Research: Trauma sensitive practice with children in care

This Insight is intended to summarise the evidence in this challenging area of work and to support practitioners to reflect on their practice in this context. An enhanced understanding of trauma can enable practitioners and managers, from all the agencies working with children in care, to improve their practice with severely distressed children and to reduce the negative impact of trauma not only on children but also on the adults caring for them.

Loss is a universal human experience which we all encounter and, although it may be painful, successful resolution of loss is part of normal development. Trauma, however, results from events outside normal human experience which overwhelm usual coping mechanisms. It is associated with terror and helplessness and often involves a feeling that the individual or someone important to them is at serious risk.

Many children in care experience severe neglect in their earliest years. Neglect occurs when physical, emotional or cognitive experiences required for normal development are either inadequate or absent. The impact is severe whether neglect is deliberate or the consequence of problems caregivers face in managing their own and their children’s lives. The terror and helplessness experienced by neglected infants have led many theorists to describe early neglect as ‘developmental trauma’ (D’Andrea et al, 2012). As babies’ developing brains are organising, lack of appropriate stimulation and soothing can affect successful development of areas of the brain associated with cognitive, social and emotional skills. Children struggle to manage later traumatic events if they cannot regulate emotions or acquire reflective skills to make sense of what has happened to them.

Single terrifying events or experiences can have a lasting impact on individuals and some experience symptoms of post-traumatic stress disorder such as nightmares, flashbacks or avoiding situations reminiscent of the trauma. Disabling though these symptoms are, the impact of complex trauma is more pervasive and harmful. Complex trauma occurs when terrifying experiences, caused by someone who should be a figure of trust, are the norm in children’s lives (D’Andrea et al, 2012). Children adapt to this hostile environment and their baseline reactivity changes. Children can become over-sensitised to threat and may respond negatively to neutral and even positive cues.

These early experiences can have cascading and damaging effects throughout childhood and adolescence and well into adulthood. The impact of early neglect and trauma can cross every area of children’s lives, negatively affecting their capacity to learn basic self-regulatory skills, develop a moral sense, manage a formal educational environment and make close, trusting relationships.

All children have different genetic heritages and a unique set of life experiences which result in varying responses to adversity. Trauma results from the way children experience adverse events not the events themselves. Some children suffer multiple adverse events without being traumatised, whereas others are overwhelmed by apparently less serious experiences. Some recover spontaneously from trauma but others suffer serious long-term effects that interfere with daily life. Many children have experienced severe trauma before admission to care but some are also exposed to additional trauma during their care journey. This may be due to continued failure to protect them from traumatic experiences within their family or community but it may also be as a direct result of individual or systemic abuse while in care. Despite the potential damage caused by early destructive experiences, every reduction in risk limits the long-term impact of trauma on children. No child is beyond help if support is provided to prevent a particular adverse experience or to ameliorate its effects (Appleyard et al, 2005).  

Key points

• Children in care are likely to have experienced trauma but not all children who have adverse experiences will be traumatised. Every child is unique and their responses to the same adversity will differ.
• Trauma can affect brain development. Many traumatised children function at an earlier developmental level than their chronological age suggests.
• Traumatised children may struggle to develop regulatory skills needed for learning and social relationships.
• Some children react powerfully to sensory triggers related to their trauma by becoming hyperaroused or dissociating. These reactions often occur below the level of conscious awareness.
• If adults involved with traumatised children are unable to manage their own emotions, this can escalate children’s distress.
• Effective help requires intervention that is congruent with neuroscience, developmentally relevant and relational.
• The key adults in helping children recover from trauma are their carers and teachers. They require relevant support and training to be most helpful to traumatised children.
• Crisis-oriented care organisations may exacerbate trauma and undermine the efforts of committed practitioners.
• Post-traumatic growth and resilience is possible. Traumatised children need hope and adults involved with them must believe in a positive future for them.

This Insight is written by Judy Furnivall (CELCIS) and Edwina Grant (Scottish Attachment in Action).