Child Welfare Trauma Referral Tool (CWT) (Nicole Taylor, Charles Wilson, & Alan Steinberg, 2006)

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Mervyn Douglas
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1 Module 8 Child Welfare Trauma Referral Tool (CWT) (Nicole Taylor, Charles Wilso, & Ala Steiberg, 2006) This measure is desiged to help child welfare workers make more trauma-iformed decisios about the eed for referral to trauma-specific ad geeral metal health services. It is to be completed by the child welfare worker through record review ad key iformats (i.e., atural paret, foster paret, child therapist, school-aged childre or adolescets if appropriate, ad other sigificat idividuals i the child s life). Sectio A allows the child welfare worker to documet history of exposure to a variety of types of trauma ad idicate the age rage over which the child experieced each trauma. Sectio B allows the child welfare worker to documet the severity of the child s traumatic stress reactios. Sectio C allows the child welfare worker to documet attachmet problems. Sectio D allows the child welfare worker to documet behaviors requirig immediate stabilizatio. Sectio E allows the child welfare worker to documet the severity of the child s other reactios/behaviors/fuctioig. Sectio F provides strategies for makig recommedatios to geeral or trauma-specific metal health services by likig the child s experieces to their reactios. To obtai permissio to use the Child Welfare Trauma Referral Tool, please cotact Lisa Coradi, at lcoradi@rchsd.org or , ext Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-1

2 Form Completed by (Name/Title/ID Code): Date: Child s Name: Age: Number of Moths i Curret Placemet: Reaso for Curret Evaluatio (check all that apply): Baselie Assessmet: New cliet New Trauma Reported Problematic Reactios/Behaviors Reported Chage i Placemet (Specify): Other (Specify): A. Behaviors Requirig Immediate Stabilizatio (Refer to Flow Chart for Specific Referrals for each type of problem) How to Recogize Problem Behaviors: Yes No Suspected (Check Yes if child presets with ay of the descriptors listed below) Suicidal Ideatio Thikig about, cosiderig, or plaig for suicide. Active Substace Abuse A uhealthy patter of substace (alcohol or drug) use that results i sigificat problems i oe of the followig ways: (1) A iability to adequately take care of your resposibilities or fill your role at work, school, or home; (2) The frequet use of substaces i situatios where it might be dagerous to do so (for example, drivig while uder the ifluece); (3) Repeated legal problems due to substace use (for example, public itoxicatio or disorderly coduct); ad (4) The cotiued use of substaces eve though the substace use is causig cosiderable problems i your life. Eatig Disorder Ay of several psychological disorders (as aorexia ervosa or bulimia) characterized by serious disturbaces of eatig behavior. Serious Sleep Disorder Disturbace i the patiet's amout of sleep, quality or timig of sleep, or i behaviors or physiological coditios associated with sleep. Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-2

3 B. Curret Reactios/Behaviors/Fuctioig Does this iterfere with child s daily fuctioig at home, school or i the commuity? Yes No Suspected How to Recogize Problem Behaviors: (Check Yes if child presets with ay of the descriptors listed below) Affect Dysregulatio Childre with affect dysregulatio may have difficulty expressig specific feeligs, whether positive or egative, ad may have trouble fully egagig i activities. They may have problems modulatig or expressig emotios, experiece itese fear or helplessess, or have difficulties regulatig sleep/wake cycle. Axiety Axious childre ofte appear tese or uptight. Worries may iterfere with activities ad they may seek reassurace from others or be cligy. These childre may be quiet, compliat ad eager to please, so they may be overlooked. They may report phobias, paic symptoms, ad report physical complaits, startle easily, or have repetitive uwated thoughts or actios. Attachmet Difficulties This category refers to a child s difficulty formig or maitaiig relatioships with sigificat paretal or caregiver figures. It relates to the child s sese of security ad trust i iteractig with others. Ofte childre with attachmet difficulties iteract with ew acquaitaces i uusual ways. They may bod too quickly (e.g., huggig stragers ad climbig o their laps), or fail to egage i appropriate ways (e.g., avoid eye cotact ad fail to egage i appropriate coversatios/iteractios). Attetio/ Cocetratio Childre with problems with attetio, cocetratio ad task completio ofte have difficulty completig schoolwork or may have difficulty formig strog peer relatioships. Coduct Problems Defied by a variety of differet coduct problems. Child may be physically or verbally aggressive to other people or aimals. Childre with coduct problems may destroy property, steal, break the law, or start fires. They may ru away from home or act i a sexually promiscuous or aggressive fashio. Depressio Depressed childre may appear tearful/sad, show decreased iterest i previous activities, have difficulty cocetratig, or display irritability, They may preset with depressed mood, social withdrawal, sleep disturbaces, weight/eatig disturbaces, loss of motivatio, verbal aggressio, sulleess, grouchiess, hopelessess, or egativity. They may have frequet complaits of physical problems. Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-3

