1

Trauma refers to a deeply stressful experience 

or its short and long-term impacts. Because 

exposure to trauma can cause a host of problems 

with lifelong consequences, early screening and 

intervention is essential. Child maltreatment can 

cause traumatic stress in some children, while 

others are more resilient and show few, if any, 

lasting effects. Widespread recognition of trauma's 

harmful impacts and the related consequences 

for children, families, and society has resulted in 

Federal, State, and local initiatives over the last 

decade to promote trauma-informed care. 

This issue brief outlines the essential components 

of a trauma-informed child welfare system and 

features examples from State and local programs 

that are incorporating trauma-informed practice. 

After providing a brief overview of trauma and its 

effects, the brief explores trauma-informed practice 

and the importance of strengthening families 

and communities to help them develop resilience 

and heal. The brief concludes by highlighting the 

importance of cross-systems collaboration in 

creating a trauma-informed child welfare system 

that improves child and family well-being.

WHAT'S INSIDE

The Importance of a TraumaInformed Child Welfare System 

Building resilience: The role of protective 

factors

Trauma and its effects

What is trauma-informed practice?

Transitioning to a trauma-informed child 

welfare system

Children's Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

Cross-system collaboration

ISSUE BRIEFS | MAY 2020

Additional resources

Conclusion

References
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 2

Some of the information in this issue brief 

is based on interviews with practitioners 

and thought leaders who have been at the 

forefront of implementing and evaluating 

trauma-informed child welfare practice, 

including U.S. Department of Health and 

Human Services (HHS) grantees funded 

through the Children's Bureau and the 

Substance Abuse and Mental Health Services 

Administration (SAMHSA). 

TRAUMA AND ITS EFFECTS

According to 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" (HHS, SAMHSA, 2014, p. 7). Trauma 

that follows a single event and that is limited 

in time (such as a car accident, shooting, or 

earthquake) is called acute trauma. Complex 

trauma occurs 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 

that cause long-term harmful consequences 

(National Child Traumatic Stress Network 

[NCTSN], 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. 

Children's responses to trauma are affected by 

many factors, including their age at the time 

of the event, the severity of the traumatic 

event, their caregivers' reactions, and a 

prior history of trauma and other behavioral 

health conditions (NCTSN, n.d.-a). Traumatic 

experiences can cause a "fight, flight, or 

freeze" response that affects children's bodies 

and brains and overwhelms their natural 

ability to cope. Chronic exposure to trauma 

can create toxic stress, which interferes with 

normal child development and can cause 

long-term harm to children's physical, social, 

emotional, or spiritual well-being. This can 

impair 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, 

for example, complex traumatic experiences 

have been linked to issues such as addiction, 

depression and anxiety, and risk-taking 

behavior (NCTSN, n.d.-c). These in turn 

can lead to a greater likelihood of chronic 

ill health, including obesity, diabetes, heart 

disease, cancer, and stroke (Harvard Women's 

Health Watch, 2019). 

A recognition of the potentially lifelong 

consequences of trauma from adverse 

childhood experiences (ACEs) is at the core 

of Federal and State child maltreatment 

prevention policies and initiatives. Child 

Historical trauma affects populations 

who have experienced cumulative and 

collective trauma over multiple generations 

(e.g., American Indians, African Americans, 

immigrant groups, families experiencing 

intergenerational poverty) (Brave Heart, 

1998). Children within these families may 

exhibit signs and symptoms of trauma—

such as depression, grief, guilt, and/or 

anxiety—even if they have not personally 

experienced traumatic events.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 3

Welfare Information Gateway's Adverse 

Childhood Experiences webpage discusses 

impacts from traumatic stress and offers a 

wide variety of prevention and information 

resources. Information Gateway's factsheet, 

Long-Term Consequences of Child Abuse and 

Neglect, explores these impacts further. 

For detailed information and resources, see 

SAMHSA's manual, Concept of Trauma and 

Guidance for a Trauma-Informed Approach,

and the HHS Administration for Children 

Families (ACF) toolkit titled Resource Guide to 

Trauma-Informed Human Services.

WHAT IS TRAUMA-INFORMED 

PRACTICE? 

Trauma-informed practice involves an 

ongoing awareness of how traumatic 

experiences may affect children, families, 

and the human services professionals who 

serve them (NCTSN, 2016). Trauma-informed 

child welfare staff recognize how clients may 

perceive practices and services. They are 

aware of how certain actions and physical 

spaces have the potential to retraumatize 

or trigger behaviors in the families they 

serve (HHS, ACF, n.d.). Trauma-informed 

practice likewise acknowledges the reality 

of secondary traumatic stress (STS) and 

incorporates efforts to address and mitigate 

it so staff can be grounded and effective in 

their interactions with families or clients and 

families. 

