This is the final piece (Part 3) of a series that addresses childhood trauma and how we can help. In Part 1, I discuss the stats, types, and signs of trauma exposure, and in Part 2 I discuss the implications of poverty, oversights(mistakes) and medication to childhood trauma care. And in Part 3 I share solutions.
The Case for Safe, Stable, Nurturing Relationships
Rescue me before I fall into despair.
As the American Academy of Child and Adolescent Psychiatry points out in their practice parameters (2010), trauma treatment must focus on psychological strategies rather than medication. Quite simply, if it’s trauma, medication should be the last choice.
When it comes to prescribing kids antidepressants, benzodiazepines, and stimulants for diagnoses of mental disorders such as depression, anxiety and ADHD, ample research suggests the efficacy and hypothesized advantages of such drugs are questionable and dubious. Particularly with young people, trying to contain each of the wide-ranging symptoms that can present in trauma reactions, such approaches to mental health typically result in a cocktail of psychotropics. There are more thoughtful treatment approaches to take.
As the American Academy of Pediatrics (2021) recently shared, their primary recommendation and focus to address trauma is called SSNR, Sounds like a new medication or some sort of chemical in the brain, right? The acronym, however, represents what traumatized kids actually need, Safe, Stable, Nurturing Relationships,
The bottom line is that there is a better path to combating childhood trauma. And to put such efforts in motion we need to bring this issue of trauma to the forefront of discussion, legislation, and practice. We need clinicians, and again definitely psychiatrists, to understand that medicating traumatized children is not the correct approach or anywhere close to the safest and most effective approach. The cure for this epidemic is going to require a more systemic focus.
Turn the Ship Around
Only hope can keep me together.
We need more schools and child welfare agencies to use more holistic assessments (with documented reliability and validity) that consistently and accurately alert them to childhood trauma and mental health concerns so they can direct children and families to the best services.
Unfortunately, a diagnosis in today’s mental health world too often leads to medication which require more doctor visits, which too often lead to additional diagnoses which lead to additional medications, more side effects, and more doctor visits. And if such medications are possibly exacerbating the symptoms of trauma, well, this is not good for any child.
Medicating for mental disorders holds far too much potential for feeding a vicious cycle that is not beneficial to children and families. Medicating a child is not productive for schools and state agencies seeking to increase the quality of care and shorten the duration of services needed. This vicious cycle has a history of damaging our communities. Think about it, where did the opioid addiction come from? Too many doctors prescribing too many unneeded, addictive, and dangerous drugs.
We must consider how to better identify, measure, and differentiate between symptoms of trauma and mental disorders. Treating trauma first is the first step to better determining the most appropriate treatments.
For clinicians needing a mental disorder code from the ICD or DSM before treating the mental disorder (for Medicaid or insurance companies to pay), consider using PTSD or an adjustment disorder (trauma) as the code. And then consider psychological strategies and how best to better solidify Safe, Stable, Nurturing Relationships for the child.
This is how we can avoid prescribing children another depression medication to take with their existing depression medication, which is not working. By taking a more holistic approach we can also avoid increasing the chances of suicidal ideation or thought that nearly all the depression medication commercials warn us about. This is how we won’t have to prescribe another drug to subdue a child’s facial tics and contortions caused by their cocktail of medications, or give them insomnia medication to help counteract the stimulants keeping them from sleeping.
Treating trauma first and correctly is how we help kids process (with a clear non-medicated mind) what they have been through and help them develop the coping skills needed to rise above trauma.
RISE from Trauma
Let’s help these castaways, looking for a home.
To achieve a paradigm shift in how we combat childhood trauma, we also need to train more adults in how to help these kids. Specifically, we need to train and support educators and child welfare workers working tirelessly on the front lines of this childhood epidemic. At the least we need to fund community-based coalitions to help support our educators and child welfare workforce, and equally important put preventative and proactive community actions in place which seek to reduce the occurrence of childhood trauma exposure. So how do we accomplish these lofty goals one might ask?
Well, believe it or not, since 1973 more than 50 trauma-informed bills have been introduced. You know the song and how it works, I’m just a bill on capitol hill, Only two of these 50 became law, but the trauma portion of such bills did not come with adequate funding if any funding. They just basically stated agencies should have a trauma-informed plan and that staff should be trained. In the past 5 years, however there are at least two proposed pieces of promising trauma legislation that have been introduced, but once again like their distant cousins these proposals were referred back to committee (which too often reflects an idiom equating to sorry about your luck,
Rarely am I a believer that legislative efforts can provide a speed to impact contribution to societal challenges, but the latest legislation proposed could truly be a game changer for millions of kids and families. The latest bill with bipartisan sponsorship introduced by Senator Durbin, S.2086 – RISE from Trauma Act, has proposed the creation of a $600 million annual Health and Human Services (HHS) grant program. This legislation would fund community-based efforts to prevent and mitigate the impact of trauma, by expanding training and workforce development efforts to support health care, education, social service, first responders, and community leaders to foster resilience and deliver services to heal the impact of trauma.
If we are spending nearly a half trillion dollars (ie, $500 billion) a year (if not more) to manage the fallout of trauma, why would it not make sense to spend $600 million a year to not only treat the victims but also put efforts forward to combat childhood trauma?
The S.2086 – RISE from Trauma Act could help tens of millions of kids every year not be exposed to childhood trauma and actually provide them with the support and therapy they need to manage toxic stress. Although SAMHSA annually and admirably awarded millions in grants to combat child trauma, it’s most likely not enough to combat trauma. Our kids need and deserve more.
Let’s send an SOS to the world.
With such federal funding in place, school systems and their communities would benefit greatly by further training educators, specialists and staff on the prevalence, impact and types and characteristics of trauma. Such trainings could be focused on the 4R’s and helping educators more effectively identify signs of trauma and provide support to students, but also help educators better manage the trauma or vicarious trauma they might be experiencing.
Additionally, with COVID-19 possibly providing a reprieve and simultaneously a wakeup call that we should be concerned about mental health, schools could consider and more actively fund assessing the mental fitness of students, educators and parents and guardians. For example, Chicago Public Schools invested $24 million in student trauma and mental health programs. And the Hawaii State Department of Education has started pursuing trauma-informed professional development efforts to provide such trainings as well as assessment and identification of needs.
For Health and Human Services, Child Welfare & CPS departments, with not enough clinicians and specialists trained in trauma or available to serve the ever-growing population of vulnerable youth and families they support, states could use such funding to add on more specifically trauma- trained mental health staff capable of providing such care in a timely fashion. Efforts could be made to train staff working in the field to better identify trauma exposure, recognize symptoms, and provide initial support more efficiently and effectively.
And with the new legislation also possibly funding community initiatives, child welfare agencies would have more help and partners to take a more proactive and preventative approach to reducing trauma issues. By becoming trauma-informed and adopting new case management technology that supports such efforts to assess and guide this trauma focus, the potential to provide more efficient support and effective care could be greatly enhanced; leading to safer homes, better care, and shortening duration of services needed.
Taking a triage approach, and first focusing on lower income populations, could be a major and beneficial first step. Beginning efforts to help every child in schools or child welfare or CPS develop stronger resiliency capabilities also could truly improve success. Because one of the issues with trauma relates to resiliency. While two youths might experience a similar type and level of trauma, due to differing levels of resiliency, the response and symptoms experienced are often different. While one might be capable of not being impacted as much by the trauma, the other could be experiencing feelings that make life very hard to manage.
With renewed focus and investment, we can help many rise from trauma and in the process help so many more avoid it. I do hope you got my message. And I do hope you help share this SOS; our youth deserve nothing less.