PRACTICE AND POLICY LECTURE SERIES, SEPTEMBER 2012 - WHAT’S TRAUMA GOT TO DO WITH IT?  CREATING TRAUMA-INFORMED SYSTEMS

No Audio: Lisa Conradi, Psy. D.  Chadwick Center for Children and Families.  Rady Children’s Hospital - San Diego.  September 13, 2012.

Dr. Lisa Conradi: I am so excited to be here and I think anytime that we have an opportunity to come and talk to folks in Oklahoma we’re overjoyed because... here’s a little secret, when I talk about states that are doing really good work when it comes to trauma-informed systems, Oklahoma’s always at the top of my list. 

Now you may go, "Oh well, you know, we do some things good, we have some room for improvement." But I have to tell you before I do anything else that you guys are far ahead of the curve in terms of your thinking and the practices that you’re implementing. So, my hat goes off to everybody in this room and to the state for all the work that it's doing related to trauma-informed systems. 

Let me get a sense of who is in the audience today just so I can understand a little bit about maybe presentations you’ve been to related to this. Who here is in the child welfare system in some capacity? Okay? Who here is in mental health in some capacity? Okay? Kind of policy administration? Okay. Juvenile justice? Who am I missing? I know... Education? Education. Oh, wow! Front and center that’s great. What am I missing? Foster Parent, of course. Family members, foster parents, birth parents, youth alumni of care, you? Okay, yeah, great. Anything else that I’m missing? Foundations. Fantastic. 

Okay, well thank you so much for being here today, like I said I’m very excited. And let me start by giving just a brief overview of what I am hoping we’ll be able to cover today. It's going to be very, very quick. But just kind of a taste of some of the great information that we have to share.

No Audio: “Goals and Objectives.”
 
First thing we’re going to do is talk a little bit about what we call are the essential elements of a trauma-informed child welfare system. Who here has maybe been to presentations done by my colleagues, maybe Charles Wilson or Allison Hendricks who talked about the essential elements before? So just a couple of you. So that’s fantastic because I love sharing the elements. 

We’ve retooled them so there’s some updates probably from when Charles or Allison presented them to you. So then we’re going to take that and those are these lovely, lofty kind of goals or framework for creating a system and they’re really for child welfare in some respects, but I think you’ll find that they apply across systems as we’re having this conversation. But you know they are lofty. 

So what people usually say is, "Well those are fantastic elements, but what do we do with them? How do we know it when we see it?" So what I’m going to talk about today is first a project, the Breakthrough Series Collaborative that actually you guys were involved in. 

Anybody here familiar with the Breakthrough Series on using trauma-informed child welfare practice to improve placement stability? Okay? So there was a great team that participated in that BSC and has taken that work to the next level and continues to do it. So I’m going to introduce that project and then I’m going to talk about what we call our practice model guidelines. 

So actually when you’re walking through the process, what can you do? What are really tangible, concrete things you can do? So we’re going to start up here, we’re going to go down here, and hopefully we’ll end here so you leave with an idea of what you can do when you go back to your offices. Sound good? Okay? You guys excited? Psyched? I’m excited. 

(laughter)

Dr. Conradi (continues): It’s been a tough day I’m really excited to be here. You have no idea.

(laughter)

Dr. Conradi (continues): Okay. So, let’s get started. So first thing I want to present here. Well actually I’m going to come back to this, to the definition. Anybody here familiar with Bryan Samuels? He’s the Commissioner for the Administration for Children and Families. So this is the federal agency that oversees child welfare. 

Okay so they do the Child and Family Service Reviews, they do a lot of work related to child welfare. And as Connie said, there is a huge focus right now on trauma-informed. So for those who are in child welfare you know your goals of safety, permanency and well-being, right? Those are kind of ingrained, the discussion over and over again. 

So this commissioner, I think is very forward thinking. And what he is proposing is that the idea of trauma is connected to well-being. Okay so he is really about social and emotional well-being. And well-being... So it’s not like safety is prominent, permanency is second, well-being is if we have time we get to it. Not according to this commissioner. 

For him, well-being is the way you get to safety and permanency. If we address social and emotional needs of kids, we help them stay safe and we help them in permanency. And I hope that by the end of today you’ll understand what I mean when I say that. Because sometimes that can be, "Wait, wait, how does that work? How does that work?" But really well-being is the doorway to the other two. 