4 Does this iterfere with child s daily fuctioig at home, school or i the commuity? Yes No Suspected How to Recogize Problem Behaviors: (Check Yes if child presets with ay of the descriptors listed below) Dissociatio Childre experiecig dissociatio may daydream frequetly. They may seem to be spacig out ad be emotioally detached or umb. They are ofte forgetful ad sometimes they experiece rapid chages i persoality ofte associated with traumatic experieces. Impulsivity Actig or speakig without first thikig of the cosequeces. Oppositioal Behaviors Defied by egativistic, hostile ad defiat behaviors. Child may lose temper frequetly, argue with adults, ad refuse to comply with adult rules. Child may deliberately aoy people ad blame others for mistakes or misbehaviors. Regressio Child ceases usig previously adaptive behaviors. Child may begi wettig or soilig themselves after they had bee potty traied, ad may begi usig baby talk or refusig to sleep aloe whe these skills were previously mastered. Somatizatio Somatizatio is characterized by recurret physical complaits without apparet physical cause. Childre may report stomachaches or headaches, or o the more serious ed of the spectrum, they may report blidess, pseudoseizures, or paralysis. Suicidal Behavior Icludes both superficial ad more serious actios with potetially life-threateig cosequeces. Examples iclude overdosig, deliberately crashig a car, or slashig wrists. Self-Harm Whe someoe deliberately harms him or herself. Icludes cuttig behaviors, puchig oeself, pullig out hair or eyelashes, pickig ski causig sores, burig, ihalig or overdosig o medicatios. Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-4

5 C. Trauma/Loss Exposure History Trauma Type (Defiitios attached) Age(s) Experieced (Check each box as appropriate example: sexual abuse from ages 6 9 would check 6, 7, 8, ad 9) Yes No Suspected Commuity Violece Exposure Domestic Violece Exposure Emotioal Abuse Extreme Persoal/Iterpersoal Violece Exposure Forced Displacemet Natural or Mamade Disasters Neglect Physical Abuse or Assault School Violece Exposure Serious Accidet/Illess/Medical Procedure Sexual Abuse or Assault/Rape Systems-Iduced Trauma Traumatic Grief/Separatio (does ot iclude placemet i foster care) War/Terrorism/Political Violece Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-5

6 D. Curret Traumatic Stress Reactios Yes No Suspected Defiitio (Check Yes if child presets with ay of the descriptors listed below) Re-experiecig These symptoms cosist of difficulties with itrusive memories or remiders of traumatic evets, icludig ightmares, flashbacks, itese relivig of the evets, ad repetitive play with themes of specific traumatic experieces. Also icluded is proouced reactivity to trauma or loss remiders. These symptoms are part of the DSM-IV criteria for PTSD. Avoidace These symptoms iclude efforts to avoid stimuli associated with traumatic experieces. The child may avoid certai places or people, or avoid discussig the specifics of the trauma. These symptoms are part of the DSM-IV criteria for PTSD. Numbig These symptoms iclude umbig resposes that are part of the DSM-IV criteria for PTSD. These resposes were ot preset before the trauma. Numbig symptoms iclude feeligs of detachmet or estragemet from others, restricted rage of emotio (e.g., uable to have lovig feeligs), feelig out of syc with others, or havig a sese of a foreshorteed future. Arousal These symptoms cosist of difficulties with hypervigilace (a exaggerated awareess of potetial dagers), difficulty cocetratig, exaggerated startle reactios, difficulties fallig or stayig asleep, ad irritability or outbursts of ager. Childre with these symptoms ofte seem distractible, impulsive ad iattetive, leadig to a commo misdiagosis of ADHD. Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-6

7 Child Welfare Trauma Referral Tool: Referral Flowchart Likig Experieces to Reactios Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-7

8 Referral Guidelies I scorig the Child Welfare Trauma Referral Tool, the followig guidelies are recommeded (as outlied i the referral flowchart): Trauma-Specific Metal Health Referral: The child has a trauma exposure history with a peetratig ijury or sexual assault. The child exhibits traumatic stress reactios, regardless of the child s trauma history. The child had a trauma history before the age of three or the caregiver is uaware of the child s history before the age of three, ad the child is experiecig attachmet difficulties. The child has a history of trauma ad this history is liked to curret reactios/ behaviors/fuctioig problems. Geeral Metal Health Referral: If the child exhibits curret reactios/behaviors/fuctioig problems (other tha traumatic stress reactios) i the absece of a trauma history. If the child exhibits behavior problems ad these are ot liked to the traumatic experieces. Specific Metal Health Referral: Hospital: If the child presets with suicidal itet, a referral to the hospital for stabilizatio is recommeded. The child should be re-assessed oce they are stabilized. Substace-Abuse Program: If the child presets with a sigificat substace abuse problem, a referral to a substace-abuse specific program is recommeded. The child should be re-assessed oce substace-abuse problem is stabilized. Eatig Disorder Program: If the child presets with a sigificat eatig disorder, a referral to a eatig disorder program for stabilizatio is recommeded. The child should be re-assessed oce they are stabilized. No Metal Health Referral: If the child has a trauma exposure history but there are o traumatic stress reactios ad the child is fuctioig well. Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-8

