Paper
The impact of trauma on children in protection and care: an ap-proach to understanding trauma through the use of assessment and outcome measures
- issue: Issue 2 / 2009
- authors: Carly Black, Margarita Frederico, Annette Jackson, Trish McCluskey
- keywords: Australia, trauma
- views: 4679
- downloaded: 1
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abstract
Background. Infants, children and adolescents in the child protection and out-of-home care system have been identified as a highly vulnerable population in need of more than just protection and care.
This paper describes the client group of Take Two, a therapeutic service for child protection clients who have suffered trauma as a result of serious maltreatment. It is Australia's first dedicated therapeutic service for children in the child protection system. The service is funded by the Victorian Department of Human Services and has been in operation since January 2004.
Purpose. We describe the children referred to Take Two, their experiences, interventions provided by Take Two and the impact of these interventions. Assessment and outcome measures are used to portray the client group. Since 2004 over 1000 children have been accepted into the Take Two program.
The children are aged from zero to 17 years, and the majority are living in out-of-home care. Referral information reveals that these children, even at a young age, have extensive histories of involvement with child protection and multiple placements, frequently including unsuccessful attempts at reunification (Frederico, Jackson, & Black, 2005; 2006).
A specific assessment measure developed by Take Two, The Harm Consequences Assessment (HCA) is completed by the referrer providing a cumulative picture of what has happened to the children over their lifetime in terms of abuse and neglect, as well as the emotional, behavioural and developmental consequences. This data reveals that nearly all children have experienced multiple types of trauma.
Outcome measures used include the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1999); the Trauma Symptom Checklist for Children (TSCC; Briere, 1996); the Trauma Symptom Checklist for Young Children (TSCYC; Briere, 2005) and Social Network Maps (Tracy & Whittaker, 1990). Taken together, these outcome measures provide insight into the children's emotional and behavioural presentation, trauma-specific symptomology and their perception of their social world.
Key findings and recommendations. Major findings regarding Take Two interventions include the successful engagement of the large majority of children and/or their networks. This is notable given traumatised children have been reported in the literature as being difficult to engage in therapeutic intervention. Interventions include individual child therapy, interventions with the child and parent/carer, parent and/or carer work, work with other aspects of the service system, such as schools and care teams.
The SDQs revealed that most respondents, including the children themselves, reported significant emotional and behavioural problems. Over 50% of the children were reported by parents and carers to be in the borderline or clinical range of all SDQ scales at initial assessment, particularly for conduct and peer problems. Self reports also indicated that 62% of children felt they were in the borderline or clinical range for conduct problems and hyperactivity. Teachers were less likely than parents or carers to report emotional difficulties, focussing more on behavioural based problems like conduct and hyperactivity.
Comparison with repeated measures SDQs, completed during Take Two intervention, showed a significant decrease in the number of children reported to be in the borderline or clinical range of the SDQ scales. Carers reported a significant improvement across all SDQ scales, and parents and teachers noted significant improvements in the child's conduct and peer problems.
The total difficulties score reported by parents at initial assessment was in the borderline or clinical range for all children, after Take Two involvement this figure was reduced to 73.7%. The children themselves also reported a significant reduction in total difficulties from 58% in the clinical/borderline range to 32%, signifying the positive impact Take Two intervention has had on the emotional and behavioural difficulties experienced by these children.
The TSCC revealed that the majority of children had a clinically elevated score on one or more scales indicating the serious intra-personal impact of trauma. Repeated measures completed during Take Two intervention reported a declining trend in mean t-scores across all of the TSCC scales, with significant reductions in mean anxiety and anger scores. This trend was also reflected in the TSCYC with parents and carers reporting lower scores across all of the sub-scales, with significant reductions in Anger and Sexual Concerns.
Analysis of the social network maps revealed the children often have extremely limited social networks. The children's descriptions of their networks frequently highlight an absence of parental figures. Siblings and extended family were a key presence even when they did not live with the child. Some children also included pets or deceased relatives as part of their social network. Examination of the social networks over time reveals an increase in the number of people described by the child as being close to them, and providing them with emotional support and information/advice.
Major findings regarding Take Two interventions include the successful engagement of the large majority of children and/or their networks. This is notable given traumatised children have been reported in the literature as being difficult to engage in therapeutic intervention. Interventions include individual child therapy, interventions with the child and parent/carer, parent and/or carer work, work with other aspects of the service system, such as schools and care teams.
The trends in all the outcome measures suggest that Take Two has a positive impact on child wellbeing. There are strengths and limitations of the outcome measures for both clinical practise and for research and evaluation. By completing outcome measures at time of assessment, six-monthly reviews and at closure allows for both the impact of the trauma and the impact of therapeutic interventions to be explored. Having the outcome measures completed by the child and key people in the child's world allows for useful comparisons. The outcomes data is also able to be compared with other research both within Australia and internationally. This provides a broader context within which to interpret the results from the Take Two service.
Key references
Frederico, M., Jackson, A. & Black, C. (2005). Reflections on complexity - Take Two first evaluation summary report. Bundoora: La Trobe University (www.berrystreet. org.au).
Frederico, M., Jackson, A. & Black, C. (2006). Give sorrow words. - A Language for Healing, Take Two - Second Evaluation Report 2004 - 2005, Bundoora: School of Social Work and Social Policy, La Trobe University (www.berrystreet.org.au).
Contacts: Carly Black, Berry Street Victoria, PO Box 167, Campbellfield VIC 3061, Australia, E-mail: cblack@berrystreet.org.au, Phone + 61 3 9479 2742