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ISSUE BRIEF

May 2015

Developing a Trauma-Informed 

Child Welfare System WHAT’S INSIDE

Trauma and its effects

Implementing traumainformed practice in 

child welfare systems

Cross-system 

collaboration

Conclusion 

References

Acknowledgments

The effects of child abuse and neglect are as varied 

as the children affected. Some children who have 

experienced trauma are resilient and show few, 

if any, lasting effects. Others experience intense 

trauma, which may affect many aspects of their 

lives and last well into adulthood. It is essential 

that child welfare professionals are prepared to 

provide appropriate support to all children and 

families who experience trauma as a result of 

child abuse, neglect, or other acts of violence. 

This issue brief will discuss the steps that may 

be necessary to create a child welfare system 

that is more sensitive and responsive to trauma. 

Every child welfare system is different, and 

each State or county child welfare system will 

need to conduct its own systematic process of 

assessment and planning, in collaboration with 

key partners, to determine the best approach. 

After providing a brief overview of trauma and 

its effects, this issue brief discusses some of the 

primary areas of consideration in that process, 

including workforce development, screening and 

assessment, data systems, evidence-based and 

evidence-informed treatments, and funding. 
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

2

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Although partnerships are emphasized throughout 

the document, we end with a more indepth discussion 

of the importance of collaboration in creating a 

successful, trauma-informed child welfare system. 

The field is still in the beginning stages of gathering 

evidence about what is required to implement a traumainformed approach to child welfare, and what the 

outcomes of such an approach may be. For this reason, 

some of the content for this issue brief has been 

influenced by interviews with Children’s Bureau grantees 

and other thought leaders in the field who are among the 

first to implement and evaluate such an approach. This 

includes grantees funded through the Integrating TraumaInformed and Trauma-Focused Practice in Child Protective 

Service Delivery (HHS-2011-ACF-ACYF-CO-0169; http://

www.acf.hhs.gov/hhsgrantsforecast/index.

cfm?switch=grant.view&gff_grants_forecastInfoID=29079), 

Initiative to Improve Access to Needs-Driven, EvidenceBased/Evidence-Informed Mental and Behavioral Health 

Services in Child Welfare (HHS-2012-ACF-ACYF-CO-0279; 

http://www.acf.hhs.gov/hhsgrantsforecast/index.

cfm?switch=grant.view&gff_grants_forecastInfoID=40944), 

and Promoting Well-Being and Adoption After Trauma 

(HHS-2013-ACF-ACYF-CO-0637; http://www.acf.hhs.gov/

hhsgrantsforecast/index.cfm?switch=grant.view&gff_

grants_forecastInfoID=64839) grants.

Trauma and Its Effects

According to the Substance Abuse and Mental 

Health Services Administration (SAMHSA), “Individual 

trauma results from an event, series of events, or set 

of circumstances that is experienced by an individual 

as physically or emotionally harmful or life threatening 

and that has lasting adverse effects on the individual’s 

functioning and mental, physical, social, emotional, 

or spiritual well-being” (SAMHSA, 2014). If trauma 

follows a single event that is limited in time (such as 

a car accident, shooting, or earthquake), it is called 

acute trauma. When children are exposed to multiple 

traumatic events over time that are severe, pervasive, 

and interpersonal in nature (such as repeated abuse and 

neglect), and they experience long-term consequences 

from these experiences, this is called complex trauma 

(National Child Traumatic Stress Network, 2014). 

Complex trauma may interfere with a child’s ability to 

form secure attachments to caregivers and many other 

aspects of healthy physical and mental development.

Historical trauma affects populations that have 

experienced cumulative and collective trauma 

over multiple generations. Affected groups in 

the United States include American Indians, 

African-Americans, immigrant groups, and 

families experiencing intergenerational poverty. 

Children within these families may exhibit signs 

and symptoms of trauma—such as depression, 

grief, guilt, and anxiety—even if they have not 

personally experienced traumatic events.

Traumatic experiences overwhelm children’s natural 

ability to cope. They cause a “fight, flight, or freeze” 

response that affects children’s bodies and brains. 

Chronic or repeated trauma may result in toxic stress 

that interferes with normal child development and cause 

long-term harm to children’s physical, social, emotional, 

or spiritual well-being. These adverse effects can include 

changes in a child’s emotional responses; ability to think, 

learn, and concentrate; impulse control; self-image; 

attachments to caregivers; and relationships with others. 

Across the life span, traumatic experiences have been 

linked to a wide range of problems, including addiction, 

depression and anxiety, and risk-taking behavior—these 

in turn can lead to a greater likelihood of chronic ill 

health: obesity, diabetes, heart disease, cancer, and even 

early death. For more information about the long-term 

effects of child abuse and neglect and other traumatic 

experiences, see the Adverse Childhood Experiences 

study (ACE Response, http://www.aceresponse.org/

who_we_are/subpage.cfm?ID=43) and Longitudinal 

Studies of Child Abuse and Neglect (LONGSCAN, 

http://www.unc.edu/depts/sph/longscan/). Child 

Welfare Information Gateway also produced a factsheet 
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

3

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that explains the long-term physical, psychological, 

behavioral, and societal consequences of child abuse 

and neglect. Read Long-Term Consequences of Child 

Abuse and Neglect at https://www.childwelfare.

gov/pubs/factsheets/long-term-consequences.

