When we first meet a child at a Children’s Advocacy Center, it’s usually because they’ve experienced trauma from child physical or sexual abuse. As healthy adults, we know that a child victim is NEVER to blame, no matter the context of any specific abuse or trauma. But inside the mind of a traumatized child, the lines of guilt, responsibility, and self-worth are less clear.
In their experience of abuse, a child victim like has likely heard complicated or downright harmful messages about blame, consent, love, and value. The confusion created by trauma can last a lifetime a lifetime—but it doesn’t have to. Just like JTR, a child victim who found healing through trauma therapy at a Children’s Advocacy Center, we believe that every child deserves to recover from trauma—to find their “happiness inside.” CACs are here to help make that possible.
The Oxford Language dictionary defines trauma as “emotional shock following a stressful event or a physical injury, which may be associated with physical shock, and sometimes leads to long-term neurosis.” The CDC calls many of the circumstances that create childhood trauma Adverse Childhood Experiences, or ACEs.
Trauma
Def. emotional shock following a stressful event or a physical injury, which may be associated with physical shock, and sometimes leads to long-term neurosis.
ACEs include:
- physical, emotional, or sexual abuse
- physical or emotional neglect
- household dysfunction, including mental illness, incarcerated relatives
- substance abuse, divorce, and a parent or caretaker being treated violently
Children who come to a CAC are often experiencing abuse and other ACEs simultaneously. At a Children’s Advocacy Center, our role is to intervene and work together with all the people involved in a response (law enforcement, child welfare caseworkers, forensic interviewers, medical providers, district attorneys, and mental health professionals) to make sure each child has access to the safety, support, and resources that stop the immediate danger from continuing.
But what happens after the initial investigation?
How do we address the lingering effects of trauma that follow not only the child victim of abuse, but also their supportive caregivers and siblings? Over the last several decades, our understanding of the neurological effects of trauma has grown substantially. And one thing is clear: stopping the immediate harm is the first important step, but that’s just the beginning. Our job is to end abuse, but it’s also to help children heal from trauma.
Without continuing trauma care, ACEs (such as abuse) can create patterns of recurring harm and re-traumatization that follow child victims throughout their lives. According to the CDC, “ACEs can have lasting, negative effects on health, well-being, as well as life opportunities such as education and job potential.” Without further intervention, children can carry these additional risks for years, sometimes decades, and even pass on a history of trauma and its harmful effects to their own children.
To address the ongoing effects of ACEs and provide the best possible chance at healing for the kids in our care, PennCAC recommends ongoing trauma therapy. All of our CACs provide referrals for trauma therapy, and many offer it on-site.
Janine Fortney, LSW and Program Director of The Children’s Advocacy Center of Susquehanna and Wyoming Counties, supervises a team of trauma therapists who specialize in helping child victims of abuse heal. She agreed to share some insight on what trauma therapy is, and explain some of the models that local CACs have found to be effective.
Before diving into trauma therapy models, Janine makes an important distinction between trauma therapy and another term you’ll hear quite a bit in the CAC world: trauma-informed care. “Trauma-informed care is really about the overall environment of a service provider like a CAC, making sure that everyone on the team is understanding and mindful of everyone else in that space. It isn’t only about the client you are serving, though obviously that’s the priority—it’s also about your colleagues, your peers, the maintenance staff, the administrative staff. Trauma-informed means that we need to be considerate of the fact that anyone around us could have been exposed to a traumatic experience.” When CACs are supportive of their own team members who may have their own histories of trauma, they do a better job of serving clients.
“Trauma therapy refers to the evidence-based therapeutic models we recommend or provide for children and their families.” Using evidence-based trauma therapy models is vital because, according to Janine, we never want to cause more damage by going in without a clear understanding of how we can give the best service and care to child victims and their families. “These models have been thoroughly researched and tested, enough that we can be confident that following these steps is proven to work.”
Providing clear steps for children and families to follow as they heal can create structure in the midst of an otherwise chaotic experience. “There is so much stress and chaos going on when a child has been through a traumatic experience. It matters that we’re able to present them with treatment models that are stable, proven, with clear steps to follow. And then there’s room within that structure to accommodate each family’s unique needs—for example, we find ways to include other members of the family who might have been impacted by the trauma.”
