A Trauma-Informed Approach for Working with Youth Involved in Multiple Systems

welcome to today's webinar hosted by the national trial traumatic stress Network we are delighted you could join us today the presentation will begin shortly but first we wanted to cover a few technical points if you encounter any difficulties try closing and reopening Zoom if the issues persist please feel free to use the chat feature to ask a question as the format of today's training does not allow direct interaction with the panelists we encourage you to utilize the Q a feature in Zoom to submit all questions including any technical assistance you may require please feel free to engage and participate actively by asking your queries using the Q a feature throughout today's session additionally we have allocated time at the end of the session specifically for audience-led questions remember that this webinar will be archived on the nctsn Learning Center website enabling you to revisit the presentation later and complete a short evaluation the CE post test and obtain a printable CE certificate for those seeking CE credit please note that no hard copies will be mailed the national Center is approved by the American Psychological Association and the national board of certified counselors to offer CE credits thank you again for joining us and now let's begin our presentation hi everybody welcome thank you for being here today we're excited to um cover a lot of material that goes hand in hand with a resource that our work group for youth involved in multiple systems have spent a lot of time developing and because we've got a lot of material to cover let's go ahead and Dive Right In can I please see the learning objective slide okay here we go this is why we think and hope that today's talk is going to be of value today we're going to spend just a little bit of time laying the groundwork and helping folks understand why youth involved in multiple systems are population worth special attention but the bulk of our talk today is really going to cover these these latter two points where we help folks consider what it actually looks like to use a trauma-informed lens with this population of Youth and why it's important to do so so in a couple of minutes here my colleague Dr Julian Ford is going to orient you to a resource that we've recently developed the resource has much more detail than what we're able to cover today so please know that what we're covering today is touching on a few of the recommendations from each of the sections of the resource but we strongly encourage you to please check out the resource itself on the nctsn website I also wanted to briefly call attention to something that my other colleague Dr Alex Miller will be touching on today and that's the second resource that our work group has developed it's the trauma-informed practice supplement for users of the crossover youth practice model so Dr Miller is going to tell us a little bit about the crossover youth practice model but we hope to host a webinar sometime in the very near future that goes into that other resource in much more detail and then finally just to mention our talk today is going to be centered around two case vignettes and our purpose for doing this is to really take the material and to bring it to light and to apply it in a way that gives it more meaning and makes it a more interest today please know that these are two youth um not based on any particular use but rather just a compilation of the various types of Youth that do move through our systems slide please so here are all of my wonderfully um brilliant and collaborative co-presenter so you'll hear from each of the people listed on the slide here I also wanted to mention and give special thanks to some members of our work group down at the bottom who were not able to join us in the webinar today but who played a major role in developing these products and then to give a special thanks to Mr Antron D McCullough who serves on the nctsn family and youth partler affiliate we're really happy to have him collaborating with us in today's webinar great thanks so much Tracy um hi everybody my name is Alex Miller and I'm the deputy director for multi-system operations at Georgetown University's Center for Juvenile Justice Reform or since that's kind of a mouthful we uh usually refer to ourselves as cjjr I'm truly honored to be here today alongside our partners from the nctsn multi-system involved work group who we've been so fortunate to collaborate with on this Resource as well as the trauma focused practice supplement for the Crosser wreath practice model um which Tracy referenced earlier and both of which really speak to the heart of our work at cjjr so cjjr is a research and technical assistance center that focuses not only on the Juvenile Justice realm but really in the development of multi-systemic approaches to supporting Youth and families and so at cggr we collaborate with a multitude of systems and agencies from child welfare to Juvenile Justice to courts and legal personnel as well as education and Behavioral Health fields and through those Partnerships we connect with both leaders and Frontline staff to provide various training and technical assistance opportunities for instance cjjr hosts certificate programs in which teams from communities around the country come together for a week-long intensive training with experts from the field to learn and respond to Niche topics some of which include things like girls Center practices in the Juvenile Justice System racial and ethnic disparities the school of prison Pipeline and supporting the needs of lgbtq plus youth who are system involved at cjjr we also facilitate a number of leadership consortiums such as the Juvenile Justice leadership Network and the public information officers learning collaborative and we engage with other research and technical assistance centers on initiatives such as the stock solitary for kids campaign and the center for coordinated assistance to States however the portfolio of work that is really kind of nearest and dearest to me is the crossover youth practice model which I will dive into next um so Andrea if you could move the slide to the next slide thank you so the crossover youth practice model or cypm is uh it's a three-phase operation that's designed to bolster interagency collaboration communication and information sharing between Juvenile Justice and child welfare entities as well as other related stakeholders in order to address the needs of Youth who cross over between systems or or those kiddos who are multi-systems involved as Tracy referenced earlier and so while it may appear that this group of Youth would have access to the greatest number of supports due to their involvement in a multitude of systems what we've actually found is the exact opposite uh oftentimes youth who cross over between systems or involved in multiple systems experience a lack of coordinated case planning between agencies they oftentimes experience duplication of services or service gaps for that matter there's a lot of uncoordinated and frequent placement changes and extensive and unnecessary stints in detention and congregate care and usually what these issues really boil down to is a lack of cohesion between agencies who are meant to be supporting these kiddos so to address these challenges my team and I um use the cypm to restructure Frontline and systemic level practices in communities to strengthen collaboration between child welfare youth Justice and related stakeholders like Behavioral Health agencies in the courts and so what you're seeing on this slide here is the fundamental format that we use to develop taste practice protocols that really kind of set the stage for expectations for when and how agencies should engage with one another in support of those those shared young young people on their caseloads so there are three General