NCTSN (n.d.-b, para. 1) defines a traumainformed system as one in which programs 

and agencies "infuse and sustain trauma 

awareness, knowledge, and skills into their 

organizational cultures, practices, and 

policies" and use the best available science 

to "maximize physical and psychological 

safety, facilitate the recovery of the child and 

family, and support their ability to thrive." It 

is an ongoing commitment that involves the 

day-to-day work of the entire system. 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 screenings, assessments, 

and evidence-based treatments (EBTs) they 

need. These improvements, in turn, may 

produce better outcomes for children and 

families, including the following (HHS, 2013):

 Fewer children requiring crisis services, 

such as emergency department visits or 

residential treatment

 Decreased prescriptions for psychotropic 

medications 

 Fewer foster home placements, including 

reentries

 Overall improved child functioning and 

well-being 

SAMHSA notes that a trauma-informed 

practice achieves the following (HHS, 

SAMHSA, 2014):

 Realizes the impact of trauma 

 Recognizes the signs and symptoms of 

trauma in clients, families, staff, and others

 Responds by fully integrating knowledge 

about trauma into policies, procedures, and 

practice

 Resists the retraumatization of children and 

the adults who care for them
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 4

SAMHSA also notes that trauma-informed 

care recognizes the importance of safety; 

trustworthiness and transparency; peer 

support; collaboration and mutuality; 

empowerment, voice, and choice; and 

cultural, historical, and gender issues (HHS, 

SAMHSA, 2014).

TRANSITIONING TO A TRAUMAINFORMED CHILD WELFARE 

SYSTEM

Moving to a trauma-informed approach 

requires a major commitment from childserving systems. The Children's Bureau 

awarded three clusters of grants in 2011, 

2012, and 2013 to help child welfare agencies 

become more trauma-informed at the 

individual and systems levels to improve 

safety, permanency, and well-being for 

children and families. These grants include 

Integrating Trauma-Informed and TraumaFocused 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 Well-Being and Adoption After 

Trauma (HHS-2013-ACF-ACYF-CO-0637).

The grants explored key elements in building 

a trauma-informed child welfare system, 

including routine screening and assessment, 

workforce development, acknowledgement 

and treatment of STS, measurement-driven 

case planning and referral to evidencesupported treatment, changes to data systems, 

and sustainability. This section explores some 

of the basic components of a trauma-informed 

system and related grantee work. 

SCREENING AND ASSESSMENT

Screening and assessment are fundamental to 

identifying children and families with trauma 

histories and, if necessary, securing effective 

treatment as soon as possible. The goals of 

trauma screening and assessment include the 

following:

 To learn about a child's trauma history, 

identify current symptoms and functional 

delays and identify children who need 

further assessment and possible treatment 

 To conduct a more detailed clinical 

evaluation for children whose trauma 

screen indicates a trauma history combined 

with psychological symptoms and/or 

functional delays, which will form the basis 

for treatment planning 

 To gather data about a child's strengths and 

needs via a functional assessment, measure 

improvement in skills and competencies 

and inform ongoing case planning 

 To measure outcomes to ensure that 

services are achieving desired effects at the 

child level, and, if not, to inform changes to 

the treatment plan

 To identify changes needed at the system 

level to improve the effectiveness of the 

service array

Several considerations are involved in 

selecting the appropriate screening and 

assessment instruments including the 

following:

Length. Initial screenings should be as brief 

as possible. If the initial trauma screening 

is positive, a mental health clinician should 

follow up with a thorough assessment.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 5

Screening for trauma exposure versus 

screening for symptoms. Tools that facilitate 

connections between the two will help 

identify more appropriate referrals.

Administration and data-sharing. Agencies 

and partners should assess the ease with 

which data can be shared. Is the screening 

administered by paper and pencil or by 

computer entry that links to an existing 

data system? Is the tool self-scoring? Is the 

information taken from the parent, the child, 

or case records?

Costs. Items to consider include the initial 

purchase of the tool, required training, and 

expenses associated with data collection 

and/or analysis.

Psychometric properties. How accurately 

does the tool measure what it purports to 

measure? How many false positives or false 

negatives are likely?

State Examples of Screening and Assessment 

Work

In Connecticut, statewide trauma screening 

was implemented as a major part of its 

Collaborative on Effective Practices for 

Trauma (CONCEPT), a Federal grant in the 

Integrating Trauma-Informed and TraumaFocused Practice in Child Protective Service 

Delivery cluster designed to improve 

outcomes for trauma-exposed children. The 

grant resulted in the statewide use of a brief 

screening tool, the Child Trauma Screen, 

developed by Connecticut's Department of 

Children and Families (DCF) in collaboration 

with the Child Health and Development 

Institute (CHDI) and Yale University. 

The screening tool is used during the 

multidisciplinary evaluations that take place 

when children come into DCF care. 