And so in his testimony to Congress he said, “The research is clear that the experience of abuse or neglect leaves a particular traumatic fingerprint on the development of children that cannot be ignored if the child welfare system is to meaningfully improve the life trajectories of maltreated children, not merely keep them safe from harm.” Okay. I love this. This idea that we are not... I mean safety of course is critical, but we don’t want to... our goal - and I think everybody in this room shares the goal - that physical safety for kids, while critical and necessary is not sufficient. 

We want to get them back on a nice trajectory towards well-being. And the fact that he’s acknowledging to Congress how important it is that we think about it this way is critical. So not only am I excited about this, but I think the country is excited about it. 

As Connie said there are grants coming out left and right, we applied to continue our current grant, which I think we’ll find out any day. And then the Administration for Children and Families’ grant. A lot of great agencies are applying for that as well. So there’s federal dollars. 

This is something that if you’re not on board, and usually you guys are on board, if your colleagues aren’t on board yet, they’re going to be. Because they’re going to have to be. So we started thinking a bit about, "Okay, trauma-informed is great. We’ve got the Commissioner’s support on this. 

What does it actually mean to be trauma-informed?" So as part of our National Advisory Committee, which we have representatives from Oklahoma who sit on that committee, we worked on creating a definition for a trauma-informed system. Okay? 

No Audio: “Definition of a Trauma-Informed Child Welfare System:  A trauma-informed child welfare system is one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers and those who have contact with the system.  Programs and organizations within the system infuse this knowledge, awareness and skills into their organizational cultures, policies and practices.  They act in collaboration, using the best available science, to facilitate and support resiliency and recovery. - CTISP National Advisory Committee”

So, you know, you guys, I think you have the handouts or you can read this. So I’m not going to go through it, but there is a couple of things that I want to highlight for you. First thing is that we are really... is this idea of varying impact. Okay? We acknowledge that not all kids are affected in the same way by trauma that happens to them. Okay? 

So a one-size-fits-all approach is not going to be sufficient for our kids. So, really understanding how individualized trauma can be for each child. The other thing I wanted to highlight here is that this organizational culture piece. Okay? 

I think it’s fantastic if we have caseworkers, mental health providers, making changes day to day in their practice. That’s absolutely critical and you’ll see some great examples of stories where that has worked really well. But if the overall leadership of the organization is not brought in, if the organizational culture is not prepared to shift to one where we understand and actually promote the idea of a trauma-informed system, then we’re not going to get very far. Okay? 

So really this idea of organizational culture as well as using the best available research. Okay? So I’m not going to stand up here and say, "We’ve evaluated that a trauma-informed system is better than a non-trauma-informed system." Anybody who has research background knows that is not, not an easy evaluation to do. 

What I can tell you is that every time we try to infuse trauma-informed policies and practices, we see better outcomes with our kids. I actually have a great... you know some of the great work done on the Breakthrough Series from Oklahoma is improved placement stability, started using trauma-informed practices, in their daily practice and kids weren’t moving as much. 

And we hope to... I think hopefully you’ll understand why at the end of this presentation. And I’m guessing, and this is why you all are here, there’s something about that that’s intuitive. I can’t tell you how many times I do a talk and I go... and people say, “Trauma is... actually understanding trauma is what links our systems together. 

Because we know all our kids have had that experience and it’s a common language that we can develop in order to communicate more effectively with one another. It helps to explain child behavior, a child’s emotional experiences and for us to really share with one another.” 

So, I think it’s intuitive. We have some qualitative data. We’re hoping to gather quantitative data. But we really know there are some things that work. So if we know things work, we want to keep doing them. So, from there, you know we have our overarching definition. 

The next thing we have are these essential elements. And for those who are familiar maybe with the child welfare trauma training tool kit. Anybody here been trained on it? That sound familiar? Okay. It’s a tool kit for child welfare workers. It’s kind of a curriculum. A two-day curriculum. 

And we had... we developed these essential elements over years and we recently refined them. And when I say recently, I’m talking about during this current calendar year, we’ve refined these essential elements. And what we wanted to do was actually align them with the goals that we all have for kids. So, those in child welfare will see safety, permanency and well-being kind of strewn throughout. 

And we also wanted to highlight strengths and resilience. I think every time I do a talk the first question somebody asks is, “How are we addressing resilience in our kids?” We don’t talk about that enough. So, this is the list of the seven elements. I’m very briefly going to go through them and then we’re going to talk about what you can actually do with them. 