Not all children will experience all of these effects. 

Children’s responses to traumatic events are unique 

and affected by many factors, including their age at 

the time of the event, the frequency and perceived 

severity of trauma, and the child’s innate sensitivity, 

as well as protective factors such as the presence 

of positive relationships with healthy caregivers, 

physical health, and natural coping skills.

Trauma of all kinds is extremely common among children 

involved with child welfare. Studies show that as many 

as 9 out of 10 children in foster care have been exposed 

to some form of violence (Stein et al., 2001). Entry into 

the child welfare system causes additional trauma due 

to separation from family, school, neighborhood, and 

community, as well as fear and uncertainty about the 

future. In addition, children who enter the child welfare 

system are more likely than others to have experienced 

multiple traumatic events and to exhibit more complex 

symptoms (Chadwick Trauma-Informed Systems 

Project, 2013). For example, one study showed that 

nearly half of youth who were subjects of maltreatment 

reports had emotional or behavioral problems that 

were clinically significant (Burns et al., 2004). 

Professionals who work within child-serving systems 

must be aware of a child’s trauma history and its 

effects, or their actions and responses to the child 

may inadvertently trigger trauma memories, worsen 

symptoms, or further traumatize the child. When child 

welfare professionals are mindful of a child’s history 

of trauma, they are better positioned to connect that 

child to appropriate, trauma-informed, evidence-based 

services for support. With awareness and knowledge of 

how to address and treat children’s trauma histories, the 

child welfare system can become a place of healing.

Implementing Trauma-Informed 

Practice in Child Welfare Systems

The National Child Traumatic Stress Network 

(NCTSN, n.d.) adopted the following definition of a 

trauma-informed system:

A trauma-informed child- and family-service 

system is one in which all parties involved 

recognize and respond to the impact of traumatic 

stress on those who have contact with the system, 

including children, caregivers, and service 

providers. Programs and agencies within such a 

system infuse and sustain trauma awareness, 

knowledge, and skills into their organizational 

cultures, practices, and policies. They act in 

collaboration with all those who are involved with 

the child, using the best available science, to 

facilitate and support the recovery and resiliency 

of the child and family.

In other words, trauma-informed child welfare practice is 

not a discrete task but rather involves the day-to-day 

work of the system as a whole. Child welfare systems that 

are trauma informed are better able to address children’s 

safety, permanency, and well-being needs. Service 

improvements include more children receiving the 

trauma screening, assessment, and evidence-based 

treatment they need. These improvements, in turn, may 

produce better outcomes, including:

 Fewer children requiring crisis services, such as 

emergency department visits or residential treatment

 Decreased use of psychotropic medications 

 Fewer foster home placements, placement 

disruptions, and reentries

 Reduced length of stay in foster care 

 Improved child functioning and increased well-being 

(U.S. Department of Health and Human Services, 2013)
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

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Use of Psychotropic Medications

Studies consistently show that children involved 

with child welfare are prescribed psychotropic 

medications at higher rates than the general 

population (Children’s Bureau, 2012). 

Effective screening and assessment for trauma 

can help child welfare systems more effectively 

identify and treat psychological symptoms and 

behaviors resulting from trauma. Addressing 

trauma symptoms with appropriate, evidencebased psychosocial treatment may decrease the 

need for psychotropic medications. 

See the following resources for more information:

 Use of Psychotropic Medications web section 

(resources for professionals, collected by Child 

Welfare Information Gateway): https://www.

childwelfare.gov/topics/systemwide/

mentalhealth/effectiveness/psychotropic/

 Making Healthy Choices: A Guide on 

Psychotropic Medications for Youth in Foster 

Care (a guide for professionals to use when 

working with youth, produced by the Children’s 

Bureau): https://www.childwelfare.gov/pubs/

makinghealthychoices/

Key elements of a transition to a trauma-informed child 

welfare system may include workforce development; 

routine screening and assessment for trauma history 

and related symptoms; changes to data systems; 

implementation of trauma-informed, measurementdriven case planning and referral to evidence-supported 

treatment; and new approaches to funding for services.

For more information and resources on implementation, 

see the Trauma-Informed Practice section of the 

Information Gateway website at https://www.

childwelfare.gov/topics/responding/trauma/. 

Workforce Development Considerations

The workforce is a critical element in the trauma-informed 

child welfare system. The workforce includes staff at all 

levels of the agency (receptionists, frontline staff, 

caseworkers, supervisors, managers, administrators, and 

other staff), as well as foster and adoptive parents. 

Many consider development of a trauma-informed 

workforce to be a necessary step before other 

components of a trauma-informed system can be 

implemented effectively. In order to become more trauma 

informed, professionals and resource families may need to 

make significant shifts in thinking and behavior while 

performing jobs that are stressful already. It will be 

important to integrate a trauma perspective throughout 

the system’s day-to-day activities as much as possible so 

that staff view this as an essential element of their work, 

rather than as simply another new initiative that may fade 

quickly. 