phases of the cypm and that's what you're seeing in this diagram and this diagram specifically kind of follows the case flow for a young person who crosses over from the child welfare system into the Juvenile Justice System um and the reason we're focusing on this one here is because this is the most common pathway that we see although the reverse pathway is certainly also possible um so phase one of the cypm essentially begins with the identification of a youth who has crossed over into a second system we say second system as Tracy said earlier these kiddos really are involved with multiple systems but typically when they go from Child Welfare to Juvenile Justice is what we're focused on here um and so for this pathway this identification would begin when a kiddo is arrested or receives a citation this would then prompt uh juvenile intake for instance to contact the local child welfare office in some Manner and determine if that case um is is a shared case between those agencies and if so the Child Welfare caseworker would then be brought to the table to determine next steps which might involve diversion or charge with being dropped or Chargers being pursued and the key here is to ensure that the professionals involved with that young person are aware you know within the confines of information sharing statutes but that they're aware of that that Young Person's history and relevant contextual information such as placement information or known trauma responses or recent changes in The Young Person's life in order to make well-rounded decisions about that new about that new case and also about the existing case the one that was already open uh so next phase two is where professionals conduct assessments and um you know kind of continue sharing information again as they're able to which sets the stage for uh joint case planning and so although it's pretty typical that child welfare and Juvenile Justice agencies in particular are required to have their own uh respective case plans what we strive for here is to ensure that those case plans complement one another goals should be aligned Services should align and most importantly the Youth and Family should be front and center in this planning process and so this leads us into phase three in which coordinated case management is used to support the youth and the family's success so this might be accomplished with joint home visits uh regular ongoing assessment to gauge you know if services are or continue to meet the needs of the young person and their family as well as to prepare the young person and family for things like transition to adulthood and permanency planning and ultimately a successful case closure with both agencies um so we've we've introduced the cypm in over 120 jurisdictions across the country and what we've seen is that it benefits youth families and agency staff a number of internal and external evaluations have shown that the cypm is helpful in improving early access to a wider array of services and in supports which leads itself to or lends itself to reductions in future and deeper system contact and improvements in Behavioral Health um but but the bottom line is that none of that is possible without concerted efforts to engage across systems of care um and so on that note I'm gonna pass the Baton I think back to Tracy who's going to discuss a little bit more about youth who are involved in multiple systems and the importance of that collaboration thank you Alex yes this is our one slide where we're going to really hit home um why it's important to really focus on youth that are multi-system involved though I suspect that if you're joining this conversation this webinar you probably already have a little bit of insight into this um we'll start right there in the middle of the page um with bullet number three and the reality is that we really need to know much more about this population when you go to the research you will certainly find a few fabulous studies but there's still very much more that we need to learn so that we can more fully support and prevent multi-system involvement to the greatest extent possible um going back up to the top of the page we can extrapolate from some of the other areas of research that we do know a lot about so so youth involved in Juvenile Justice and youth involved in child welfare have been studied and we've worked with them for a long time and so we do know things like youth in either of those systems have much higher rates of trauma exposure they're more likely to experience a broader range of different types of traumatic events and a larger number of them over their childhoods than youth who are non-system involved likewise these youth in either of these systems are more likely to have more traumatic stress symptoms happening and thereby we can assume that if youth within either of these systems are presenting with more trauma-related needs the youth involved in most of these systems are probably or or multiple systems are probably unfortunately having those same needs with regards to trauma and traumatic stress we want to acknowledge that it actually makes sense that some youth do become multi-system involved again we have a lot of research research showing that youth that that grow up unsupported you know without healthy stable reliable attachment figures youth that are exposed to child maltreatment are at greater risk of of engaging in behaviors that put them at risk of interfacing with the police and that can be something as simple as missing school and truancy or trying to get their needs met by by petty theft it could also be something more serious when you see a youth trying to cope with survival coping and engaging in more kind of aggressive or violent behaviors but it really does make sense that youth especially that that are having problems in their in their home lives do end up interfacing with the Juvenile Justice System so so I'll move on to the next Point here um it's also really important for us to acknowledge that many of our multi-system involved youth have one or more marginalized identity so you see that there is this over representation of Youth of color for example within JJ within child welfare and within the population of multi-system involved youth we also see unusually high rates of gender non-conforming youth um youth that identify as lgbtq all of these pieces of their identity unfortunately puts them at greater risk of being exposed to ongoing trauma both outside the systems as well as within the systems that they work in and and just to really kind of sit with that for a moment and recognize that you know many of our systems are still informed by outdated policies some of which were built upon and actually promote inequitable and sometimes racist practices and so it's important for us to recognize that as we talk about how to use a trauma-informed lens when interfacing with this population of Youth and then finally just important to recognize that it's complicated enough for Youth and families to navigate any given system but when they are interfacing with Professionals in different systems that may have different expectations and different goals and different treatment plans it becomes very difficult to navigate and even more likely that the youth's needs and strengths are going to be accurately identified and that they won't slip through the cracks if you will so now I'll go ahead and pass the slide on I believe to Julian thank you Tracy let's go to the next slide so given that there are these really formidable challenges for the youths who have become involved in multiple systems and for those of us who are working to help them and help their families this group formed to to develop a a resource guy and that's what we're going to actually walk through you with you in this webinar we won't do every part of it but we're going to give you a preview of this entire guide but it's also