In North Carolina, the Judicial College at 

the University of North Carolina's School of 

Government is training judges to become 

more trauma informed. One unintended 

consequence of widespread training has 

emerged, however. As judges learned about 

one highly evidence-based treatment for 

child trauma, Trauma-Focused Cognitive 

Behavioral Therapy (TF-CBT), some began 

court-ordering children and youth in the 

child welfare system to receive that specific 

treatment. Now, the North Carolina Child 

Treatment Program (NC CTP) and other 

stakeholders are working to ensure that 

children and youth receive a trauma-informed 

clinical assessment and the most appropriate 

treatment, since no single treatment will 

work for every child. NC CTP trains clinicians 

in several EBTs, including TF-CBT, parentchild interaction therapy, child-parent 

psychotherapy, structured psychotherapy for 

adolescents responding to chronic stress, and 

CBT for children and youth with problematic 

sexual behavior (M. Blythe, personal 

communication, October 14, 2019). 

For additional resources on screening 

children for trauma and related assessment 

tools, visit the following webpages:

 Screening and Assessment of Child Trauma

(Information Gateway)

 Screening and Assessment (NCTSN)

 Screening Tools (SAMHSA)
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 6

WORKFORCE DEVELOPMENT

The development of a trauma-informed 

workforce is an essential first step in 

implementing an effective trauma-informed 

system. It is important to integrate a trauma 

perspective in the organization's day-to-day 

activities so that all levels of agency staff—

receptionists, caseworkers, supervisors, 

managers, administrators, and other program 

staff—consider this as foundational to their 

work. This includes training for foster and 

adoptive parents.

Moving to a trauma-informed approach 

requires the workforce to make paradigm 

shifts in the areas listed below:

 Perspective. Becoming a trauma-informed 

system involves shifting the conversation 

from asking "What's wrong with you?" 

to "What happened to you?" Traumatic 

stress is often misunderstood and 

misdiagnosed as a behavioral problem by 

foster parents, child welfare workers, and 

other professionals. Applying a traumainformed lens involves close consideration 

of an individual's trauma experience as an 

underlying explanation for behavioral or 

emotional issues.

 Goals. The focus of child welfare services 

is often on substantiating a case of abuse 

or neglect and ensuring a child's physical 

safety. With trauma-informed care, the 

goal includes helping children heal from 

the impact of the trauma and improving 

their social and emotional well-being while 

preventing additional trauma.

 Importance of collaboration. When child 

welfare agencies successfully work with 

other service systems through improved 

communication, collaboration on joint goals, 

data sharing, and strategic use of funding 

streams, they are more likely to enhance 

well-being and maximize access to services.

 Focus on early intervention. A traumainformed child welfare system reflects 

the understanding that focusing more 

resources on the identification of trauma 

and early intervention services may prevent 

or mitigate some of the long-term effects.

 Approach to families. It is important to 

be clear with families about the boundary 

between their involuntary participation in 

the child welfare system (i.e., when there 

is a 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, 

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. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 7

 Awareness of STS. Hearing about children's 

and families' trauma histories may result in 

STS among professionals and caregivers. 

Left untreated, this can decrease 

effectiveness and lead to excessive burnout 

or turnover. This often occurs in addition to 

workers' experiences with primary trauma 

(e.g., witnessing violence, participating in 

a removal, being threatened) or their own 

personal trauma histories. Being traumainformed requires attention to trauma's 

effects on all participants in the system, 

including caregivers and service providers.

As agencies move toward establishing a 

trauma-informed workforce, they will need to 

establish practices and protocols that address 

the following challenges cited by the U. S. 

Government Accountability Office (2019):

 High rates of child welfare staff turnover

 Insufficient funding and staff time to spend 

on trauma initiatives 

 Lack of trained clinicians

The National Child Welfare Workforce 

Institute (NCWWI) offers several training 

resources on trauma-informed practice, 

STS, and staff burnout. Some of the practices 

below provide examples of how jurisdictions 

are working to overcome these barriers.

Trauma Systems Therapy

In child welfare, there has been a shift toward 

a more holistic approach to trauma-informed 

care and a recognition that everyone in an 

organization—regardless of their rank or 

level—should be trained in helping individuals 

who experience trauma feel more comfortable 

and confident. Saint Francis Ministries, a 

nonprofit organization serving children and 

families in Kansas, Nebraska, Oklahoma, 

Arkansas, Texas, and Central America, has 

implemented a Trauma System Therapy (TST) 

approach to become more trauma informed. 

TST is both a clinical and organizational 

model that coordinates care and addresses 

the social environments of traumatized 

children. Saint Francis has made a systemwide 

commitment to becoming trauma informed 

that includes the following (P. Cornwell, 

personal communication, November 8, 2019):

 An organizational plan with timelines and 

specifics for pilot testing (location, numbers 

of children to serve, staff involved, etc.)

 Measurements of completion (training, 

number of children eligible, number of 

individuals treated, etc.)

 Implementation teams, which represent 

executive-level leadership, midlevel 

management, clinical staff, and 

multidisciplinary treatment staff, that 

report to the organization's leadership 

 "Trauma champions" within each of 

the teams to become TST trainers and 

coaches/consultants who train across the 

organization as additional program sites 

emerge and as new staff are hired 

 Application of trauma-informed care on 

a larger scale through an organizationwide committee that assesses a variety 

of safety-related measures, the review 

of stress and burnout surveys from staff, 

and the implementation of environmental 

culture surveys that help the organization 

understand its progress in becoming more 

trauma responsive
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 8

 Creation of groups to address staff burnout 

and STS 

 Engagement of evaluators to assess the 

organization's trauma-informed practices 

and processes and ensure sustainability

For more on TST, visit the NCTSN website. 

