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Assessing Trauma in Children

Danielle Mott, an intern at the CTAC in 2016, works with a young child during a child trauma assessment. Photo courtesy of Western Michigan University.
It’s key to helping them thrive, and WMU center leads the way

When social worker Jim Henry met the 7-year-old, she was living with an aunt after her mother had died.

The girl was struggling in school. Wasn’t sleeping. Had emotional issues.

Henry drew two houses on a whiteboard and pointed to one. “This is your aunt’s house,” he said, and then, pointing to the second house, said, “I know you lived with your mom here.” Then he asked, “So how did you get from your mom’s house to your aunt’s house?”

The little girl took the marker out of Henry’s hand and drew a stick figure with a noose around its neck.

“That immediately tells us that her mother’s suicide is ever-present for her,” Henry says, “and her view of everything comes from ‘My mama hung herself.’”

Henry told the little girl, “You know, I’ve talked to a lot of kids whose mom and dad have either died or they’ve hurt themselves. And lots of times the kids feel like ‘I could have done something to stop it.’”

The 7-year-old jumped up from her seat. “I never should have gone to the soccer game,” she said to Henry, “because if I wouldn’t have gone, my mom would still be alive. It was my job to make sure she was safe because she always talked about killing herself. But I went to the soccer game.”

“Now that’s the trauma, the death of mom,” Henry explains in retelling the conversation. “The impact is ‘I killed my mom.’”

“We went on a little longer and then she looked at me and said, ‘It’s like you’re right in my head,’” recalls Henry. “That was really important because oftentimes kids with trauma don’t trust others. But if a child feels listened to and thinks that you understand what it’s like to be them, it opens up this validation that they are not abnormal. And that’s the first step in helping them to heal the damage from the trauma.”

Creating CTAC

About twenty-three years ago, Henry and four other Kalamazoo-area professionals launched the Southwest Michigan Child Trauma Assessment Center at Western Michigan University. At the time, few people knew how traumatic experiences can negatively affect the developing brain of a child. But the founders of CTAC did. And the center they created to assess traumatized children has not only become the model for similar centers across Michigan and in Colorado, but also has effected change in the state’s child-welfare system and beyond.

CTAC has grown from its original five founders to a staff of 15, opened a second center in Cadillac, and earned more than $13 million in grant funding for its work. In addition, the center has trained more than 150,000 individuals in identifying trauma in children and its effects.

The center was founded in November 1999 by Henry; social worker Connie Black-Pond; pediatrician Dr. Mark Sloane; Ben Atchison, then a professor and chair of the WMU Department of Occupational Therapy; and Yvette Hyter, then a professor in WMU’s Department of Speech, Language and Hearing. Their aim was to work specifically with children in the child welfare system.

“Between the five of us, we had 150 years of working with child maltreatment,” says Henry, the center’s project director. “We had come to the point in our careers where we wanted to take the next step and create something that was going to help these kids’ trajectories as well as help them build resiliency.

“We want to replace the question of ‘What’s wrong with this kid?’ with ‘What happened to this kid and how does that affect his/her behavior, academics, brain?’ to change the understanding of children’s behavior from the typical American culture of ‘it’s willfulness’ to viewing it with a trauma-informed lens.”

The five founders created an extensive screening tool to assess childhood trauma that not only looked at the trauma a child has been exposed to, but how those traumatic events affected that child’s cognitive, emotional, behavioral functioning and mental health.

But it wasn’t enough to assess kids for trauma. The founders discovered that they needed to change the system so that adults who touched these kids’ lives — from medical professionals, teachers and judges to caseworkers and caregivers — were well informed about trauma, understanding trauma’s effects and knowing how to give traumatized children specific support.

Traumatic events may include neglect, abuse, community or school violence, serious accidents, life-threatening illness or the sudden loss of a loved one (see infobox above). A child who has experienced trauma can become anxious, fearful and depressed, cry and scream frequently, and have difficulties sleeping, eating and concentrating. Once these kids reach middle- and high-school age, they may develop eating disorders or self-harming behaviors, abuse alcohol or drugs and engage in risky sexual behavior.