available as a as a full-blown document on the national child traumatic stress Network website and we're going to cover first of all what is it like for youths who have been involved in multiple systems or are what kinds of traumas have they've experienced how have those affected them you're going to get a brief introduction to that by meeting two composite youths in just a moment then we're going to talk a little bit about what it means to really do trauma-informed practice how can we provide help and guidance and assistance in a way that is affirming that it recognizes the kinds of challenges identity based challenges as well as traumatic stressors and other kinds of adversities that these young people have faced how can we do do this in a way that is truly trauma informed and not just throwing that around as a term and then we're going to look at how trauma-informed screening and assessment can be crucial in helping to identify what we can do that can be of most help for these use and their families and that in turn then leads to an approach to case planning that is trauma informed that really looks at the whole person the whole family the community the the entire environment in which these youths are living and which they are facing many many challenges and we'll conclude by reminding all of us that it's crucial that we remember that we're affected too and when we experience the impact of some of the traumas and other adversities that these youths have have experienced in their lives it has an effect on us and we need to make sure that we're doing things so that we can be fully with those youth and families and taking care of ourselves as well well that's the guide but now let's let's actually walk through it and to begin with let's meet a couple of young people who are not actual individuals but they're based on the lives of many many youth who have been involved in multiple systems and for that I'm going to turn that the webinar over to Mr McCullough thank you so just before we get started I do want to make note that this information this is the information that workers had about these two individuals the first person on the screen that you see Jordan prior to the screening and assessment so as we're taking a look at Jordan we see that she's a 16 year old biracial female her mom's white her dad is black she has two younger siblings and she's been faced with some challenges First with her dad being deployed he's a member of the military seen him deployed for the fourth time and then Jordan also describes him as being very jumpy and she's kind of paranoid and her dad also drinks very heavily her mom is currently working two jobs to assist with the family financial resources and this has made Jordan turn into a somewhat of an adult at an early age where now she has to care for her two younger siblings who are her mom's at work during this time she's also been faced and experienced a history of domestic violence with between her parents um and this has turned her to coping with other individuals older individuals meeting a 30-year 30 year old male online and eventually being sexually exploited after an assault and so right now Jordan she's describing her feelings that's very irritable she's troubled she can't sleep at night and she's consistently crying and she's fears for her mom's safety but she's also blaming herself for the assault and she's feeling somewhat disconnected from individuals and within this last year she was suspended from school for truancy and for fighting with other girls however prior to that Jordan she was on the honor roll prior to the suspension and so one of the things that I want to discuss with this individual is what I would call something sometimes being a trickle-down effect and so looking at a little bit of research in the military and deployment it's greatly increased over the past 10 years or so and so family and children are becoming greatly affected by these deployments and so recent Studies have shown to have clarified these effects as well and so individuals in the United States they tend to leave home more frequently and at a more increased rate over the past in 10 years and as a result many of the children from these families have experienced absence for one or both of their parents and so this effect has shown children having an increase in behavioral problems a survey showed that about 20 percent of individuals reported having increases in behavioral problems exhibited from their parents when their parents did leave home and another study showed that Mental Health visits increased by 11 while behavioral disorders increased by 19 and stress disorders increased by 18 and so these rates especially increase in the older children which we can relate to correlate to George's Behavior mostly attributes to her father's absences and then him coming back into the family and what her mother is having to go through and deal with on an ongoing basis the individuals who when when parents are left out of an individual's life the number of months the amount of time that they're going is also strongly related to the number of challenges that these individuals are facing um giving greater given a greater sense of stress that the child faces and also we're finding that for individuals such as girls are having more problems with being able to read integrate into society more so than boys who are their own age and individuals who are older children in particular or those in the middle or later adolescents they experience more problems with the parents who are outside of the home with reintegrating into society and with others and so one of the things that we want to look at is when were these issues first recognized and how do these situations really fit in in common experience of Youth who are faced Within These systems um we know that the experience both by youth being exposed to an adulthood at an early age earlier than expected and turning to individuals as a coping mechanism or a way of them feeling that they can be understood there's also a lot of pressure and stress on teams there's pressure to do well in school if an individual is an athlete to be the very best that they can to that winning is the most important thing in addition to these feelings individuals are also being faced with the challenge of having to grow up faster than what they normally would have as a child and so these child attachments behaviors they're being related to the parents being out of their out of their children's environment and so children are facing a greater number of stressors due to this with this situation with Jordan we're also seeing that with the dad leaving the mom's struggling the dad also not getting the hope that he needs it's causing friction between the parents and again Jordan she's having to become a parent at an early age by looking over her siblings and now she's being exploited due to seeking Comfort outside of her home outside of her home and it's turned into what could consider to be an ongoing cycle of trauma and pain that individuals go through you go to the next slide please and so next we're going to meet another individual and again this is information that the workers had about Joshua prior to screening and assessment and Joshua he is a 17 year old Latino his mom abandoned him at Birth and her whereabouts are still unknown his biological dad Lost full custody of him at the age of four due to physical abuse and neglect and his grandfather reaches out to him on occasion but has had no contact for a while and so Joshua transitioned from personal home to false home in different schools countless times since the age of four and at age seven he found himself self-harming and was briefly hospitalized where at the age of eight he was actually expelled from school from verbally threatening a teacher and by the time he was 17 he was actually charged with attempted armed robbery Josh said that he