Best PracticeN e x t P r a c t i c e

A service of theChildren’s BureauU.S. Department of Healthand Human Services

Children, Families, andWorkers: Facing Trauma

in Child Welfare

Braced for the Storm:Child Welfare in New

York City

Foster Families andAgencies Respond

Reaching Outto Children

The Importance ofHelping the Helper

Resources

in this issue

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F a m i l y - C e n t e r e d C h i l d W e l f a r eA Biannual Publication of theNational Child Welfare

Resource Center forFamily-Centered Practice

Winter 2002

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Trauma andChild Welfare

The grief and the sadness over the eventsof September 11 have affected manypeople with shocking immediacy. Whereasthe events themselves brought the coun-try to a brief standstill, these events werereally only the beginning of what we mustnow understand and confront if we areto continue to make progress and im-provements in the child welfare system.

A broad range of consequences flowfrom that day magnifying other socialand economic trends. The events them-selves and the rippling aftershocks willproduce substantial effects in child wel-fare. These effects may be difficult todocument, but they do require a response.

In this issue of Best Practice/NextPractice we have set ourselves a challeng-ing task: connecting the effects of Sep-tember 11 to child welfare populationsand presenting strategies to improve prac-tice with families affected by trauma.

Personal lossHow can we look at the scope of the eventsof September 11? On one level there was anumbing personal experience of the events.At the epicenter, thousands lost their lives.Thousands more lost close family mem-bers. Many thousands more lost friends,colleagues, neighbors, and acquaintances.Within these expanding ripples, news andstories about the events made the experi-

ence a strangely personal one for peoplearound the world. People were connectedas they witnessed the events unfolding inlive television coverage. At this level of per-sonal experience, the events had serious con-sequences, inflicting trauma that interruptedeveryday life. Insecurity, uncertainty, and feartraveled alongside virtually all families asthey sought, under the increased stress, todo their work and care for each other.

The significance of this stress is height-ened among a child welfare populationthat is already vulnerable. For some of themost disenfranchised families—thosewhose lives are too distressed to even no-tice the national tragedy—the aftershocksmay prove to be even more powerful.

The extent of this trauma has beendocumented. Research conducted by theRand Corporation and published in theNew England Journal of Medicine statesthat close to half of American adults—44 percent—reported having one or moresubstantial symptoms of stress in thehours and days following the September11 terrorist attacks; nine out of ten adultshad stress reactions to some degree.Among children five years old or older,more than a third displayed one or morestress symptoms and almost half ex-pressed worry about their own safety orthe safety of loved ones.

Children, Families, and Workers:Facing Trauma in Child Welfare

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Economic aftershocksThe events of September 11 also contrib-uted to a series of economic aftershocks.For example, in the days following Sep-tember 11, the closure of Reagan NationalAirport directly affected numerous airlineand airport staff. With no passengers com-ing to the airport, the local taxis, hotels,and restaurants saw a drastic decrease in theirbusiness. That in turn created a bout oflayoffs among hotel staff. At the same time,local distributors who supplied the airport,hotels, and restaurants saw a decrease intheir business, and they in turn decreasedthe work for their staff and orders to theirsuppliers. And a myriad of other serviceand tourism industries in the Washingtonand New York areas and elsewhere havebeen affected with layoffs, decreased sala-ries, or shortened workweeks. Now we arein a recession, and the effects tied to theseeconomic aftershocks are proliferating.

With decreasing incomes many peoplecannot locate affordable housing. The NewYork Times recently reported cities aroundthe country are experiencing a new and sud-den wave of homelessness. Shelters are over-flowing, and more people this year—manyfamilies with children—are sleeping onfloors in social service centers, living in cars,or spending nights on the streets. “In NewYork, Boston, and other cities, homelessnessis at record levels .…A survey by the U.S.Conference of Mayors released [in Decem-ber] found that requests for emergency shel-ter in 27 cities had increased an average of13 percent over last year.”

Effects on child welfareIn part, our existing knowledge framesmany of the implications of this for child

welfare. We know economic dislocationexacerbates family stress. We know thatthe child welfare population is drawn dis-proportionately from the ranks of thosewho are poor, with the highest correla-tions between poverty and serious andchronic neglect. We know also that theincreased incidence of stress on familiescontributes to family violence—in theforms of domestic violence and childabuse—as resources and self-esteem erodeunder the forces of scarcity. Newspapersacross the country, including the BostonGlobe and Washington Post, are already re-porting a rise in crime and violence.

We also know that the largest growthin the economy in recent years has beenamong lower-paying jobs with few ben-efits and little room for savings. This hasbeen the economic force nudging forwardthe lower numbers of children in povertyby expanding the numbers of families ableto earn a subsistence wage from the serviceeconomy. Under these circumstances, wewould be well advised to anticipate the waysin which this population of families, strug-gling for subsistence in a shrinkingeconomy, may need increased resources forfamily support to handle the increased stressof the loss of a job or growing unemploy-ment around them.

At the same time, we face the effectsof untested linkages in child and familypolicy. In the first days after the passage ofwelfare reform legislation, some observersbecame concerned that transitioning peopleoff of welfare would degrade conditionsfor children and lead to an increased reli-ance on Title IV-E funds—the remainingentitlement program supporting children’swell-being. The early years of welfare re-

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form saw a “truce” in this debate, as abooming economy absorbed workingmothers, and critics were confounded bythe fact that the baseline at which states’Temporary Assistance for Needy Fami-lies (TANF) grants were set produced theunexpected state debate over how to usethe TANF surplus.