Let’s look at some of the trauma therapy models that families might encounter on their healing journey at a CAC:
Trauma Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is designed to provide tools that help children who have experienced trauma manage difficult emotions in healthy, productive ways. In TF-CBT sessions, children and caregivers are taught what traumatic stress is and how it might affect them.
They’re given emotional regulation tools to navigate trauma reminders, and through the use of narrative, work toward correcting maladaptive beliefs, like guilt, shame, and self-blame. By providing children and their parents skills they can practice at home, TF-CBT provides a sort of road map for navigating the inevitable ups and downs of recovery. TF-CBT is generally a short-term treatment (between 12 and 16 sessions) and research indicates that more than 80% of children experience positive results in this time. Trauma-related emotions become much easier to manage, and trauma stories become part of the past instead of continuing to negatively impact the present.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a thoroughly researched and tested psychotherapy based in evidence that the mind can heal in similar ways to the physical body. Therapists use eye movement to trigger biological responses connected to REM sleep and help children process traumatic memories.
EMDR.com explains it this way: “It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes.”
In over 30 positive controlled outcome studies, EMDR has proven to be remarkably effective, with some studies showing 84%-90% of trauma victims no longer diagnosed with PTSD after just three sessions.
Parent Child Interaction Therapy (PCIT)
In PCIT, a therapist observes and coaches the parent-child interaction to help parents and caregivers learn how to help their child feel safe, supported, and secure. PCIT is usually structured in two phases, the first to establish warmth and connection between the parent/caregiver and child, and the second to address behavioral challenges.
Over the course of treatment, parents/caregivers learn how to effectively reinforce positive behaviors in place of punitive discipline, a skill that can be particularly useful to help children who have experienced ACEs learn and grow without causing them further trauma.
Why these methods matter
It’s easy to understand why trauma therapy is a necessary, productive next step for child victims of abuse. But there are two less obvious reasons Janine advocates for evidence-based trauma therapy models.
Because the relationships surrounding the child ALSO need to heal.
“One of the most beneficial outcomes of trauma therapy I’ve witnessed is the healing of relationships. Disclosures don’t always come from the child themselves, and when the truth of the trauma comes out, it can create a wall between a supportive caregiver and the child. Neither completely understands what just happened, and now there are court processes and investigative processes. Using these models, I’ve seen the healing facilitated between parent and child, or between the child who experienced trauma and their siblings.”
Trauma therapy models like TF-CBT and PCIT, which invite children and their family members to participate and learn together, can help restore essential family bonds. And strengthening those bonds sets kids up for a much brighter future.
Because shame and blame are persistent—for kids, and also for parents and caregivers.
“I have the privilege of doing the interviews at my CAC, and I’ve been using these evidence-based models for twenty years. When I sit in the interview room and hear a kid say Phew, I’m glad I got that off my chest, and they can go into therapy and learn that they are not to blame for the trauma that occurred, there is a weight that is lifted. They have to learn that it isn’t their fault, and therapy helps them do that.”
“That guilt and blame lifts for caregivers as well. Why didn’t I know? Why didn’t I see? In many of these models, the parents are closely involved in the healing process. That makes an incredible difference in everyone’s healing.”
All of these models are approved by National Children’s Alliance for use in a CAC context. However, there is no single trauma therapy method that will be the best fit for all kids or families. By having a variety of evidence-based treatment modalities available, CACs and their therapeutic partners are able to find the best fit for each individual child, whether that’s a single method and a short course of treatment, or a combination of methods over a longer period of time.
Intervention is an essential part of the work we do. But what happens after intervention can make the difference between healing and sustaining further trauma. For the children who enter our care, as well as the supportive caregivers who surround them, we’re committed to providing access to evidence-based therapeutic practices that combat shame, promote strong family connections, and offer the best possible chance at a future full of thriving.
Janine Fortney, LSW and Program Director of The Children’s Advocacy Center of Susquehanna and Wyoming Counties