didn't recall the incident and just woke up and just realized that everything was a mess and he started turning to other things such as alcohol as well as trying drugs and the social worker described him as being very distant from his foster family and very disconnected from biological relatives in his family culture and that Heritage and so when youth have abandonment issues when a parent or caregiver does not provide with a consistent warmth or a tentative interactions leaving them feeling chronic stress and fear the experiences that happened during a child's development will often continue into their adulthood and this is why abandonment issues become more prevalent as just individuals get older and can affect their relationships these abandonment issues they can stem from a number of things from loneliness which can be a phobia or a form of anxiety they can also affect relationships often stem from a childhood loss and other factors that turn into abandonment injury shoes as well as the environment medical factors genetics as well as brain chemistry so some of the things that we are seeing between the two individuals looking at three factors abuse looking at the physical emotional and sexual side of things the neglect the physical and emotional side of things as well as household dysfunctions where these individuals are facing challenges and having mental illness incarceration mother being treated violently substance abuse and different factors of these sorts and so how do we how do these situations fit in common experience of Youth who are in the system and how do we assist and how do we help them so when treating abandonment issues the first step is really understanding what triggers the youth and allowing them to learn how to withdraw when these triggers come up um it takes time but if it's done in a respectful manner then the youth can overcome that fear where they're doing it with a partner or family member or a close friend where they're able to discuss and talk about their feelings therapy if youth are going to therapy this can also be a mechanism to help them for the latter parts of their lives on into adulthood um in therapy they're able to really explore the root of the cause of the fears and identify the negative situations and the patterns that continue to rise and so those therapists are able to help with more healthy and more realistic thoughts and they're also able to help themselves set healthy boundaries and relationships and avoid behaviors that might hinder unhealthy relationships there's a study according to the Center for Disease Control and prevention that discusses a little bit adverse childhood experiences that are linked to things such as chronic health problems mental health and substance misuse from youth on into adulthood and so the vast majority of individuals they're unaware of the of what these experiences have really done to them that have led to toxic stress and lifelong problems with the health wellness and learning and so these abandonment issues they really can develop because of many emotional and environmental factors so if they're experience a fear of Abandonment in their relationship it might be helpful for them to reach out to counselors or therapists and really be able to talk about their feelings and develop a treatment plan for those traumas that they face these childhood experiences are traumatic events that occur generally from childhood from birth up until the age of 17 and sometimes on into adulthood and so they have a lasting negative effect on healthy relationships and on their well-being and opportunities as a whole however with Josh he understands and he realizes that he does need help which generally does not happen in today's society when it comes to people of color especially with men in some communities it's actually looked down on to seek treatment to get the help that's needed and so Josh understands that in order to be a successful product of society that he really needs to look for the opportunity and a second chance to really be able to prove his ability to do better and not become a product of his environment in a negative way but in a positive way by getting that help seeking that help that he needs and working with mentors I'm now going to turn it back to Julian and he's going to discuss a little bit more about trauma-informed practice thank you having met Jordan and Joshua let's now talk about what it means to provide trauma-informed practices for youth who are involved in multiple systems like these two and we need to begin by just remembering that these are youths who are all too often viewed as cases to be managed or problems to be fixed but really they they are survivors who have tried to find ways to reclaim their lives and in so doing they often have kind of gone into a of hiding behind a wall that may look like they're just too distant to be connected with or they're too defiant to ever cooperate or that they're just too defeated and that they've given up but these are youth who have not given up and we need to reach them and the first thing that we can do is by getting to know them as a person and that means having a conversation and not just an examination or a testing yes you'll learn a lot and it's important to do the assessment but it's most important to get to know this young person as a person and show them that you're actually interested in them genuinely interested in what they care about and what's important to them in their lives what they've accomplished what they love what they want what they what their aims are what their goals are so for example Jordan loves to play the violin and that that really helps her to just calm down and feel confident and relaxed and Joshua had a math teacher who actually was the first person to ever tell him that he was smart these are the kinds of nuggets that we need to take and hold and make sure that we continue to come back to as we work with kids and in a trauma-informed way and that means also listening carefully when they tell us about their experiences and noting when the these are experiences that may have been traumatic but not to dwell on them at least not initially and it's also important to learn about these youth through the records that we have and through other sources others providers who have worked with them let's go to the next slide and in so doing it's possible to to actually show respect and genuine concern for the Youth and I know that should go without saying but this is something that's easy to forget when we we're so busy trying to do our job that we need to acknowledge clearly the bad things have happened that should not have happened and should not continue and we need to also help these youth plan for ways to be safer and to not be caught up in additional traumas or other kinds of adversity and to do so with their active involvement and agreement so that means doing things like talking with Jordan about ways that she can be cared for that aren't abusive not forcing or telling her what those are but drawing her out and helping her think through that question for herself and supporting Joshua's involvement in friendship with peers who are pro-social who are kids who probably he wants to get along with but he may feel that he doesn't deserve those kinds of friends and that's something that we perhaps can help him to begin to recognize he does deserve them next slide and that means in showing genuine respect and concern we're we also need to carefully consider how these used lives and how they cope have been shaped by the traumas that they've experienced and that means that when when they're doing things that don't seem to make sense or that seem problematic for them or for others that these are often reactions that they've just done in order to survive so for example Jordan's attachment to the older man that could be related to memories of Family Violence in an attempt to find