What the past will do to me
In the future
– Yehuda Amichai, Concrete Poem
Through the Eyes of a Trauma-Informed Social Worker
Last year, 20 years after receiving my Master’s Degree in Social Work I completed an 18 month certification in Child
and Parent Psychotherapy with an emphasis on treating children exposed to trauma in conjunction with their caregiver through individual and dyad therapy. This was not because trauma was a new subject to me in my work. On the contrary, my very first clients were children exposed to abuse and neglect, and this has been my primary focus throughout my career. I delved deeper into a successful treatment model for traumatized children due to the growing body of evidence explaining not only the short-term consequences of adverse conditions, but the potential for long-term health risks associated with early exposure to trauma. Most of the affected children I have worked with over the years have been harmed by their caregivers. Some have been in accidents or exposed to violence or unexpected tragedy. Though heartbreaking, in these cases, at the very least a clinician has the feeling that there is a victim and a perpetrator. When parents themselves have been victims of abuse and go on to traumatize their children, through joint treatment at least a therapist can aim to have the perpetrator take responsibility and be an active participant in assisting the child to heal and move forward.
Many of us in the world of childhood trauma and advocacy have been saddened as of late with the news of over 2,000 children separated abruptly from their parents and placed in refugee centers over the course of six short and tragic weeks this summer in an effort to end illegal immigration. What do we do when the cause of trauma is a governmental policy? How can we make sense of it and what role do social workers have in moving forward? But before examining this recent policies and the potential long term effects of these events lets first take a peek at understanding what trauma looks like in children and the short-term affects it can have.
What is Early Childhood Trauma?
In an update for mental health professionals produced by the 2008 presidential task force on PTSD and Trauma in Children and Adolescents http://www.apa.org/pi/families/resources/children-trauma-update.aspx the scope of the problem was described this way (and these do not even include physical abuse, neglect and domestic violence):
- “Estimated rates of children and adolescents witnessing community violence range from 39% to 85%
- Rates of youths’ exposure to sexual abuse, another common trauma, are estimated to be 25 to 43%.
- In 2006, 7.9 million U.S. children received emergency medical care for unintentional injuries (from motor vehicle crashes, falls, fires, dog bites, near drowning, etc.), and more than 400,000 for injuries sustained due to violence.
- In one study of children under the age of five, more than half (52.5 %) had experienced a severe stressor (Egger and Angold, 2004).
Trauma rates vary depending on the type of event, the age of the child and the measure for collecting the data. But what has emerged as a certainty is that many children are experiencing exceedingly stressful life events. These early traumas, sometimes called Adverse Childhood Experiences (American Journal of Preventive Medicine, Vol 14, pgs. 245-258. May 1998) http://dx.doi.org/10.1016/S0749-3797(98)00017-8 are defined as including but not limited to the following:
- Exposure to Neglect and Parental Depression
- Exposure to Physical, Sexual and Emotional Abuse
- Exposure to Domestic Violence
- Exposure to Natural Disaster
- Exposure to a Life Threatening Illness, Accident or Medical Emergency
- Sudden Loss or Death of a Close Caregiver or Family Member
- Incarcerated Family Member or Parent
What Childhood Trauma Looks Like
Just as play is a vehicle for learning in young children, behavior provides invaluable clues into their mental health status and feelings of wellbeing. Trauma in a child can manifest through many of the following short-term behaviors and consequences:
- Difficulty Managing Emotions
- Clingy or Increasingly Fearful
- Difficult to Console
- Aggressive & Impulsive
- Poor Verbal Skills and Other Developmental Delays
- Regression in Behaviors Including Enuresis
- Difficulty Focusing
- Poor Social Skills (including overreacting)
- Demanding of Both Positive and Negative Attention
Why Are We Talking About Trauma as related to Immigration Right Now?
A brief look at the history of the immigration debate in our country tells us that what to do with children and families crossing the southern border into the United States illegally is not a new discussion. Many administrations have attempted to decrease illegal immigration through prosecution and deportation.
- The Bush Administration also had a policy to prosecute anyone who entered the U.S. illegally but attempted to limit family separation whenever possible.
- President Obama, to the dismay of previous supporters, became referred to as the “Deporter and Chief” due to the increased number of immigrants deported during his time in office. Families were also detained during lengthy legal proceedings; however, families were kept together when possible and some parents were also released to be with their children by being placed on house arrest or wearing ankle monitoring bracelets.
The Trump administration is different in perhaps two fundamental ways. First, Trump campaigned for office on a platform of being tough on immigrants and threatened to seal the southern border with the infamous “Wall.” He used “America First” rhetoric akin to slogans used during WWII, pushing for patriotism at the expense of the “other” and some would say played on some American’s fears related to growing diversity in our country. Second, early in his presidency he and his officials began talking about a “Zero Tolerance” stance toward illegal immigrants. And although the recent separation of immigrant children from their parents has gained increased attention and exposure in the last month, the stage was being set for these hard line measures over a year ago.
A brief timeline of events leading to family separation at the border and current outrage
- According to USA Today, in March 2017 the former Secretary of Homeland Security, John Kelly reported that the administration was considering separating children from their families at the border as a means of deterring future illegal immigrants.
