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Advocacy from a trauma based perspective . Center for Children’s Advocacy www.kidscounsel.org May 1 st , 2012 . Human Cost of Trauma. Depression is at least 3 to 5 times more common in individuals with histories of child maltreatment. (Felitti, & Anda, 2003)

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advocacy from a trauma based perspective

Advocacy from a trauma based perspective

Center for Children’s Advocacy www.kidscounsel.org

May 1st, 2012

human cost of trauma
Human Cost of Trauma
  • Depression is at least 3 to 5 times more common in individuals with histories of child maltreatment. (Felitti, & Anda, 2003)
  • Victims of child abuse are about 12 times more likely to attempt suicide. (Dube et. al., 2001)
  • Histories of adverse childhood experiences were strongly associated with leading causes of death including cancer, diabetes, liver disease and emphysema. (Felitti, et. al., 1998)
  • Increasing evidence that maltreatment and exposure to domestic violence can lower children’s intellectual quotient (IQ). (Koenen, et. al., 2003)
challenges for systems and advocates
Challenges for Systems and Advocates
  • Paradigm Shift
  • Resistance
  • Advocate without becoming a therapist
  • Creative use of resources
  • It takes time
  • Vicarious/Secondary trauma
four steps to trauma informed advocacy practice
Four Steps to Trauma Informed Advocacy Practice
  • Recognize symptoms & assist in healing
  • Access trauma based services for clients
  • Monitor systems’ compliance
  • Practice self care

Goal: Help clients access resources they will need to engage and continue their path to healing from trauma.

step 1 r ecognize symptoms assist in healing
Step 1: Recognize symptoms & assist in healing
  • Acute v. Chronic
  • In general, some symptoms in children include:
    • Avoidance
    • Feeling emotionally numb or disengaged
    • Hyper-arousal or behavior agitation
    • Re-experiencing (e.g. nightmares, intrusive memories)
    • Feelings of powerlessness and helplessness
    • Hyper-vigilance (e.g. watchfulness, alertness)

Source: National Child Traumatic Stress Network

step 1 r ecognize symptoms assist in healing1
Step 1: Recognize symptoms & assist in healing
  • Educational Context:
    • Pre-school: lose recently acquired developmental skills; become more irritable or experience difficulty falling or staying asleep; having nightmares.
    • Elementary: may show somatic complaints (e.g. stomachaches). Show a change in school performance, impaired attention and concentration and more school absences.
    • Middle and High School: self conscious about their emotional responses to the event. Feelings of shame and guilt; fantasies about revenge and retribution. Some may engage in reckless, self destructive and accident prone situations.
    • Source: National Child Traumatic Stress Network
step 1 r ecognize symptoms assist in healing2
Step 1: Recognize symptoms & assist in healing
  • Getting the information: Preliminary Sources
    • Child abuse/neglect context:
      • Starts with reading neglect petition, Order Temporary Custody documents, social worker affidavit.
      • Client visitation & interviews with collateral contacts (foster parents, treatment providers).
      • Multi-disciplinary Examination (MDE)
    • Educational Advocacy:
      • Education record review/cumulative file review
      • Client (parent & child) interview & interviews with collateral contacts
step 1 r ecognize symptoms assist in healing3
Step 1: Recognize symptoms & assist in healing

Elvira is a 14 year old undocumented student who was sexually abused by one of her caregivers. She is now staying with an acquaintance. There are some inconsistencies in the timeline as well as other details of her story. She received a medical examination and the results are highly suggestive of sexual abuse. As the date of the preliminary hearing for neglect approaches she recants certain incidents of abuse and provides other details of more serious forms of abuse by a second perpetrator.

