Leading the Way for a Trauma-informed Child Welfare System

Though mental health receives special attention every year on Oct. 10, World Mental Health Day, Texas CASA works year-round to improve mental health and substance abuse services for families involved in the child welfare system. We’d like to share with you some of those initiatives.

Utilizing data from the final report Understanding Trauma-Informed Care in the Texas Child Welfare System: Data and Recommendations from the Field (2015), Texas CASA’s Public Policy team is working to ensure that everyone involved in a child’s case receives proper training on identifying, understanding and advocating for the needs of children who have experienced trauma. It is important to remember that children in the foster care system experience trauma not only prior to removal, but also as a result of it. Not all damage from abuse, neglect, and loss of family and familiar environments is visible, and we as CASAs must educate ourselves and others on how to address special needs that lie beneath the surface.

One resource available for immediate use is the one-hour training video Trauma-Informed Advocacy, developed by the Children’s Commission in partnership with Texas CASA and the Shield-Ayres Foundation. This training, led by Regional Attorney for the Department of Family and Protective Services (DFPS) Elizabeth Watkins, JD, helps to introduce trauma-informed care and promote strategies for advocating for children in courtrooms, schools and placements.

It helps to think of children in the foster care system as icebergs, said Watkins.

“Underneath the surface of these kids is all the stuff we were never there for,” she explained. “What we see is the tip of the iceberg… [but] it’s the behavioral changes that we need to be aware of as well.”

In an effort to address these behavioral changes and special needs, Watkins promotes the three core principles of Trust-Based Relational Intervention® (TBRI®) developed by the Karyn Purvis Institute of Child Development: Empowering, Connecting and Correcting.

“You need to empower [these children]. You need to connect with them, and then you need to stay connected with them,” she said. “And then if you’re having those issues with behavior there are some strategies to correct that behavior.”

Providing case examples, Watkins illustrates how trauma-informed advocates can help safely bring issues to the surface, where they can be effectively dealt with and “melt away.”

Thanks to a grant from the Hogg Foundation for Mental Health, we have been able to hire two-year Public Policy Fellow Bryan Mares. Still in the research phase of his work, Mares says that most of his legislative proposals will be “focused on establishing prevention strategies and early detection for referral to services.”

These proposals include:

  1. Allocating more funding for adult mental health and prevention services, including services for families at risk of CPS involvement.
  2. Ensuring that everyone who interacts with children in foster care understands trauma-informed care so that these children are supported by a trauma-informed system.
  3. Allocating state funding for the expansion of family drug and mental health courts into other counties and for the identification and adoption of best practices. Mares will also develop proposals that would enable families to stay together when home safety is not a concern. This way, children can stay at home while their families receive outpatient mental health services.
  4. Supporting funding and expansion of family-based residential treatment facilities for substance abuse disorders so that children receive professional care while their parents receive inpatient treatment.
  5. Directing the Health and Human Services Commission (HHSC) to develop a Medicaid auto-renewal process so that former foster youth maintain federally-guaranteed coverage through age 26 and their mental health services are not disrupted.
  6. Supporting periodic mental health and substance abuse screenings for youth ages 15-26, a population with a higher risk of substance abuse, both in and out of foster care.

With the help of other advocacy groups and Superior Health Plan, Mares is also reviewing both the operational requirements and Medicaid reimbursement rates for mental health providers operating within the STAR Health network.

“We have an alarming rate of child removals where substance use or mental illness was a factor,” Mares said. “In addition to prevention practices, we need to improve our mental health services by going beyond medicated treatment and supplementing it with therapeutic interventions.”

Mares explained that not only do we need to identify and support communities with higher risks of CPS involvement and removals, we must also make concerted efforts to understand these communities.

“I think one thing we can work on is the use of culturally sensitive practices by behavioral providers and CASA volunteers,” he said. “[Furthermore,] families of color may be reluctant to seek treatment simply because of the perpetual stigma associated with mental illness within their culture. We can work to reduce this stigma by using a multicultural perspective in addition to addressing mental health the same way we do physical health.”