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Wednesday, 18 September 2013

A tiered approach to addressing childhood trauma and adversity

The experience of childhood trauma and adversity remains a significant problem in Australia. Lots of kids will be exposed to potentially traumatic events and whilst many of them will be resilient, some will go on to develop difficulties with their physical health, mental health, relationships, self esteem and education. 

We talk alot about the impact that trauma and adversity has on kids. But what we really need to know is how to stop kids from being adversely affected from their exposure to trauma and adversity. How do you do this?? It can seem almost impossible. How can we stop children being exposed to abuse and neglect? We can't stop children from being exposed to other adversities, such as separation and divorce, car accidents, a death in the family.

This is why there needs to be a tiered approach to the way that we address the impact of trauma and adversity in children. A tiered approach means having a suite of interventions that are appropriate at different ages and stages and that work to prevent and intervene early in cases of trauma and adversity.

1. Early home visiting programs and parenting support programs for parents with children under 3 years.
Early home visiting programs that target vulnerable families and provide intensive support through regular home visits over an extended period have been shown to be a cost effective way for governments to address the issues of child abuse and neglect. These programs often target vulnerable parents and families, such as first time young parents and those that have a history of abuse themselves and work to form a consistent, supportive relationship between the visiting nurse and the mother with the aim of improving the health and wellbeing of both the parents and the child. The Nurse Family Partnership program in the US has been in operation for 30 years and has demonstrated many positive outcomes.  Outcomes from this program have shown improved parental health, fewer childhood injuries, increased maternal employment and improved school readiness. A similar program is now in Australia, working to support Indigenous mothers.

Another parenting program, with demonstrated outcomes, that has been available in Australia for many years now, is the Triple P program (Positive Parenting Program). This program aims to prevent severe behavioural, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents. This program has been offers support in many different forms - from DVD's that can watched at home, through to group programs and home visiting. There have been several studies that have shown that Triple P works to improve children's behaviour, improve parent child interactions and reduce child maltreatment, out of home care placements and hospital visits.

2. Programs that target kids and families and help to build resilience
Adversity is unavoidable, so helping kids and families have the skills necessary to get through tough times is essential. There are many programs for kids that help to support and build resilience. Kids Matter is an early childhood and primary school initiative that has been successful in reaching out to a great number of children and improving mental health and wellbeing. 

3. Increasing the knowledge and information that is available to families and the community
Families and the community need to know more about the impact that trauma and adversity has on kids. This includes more information about how kids of different ages and stages respond to trauma and adversity, what factors may make children more vulnerable in the face of adversity and what families can do to protect and support children. The Trauma and Grief Network: Supporting Families website has worked to develop tip sheets and resources that increase family knowledge of these impacts and their ability to respond to them. 

4. Increasing professionals knowledge and information about the impacts of trauma and adversity and how this contributes to other mental health difficulties
We know from the large body of research that is now available, that trauma and adversity has the potential to impact on a childs mental health, physical health, behaviour and education. The diverse range of professionals who work with children need more knowledge and information about how trauma impact on children. Mental health professionals need more information and knowledge about how trauma and adversity impacts on a child's mental health. School professionals need more information and knowledge about how trauma and adversity may impact on the child's ability to learn and their ability to function in the classroom. Early childhood professionals and those working with vulnerable families need more informaiton and knowledge on the impacts on behaviour and parent child relationships. Our (the Australian Child & Adolescent Trauma, Loss & Grief Network) website has been working to develop resources, hold webinars and is currently developing an e-learning module to increase knowledge and information for a diverse range of professionals working with children. 

5. Trauma informed systems and incorporating knowledge about and response to trauma within services
The practice of considering trauma needs to be incorporated into the systems and practices of agencies working with children affected by trauma and adversity. Recently, at the Journey 2 Recovery conference, there were some great stories of services that had successfully incorporated trauma informed care into their programs for kids, and with great success for both the staff and the children they worked with. A presentation by Burnside on incorporating a trauma informed system into their residential care was particularly inspiring. 

6. Trauma specific systems - with evidence based interventions for kids that directly target the impact that the trauma has had on the child.
Trauma specific services are those that treat kids that we already know have experienced a significant trauma. Judy Atkinson recently wrote a great paper on trauma informed services and trauma specific care. Once children are recognised as experiencing difficulties as a result of trauma or adversity, they then needed to be treated with approaches that we know are going to help them. In our last blog, we discussed the treatment guidelines for Post Traumatic Stress Disorder (PTSD) from the Australian Centre for Post Traumatic Mental Health. There are a number of interventions that are used to treat children who have PTSD or other mental health or emotional difficulties as a result of trauma, however, many of these need further research to ensure that they are actually effective in their approach. 

In the end, we all need to be keeping trauma and adversity in mind in our work with children. And we need to continue to make these issues part of the national agenda. Intervening early for kids who have experienced trauma and adversity means preventing the onset of many mental health, social, emotional and educational difficulties. 

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