Shifts in Thinking

Moving from a traditional child welfare approach to one 

that is more trauma informed requires members of the 

workforce at all levels to make certain paradigm shifts. 

These may include the following:

 A “trauma lens.” In the past, trauma was thought to 

result from a single, catastrophic event. We now know 

that chronic neglect, abuse, or any incident of 

separation, loss, or grief—even a sudden move or 

placement change—can be traumatic for children. 

Developing a trauma lens includes reinterpreting 

behaviors that were previously seen as being caused 

by a mental illness or behaviors exhibited by a “bad 

kid” as the potentially reversible consequences of 

trauma.

In general, becoming a trauma-informed 

child welfare system involves a shift from 

asking, “What’s wrong with you?” to asking, 

“What happened to you?” 

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 Shift in goals. The focus of child welfare services is 

often on substantiating a defined occurrence of child 

maltreatment and ensuring children’s physical safety. In 

a trauma-informed system, the focus broadens to 

include healing the impact of trauma and improving 

children’s social and emotional well-being, along with 

the more traditional goals of safety and permanency. 

 Importance of collaboration. To achieve the goal of 

enhancing well-being, many child welfare agencies find 

they must significantly deepen their collaboration with 

other service systems, including enhancing 

communication, planning and working toward joint 

goals, sharing robust data about the families they 

serve, and strategically blending or braiding funding 

streams.

 Focus on early intervention. A growing body of 

research demonstrates the long-term effects of trauma 

on children’s physical, social, and emotional well-being. 

A trauma-informed child welfare system reflects the 

understanding that by focusing more resources on 

identification of trauma and early intervention services, 

we may prevent or mitigate some of those long-term 

effects.

 Approach to families. In making this shift, it is 

important to be clear with families about the boundary 

between their involuntary participation in the child 

welfare system (substantiation of maltreatment) and 

what may be their voluntary participation in services to 

promote healing from trauma. 

 Awareness of intergenerational trauma. It also is 

important to understand that family members are likely 

to have experienced their own trauma. Like their 

children, caregivers’ challenging behaviors may be 

most productively viewed as maladaptive responses to 

their own trauma.

 Role of child welfare professionals. With the shift in 

attention toward well-being and healing, the child 

welfare professional’s role changes. Staff will spend 

more time screening for trauma, facilitating effective 

mental health treatment, and following up to ensure 

appropriate progress is being made toward those 

treatment goals, including monitoring the use of 

psychotropic medication. 

 Awareness of secondary traumatic stress. Hearing 

about children’s trauma histories may result in 

secondary traumatic stress among professionals and 

caregivers. Left untreated, this can decrease 

effectiveness and lead to excessive burnout or 

turnover. Being trauma informed requires attention to 

trauma’s effects on all participants in the system, 

including children, caregivers, and service providers. 

Staff Training

Trauma training should be introduced from the beginning 

of each staff member’s employment at the agency. Topics 

may include:

 Trauma basics: What trauma is, its impact on the brain, 

nd how it affects children (including the role of 

riggers/reminders)

a

t

 How to screen children for trauma

 Children’s need for physical and psychological safety 

 Resiliency case planning: Looking beyond risk to 

explore how services can build children’s resilience and 

sense of competency

 When, how, and where to refer children for evidencebased trauma treatment

 How to work with parents who have been traumatized 

The National Child Traumatic Stress Network 

(NCTSN) offers the Child Welfare Trauma Training 

Toolkit, which is available at http://www.nctsnet.

org/products/

child-welfare-trauma-training-toolkit-2008.

NCTSN also offers a guide for administrators on 

using a trauma-informed lens to transform child 

welfare systems. It is free and can be accessed 

after creating an account and logging in at http://

www.surveygizmo.com/s3/1769592/

Access-to-Creating-TICW-Systems-A-Guide-forAdministrators-CTISP-DI. 

For more training resources, visit the NCTSN 

website at http://www.nctsnet.org/resources/

training-and-education.

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Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
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6

Effective training for trauma-informed child welfare 

practice will require more than a single workshop or class 

session. Staff need to be actively engaged in changes to 

the system; soliciting their input will be critical to creating 

buy-in and successful implementation. Adult learners also 

need to hear messages many times, and in a variety of 

ways, before they are likely to change their behavior. 

Training can be conducted separately for child welfare 

professionals, but it may have more impact if child welfare 

staff are cross-trained with other professionals in partner 

agencies and systems. After initial training, follow-up 

training and technical assistance can be provided in some 

or all of the following formats:

 Supervision, including case review, fidelity monitoring, 

and accountability

 Coaching and mentoring

 In-house “trauma consultants” or “trauma champions”

 Learning collaboratives

 Periodic “booster” trainings (face to face or via 

webinars)

 Newsletter tips and reminders about trauma 

symptoms, behaviors, and impact

Education and Support for Resource Families

In a trauma-informed child welfare system, information 

about child traumatic stress is a central part of the initial 

training required to become a foster or adoptive parent. 

