This is the final piece (Part 3) in a series that deals with childhood trauma and how we can help. In Part 1, I discussed the statistics, types, and signs of trauma exposure, and in Part 2, I discussed the implications of poverty, oversights (mistakes), and medications on care. childhood trauma. And in part 3, I share solutions.
The Case for Safe, Stable, and Rewarding Relationships
Save me before I sink into despair.
As the American Academy of Child and Adolescent Psychiatry points out in its Parameters of Practice (2010), trauma treatment should focus on psychological strategies rather than medication. Quite simply, if it is trauma, medication should be the last choice.
When it comes to prescribing antidepressants, benzodiazepines, and stimulants to children for the diagnosis of mental disorders such as depression, anxiety, and ADHD, a great deal of research suggests that the efficacy and hypothetical benefits of these drugs are questionable and dubious. Especially in young people, trying to contain each of the wide-ranging symptoms that can present themselves in traumatic reactions, such approaches to mental health usually result in a cocktail of mood-altering drugs. There are more thoughtful treatment approaches to take.
As the American Academy of Pediatrics (2021) recently shared, its main recommendation and goal for treating trauma is called SSNR. Sounds like a new drug or some kind of chemical in the brain, doesn’t it? The acronym, however, represents what traumatized children actually need, Secure, stable and rewarding relationships.
The bottom line is that there is a better way to deal with childhood trauma. And to set such efforts in motion, we must bring this issue of trauma to the forefront of discussion, legislation and practice. We need clinicians, and again certainly psychiatrists, to understand that medicating traumatized children is not the right approach or is not close to the safest and most effective approach. The cure for this epidemic will require a more systemic approach.
Only hope can keep me together.
We need more schools and child welfare agencies to use more holistic assessments (with documented reliability and validity) that consistently and accurately alert them to childhood trauma and issues of mental health so they can refer children and families to the best services.
Unfortunately, one diagnosis in today’s mental health world too often leads to medications that require more doctor visits, which too often leads to additional diagnoses that lead to additional medications, more effects side effects and more doctor visits. And if those drugs eventually exacerbate the symptoms of the trauma, well, that’s not good for any child.
Medication for mental disorders has far too much potential to fuel a vicious cycle that is not beneficial for children and families. Medicating a child is not productive for schools and public agencies seeking to improve the quality of care and shorten the duration of needed services. This vicious circle has a history of harming our communities. Think about it, where does opioid addiction come from? Too many doctors prescribe too many unnecessary, addictive and dangerous drugs.
We need to think about how to better identify, measure and differentiate between trauma symptoms and mental disorders. Treating the trauma first is the first step to better determine the most appropriate treatments.
For clinicians who need a mental disorder code from the ICD or DSM before treating the mental disorder (for Medicaid or insurance companies to pay), consider using PTSD or adjustment disorder (trauma) as code. And then consider psychological strategies and the best way to better solidify Secure, stable and rewarding relationships for the child.
This is how we can avoid prescribing children another depression medication to take alongside their existing depression medication, which is not working. By taking a more holistic approach, we can also avoid increasing the risk of suicidal ideation or thoughts that nearly all depression drug ads warn us about. This is so we won’t have to prescribe another medication to calm a child’s facial tics and writhing caused by his cocktail of drugs, or give him insomnia medication to help counter the stimulants. which prevent him from sleeping.
Dealing with trauma first and right is how we help children process (with a clear, drug-free mind) what they’ve been through and help them develop the coping skills needed to overcome trauma.
RISE of Trauma
Let’s help these castaways, looking for a home.
To achieve a paradigm shift in how we deal with childhood trauma, we also need to train more adults on how to help these children. Specifically, we need to train and support the educators and child protection workers who work tirelessly on the front lines of this childhood epidemic. We need to at least fund community coalitions to help support our educators and child protection staff, and equally important to put in place preventative and proactive community actions that aim to reduce exposure to childhood trauma. So how can we achieve these lofty goals one might ask?
Well, believe it or not, since 1973 over 50 trauma-informed bills have been introduced. You know the song and how it works, I’m just a bill on Capitol Hill. Only two of those 50 became law, but the traumatic part of those bills was not accompanied by adequate funding, if any. They simply said agencies should have a trauma-informed plan and staff should be trained. In the past 5 years, however, at least two promising trauma bills have been introduced, but once again, like their distant cousins, these proposals have been sent back to committee (which too often reflects a idiom likening to sorry for your luck).
I rarely believe that legislative efforts can accelerate contribution to societal challenges, but the latest proposed legislation could truly be a game-changer for millions of children and families. The latest bill with bipartisan sponsorship introduced by Senator Durbin, S.2086 – RISE of Trauma Act, proposed the creation of a $600 million annual grant program for health and human services (HHS). This legislation would fund community efforts to prevent and mitigate the impact of injuries, expanding training and workforce development efforts to support health care, education, social services, first responders and community leaders to foster resilience and provide services to heal the impact. of trauma.
If we’re spending close to half a trillion dollars (that’s $500 billion) a year (if not more) dealing with the fallout from trauma, why wouldn’t it make sense to spend $600 million dollars a year not only to care for victims, but also for efforts to address childhood trauma?
S.2086 – RISE from Trauma Act could help tens of millions of children each year avoid exposure to childhood trauma and provide them with the support and therapy they need to manage toxic stress. Although SAMHSA has admirably awarded millions of grants each year to address childhood trauma, it’s probably not enough to address trauma. Our children need and deserve more.
Let’s send an SOS to the world.
With such federal funding in place, school systems and their communities would greatly benefit from further training of educators, specialists and staff on the prevalence, impact, types and characteristics of trauma. Such trainings could focus on the 4Rs and help educators more effectively identify signs of trauma and provide support to students, but also help educators better manage the trauma or vicarious trauma they may be experiencing.
Additionally, with COVID-19 perhaps offering a reprieve and simultaneously a wake-up call that we should be concerned about mental health, schools could more actively consider and fund mental fitness assessment of students, educators and parents and guardians. For example, Chicago Public Schools invested $24 million in trauma and mental health programs for students. And the Hawaii State Department of Education has begun pursuing trauma-informed professional development efforts to provide such training and needs assessment and identification.
For the Departments of Health and Social Services, Child Protection and CPS, with an insufficient number of clinicians and specialists trained in trauma or available to serve the ever-growing population of vulnerable young people and families that they argue, states could use this funding to add more specifically to trauma. trained mental health personnel capable of providing this care in a timely manner. Efforts could be made to train staff working in the field to better identify exposure to trauma, recognize symptoms and provide initial support more effectively and efficiently.
And with new legislation that could also fund community initiatives, child protection agencies would have more help and partners to take a more proactive and preventative approach to reducing trauma issues. By becoming trauma-informed and embracing new case management technology that supports such efforts to assess and guide this trauma focus, the potential for providing more effective support and effective care could be greatly enhanced; leading to safer homes, better care and a reduction in the duration of needed services.
Adopting a triage approach and focusing on low-income populations first could be an important and beneficial first step. Starting efforts to help every child in schools or child protective services or CPS develop stronger resilience skills could also really improve success. Because one of the issues with trauma is about resilience. Although two young people can experience a similar type and level of trauma, due to different levels of resilience, the response and symptoms experienced are often different. While one may be able to not be affected by the trauma as much, the other may experience feelings that make life very difficult to deal with.
With renewed focus and investment, we can help many people recover from trauma and, in doing so, help many others avoid it. I hope you received my message. And I hope you will help share this SOS; our young people deserve nothing less.