a father figure and Joshua's defiant behavior of a teacher may actually be an expression of his fear of trusting adults due to past abuse let's go to the next slide and then what's most important is helping use to transform those kinds of survival coping tactics into effective action and that begins by just explaining that these are coping strategies that we understand that they made sense at the time because they may have been the best way available for the use they may have needed to shut down they may needed to fight back they may have felt that they needed to take drugs in order to just cope with the incredible emotional turmoil and they may have felt that they needed to take risks because they were in such an unsafe situation and had so little help but these may have been the only Alternatives or the best they could find at the time but they're not now and they don't mean that this is a youth who's messed up this means a youth who has actually survived and we can then highlight their positive abilities and coping strategies and help you see that these are ways in which they can replace the old survival tactics with goals and ways of accessing their abilities for example Jordan has great compassion and dedication for those who she cares about and Joshua is a natural scholar always looking for new things to learn even though his teachers think that he doesn't want to be involved in school he wants to learn and let's go to the next slide so trauma-informed practice really means meeting the use where they are respecting who they are showing interest in who they are and helping them see who they can become in order to do that we have to carefully consider that these youths have not only experienced trauma but they've often excused they these use have not only experienced trauma but they've often experienced identity-based trauma that have basically threatened their whole sense of who they are and those could take the form of micro or macroaggressions discrimination and stigma disparities and access to Key Resources being exploited or oppressed even hate crimes or abuse based on their ethnicity their culture their language their nationality their peer group their religion their sexual identity their gender their age or any disabilities they may have we need to factor all of this into how we know them and recognize that these are challenges that these youths have faced and challenges that we need to help them find ways to face that draw on their abilities instead of repeating the survival tactics let's turn now to what we can do in terms of learning about youth through screening and assessment thank you Julian so for the next three slides we're going to cover the impact of trauma informed screening assessments again we refer everybody back to our written resource which includes a lot more detail um with regards to the use of trauma-informed screening assessment with youth that are multi-system involved here I'm just going to touch on each of the bullets presented in the slide in the first one really points out that trauma-informed screening should not be optional within systems rather it is something that should be occurring routinely with every child upon their first entry into the system the trauma-informed screening should cover two broad areas the first being trauma exposure the trauma exposure refers to any trauma exposure that may be happening presently as well as anything that's happened over the course of the child's life history it includes interpersonal violent events so childhood sexual abuse or physical abuse as well as neglect emotional abuse and we're also looking at type of traumas that may be related to the way the child identifies so it could be discrimination or biases that they've encountered it could be racial trauma and or historical trauma it's really important to get a broad range of trauma experiences when interacting with the youth especially given that many of our youth of color are disproportionately represented within our child serving systems the second broad area that we want to make sure our trauma screening covers is that of symptoms so knowing what the child's exposure history is is important but it's not enough really what we need to know is presently is the child having any symptoms that may be related to their trauma history if that is the case then what we do is we use those findings when we see that both they have a positive trauma history and current symptoms to refer the use for a comprehensive trauma-informed assessment now the comprehensive trauma-informed assessment is different from a screener it generally takes many hours sometimes over a couple of different appointments it does need to be administered by a trained mental health professional with experience and or expertise within the area of trauma um that in in comparison to the trauma screening tool um moving on to point three here just about anyone within the agency setting could be trained to administer a trauma screening um so long as they are doing so within an established protocol that covers why the screening is happening how the screening should happen and when it should happen it is also important that any one administering screenings is part of Youth serving systems is provided with ongoing support and supervision so that they can problem solve any of the issues that may be coming up as part of the screening process and really consistently think about how the findings from the screening can be applied in a meaningful way to each and every case we would always encourage folks to use tools that are already known to be both valid and reliable and that have been developed specifically for or at least used effectively with the specific population that you're serving it is important to acknowledge that sometimes you're going to need to pull together two different trauma screeners because some of our trauma screeners developed over time have only asked about certain types of traumatic events whereas for example we may need to pull in tools that are specifically developed to think about racial trauma or historical trauma um and then finally maybe one of the most important points on this slide is once we have results of either trauma screening or assessment it is absolutely essential that we are being open and transparent with our youth and families and offering that information back to them offering what the screener of the assessment tells us and how we make sense of it and how it may inform the recommendations that we want to make as part of their service or their treatment plan it's also important that we ask families permission and let them know the importance of sharing this information with the other members of the multi-disciplinary team and even occasionally going outside of the multidisciplinary team and sharing it with other providers as long as there's good reason to do so slide please okay so on this slide here we're going to talk just for a second about how trauma-informed screening played an important role in the vignette or the case of Jordan who was referenced um throughout today's talk so as as you may recall um Jordan's attention came to our Jordan came to the attention of child welfare via a report made by her school teacher the teacher was initially worried that Jordan may be in a situation where she was being sexually exploited and indeed she was but because the investigating worker used to chose to use a trauma history screening interview she was also able to find out that Jordan had also witnessed her father's violence towards her mother on multiple occasions with this more comprehensive understanding of Jordan's trauma history the worker was probably better able to connect the dots if you will so to understand how her trauma history may somehow be contributing to the current emotional problems School problems and or sleep problems that Jordan was complaining of in a way where the worker could see