Childhood trauma is a negative life event experienced by a child. Most children start experiencing trauma from birth. Those below five years are at high risk of exposure to traumatic stress due to their reliance on caregivers and limited coping skills, and rapid developmental growth (Buss et al., 2015). Traumatic events in a child’s life include but are not limited to community violence, trafficking or terrorism, sexual, physical, or psychological abuse, loss of loved ones, substance abuse by family or individual, life-threatening illnesses, and severe accidents or disasters.
Traumatic events in children’s lives have a wide variety of consequences that interfere with their daily life and social behaviors. They also worsen preexisting mental health issues and disrupt the child’s ability to handle life problems. Trauma reactions present themselves in various ways and can be triggered to re-enact themes from traumatic events that happened to them. Children may avoid situations that remind them of the traumatic experiences (Zero to Six Collaborative Group, National Child Traumatic Stress Network, 2010). Other frequent symptoms include diminished interest in play or other social activities, increased irritability, poor eating patterns, anxiety, a constant state of alertness, poor concentration, hyper arousal, physical aggression, constant startle responses, and high activity levels.
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Failure to treat childhood trauma can cause long-term health effects such as brain and nerve disorders, increased health risk behaviors such as substance abuse and eating disorders, and long-term health problems such as diabetes and heart diseases. Untreated child traumatic stress also caused deep-rooted societal problems such as poverty, substance addiction, mental health problems, crime, and mental health problems. Early treatment can reduce childhood traumatic stress's impact (Buss et al., 2015). Fortunately, there are evidence-based treatments and services available to counselors to help treat child traumatic stress. The evidence-based treatments are based on evaluated scientific theories that have been proven to yield positive results.
Trauma-Informed Practice
Trauma-Informed Care practice often referred to as TIC, is an approach in the human service field based on the assumption that a person is more likely than not to have a trauma history. This practice acknowledges any emergence of trauma symptoms and the role it plays in a person’s life. TIC aims to give support services that are accessible and appropriate instead of treating symptoms and issues related to sexual, physical, or emotional abuse (Substance Abuse and Mental Health Services Administration, 2014). Operating protocols that do not apply the TIC approach are likely to trigger or worsen trauma symptoms and re-enact traumatic experiences.
TIC follows six guiding principles as listed below: (SAMHSA, 2014).
Safety; The first most critical step is ensuring that a person's social, emotional and physical safety is addressed.
Trustworthiness and transparency; An individual has to know if the provider can be trusted. The evidence of trustworthiness is shown by establishing and being consistent with boundaries and clear communication of task expectations.
Empowerment, voice, and choice; When an individual has the power to choose and control their service experience, they are more likely to participate in the services making them more effective. Empowerment encourages concentrating on a person’s abilities and encouraging them to enhance those strengths that help them develop coping skills, providing a healthy foundation for individuals to fall back on if and when they end treatment.
Collaboration and mutuality; when an individual has the liberty to choose, they collaborate with the service providers, the services provided are more effective.
Peer Support; Peer support and mutual self-aid help develop safety, build trust, strengthen collaboration, and use their experiences to recover and heal. “Peers” is often used to describe people who have lived through trauma.
Cultural, historical, and gender issues; An organization with a TIC approach actively gets past cultural stereotypes such as age, religion, gender, among others. It offers easy access to gender-receptive services and incorporates policies and processes responsive to an individual's racial, cultural and ethnic requirements.
Integrative Treatment of Complex Trauma intervention model
Integrative treatment of complex trauma, also known as ITCT, is a component-based, multi-modal, evaluation-driven treatment initially developed for children, adolescents, and young adults aged 5-21. The clients targeted by the model are undergoing traumatic stress and are located in culturally diverse areas ("Integrative Treatment of Complex Trauma for Adolescents," 2021). It was formulated to aid clinicians in evaluating and treating children, adolescents, and young adults who have undergone several forms of psychological trauma in such as poverty, homelessness, racial discrimination, and deprivation. The treatment model is based on culturally adapted, developmentally appropriate methods applied in several settings such as schools, hospitals, outpatient clinics, and residentials. Collaboration with multiple community agencies is at the heart of the model, and it addresses problems associated with complex trauma. There are separate treatment manuals that address substance abuse and self-injurious behavior. Clients between 5-12 years get ITCT for children, while ITCT-A is for adolescents aged 12-21 years. The significant components of ITCT are:
The protocols followed involve empirical interventions for complex trauma and have different treatment modes such as cognitive therapy, relational /attachment oriented exposure therapy, family therapy, trigger management, psychoeducation, and mindfulness skills development.
Exploring trauma and therapeutic exposure is facilitated in an appropriate and safe environment that seeks to increase regulation capacities, self-efficacy, and self-esteem.
The treatment has specific approaches for complex trauma treatment that include cognitive behavior therapy and attachment theory.
Clients receive treatment depending on their needs assessed through standardized tests and the Assessment-to-Treatment Flowchart Adolescent Version (ATF-A). Other factors that affect the type of treatment are developmental and cultural challenges in the client’s surrounding.
Immediate trauma-related issues such as anxiety and depression should be addressed in the early stages of treatment to enhance the client’s ability to deal with more severe and difficult trauma issues.
Complex trauma issues should be addressed as soon as they come up. These include interpersonal difficulties, attachment disturbance, identity-related issues, and high-risk behavior, among others. There is a specific treatment module for substance abuse.
