Advancing Developmentally

Appropriate Child Welfare Practices for Adolescents

Johanna Folk, Ph.D.University of California, San Francisco

Paige Blankenship, Ph.D.Johns Hopkins All Children’s Hospital

QPI 2020 Virtual Conference

The process of, or capacity for, successful adaptation despite

challenging or threatening circumstances

Protective Factors

Risk Factors

Resilience

● Problem-solving skills● Impulse control● Consider future consequences

● Emotional reactivity● Stress tolerance● Using cognitive skills in high stress

situations

Limbic System

Neurodevelopment

Prefrontal Cortex

Video: https://www.youtube.com/watch?time_continue=5&v=oASRbVWydC8

Socioemotional Development

Emotional Social Behavioral Self-Concept

Cognitive

Learning to identify

feelings & understand where they come from

Learning to cope & express feelings

Abstract thinking & advanced reasoning

Neural connections

strengthening

Developing executive

functioning

Identity exploration

Self-conscious

Adjusting to biological changes

Increased risk taking

Susceptiblity to peer

influence

Feeling invincible

Spending more time

with peers & less with family

Increased autonomy,

seeking new experiences, & taking on

more responsibility

More than ⅔ of kids experience at least one traumatic event by 16

years old

Trauma & StressorsTrauma

Real or Perceived Threat to Safety of Self of Loved One

Adverse Childhood ExperiencesAbuse, Neglect, & Household Dysfunction

Toxic StressProlonged Stress Response

Complex TraumaChronic trauma inflicted by a

caregiver at a young age

Sensory information sent to brain

Brain compares this to past experiences

If it is a perceived threat, info is sent to amygdala

Fight/Flight/Freeze response is activated

Body is flooded with hormones, brain takes a back seat

Fear Response

The brain is impacted by all experiences ● Overactive or underactive “fight, flight,

or freeze” response● Increased emotional reactivity

● Reasoning, judgment, decision making, and planning impacted

● Emotion and behavior control more difficult

Limbic System

The Impact of Trauma on Neurodevelopment

Prefrontal Cortex

Impact of Trauma on Socioemotional Development

Emotional Social Behavioral Self-Concept

Cognitive

Greater difficulty

understanding how to identify

and express feelings

More intense, overwhelming

emotions

Exhausted coping skills

Trouble learning and functioning at school

Difficulty with attention

Impaired planning and

reasoning skills

Self-doubt or low self esteem

Perceived lack of power and control

Blame, shame, & guilt

Impulsivity & Hyperactivity

Aggression

Self-destructive &

high-risk behaviors

Difficulty controlling behaviors

Trouble forming and maintaining relationships

Harder timetrusting others

Difficulty with boundaries

Trauma + Development

Defiance

Withdrawal

Aggression

LyingRule-Breaking

Substance Use

Irritability

Self-Injury

Overcontrol

Running AwayMoodiness

Trauma + Development

Adaptable

Resilient

BraveStrong

Corageous

Creative

Humorous

Independent

Persistent

EmpatheticAutonomous

Challenges within the child-welfare systemo Shift to virtual visitationo Safety within facilities (e.g., group homes, STRTPs)o Court hearings and reunification planning stalled

And Many More!

COVID-19Additional stressors for adolescents and adultso Social distancing and isolationo Anxiety / Fear of unknowno Virtual schoolingo Limited access to treatment /

adjusting to telehealth serviceso Financial stress / unemploymento Illness and loss

