BEHAVIORAL HEALTH RESOURCES & INFORMATION
CHILD ABUSE AND EMOTIONAL TRAUMA
A traumatic event is a frightening, dangerous, or violent incident that poses a threat to a child’s life or emotional security. There are multiple forms of child trauma including child maltreatment, natural disasters, family or community violence, familial substance abuse, a family death, and war. The impact traumatic stress is greater for some children and families and dependent, in part, on a variety of risk and protective factures. Children who have been exposed to one or more traumas over the course of their lives are at greatest risk for neurodevelopmental problems. A variety of behavioral and physical health issues can arise.
Child abuse and neglect are forms of child emotional trauma. Repeated exposure to emotional trauma places children at risk for neurodevelopmental problems leading to long term behavioral and physical health issues. Major goals for the CARE Network include the identification of child abuse and neglect in order to prevent emotional trauma and to recognize behavioral health symptoms related to emotional trauma through screening. Fortunately, when identified, there are evidence-based practices to treat children who have experienced the emotional consequences of maltreatment.
A significant portion of the population has experienced child trauma, yet primary care providers often feel ill-equipped to support these patients. Evidence-based practices to screen for and treat the symptoms of trauma are available. In 2013, only 4% of pediatricians who responded to the American Academy of Pediatrics’ National Periodic Survey were familiar with childhood trauma. Yet, pediatricians are likely to be the first, and often only professionals who encounter the 68% of American children who have experienced trauma.
Up to 80% of children experience at least one significant traumatic event in childhood. Minority children are disproportionately impacted by trauma. Research has demonstrated that childhood adversity is linked to poor behavioral health and physical health outcomes, such as risk of suicide, early pregnancy, mental health problems and substance abuse. There are also links to higher rates of obesity, cardiovascular disease, diabetes and lower life expectancy. The lifetime burden and cost to society is substantial and is related to healthcare cost, loss of productivity, education, child welfare and criminal justice system expense.
Effective interventions to mitigate child trauma are well-described. Early intervention can improve outcomes for individual patient and society at large. CARE Network Designated Providers are well-positioned to address child trauma and are viewed as a trusted source for support and referral. For more information on access to services for traumatized children, their families and communities visit The National Child Traumatic Stress Network Website.
IMPROVING QUALITY AND ACCESS
The primary mission of the CARE Network is to provide every maltreated child easy access to quality and compassionate medical and behavioral health care. This system ensures that all children have access to competent and trauma-informed health and safety screenings that result in accurate diagnosis and evidenced-based treatment regimens. The CARE Network is committed to treating the whole child by bringing both medical and behavioral health providers together through joint training opportunities, and offering discipline specific ongoing education, peer-review and mentorship, and financial incentives for engaging in the multi-disciplinary child maltreatment process (i.e., cross communication with child welfare, medical providers, court, etc.). The guidelines provided within are best practice guidelines for designated behavioral health providers.
CARE PROCESS MODEL
Pediatric traumatic stress, with or without suicidality, is routinely overlooked in pediatric settings (Keeshin, 2018). Up to 80% of children experience at least one traumatic event in childhood (Turner, Finkehor, & Ormrod, 2010). As such, an effective and standardized model, The Care Process Model (CPM) was developed by University of Utah and Intermountain as a part of a Category II Center within the National Child Traumatic Stress Network. This model is the basis for behavioral health diagnosis and management for the CARE Network.
The model identifies key quality measures necessary to deliver care to trauma-exposed children in an efficient and feasible manner. The three quality measures included in the model are:
Identifications of potentially traumatic events that warrant a referral to child protective services or law enforcement;
Identification and response to risk of suicidality
Identification of symptoms that indicate that traumatic stress may underlie the youth’s difficulties and warrant a trauma-informed and healing centered assessment and treatment plan.
BEHAVIORAL HEALTH PARTNERS
Below is a list of the different types of behavioral health providers you may encounter within your community. It is important to note that there is not one discipline, or credential that is “better” than another. What is most important when looking to establish a referral resource for your pediatric patients is that whomever you refer has experience with pediatric populations and has received training in a trauma focused evidenced-based practice (EBP). Some EBP practices that are common among behavioral health providers are: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Dialectical Behavior Therapy (DBT), Parent-Child Interaction Therapy (PCIT). Behavioral health providers often indicate their practice modality on their website. If you are unable to locate the information there, you may ask the provider directly.
Additionally, licensure of provider(s) should be verified through DORA. Be sure to verify that licenses are in good standing and if applicable, review any grievances. If the behavioral health provider is not licensed, it is important to verify that they have registered with DORA as an “unlicensed psychotherapist” and inquiry the behavioral health provider about their current clinical supervision plan (i.e., are they in the process of becoming licensed?). Conduct the same licensure check for supervisors as advised above. Finally, ask behavioral health providers if they hold malpractice insurance. Exercise caution when referring to a provider who does not hold a clinical license or are not under the supervision of a licensed clinical and to those without malpractice insurance.