This will change in the aftermath ofSeptember 11. The boundary around thechild welfare population that exists as astandard of minimally acceptable safetyand well-being can shift. The combina-tion of economic recession and welfaretime limits could add up to drasticallyincreased strains on child welfare systemswhose capacities are pushed to their lim-its already.

State funding for childwelfareThe accumulation of stress factors in thewake of September 11 extends to statebudgets as well. Memories of the TANFsurplus are fading fast. States now findthemselves having to spend millions ofdollars on internal security to respond toresidents’ fears and potential dangers fromterrorists. At the same time, significantbudget cuts are soon to be enacted. Thesecuts include significant lay-offs of childwelfare and social services staff. Discus-sions with state child welfare staff in ev-ery region confirm this trend. At the sametime, as state child welfare departmentsstruggle with budget cuts, the federal re-view process, the Child and Family Ser-vices Review (CFSR), continues to chal-lenge state systems with its call for sys-temic change and family-centered bestpractice. Everyone involved must respond

by reaching for new reserves of hard workand commitment. It is no easy task.

Bracing for the aftershockThe effects of September 11 are cumula-tive, and they are building. The truth isthat we cannot trace people’s behavioralresponses to traumatic events back to asingle incident, nor can we say definitivelywhat triggers the symptoms of post-trau-matic stress disorder. We can, however, beaware of and prepared for effects most likelyconnected to recent traumatic events.These effects can include the following:

◆ Personal feelings of insecurity expressedas fear of going to work or school, ofbeing left alone, or of being away fromparents. In parents, role conflict inten-sifies. In children, relatively simple fearscan complicate daily routines, whichcan add stress to parenting.

◆ Recent assessments of mental health inchild welfare find that mental healthissues affect both children and caretak-ers in child welfare in many complexways. They are both cause and effectof child welfare involvement, and ef-fective assessment and treatment is elu-sive. Exacerbated by September 11 andits aftershocks, we should be preparedto identify persistent mental health sideeffects and mobilize innovative sup-ports to address them.

◆ Substance abuse and other negativehealth habits rise in reaction to trauma.When upwards of 80 percent of childwelfare cases involve substance abuse,this is a serious concern.

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◆ Child welfare workers are vulnerable tomultiple issues generated by the trauma.Practice in an atmosphere of fear andfatigue can undercut more clinically so-phisticated family-centered approaches.

Perhaps our greatest concern should bereserved for those families and childreninvolved in child welfare untouched byour current situation. The most disenfran-chised populations in child welfare livelives in which the trauma of September11 and its aftershocks become a part of adeadening routine. What does this meanfor long-term policy and development?Does it point towards better understand-ing of our responsibilities?

The articles in this issue of Best Prac-tice/Next Practice can help us be aware ofand prepared for effects most likely con-nected to both previous and the recenttraumatic events. We begin our discus-sion close to the epicenter of the recentevents and expand our focus. In “Bracedfor the Storm,” we interviewed agencystaff in New York City, some only blocksfrom Ground Zero, to see how they dealtwith and continue to face the demandsplaced on their services and staff.

In “Foster Families and Agencies Re-spond,” foster parents discuss the behav-ioral changes in the children in their carefollowing September 11. How have somelocal agencies responded to their ownneeds as well as those of child welfareworkers?

“Reaching out to Children” describesthe symptoms of post-traumatic stress

disorder in children, explains the mentalhealth needs of children in the child wel-fare system, and provides suggestions forfamilies and caregivers.

Child welfare workers are vulnerableto trauma. They need support from ad-ministrators and supervisors. In “The Im-portance of Helping the Helper,” RogerFriedman explains the prevalence andimpact of traumatic stress on child wel-fare staff and describes secondary trau-matic stress. He explains how individualsand agencies can successfully cope withthese challenges.

A state of alertWe need to see the extended and indirecteffects tied to September 11 to honestlytake the measure of the events. We needto see the fabric of relationships connect-ing these events, and connecting us all tothese events and their consequences. Butwhat, in the end, should we learn?

We are not in a state of alarm. Butwe are, as advised, in a heightened stateof alert. As time goes on, and we con-tinue to deal with the rippling effects ofSeptember 11, we also need to create aheightened state of humanity within thecomplex world of child welfare and else-where. We have to recognize the fact thatpeople live with the effects of trauma ev-eryday—in a way in which September 11only makes us more aware—and this is apotent argument for making policy andpractice dealing with families as humaneand as family-centered as possible.

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Braced for the Storm: Child Welfarein New York City“It took a couple of days after September 11 before some of us broke down and cried. Ourinitial reaction was ‘we need to do what we can,’ and didn’t allow any time to reallyprocess what happened. Even the night of September 11, Child Protective Services workerswere going into the field to assess child abuse and neglect reports. They basically didn’tstop to think about their own safety; they were just willing to do what was necessary.Some staff were severely traumatized by the tragedy and stayed home days, even weeksin some cases; others did not know where to report to work because we were evacuatedfrom our central location near the World Trade Center. However, the majority of thestaff came to work shortly after the event and continued to provide support to bothfamilies and fellow staff members.” – Zeinab Chahine, Deputy Commissioner, Divi-sion of Child Protection, Administration for Children’s Services, New York City

work with children and families. Whatare the effects on caregivers?

