Trauma Informed Care: Getting to root causes

Adverse Childhood Experiences are the underlying theme for most ailments in our society from academic failures, to ADHD-like behavioral disturbances, to anxiety and depression, to heart attacks, lung cancer, stroke and diabetes, to name a few. These illnesses develop as a result of maladaptive coping skills such as smoking, alcohol and other mind-altering substance abuse, overeating, unhealthy-sex, all of which are self-medication methods traumatized individuals turn to.

Thus, when our schools suspend children and adolescents from school because of behavioral problems, they are addressing only the tip of the iceberg and in a punitive manner rather than a rehabilitative one. When, in hospitals we get upset with patients with obstructive lung disease who insist on smoking, we are missing the underlying depression. When we try children in adult court system for a crime, we are missing an opportunity to help them become good citizens. When our child protection services do not explore childhood trauma history of children and their caretakers, we are not addressing the underlying causes of child abuse and neglect and allowing family dysfunction to be transmitted from one generation to the other.

The answer to unfolding the root causes of these public health issues is to implement trauma informed care (TIC) in all agencies providing services to citizens, but more so in medical, educational, social services, and justice systems. The Substance Abuse and Mental Health Services Administration defines TIC as follows: 'A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”

In my clinic, we have implemented TIC for children and families. I can't begin to tell you how appreciative families have been just because we attempt to learn their trauma history, their strengths, and their current needs from public service providers in a compassionate manner.

Community service agencies should collaborate with strong family navigation resources to help families reach necessary rehabilitative and therapeutic resources. This then brings up, the need for resources.

Iowa is underserved in mental health services. We need widespread expertise in all counties of Iowa on psychological first aid, parent child interaction therapy, trauma-focused cognitive behavioral therapy, and psychiatric treatment to provide trauma specific services. We need non-judgmental family-friendly parenting education programs in all counties that provide easy access to all young parents. We need quality day-care services available to all young parents at affordable cost, knowing that $1 of investment leads to $9 of return even if it is a decade or two later. We need to start investing in prevention and investing in our children.

The readers also have a responsibility in this paradigm shift: Ask your doctor whether their facility is a TIC facility. Ask the principal of your child's school what they have done to bring TIC to their school, their guidance counseling/nursing system. And ask all politicians who ask for your vote, what they are planning to do to invest into our children's future.

' Dr. Resmiye Oral is a Clinical Professor of Pediatrics and Director of the University of Iowa, Carver College of Medicine's Child Protection Program. Comments: (319) 384-6308; resmiye-oral@uiowa.edu