Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research
Authors: Collin-Vézina Delphine 
Published: October 2020

Twenty years ago, findings from the Adverse Childhood Experience study revealed that experiences of child maltreatment and family dysfunction were far more prevalent in the general population than previously known. It also drew attention to the impact of these experiences on later health, mental health and functional impairments in adulthood, which increased with each additional adverse childhood experience exposure (Felitti et al., 1998). Finkelhor and colleagues expanded the types of adverse events examined to include victimization experiences outside the home (Finkelhor, 2008; Finkelhor et al., 2011), and showed that, at levels past a certain threshold, these events increased post-traumatic stress symptoms and functional impairments, as well as risk of exposure to future victimization (Finkelhor et al., 2007). A relative consensus now exists among leading trauma experts that chronic, cumulative interpersonal maltreatment, neglect and/or violence occurring early in life can disrupt all aspects of normative development: cognitive, biological, neurological, emotional, relational and behavioral (Briere & Spinazzola, 2005; Cloitre et al., 2009; Courtois, 2008; van der Kolk et al., 2005). The term “complex trauma” refers to both the exposure to chronic, interpersonal experiences for children and youth, and the constellation of possible sequelae causing significant impairments across the lifespan (Cook et al., 2005). Despite recent enhancement of our social responses to child and youth trauma through research, practice and policy, misconceptions about trauma-informed practices continue to permeate mental health services and hinder true paradigm shifts from occurring (Sweeney & Taggart, 2018). Consequently, many children and youth presenting with complex trauma continue to suffer unnoticed, without receiving necessary resources and support. There is an urgent need to provide children and youth impacted by trauma in childhood with resources and support that are trauma-informed, resilience- and healing-centered and culturally relevant (Collin-Vézina, Brend, & Beeman, 2020). This thematic section intends to move this field forward by highlighting important practice and policy-driven scholarly work. It hopes to be a source of influence to learn, grow and contribute collectively to improve the wellbeing of children and youth impacted by trauma. As we readers of the International Journal of Child and Adolescent Resilience know, strengthening individual and community resilience, by unifying and enhancing social responses to trauma through research, practice and policy, is paramount to the wellbeing of children and youth.

Steward and colleagues’ paper confirm, among a large sample of children and youth receiving mental health services, that childhood traumatic experiences are far too common and lead to severe negative outcomes. Their findings draw attention to the complex relationship between adverse childhood experiences and harm to self and others, which supports the adoption of screening and assessment strategies in mental health settings that take into account childhood traumatic experiences. Their study contributes to contemporary debates on the use of systematic trauma screening in health settings (see Collin-Vézina, Brend, & Fallon, 2020, for a review) and highlights the importance of rethinking these procedures alongside a strong paradigm shift towards trauma-informed patient care. Along the same lines, Lowenthal’s review paper presents a broad summary on trauma-informed programs implemented in child and youth serving sectors, which brings essential information on the extent of implementation and the characteristics of existing programs, as well as promising findings and noted roadblocks. These reflections are essential to inform future research in the area of trauma-informed practices and organizational policies.

Alie-Poirier and colleagues, as well as Hébert and colleagues, tackle the important trauma-related social issue of sexual victimization. The former paper explores the impact of cumulative trauma beyond sexual abuse in a sample of children and youth under the care of child protection services. This study highlights four profiles that are linked with cumulative traumas and the number of years in the child welfare system, and sadly confirms that many of these children and youth present with severe complex trauma symptoms or dissociative-type profiles. The latter manuscript offers insights on how to adapt the well-known, internationally recognized Trauma-Focused Cognitive Behavioral Therapy intervention program (TF-CBT; Cohen et al., 2012) to sexually abused children and youth who present with complex trauma profiles. This paper goes beyond describing and empirically testing hypotheses on the link between trauma and mental health, by offering concrete, practice-driven tools to better respond to the needs of this highly vulnerable population and, thus, promote their resilience. In the same vein, Bruneau-Bherer and colleagues’ and Brend and colleagues’ papers offer insights on innovative approaches with complexly traumatized children. The first paper focuses on mindfulness strategies and presents a newly developed yoga-based program, called Namasté, that shows promising results in supporting regulation and development among children served by child protection services. Specifically designed for children in group home settings, the second paper presents a trauma-informed training program for child protection staff, called Penguin, for which initial evaluation findings suggest positive changes over time with regards to professionals attitudes towards trauma-informed care and less punitive measures adopted in group homes to deal with clients’ challenging behaviors.

Maurer’s paper contributes theoretically to the field of resilience by applying a biopsychosocial process definition of resilience to in-depth interviews with youth regarding their affect regulation when experiencing high affect arousal. These young people, who have all experienced family violence, describe both their internal turmoil and great need for support, which reinforces the importance of adopting a whole-person, system-wide approach that goes beyond pathologizing mental health challenges displayed by youth and, rather, focuses on improving access to resources in their environments. This broader, system-wide perspective is also emphasized in Brend and Sprang’ paper on child welfare professionals’ well-being. The authors bring attention to the importance of ‘taking care of the carers’ so these adults can be fully prepared and equipped to act as positive agents of change for children and youth presenting with complex trauma. Their paper, which focuses on child protection settings more particularly, recommends organizational strategies to promote workers’ well-being and, thus, to enhance positive work climates. These findings are particularly important in light of Doucet’s paper that draws attention to the vital importance of young people in care establishing meaningful relationships and building trust in self and others. Young people interviewed remind us of the importance of building supportive community organizations and training workers to be culturally responsive, as a means of responding to their needs while in care and when exiting care.

Taken together and informed by guidelines put forth by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2014), the papers included in the thematic section invite all of us to take part in a societal transformation that aims to bring awareness to childhood trauma and to shift practices to recognize the prevalence and the impact of trauma in many peoples’ lives. They also call upon us to show courage in adapting our interventions and policies to better respond to the needs of traumatized children and youth, and to make every effort necessary to build societies that no longer perpetuate maltreatment and violence.