The first one is maximizing physical and psychological safety for our children and our families. What I like to highlight here is a couple of things: One, we’re not just talking physical safety. Physical and psychological safety are two different things, right? You can be physically safe. You can be in a really nice... 

For kids in child welfare you might have been removed from a very unsafe home and placed with fantastic foster parents who are taking care of all of your physical safety needs, yet still feel unsafe. Okay? How many of you have been in situations where you were physically safe, but because maybe of something that happened a week ago, you feel unsafe? 

So my joke is, I was actually doing a day-long training in Reno and you know, it’s lunch and it was a kind of early not quite too hot in December and I like to go for a walk, kind of clear my head, during the break. And I go out in Reno and we’re at this lovely wildlife kind of preserve and there is a snake that comes in front of me. 

Anybody here maybe not the biggest fan of snakes? Willing to admit it? I have all respect for snakes as long as they’re not in my business. Okay? So I, you know, I kind of have my freeze response which is my response. I kind of go, "Ew, ew, okay, okay, and then we’re going to get over here and then we’re going to go back." 

And it was small which for some reason made it less scary for me until I was told later, “Oh it was a baby they’re born dangerous.” 

(laughter)

Dr. Conradi (continues): Great. Fantastic. All day, for the rest of the training and I use that in the training, I mean really, we’re talking about triggers, fear, responses, why not? Right? Anytime I see a stick or something out of the corner of my eye, I’m a little jumpy. Because I didn’t feel psychologically safe yet. 

Now that’s a very, you know, nothing kind of an example. So imagine how that applies to our kids, that sense of safety. Okay? And think about those kinds of things in your own life. And what that means, not only for our kids, but for our parents. So our parents that are involved in the systems, they have more likely than not, our biological parents, been in their own kind of trauma where they’re feeling unsafe. 

And every reaction or interaction triggers that sense of not feeling safe. And how are you when you don’t feel safe? I know I’m a little jumpy. I might be irritable, I might not listen to everything somebody’s telling me because I’m in survival mode. This is what our parents are like as well as our kids. 

The second one, is this idea of identifying the trauma-related needs of children and families. There’s a couple different parts to this. The first one is how, you know, how can you identify trauma-related needs if you don’t know what trauma is? So there’s this kind of trauma education, developing the same language. 

What is trauma? What are the effects of trauma on kids? So really having kind of trainings and that sort of thing focused on that. The second one then is this idea of universal screening for trauma. For those who are familiar with the federal guidelines, actually last December, so very recently, there was kind of a new wording in the legislation saying that states need to create systems essentially for identifying, for screening for emotional trauma. Okay? So this idea of screening. 

We’ve been talking about it for years. In the last eight months, I’ve heard more about... you know we talk a lot about screenings so people are always like, “Is there a screening tool? How do we screen? Who should screen? Where should we screen?” This idea of screening is huge. So I just want to kind of put it out there to you guys that we’re going to be... there’s probably dialogues happening, if not already about trauma screening. 

And for us, a trauma screen really is understanding what the child has experienced, understanding if there are reactions related to those experiences, so trauma responses essentially. So that we know what those kids might need based on that. Okay? 

So, it’s universal, it’s usually quick and it’s used to refer for more comprehensive services or case planning. The third part of that is this idea of a trauma-focused mental health assessment. So for those who are in mental health I’m talking to you. There are a lot of screening, or no, I’m sorry, assessment measures designed for trauma. 

There are specific ways you might asses for trauma in terms of a clinical interview, certain behaviors you’d look like. So conducting a trauma-focused mental health assessment and using that for case planning. Okay? So a trauma-informed system knows how to identify for trauma in the population and what to do with that information once you get it. That, I mean, across systems - that’s what we’re looking at. 

The next one is enhancing child well-being and resiliency, okay? You can see we pulled from this language on well-being and I think for some good reasons. When we’re talking about child well-being, we’re talking about one, making sure that they are connected. Okay? So, relationships. Now I’m a psychologist, I have mental health background. 

I’m all for kids getting into treatment and having that be really... and I think it’s a... and for many kids a very helpful, necessary part of their healing. But by no means am I going to argue that that’s the way we do it, all the time, with every child. In fact, I think that everybody in this room plays a critical role in ensuring that our kids’ well-being and resiliency needs are met. 