We know that often the response fromthe caregiver has a greater, direct impacton children’s sense of safety and well-being, especially the very young popula-tion, than a tragedy such as the destruc-tion of World Trade Center. Children takeclues from their caregivers—if thecaregivers can provide reassurance andsense of connection and support, kidstend to do better. We can give parents age-appropriate information on how to talkto their children about the events and howto assess whether kids are having strangerthan normal reactions requiring a refer-ral. We need to help caregivers recognizewhen to seek appropriate professionalhelp. We need to help them be healthyand respond in positive ways.

Because of the children’s stress andrelated behavioral problems, financialconcerns, and foster parents’ employment-related stress following the events of

Many reports and articles have discussedthe personal impact of September 11, andothers have focused on the impact Sep-tember 11 has had on a wide range ofsystems, from economics and employ-ment to airlines and national security. Butwhat of the child welfare system in NewYork City? Was this a system caught, likeso many, unaware? How did this large,centralized system function and react fol-lowing the events of September 11?Could it meet the needs of so many? Whatare frontline workers’ experiences in theaftermath of those days? To find out theanswers to these questions and learn more,we interviewed child welfare workers andadministrators close to Ground Zero,some who work only blocks from whatonce was the World Trade Center to learntheir perspective and experiences.

Surely, there are many short-term andlong-term impacts following the eventsof September 11, both to individuals inthe child welfare system and those who

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September 11, placements may be dis-rupted. Some foster parents may findthese stresses too overwhelming rightnow. Children may be acting out morein school resulting in constant calls tofoster parents from the schools. Agenciesare trying to anticipate and plan for sup-portive services to help caregivers, espe-cially foster parents, cope.

Because of September 11, some bio-logical parents are reliving some of thetrauma they experienced when their chil-dren were removed from them. Manybiological parents want to meet with theirchildren. We are trying to help the bio-logical parents and to work closely withthe foster parents to allow for contactbetween parents and their children. Agen-cies perceive this as a positive trend.

Parents with mental illness or traumahistories also are at greater risk of negativeresponses—symptoms may be exacerbatedand daily functioning may become im-paired. We are especially concerned aboutthe preventive services population, espe-cially parents who may have had previoussubstance abuse problems. This may leadto an increased potential for relapse. Weare concerned that there might be a higherlikelihood of people resorting to substanceabuse and alcohol to deal with stressful is-sues. We are working with our commu-nity-based agencies to make crisis-counsel-ing services available to all our clients.

Child protection and child welfare arestressful fields. How are workers man-aging this type of trauma? What ser-vices do you offer workers to help themcope with these issues?

Directly following the incident, the weekof the September 11, we began on-site

debriefing sessions in each of our fieldoffices, with the help of outside facilita-tors (National Organization of VictimAssistance and the New York Universityand Columbia Schools of Social Work).In Manhattan we held additional confi-dential sessions as soon as we moved backinto our offices, which are relatively closeto the World Trade Center. Some staffwere near the World Trade Center thatday, so they particularly appreciated theopportunity to talk about the events andtheir reactions, to discuss coping strate-gies, to learn about normal responses totraumatic events, and to get informationabout referral resources. The confidentialsessions were offered to everyone, so theydid not single out anyone. We receivedpositive feedback from staff about thedebriefing sessions. Also, the commis-sioner sent a memo to all staff indicatingthe symptoms of trauma, how to recog-nize these in yourself, how to do self-care,and what to do to seek additional help.The memo explained the resources avail-able to staff. If individuals needed follow-up counseling, we connected them tothose resources.

You seem to have responded to the needsof children, caregivers, and workers ina timely and appropriate manner. Priorto September 11 did your agency have aclimate or a structure set up to assistworkers concerning job-related stressand issues such as these?

Prior to September 11, we had discussedmaking support services available to staffto address “vicarious traumatization” (vi-carious traumatization refers to the ideathat working with traumatized clients canhave a cumulative, negative impact on

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helping professionals). September 11 onlyfurther demonstrated the importance andutility of providing emotional support toworkers, in addition to other concretesupports (e.g., opportunities for educa-tion). The fact that we were already sen-sitized to the issues of job-related stressamong our workers helped in quicklyorganizing support services to the staff.

What has also helped us respond werethe many procedures and interventions weset up several years ago, as we preparedfor the much-discussed possible Year2000 (Y2K) events. We devised a varietyof contingency plans for Y2K, and wefound that they were very useful in theSeptember 11 situation. Being preparedon that level helped to muster the re-sources and to provide for the staff.

The response and the coordinationwith other systems went well. We workedout the same plan we did as preparationfor Y2K. With this plan, the New YorkPolice Department responded to cases be-low 14th Street and Manhattan, which wasblocked off at that point. We workedclosely with the police to respond to neces-sary cases of child protection. Also, throughthe wonderful work of our medical servicesdivision, they quickly assisted us.

We also planned for a disruption ofour data systems and use of manual sys-tems while our data systems were down.Since our computer systems were not op-erational, we could not get reports fromthe State Central Register (i.e., the stateclearinghouse for child abuse and neglectreports). We were taking calls over thephone or by fax. We used emergencyphone numbers that we had to contacteach other. Having one central operation

was not effective, so in each borough, wedesignated a center to be our emergency24-hour operations center. All of thesestrategies helped to stabilize the response.We did not have the kind of chaos thatone would have expected.