WORKFORCE TRAINING

It is essential that child welfare professionals 

recognize trauma and provide early and 

appropriate interventions for children 

and families who have experienced child 

abuse, neglect, or other acts of violence.

Trauma training should be introduced 

from the beginning of each staff member's 

employment. In addition to the basics about 

what trauma is, its impact on the brain, and 

how it affects children (including the role of 

triggers and reminders), training topics should 

include the following: 

 How to screen children for trauma

 Children's need for physical and 

psychological safety 

 Resiliency case planning (i.e., using services 

to build a child's resilience and sense of 

competency)

 When, how, and where to refer children for 

evidence-based trauma treatment

 How to work with parents and caregivers 

who have been traumatized 

 The impact of STS

Effective training for trauma-informed 

practice will require more than a single 

workshop or class session. Ongoing training 

and staff mentoring are essential. Trauma 

training may be more effective if child welfare 

staff are cross-trained with professionals 

from partner agencies and systems, such as 

mental health and education, so that all childserving systems can work together in the best 

interests of children and their families. After 

the initial training, follow-up training and 

technical assistance can be provided in the 

following formats:

 Supervision, including case review, fidelity 

monitoring, and accountability

 Coaching and mentoring

 In-house trauma consultants or "trauma 

champions" (i.e., individuals specifically 

trained in trauma therapy) 

 Learning collaboratives

 Periodic booster trainings (face to face or 

via webinars)

 Tips and reminders in newsletters or other 

office communications about trauma 

symptoms, behaviors, and impact

See the NCWWI website for more 

information.

SECONDARY TRAUMATIC STRESS 

A trauma-informed child welfare agency 

recognizes the need to invest in the health, 

well-being, and resilience of its workforce. 

Because child welfare professionals and 

resource parents often experience STS, 

agencies should consider making STS training 

and coaching available. Left untreated, STS 

(sometimes referred to as vicarious trauma 

or compassion fatigue) can lead to lower 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 9

productivity, increased absenteeism, and high 

rates of turnover (HHS, ACF, n.d.). Agency 

leaders committed to trauma-informed care 

can offer the following to combat STS: 

 Continuing education on the pervasiveness 

of STS and how to manage it

 Wellness activities, such as mindfulness 

training or other forms of self-care, to 

mitigate STS

 Therapeutic supports, including restorative 

spaces to help staff decompress, access to 

counseling, or the availability of therapy dogs 

There are many resources for STS, including 

the following:

 The July 2016 issue of Children's Bureau 

Express features articles on STS by 

Children's Bureau trauma grantees. 

 The resources section of the NCTSN 

website offers several publications on STS. 

 "Addressing Trauma Through a Culture 

of Resiliency," a NCWWI video, looks at 

strategies to help children, families, and 

workers cope with trauma. 

 The Secondary Traumatic Stress section

on the Information Gateway website offers 

resources about what STS is, its impact, 

how to identify symptoms, and how it can 

be prevented and mitigated.

NCTSN offers several trauma-related training 

resources:

 Child Welfare Trauma Training Toolkit

 "Working With Parents Involved in the Child 

Welfare System"

 Core Curriculum on Childhood Trauma: An 

Introduction and Overview

 "The 12 Core Concepts for Understanding 

Traumatic Stress in Children and Families" 

For more training resources, visit the NCTSN 

website.

STS Trainings Tailored for Workers and 

Supervisors

In North Carolina, county child welfare 

staff have access to several online training 

programs for STS, including a program

developed specifically for workers and 

another class designed for supervisors 

and managers. The supervisor and 

manager class gives agency leadership 

an opportunity to understand how 

STS is affecting their team so they can 

develop agency-level strategies to build 

staff resilience (J. McMahon, personal 

communication, November 1, 2019).
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 10

RESOURCE PARENT TRAINING

The lack of a trauma-informed perspective 

from resource parents can put a foster care 

placement at risk, as parents may struggle 

to understand and respond to negative and 

trauma-based behaviors and emotions. 

Training for new foster or adoptive parents 

should include information about child 

traumatic stress. This training also should 

be offered to kinship caregivers as well as to 

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 trauma-related behaviors, 

how foster and kinship caregivers can work 

effectively with parents, and the importance 

of self-care. 

Some examples of trauma-informed resource 

parent training are included below:

 "Caring for Children Who Have Experienced 

Trauma: A Workshop for Resource 

Parents," also referred to as the Resource 

Parent Curriculum, is a 16-hour training 

curriculum developed by NCTSN to help 

resource parents understand the effects of 

trauma on the children in their care. 

