Helping Young Children Who Have Experienced Trauma: Policies and Strategies for Early Care and Education

In almost every early care and education (ECE) program across the country, there are children who have experienced trauma or who will, during their early childhood, experience traumatic events. Trauma in early childhood takes many forms, including abuse or neglect, witnessing violence, and having prolonged separation from or loss of a parent. An extensive body of research has documented the negative impacts of trauma on young children’s behavior, learning, and other long-term school- and health-related outcomes. The prevalence of early childhood trauma is difficult to establish, as researchers typically focus on specific forms (e.g., child abuse and neglect). However, one study found that 70 percent of children endure three or more adverse childhood experiences—highly stressful or traumatic events—by the time they reach 6 years old. The high prevalence of trauma and the potential magnitude of its effects underscore a critical mandate for ECE programs and associated systems: to identify and implement promising strategies for supporting the healthy development of children who are victims of trauma. Children in families at all economic levels experience trauma, but early childhood trauma occurs more often in families facing financial hardship. Because many young children spend long hours in ECE programs, it is important to understand the challenges of children who experience trauma, of their families, and of their teachers. It is equally important to identify features of programs (both center-based and in homes) that help these children form positive relationships, feel safe and secure, and enjoy learning and playing with their peers and caregivers

Youth Outcomes of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in the Child Trauma Training Center (CTTC)

Objectives: Exposure to trauma among youth is common and can cause behavioral, social and functioning problems. Use of evidence-based trauma treatment can reduce post-traumatic stress (PTSD) symptoms and behavioral problems. This poster highlights the outcomes of youth who participated in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) provided by clinicians who were trained through the University of Massachusetts Medical School (UMMS) Child Trauma Training Center (CTTC). Methods: 308 youth ages 6-18 were enrolled into the CTTC evaluation with a mean age of 11.31 years (SD = 3.5); over half were female (58.1%), the majority were white (62.3%) and 37% were Hispanic. Data was collected by clinicians at three different time points: baseline, six-months and discharge through REDCap using the following measures: Child Behavior Checklist (CBCL), UCLA PTSD Index and the Social Connectedness survey. Results: The results of the UCLA PTSD Index indicated that youth experienced significantly fewer Re-experiencing (baseline [M = 9.67]; discharge [M = 6.36]), Avoidance/Numbing (baseline [M = 10.55]; discharge [M = 8.63], and Arousal symptoms (baseline [M = 11.46]; discharge [M = 9.02]), as well as less severe symptoms (baseline [M = 33.43]; discharge [M = 24.71]) overall. The CBCL revealed youth experienced fewer Internalizing (baseline [M = 64.51]; discharge [M = 62.18]), Externalizing (baseline [M = 64.51]; discharge [M = 62.18]) and total problem behaviors (baseline [M = 65.48]; discharge [M = 61.82]) overall compared to baseline. Additionally, youth reported significantly better change in Social Connectedness (M = 4.32) compared to baseline (M = 4.06). Conclusion and Discussion: Results of the youth and parent/caregiver reports of PTSD symptoms, behavioral problems and social connectedness indicates that youth and parent/caregivers noticed significantly fewer and less severe PTSD symptoms, fewer behavioral problems and improvement in social connectedness compared to baseline. These results adequately show positive child outcomes as a result of TF-CBT treatment in the context of CTTC’s framework

Research-to-Practice Brief: Promising Evidence that Early Head Start Can Prevent Child Maltreatment

This brief addresses two main questions in a sample of Early Head Start eligible children: 1) the number and type of maltreatment episodes and 2) the impact of Early Head Start on child and family involvement in the child welfare system. These findings are especially important given the lack of scalable and effective preventive interventions. In addition, they are also timely given the recent interest in fostering collaborations between early care and education programs and child welfare agencies, agencies responsible for overseeing child protection from maltreatment (OHS & ACYF, 2010; ACYF & OHS, 2011; ACYF & OCC, 2011). The current study represents a first look at the impact of Early Head Start on child maltreatment. We are continuing to collect data and will have more information in the upcoming years

It’s Not as Simple as it Sounds: Problems and Solutions in Accessing and Using Administrative Child Welfare Data for Evaluating the Impact of Early Childhood Interventions

In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children’s involvement with the child welfare system from birth through age eleven. We provide “lessons learned” for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research