And I’m talking about relationships. Okay? We’ve known for a long time... anybody who has talked with a youth alumni of care, okay? Or even you can think back to your own life when you were going through a hard time. Was it, you know, making sure you got the right mental health treatment, if that’s what it was for you? Usually kids say, "One person believed in me. That’s what made the difference.” 

If you have ever asked your, the youth that you’ve worked with, they usually say, “I just... it was one person. It was a teacher, it was a social worker, it was somebody who didn’t give up on me.” And our kids have had so many disruptions in relationships that they’re moving from placement to placement. 

And right when they start to feel safe and trust the parent, something happens and they have to move again. You know there’s, for many of our kids they just shut down. That idea of forming relationships feels so unsafe. And so what we want to do is really help build that capacity again. Because, we get to know who we are and what we’re capable of through relationships. Right? 

I mean think about it. Think about your own lives. Think about how you developed who you were. Through our critical relationships. So, really enhancing the ability for kids to develop those relationships and based on the assessment, referring for mental health as needed. So those are kind of the two pieces I wanted to highlight for that one. 

The next one is enhancing family well-being and resiliency. So what I’m talking about here is working with our parents, working with our caregivers. This is one of the... I think we have a foster parent, right, in the room. You would certainly agree that foster parents need support and assistance when it comes to working with kids. 

I’ve had the pleasure of working with foster parents and training on the, what we call the resource parent curriculum. And really so many of them come in for the right reasons you know, and they want to be here, "I want to support kids, this is some of the great work that I can do and ways to give back." 

But if we don’t equip them with some of the tools to manage the behaviors and the reactions from trauma then we’re doing them a disservice in some ways. I can’t tell you how many parents have come forward and said, “If I’d had, if I understood trauma, I wouldn’t have given my notice on this kid.” And usually there’s a kid they’re thinking about who kind of was expressing all of those trauma reactions. Okay? 

So, resource parents is part of it, but that’s not all. The other folks that fall under this are your biological parents. And I have to share that in a lot of the work that we’ve done this has become one of the most important things that I think we can talk about - working with biological parents. And for many it’s kind of a shift in thinking. 

I know when I first started doing this work we kind of avoided calling the bio-parents. We worked with the foster parents. And I had the pleasure of meeting and working very closely with Pam Toohey. I’m not sure if anybody here... she actually speaks around the country now. She is a birth parent who had her child removed from her care and was later reunified. 

And she is one of those stories that if you’d met her when her child was removed from care you would have really, I mean hopefully, who knows, but my gut was like, "I would have not believed she’d make the progress that she made." And she is really, really remarkable. And she has provided so much insight and understanding about the role of biological parents and children, their child’s care. The reality is many of our parents, our families are going to be reunified. 

So we might as well make sure we incorporate bio-parents into case planning. And many of our kids, even if they’re not reunified - and I’d be curious how many of you guys can relate to this story - kids actually find their parents after they turn 18 because they feel they are a part of them. Even if parental rights are terminated, they’re still a part of who they are. 

And, you know, this idea that we can remove them and give them a nice... you know maybe kids that go for adoption. It doesn’t actually, it may... we know that kids who are successfully adopted don’t necessarily have way better outcomes than kids that aren’t. Okay? 

So we want to make sure that whatever we can do to help that family support itself I think is critical. And that means working with our biological parents. The next part, which I think might ring home for just about everybody in this room in some capacity or the other, is working with the work force. 

I don’t know about you guys, I do know I get all the news alerts on child welfare across the country. I get a sense of when really scary, bad things happen within child welfare. Things happen in mental health. This work is hard work. And we, anybody in this room who gets into the field of helping kids, is part of what we call the child serving system. 

They get into the field because they care about kids. And they’re the kind of person that usually feels things. Right? You’re not a computer engineer usually. You’re usually somebody who feels... who gets in this work because they believe in the work of working with kids. And that makes you all the more vulnerable to being affected when really scary, bad things happen. Okay? 

And, not only do you have that idea of secondary trauma when you hear the stories and you hear, you know what, what I like to say is... I don’t talk a lot about my work to people at home because what we’re dealing with is the most scary, awful things that can happen to somebody in their life. Right? 

If I tried to talk to my sister about it, she has two kids. She’s like, “I don’t want to hear about that. I don’t want that in my world. That’s too dark.” Okay? So not only are we affected by hearing the stories, it’s dangerous work. 