Current resource parents can be trained separately or 

engaged in joint trainings with child welfare staff. This 

training also should be offered to kinship caregivers, as 

well as to birth parents who are reuniting with their 

children. It should include the basics of trauma and its 

impact on children, the significance of trauma triggers, 

how to recognize and respond appropriately to traumarelated behaviors, how foster and kinship caregivers can 

work effectively with birth parents, and the importance of 

self-care.

Education is an ongoing process. After initial training, a 

trauma-informed perspective can be infused in work with 

resource parents in additional ways, including the 

following:

 Regularly include tips or articles about child trauma in 

resource parent newsletters. (See the Information 

Gateway factsheet Parenting a Child Who Has 

Experienced Trauma, which can be found at https://

www.childwelfare.gov/pubs/factsheets/child-trauma.) 

 Connect foster parents or kinship caregivers with birth 

parents soon after placement, and collect information 

from birth parents to share with caregivers regarding 

the child’s trauma history, triggers, and behaviors.

 Conduct child-focused team meetings that engage 

birth parents and kinship caregivers or foster parents in 

collective planning and problem solving. Include a 

trauma consultant on these teams to provide early 

intervention to children who display troubling 

behavioral symptoms in placement.

 Implement placement disruption prevention meetings 

when needed.1

1 Some of the training suggestions for professionals and resource 

families are derived from the National Child Traumatic Stress Network 

(2013).

Caring for Children Who Have Experienced Trauma: A 

Workshop for Resource Parents, by the National Child 

Traumatic Stress Network, is a training resource that may 

be useful when working with resource parents, see http://

www.nctsnet.org/products/

caring-for-children-who-have-experienced-trauma.

Secondary Traumatic Stress

Working with children and families who have experienced 

trauma is undeniably difficult. As professionals screen and 

assess children and families for trauma, and resource 

parents receive more information about children’s 

histories, they may be vulnerable to secondary traumatic 

stress (STS)—traumatic stress as a result of exposure to 

others’ experiences. (Secondary traumatic stress is 

sometimes referred to as vicarious trauma or compassion 

fatigue.) Left untreated, STS can lead to decreased 

effectiveness and morale and high rates of burnout and 

turnover.

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7

A trauma-informed child welfare agency recognizes the 

need to invest in the health, well-being, and resilience of 

its workforce. Some suggestions for helping to prevent 

and address STS (and attend to primary stress 

experienced on the job) include the following:

 Begin trauma trainings with a discussion of STS. This 

can help professionals make a personal connection to 

the topic and build buy-in for the training, while 

validating staff experience.

 Create peer-to-peer support groups to give staff and 

resource families opportunities to learn about STS, 

share their experiences, and discuss coping strategies.

 Build “resident expert teams” of 6 to 10 staff members 

charged with identifying and assessing STS and its 

effects and helping to build a system to better support 

affected staff. 

 Offer health and wellness activities (e.g., mindfulness, 

yoga, dance, art) in the office and at foster parent 

trainings or gatherings to encourage resilience.

 Integrate resilience skill-building into training, staff 

meetings, and supervision.

 Offer Psychological First Aid to staff and resource 

families who work with a child or family involved in a 

tragic accident, incident of violence, or death.2

2 Psychological First Aid is an evidence-informed approach for assisting 

children, adolescents, adults, and families in the aftermath of disasters, 

see http://www.nctsn.org/content/psychological-first-aid.

 Take time during supervision and/or case staffing to 

address how cases are impacting the child welfare 

professional personally and what support is needed 

from peers.

Find more information about STS on the Child Welfare 

Information Gateway website at https://www.childwelfare.

gov/topics/responding/trauma/secondary/.

Screening and Assessment

A trauma-informed child welfare system relies heavily on 

initial and ongoing screening and assessment to identify 

children’s trauma-related needs and assess their progress 

(U.S. Department of Health and Human Services, 2013). 

The goals of trauma screening and assessment include 

the following:

 Trauma screening to learn about a child’s trauma 

history, to identify current symptoms and functional 

delays, and to identify children who need further 

assessment and possible treatment. Screening should 

be brief and should be administered to all children 

entering child welfare, as part of or in addition to 

regular, comprehensive screenings already conducted 

by child welfare professionals, such as safety and risk 

assessment, family assessment, placement tools, and 

collection of prenatal and parents’ medical history. 

Screening should be repeated periodically thereafter, 

including after stressful events, such as a change in 

placement.

 Mental health assessment for children whose screen 

indicates a trauma history combined with 

psychological symptoms and/or functional delays. A 

positive screen warrants referral to a specialist. This 

more indepth clinical evaluation by a mental health 

professional may include a diagnostic interview in 

addition to standardized mental and behavioral health 

assessment tools. The mental health assessment forms 

the basis for treatment planning. 

 Functional assessment or periodic and holistic 

evaluation of a child’s social and emotional functioning. 

In the case of functional assessment, measurement 

tools are used not to reach a diagnosis but to gather 

data about individual children’s strengths and needs, 

measure improvement in skills and competencies, and 

inform ongoing case planning. Many evidence-based 

treatment models incorporate this within service 

delivery.

 Outcome measurement. At a child level, outcomes 

are measured to ensure that services are achieving 

desired effects and to inform changes to the treatment 

plan. At the system level, this process can help identify 

changes needed to improve the effectiveness of the 

service array as a whole.