“When children are traumatized, it eventually affects the entire community,” Gretchen Slenk, a former CTAC social worker, said in a 2016 interview published in WMU Magazine. “It can be hard to see the hurt 6-year-old in the 35-year-old convict, but he’s there.”

Since its founding, CTAC has assessed more than 6,000 children ages 3 months to 17 years old. Each child is assessed by two clinicians in a process that can take up most of a day and includes a physical exam; neurodevelopmental testing for cognition, language, memory, gross and fine motor skills, sensory processing, and social communication; and a psychosocial interview with the child. The assessment also includes interviews with parents and caregivers as well as observations of child and caregiver interactions.

In 2018, the State of Michigan spent $7.5 million to fund eight trauma assessment centers across the state that use the CTAC trauma assessment screening and whose staffs have been trained by CTAC, Henry says.

“The state adopted our model of trauma assessment and now there are eight trauma centers modeled after ours that we’ve provided the training for, so every kid that comes into foster care gets a trauma screening,” says Henry.

The primary outcome of the screening is to provide a detailed understanding of what is going on with a child. “We use a phrase from Dr. Dan Siegel, a brain expert, who said, ‘To name something is to begin to tame it,'” says Henry.

CTAC doesn’t provide trauma-informed therapy, but it does outline a “resiliency plan” for each child, which is a list of recommendations for supports and therapies to help the child recover from trauma.

“We’ve really worked in resiliency as a component of all trauma assessments,” Henry says. “Resiliency is basically three things: One, that you feel valued, loved, cared for. Two is mastery and efficacy, the ability to believe that you can be successful at something and do it well. And then third is the ability to regulate. When kids have those three, even if they’ve had little therapy or no therapy, they can heal from trauma. If they don’t, then that certainly creates all kinds of significant challenges in their future.”

Change through training

About 90 percent of CTAC’s clients are youth in the child-welfare and foster-care system. But in 2020, CTAC opened the Resiliency Center for Families and Children within its Oakland Drive facility, to provide services to help families and children outside that system, especially children who have been adopted, says CTAC Clinical Director Amy Perricone.

“These are kids who have come up in the child-welfare system but have the same challenges they had before those magical adoption papers were signed,” says Perricone. “Those challenges don’t go away, and adoptive families don’t have access to the same kind of services that a foster-care family would have, so we’ve been able to see a lot of post-adoption cases and really help keep those adoptions together.”

Making sure the people who are a part of children’s lives understand trauma and how to support those children is a critical mission of CTAC, which it is accomplishing by training others. The 150,000 individuals CTAC has trained since 2015 include medical professionals, judges, caregivers and more than 15,000 educators.

“We take a very systems approach. If we’re not touching all the different parts of the system, then we’re not really going to impact the lives of our kids,” says Henry.

Sloane, CTAC’s medical director and an adolescent behavioral specialist, has specifically been training physicians in Michigan on the links between trauma, schools and medicine. Sloan’s clinical experience includes the medication management of more than 1,200 traumatized, drug- and alcohol-exposed children assessed at CTAC. He speaks directly to the neurodevelopmental harm caused by trauma that can result in a variety of behaviors such as anxiety, hypervigilance and inability to focus, some of which can be managed with the help of medication.

A model for Colorado

The center’s impact has been felt beyond Michigan’s borders. Since 2014, Henry and Perricone have collaborated with the Child Welfare Resiliency Project, a seven-county consortium in Colorado. One aim of CWRP is addressing trauma to reduce the number of children being placed in “congregate care” — group homes or institutional settings that generally have worse outcomes for children than family-based settings like foster care.

By 2019, using CTAC trauma-assessment screening tools and protocols, CWRP had screened more than 3,000 youth and achieved a 33 percent decrease in the number of children who went into congregate care.

In addition, CTAC provided guidance and a model for setting up trauma-assessment centers in the seven Colorado counties. One is the CSU Trauma and Resilience Assessment Center at Colorado State University in Fort Collins, which provides assessments for children in Larimer County.