What, what did I... yesterday actually I was in St. Louis at a meeting and they were talking about a caseworker had been killed. Not, it wasn’t in St. Louis, I think it was in Iowa, but a caseworker had been killed in duty going to, I think going to a home and then the woman who was talking was talking to the new caseworker who had been assigned to the case.

And it was, this person was like “Oh my gosh. You know. Really? Like...” And, you know, there’s, you know, that’s very extreme, but it’s dangerous work. It doesn’t happen in most jobs where you’re going out facing kind of physical danger. My boss, Charles Wilson, was a worker for a long time and he has more than once where he had a gun pointed at him when he went for a removal. So there’s dangerous work. 

Plus, sometimes doing this work can trigger things for ourselves. So we have kind of that, that comes up. This child, you know, if you have a child the same age as a child that you’re working with that can trigger it for us. 

So, it’s critical that we have systems in place to really address secondary trauma in our work force. And I think Oklahoma is really moving forward on some great work in this area. But what I want to highlight here is that it’s not just training on, "Here’s what you should do to take care of yourself: exercise, do yoga, eat healthy." I think we’ve all been to those lectures. Right? 

It’s really having a system in place to address peer support, organizational support, it’s really going deeper. Okay? When we’re talking about that. Partnering with youth and families, I already talked about my experience with Pam Toohey. So really having families inform the work and be true partners in the work is critical. 

As well as partnering with child serving agencies and systems. These are kind of no-brainers, but critical and I have to tell you that last one tends to be the hardest part for many. You can feel like maybe your system is doing, is getting there, but the second you refer them, you know, the judge then orders something against what you’ve been working on. 

So really having systems have the same conversation and dialogue, it’s critical. So how do we get there? This is a pretty big framework, right? Very lofty goals, I can hear you guys kind of, your wheels turning, going, “What? How would we do that?" and, "Oh my gosh this sounds like a lot more work.” 

And what I want to highlight here is that when we’re talking about trauma-informed, I’m not just talking about, "Okay here’s another new initiative that you guys should consider rolling out." It’s... the best success stories I’ve heard have really focused on weaving it into an existing structure. Okay? 

So, partnering it with other initiatives that are happening, thinking about it like culture, okay? Have, you know, where it’s really woven through the fabric of the organization. It’s not just something new placed on the organization. Does that make sense? Okay. 

So let’s talk about the Breakthrough Series. So one of the kind of great quotes that we talk a lot about in the BSC is, “Every system is perfectly designed to achieve the results it gets.” And most systems, when you talk about change, and I think you guys, like I said, you’ve done the BSC and you’re doing a state BSC so you’re really rolling it out on a level that’s... 

When I say "BSC" that’s Breakthrough Series Collaborative for those who aren’t familiar. When you’re doing this work, usually, when you’re trying to roll out a new initiative usually there’s a lot of meetings. You form a task force. The task force has meetings every month and they start to do a plan but six months down the road some other thing becomes priority and that task force then works into another task force and this kind of the work. 

So the spirit of a Breakthrough Series that you really implore folks to make changes top down, bottom up. Okay? So let’s talk about this, allow the people within the system to change the system. So, it’s a quality improvement strategy developed by the Institute for Healthcare Improvement back in 1995. 

And it really was initially focused on how do we, you know, make sure that we reduce central line infections in hospitals. It was very hospital driven. But Casey Family Programs, for those who are familiar with Casey, really took this and adapted it for child welfare. Okay? 

And then, you know, we kind of played with the idea and have adapted then for this kind of trauma system within the National Child Traumatic Stress Network. And, it really focuses on figuring out what are the best practices, testing them. So testing ideas and spreading them. Okay? 

So what this really means is you’ve got a team of nine or ten people that range from, for us it was foster parents, birth parents, youth, caseworkers, mental health providers, supervisors, child welfare supervisors, mental health administrators, child welfare administrators, every... kind of all levels of the system committed to this. And you go in a room and you go, “Let’s go for some ideas. This is the model for improvement. Whoever has a good idea, as long as you’re not hurting kids, you can test it out. Okay? As long as it’s safe, you test it out." 

Really fun, because people finally go, “You know what? I can do... I can try this out? I’ve been thinking about it and I’m just going to try it with this one child on my caseload.” And the saying is, "What can you do by Tuesday?" So it has to be something small that you can do within a week. 