Safety and Engagement 

It is important for child welfare professionals to understand trauma-informed care; however, adding 

training requirements to a professional's already busy schedule may be met with resistance. While 

caseworkers have a different role than mental health therapists, equipping them with basic trauma 

principles can act as a safeguard by helping them recognize the signs of escalating behaviors 

and the importance of co-regulating themselves and their families to a safer place. For example, 

a worker may have to deliver unwelcome news to a parent or child. Having the presence of 

mind to understand how the presentation of that information may trigger past feelings of loss, 

abandonment, or fear connected to the person's past trauma experience enables the worker 

to refine how the message is presented and the support that may be offered. Ensuring staff 

possess the proper tools for engaging and affirming families, while mitigating potentially negative 

reactions makes a critical difference in worker safety and child and family outcomes (K. McCauley, 

personal communication, November 12, 2019). While there may be challenges in getting agency 

and worker buy-in on appropriate workforce training, crafting a message that shifts the focus from 

a time-consuming mandate to more tangible worker benefits may help. This includes the following 

training benefits: 

 Increased personal safety

 Increased awareness of STS and how it impacts worker engagement and success

 Improved ability to self-regulate and engage with families 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 11

 Child Development and the Effects of Trauma

Series is a free training for resource parents

sponsored by the Family and Children's

Resource Program at the University of

North Carolina at Chapel Hill and developed

in partnership with North Carolina's

Division of Social Services.

 "RPC [Resource Parent Curriculum] +

TIPS [Trauma Informed Parenting Skills] for 

Tuning In" is a free 10-week training

program developed by the Vermont Child

Welfare Training Partnership to teach

foster, kinship, and adoptive caregivers

positive parenting skills to help address

behaviors associated with complex trauma.

The training focuses on caregiver selfregulation and positive attention rather than 

a reactive parenting approach to help

children heal from trauma.

 TST for Foster Care is a four-module

training curriculum containing Power Point

slides, facilitator guides, an implementation

guide, and a resource guide for foster

parents. This curriculum helps foster

caregivers build resilience and promote

regulation in children affected by trauma by

reinforcing their sense of safety and their

ability to trust adults. 

Education and support are an ongoing 

process. After the initial training, a traumainformed perspective can be infused in work 

with resource parents in additional ways, 

including the following:

 Connect foster parents or kinship

caregivers with parents soon after

placement—or, if this is not possible, collect

information from the parents or others—

to better inform caregivers regarding 

the child's trauma history, triggers, and 

behaviors.

 Conduct child-focused team meetings that

engage parents and kinship caregivers or

foster parents in collective planning and

problem-solving. Agencies can include

a trauma consultant on these teams to

provide early intervention to children who

display troubling behavioral symptoms in

placement.

Information Gateway's factsheet for families 

titled Parenting Children and Youth Who Have 

Experienced Abuse or Neglect may also be a 

valuable resource for families.

Trauma Trainings to Improve Placement 

Stability

Tennessee's TRANS/form (Trauma/

Resilience and Network/System 

Transformation), a Children's Bureau 

grant from the Promoting Well-Being and 

Adoption After Trauma cluster, yielded 

several interventions and tools to improve 

placement stability. It developed a 

storytelling tool to help children process 

their trauma as they navigate through 

State custody and care. The Tennessee 

Department of Children's Services 

added this life-narrative model to its 

training module for new hires, which also 

includes multiple courses that address 

trauma-informed care. The State has also 

incorporated trauma coursework in its 

training suite for foster parents. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 12

BUILDING ACCESS TO EVIDENCESUPPORTED TREATMENT

While support from a primary caregiver is 

recognized as the first line of defense for 

children exposed to trauma, therapeutic 

interventions may be essential to help 

children and youth recover from complex or 

especially traumatic experiences. Children 

and families dealing with complex trauma 

require a targeted treatment plan based 

on a thorough assessment and accurate 

diagnosis by skilled child welfare staff and 

mental health therapists. The Family First 

Prevention Services Act of 2018—designed 

to reduce the number of children going into 

foster care by providing at-risk families with 

relevant family preservation services—is 

moving child welfare toward trauma-informed 

care by requiring that all federally funded 

prevention services be trauma informed 

and categorized as promising, supported, or 

well-supported programs, as defined by the 

California Evidence-Based Clearinghouse for 

Child Welfare. To implement this requirement, 

HHS was mandated to develop a Title IV-E 

Prevention Services Clearinghouse to review 

and rate programs designed to support child 

and family mental health and reduce foster 

care placements.

Training Clinicians in Evidence-Based 

Treatments

Through its CONCEPT grant, Connecticut's 

DCF partnered with CHDI to support the 

training of more than 30 agencies and over 

800 clinicians in EBTs for trauma, specifically 

TF-CBT and the child and family traumatic 

stress intervention (CHDI, 2019). This has 

added more EBTs to the previous set the 

State used (modular approach to therapy for 

children with anxiety, depression, trauma, 

or conduct problems; cognitive behavioral 

intervention for trauma in schools; and the 

attachment, regulation, and competency 

framework). More than 13,000 Connecticut 

children have received these interventions, 

and evaluation outcomes indicate significant 

reductions in posttraumatic stress and 

depression symptoms.

