“We all cry here, and there’s nothing wrong with that,” says Cara Weiler, a clinical social worker for Southwest Michigan Children’s Trauma Assessment Center.
She’s addressing a table of Western Michigan University student interns during a Friday morning meeting, letting them know they can come to the staff during the day if they need support.
Every Friday, the Children’s Trauma Assessment Center, on WMU’s campus, provides neurodevelopmental assessments of children age 3 months to 17 years who are survivors of trauma. Trauma can involve neglect, physical abuse, emotional abuse, prenatal exposure to alcohol and drugs, or a combination of all of these factors. Today’s meeting, led by Weiler and co-facilitator Amy Perricone, who is also a clinical social worker at the center, is a briefing on case histories of clients the center will see that day.
For the children who come to the center, life has become unmanageable. Many are acting out in the classroom or at home, and caregivers are at a loss as to what to do to help them.
“Children with a history of trauma are some of the most misunderstood kids,” says Connie Black-Pond, co-founder and clinical director of the center. “These kids have been exposed to danger and have learned to react from fear.”
Since the clinic opened its doors in 2000 (initially backed by a Kalamazoo Community Foundation grant), the faculty and staff have assessed more than 3,300 children in these Friday clinic settings. Of that number, 90 percent are in or have been in foster care and were referred to the center by caseworkers, therapists or physicians for assessment and diagnosis. Identifying trauma early in a child’s life helps in diagnosing the mental, physical and social problems that might result and in recommending appropriate and effective treatment, the center’s founders say.
“The impact of childhood trauma hasn’t been fully identified,” says Black-Pond, who explains that identifying this impact is a focus of the center as well. “These children will grow into adults and be parents, though, so we need to know how to support these children better now.”
The Children’s Trauma Assessment Center operates programs to reach child survivors of trauma and provide education to those who are in continual contact with these kids. Everyone from caseworkers to teachers needs to understand what causes trauma, what problems trauma can create for a child and how to help counter those effects, the center’s staff says.
Connecting with kids
During the Friday meetings, the facilitating staff, the observing student interns and the clinical social workers and trauma interventionists review written histories of the children coming for the day. Each history is developed by a person who has spent time compiling information via interviews with caregivers and family members as well as any medical or psychological records they’re given. On this day, four children are attending the clinic. Currently there’s a nine-month wait to get into the clinic, so these children and their caregivers have been waiting a long time for this day.
“Nothing is more painful than meeting a kid who wants to get in but having to tell them they have to wait nine months,” says Dr. Jim Henry, co-founder and project director of the center, pointing to funding as the culprit.
“It actually costs us money each time we assess a child,” adds Black-Pond.
After the history briefing, the staff splits up. Those who will be running assessments are assigned a case and a room number. Often two social workers or clinical interventionists are assigned to a child. The student interns split up and file into a room behind darkened observation windows, connected to the assessment rooms by two-way mirrors. Speaker systems and headphones enable the interns to listen in on the assessments.
The interns observe the IQ and motor-skill screenings of the children, then move to another observation room when the children go to see Dr. Mark Sloan, a pediatrician and co-founder of the clinic, who measures their growth and performs a reflex test. He’s making sure the kids are on track for their age and is screening for fetal alcohol syndrome, which can present physical and psychological problems for children into adulthood. Diagnosis helps in treating the symptoms, Black-Pond says.
During the afternoon, the children go through a psychological examination. At the end of the day, the staff and interns meet again to go over what happened: What did each person see? What questions did observers have? What conclusions can be drawn about the cases they viewed?
Four more children have been assessed, but 175 more are on a waiting list for the same service.
The center has trained about 300 interns from WMU — students in social work, occupational therapy, speech-language pathology and nursing. The staff is on hand throughout the day for support and direction, but, for many of the social work and psychology students, observing the sessions and helping to facilitate one provide the type of hands-on training they need in order to understand what the job entails and to decide if this work is right for them.
