Working with Traumatized Youth in Child Welfare

This interesting book is a look at traumatized children and youth in the child welfare system. This is an important issue as most traumatized children treated by child psychiatrists (as well as the severely traumatized), are likely captured under this scenario (have been, will be, or currently are in the care of Child Welfare). As a practitioner in this field (the regional Trauma/Attachment Program in Edmonton) I believe this book serves several purposes. Firstly, for child psychiatry, it gives a good overview of the problem from a social work perspective, something we can prosper from in our own sometimes conflicted dealings with the child welfare system. It helps to see that we all have a similar motive, even though the welfare and health systems appear to deflect problems onto each other. In our training as biopsychosocial physicians, this book adds a healthy dimension of the social aspect and thus a greater ability to integrate. Secondly, for all practitioners who treat or are responsible for these children, this book is an up-to-date review of the current biopsychosocial understanding and treatment of the problem. Part I (five chapters) covers impact of trauma to children, the effects of placement in care, trauma pathology and its neurosequential developmental impacts, assessing trauma, assessing medical and social factors that mediate resiliency and, how to identify and make use of these. Then in Part II (eight chapters), specific aspects of treatment are reviewed, including structured groups, individual play and expressive therapy, CBT, EMDR and Animal Assisted Therapy. Of note for child psychiatry is that no chapters are dedicated to the pharmacological approaches to these conditions. Part III (two chapters) deals with collaboration between child welfare and mental health. Although the authors are all USA based, I find the general principles equally relevant in Canada. The editor is Nancy Boyd Webb, a well respected author in this area. The other authors include Ph.D., M.S.W., Ed. D or DSW backgrounds covering the fields of child welfare, education, developmental psychology and trauma therapy in many forms. As well Chapter 3 is by Bruce Perry. M.D., who gives an excellent overview of “The Neurosequential Model of Therapeutics” (N.M.T.) (see www.childtrauma.org). This chapter is worth the book itself. The final chapter by Marilyn Benoit, M.D., past president of the American Academy of Child and Adolescent Psychiatry, gives an excellent overview of the collaboration on these children in the child welfare system from a mental health perspective. She emphasizes how important attachment is regarding the development of resiliency in trauma pathology and the associated conditions of ADHD, chronic anxiety, depression or other comorbidity. These chapters are “state of the art” and easily translated into clinical usefulness. One possible criticism of the book is that there is not enough attention given to the attachment disorders these children invariably have. Trauma and attachment pathologies are inter-twined. Many boundary issues arise in this population, and it has been my experience that not until basic trust in a dyadic attachment and a true sense of inner ‘safe place’ has been restored, can one expect to move through trauma healing with much success. Further, acute regression in these children often has as much to do with attachment pathology as with their trauma pathology. This in turn guides the strategies one might use in these critical moments. Overall this book was considerably helpful in understanding this population. It will be shared with staff, students, social workers, and foster parents. It allows one to see how collaboration amongst disciplines helps achieve the overall goal of a Trauma and Attachment Program - that of a “realistic and coherent life narrative” for the resolution of trauma and attachment in a way that allows for normal functioning and ongoing progressive development.

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