“Our program is similar to CTAC in the sense that it’s housed in a graduate clinical training program. (CTAC’s program) is clinical social work; ours is marriage and family therapy,” says C.K. Rizzo, CTRAC’s assistant director of operations and research. “Jim and Amy were doing trauma assessments for Larimer County Child Welfare, and the county got really excited about the assessments and put out a request for proposals to do trauma assessments. We were accepted, and Jim and Amy gave us a lot of guidance, support and education in terms of the protocol and training graduate students. They observed a lot of the assessments that we did in the beginning and offered feedback. They were really instrumental, not only in showing us the model that they used, but in helping us to build confidence as a center.”

Henry and Perricone are also working with Colorado’s justice system, providing trauma assessments for juveniles who have been accused of murder or attempted murder. In Colorado, children between the ages of 14 and 17 can be charged as adults and often end up in adult prisons, with long sentences and lifelong felony records.

“In Colorado, if you commit a capital crime, then you immediately are in adult court, even if you’re a juvenile. You have to have a reverse transfer hearing to go back to juvenile court,” explains Henry, “so we do the trauma assessments and testify for the reverse transfer so they hopefully can remain a juvenile rather than going to corrections.

“Killing someone is a horrific manifestation of all the trauma a kid has experienced. Most of the kids we see have very significant trauma histories and serious executive-functioning issues (problems with the mental processes that enable someone to plan, focus, remember and juggle multiple tasks) because of it. (For them) to recover, we’re trying to help rewire the brain, and you need to do that within a juvenile-justice milieu that’s built around resiliency versus the Department of Corrections, which is built on punishment.”

Dealing with secondary trauma

Seeing and hearing children’s tragic stories can have a detrimental effect on those who work with these children. This effect is called secondary traumatic stress. Perricone says that training CTAC staff to cope with secondary traumatic stress was a necessity, especially because many of the students in the WMU School of Social Work’s graduate program work at the center.

“We’re sending young people out to do the hardest work, and we want them to know that secondary trauma is real, to expect it, and (to know) the ways to mitigate it and work through it,” she says.

Now CTAC staff provide secondary-trauma training throughout the state. “Our curriculum focuses on understanding what secondary trauma is and ways to manage secondary trauma,” Perricone says. “We want to empower staff, whether you’re the director or the secretary at the front desk, to understand how working with desperate people, both adults and kids, can impact you.”

CTAC also trains crisis response teams in every county in the state of Michigan in what they call psychological first aid, which helps victims to adapt and function in the immediate aftermath of disaster, terrorism and community violence.

Henry himself is leading the trauma response efforts for faculty, staff, students and others who survived the Oxford High School shooting of November 2021, when four students were killed and seven people, including a teacher, were injured.

Sacred moments

Of the five founders of CTAC, Sloane and Henry still work there. Atchinson, Black-Pond and Hyter retired in recent years.

Almost a quarter-century after its founding, Henry acknowledges the limitations of CTAC. He says they mainly assess children in foster care or otherwise involved with Children’s Protective Services, and even then it’s a struggle for CTAC to keep up with demand. In addition, there’s no guarantee that the center’s recommendations for treatment will be implemented.

But Henry says the growth of CTAC, as well as the funding increases that have allowed the center to expand its capacity, are evidence of its success.

“We used to have a four- or five-month waiting list but now can expedite kids coming in to about three weeks,” he says.

At 70, Henry says what he still most appreciates is the “opportunity to sit with a child.”

“Nothing humbles me more. And nothing is a greater gift. We developed a key phrase over the last 10 years we call ‘sacred moments.’ Sacred moments are when I’m sitting with you and you’re sharing, and this connection that the child feels and you feel transcends time and space.

“We usually see the worst cases from across Michigan and hear horrific things, but the gift is to sit with that child and be present and not be afraid of their pain, not be afraid to go to those places that hurt because we can hold and be with them. Those sacred moments are really critical for us.”

Marie Lee

Marie is the editor of Encore Magazine and vice president of Encore Publications, Inc. She’s been at the helm of Encore since October 2011. Marie’s background covers the gamut; she’s a former newspaper reporter and editor, a public relations and marketing communications professional, and book editor and collaborator. As Encore’s editor, she is dedicated to bringing the best things about the greater Kalamazoo community to the magazine’s readers.

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