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Developing a Trauma-Informed Therapeutic Service in the Australian Capital Territory for Children and Young People Affected by Abuse and Neglect


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Developing a Trauma-Informed Therapeutic Service in the Australian Capital Territory for Children and Young People Affected by Abuse and Neglect




September 2014




This paper has been developed as part of the Trauma Recovery Centre Project funded by the ACT Government in 2013-14. The project operated from the ACT Community Services Directorate, Office for Children Youth and Family Support, Early Intervention and Prevention Services.


The Authors:
Kate Gimson (Psychologist) Senior Project Officer

Alison Trewhella (Social Worker) Project Officer


Message from the Deputy Director General of Community Services Directorate


Childhood trauma is one of the nation’s most important public health concerns with adverse childhood experiences being one of the strongest predictors for difficulties in life.


Research demonstrates that children in care display consistently higher rates of behavioural and other mental health problems as well as compromised cognitive and adaptive functioning than children in the general population. By the time a child has entered the care system, they may have already been exposed to multiple traumatic experiences.
In Australia, there is a growing recognition that an integrated whole of government response is required to protect children and young people from abuse and neglect. The National Framework for Protecting Australia’s Children, endorsed by the Council of Australian Governments in 2009 and the Closing the Gap strategy, support this approach.
In the 2013–14 budget, the Australian Capital Territory (ACT) Government committed $3.05 million over four years to establish the Trauma Recovery Centre to support children recovering from abuse and neglect. Now known as ‘Melaleuca Place’ the Trauma Recovery Centre is a targeted, multi-disciplined, holistic, early intervention and prevention service, committed to supporting children and young people to heal from trauma, repair existing relationships and establish new supportive and protective networks.
Developing a Trauma-Informed Therapeutic Service in the Australian Capital Territory for Children and Young People Affected by Abuse and Neglect provides a sound foundation for the establishment of a trauma-informed therapeutic service. This paper provides an excellent resource for service providers working with vulnerable children and families and paves the way for better interagency collaboration and the development of trauma-informed services across the ACT.

Sue Chapman

Deputy Director General, Community Services Directorate

September 2014

Contents



Executive Summary

5

Background and Policy Context

7

Trauma Overview

8

Child Development and the Impact of Early Trauma

9

Key Theoretical Frameworks

10

Trauma-Informed Therapeutic Approaches

12

Applying the Theory in Practice

13

Collaboration, Supportive Practice and Environment

18

Child Protection: The Australian Context

20

Children in Out of Home Care

20

Trauma and Aboriginal and Torres Strait Islander Children and Young People

21

A Shift in Focus to Trauma-Informed Services in Australia

22

Trauma-Informed Therapeutic Services

23

ACT: The Trauma Recovery Centre

27

Future Directions

29

References

30



Executive Summary

A growing body of research demonstrates that adverse childhood experiences have a significant and pernicious impact through the life-span of a person. Experiences such as chaos, threat, traumatic stress, abuse and neglect, alter a developing child’s brain in ways that result in enduring emotional, behavioural, cognitive, social and physical problems (Perry, 2006; cited in Webb, 2006). These effects are often observed in the child’s diminished capacity to develop the new physical, social, emotional and cognitive skills necessary to become a functioning and mature adult.


Childhood trauma is one of the nation’s most important public health concerns with adverse childhood experiences being one of the strongest predictors for difficulties in life including mental health problems, physical health problems, social/relational problems, poor educational and vocational outcomes, alcohol and other substance use problems, contact with the criminal justice system and lower socio-economic status. Bessel van der Kolk, an American trauma expert, asserts thatChildhood trauma, including abuse and neglect, is probably our nation’s single most important public health challenge, a challenge that has the potential to be largely resolved by appropriate prevention and intervention’ (van der Kolk, 2005:2).
Across Australia, 184,284 children aged 0–17 years were the subject of child protection notifications in 2012–13 and 40,624 children were in Out of Home Care (OoHC) as at 30 June 2013 (Australian Productivity Commission, 2014). In the ACT, the most current data is from the incomplete 2013–14 year where there were 590 children and young people in OoHC as of 9 February 2014; approximately 75% aged 0–12 years, with each of these children ipso facto having experienced moderate to severe complex trauma. A recently finalised ACT Community Services Directorate study (2014) outlines that at 30 June 2013, 49% were under the age of two and 17% were older than 2 years and younger than 4 years giving a total of 66% under four years.
Research demonstrates that children in care display consistently higher rates of behavioural and other mental health problems as well as compromised cognitive and adaptive functioning than children in the general population. By the time a child has entered the care system, they may have already been exposed to multiple traumatic experiences including abuse, neglect, exposure to domestic violence, a family history of mental health, and drug and alcohol abuse. Children and young people whose histories have resulted in removal to foster or residential care settings, and who experience multiple changes in caregiver are unlikely to have established or maintained secure attachments with a primary caregiver. As normal development is dependent on the presence of at least one secure attachment during childhood, the consequences of this are pervasive (Schore, 2001). There is also an established link between children who suffer complex trauma and subsequent involvement in the youth justice system (ACT Human Rights Commission, 2011).
The increased use and availability of medical imaging technologies has furthered our understanding of exactly how the brain is altered following prolonged exposure to trauma and/or stress. Significantly, there is now growing evidence that persistently elevated levels of the stress hormone cortisol, can disrupt the developing architecture of the brain, including its size. This can then lead to permanent changes in brain structure and function including difficulties in learning memory and executive functioning (Shonkoff & Garner, 2011). These developments have coincided with the emergence of new theoretical frameworks that focus on trauma-informed therapeutic approaches to working with children, and in particular focus on a child’s developmental age (as opposed to chronological age) and the importance of building safe and secure relationships as a means of recovery.
As a community, we need to endeavour to prevent child maltreatment before it occurs. The Child and Family Centres based in the ACT and other universal primary prevention and early intervention services focus on this goal. However, where maltreatment has already occurred, there is growing evidence that intensive intervention as early as possible in the life of the child and in the development of the problem can help to temper the detrimental effects of abuse and neglect. In essence, there is a need for ‘early intervention in the tertiary system’. That is, the prevention of further traumatic and harmful situations for a child who has already come to the attention of statutory authorities.
This discussion paper will explore the policy context in which the Trauma Recovery Centre has been established as well as some of the literature regarding the impact of trauma on a child’s physical, psychological and cognitive development. The key theories and/or frameworks being utilised by experts in this field will be examined as will the importance of understanding the cumulative impact of trauma on children in OoHC. An analysis of the trauma-informed services in Australia as well as the key aims of the Trauma Recovery Centre will be explored with reference to the OoHC data in the ACT, and will conclude this paper.
This paper highlights that a whole of government and cross sector approach is required to provide a trauma-informed, safe and nurturing environment for children and young people. Significantly, there are existing services in the ACT that provide trauma-informed therapeutic support to children and young people, such as the Child at Risk Health Unit and Canberra Rape Crisis Service. A key aim of the Trauma Recovery Centre will be to compliment these existing organisations, whilst also providing a holistic, intensive and peripatetic therapeutic service. The challenge thus lies in building a trauma-informed service system, which utilises a partnership and collaborative approach whilst also recognising the skills and expertise of individual service providers.

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