Young Mothers, Infant Neglect, and Discontinuities in Intergenerational Cycles of Maltreatment

Infant neglect is the form of child maltreatment that occurs most often, yet has been the least amenable to prevention. With the aim of informing prevention efforts, this dissertation study examined moderators and mediators of the relation between a maternal childhood history of maltreatment and risk for infant neglect among young mothers (n = 447). Neglect risk was assessed using four parenting measures: reports of neglect substantiated by state child protective services, maternal self-reports of neglect, maternal sensitivity, and maternal empathy. The study results supported the theory of intergenerational transmission, but affirmed the hypothesis that most mothers who were victims of maltreatment break the cycle with their children. Specific patterns of maltreatment in the sample differed by type (neglect, physical abuse, multiple type maltreatment) and measurement methodology (substantiated reports, maternal self-reports). Substantiated reports suggested that infants were neglected most often (16% of the sample), but self-reports indicated that physical abuse was more common (21% of the sample). Discontinuity was higher for substantiated reports than self-reports (77% versus 67%). Maternal age moderated the relation between mothers' childhood history of neglect and infant neglect, and between mothers' childhood history of multiple maltreatment and maternal sensitivity. Social support moderated the relation between childhood neglect and maternal empathy. Racial/ethnic differences emerged for three of the four parenting outcomes. Significant mediation effects were not found. Study findings highlight resilience in parenting despite risk for infant neglect, but underscore the context specificity of protective processes

How to implement trauma-informed care to build resilience to childhood trauma.

Children who are exposed to traumatic life events are at significant risk for developing serious and long-lasting problems across multiple areas of development. However, children are far more likely to exhibit resilience to childhood trauma when child-serving programs, institutions, and service systems understand the impact of childhood trauma, share common ways to talk and think about trauma, and thoroughly integrate effective practices and policies to address it—an approach often referred to as trauma-informed care (TIC)

Resources for Supporting Children’s Emotional Well-being during the COVID-19 Pandemic

While the Centers for Disease Control and Prevention (CDC) currently reports that the risk of exposure to COVID-19 is low for young Americans, research on natural disasters makes it clear that, compared to adults, children are more vulnerable to the emotional impact of traumatic events that disrupt their daily lives. This resource offers information on supporting and protecting children’s emotional well-being as this public health crisis unfolds. The following guidance, recommendations, and resources are provided by child trauma experts at Child Trends and the Child Trauma Training Center at the University of Massachusetts. The Center is housed at the University of Massachusetts with Child Trends as the lead evaluating agency, with funding from SAMHSA and the National Child Traumatic Stress Network and additional support from HRSA

Trauma-Informed Care in the Massachusetts Child Trauma Project

Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children\u27s needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers\u27 participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC

The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse

Pathways to Prevention: Early Head Start Outcomes in the First Three Years Lead to Long-Term Reductions in Child Maltreatment

While there is growing evidence that early childhood prevention programs can have positive outcomes for children and families, research has tended to focus on short-term outcomes, with fewer studies of long-term benefits. In addition, evaluations of such programs rarely go beyond the question, “does the program work?” despite numerous calls over the past decade for more research that can help understand how these programs have their effects. Using longitudinal, experimental data from the Early Head Start (EHS) Research and Evaluation Project (EHSREP) linked to child welfare agency records for 2794 children, we examined the effectiveness of EHS birth-to-three services in preventing child maltreatment during children’s first 15 years of life. Following this, we assessed whether changes in specific child and family outcomes at ages 2 and 3 acted as mediators for later maltreatment prevention. Results showed that EHS has a long-term impact on the likelihood of child welfare system involvement that is driven by earlier impacts on parenting behaviors, family well-being, and child developmental status. By children’s second birthday, families randomly assigned to participate in EHS had lower family conflict and parenting distress, and more positive parent-child interactions; these impacts, in turn, led to later reductions in the likelihood of children being involved with the child welfare system through age fifteen years. Furthermore, at age three, children in EHS were more attentive and engaged in play with their parents and had higher scores on cognitive development assessments compared to controls; these outcomes were similarly associated with long-term reductions in the likelihood of child maltreatment. These findings suggest that early two-generational programs, like EHS, that are able to successfully decrease family conflict and stress and support positive, emotionally responsive parenting and child development, may reduce the likelihood of abuse and neglect later in life