How do you plan to expand services tomeet the anticipated needs? What didyou offer to preventive agencies in termsof flexibility of response?

We have a two-stage plan. The first stagewas short-term counseling consisting ofone to three crisis sessions that we wouldallow per person or family. This counsel-ing was not just for our own clientele,but for anyone who requested it or whohappened to walk in. We wanted to pro-vide concrete services and informationreferral to other systems that were oper-ating. We worked with the State Officeof Family and Children Services and wereable to garnish some waivers regardingpreventive cases. We offered services toanyone who wanted services. We have alsobeen able to work with the mental healthservice system to make more crisis coun-seling services available to our clients us-ing Federal Emergency Management Ad-ministration (FEMA) funds.

The second stage is more of an ongo-ing support that we would like to see forour clients as well as other people in thecommunity. We will continue to providesupportive counseling services. We are imple-menting training/education for clients,caregivers, staff, and managers on the issuesof trauma and how each group can respondappropriately and adequately to issues theyeach encounter. We intend to also conductongoing needs assessments as we continueto meet the service needs of our system.

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Are you noticing that the systemsare able to collaborate more, orare more unified in an approachto the delivery of services?

We have been working closelywith the mental health service sys-tem for the past four years andwith the substance abuse treatmentsystem for the past two years. Theimpetus of our collaboration withthese two systems has been theAdoption and Safe Families Act.We have worked with the mentalhealth system to improve access toservices for our clients and to im-prove communication and case co-ordination. Similarly, we had beenworking closely with the Office ofAlcoholism and Substance AbuseServices and the treatment pro-vider community to establish prin-ciples of collaboration between thetwo service systems and to developcross-systems operational proto-cols that would guide workers inboth systems as they work to-gether throughout their interven-tion with a client. The protocolswere issued jointly in April 2001,and we have been training the pro-viders in both systems around theuse of the protocols in the com-munity districts. The events ofSeptember 11 have delayed thetraining that we were going to doin one particular borough, but weexpect no major set back.

our response would have been somuch different, and most likelymuch less effective. Now, after Sep-tember 11, our momentum hassimply increased, and we continueto build. We received a lot of callsfrom all over the country offeringhelp and support. We are so appre-ciative of all the offers of help; ithas been overwhelming and heart-warming. We are very thankful.

Participants: Zeinab Chahine,Deputy Commissioner, Division ofChild Protection, ACS; BenjaminCharvat, Assistant Commissioner,Office of Management Develop-ment and Research; AmanD’Mello, Office of ManagementDevelopment and Research; Ur-ban Fellow Observer; Alana Gunnand Selina Higgins, Child Protec-tion Support Team; SharonMcDougall, Borough Director,Manhattan Division of Child Pro-tection; Hee Sun Yu, AssociateCommissioner, Medical ServicePlanning; Chandra Waddy, Na-tional Child Welfare Resource Cen-ter for Family-Centered Practice.

The already-begun collabora-tive efforts with other service sys-tems, we believe, have moved thechild welfare system and thoseservice systems closer togetherand made a more unified approachpossible. As a result, the systemsare able to collaborate more. Wewill have to build on our collabo-rations to be vigilant about whatis happening among our clientswho are already in treatment andwhether or not they are experienc-ing more negative outcomes, suchas relapses, and work with eachother to respond to any indica-tion of such trend.

New York City’s child welfaresystem was truly braced for thestorm. In summary, what hashelped you the most?

We have done much to consultwith each other, collaborate better,and redesign our system to theneighborhood level. When thistragedy happened, we were able torespond as a system. We were pre-pared. We could communicatewith each other, even in the min-utes after the crisis. People could goto the ACS Web site www.nyc.gov/acs and find out where we were andcontinue to contact us; ongoingclear communication with our pro-viders was very important. If theseevents had happened six years ago,

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New York City’s child welfare system is notthe only place that has felt the effects ofSeptember 11, the anthrax scare, and theaftermath. Most child welfare systems aredealing with the effects of terror and trauma.

Washington, DC was not only af-fected by the Pentagon crash, but also bythe anthrax scares and the evacuation ofsome federal facilities. Carolyn RussellLander, ombudsperson for the District’sChild and Family Services Agency re-ported, “Many of our parents—both birthand foster parents—if they are employedare federal workers. As a matter of fact,one of our foster parents, who was in theprocess of adopting her foster child, waskilled in the Pentagon crash. As federalworkers, some of our parents had toevacuate their work place. And whenchildren’s parents are in danger, childrenhave a heightened state of anxiety. Ouragency’s workers are reporting that manyof the children in care are exhibiting aheightened vigilance or even hyper-vigilance. They are much more aware ofharm and violence and death.”

In addition, problems for theDistrict’s agency were exacerbated by thefact that in the chaos of September 11,there was no existing plan for evacuatingand closing the agency building. One su-pervisor said, “We didn’t know what todo. There was no guidance from city of-ficials, and we had many children in thebuilding at the time federal offices, theWhite House, and the Capitol were be-ing closed.”

