Learning about trauma and what we can do to help children recover from it is critically important if children who have experienced trauma are to heal and thrive. Here is  the second installment of an interview with Nina Marino, former director of foster care and adoption for Lutheran Family Services, who has a broad background in treating childhood trauma. You can view part one of Nina’s Interview here.

Talk about some general examples from your work. Walk us through a traumatic event and how it might play out for a child.

I worked with a family where the Dad was held at gunpoint at a Burger King. Two of his children a son, 5, and a daughter, 4 both saw it. The older child developed a host of trauma-related symptoms. The girl was very shaken up but was fine after a couple of days with no lingering traumatic symptoms. So it isn’t necessarily age-related, the little sister was more resilient in the face of this event despite having experienced the same traumatic situation.

The boy was afraid to go out of the house, had bad dreams, would startle easily at loud noises, and would cower in the car whenever they went by any Burger King, not just the one where the incident happened. The father had to use a different route home. This child had been shot with a BB gun by a neighbor’s child and was already fearful of guns. And part of it was that he was responding to his Dad’s anxiety.

We helped the son understand that even though bad things happen, the world is generally a safe place. For him, the trauma of that situation had visible effect and if left untreated this child could have gone on to develop post-traumatic stress disorder. He successfully went through treatment and no longer had symptoms after about six months.

How are trauma-informed services changing the child welfare system?

Trauma-informed services are taking a look at situations through a trauma lens to try to understand a child’s history and how he or she might be experiencing the world. The goal is to help children re-establish a sense of safety, because that sense of safety is damaged with trauma. A child or an adult can continue to feel unsafe physically and psychologically even if nothing bad is happening. For example the site of a Burger King triggered and retraumatized the child who witnessed his father being held up, even though he was not in danger anymore. We have to help re-establish psychological safety. This is a huge thing in foster care. We can take them out of a physically unsafe place into safe foster home, but children will still react and experience things through the trauma lens and not feel safe. They established patterns of behavior that they needed when they were not safe that are not needed in their new homes. Each child is different and you have to figure out what that child needs to feel psychologically safe.

Here’s another example: I did a home study for a family with two teen-aged children in foster care. Every time the foster mother said, “It’s time to get in car, we’re going,” the two teenage boys would become oppositional, yell and throw a fit saying that they weren’t going. Every time! Eventually the boys were able to say that they got scared when they had to get in car because they didn’t know what would happen next. Their biological mother had told them they were going out, and dropped them off at another family’s house, left, and didn’t come back. The foster mother was able to explain where they were going, how long they would be gone, which reassured them and helped them regain a sense of safety and control.

Trauma-informed services offer an the individualized approach to helping children feel safe. We look at everything–our policies and procedures, our environment, our tone of voice and how we communicate to make sure that they are appropriate for kids who have experienced trauma. Our kids have all experienced loss because they are leaving their family of origin and have to leave relationships with friends, teachers, siblings and family behind. A trauma-informed approach looks at what we can do to create stability in the home and the best way to work with these kids.

Why does trauma have lifelong consequences? What are they?

LFS has done a lot of training on trauma to help our staff understand the impact of trauma on the brain and a child’s development. We also have done training on working with children who have been sexually abused since a high percentage of youth in foster care have experienced this trauma. We look at how to work with those kids and how to help foster parents work with them.

In addition to training, our foster care staff have all read “The Boy Who was raised as Dog.” The book contains vignettes of kids the author worked with over the years. It has helped us understand how trauma affects children and specifically all of the various ways it can impact children differently. We also changed our pre-service to have a day and half of training related to trauma, loss and attachment. We have four in-services for foster parents that focus on trauma. We also added a trauma assessment to monthly paper work so we can refer them to the best services in the community. We have changed our focus and goals in our plans for children to make them more trauma-informed. It is very hard, emotional work, and we pay attention to how our staff is handling their work. We are all susceptible to vicarious trauma and we need to support our staff and raise awareness about vicarious trauma to keep our staff healthy.

What’s the good news?

Understanding trauma is empowering staff and parents to feel competent to work with this very challenging group of kids. Eventually, we will see it make a difference in the lives of our kids. The systems that serve children – the courts, Departments of Social Services – are moving to the trauma-informed model. But there still is a lot of work to do. The good news is that there is a growing awareness about how chronic trauma impacts children and more recognition about how to best intervene to be healing-based instead of compliance-based. This will move us toward the best outcomes for children and families.