Elvira is a special education student under the label of emotional disturbance who is failing all of her classes and has been suspended from school several times this year. She is facing expulsion due to a recent assault at school.

step 1 r ecognize symptoms assist in healing4
Step 1: Recognize symptoms & assist in healing
  • Interviewing: Ask age appropriate questions to obtain information from the child that will aid in decision making.
    • Child development literature & impact of trauma on child development
    • Consider setting
    • Short and simple: avoid abstract questions
    • Use concrete language (“in the backyard” vs.. “area”)
    • Rapport & Trust takes time

See With Me, Not Without Me: How to Involve Children in Court, ABA, Child Law Practice, Vol. 26 No. 9 (November 2007).

step 1 r ecognize symptoms assist in healing5
Step 1: Recognize symptoms & assist in healing

Elvira’s Goals:

  • Become part of a family
  • Obtain Lawful Immigrant Status in the United States
  • Stay in her current school.
  • Graduate High School and Attend College
step 1 r ecognize symptoms assist in healing6
Step 1: Recognize symptoms & assist in healing

Evidentiary Issues: Preparing Your Client to Testify and Proving Her Case

  • Does the child need to testify?
  • Is it psychologically harmful?
  • Use of Expert Testimony:
    • Are there any external means of proving the case without the child’s testimony?
    • Does trauma account for inconsistencies in testimony?
step 1 r ecognize symptoms assist in healing7
Step 1: Recognize symptoms & assist in healing

Elvira Decides to Testify at Neglect Hearing: Is it Harmful?

  • File motion requesting permission for child to testify pursuant to Conn. Practice Book Section 32a-4(b).
  • Make accommodations that help children feel comfortable in the adversarial process to minimize impact of re-traumatization.
    • Consider requesting In Camera (private judicial) interview. You will need consent from all of the parties. PB Section 32a-4(d)
    • PB Section 32a-4(c) allows an adult with whom the child or youth is comfortable with to sit in close proximity
    • Parent may be excluded to hear testimony of their child upon showing by clear and convincing evidence that the child or youth witness would be so intimidated or inhibited that trustworthiness of the child witness is seriously called into question. PB Section 32a-4(e)
step 1 r ecognize symptoms assist in healing8
Step 1: Recognize symptoms & assist in healing
  • Use of Expert Testimony to:
    • Corroborate report of abuse or neglect
    • Explain potential inconsistencies in testimony due to memory issues resulting from trauma.
    • Explain recantation of sexual abuse.
    • Best bet is expert witness who has extensive knowledge of trauma based therapies/services.
      • SeeThe State of the Debate About Children’s Disclosure Patters in Child Sexual Abuse Cases, Juvenile and Family Court Journal, Vol. 57 No. 1, Winter 2006.
step 2 a ccess trauma based services for clients
Step 2: Access trauma based services for clients
  • Become familiar with treatment approaches and who offers them in your area:
    • Cognitive therapy
    • Play therapy (children)
    • Target (University of Connecticut)
    • Exposure therapy
    • Eye movement desensitization & reprocessing (EMDR)
    • Medication
    • Group Therapy
    • Family Informed Trauma Treatment (FITT)
    • Family Therapy
step 2 a ccess trauma based services for clients1
Step 2: Access trauma based services for clients
  • DCF Voluntary Services
  • Reasonable Efforts & Specific Steps
  • Court Ordered Evaluations
  • Multi-Disciplinary Evaluation -MDE
  • DCF Treatment Planning & Administrative Case Review Process
  • Planning & Placement Team (PPT) & Due Process Complaint-Education Setting
step 2 a ccess trauma based services for clients2
Step 2: Access trauma based services for clients

Pursuant to DCF policies and regulations, the admission

criteria to the Voluntary Services Program are as follows:

  • Child has a DSM-IV diagnosable disorder
  • Child’s needs cannot be met through services currently available to the guardian
  • Child’s disorder can be treated with services offered, administered, under contract with, or otherwise available to DCF at the time of application
  • Child is under 18 at the time of referral.

RCSA Section 17a-11-7

step 2 a ccess trauma based services for clients3
Step 2: Access trauma based services for clients
  • After the child is placed in DCF custody, DCF policy provides that the child must undergo a Multi-Disciplinary Evaluation (MDE) within 30 days of placement (DCF Policy § 44-1). The evaluation will be performed by a community-based assessment team.
  • The MDE is intended as a comprehensive physical that will assess the child’s medical, emotional and developmental status and offer recommendations for appropriate treatment.
  • DCF will also identify the child’s diagnoses and treatment recommendations in the child’s Treatment Plan (Conn. Gen. Stat. § 17a-15; DCF Policy § 44-4-1).
step 2 a ccess trauma based services for clients4
Step 2: Access trauma based services for clients
  • Planning and Placement Team (PPT)
  • A child is eligible for special education if: (1) the child has a disability that impacts his ability to make educational progress; and (2) needs specially-designed instruction to access the general curriculum and make educational progress.
step 2 a ccess trauma based services for clients5
Step 2: Access trauma based services for clients
  • Child Find and Referral to PPT1
    • Prompt referral to a planning and placement team be made for any child who has been suspended repeatedly or whose behavior, attendance or progress in school is considered unsatisfactory or at a marginal level of acceptance.