A trauma-informed system
In-center assessments are just one part of what the Children’s Trauma Assessment Center does. The center also trains other children’s trauma centers (six Michigan-based centers in the last five years), partners with the Michigan Department of Human Services’ MiTEAM to influence best practices in child welfare, coaches trauma-assessment teams across Michigan, and consults with state and community agencies. It has developed a nationally used trauma screening checklist for social workers, caregivers and medical personnel. Altogether the center has trained more than 70,000 people across the U.S. in these combined capacities, Henry says.
“We have two main focuses really,” he says. “One is the assessments, of course, but another is to effect systemic change. We work to create a trauma-informed system.”
A trauma-informed system, according to the center, involves across-the-board education for professionals about trauma so that children who have experienced it have a chance to receive specific aid and support.
“We want the systems, whether child welfare services, schools, the medical system, caregivers, court systems, foster systems, etc., to look at these kids and ask not just ‘Why are these kids difficult?’ but ‘What can we do to help these kids overcome their behavioral differences, manage their emotions and relationships and respond to therapy?’” Henry says.
Black-Pond adds, “It shifts the prevailing viewpoint or attitude of ‘What’s wrong with these kids?’ to ‘What’s happened to these kids?’”
Effecting system-wide change isn’t just about connecting the supporting government and private care systems in a trauma-informed perspective, but also about connecting different disciplines within the medical and mental health fields, says Dr. Ben Atchison, a center co-founder and chair of WMU’s Department of Occupational Therapy.
“We work in a transdisciplinary role-release model,” he says. “We release our normal roles as occupational therapists, speech therapists, medical doctors or social workers to come together and join resources and knowledge to create a free dialogue and a unique support.”
Bringing together different professional perspectives on trauma allows the center to move ahead in its research and approaches more quickly and to help bring about a trauma-informed system.
“It’s all about understanding these kids and helping others understand them too,” Henry says.
The funding hurdle
“Our most significant obstacle is money,” he says. “Let’s just leave it at that.”
It turns out it’s hard to leave it at that, because the mention of funding brings up many of the center’s stopping points, almost all of which stem from funding issues — the long wait for children to get assessed, the fact that many of the staff don’t receive full benefits and the limit to the center’s reach.
From an outside perspective, funding might not seem like an issue. The Children’s Trauma Assessment Center currently runs on four federal grants, two state grants, fees and private donations. Since the center’s beginning, it has received more than $11 million in grant funding. But, spread over 15 years, that grant funding averages only about $733,000 per year. That grant funding supports the center staff, outreach training, teaching student interns, screening programs in the community, trauma-centered community programming and working with state and local organizations to influence trauma-informed systems and there’s just not enough money for the center’s staff to do what they want to do, say Black-Pond, Henry and Atchison.
“Each of these grants provide a specific set of goals to accomplish,” Henry says. The grants can leave out services that don’t fall within their funding parameters, or they might cover only one discipline and leave out other aspects of the center’s multidisciplinary approach, which unites occupational therapy, social work, psychology, speech pathology and medicine.
Atchison says, “We’ve been successful getting these amazing grants that have funded things that we need to do, but the donations fund us to help children directly.”
He is talking about the clinic itself. The clinic and its assessments run as an auxiliary program to the center, funded separately and almost entirely by outside donations from the community, Atchison says. It operates on a year-by-year funding basis, with no permanent funding. The center co-founders have to figure out ways to fund the assessments outside of grant funding the center receives, and they often come up short.
Even within the center’s grant-funded programs and operations, grants can’t be relied on for everything.
“The grants end. Five of our grants end in the next two years,” Henry says. “We’re always thinking ahead to where we’re going to get money after our current resources run out. What do we do?”
That’s not to say, though, that the center doesn’t greatly appreciate the funding it does receive.
“Almost all of our work is done by way of grant work and contributions as well as our fees,” Atchison says. “We still struggle financially and depend on the community, and federal funding isn’t looking like a long-term option, but we’ve only been able to do the outreach we have because of it.”
The staff hopes to continue that outreach and expand the center’s current capacity by obtaining more private donations.
“People always say they’re for children — in politics, in government and in the university — but what they really do with their money is how that becomes true or not true,” Henry says. “Our kids need it most. We need the support.”
To donate to the Children’s Trauma Assessment Center or to learn more about its assessments and programs, visit WMich.edu/TraumaCenter.