is an abundance of evidence suggesting the proposed biological assumptions cannot be confirmed. Also, we must consider that these drugs some people want to call “medicine” only temporarily and chemically mask the problem, and often come with worse side effects than the symptoms or behaviors the client is already displaying or experiencing (e.g., opioids leading to heroin addiction, depression drugs leading to suicidal ideation). Diagnosing mental health disorders is necessary and beneficial. But if history predicts the future, the possibility exists these at-risk children, we are drugging for acting like at-risk children, will spend the rest of their time in child welfare and possibly many years more medicated.

Please note, as many headlines have echoed, it is not uncommon to find children in child welfare (e.g., foster care) being prescribed far too many pharmaceutical drugs. For many foster children, their days consist of waking up every morning to taking a powerful ADHD stimulant drug to focus. They also might take more drugs to treat their obesity and blood pressure, and another to mask their depression symptoms which trauma and long-term use of the ADHD drug quite likely have contributed to. They then take a drug to help them find an appetite and end the day with a drug to go to sleep. For a great number of foster parents, foster children, and child welfare first responders, there is much hope abound to find a better way to help these kids find a bypass to their challenges.

The true root of the symptoms for the at-risk youth in child welfare most likely does not rest in the hard-wiring of their brain, a chemical imbalance, or for those spouting genetic links, in their DNA. The real cause can be more often attributed to the behaviors and trauma they observed and experienced in their homes and communities; let’s call it their “cultural DNA.” Coincidentally, the science of epigenetics is now explaining that our day-to-day lived experiences can change the expression of our genes. Additionally, please note, as our research has identified, trauma is often misdiagnosed as Bipolar.

The point is these dedicated first responders need new systems in place which better empower collaboration between investigators, caseworkers, and clinicians; help mental health in child welfare become more trauma-informed. We can get rid of the headlines about foster kids being over-medicated, by simply proactively pursuing better approaches to care. As a result, efforts will need to adopt new technology that can be tailored to support these more holistic, team-based approaches to help those in child welfare also “treat” the learned behaviors and social conditioning so many bring with them. But if we are going to adopt a new mainframe, we might also consider allowing our child welfare first responders to offer the valuable frontline insights needed to reframe future efforts, aka improve existing approaches.

Every Child is Vital

But how can we take what appear to be more demanding trauma-informed systems-based approaches if the clinicians, administrators, caseworkers and staff have far too much to do already? This is an important question to wrestle with. There is only so much time in a day, and the challenges associated with this hurricanic child welfare storm spanning across the mainland are showing no signs of retreating back to the sea or dying off.

Research documents, however, that such pharmaceutical-flawed approaches to “care” will most likely only lead to longer duration of mental health treatment and thus more expense to the state, the federal government, and insurance companies. Therefore, if states are going to take the time to adopt new technology to better manage efforts, they might also want to take some time to figure out which existing approaches need to be addressed and fixed to further help improve efficiency and effectiveness of care, plus the ethics, for today’s populations in child welfare. And similar to many of our colleagues still working in the child welfare sector, we believe that a broader focused team-based approach, where even the youth and parents (when possible) are part of the planning process and have a voice as well, would be most beneficial to determining what is needed and working.

We must accept that though current systems and processes, or even some new systems which provide a mobile platform starting with CPS intake and ending with initial risk assessment, offer a functional path for day to daycare, they are not ideal. They do not provide an end-to-end solution spanning the systems of care. Furthermore, a state of perpetual controlled chaos falls far short of what our child welfare first responders and those they care for deserve. Moreover, regular exposure to the trauma experiences of those we care for can create an experience of vicarious trauma; aka the child welfare staff or clinician begin developing signs of trauma, which is yet another challenge to overcome.

Child welfare needs new systems to help this dedicated workforce, and get their kids, and equally important their families, back on their feet for the long haul. We must avoid adopting technology that allows us to check off the box for meeting accountability under CCWIS, and instead adopt systems that can provide better monitoring for decades to come and help more foster kids and juvenile offenders graduate with the degrees they need. We need an approach which will help families discover what it takes to be self-sufficient and capable of raising children more responsibly.

Reentry into the child welfare system, as well as needing life support services from multiple agencies along a youth’s path to stabilization, is all too common. As a result, we must embrace a better way to collect comprehensive information and make it more readily available across agencies, user-friendly for all connected to the care to benefit from. We need systems to help better determine which resources the youth and families truly need; when they need it and for the time they need it.

Tracking the Storm

The bottom line is that throughout the year child welfare efforts deserve just as much of our public attention as a hurricane does. Now if we could get reporters to spend hours standing in the full force storms our caseworkers, staff and clinicians experience every day, similar to weather reporters ceremoniously standing in the winds and rain during a hurricane, maybe we could solve this problem quicker.

But with so little positive or supportive coverage given in the media to child welfare and juvenile justice, the work most likely will fall once again on the few who serve so many millions in the child welfare systems of care. Child welfare first responders and those in juvenile justice need your help and support. We hope that after reading this all have a better idea of what these folks are facing, and the investment this sector deserves. Thanks again to those in the child welfare systems of care for all you do.

Authors' Note: Drs. Corrigan and Foltz are passionate psychologists and professors who are on a mission to make a measurable difference. They specialize in educational, developmental and clinical psychology, as well as evaluation, advanced statistical analysis, and psychometric development. Their $19.5 million in federally funded research endeavors and professional efforts have been focused on helping at-risk youth for decades. For more insight on their efforts to assist Child Welfare and Juvenile Justice, please visit https://vitalchild.solutions/ to learn about their trauma-informed approach developed in partnership with Oracle and Helix Business Solutions.

References

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174-186.