February 18, 2016

Assessment in Practice with Vulnerable Children and Families Series – Part 3

This article was authored by Joe Tucci, CEO at the Australian Childhood Foundation.

In this third article in my series on assessment (see part 1 and 2 here) I hope to address the question “What is a trauma informed assessment of harm for children and young people?”

As we all know, trauma has very specific consequences for children as a result of the specific experiences of abuse and neglect they have had. This knowledge is an important dimension of any contemporary approach to understanding the needs of vulnerable children and young people. it must be specific and connect up the problems that children and young people experience with the ways that the abuse and neglect has permeated their lives.

Abuse and neglect causes physical pain and injury to children, exposes children’s brain and body systems to toxic levels of stress and symbolically communicates messages to them about themselves, the nature of relationships and what is true about the world.

If an assessment is trauma informed, it should detail all of this through the collection and analysis of information about the following:

  • What physical impact did the child/young person suffer? Has it affected his/her body to move freely, balance, sit, and lie down?
  • Does the child/young person avoid using certain parts of his/her body? Do they avoid doing any activity?
  • Is there any form of medical or other body based treatment required to help the child/young person remedy any physical problems or delays? What impact, if any, has the trauma had on the memory functioning of child or young person? Can he/she remember simple instructions? Can they remember sequences of events?
  • What, if any, trauma based behaviour has the child engaged in? What is the function of the behaviour? How can it be understood in the context of how it evolved in order to survive the threat and danger they experienced arising from the abuse and neglect? What is the impact of this behaviour? How does it promote or restrain others from engaging with children in meaningful relationships?
  • Under stress, how what are the behavioural routines that children follow? Can you identify any triggers to these responses?
  • How does the child/young person respond to a lack of routines? How much support does the child/young person need to be able to respond to predictability in their relationships and environment? How accurately does the child/young person read social cues in peers? How do they understand the humour of their peers? How effective are peers in settling them when they exhibit signs of stress?
  • What is the extent to which they engage in risky behaviour? Have they attempted or engaged in self harming behaviour?
  • To what extent do they use alcohol or other substances as a way of feeling better about their experiences of distress or stress?
  • To what extent does the child/young person carry with them the worldview of the perpetrator of the abuse and/or neglect? What are the messages they have come to believe about their abilities/ what are the messages they have to come to believe about qualities of relationships such as trust, privacy and love?
  • How were these messages reinforced? What role did threat, intimidation and fear play a part in confirming the validity of the messages the child/young person has taken on?
  • How much did the child/young person believe that they were not a priority for their parents/carers?
  • When they feel distressed in the present, how much do these messages become reinforced? How much of these messages act as triggers to dysregulation in the child/young person?

These are examples of trauma-informed questions; questions that are informed by the evidence of the neurobiology of trauma and attachment. The list is not exhaustive, and more questions are possible depending on the specific circumstances in which the child/young person was abused and/or neglect.

If practitioners ask questions like these, the answers will assist them in compiling an analysis of the needs arising from the harm experienced by the child or young person. This analysis is an important source document that guides the support that needs to be organised and coordinated for the child or young person. Without this, we run the risk of making judgements informed by our own biases – as discussed in part 2 of this series.

How trauma-informed is your assessment process? At the Australian Childhood Foundation, we have worked hard to integrate the ever evolving and emerging knowledge and research in the field. Our assessment process happens over several weeks, and we strive to keep our time with children and their families purposeful, our decisions informed and our framework informed by current research at all times.