Is Providing Trauma-informed Care for Kids as Easy as Changing the Lens?
“A child is only as healthy as the family is. And as secure as the family is.”
We know that early interventions are always best, so when it comes to children and families, providing holistic, trauma-informed care is pivotal. And organizations like The Children’s Clinic, “Serving Children and Their Families” (TCC), Long Beach, California, are leading the charge.
Since 1939, TCC has provided health care to all children — especially those from low-income families; since then, the agency has evolved to provide primary care services for children, teens and adults. TCC is not a newcomer to the concept of trauma-informed care; it has always been integral to their mission to provide quality, integrated, innovative health care to the underserved of all ages.
“This is not a new concept for those of us who have committed our careers to serving children and families — especially ones who live in poverty,” says Elisa Nicholas, MD, MSPH, TCC’s chief executive officer and practicing pediatrician. “We know they have a lot of stressors in their lives and we know that if there’s not food on the table and they’re not in good health, the family will be stressed and the child won’t do as well as if there weren’t those stressors in their lives.”
The cost of ignoring childhood stress and trauma can be immense for children — decreased executive function, problems in school and increased risk of alcohol and drug use. As they grow into adulthood, the problems can escalate to obesity, poverty, hypertension, heart disease, diabetes and myriad other problems.
That’s why it’s imperative to recognize and intervene as early as possible. A primary care environment, like TCC, provides an ideal opportunity for long-term relationships built on trust that encourage dialog with families about trauma and stressors both post and present in their lives.
“We know the one place that parents go with their children is to the doctor,” Dr. Nicholas explains. “After birth you go as many as eight times to the primary care practitioner for well child care and immunizations. So, we have a unique opportunity to screen and support parents and to screen them to let them know they’re not alone and that we can help them.”
To make the most of this opportunity for early and ongoing intervention, TCC created the Everychild Bright Beginnings Initiative to address the effects of toxic stress and chronic exposure to violence in infants, toddlers and pregnant mothers by embedding stress screenings, which measure not only stressors but support and build protective factors, into routine prenatal and pediatric medical check-ups. This innovative program’s goal is to recognize trauma-related issues during the first three years of life, a critical time in childhood development that has long-lasting effects on how they behave and cope with life changes as they grow older.
For a program like this to succeed, the right training throughout the organization is essential to ensure staff buy-in and commitment. As Dr. Nicholas explains, “I think the biggest thing that we did was trauma-informed care training because you have to set the stage on how staff will respond. We had the National Council of Behavioral Health train all of our staff, including the billing staff and the finance staff, as well as the staff that has contact with patients. The National Council first met with the leadership and reviewed trauma and trauma-informed care and answered any questions on what it means. Then, they met with all of our staff in an interactive session. They even met with the advisory committee for our project.”
The impact has been far-reaching, even affecting the providers themselves. “It’s really opened their eyes to see if they have a patient who is not complying with their recommendations or not improving where they should be. They think about this and ask, ‘Is there something going on in your life that’s keeping you from helping yourself with your disease?’ Whether they’re not taking their medicines or they’re not testing their blood sugars. And a lot of times there’s something going on that they need help with,” says Dr. Nicholas.
Dr. Nicholas’ message to anyone considering implementing trauma-informed key is, “It’s not as hard as you think it might be. Because I think that by being empathetic and not just looking at how somebody reacts, but what’s going on behind it, is going to help you in all aspects of your life.”
Ultimately, she says, “It is about changing the lens through which you are looking.”