Okay, you know what? I’m going to write up this form explaining what trauma is and I’m going to present it to one of the parents in my caseload next week. Because I feel that’s an area we need to focus on. Okay? You test it out, you see how it works, you might refine it, test it again. You do that a couple of times. 

Eventually it can really lead to kind of large system change because you spread it. Start small, then your other caseworkers try it out on their clients and then eventually it grows and grows and grows. And I’ve got great examples of how that grows across systems. Okay? So that’s, in a nut shell, although it gets far more complex, what it really means to do this kind of system change. 

Start small and you grow it and spread it. Okay? It’s really taking the folks who are doing the work every day and having them be the innovators of change. Okay? 

No Audio: “Goal of the Trauma-Informed Child Welfare BSC (TICWP-BSC):  To develop and promote trauma-informed policies and practices related to foster care placement, thereby increasing placement stability and promoting a sense of permanency among children in care.”

So the goal of this particular Breakthrough Series - you can see it here. 
It was really focused on improving placement stability. So using trauma-informed practices to meet one of those critical child welfare goals because our kids were moving around too much, right? 

And I think we all know that we want to minimize the amount of placement changes, unless they’re kind of what we say good placement changes. So, "Oh we were able to place a child with a sibling that they were close to or keep them in the school that they were accustomed to." 

A lot of times, and you guys know who I’m talking about, the kids that have the highest placement changes are those kind of frequent fliers. So for a lot of systems they kind of did an analysis and found that, you know, there were fairly good, you know, kids move for okay reasons or they’d have one or two changes, but there was a subset of kids that moved twelve to fifteen times. Okay? 

What do we do about that group of kids? Because that’s... clearly there’s a problem there. Okay? So that was the goal of this Breakthrough Series. It was sponsored by NCTSN. Here’s a list of the teams. And I already described kind of the structure. 

No Audio: Using Trauma-Informed Child Welfare Practice to Improve Placement Stability: A Breakthrough Series Collaborative (TICWP-BSC): Sponsored by the National Center for Child Traumatic Stress with funding from SAMHSA. Includes 9 sites from across the country (CO, FL, MA, NC, NH, OK, TX, Los Angeles and San Diego). Public child welfare system is lead, but the team is a partnership between child welfare jurisdictions, partner mental health/trauma sites, and family representatives (youth, parents, foster parents).

So public child welfare was the lead, for us, for I’m sorry, for you guys. I’m in Oklahoma so I’m in "us" I guess. Deborah Smith was the senior leader of the project so we had real buy-in across all levels. Okay. And then there’s kind of five areas of focus. 

So these were knowledge-building, those are things like training, "Let’s see how we can do some training on it." Trauma-informed mental health assessment, that actually encompass screening and assessment which I talked about, case planning and management, what can child welfare workers do in terms of case planning? Externally delivering trauma-informed services. That’s a long way of saying trauma treatment as well as that cross-systems piece. Okay so a lot of the essential elements I talked about you can see in these goals of the child welfare Breakthrough Series. 

So we did this project and we’ve actually been doing it for almost two years. It’s about to end this month. Okay? We’ve had all our learning sessions, that’s part of a BSC is you come together, people have tested stuff, they’re moving toward spread, implementation, kind of getting the word out. 

And like I said, Oklahoma has decided we’re just going to do another Breakthrough Series statewide to really make change which is extremely exciting. So here’s some highlights I just want to briefly talk about. 

Identify and map trauma-informed practices with system priorities. So I forget are you guys doing signs of safety? No. Okay, okay. So some of our, our folks on the teams were doing this signs of safety which is partnered with structured decision-making and it’s a way, it’s an engagement strategy for child welfare essentially. 

San Diego was doing it, I think Colorado was implementing it, so some of our teams are doing this. And so they, we work a lot with our local child welfare, and our Director whose name is also Deborah -  Deborah apparently is a very common name for child welfare directors, if you want to know.

(laughter) 

Dr. Conradi (continues): There's like four I know, really? So Deborah and our San Diego team was saying, "We’re doing signs of safety. We don’t have time for this, this is too much for us to do. We can’t do trauma-informed and signs of safety, we have to train our trainers." 

But thank goodness she’s still motivated and really on board with this. Her team said, “What if we weave trauma-informed through our signs of safety?” So what they did, which I think was so innovative and wonderful, was they did this kind of six-hour trauma training, they’d already done signs of safety training, but they linked. 