9 Defiitios of Differet Trauma/Loss Exposure History Categories COMMUNITY VIOLENCE EXPOSURE Extreme violece i the commuity (i.e., eighborhood ad gag violece). DOMESTIC VIOLENCE EXPOSURE Exposure to emotioal abuse, actual/ attempted physical or sexual assault, or aggressive cotrol perpetrated betwee a paret/caretaker ad aother adult i the child victim s home eviromet. EMOTIONAL ABUSE Acts of commissio agaist a mior child, icludig: Verbal abuse (e.g., isults; debasemet; threats of violece), emotioal abuse (e.g., bullyig; terrorizig; coercive cotrol), excessive demads o a child s performace (e.g., scholastic; athletic; musical; pageatry) that may lead to egative self-image ad disturbed behavior. EXTREME PERSONAL/INTERPERSONAL VIOLENCE Icludes extreme violece by or betwee idividuals that has ot bee reported elsewhere, icludig exposure to homicide, suicide ad other similar extreme evets. FORCED DISPLACEMENT Forced relocatio to a ew home due to political reasos. NATURAL/MANMADE DISASTERS Major accidet or disaster that is a uitetioal result of a mamade or atural evet. NEGLECT Failure by the child victim s caretaker(s) to provide eeded, ageappropriate care although fiacially able to do so, or offered fiacial or other meas to do so. Icludes: Physical eglect (e.g., deprivatio of food, clothig, shelter), Medical eglect (e.g., failure to provide child victim with access to eeded medical or metal health treatmets ad services; failure to cosistetly disperse or admiister prescribed medicatios or treatmets (e.g., isuli shots), ad Educatioal eglect (e.g., withholdig child victim from school; failure to atted to special educatioal eeds; truacy). PHYSICAL ABUSE OR ASSAULT Actual or attempted iflictio of physical pai (e.g., stabbigs; bruisig; burs; suffocatio) by a adult, aother child, or group of childre to a mior child icludig use of severe corporal puishmet. SCHOOL VIOLENCE EXPOSURE Violece that occurs i a school settig (i.e., school shootigs, bullyig, classmate suicide). SERIOUS ACCIDENT/ILLNESS/MEDICAL PROCEDURE UNINTENTIONAL ijury or accidet such as car accidet, house fire, or accidetal fall dow stairs. Havig a physical illess or experiecig medical procedures that are paiful ad/or life threateig. Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-9

10 SEXUAL ABUSE OR ASSAULT/RAPE Actual or attempted sexual cotact (e.g., fodlig; geital cotact; peetratio, etc.) ad/or exposure to age-iappropriate sexual material or eviromets by a adult to a mior child. SYSTEMS-INDUCTED TRAUMA Traumatic removal from the home, traumatic foster placemet, siblig separatio, or multiple placemets i a short amout of time. TRAUMATIC GRIEF/SEPARATION Icludes: Death of a paret, primary caretaker or siblig; Abrupt, uexpected, accidetal or premature death or homicide of a close fried, family member, or other close relative; Abrupt, uexplaied ad/ or idefiite separatio from a paret, primary caretaker, or siblig due to circumstaces beyod the child victim s cotrol. WAR/TERRORISM/POLITICAL VIOLENCE Exposure to acts of war/terrorism/ political violece. Icludes icidets both withi the U.S. (i.e., Oklahoma bombig, 9-11) ad outside of the U.S. (i.e., bombig, shootig, or accidets that are a result of terrorist activity). Child Welfare Trauma Traiig Toolkit: Child Welfare Trauma Referral Tool (CWT) Revised, Jauary 2013 The Natioal Child Traumatic Stress Network 6-10

Types of Trauma 5/16/2016. Prevalence of Trauma in Young Children. Acute: a single traumatic event that is limited in time.

Types of Trauma 5/16/2016. Prevalence of Trauma in Young Children. Acute: a single traumatic event that is limited in time. 5/16/2016 Prevalece of Trauma i Youg Childre Victims 0-3 make up 27.3 %of all maltreatmet victims (2013 US Dept of Health ad Huma Services) Ifats are the fastest growig populatio of childre to eter foster