these not as individual types of mental health problems but perhaps um rather Jordan's attempt to cope with what was going on or a constellation of really just pardon me post-traumatic stress reactions um and then because the findings of the trauma screener conducted by the investigative worker was shared with the caseworker that was assigned to Jordan um that caseworker was then very quickly able to make an appropriate referral to a local Clinic that then provided Jordan with trauma focused therapy assisting both her and her family and healing from the traumas that they had experienced next slide unfortunately in Joshua's case um the workers that he was interacting with did not think to apply a trauma-informed lens and so we just want to pause for a minute and think about what could have been um how might Joshua's case had been different had they initiated some trauma-informed screening early on so if you recall at age seven Joshua was engaging in self-harming behavior that resulted in hospitalization and then subsequent brief outpatient counseling that was not trauma informed very shortly thereafter at age eight Joshua's problems continued and he was actually dispelled from school as a result of having threatened a teacher and so we want to think about you know how things might have been different at that young age for Joshua had someone administered a trauma screening and then a more comprehensive follow-up assessment I think that the people interacting with Joshua would have perhaps better understood how his history of physical abuse abandonment neglect and having bounced around from multiple homes in multiple Schools starting at age four might be contributing to some of the misbehavior and some of the self-harming behavior that were being witnessed by the variety of adults in his life perhaps he could have connected to early intervention and really um been sat on a different life path However unfortunately that was not the case unfortunately Joshua continued to struggle over time through grade school eventually fell in with the wrong crowd began to experiment with or even perhaps coping with using drugs he ended up committing a crime that he had no memory of committing and then when he was back in the courts um which is the second major bullet there um we see that because the Child Welfare worker did help the judge understand a little bit about Joshua's history the judge positively saw Joshua as a kid who was not a criminal who did not need to go to jail but rather conceptualized him as a kid that was struggling with addiction and so thereby Joshua got referred for a drug rehabilitation program but he was not referred for anything that could have helped address the traumatic stress symptoms that he was struggling with nor did the caseworker mention any of Joshua's strengths or his talents or his interest in having a mentor and so we really just want to pause for a minute and kind of consider what would have happened if the case had told the judge about Joshua's long-standing history of of hospitalizations of mental health issues during childhood and what would have happened if that had come hand in hand with the results of a recent trauma assessment to give the judge a more comprehensive picture of this is a youth who's really struggling with um symptoms of post-traumatic stress thereby being referred to a more well-matched treatment intervention and that's what we're going to wrap up trauma-informed screening and assessment so I will pass it off here certainly well um so in the next couple of slides I'm going to talk a little bit more about just the the basics of trauma-informed case planning or as I like to talk about it trauma-informed care planning because it really is about planning for a Young Person's care um and one of the the first pieces there is that you need to have communication and coordination across all the Professionals in the system and while that sounds like a very simplistic ask it's probably the most difficult component of Coordinated Care planning because if you think about you know I'm a I'm a child no less than psychologist and I trained um as a child adolescent psychologist I did not train as a child adolescent psychologist to work in a juvenile justice system or to understand specifically the needs of young people in justice system so uh I have not worked specifically in the child welfare system or the educational system so one of the unique qualities about looking at communication and care coordination is to ensure that each person understands a little bit more about um what kinds of information those systems collect what kinds of ways that they interact with young people what are their policies and procedures look like so that's necessary when we start talking about communication and coordination that that the communication involves kind of getting to know each other um as a part of that the second is um you really want to look at a multi-disciplinary team and you really want to look at how are you going to look at the Shared understanding of risk needs and resilience factors so those terms even have very different meanings depending on the system so as a a person from mental health we think about risk we think about risk for things like suicide we think about risk for increased levels of mental health needs when I think about the child welfare system we often think about risk for further disengagement from family or challenges to permanency risk of some sort of violence within family and then when I think about the Juvenile Justice System we talk about risk for recidivism so risks can mean many things and so we're looking and assessing and trying to understand this young person from our own lens and so we're really beginning to say this is the point where we have to become a team and to put all of our lenses out there and including the the family's lens to think about you know what are some of the risk factors um that may exist and being able to ensure that we're including the family and being able to find what they see as risks or challenges um and then what are the needs the other side of a risk is a need what are the things that if we can give this to a youth or a family if we can ensure that the service or support is in place that it reduces the likelihood you know of um whatever risk factors we're looking at and then finally we want to and and probably most importantly is that we want to support all of this by looking at resiliency so what are the variables that a family has in place that a young person has a place that can be used to facilitate their engagement and services to make them functional for them so we talk about things like strength so if a young person for example has a a real propensity for reading like they really enjoy reading you may be looking at interventions that allow them to do some self-exploration because that's something they they like something they're good at bibliotherapy so trying to look at all of those factors the third point is um we really want to explore how use family legal behavioral emotional and medical needs and learning challenges could be understood as a result of traumatic stress reactions and what I what a way I look at this is that we really want to look at the drivers for what we see and could trauma be a part of that and part of doing that is that screener and that assessment that Dr fairbach talked about so understanding how one thing can drive another so we know that a young person uh may have a substance use issue but as the substance use issue primary or is it a coping strategy for trauma or some other difficult event in their life um and then finally we look at the case managed case flow management process we really want to see how are we going to communicate and connect on an ongoing basis we want to make sure that the plans are coordinated but not overlapping or conflictual and that requires us to have conversations frequently and