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These goals are not mutually exclusive—a single 

instrument, in the right context, may be used for multiple 

purposes. For example, functional assessment measures 

may be administered as part of the mental health 

assessment and may also serve the role of outcome 

measurement. (For a more detailed discussion, see 

Conradi, Landsverk, & Wotring, 2014.)

Selecting Screening and Assessment Measures

The following are some considerations that child welfare 

agencies and their partners might weigh when selecting 

trauma screening and assessment instruments:

Length. Keeping an initial screening as brief as possible is 

critical, in light of other activities that must be completed 

by child welfare professionals upon children’s entry to the 

system. Children whose initial trauma screens are positive 

should receive a more thorough follow-up assessment by 

a clinical mental health provider.

Content. Most screening tools seek to assist busy child 

welfare professionals in quickly identifying trauma 

exposure and/or symptoms. There tend to be different 

screening tools for older and younger children, and some 

tools employ language and cultural adaptations for 

different populations. A follow-up assessment should 

more fully explore the child’s trauma history and current 

symptoms. Symptoms may include internalizing and 

externalizing behaviors, as well as moods, cognitive 

issues, school difficulties, trauma triggers, and relational 

skills, among others. 

Connections Between Trauma Exposure and 

Symptoms. Some tools have the potential to help 

professionals see important connections between a 

child’s exposure to traumatic events and his or her 

present functional difficulties. An instrument that makes 

these connections explicit may help prevent staff from 

misinterpreting behavior and may facilitate more 

appropriate referrals.

Cost. Costs to consider include the initial purchase of the 

instrument, training required to implement it, and 

expenses for data collection and/or analysis.

Ease of Administration and Data Sharing. Agencies 

and partners may need to ask the following questions: Is it 

a paper/pencil screening, or can it be administered via 

computer, with results linked automatically into the 

existing data system? Is the instrument self-scoring? 

Where will the necessary information come from (the 

parent/caregiver, the child, other sources such as case 

records and third-party reports)? 

Psychometric Properties. How accurately does the tool 

measure what it purports to measure? How many false 

positives and/or negatives will it produce (e.g., sensitivity 

and specificity)?

For more potential screening and assessment tools, visit 

the following websites:

 National Child Traumatic Stress Network Measures 

Review Database: http://www.nctsn.org/resources/

online-research/measures-review

 SAMHSA, Screening Tools for Trauma: http://www.

integration.samhsa.gov/clinical-practice/

screening-tools#TRAUMA

Data System Needs

Selecting appropriate screening and assessment tools is 

important, but it is equally important to consider how the 

data will be used—individually, on a systems level, and 

across systems. Currently, the research base does not 

exist to say what approaches to data collection and 

sharing are most effective. The field is just beginning to 

explore what data a trauma-informed child welfare agency 

needs to collect and how those data should be used. 

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9

The following are some questions for child welfare 

agencies to consider as they assess their own data 

systems’ strengths, needs, and gaps, and develop 

processes for filling those gaps:

 On a child level, how might critical data (for example, 

screening and assessment results) be captured as a 

child moves throughout the system? Could these data 

be used to prompt a caseworker to follow up with 

further assessments or treatment, or could the data 

system help track an individual child’s progress and 

drive case planning by comparing results over time? 

 On a systems level, how can aggregated data be 

used to understand what is happening to children in 

the child welfare system? For example, what types of 

children are improving, based on functional 

assessment scores? What services are they using? 

Which children are not improving or are getting worse? 

 Across systems, how could data be made accessible 

to all service providers who are involved with a child, 

including those working in systems such as mental 

health and Medicaid, while taking into consideration 

confidentiality concerns and privacy guidelines where 

applicable? Likewise, could the results of assessments 

completed by mental health professionals and 

Medicaid claims data (for example, data related to 

prescription and dosage of psychotropic medications) 

be accessible within the child welfare data system to 

inform case planning?

Evidence-Supported Practices for Trauma 

Treatment

To recover from trauma, children and families often 

require treatment delivered by skilled child welfare staff 

and mental health therapists. Children are well served 

when interventions are effective and appropriate for their 

needs, gaps and duplication are eliminated from the 

service array, and funders work together to coordinate 

services and reimburse providers for treatment.

Selecting Evidence-Based/Evidence-Informed 

Interventions

To ensure an appropriate array of evidence-based and 

evidence-informed services for children who have 

experienced trauma, child welfare systems must first 

assess the needs of their population and the services that 

currently exist within their communities. 

Children and youth should be reevaluated periodically to 

identify any new symptoms that have emerged and to 

assess treatment progress. Data about children’s 

improvement (or lack thereof) over time, gathered from 

functional assessments and outcomes measurement, can 

be used to continuously monitor individual children’s 

progress and guide case planning. 