So they actually had links on the PowerPoint to say this links to signs of safety like this. So that workers could link it to things they had already learned and were working on because you know when it comes to learning you got to link it to things you already know. That’s how it attaches. Right? You want to make it sticky for people, so it hooks into them. 

So they have this training and then they have monthly consultation where they do more training but they infuse it with signs of safety. Great! They love it and it's seamless to them. Okay? So you want to infuse it. Partner with families and youth. Of course that’s critical. What I, one of the great things that happened is our first learning session, which was a year and half ago in Chicago. We had this kind of great day. 

But one of our birth parents from our Florida team was feeling very uncomfortable. She was really feeling like her voice wasn’t being heard, her team wasn't acknowledging her. And that’s something you struggle with. Okay? Engaging family members, we’re not as prepared to do it sometimes as we think we are. So in the moment her team didn’t know how to engage her and she didn’t know how to engage with her team. 

So we actually kind of sensed this and we talked with her about it. And she then basically stands up and says, “Here’s the deal. When my child was removed from my care, I was a mess. I was a mess. So it was probably the best thing that my child was removed, but nobody asked me anything about my child and in that moment, I still was her parent and I would have wanted to be her parent.” 

And the teams went buzzing. They went, “Oh my gosh this is...” It changed the trajectory of this Breakthrough Series and they all created these kind of "all about my child" forms. Okay? So at the point of removal, and I have to tell you, I didn’t know if this would fly. 

And this is what I love about this process - is you have room for innovation, people try it out. At the point of removal, or within 24 hours, the worker works with the parent to complete an "All About My Child Form." And it’s things like, what time does your child go to sleep? Do they use, you know depending on their age, do they use what do they call a pacifier? If they use a pacifier, what are their favorite foods? What do they, you know, do they have a blankie? Do they have... You know all those sorts of things as a parent you’d want somebody to know about your child. Okay? 

And there is some parents you can’t get that information at removal, but overwhelmingly, there are more than I ever imagined you can. And it sets up the stage for the whole process in a very different way. And that is a great example of how that just transformed our process. And this was because a birth parent had the courage to stand up and make this suggestion to the group. Okay? 

So, partnering with youth and families. Trauma screenings, talked a lot about that already. Really looking at the trauma experiences by stakeholders. So parents as well. Workers, how that might impact their work. Think beyond mental health treatment, so looking at multiple options for improving relational capacity. 

Share across systems. Training, training, training. Training is not enough. Got a lot more to do after that, but it’s a good place to start. Develop a shared language. Changes from top down and bottom up. Like I said, having caseworkers try stuff out was far more effective than when, and I think senior leaders play a critical role in this, but if a system goes we’re just going to do this now. Everybody needs to do it. 

It’s not as effective as if workers are saying, "You know what? We really need to make this change," and they’re bought into it. Replace practices, so imbed, imbed, imbed. Next steps as we’re looking at addressing STS. I know Annette Burly who is with child welfare here, wait are you here? Oh my gosh! I’ve had conversations with Erica... I didn’t know you were here... with Erica Tolberk about addressing secondary trauma. 

So we’re really committed across the teams with helping with that and we’re putting together a final report. So that is kind of our Breakthrough Series. And what I have here - and I’m not going to go through all of them because time is running out. 

Time flies when you’re having fun - but there are some... what we’re doing is actually developing practices that you can do specifically within each portion of the case. Okay? So it’s practice model. This is kind of our, each of these, and what you’re getting today is before it’s published. 

I’m hoping it will be out in the next couple of months. But really steps that can be taken throughout the process. So we’re talking about slow down, plan the investigation. No. What I want to say here is, a lot of this is really good child welfare practice. Okay? It’s good mental health practice. 

I can imagine a lot of you might be looking at this going, “But I know that that’s important. This isn’t anything new and innovative.” But I also find that folks go, “We used to do that, but we don’t do it anymore. I wonder why that is.” So what I just, implore you to do is think about the practices that have worked, maybe you’re not doing them, maybe you should be doing them. 

I had that happen yesterday where somebody was going, “Oh well we could do this. We used to do that. Why don’t we do it?” So really think about really good practices and imbed them, but the difference here is we’re connecting them to trauma and our understanding of trauma. It’s the, "Why are we doing the practice?" Okay? 