The process of, or capacity for, successful adaptation despite

challenging or threatening circumstances

Protective Factors

Risk Factors

Resilience

Understand typical adolescent

development and the impact of trauma

Curiosity Regulation

Get curious about what might be underlying a

behavior

Stay regulated and help facilitateco-regulation

Trauma-Responsive Approach

Collaborate with all the important adults in your youth’s life

COLLABORATION

Understanding

Trauma-Responsive CaregivingRegulate

o Stay calm and be patiento Don’t take it personallyo Co-regulation is key

o Developmental considerationso Deep breathing, body relaxation

Communicateo Don’t avoid tough

conversationso It’s okay to take breaks

o Non-judgmental, reflective listening

Strengthen Relationshipso Just one stable relationship

can build resilienceo Schedule positive individual

timeo Facilitate communication

with friends, family, and community

Empowero Provide choices and

independenceo Help youth find outlets they enjoy

o Connection with cultureo Use a lot of specific praiseo Practice acceptance

Trauma-Responsive Caregiving

Know When to Ask for Helpo Lean on your support network

o Take care of yourself and take respite when you need too Know when your youth could benefit from professional

help – if they have symptoms that impact their ability to function at school or home (sleep difficulties, anxiety,

dangerous behaviors, intrusive memories)

Provide Assuranceo Model confidence

o Help them see their strengthso Assure safety

o Help relieve responsibility for past trauma

Be Consistent & Predictableo Provide routines & rituals

o Clear expectationso Follow-through

o Provide warning prior to changes

Trauma-Responsive Behavior Support

Monitoring & Supervisiono Know how your teen is spending their timeo Set clear, reasonable rules and expectationso Try to understand high-risk behaviors, and help

them plan for safety

Reinforce Positive Behaviorso Be on the lookout for good behavioro Positive attention and specific praise

o Ignore minor behavioral issueso Talk to teen about what is reinforcing for them

Consequenceso Only use when absolutely necessary

o Make sure expectations & consequences are crystal clearo Consider trauma-history & talk to teen about it

o Ensure consequence doesn’t interfere with healthy coping

Practical Tips for ProfessionalsBe Consistent & Predictable

o Include routines & rituals in your interactionso Clear expectations for youth and family

o Follow-through with appointments and promises

Advocateo Maintenance of relationships, community, and culture

o Evidence-based practices and treatmento Ask teens what they need to feel safe, happy, and healthy

Communicateo Model regulation and healthy communication

o Don’t avoid tough conversationso Use reflective listening & specific praise

o Ask for teen’s inputo Provide warning prior to changes

o Help plan for safety in high-risk situations

Resources

• National Child Traumatic Stress Network (NCTSN)• https://www.nctsn.org/resources• You can sort resources by topic type and audience

(caregiver, youth, child welfare professional, etc.)

• SAMHSA – Understanding Child Trauma• https://www.samhsa.gov/child-trauma/understanding-child-trauma• Good information about trauma rates, symptoms, and how

to respond

• California Evidence-Based Clearinghouse• https://www.cebc4cw.org/• You can search for descriptions and ratings of treatment

programs and interventions

• Trauma-Focused Cognitive Behavior Therapy (TFCBT)• https://tfcbt.org/• Find a certified TF-CBT Therapist, Find local trainings• TF-CBT Workbook for Teens: https://tfcbt.org/wp-

content/uploads/2019/02/Revised-Dealing-with-Trauma-TF-CBTWorkbook-for-Teens-.pdf

Blaustein, M.E. & Kinniburgh, K.M. (2019). Treating Traumatic Stress in Children and Adolescents, Second Edition. The Guilford Press, New York, NY.

Cohen, J.A., Mannarino, A.P., Deblinger, E. (2017). Treating Trauma and Traumatic Grief in Children and Adolescents, Second Edition. The Guilford Press, New York, NY.

Copeland, W.E., Keeler G., Angold, A., & Costello, E.J. (2007). Traumatic Events and Posttraumatic Stress in Childhood. Archives of General Psychiatry. 64(5), 577-584.

Felitti, V.J., et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACEs) Study. American Journal of Preventative Medicine, 14(4), 245-258.

Jensen, F.E with Ellis Nut, A (2016). The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults.

National Childhood Traumatic Stress Network (NCTSN): https://www.nctsn.org/

Perry, B.D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky and E.P. Benedek (Eds.), Textbook of Child and Adolescent Forensic Psychiatry (pp. 221-238). American Psychiatric Press, Inc., Washington, D.C.

References