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July 2016 | Volume 4, Issue 3
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EVIDENCE IN ACTION
A quarterly research brief from the
Center on Trauma and Children
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Identifying the Trauma Recovery Needs of Maltreated Children: An Examination of Child Welfare Workers' Effectiveness in Screening for Traumatic Stress
The following is a study conducted by the Center on Trauma and Children. Whitt-Woosley, Adrienne, "Identifying the Trauma Recovery Needs of Maltreated Children: An Examination of Child Welfare Workers' Effectiveness in Screening for Traumatic Stress" (2016). Theses and Dissertations--Social Work. Paper 11. http://uknowledge.uky.edu/csw_etds/11 |
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Maltreated children in child welfare systems are significantly affected by trauma, and child welfare workers are an effective yet often underutilized resource for identifying their trauma recovery needs via trauma screening.
INTRODUCTION
- In 2012, approximately 679,000 children in the United States were found to be victims of maltreatment and approximately 638,000 children entered foster care (1)
- Rates of maltreatment-related trauma in children in foster care range from 80 to 93 percent (2,3,4)
- The Adverse Childhood Experiences study and others demonstrate the deleterious, long-term consequences of early trauma such as mental health disorders, substance abuse and serious physical health problems such as heart disease, obesity and even shortened life expectancy (5,6)
- Childhood maltreatment has been found to present a ten-fold increase in the lifetime risk for Posttraumatic Stress Disorder and other anxiety, mood and substance abuse disorders (7)
In spite of high rates of posttraumatic stress being observed in children in child welfare, there is currently no standard for universal screening for traumatic stress in most systems although this has been a best practice recommendation and cited as a critical pathway for the implementation of trauma informed care.(8) Child welfare workers represent an important resource for addressing the under-identification of maltreated children's trauma recovery needs given their access to a unique database to support trauma screening.
THE STUDY
This study was designed to examine child welfare workers' effectiveness in screening children with substantiated maltreatment (N= 131) for traumatic stress. Child welfare workers completed the Child Welfare Trauma Referral Tool (9), and their responses were compared to outcomes on clinical measures completed by child self-report (Trauma Symptom Checklist for Children (10)) and/or caregiver report (Trauma Symptom Checklist for Young Children (11)) depending on age-eligibility to complete the measures.
THE SAMPLE
- Age ranged 3 to 17 years (mean= 7.75, SD= 3.90)
- Average exposure to 4.36 (SD=1.99) different types of trauma
- Neglect (96.4%), domestic violence exposure (77.5%), emotional abuse (53.3%), physical abuse (44.4%) and sexual abuse (44.3%) were the most common trauma exposures reported
RESULTS
The children self-reported the lowest rate of clinically concerning total posttraumatic stress at 21.1 percent, followed by caregiver reports at 40.6 percent and worker reports at 40.8 percent. Examination of specific trauma symptoms of intrusion, avoidance, and arousal indicated that both caregivers and workers observed the presence of concerning levels of arousal in the children more frequently than the other symptoms at rates of 38.4 and 49.4 percent respectively.
Four hierarchical regression models were analyzed to examine relationships between child welfare workers' trauma screening information (child age, trauma history and total posttraumatic stress symptoms) and child/caregiver reports of posttraumatic stress symptoms (total posttraumatic stress, intrusion, avoidance and arousal). The three models testing total posttraumatic stress, intrusion and avoidance were significant and explained 21.8, 21.1 and 19.7 percent of the variance respectively. The model testing arousal explained only 9.1 percent of the variance.
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TRANSLATIONAL TIPS
The results from this study suggest that...
- Child welfare systems should promote the implementation of routine trauma screenings for maltreated children and provide supervision and other supports to integrate this information into case planning with children and families
- Child welfare workers can be an effective resource for identifying maltreated children's traumatic stress symptoms using measures like the Child Welfare Trauma Referral Tool. (9) Child welfare workers have historically not been utilized in the trauma screening role presumably because many systems have not yet acquired a trauma-informed perspective, as well as concerns that workers may not have sufficient knowledge to assist with the screening process.
- Utilizing child welfare workers as trauma screeners could be a path to develop resources to address the public health issue of trauma exposure and the consequences of adverse experiences among maltreated children.
- This study also provides an opportunity to target training to enhance workers' functionality in this role. Trainings on the trauma screening process should consider including specific information regarding the challenges of distinguishing symptoms of traumatic arousal from other externalizing conditions.
- Effectively training child welfare workers to conduct trauma screenings, with emphasis on helping them recognize and distinguish symptoms of arousal has the potential to substantially improve outcomes for maltreated youth.
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- U.S. Department of Health and Human Services, Administration for Children and Families, Children's Bureau. (2014). Trends in foster care and adoption FFY 2002-FFY 2013. Washington, DC: Author. Retrieved from http://www.acf.hhs.gov/programs
- Lipschitz, D.S., Winegar, R.K., Hartnick, E., Foote, B., & Southwick, S.M. (1999). Posttraumatic Stress Disorder in hospitalized adolescents: Psychiatric comorbidity and clinical correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 40(5), 588-594.
- Stein, B., Zima, B., Elliott, M., Burnam, M., Shahinfar, A., Fox, N.,& Leavitt, L.A. (2001). Violence exposure among school-age children in foster care: Relationship to distress symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 40(5), 588-594.
- U.S. Department of Health and Human Services, Administration for Children and Families, Children's Bureau. (2013). Child Maltreatment 2012. Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment
- Anda, R.F., Felitti, V.J., Bremner, J.D., Walker, J.D., Whitfield, C.H., Perry, B.D., ... & Giles, W.H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174-186.
- Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., & Marks, J.S. (1998). 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), 245-258.
- Scott, K., Smith, D., & Ellis, P. (2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of General Psychiatry, 67, 712-719.
- Griffin, G., McClelland, G., Holzerg, M., Stolbach, B., Maj, N., & Kisiel, C. (2012). Addressing the impact of trauma before diagnosing mental illness in child welfare. Child Welfare, 90(6), 69-89.
- Taylor, N., Steinberg, A., & Wilson, C. (2006). The Child Welfare Trauma Referral Tool. San Diego, CA: Chadwick Center for Children and Families, Rady Children's.
- Briere, J. (1996). The Trauma Symptom Checklist for Children. Odessa, FL: Psychological Assessment Resources.
- Briere, J. (2005). The Trauma Symptom Checklist for Young Children. Odessa, FL: Psychological Assessment Resources.
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