North Carolina, seeking to increase 

community access to EBTs, implemented 

a pilot project in 2006 to train agency 

providers in TF-CBT for traumatized youth. 

The pilot focused on the development of 

clinical workforce capacity using the National 

Center for Child Traumatic Stress Learning 

Collaborative (LC) model on the adoption 

and implementation of EBTs, which seeks to 

enhance clinical skills as a part of training. 

NC CTP developed, piloted, and evaluated 

the training and implementation platform. 

Training includes a role-playing requirement 

to ensure high fidelity to the treatment 

models, 1–2 years of extended consultation 

with 2–4 in-person trainings (didactic and 

interactive teachings), and a requirement that 

the clinician has handled two cases before 

graduating and becoming a rostered clinician 

(H. Seifert, personal communication, October 

14, 2019). The project resulted in a significant 

reduction in negative behaviors in the youth 

being treated and in related parental or 

caregiver stress as well as legislative support 

for the dissemination of a service array of 

EBTs by NC CTP (Amaya-Jackson et al., 2018). 

Evaluators concluded that outcomes-oriented 

implementation of EBTs is best accomplished 

through practice-based learning, fidelity 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 13

coaching, clinical assessment and outcomesoriented treatment, organizational skill 

building, and the availability of trained 

providers through an online roster of 

approved clinicians. As of January 2020, 

the NC CTP roster included 1,144 clinicians 

serving 81 of 100 counties in the State.

For more information about EBTs, refer to the 

following resources:

 Effective Child Therapy

 Title IV-E Prevention Services 

Clearinghouse

 Trauma Treatments (NCTSN)

 Trauma Treatment (Child & Adolescent)

(California Evidence-Based Clearinghouse 

for Child Welfare)

 Parent-Child Interaction Therapy: A Primer 

for Child Welfare Professionals (Information 

Gateway)

 Trauma-Focused Cognitive Behavioral 

Therapy: A Primer for Child Welfare 

Professionals (Information Gateway)

DATA SYSTEM NEEDS

Reliable data inform the strengths, needs, 

and gaps in child welfare practice and are the 

underpinning of sound policy. Child welfare 

agencies may wish to consider the following 

questions in assessing data needs related to 

trauma-informed practice:

 On a child level: How might critical data 

(e.g., 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? 

Could the data system help track a 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)? Which children are 

not improving or are getting worse? What 

services are they using and what type of 

treatment services are most needed?

 Across systems: How could data be made 

accessible to all service providers involved 

with a child—including those working 

in systems, such as mental health and 

placement providers—while taking into 

consideration confidentiality concerns and 

privacy guidelines where applicable? Could 

the results of assessments completed by 

mental health professionals and Medicaid 

claims data (e.g., data related to the 

prescription and dosage of psychotropic 

medications) be accessible within the child 

welfare data system to inform case planning?
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 14

BUILDING RESILIENCE: THE ROLE 

OF PROTECTIVE FACTORS

A child's response to traumatic events can be 

buffered by a variety of community, relational, 

and individual strengths, referred to as 

protective factors (e.g., access to basic needs, 

positive relationships with caregivers and 

peers, natural coping skills). Just as research 

finds a correlation between ACEs and negative 

health consequences, it also shows that 

positive childhood experiences can mitigate 

those effects (Bethell et al., 2019). A traumainformed child welfare system recognizes 

and promotes the importance of protective 

factors in healing children and families. When 

professionals, organizations, and communities 

work together to create healthy environments 

for children and families, they are developing 

the protective capacities that help children 

thrive, strengthen parents and caregivers, and 

result in fewer ACEs while buffering those 

that already exist. 

For those who have experienced trauma, 

hope may be a powerful healing factor to 

promote well-being and reduce the risk of 

child maltreatment (Hellman et al., 2018). 

The HOPE (Health Outcomes from Positive 

Experience) framework actively promotes 

positive experiences for children and families 

to encourage healthy development and offset 

ACEs and other negative environmental 

influences. For more information, visit the 

HOPE website and see the report Balancing 

Adverse Childhood Experiences (ACEs) With 

HOPE: New Insights Into the Role of Positive 

Experience on Child and Family Development.

Using Data to Understand Outcomes and Refine Treatments

North Carolina developed a Performance Outcomes Platform (NC-POP) to track how selected 

EBTs are provided to children and families in the State. NC CTP developed the system and allows 

agencies across the State access to their data to better use, understand, and report on clinical 

performance and outcomes. An enhanced system is now in development that will allow other 

stakeholders (e.g., policymakers and third-party payers) to access aggregated data to inform 

quality assurance and policymaking (M. Blythe, personal communication, October 14, 2019).