- Unbeknown to most Americans, family separations at the border began in October 2017.
- In December of 2017 the US Office of Homeland Security received filed complaints from immigration advocacy groups. Numbers of children separated from their parents ranged from 150 to 650 in 2017. (https://www.nytimes.com/2017/12/21/us/trump-immigrant-families-separate.html)
- In April 2018 the separations increased dramatically after Attorney General Jeff Sessions announces a “Zero Tolerance” policy which demanded federal prosecution of all illegal immigrants. This policy entails remanding offenders to detention centers, thereby removing them from their children at the border. Children are then housed in centers overseen by the federal Office of Refugee Resettlement (part of the Department of Health and Human Services).
- Approximately 2,400 children were separated from their parents at the border between May 5, 2018 and June 19, 2018. As pictures, videos, audio clips and testimonials about wailing and inconsolable children in shelters began to surface on social media and the public began to lash out.
- Conservative leaders and noteworthy figures lent their voices to denounce family separation policies including Former First Lady, Laura Bush, Evangelical Christian leader Franklin Graham and even the current First Lady, Melania Trump (Time Magazine, July 2, 2018).
- June 20, 2018 President Trump signed an executive order attempting to end or put limits on timeframes that children can be separated from their parents, and current facilities are given 30 days to reunite children with their parents.
- Experts now admit that reunification will be difficult and will take time as proper steps were not taken to adequately document where children separated from their parents were being moved to.
Long Term Effects of Trauma on Children and the Role of Social Workers in This Current Predicament.
Now time will be the great decider. Will children be reunited with their parents in a timely manner? Since the signing of the executive order will current refugees and immigrants be detained for extended periods of time with their children? What will the consequences be for the youngest victims of these recent hardline decisions?
Why should it matter to all of us?
This essay is not intended as a policy debate. Some will argue that parents should not risk being arrested or separated from their children in an attempt to cross into the United States illegally. They will defend current separations as needed measures to uphold the law. Others will state that many families are fleeing desperate and even dangerous situations in their countries of origin and are taking great risks in an effort to provide a better life for their children. It can be said that information about the treatment of immigrants changes rapidly and those attempting to enter the US may be ill informed and even uneducated to the dangers. Putting politics and partisanship aside – there is little debate over the harm done to children who have been separated from their parents at the border. One of the worst cases catching the ardor of the American public was a 10 year-old girl with Down Syndrome being pulled away from her mother, crying uncontrollably and vomiting (reported on CNN, NY Times, Time.com, and The Guardian). Members of the American Pediatric Association have weighed in referring to multiple studies regarding the affects that this type of separation and trauma may have on these children later in life.
One such study (ACE Study;1998) by the CDC and Kaiser Permanente followed over 1700 participants to clearly show that Adverse Childhood Experiences (ACEs) can have long term physical and mental health consequences affecting nearly 60% of adults. One of these traumatic events is the sudden loss or separation from a parent. This does not even speak to the fear and confusion these children must continue to feel as they are detained in refugee shelters with little or no communication with their parent.
How these separations clearly represent trauma for the children effected
- Normal stress occurs for most of us over the course of a life time but evidence suggests that for children experiencing traumatic experiences, the presence of a loving parent helps to mitigate possible long term effects of these events.
- When a parent is part of the problem or when a loving care giver is not able to console or cuddle or assist a child in dealing with fear and adverse experiences, this combination can lead to toxic stress for a child.
- Toxic stress can lead to chronic damage to the adrenal glands and other organs, leading to prolonged health affects in adulthood including:
- Increased rates Heart Disease.
- Drug Abuse
- Learning Disabilities
The point of this essay is to make the link between recent events spotlighted in our national discussion on immigration and the lasting effects of early childhood trauma on adults. Understanding the potential costs and risks associated with these adverse childhood experiences means that we need to be vocal and determined to the treatment of the effected population.
- This will calls for painstaking steps toward family reunification and healing measures for those traumatized by recent immigration policies and zero tolerance measures.
- Social workers should become educated on both sides of the immigration debate.
- We must work to make sure information is disseminated to vulnerable populations before they reach the border or risk dangerous journeys and precarious legal situations.
- We must follow the roots of our profession and advocate for social justice of those offended and the vulnerable. This may include action to demand compensation for those harmed via these recent separations and healing measures taken for children traumatized by these detentions or separations.
Even if we are late to the crisis or just beginning to wrap our brains around the current news, the fate of these children is yet undetermined. Our understanding of resiliency in children is evolving but steps can be taken to heal the damage that has been done if we are bold. If we demand our government take responsibility for the potential toxic stress it has inflicted on these children and if we act in accordance with our current understanding of how to treat childhood trauma effectively. As social workers it is important to hold multiple frameworks in mind simultaneously and our role in this discussion has only just begun.
US Department of Health and Human Services; Administration for Children and Families; Administration on Children, Youth and Families; Children’s Bureau. Child Maltreatment 2011. http://www.acf.hhs.gov/programs/cb/resource/childmaltreatment-2011. Accessed May 29, 2014