We’re doing it because we understand the effects of trauma on kids and we understand that if we do these things, we help their responses, we help them feel safer. So they’re not just good practices, they’re connected to something. Make sense? So you know interviews in a safe location. If you’re responding with law enforcement imagine how scary that might be for a child so be thoughtful about maybe what those interactions are going to look like if possible. Be calm and non-threatening. 

Consider that the investigation may trigger parents’ own traumas. And then during removal, I talked about the "All About Me" form, it’s kind of a great tool to use. Identify common feelings and thoughts. I sometimes say that to kids. "Gosh, you know, during this process this can be really scary. You’re not sure when you’re going to see your mom again." All those sorts of things. Ask the child what they need to feel safe. 

And that’s a very simple one that sometimes we forget. We get very busy in the work that we’re doing and just saying, "What do we need to feel safe and comfortable right now?" Here’s some, you know, kind of, critical decision points. You know just some real concrete practices. 

Assessment of family functioning, understanding bio-parents. Their role, their overall functioning. Their trauma history and how that may impact their thoughts and behaviors. 

Case management, so just general, you know, if necessary request a mental health assessment, referral for trauma treatment practices. There’s actually, we’ve developed a question to ask providers to see if they’re trauma-informed. Out-of-home placement, kind of initial ways to prepare resource parents as well as ways to prepare kids for moving into foster placement. 

And I’ve heard some great ideas and I bet you guys are reading this going, "Yeah, but you know I could do this and this." Some great ideas out there of, "Hey here’s a book of the family you’re going to. Here’s their dog. This is their brother and sister, you know these are the other kids in the home." A lot of times just that can help kids feel prepared. 

Because you know what? I feel a lot safer when I have an expectation of what’s going to happen. So do our kids. Allow phone contact between the child and parent. Pam tells the story that she went three weeks without talking to her son when he was removed and those were the worst three weeks of her life. Because she didn’t know where he was and he was three so you must imagine what it was like for him, right? 

Notify the school. Schools play a critical role in this partnership and if we can try to keep kids in the same school which I know people try to do anyway. Ongoing, information ongoing about trauma. Change of placement, really sitting down explaining, preparing in the same way as you did for initial placement. 

So those are just some of the ideas, but there are a lot more out there. I’m hoping our adaption guidelines are going to be completed in the next couple of months and we’ll make sure everybody knows about them. And they talk about these, but in a lot more detail. These are some other resources we’ve developed. We have a website that’s on the next slide. 

No Audio: CTISP Products: Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators. Desk Guide on Trauma-Informed Services for Child Welfare Supervisors. Desk Guide on Trauma-Informed Services for Mental Health Practitioners. Guidelines for Applying a Trauma Lens to Child Welfare Practice Model. Trauma-Informed Child Welfare Implementation Toolkit.

The guide for administrators is done. It’s out there. It’s freely available on our website. The other resources should be done in the next six months. Okay? So it’s our trauma-informed tool kit that I’m very excited about and hopefully, you know, fingers crossed it will be done very soon.

No Audio:  Resources: Chadwick Trauma-Informed Systems Project - www.ctisp.org. California Evidence-Based Clearinghouse for Child Welfare - www.cebcw.org. National Child Traumatic Stress Network - www.nctsn.org and learn.nctsn.org. Chadwick Center for Children and Families - www.chadwickcenter.org. Child Welfare Trauma Training Toolkit - http://www.nctsn.org/products/child-welfare-trauma-training-toolkit-2008. Caring for Children who have Experienced Trauma: A Guide for Resource Parents - http://www.nctsn.org/rpc/.

Again, these are some websites I encourage you to check out if you’re not familiar with them. This is our project, the California Evidence-Based Clearinghouse for Child Welfare talks a lot about trauma treatments and provides a rating related to research. The National Child Traumatic Stress Network, who here is familiar with the NCTSN? 

Some of you so those of you who aren’t, your homework is to just go on the website. It was for mental health, but we talk across juvenile justice, child welfare, schools, there’s committees, we’re really working on addressing trauma across the board with our kids. Our center, the Child Welfare Trauma Training Toolkit. 

We are revising it. We actually are very... we’re kind of working around the clock right now to get it done. So it'll be available in the next month or so. And then Caring for Children is a curriculum for resource parents. It’s fantastic. So with that, this is my information. 

No Audio:  Lisa Conradi, Psy. D.  CTISP Project manager, Chadwick Center for Children and Families.  Phone: 858-576-1700 x6008.  Email: lconradi@rchsd.org