to make sure that we're having conversations with the youth and with the family so that we we see this as a coordinated process many times we get into a place where we look at our own Silo and we make prescribed prescriptive recommendations like you're going to go to substance abuse treatment and you're going to go to parenting classes and you know you're gonna have these different Pieces come together and then you have education making separate recommendations and we're really talking about one child so one child one family one plan even if it's when it needs to be a coordinated plan next slide please so um a kind of specific way something that we might incorporate more specifically into a case plan is um is the what we call the trauma recovery and safety plan or the t-rasp these are basically recommendations to help the youth understand the impact of trauma develop alternatives to their potentially unhealthy trauma responses and to really build upon their strengths so it takes the information that you get from the screening and assessment process and really begins to look at things like you know what is the the child's entire trauma history look like let's summarize that and look at when did events happen in certain stages of their lives developmentally so it's important to know if an event occurred when a child was six what else was happening with them developmentally and how could that event have impacted that developmental process we often talk about attachment and relationships as being extremely important and while that happens through our entire lifespan some of our earliest experiences with people that should be trusted adults and the nature of those relationships are formative and can can Cascade and have greater difficulty along the way so understanding when that occurred what was happening becomes important we're really looking at what might be some trauma reminders what might be things that remind that young person of a prior trauma things that may have been happening at the time could be other things experience so whether that was noises whether that was people whether that was smells or volume of voice those can all be potential reminders um and so we think about reminders as being in some way triggered so when a person is triggered by potentially a reminder they then may begin to have early warning signs uh early warning signs are you know maybe for me if I'm triggered um by a loud noise or someone yelling I might shake or I might become flushed that's kind of like an early warning sign that I've been triggered and it's an opportunity to try and figure out what's the best strategy or what we call intervention to help me to calm my body to call my mind to regain control so we really want young people to use active coping strategies active means that you are doing something in order to assist in coping and of course active healthy coping strategies this might include trying to find time to be with people that you trust that can that you that you enjoy being with maybe being in a different place so for me my active coping is you know I end up in my dark cold um bedroom because that's my that's my place that that signals to my body and my mind that it's time to um to just to calm so I can just sit quietly in my room and do that um so anything that a young person does that can regulate them or help them to feel safe so that's included on this plan um you want to think about things like activities or interests and these are really about building Brazil resiliencies and helping to support who you are so many times because of the many different experiences a young person has had you will find that they that who they are becomes kind of hidden it doesn't allow it allow them to evolve and to explore because exploration um can only come from a place of safety and when you're constantly feeling unsafe you are less likely to take risks and to explore and so it's important to gradually help young people figure out what who am I what do I like to do what are my strengths and so participating in interest become important um we've talked a little bit about but once again identifying the adults and peers that you can connect with needed and then finally referring for trauma focused mental health treatment when indicated to address trauma responses and I will just say related to that um it's about more than referring it's about finding the right fit because there are all different types of mental health providers all different types of interventions but we know at the core that that relationship with that person is is is extremely important to level of Engagement and understanding sometimes that can relate to um identity so whether it's racial or ethnic identity gender identity really have to look at does this person fit with that mental health provider so we're gonna I'm gonna transition now to Dr Cheng who's going to talk more about how these pieces played for the two young people thank you Monique my colleagues have already done an amazing job on covering all the important highlights that we wanted to make sure that we wanted to bring um for your awareness and one of the things about case planning if we go to the next the care planning that I like the title is we go to the next slide please um if we focus on Jordan um we as we already mentioned there was a lot of wonderful interventions that were happening to her and um we can connect the dots and many times that's what we see when um the services that we are providing are are really meaningful and they are based on uh drumming form screenings and assessments um so in whatever role that you are at if you could also think about how you can utilize this tool that would be really a wonderful way to to bring more awareness and to bring more um a better outcome for uh the youth that you're working with and the good and the wonderful message is that you are not doing it alone right so in the case of Jordan the teacher was the one her teacher was the one that um started noticing things she reported to the Child Welfare worker and then uh uh screened happen a follow-up is going to happen where it was really um a wonderful intervention conducted so more things were happening afterwards for Jordan um we know that Jordan um as a result started working with a psychologist who started doing more um zooming form assessments and then the communication happened uh smoothly and um there was a lot of different um interventions from many different providers and different contexts which make a difference in Europeans um care what we also tried to figure out is what could if there was anything else that could happen right so there were other opportunities as we already mentioned where um other providers could also have interviewed them in Jordan's case it could be during the police response um right and we know that some jurisdictions have a unit of social workers to respond to domestic violence situations and assess the needs of children specifically and provide their intervention right there also you know another way that we could have intervened in Jordan's care was providing family support right um how about the needs of her younger siblings uh her mother her father and we know that there was um the involvement with the military services that that could be another way that we could explore other types of support that the family and also parents could could uh received if we go to the next slide please now we focus now in in the care of care planning for yahshua and I really like the subtitle here is never too late and we definitely saw the big help and support that Joshua had after he completed his substance abuse program right um the Child Welfare worker was able to coordinate services with approvation with uh Joshua's probation officer which truly make a difference also in terms of what else Joshua needed and how drumming forms Services were um now at the core of treatment for him