Eventually, this data also may be aggregated to help 

agencies assess the appropriateness of the service array 

for all children and for particular subgroups. Using that 

information, the service array can be further reconfigured 

to best meet the measured needs of children, as part of 

the agency’s continuous quality improvement (CQI) 

process. (For more information about CQI in child 

welfare, see the Children’s Bureau Information 

Memorandum on Establishing and Maintaining 

Continuous Quality Improvement Systems in State Child 

Welfare Agencies, http://www.acf.hhs.gov/sites/default/

files/cb/im1207.pdf, and the Information Gateway web 

section on Approaches to Quality Improvement at https://

www.childwelfare.gov/topics/management/practiceimprovement/quality/approaches/.)

Following are some evidence-based and evidenceinformed programs that are being used to help children, 

youth, and families who have experienced trauma. 

The research base for these treatments varies; the 

inclusion of a program in this issue brief should not be 

viewed as an endorsement by the Children’s Bureau. 

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10

For more information about evidence-based 

treatments, visit the following websites:

 California Evidence-Based Clearinghouse for 

Child Welfare, Trauma Treatment (Child & 

Adolescent): http://www.cebc4cw.org/topic/

trauma-treatment-for-children/

 National Child Traumatic Stress Network 

Empirically Supported Treatments and 

Promising Practices: http://www.nctsn.org/

resources/topics/treatments-that-work/

promising-practices

 SAMHSA’s National Registry of Evidencebased Programs and Practices: http://www.

nrepp.samhsa.gov/

Evidence-based treatments are those that are supported 

by scientific research as being effective in improving 

outcomes for children and families. They have strong 

research design, evidence of significant positive effects, 

sustained effects, and capacity for replication.

A strong evidence base supports the following practices, 

according to the California Evidence-Based 

Clearinghouse:

 Trauma-Focused Cognitive-Behavioral Therapy 

(TF-CBT) is one highly popular and well-researched 

intervention shown to help children and adolescents 

who have experienced trauma. It is designed to reduce 

negative emotional and behavioral responses by 

addressing distorted beliefs and attributions related to 

the trauma. For more information about TF-CBT, visit 

http://tfcbt.musc.edu/ or read Information Gateway’s 

Trauma-Focused Cognitive Behavioral Therapy for 

Children Affected by Sexual Abuse or Trauma at 

https://www.childwelfare.gov/pubs/trauma/. 

 Parent-Child Interaction Therapy (PCIT) is a familycentered treatment approach proven effective for 

abused and at-risk children ages 2 to 8 and their 

caregivers. During PCIT, therapists coach parents while 

they interact with their children. For more information, 

visit http://www.pcit.org/ or read Information 

Gateway’s Parent-Child Interaction Therapy With 

At-Risk Families at https://www.childwelfare.gov/

pubPDFs/f_interactbulletin.pdf. 

 Eye Movement Desensitization and Reprocessing 

(EMDR) has been validated as an effective treatment 

for trauma victims. It integrates a number of different 

therapeutic approaches, including cognitivebehavioral therapy and the use of eye movements to 

decrease emotional distress related to traumatic 

memories. For more information about EMDR, visit 

http://www.emdr.com/.

Evidence-informed practices make use of the best 

available research and practice knowledge to guide 

program design and implementation within the context of 

the child, family, and community characteristics, culture, 

and preferences.

The following are some of the available trauma-focused 

treatment models supported by research or practice 

knowledge:

 Alternatives for Families: A Cognitive-Behavioral 

Therapy (AF-CBT): http://www.afcbt.org/ 

 Attachment and Biobehavioral Catch-up (ABC): 

http://www.infantcaregiverproject.com/#!about_us/

cjg9 

 Attachment, Self-Regulation, and Competency 

(ARC): http://www.traumacenter.org/research/ascot.

php

 Child and Family Traumatic Stress Intervention 

(CFTSI): http://www.nrepp.samhsa.gov/

ViewIntervention.aspx?id=305

 Child-Parent Psychotherapy (CPP): 

http://preview.childtrauma.ucsf.edu/resources-0

 Cognitive-Behavioral Therapy for Posttraumatic 

Stress Disorder (CBT for PTSD): http://www.ncbi.nlm.

nih.gov/pmc/articles/PMC3083990/

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

11

 Modular Approach to Therapy for Children with 

Anxiety, Depression, Trauma or Conduct Problems 

(MATCH-ADTC): http://www.practicewise.com/

portals/0/MATCH_public/index.html

 Prolonged Exposure Therapy for Adolescents: 

http://www.med.upenn.edu/ctsa/certification.html

 Real Life Heroes: http://reallifeheroes.net/ 

 The Sanctuary Model: http://sanctuaryweb.com/

sanctuary-trauma.php

 Structured Psychotherapy for Adolescents 

Responding to Chronic Stress (SPARCS): 

http://sparcstraining.com/

 Trauma Affect Regulation: Guide for Education and 

Therapy (TARGET): http://www.advancedtrauma.com/

Services.html

 Trauma Systems Therapy (TST): http://www.

aboutourkids.org/traumasystemstherapy/ 

Selecting Interventions

Before meaningful changes to the service array can be 

made, there must be buy-in at all levels of the childserving system, as well as collaboration across systems, 

including Medicaid, mental health, juvenile justice, 

education, and health care. Administrators and decisionmakers must fully understand the effects of trauma and 

embrace the need to develop and fund evidence-based 

treatments. 