In Connecticut, the CONCEPT grant has yielded valuable data on how EBTs are working. As 

one of a few States where child behavioral and mental health falls under the jurisdiction of the 

Department of Children and Families, Connecticut has been a leader in providing EBTs to children 

with mental and behavioral health needs and gathering important data for how those treatments 

are working (J. Lang, personal communication, October 29, 2019). Children receiving TF-CBT, for 

example, showed a 46–76 percent greater improvement in problem severity than children who 

did not receive an EBT, and children receiving the modular approach to therapy for children with 

anxiety, depression, trauma, or conduct problems (MATCH-ADTC) registered a 68–75 percent 

improvement (Lang & Lee, 2019). Significantly, the data also revealed that the EBTs reduced 

outcome disparities for children of color. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 15

Social determinants of health (economic 

stability, education, social and community 

context, health and health care, and 

neighborhood and built environment) play 

an important role in preventing trauma. 

Entry into the child welfare system can 

cause additional trauma to children when 

they are separated from their family, school, 

neighborhood, and community. A major 

goal of the Children's Bureau is to shift this 

paradigm by offering prevention services that 

strengthen the protective factors that help 

keep families together. This includes access 

to basic, concrete services to give parents and 

caregivers the safety net necessary for helping 

to keep infants and children safe. In addition, 

home visiting programs and communitybased family resource centers offer families 

an opportunity to make connections and learn 

new parenting practices to enhance their 

caregiving skills and strengthen their families 

(Milner & Kelly, 2019).

Meeting the Needs of Colorado Children

Colorado has been working to infuse traumainformed care in child welfare practice 

through its trauma screening and assessment 

work. Under an expansion of an existing 

title IV-E waiver demonstration project, 

seven counties (Arapahoe, Boulder, Denver, 

Douglas, Eagle, Jefferson, and Larimer) 

formed the Child Welfare Resiliency Center 

(CWRC) to expand trauma-informed child 

welfare practice. The goal is to demonstrate 

that children and youth can be maintained 

in their homes or more desirable forms of 

out-of-home care (with kinship care as a 

priority, followed by foster care)—and avoid 

congregate care or residential treatment 

whenever possible—if their developmental, 

emotional, and cognitive needs are met. 

CWRC adapted a trauma-focused screening 

and assessment model that included ongoing 

data collection and assessment of child wellbeing. 

In related work, Larimer County (CO) 

Department of Human Services was 

awarded a SAMHSA grant to implement 

the Colorado Children's Congregate Care 

Resiliency Opportunity Project (CROP) to 

develop targeted interventions to prevent 

and reduce congregate care placements 

for children involved with child welfare and 

juvenile justice. CROP is screening children 

and their caregivers for trauma, providing 

Tennessee Public Awareness Effort to 

Mitigate Trauma from ACEs

Tennessee launched a major preventionoriented public awareness campaign to 

build resilience statewide for children 

and families by preventing and mitigating 

ACEs and their potential traumatic 

impact. Through widespread knowledge 

about the negative consequences of 

ACEs and public policy support for 

creating positive community conditions 

to prevent them, the campaign seeks 

to safeguard Tennessee's children and 

families from unnecessary trauma. The 

initiative was developed as a national 

model to promote culture change in early 

childhood. For more information, see the 

Building Strong Brains: Tennessee ACEs 

Initiative website.
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 16

comprehensive neurodevelopmental 

assessments, and providing resiliency-based 

case planning (e.g., building attachment 

and self-regulation skills through intensive 

in-home coaching programs) based on 

assessment findings. Since CWRC's and 

CROP's trauma-related efforts launched, 

average daily placements in congregate care 

have fallen from 475 to 254, or 47 percent (M. 

Winokur, personal communication, January 

22, 2020).

The following resources offer additional 

information on developing protective factors 

and resilience to reduce trauma and its impact:

 Protective Factors Approaches in Child 

Welfare (Information Gateway)

 Protective Factors to Promote Well-Being

[webpage] (Information Gateway) 

 Profiles of Select Trauma-Informed 

Programs: Trauma-Informed Approaches: 

Connecting Research, Policy, and Practice 

to Build Resilience in Children and Families

(HHS Office of the Assistant Secretary for 

Planning and Evaluation)

 Building Your Resilience (American 

Psychological Association)

 Resilience Guide for Parents and Teachers

(American Psychological Association) 

 "Protective Capacities and Protective 

Factors: Common Ground for Protecting 

Children and Strengthening Families" 

(Capacity Building Center for States) 

CROSS-SYSTEM COLLABORATION

In a trauma-informed system, professionals 

involved with child welfare, juvenile justice, 

the courts, mental health, health care, and 

education collaborate with the common 

goal of maximizing services for children 

and families to help them heal. Although 

collaboration can be challenging due to 

issues such as conflicting priorities, funding 

constraints, and confidentiality concerns, 

the benefits to children and families are 

greater when communities work together to 

provide a cross-system approach that treats 

each child holistically. Systemic approaches 

to addressing trauma—such as TST and the 

attachment, self-regulation, and competency 

framework—may allow for a more coordinated 

approach. For example, KVC Kansas, an 

organization providing out-of-home care 

services to children in the State, implemented 

TST and trained more than 90 percent of 

all staff and nearly 70 percent of its foster 

parents or resource parents in the approach 

(Child Trends, 2018). Over time, children 

served through TST experienced improved 

well-being and placement stability. KVC's 

use of a common language (e.g., terms such 

as "triggers" and "emotional regulation") with 

its community partners in all TST training 

materials helped develop collaborative and 

sustainable cross-system partnerships. KVC 

promoted the materials to all members of a 

child's care team and to the broader social 

services community. KVC offered training to 

interested community partners, including 

judicial staff and representatives from the 

mental health, early childhood, developmental 

disabilities, domestic violence, and education 

fields (Redd et al., 2017). 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 17