we know that it took a while and we know that it took many years and we had you know many different opportunities as providers to to bring the best services for Joshua unfortunately happened many years later but um still he received some good Services some good interventions that truly make a difference and what I want to convey from here is that um you know again we cannot do the work on our own that there are many different opportunities for us to continue serving and bringing more from informed screenings and assessments and interventions to kids um from multiple systems um one of the things that is also super important is when these assessments include as we already mentioned before the strengths of a child Joshua had many different strengths and also accomplishments and bringing him more opportunities to expand on his strengths to really make a difference we know that as a matter of fact for with the multi-disciplinary treatment approach that he ended up receiving he also was able to participate from different programs and uh that had obviously to do with trauma treatment but also active recreational activities and things that really were meaningful for him it also was um part of the treatment that part of his care planning to involve more his grandfather to support him in in that brought a lot of other good opportunities for Yasha to become more involved which is culture and his um his Traditional Values um now if we go to the next slide we already mentioned this a little bit there were Mis opportunities in the care planning of Joshua early on right there were many different providers who who were not able to connect the dots and um there was a lot of significant time lost and opportunities lost in his treatment and we are mentioning here you know how um the lack of trauma informed screening and from informed um assessments really interfere with how different contexts and providers were unable to provide integrated services from a multi-disciplinary approach in the case of yahshua so um these are some good reminders from all of us to all of us that we can all people making a difference and bringing more um more awareness into the world that we do and the importance of drumming form assessments and drawing form screenings now I'm gonna pass president to Andrea who's going to talk to us about secondary traumatic stress okay so thank you Rocio so now we're we're talking about secondary traumatic stress and when we think about the providers working with youth involved in multiple systems it is important to think about secondary automatic stress which is the emotional distress that results when an individual here about the trauma experience of others in this case the youth and it's because the essential Act of listening to trauma stories takes an emotional toll and people with severe symptoms can even be diagnosed with post-traumatic stress disorders and so some of them symptoms that provide us my and experiences secondary traumatic stress may have are re-experiencing personal trauma or noticing and increase in arousal and avoidance reactions to related to the indirect trauma exposure they may also experience changing memory in mood perception and alterations in their sense of self-efficacy also disruptions in their perception of safety and trust and Independence so also another Point important to consider is this intersection with secondary traumatic stress culture and race providers made experience elevated levels of secondary traumatic stress and or moral distress when working with individuals who hold marginalized identities and they don't have equal access to culturally appropriate resources and that are overrepresented in the systems like child welfare and Juvenile Justice so this is a very specifically challenging for providers that hold similar marginalized identities to the youth and families that they work with and um they often experience exposure to the same oppression racism as the youth and families they've worked with they can also be experiencing and observing institutionalized racism and oppressions in the agencies they work and so as we need to consider the impact of racial trauma historical trauma structuralized racism racism and increases by it when working with youth we also and the organizations need to acknowledge in training and in support and in supervision that those experience also affect the providers and the staff so when working with youth involving multiple systems the providers should consider how secondary traumatic stress may be playing a role and and can how can it become overcome when collaborations across the systems and between providers Donna core or it breaks down so it's important that leadership pursue establish trauma-informed training programs that been have been proven to be successful in child serving settings and that have content explicitly to foreign to staff care and also to address secondary traumatic stress so um a two-prone approach really is what is best to to address secondary traumatic stress meaning that we need both organization and individual strategies to address secondary automatic stress as individuals we have the responsibility to not be harmed by the work by our work and also to take care of ourselves and so we can do our job effectively but also it we cannot be expected for for providers to to refill and we feel constantly while the work in is in a in an environment that has limited resources or that doesn't lack of of psychological safety physical safety so thinking of of the taste that we have heard of of um Joshua and and Jordans those providers may have had innovated secondary stress symptoms and given that they're working with these Jews that whole marginalized identities we know that um Joshua Latino and jordy's multi-racial so um thinking specifically of of Joshua's provider we can see there are a series of potential risk factors and organizational stresses that could impact and impact her and with providing sensible susceptibility for secondary traumatic stress and that is her gendered women and we know that women are at a greater risk for secondary traumatic stress and so um those symptoms might be intensified as she helps Russia Joshua with trauma with his trauma history navigate multiple systems and that could have Divergent goals and poor infrastructure for integrating agency Communications also if the provider holds similar marginalized identity to Joshua if she's Latina she might um identify with with Josh's experiences and may feel more impacted because of this identification and another thing to consider the organizational level is the lack of safety or support that they may experience and these things also um increase the the challenges if there are not other colleagues that who shared identities or experiences for from when they can connect to so there are multiple multiple strategies to mitigate secondary automatic stress and also to build resilience um and we can think about multiple strategies like stress reduction activities like mindfulness meditation and other regulating activities like hobbies and um Wellness practices that include um nutrition rest exercise but it is important to know too is that supervisors have a critical role in STS and we can think about reflective supervision as a way of supervision focus on emotional processing secondary traumatic stress so both um in in individual and organizational strategies can be in place to help the workers with preventing and managing secondary traumatic stress here in this last slide we have some measures for secondary stress at the individual level and and another resources to address the complex needs of high stress and Trauma exposed in workplaces um and with that um we will close our our um our webinar for today hoping that all um all these materials can help um providers working with youth involved in multiple systems and I think now we will go to the section of questions but