The following are some questions for agencies to consider 

to help assess the fit of a particular therapeutic model for 

a community’s needs:

 What level of evidence is available to support claims 

of effectiveness?

 Is the practice effective with a broad spectrum of 

children and families (including various ages and 

cultural settings)?

 Has the practice been proven effective specifically with 

children and families who have experienced 

trauma?

 Is the practice a good fit for the needs of the target 

population?

 What kind of implementation support is offered for 

the treatment model (including fidelity management)? 

Are there ongoing trainings and support, or is training 

delivered in a single session?

 Can the model be delivered in an outpatient setting?

 Does it include a caregiver component?

 Who administers the therapy? What level of education 

and training is required?

 How much will it cost to implement and sustain the 

practice?

 Who owns and supports the treatment model?

 How readily available is the model, and how 

accessible is training and support?

 Is the model a good fit with agency and partner 

needs, values, workforce capacity, and other 

resources?

 Can the model be adapted as needed while 

maintaining adequate fidelity? 

Funding

The field has yet to reach consensus on whether 

developing a trauma-informed child welfare system will 

require additional funding and what a successful 

approach to funding this work will entail. (While it seems 

clear that implementing evidence-based practices will 

require significant investments to train staff and maintain 

fidelity, these costs may be offset by savings in other 

areas within a fully trauma-informed system.) Because 

every child welfare jurisdiction is different, States and 

counties will lead the way in developing what works best 

for them.

Agencies may wish to begin by exploring opportunities to 

leverage current, existing funding streams to support 

trauma-informed training, screening and assessment, 

interventions, and data systems. This will likely include 

working closely with systemic partners—for example, 

working with the State Medicaid system and managed 

care organizations to fund evidence-based, traumainformed treatments for children. However, the available 

resources and policies guiding the use of these funding 

streams will vary by State. 

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

12

The Information Gateway Funding for Program Areas web 

section lists resources for specific types of programs, 

including mental health. It can be found at https://www.

childwelfare.gov/topics/management/funding/

program-areas/. 

For information and resources about Medicaid funding, 

see the web section on using Medicaid to fund prevention 

services at https://www.childwelfare.gov/topics/

management/funding/program-areas/prevention/federal/

nondedicated/medicaid/. 

Agencies may also want to review the guidance provided 

in the following joint Center for Medicaid and CHIP 

Services (CMCS) and SAMHSA Informational Bulletin on 

coverage of behavioral health services for children, youth, 

and young adults with significant mental health conditions 

(a category that is likely to include many children who 

have experienced trauma) at http://www.medicaid.gov/

federal-policy-guidance/downloads/CIB-05-07-2013.pdf. 

Cross-System Collaboration

To serve traumatized children and families effectively, the 

entire child-serving system—at the agency, local, and 

State levels—needs to understand trauma and create 

policies and practices that support more effective 

treatment. In a trauma-informed system, child welfare, 

mental health, Medicaid, juvenile justice, the courts, 

health care providers, and schools work together with a 

common purpose of helping children and families heal.

Collaboration is not without challenges. Some of the 

difficulties experienced by Children’s Bureau grantees 

interviewed for this brief include the following:

 Different understandings of what trauma is and how it 

affects children and families

 Conflicting goals or priorities

 Funding constraints

 Policies and practices that limit the time available to 

help children and families heal from trauma 

 Lack of a universal consent form or other confidentiality 

concerns

Despite these challenges, some strategies have shown 

promise in building collaboration across child-serving 

systems. Building relationships across systems as a matter 

of course and maintaining these relationships through 

regular contact have been found to be more effective 

than waiting for a crisis to force systems to work together. 

Some strategies for initiating stronger cross-disciplinary 

relationships include the following:

 Cross-disciplinary trauma training. When 

professionals from various child-serving disciplines 

attend trauma training together, they develop a shared 

vocabulary, commitment, and understanding of trauma 

and have the opportunity to develop norms, values, 

and procedures for how teams will work together to 

support children and families. 

 Collaborative system mapping. In this process, 

representatives from multiple disciplines work together 

to create a flow chart for how children and families 

move through each system. This can help staff and 

administrators alike learn more about how other 

systems work. Identifying points of intersection 

between systems can lead to deeper discussions 

about infrastructure, case/treatment plans, referrals, 

data sharing, and communication (e.g., when there is 

court involvement or a threat of disruption). 

 Shared STS trainings. All child-serving professionals 

have stressful jobs and experience the difficulties of 

working with children and families who have trauma 

histories. Sharing experiences of secondary trauma 

may build understanding across disciplines and “break 

the ice” for systems to work toward partnership in 

other areas, as well. 

 Case conferencing. Talking about specific children 

and families can be another way to build investment 

and relationships across systems. Working together to 

solve problems and promote healing for a specific 

child, about whom all participants share concern, 

fosters communication and relationships that may carry 

over into work on other cases in the future.

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

13

 Funding. Funding can be used in various ways to 

encourage and support cross-system collaboration to 

better serve children’s trauma needs. This is happening 

at a Federal level among the Administration for 

Children and Families, Centers for Medicaid and 

Medicare Services, and SAMHSA (for more 

information, visit http://www.medicaid.gov/FederalPolicy-Guidance/Downloads/SMD-13-07-11.pdf). At a 

local level, this might include strategies such as 

providing incentive payments to encourage mental 

health clinics to provide evidence-based trauma 

treatment services to children in the child welfare 

system, or funding a cross-disciplinary trauma learning 

collaborative.

