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Strengthening Policies to Support Children, Youth, and Families Who Experience Trauma

Authors: Janice L. Cooper, Rachel Masi, Sarah Dababnah, Yumiko Aratani, and Jane Knitzer
Publication Date: July 2007

Executive Summary

Policy responses to children, youth, and families who experience trauma remain deficient. Often reactive, they lack intentionality, long-range strategic planning, and system wide application. Further, they rarely reflect the on-the-ground realities of trauma in communities in the United States.

Trauma is pervasive among children, youth, and families in the United States, particularly for children and youth involved in public systems. Trauma exposure among children and youth is associated with lifelong health, mental health, and related problems and with increased related costs. The impact of trauma exposure can be mitigated by developing a care delivery and support system that is trauma-informed, prevention oriented, and focused on improving mental health functioning for children, youth, and their families.

This report documents critical considerations in strengthening policies to support trauma-informed practice. It reviews current policies and practices to support children, youth, and families exposed to trauma. A range of strategies were used to gather the information, including an extensive literature review, a meeting of policy and practice experts, and several case studies.

The review reveals both reasons for optimism and concern in building a trauma-responsive system. Several gaps are highlighted. First, current policy and practice responses do not match in urgency, depth, or quality the epidemic levels of trauma symptoms among children and youth in general and in selected populations. In particular, children and youth of color, sexual minority youth, and youth at increased risk for suicide have higher rates of trauma. Exposure to trauma is particularly high in certain settings, especially those that involve the mental health, child welfare, and juvenile justice systems. Second, much of the emerging and important knowledge base about trauma, how to intervene, and how to prevent further harms to children and youth, especially young children, are largely absent in current children’s mental health and related policies. Third, some policies serve to undermine tribal, state and local efforts to develop and sustain trauma informed practices.

Some states, tribes, and communities have made strides toward developing and sustaining trauma-informed care. However, supportive policies remain the exception in most communities. An invigorated federal role, combined with trauma-informed policies at the tribal and state levels, can result in improved health, mental health, and related outcomes for children, youth, and families exposed to trauma.

Reconciling the balance between current knowledge about effective practices and implementation of a trauma-informed framework requires a set of coherent trauma-responsive policies. These policies must include supportive financing, cross-system collaboration and training, accountability, and infrastructure development.

Key Recommendations

  • All federal, tribal, state, and local policies should reflect a trauma-informed perspective. A trauma informed response encompasses a fundamental understanding of trauma and how it shapes an individual who has experienced it.

    — Policies should support delivery systems that identify and implement strategies to prevent trauma, increase capacity for early identification and intervention, and provide comprehensive treatment.

    — Policies should support and require that strategies are designed to prevent and eliminate treatment practices that cause trauma or retraumatization.

    — Policies should reinforce the core components of best practices in trauma-informed care: prevention, developmentally-appropriate effective strategies, cultural and linguistic competence, and family and youth engagement.

  • Policy and practice reflective of trauma-informed principles must be developmentally-appropriate, based on a public health framework, and engage children, youth, and their families in healing.
  • — Policies should focus on prevention of trauma and developing strategies to identify and intervene early for children, youth, and their families exposed to trauma or at-risk of exposure to trauma.

    — Policies should focus on enhancing child, youth, and family engagement strategies to support informed trauma care delivery.

    — Policies should support strategies that encompass family-based approaches to trauma intervention.

  • Trauma-informed and related policies must include responsive financing, cross-system collaboration and training, accountability, and infrastructure development.
  • — Policies should ensure that funding is supportive of trauma-informed care and based upon sound fiscal strategies.

    — Policies should make funding contingent upon eliminating harmful practices that cause trauma and retraumatization across child serving settings.

    — Policies should support comprehensive workforce investment strategies.