Effects on foster parents andchildrenThe National Foster Parent’s Associationreported that the issue of terror, trauma,and stress was much on the minds and inthe members’ discussions at their recentnational convention. When asked whetherchildren in foster care were showing any

Foster Families and AgenciesRespond

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effect after the events of September 11,the president of the Colorado FosterParent’s Association, Sherry Bethurum,said, “Many of the children in the systemare suffering from undiagnosed post-trau-matic stress disorder (PTSD). Somethingas major, unpredictable, and uncontrol-lable as the tragedy of September 11 justsets the children off again. We’re seeing arange of stress behavior in the children,ranging from increased insecurity andclinginess to recurrent nightmares.” Shealso explained that this increased stress infoster children makes foster parents’ jobsharder. “Because the children are suffer-ing from PTSD, many of the foster par-ents themselves begin to suffer from sec-ondary trauma.” Secondary trauma is theemotional and behavioral stress that iscaused by directly or indirectly helping atraumatized or suffering individual orfamily. The frequent or prolonged expo-sure to such trauma creates secondarytrauma stress (STS) for the helper thatimpacts personal well-being and profes-sional effectiveness.

In Denver, one foster parent reportedthat her foster daughter regressed to herformer psychosis—she was convinced thatthe airplanes that crashed into the WorldTrade Center and the Pentagon were reallyafter her. Another foster parent observed,“In talking with some other foster parents,we’re not seeing much reaction from thefoster kids. In fact, we saw much morereaction from the children at the time ofthe Columbine shootings. But the fosterparents are another matter. I’ve been fos-tering for 17 years and, you know, the chil-dren coming into care today are muchmore damaged than we saw 15 years ago,

and fostering is harder. Some of our fosterparents became depressed after September11. It felt like one more burden on an al-ready overburdened household.”

In Des Moines, Roger Hart, a teacherat PACE Juvenile Justice Center, reportsthat many of the young people he workswith, particularly those diagnosed as seri-ously emotionally disturbed (SED), areshowing signs of increased stress. But thestreet kids hardly seem aware that anythingeven happened on September 11. “Theirminds are still on the street,” Hart said.

On the other hand, sometimes goodcan come from bad situations. StephanieEells, Clinical Director of Courthouse,Inc. in Denver, explained that in theirgroup homes for adolescents (ages 12 to18), staff let the teenagers watch the eventsunfold on television, but then took timeto talk about it with them. Over the nextdays, the teenagers showed genuine resil-ience. They made flags and red, white,and blue beads for the staff, talked abouthow they wanted to help victims and theirfamilies, and the teens who had not yetdone their community service asked ifthey could begin.

Effects of child welfareworkersBut it’s not just the families in the childwelfare system who may experience ad-ditional stress in these trying times. Asstated on page 1, close to half of Ameri-can adults reported having one or moresubstantial symptoms of stress in thehours and days following the September11 terrorist attacks, and nine out of tenhad stress reactions to some degree. If thisis true for the United States’ general popu-

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lation, it’s probably even more true forprofessionals who regularly work in high-stress situations and with clients who mayhave been traumatized.

A 1999 study assessed the prevalenceand severity of secondary traumatic stress(STS) symptoms among a sample ofchild protective service (CPS) workers inthe South. Using a survey research design,up to 37 percent of the respondents werefound to be experiencing clinical levels ofemotional distress associated with STS.In addition, levels of work exposure andwork-related personal trauma were foundto be strongly associated with the pres-ence of those symptoms.

The events this fall probably haveexacerbated this. For example, some Bal-timore City child welfare supervisors re-ported that their workers seem morestressed and irritable. And this year, incontrast to previous years, few workersparticipated in the Thanksgiving holidaybasket program for poor families. Oneworker said, “This year, I just couldn’t addone more thing. My plate’s too full, andI am feeling so numb.”

What to do?Based on the data and anecdotal infor-mation summarized here, child welfareagencies need to examine the needs of theirown agency, workers, and children andfamilies regarding terror, trauma, andstress. What plans are in place for emer-

gencies? How can workers receive addi-tional support? What additional supportdo families need?Agencies have responded in different ways:

◆ Washington, DC’s Child and FamilyServices Agency is developing an emer-gency plan to use if another crisis occurs.

◆ Colorado’s Foster Parents Associationheld voluntary training opportunitiesfor foster parents to help them dealwith PTSD in their foster children andwith their own personal secondarytrauma stress.

◆ The Baltimore City child welfare sys-tem recently offered such a STS pro-gram and the workers’ response wasoverwhelmingly positive. One workerresponded, “This is the best trainingI’ve ever gotten. I gained a better un-derstanding of what trauma is and theeffects that it can have on you, yourlife, and your job.”

As we continue to wrestle with the issuesthat surround the trauma of September11, child welfare agencies can change adeficit into an opportunity. Staff andstakeholders can have deliberate discus-sions to determine how the agency canmore regularly and effectively respond tothe impact of trauma and stress on theagencies’ children, families, and staff.

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“A climate of terrorism and war touches us all, but not equally. Some will experiencemuch more pain and distress. In addition to those who have or will experience eventsdirectly, there are many others already living with trauma or overwhelming stress whoare vulnerable to new blows. There are also children and adults whose high sensitivity totragedy and trauma leaves them particularly vulnerable to times when fear and tragedyare ever-present.” What Happened to the World? Helping Children Cope in Turbu-lent Times, Jim Greenman. p. 5, Beltsville, MD: Gryphon House Books, 2001.

The September 11 events triggered pro-found reactions in everyone. The worldbecame a scary and overwhelming placefor those injured, loved ones, survivors,and witnesses—including children of allages. Whether a child lost a loved one orviewed the events on televison, child-serving institutions saw different types ofreactions to the terrorist attacks and theiraftermath (see previous articles). Manystaff in these institutions had no experi-ence in how to respond to the uniquemental health needs of children follow-ing these events.

There are many parallels between therecent events and child maltreatment. Inboth cases, the events are perceived as anattack and children fear for their lives orthose of the people they love. Childrenwho have been abused know the confu-sion and shock that comes from beinghurt with no apparent reason. They knowquite well how it feels to live in an unsafeworld. Children who have witnessed orexperienced trauma struggle on a dailybasis to feel safe. Some have had to workhard at knowing that they are safe, andthat they no longer have to live in fear ofanother “attack.”

Not much has been said about theimpact of the September 11 events on

Reaching Out to Children

children in the child welfare system whomay be reacting strongly to these events,as the tragedy aggravates the effects of pasttraumas and fears.

Post-traumatic stressdisorderFrightening things happen to children allthe time, whether they experience the deathof a beloved grandparent, being hospital-ized, or other stressors. In most cases, chil-dren are scared, sad, angry, or confused fora period of time. Soon, they are able to gettheir strength back and move on with asense of confidence that they can cope whentimes get tough. It may happen that whensomething reminds them of the frighten-ing incident, they become sad or scaredagain for a while.But the grief or fear doesnot interfere with their everyday life. Butbeing “traumatized” is a different kind ofbeing scared. When anyone, young or old,experiences a real or perceived threat to hisor her life (or to the life of someone veryclose), certain physiological changes areautomatically triggered: the heart ratequickens, stress hormones pour into thebloodstream. In the immediate aftermathof the trauma, almost everyone will haveacute mental health needs that are demon-strated in symptoms such as extreme anxi-

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ety, nightmares, or fearfulness.Sometimes the part of the brainthat triggered the initial alarm goesinto overdrive and never calmsdown. Recurring intrusive recollec-tions of the event cause an indi-vidual to remain in a perpetualstate of fear and anxiety, on thelookout for signs of danger. Or,children may become emotionallynumb—appearing as if they arefine—but their hearts are racingand their brains are shrieking “dan-ger.” This is what is called post-traumatic stress disorder (PTSD).

Children can demonstratesymptoms of PTSD after wit-nessing isolated, terrifyingevents, such as a devastatinghurricane, tornado, or livingwith chronic domestic or com-munity violence or physicalabuse. These children may be ina constant state of fearfulness,reliving the experience over and

Mental health needs ofchildren in child welfareIt is normal for children to sufferfrom sleeplessness, lack of con-centration, and other stress-relatedsymptoms for several weeks fol-lowing a very frightening event.People who work with trauma-tized children have learned that tosome extent, the children’s abil-ity to rebound from a stressfulevent (resilience) is generally re-lated to their growing up in a lov-ing, nurturing home or having ateacher, coach, or grandparentwho cares about or believes inthem. It is also related to thechild’s temperament, cognitiveand social skills, and emotionaldevelopment. The age of a child,as well as the duration and sourceof the trauma, affects a child’sability to cope, too.

Children in the child welfaresystem may be less resilient be-cause they have histories that ren-der them especially vulnerable tothe effects of the terrorist attacks.And it gets more complicatedwhen incidents continue, as theyhave done, with the anthrax scarecoming just a month after theinitial September 11 attack. Wit-nessing or experiencing violencecan be extremely disturbing to allchildren with previous historiesof trauma who may strongly re-act as old pain, fear, and insecu-rities of previous losses areremembered.

over again in their play, theirsleep, their drawings, theirspeech, or their relationshipswith others, as they try to makesense of the incomprehensible.Some show disorganized andagitated behavior; they may re-gress to earlier behaviors such asclinging, bedwetting, or thumb-sucking; they may become irri-table and have difficulty sleep-ing or concentrating. Worsestill, because some people donot believe that children can beaffected—even by a single trau-matic experience—their symp-toms are frequently overlookedor dismissed and many childrennever receive treatment.

Some signs of post-traumaticstress are obvious. Infants cry andcling more than usual. Pre-schoolers regress to soiling theirpants, sucking their thumbs, orstuttering. School-age children areunable to concentrate on work orcomplain of headaches, stomach-aches, nausea, or nightmares.They may even convince them-selves that the terrible ordeal theywitnessed will happen again—andworse—that they were respon-sible for its occurrence in the firstplace. However, because manytrauma symptoms are less obvi-ous, they are easy to miss or mis-interpret—the withdrawn childwith the blank facial expressionwill not be as noticed as the childwho wakes up screaming in themiddle of the night.

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Addressing the mentalhealth needsPast research has documented thatexposure to community violencemay have enduring consequenceson children’s development, begin-ning in the preschool years andcontinuing through adolescence.This research has also documentedthat children who are exposed to

Training for Child Welfare StaffMany child welfare workers are unfamiliar with the specialneeds of children who witness violence. The following are somesuggested topics for training:

◆ The differential effects of trauma in children who are in thechild welfare system: how history, personality, age, supportsystem, etc., contribute to the traumatic experience and itsafter-effects.

◆ Appropriate application of DSM IV definition to the symp-toms identified in the traumatized child; factors contributingto misdiagnosis of psychological trauma in children.

◆ How to work with biological, foster, and kin parents toidentify and address behavioral challenges that result fromthe potential exacerbation of the trauma; dealing with thechallenges of “hidden” trauma, that is, the children who maybe masking their trauma experience.

◆ Different manifestations of single versus repeated trauma.

◆ Techniques for handling mistrust and other symptoms duringscreening, assessment, case planning, and interventionstages. Include topics such as determining priorities andtiming for addressing specifics of traumatic events, use ofmedications, and understanding regression as a copingmechanism.

◆ Strategies of intervention for helping children.

◆ Cultural factors that impact the traumatic experience andethical considerations when dealing with them.

◆ How to integrate assessment, intervention, and evaluationfindings in court reports, when providing testimony, and so on.

multiple forms of violence aremore at risk of developing psycho-logical consequences than thoseexposed to single or isolated vio-lent events (either at home or inthe community). Therefore, chil-dren in inner-city neighborhoods,with high violent crime rates, andwith a history of child maltreat-ment may be in double jeopardy.

The child welfare system,schools, and the network of com-munity-based organizations serv-ing the needs of maltreated chil-dren need to be prepared to re-spond to unique mental healthneeds of children and youth withprevious history of abuse and vio-lence. When children have livedwith violence, their reaction totraumatic experiences are likely tobe different from that of otherchildren. Watching, hearing, orlater learning of a parent beingharmed further threatens theirfragile sense of stability and secu-rity. Children’s reactions may takeseveral forms. Some children maybecome anxious, fearful, or with-drawn, symptoms that are re-ferred to as internalizing problemsor taking fears inward. Sadness,fear, guilt, anger, shame, and con-fusion are often experienced.Other children may externalizetheir problems, and express theirfears by being hostile or using ag-gression to as a way to solve in-terpersonal conflict with the adultworld or with their peers. Thespecialized mental health needs ofchildren and families in the childwelfare system require consistent,ongoing attention, which cannotbe obtained in a single counsel-ing or debriefing session.

Suggestions for familiesChildren who have been trauma-tized may react by behaving inways that show their stress and

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fear. Here are some ways they be-have and how you can help:

Regression. Relate to childrenat the age level they have returnedto and try to gently help themregain their skills.

Separation fears. Be patient.Give children extra time andnurturance during transition pe-riods in the day, especially whenthey are separating from you andat bedtime.

Fear. Let children know thatit is okay to be scared; they donot need to be brave. Let them

know that they are not alone andthat you are there to protect andlove them.

Breaking the rules. Try to main-tain the same rules and expectations.Knowing what is expected fromthem helps children feel safe. Donot use physical punishment, whichonly shows that it is okay to useviolence to solve problems. Instead,use reasoning, distraction, logicalconsequences, and empathy.

Nightmares. Encourage thechild to express his or her worriesduring the day so that they are not

Ten Ways to Calm an Anxious Child1. Respond as quickly as possible to the child’s signs of distress by approaching the child

and showing interest in what the child is feeling.

2. “Listen” to what the child is saying with words and actions.

3. Take the child’s feelings—especially fear and anger—seriously.

4. Get another adult to take care of siblings or other children around so you can talk to thechild privately.

5. Relax. Be as low key as possible when helping a child calm down.

6. Restate to the child what the child is saying to make sure you understand.

7. Provide appropriate outlets for strong emotions, including anger, frustration, sadness, andloneliness. Examples include letting the child use a punching bag, going with the child to aquiet corner, playing with a tape recorder, running in a special “running space,” orpainting.

8. Do not personalize it. You are not a “bad” caregiver and the child is not a “bad” child.

9. Comfort the child with extra hugs, a place on your lap, or special soothing at bedtime,when appropriate.

10.Be there for the child. Nothing is more reassuring than your presence and care.

From: Cohen, E. and Walthall, B. (2002) Silent Realities: Supporting Young Children andTheir Families Who Experience Violence. Rockville, MD: Center for Mental Health Services,Substance Abuse and Mental Health Administration.

lurking in his or her mind at night.Talk to children about their baddreams. Help the child come upwith an ending that he or shewould like. Go over the “good”ending before the child goes tosleep. Also, assure the child that thenightmares will go away with time.

Anniversary reactions. Anni-versaries provide an opportunityto acknowledge the feelings thatare still there and also talk aboutnew feelings and thoughts.

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A recently graduated social worker receives a phone call on a Sunday morning at homefrom her supervisor. She’s told that a 16-year-old teenager she has worked with for sixmonths in foster care has been shot and killed in a drug deal. Her supervisor asks her to visitthe youngster’s foster and biological families that day to give them the terrible news.

Drug dealers on the street intimidate two workers as they are making a home visit,and, when the dealers discover that they are from social services, they tell the workers ifthey see them on that block again they’ll shoot them. One flashes a pistol he has tuckedinto his belt, and the workers run to their car fearing for their lives.

A worker and aide pull a six-year-old girl from the angry arms of her mother andtransport the girl to a foster home across town. The workers know that she will be saferthere, but the workers can’t get the child’s wailing cries of help and fear out of theirheads. They had never heard a child cry the way this little one did in their car. Theworkers feel they’ve destroyed something valuable in order to save it. They worry alone,crying by themselves, all weekend.