Although collaboration can be challenging, the benefits 

to children and families are great as communities move 

from a fragmented approach to a cross-system approach 

that treats each child as a whole person.

Conclusion

Increased attention to childhood trauma within child 

welfare agencies across the country reflects a growing 

understanding of the significant impact that trauma can 

have on children’s well-being and the community as a 

whole. Left untreated, trauma may have serious, complex 

consequences for children throughout their lifespan. 

Addressing trauma effectively is more than an isolated 

practice; it requires a coordinated, system-wide approach. 

Working together, staff at all levels of the child welfare 

system and related agencies—as well as resource 

families—can implement the screening, assessment, and 

treatment practices needed to better help the children 

and families in their care heal from trauma. 

For more information and resources, see the Treatment 

and Trauma-Informed Care section of the Child Welfare 

Information Gateway website at https://www.childwelfare.

gov/topics/responding/trauma/. 

References

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Kolko, D. J. Campbell, Y., & Landsverk, J. (2004). Mental 

health need and access to mental health services by 

youths involved with child welfare: A national survey. 

Journal of the American Academy of Child & 

Adolescent Psychiatry, 43(8), 960–970.

Chadwick Trauma-Informed Systems Project. (2013). 

Creating trauma-informed child welfare systems: A 

guide for administrators (2nd ed.). San Diego, CA: 

Chadwick Center for Children and Families. http://

www.chadwickcenter.org/CTISP/images/

CTISPTICWAdminGuide2ndEd2013.pdf

Children’s Bureau, Administration on Children, Youth and 

Families, Administration on Children and Families, U.S. 

Department of Health and Human Services. (2012). 

Information Memorandum (ACYF-CB-IM-12-03). 

Retrieved from http://www.acf.hhs.gov/sites/default/

files/cb/im1203.pdf

Conradi, L., Landsverk, J., & Wotring, J. R. (2014). 

Screening, assessing, monitoring outcomes, and using 

evidence-based interventions to improve the wellbeing of children in child welfare. Washington, DC: 

Children’s Bureau. http://www.nrcpfc.org/is/

downloads/WP-ScreeningAssesingAndMonitoring.pdf

National Child Traumatic Stress Network. (n.d.). Creating 

trauma-informed systems [Webpage]. Retrieved from 

http://www.nctsn.org/resources/topics/

creating-trauma-informed-systems

National Child Traumatic Stress Network. (2013). Using 

trauma-informed child welfare practice to improve 

placement stability: Breakthrough series collaborative 

[Practice cards]. Retrieved from http://www.nctsn.org/

sites/default/files/assets/pdfs/using_ticwp_bsc_

practicecards_final.pdf

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/trauma-informed.
Developing a Trauma-Informed Child Welfare System https://www.childwelfare.gov

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trauma: Facts for caregivers. Retrieved from http://

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complex_trauma_caregivers_final.pdf

Substance Abuse and Mental Health Services 

Administration. (2014). SAMHSA’s concept of trauma 

and guidance for a trauma-informed approach. HHS 

Publication No. (SMA) 14-4884. Rockville, MD: 

SAMHSA. Retrieved from http://store.samhsa.gov/shin/

content//SMA14-4884/SMA14-4884.pdf

Stein, B., Zima, B., Elliott, M., Burnam, M., Shahinfar, A., 

Fox, N., et al. (2001). Violence exposure among schoolage children in foster care: Relationship to distress 

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Acknowledgments: 

This issue brief was developed by Child Welfare 

Information Gateway and based in part on interviews with 

Children’s Bureau grantees funded through the 

Integrating Trauma-Informed and Trauma-Focused 

Practice in Child Protective Service Delivery (HHS-2011-

ACF-ACYF-CO-0169), Initiative to Improve Access to 

Needs-Driven, Evidence-Based/Evidence-Informed 

Mental and Behavioral Health Services in Child Welfare 

(HHS-2012-ACF-ACYF-CO-0279), and Promoting WellBeing and Adoption After Trauma (HHS-2013-ACFACYF-CO-0637). Information Gateway wishes to 

acknowledge the valuable input of Becci Akin, Chad 

Anderson, Linda Bass, Sharri Black, James Caringi, Marilyn 

Cloud, Pamela Cornwell, James Henry, Kevin Kelley, Alice 

Lieberman, Patricia Long, Susana Mariscal, Kelly 

McCauley, Vickie McArthur, Kathryne O’Grady, Sherry 

Peters, Jeanne Preisler, Cheryl Rathbun, and Jim Wotring. 

The conclusions discussed here are solely the 

responsibility of the authors and do not represent the 

views of grantees or the official views or policies of the 

funding agency.

Suggested citation: 

Child Welfare Information Gateway. (2015). Developing a 

trauma-informed child welfare system. Washington, DC: 

U.S. Department of Health and Human Services, 

Children’s Bureau.

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau