Are “Trauma Informed” Just Buzz Words, or Do They Actually Mean Something?
“Trauma informed” are two of the most frequently-used words when people, usually social workers and mental health experts, tout their skills and how they are making a difference in the lives of children. Actions prove who someone is; words just prove who they want to be. All of those that serve children in foster care should want to be trauma informed. Lawyers need to prove we are trauma informed by being active, zealous advocates for what our child clients need.
The excellent work of SAMSHA, the ACEs study, and the National Child Traumatic Stress Network, among others, have opened the eyes of the professionals who serve children to the multitude of sources of trauma that impact their lives. Scientists are just now starting to understand how trauma affects the development of the brain, both in the long- and short-term. This graphic provided by the United Way shows the drastic difference between a normally developing brain and one impacted by trauma:
Trauma gets in the way of brain development. Instead of learning higher-functioning processes, the brain stays in a loop focused on its most basic task: survival. A brain focused on hunger is not going to be able to retain the skills necessary for reading.
Within a removal affidavit from CPS, one can usually pick out at least half-dozen traumatic events that the child(ren) have endured. How those traumas impact their specific brains and their outward behaviors cannot be predicted with certainty, but awareness of the possible outcomes can make a world of difference in their future.
As an attorney ad litem I represented a young girl who had a long history of trauma including physical abuse and neglect, witnessing domestic violence, witnessing drug use, living in poverty, and suspected sexual abuse. She was struggling with hygiene issues and her caregiver thought rewarding her with nice hair clips would be a good incentive to encourage her to shower every day. This incentive did not work, and in fact, it backfired. When the caregiver and I discussed the situation, I reminded the caregiver that the child had either been sexually abused or had at least been groomed by a sexual predator in the past. That child did not want to draw the attention of anyone, so “looking nice” felt like a punishment to her. Once a new incentive was found that tied in with an extracurricular activity she loved, it was easier to motivate her.
Appearances Can Be Deceiving
Trauma can have untold short- and long-term effects on someone. While we may know the trauma history of a child, it is hard to know which way the impact will make itself evident. One way that is frequently seen is physical aggression and out-of-control behavior. A lot of foster parents describe a child in their home as being a, “ticking time bomb – we never know when he will go off.” In this situation it can be beneficial to work backwards. Starting with the “explosion,” write through the events that preceded the melt-down in reverse order. Many times you can trace the outward behavior to an internal response to previous trauma.
For example, a kindergartener has an explosive fit in class, scaring his teacher and fellow students. He is crying, throwing objects, and lashes out physically at anyone who tries to subdue him. He ends up being suspended from school and the foster parent considers hospitalizing him at a psychiatric hospital, or at least adding more medications to his regimen. Once the teacher is able to reflect back on what precipitated the meltdown, she related that the class was working on cards for Mother’s Day. What she failed to recall, until after the destructive fit, was that this child was in the foster care system. He wouldn’t be with his mother for Mother’s Day. His heart hurt so badly that all he could do to take the ache away was to scream and throw things. His impaired sense of logic told him that if people are afraid of him, they won’t think he’s a crybaby because all he wants to do is cry because he misses his mom. Because of a seemingly small oversight by the teacher, this child’s life could be forever changed by being sent to an alternative school or hospital, which are both scary places at any age, but especially when you are only five.
When animals are being placed for adoption, their cages often bear signs with phrases like, “Does not get along with cats; afraid of loud noises; etc.” Sometimes it seems like it would be easy to make similar signs for children in foster care so everyone around that child knows they have different needs than a typical child their age. Maybe we should do those signs for everyone in society. I know I, and those around me, would benefit if I had a sign that said, “Only one cup of coffee so far, tread carefully.” I see my job for a child I represent as being their “sign.” I take it as my responsibility to educate the people who have daily interactions with the child about that child’s history. I certainly talk with the foster parents about what the role of past trauma may look like in the child. If I can, I speak with the teachers and school counselors. I talk with the caseworker, CASA advocate, the child’s counselor, or anyone who will listen to me. I don’t get to spend every day with my clients, but the people who do need to know how they can help that child be the best they can be.
Fast Track to Flashbacks
There is one sense that has a direct line to the brain: the sense of smell. We are able to have an immediate flashback to events of our past based solely on a triggering scent. Both good and bad memories can be brought to the forefront of our mind with a whiff of cologne, cigarette smoke, or alcohol. A child in foster care may have a fond memory of the smell of their mother’s shampoo while also having horrible flashbacks of being beaten when they get a sniff of alcohol.
As professionals who work with these fragile children, we must be mindful of their individual histories and needs. I strive to be as “scent neutral” as possible when meeting a new child client. I also ask caregivers if the child has shown a particular sensitivity to certain smells. Sometimes being in an environment with an overwhelming blending of smells, such as a school cafeteria, can be too much to handle. This could lead to a child shutting down or lashing out.