Applications of the intervention model to the Ella Case Study
The following are the applications of the twelve core concepts to Ella’s case study (Grossman et al., 2020):
Core Concept 3
After losing her husband, Kate’s economic livelihood was affected as he was the sole breadwinner. Kate had to look for a job to meet her and Ella’s necessities. The mortgage was very high, requiring them to move to an apartment from a home that had a compound. Another secondary adversity is the loss of Kate’s unborn child. Ms. Xiao’s question about what would have caused Ella’s sudden change in behavior serves as a trauma reminder for Kate as she struggles to remain collected.
Core Concept 4
The impact of trauma on Ella is evident after her mother Kate explains she felt the need to take her to the outpatient clinic due to her frequent and constant crying, clinginess, and adamancy to go to school. She reported that Ella often threw tantrums over minor things and when she becomes inconsolable.
Core Concept 5
Ella deals with insomnia due to the fear of bad dreams about monsters, and she goes to her mother’s bed in search of safety when she experiences them. She also becomes very concerned about her mother if she doesn’t come home early, and Kate has to call to assure her she is on her way. Kate’s miscarriage worries Ella, which made her frantic that she would die.
Core Concept 6
School is one of the caregiving systems for Ella. Ella’s teachers have also noted her consistent school absence, her distant demeanor, and tantrums. However, when the teachers encourage her to interact, she becomes bright and creative, showing that they would navigate Ella's situation if the school used a trauma-informed lens. Ella’s situation in class affects other students in class. For this case, the teachers admit that they lack adequate tools to deal with her in class. After the school threatened Ella, Kate, Ella’s primary caregiver, is affected by the situation and admits not to know how to go about it.
Core Concept 7
Mrs. Cole, the retired next-door neighbor, watches Ella while Kate is at work and is an excellent help to Kate. Her younger brother Richard and his family have also supported Kate and Ella after her husband’s death. Richard took care of funeral arrangements while his wife took care of Ella. Ella has great admiration for her aunt and enjoys going to church with her. Ella seems to enjoy spending time with her cousins, making it easier to deal with her trauma. Richard is busy but tries his level best to help out Kate and Ella.
Core Concept 9
Kate’s pregnancy with Ella an uncomplicated pregnancy with no problems. She hardly cried as a child, and in the rare times she did she self-soothed herself to sleep. Her relation to the traumatic experience of her father’s death is the exact opposite of her developmental neurobiology.
Core Concept 10
Kate’s faith was affected by her husband’s death because she questions why God let her husband die and lose her unborn child.
Core Concept 11
Kate allows Ella to get away with things that she would have reprimanded her for before because she tries to understand what she is going through
Core Concept 12
Ms. Xiao is left compiling notes to try coming up with the best treatment for Ella. Her papers' review served as a trauma reminder for her own experience when she experienced a miscarriage. The trauma is re-enacted through sharp pain and seeing blood flashes through her mind. It also hurts her because she has not been able to conceive since the miscarriage. When her heart begins beating faster and begins to feel lightheaded, she knows she needs help and reaches out to the counselor who assisted her confront the trauma caused by her loss.
Biblical Principals related to the case study
In this case, Ella is undergoing a distressful, painful, and shocking experience after her father's death. However, the healing power of God is still present in Kate’s and Ella’s lives even when Kate is having some negative emotions about God and her faith. Here are some of the Biblical principles would help Kate and Ella during this challenging time (Stanford, 2020).
God is omnipresent, and he is in control of our suffering
Often Christians feel like God has forsaken them and is allowing bad things to happen to them. The idea of pain seems contrary to what God wants for us, but from the Bible, Job understood God’s sovereignty, and he cares for us despite our circumstances.
Times of difficulty are the opportune times to draw closer to God
In James 1:2, The Bible encourages Christians to consider it pure joy when they go through trying times. Jesus underwent difficult times when Lazarus died and at the cross when He had to die for our sins. During difficult times, our faith as Christians is shaken, and we are required to rely on God. The Book of James 1:4 states that mature and complete faith is developed during hard times.
Our identity is grounded in Christ
We are not our traumatic experiences, and God doesn’t view us as a victim. We are all children of God, chosen before the world was created, filled with grace, forgiven and redeemed, by the Holy Spirit. Ephesians 1:4-14 teaches us that we sit at the right hand of God, and therefore we must not allow situations to define who we are in Christ.
References
Buss, K., Warren, J., & Horton, E. (2015). Trauma and treatment in early childhood: A review of the historical and emerging literature for counselors. The Professional Counselor , 5 (2), 225-237. https://doi.org/10.15241/keb.5.2.225
H. M. Grossman, L. A. Ross, & C. M. Layne (2020). Application of the 12 core concepts with the Ella Case. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.
Integrative Treatment of Complex Trauma for Adolescents . The National Child Traumatic Stress Network. (2021). Retrieved 28 March 2021, from https://www.nctsn.org/interventions/integrative-treatment-complex-trauma-adolescents
Stanford, M. (2020, November 30). Five things the scriptures teach us about trauma and suffering - By Dr. Matthew S. Stanford - Hope and healing center and institute . Hope and Healing Center and Institute. https://hopeandhealingcenter.org/five-things-the-scriptures-teach-us-about-trauma-and-suffering-by-dr-matthew-s-stanford/
Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration,
Zero to Six Collaborative Group, National Child Traumatic Stress Network. (2010). Early childhood trauma. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.