CONN. GEN. STAT.§ 10-76d(a)(1); CONN. AGENCY REGS. § 10-76d-7; see also 20 U.S.C. §1412(a)(3) (requires that states identify, locate and evaluate students with disabilities).

step 2 a ccess trauma based services for clients6
Step 2: Access trauma based services for clients
  • Elvira is a special education student facing an expulsion.
    • School must hold a Manifestation PPT to determine if the behavior subject to a suspension or an expulsion is a manifestation of her disability. (2) prong inquiry, only need to prove one of the two:
      • Behavior is a manifestation of disability (quasi evidentiary process).
      • School failed to implement the student’s IEP.
    • If the behavior is a manifestation of a child’s disability, in most cases, the school cannot impose a “disciplinary change in placement,” which means a disciplinary exclusion that is more than 10 consecutive days or 10 cumulative days that forms a pattern of exclusions.
    • The team must also evaluate the appropriateness of the student’s IEP including placement and services.
    • The IEP shall include interventions that are trauma focused (i.e. to minimize impact of PTSD symptoms at school).
step 3 m onitor system s compliance
Step 3: Monitor system’s compliance
  • MDE & Treatment Planning Conference
  • Administrative Hearing Process
  • Specific Steps
  • In Court Review
  • Motions practice
  • PPT & Due Process Complaint
step 3 m onitor system s compliance1
Step 3: Monitor system’s compliance

Child’s Right to a Treatment PlanC.G.S. 17a-15

  • Must address treatment, placement and visitation
  • Diagnosis of child’s problems (look at MDE)
  • Right to Administrative Hearing
    • If child is not provided adequate treatment plan
    • If treatment plan does not address child’s and families needs
    • If treatment plan is not being properly implemented
step 3 m onitor system s compliance2
Step 3: Monitor system’s compliance

Request a Treatment Plan Hearing pursuant to C.G.S. §17a-15c and §17a-15d; and R.C.S.A. §17a-15-1 through 11

  • Request must be made in writing (see sample letter in CCA Website)
  • Must be provided within 30 days
  • Decision must be issued in writing within 15 days
step 3 m onitor system s compliance3
Step 3: Monitor system’s compliance
  • DCF must ask juvenile court to make a “reasonable efforts finding.”
      • To prevent child’s removal from the home.
      • Subsequently, if the child is removed that reasonable efforts were made to achieve the permanency plan.
  • Specific Steps issued by the court should reflect with certainty the breadth and quality of the services needed to achieve the child’s permanency plan.
step 3 m onitor system s compliance5
Step 3: Monitor system’s compliance
  • In Court Review & Motions Practice

CGS 46b-121(b)

    • Request must promote welfare and best interests of child
    • Order can direct DCF, parent or any other custodian of child
step 3 m onitor system s compliance6
Step 3: Monitor system’s compliance
  • Motion for Appointment of Psychiatric Expert for Purposes of Development of Permanency
  • Motion for Funds for Children’s Expert on Permanency
  • Motion for Contempt
step 4 p ractice self care
Step 4: Practice self care
  • Vicarious Trauma, Compassion Fatigue, Secondary Traumatic Stress
  • Burnout
  • Counter-transference
  • Symptoms: fatigue, poor sleep, headaches, aggression, cynicism, substance use.
resources
Resources:
  • The National Child Traumatic Stress Network, www.NCTSNet.org
  • The National Center for Children Exposed to Violence at the Yale Child Study Center, www.nccev.org
  • UCONN Child Trauma Clinic
  • The New York Child Study Center, www.aboutourkids.org
  • The National Center for PTSD, www.ncptsd.org
  • The Office for Victims of Crime — US Dept. of Justice, www.ojp.usdoj.gov/ovc
  • The International Society for Traumatic Stress Studies, www.istss.org
  • National Center for Victims of Crime, www.ncvc.org
  • Infoline 211