Many of the children we serve have a background of poverty or even homelessness. The only professional-dressing people they may have been around are those in social services or law enforcement. Think how similar a navy suit looks to a police officer’s uniform from the perspective of a small child. Children could very easily associate the appearance of a person in a uniform or in business attire with the memory of the day they were removed from their parents or the day one, or both, of their parents went to jail.
When we are in a courtroom, we should dress like the professionals we are. When we are visiting our child clients, we should dress like a person they would want to spend time with. When possible I make a point to not wear a suit when I visit with my child clients, no matter the age of my client. How can I play with Matchbox cars or color pictures at the coffee table if I’m in a stuffy suit? How can I encourage a teenager to trust me if I look like an authority figure? I find being in relaxed clothes helps my clients relax with me, which leads to more honest conversations about who they are and who they want to be.
Another way I like to try to connect with my clients is to spend time with them not discussing their case. I have a “visit bag” that has a variety of coloring books, washable crayons, washable markers, plain paper, and stickers. I also stock up on the small tubs of Play-doh when they are on sale. You would be surprised how open children can be when their minds are engaged in play and fun. For a few dollars spent at the dollar store, I am able to buy some quality time with my clients when we can talk about substantive topics without them realizing it. I also get to deliver some awesome works of art to their parents and occasionally add one to my collection.
Part of representing children involves forgetting some of what you learned in law school or in practice as a lawyer. I would never attend a meeting with a private divorce client where I wore casual clothes and broke out the arts and crafts when we got to the tough topics. But the kids we represent do not need a typical lawyer; they need a lawyer who can meet them on their level and help them when they are their most vulnerable.
A Simple Fix to Behavior Meltdowns
Sometimes the most basic answer is the hardest to see. Have you ever been so hungry that it was difficult to concentrate when trying to finish that draft before lunch? Have you been so distracted by thirst that you did not catch everything the judge said in her ruling? Does your mind wander when you get too warm? These issues can be magnified for children in foster care. Children exposed to drugs in utero often suffer from chronic dehydration. Traumatic impact on the brain and body can also cause differences in metabolism.
Aaryn Landers Lamb
A child’s behavior meltdown could be very easily nipped in the bud if their physical needs are met first. At our home, when one of our three children start to have a meltdown, we first check to see if their physical needs have been adequately met. If they haven’t eaten in a while or haven’t had a drink recently, that is where we start in order to stop the downward spiral before it gets out of control. We will “press pause” on whatever moment is causing the strife and sit down with a snack and a drink. Once five minutes have passed, the snack has been consumed, and the water gulped, cooler heads (and fuller tummies) usually prevail.
When our youngest was having trouble falling asleep one night, I went upstairs to rock him. As soon as I sat down in his rocker I realized the problem: our heater was still on upstairs. It was early spring and we were still having cold spells, but this night in particular was not cold. His room was easily 80 degrees. Once we turned on his fan and the air conditioning, he gladly laid down in his cool room and fell fast asleep. This experience taught me to never take physical environment for granted. If a change in temperature can take a cranky, screaming, defiant toddler and make him a sleepy puddle in my arms, it can certainly have an impact on children’s behaviors at home and at school.
Many children in foster care have a history of chronic hunger. They were not sure when or if they were going to eat. When placed in a foster home that has plenty of food, they may still hoard food or take food from the trash. This behavior perplexes and angers many foster parents. Children who did not have an adult to meet their physical needs learned to meet their own needs and often find it difficult to trust anyone. Even if they see the pantry and fridge full of food, they cannot trust that they will get to eat. To help give kids reassurance they will not go hungry, it can help to leave a bowl of fruit or other “anytime” snacks that are in reach of the children. They know they can eat whenever they feel the need to. This may lead to them eating everything in the bowl the first few days but the long-term result will be their ability to trust their caregiver to meet their needs.
We often talk about being trauma informed, but how often do we put it into our practice? These interventions cost little to nothing but can have a huge impact on a child’s day-to-day care and long-term development.
Note: The views and opinions expressed in this blog post are those of the author, and do not necessarily reflect the views of the NACC.
Aaryn Landers Lamb
Aaryn Landers Lamb, JD, CWLS, has worked as a family lawyer with a focus on child custody and CPS litigation in the DFW area of Texas since 2006. Aaryn has participated in multiple trainings with the TCU Institute of Child Development about child trauma and the use of the Trust-Based Relational Interventions program. She has spoken on the topic of the impact of trauma and children in foster care at several continuing legal education seminars. Aaryn is striving to make “the system” truly trauma informed to better serve the children, parents, and families who are involved with CPS.