KVC also led TST training for the District of 

Columbia's Child and Family Services Agency 

(CFSA) as part of the Children's Bureau 2012 

grant to Improve Access to Needs-Driven, 

Evidence-Based/Evidence-Informed Mental 

and Behavioral Health Services in Child 

Welfare (HHS-2012-ACF-ACYF-CO-0279). 

CFSA was the first jurisdiction in the country 

to implement TST agencywide as a means 

of infusing trauma-informed therapy in its 

public child welfare system. The $3.2 million 

grant allowed CFSA to partner with other D.C. 

government agencies, researchers, clinicians, 

and private practitioners to provide trauma 

training for social workers, foster parents, 

attorneys, counselors, and other professionals 

who work with children and families. For 

more information, see CFSA's webpage, 

Trauma-Informed Practice: Cutting-Edge 

Treatment of Child Victims of Abuse and 

Neglect.

Strategies for initiating stronger crossdisciplinary relationships include the 

following:

 Cross-disciplinary trauma training. 

When professionals from various childserving disciplines attend trauma training 

together, they develop a shared vocabulary, 

commitment, and understanding of trauma 

as well as an opportunity to share ideas 

about supporting 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 

administrators and other staff learn more 

about how other systems work. Identifying 

points of intersection between systems 

can lead to deeper discussions about 

infrastructure, case and treatment plans, 

referrals, data sharing, and communication.

 Shared STS trainings. Child-serving 

professionals can experience stress when 

working with children and families with 

trauma histories. Sharing experiences of 

secondary trauma during training sessions 

may build understanding across disciplines 

and "break the ice" to help allow systems 

work toward partnerships. 

 Case conferencing. Provided confidentiality 

policies are strictly observed, 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 whom all 

participants share concern fosters 

communication and relationships that may 

carry over into work on other cases in the 

future.

 Funding. Funding can be used in various 

ways to encourage and support crosssystem collaboration to better serve 

children's trauma needs. This might include 

strategies such as 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. 
Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 18

There are many resources designed to help 

explore opportunities for collaboration, 

including those below:

 A 2019 report from the U.S. Government 

Accountability Office that highlights 

collaboration across the child welfare and 

education sectors by pointing to crosssystem trauma-informed approaches in 

Colorado, Massachusetts, North Carolina, 

Ohio, Washington, and Wisconsin

 An NCTSN webpage that explores familyyouth-provider partnerships to address 

trauma and improve care outcomes

CONCLUSION

Efforts to implement and evaluate traumainformed practice over the last decade have 

resulted in a greater recognition of the 

extent, reach, and impact of trauma and an 

understanding that addressing it requires 

a coordinated, systemwide approach. Left 

unaddressed, trauma may have serious 

consequences for children, families, 

and communities. As trauma screening 

and assessment practices become more 

widespread and data become more available, 

child welfare professionals will have an 

enhanced awareness of those most in need 

and an understanding of how best to address 

trauma histories. These developments, 

combined with an emphasis on building 

resiliency in children and families, can help 

the child welfare system become a place of 

healing and hope.

ADDITIONAL RESOURCES

 Campaign for Trauma-Informed Policy and 

Practice, a nonprofit that advocates for 

trauma-informed and prevention-focused 

public policies

 Resource Guide to Trauma-Informed Human 

Services, an ACF toolkit that offers an 

overview of trauma and multiple concept 

papers and related resources

 SAMHSA's Concept of Trauma and Guidance 

for a Trauma-Informed Approach, a 

guidebook for multiple service systems and 

stakeholder groups 

 "Systems Measures of a Trauma-Informed 

Approach: A Systematic Review," a 2019 

article from the American Journal of 

Community Psychology that provides 

a comprehensive review of relational, 

organizational, and community system 

measures of a trauma-informed approach

 Trauma-Informed Practice, a section of the 

Information Gateway website that provides 

a wide array of information on trauma 

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ACKNOWLEDGMENTS: 

This issue brief was developed by Child 

Welfare Information Gateway with valuable 

input from George Ake, Melinda Baldwin, 

Mellicent Blythe, Pamela Cornwell, James 

Henry, Jason Lang, Susana Mariscal, Kelly 

McCauley, John McMahon, Heather Pane 

Seifert, Jessica Strolin-Goltz, and Marc 

Winokur. 

SUGGESTED CITATION: 

Child Welfare Information Gateway. (2020). 

The importance of a trauma-informed 

child welfare system. Washington, DC: U.S. 

Department of Health and Human Services, 

Administration for Children and Families, 

Children's Bureau.

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/.

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children's Bureau