Traumatic experience—terrible knowledge about lifeOn September 11, 9:00 a.m. unit meet-ings in a child welfare agency in a Wash-ington, DC suburb were broken up withthe news of the attack on the World TradeCenter. A few minutes later as televisionswere dragged into hallways, staff huddledtogether and watched as the Pentagon wasattacked just a few miles away. Agencyphone lines were jammed, cell phone con-nections went down—no one could con-tact loved ones or children in school—there was only their colleagues to holdonto, to cry together, to wonder whenmore bombs or planes would hit in theWashington area. Then, together they sawthe unbelievable as World Trade Towerscrumbled. The workers went through thislike a family. Although personal lifecalled, staff hesitated to leave one another.They had been through so much together,

The Importance of Helping theHelper

By Roger Friedman, Ph.D., LCSW

they understood intuitively that this wasanother trauma they had to help eachother with. Like so much of the “terribleknowledge about life” they encounter to-gether, they knew they would never bethe same after this.

Reflection on traumaticexperienceIn the past few years a new and deeperunderstanding of the prevalence and im-pact of traumatic stress on child welfarestaff has developed. It has long been rec-ognized that child welfare agencies are re-warding but very difficult places towork—agency resources are usually inad-equate, client numbers and needs aregreat, demands for speed and productiv-ity are high, and salary/benefits are usu-ally very low. General work stresses suchas these, which exist in many human ser-vice settings, can contribute to difficul-

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ties in recruitment and retention as wellas low morale and burnout. But there isa new understanding of the challengesof child welfare work. We know thatfrequent and prolonged exposure totraumatized individuals, families, andcommunities inevitably creates second-ary traumatic stress for the helper. Sec-ondary traumatic stress, which can evolveinto post-traumatic stress disorder, iscaused by directly or indirectly helpingseverely traumatized children and adults.

Regular exposure to trauma and

terrible knowledge about life can

deeply effect staff ’s emotional,

behavioral, and spiritual well-being

in painful and unsettling ways.

This regular exposure to trauma andterrible knowledge about life can deeplyeffect staff ’s emotional, behavioral, andspiritual well-being in painful and unset-tling ways. Although general work stressis frustrating, secondary traumatic stresscan, over time, change people forever.

This article discusses the commonsources and signs of secondary traumaticstress in child welfare and how individu-als and agencies can more successfully copewith these challenges. Futhermore, thearticle explores how the society-widetrauma caused by the September 11 ter-rorist attacks is adding traumatic stress onchild welfare staff and how agencies andindividuals are coping.

Secondary traumatic stress:definitions, sources, and signsHuman disasters cause painful trauma forprimary victims. Those who are helping

become secondary victims of the disaster.Common sources of secondary trauma insocial services include:

◆ Facing the death of a child or adultfamily member from an active or re-cently closed case

◆ Investigating a vicious abuse/neglectreport

◆ Encountering street violence

◆ Continuing work with families in whichserious maltreatment, domestic violence,or sexual abuse has recently occurred

◆ Removing a child from his or her homewhen emotional intensity is great

◆ Experiencing frustrating court eventswhere the worker believes the child orfamily remains in a dangerous situation

◆ Confronting intense verbal or physical as-sault by clients or community members

Though death of a child under protec-tive care is relatively infrequent, it has tre-mendous impact on the staff involved,the agency, and family for months oryears. The other events occur regularly inmost child welfare settings, and if staffhave 20 to 30 children on their caseload,these traumas may be present in most ifnot all of their families.

The signs of traumatic stress are simi-lar to post-traumatic stress disorder. Work-ers speak of crying unexpectedly, beingunable to focus, feeling victimized, guilty,alone, and angry.

They talk of not being able to leavework issues behind when they go homeand being preoccupied with the thoughts,smells, and sounds of traumatic eventsthey have just encountered. Cognitive

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symptoms like these include preoccupa-tion with the images of the trauma, lackof concentration, despair, and recurringregrets or guilty worries about one’s owncompetency and responsibility for thetrauma, consideration of leaving the job,and being distracted by all of this awayfrom work. Emotional symptoms in-clude alternating anger and depression,loss of hope in society and in child wel-fare, anxiety for one’s own children, andirritability toward colleagues and one’sfamily. Physical signs can take the formof sleep disturbance, fatigue, psychoso-matic illness such as migraine headaches,psoriasis, and muscular pain, and substanceabuse/over-eating to manage anxiety.

Traumatic stress socially isolates staffwho are often ashamed about their strongreactions and uncomfortable burdeningcolleagues or loved ones at home withtheir painful worries.

Finally, exposure to such terribleknowledge about life often forces staff tore-examine their assumptions about reli-gion, God, families, and life itself. Mostchild welfare staff report that their expo-sure to trauma in their work has changedthem, as people, forever. These changeshave been painful, and many, without sup-port at work, leave their job because ofthem. But if they stay, and co-workers are

compassionate and supportive, in the longrun many staff feel that these challengeshave helped them mature. They reportbecoming more humble and wiser as so-cial workers, more compassionate for oth-ers, more content or appreciative of therelationships and relative security they havein their own lives, and more spiritual. Theyoften say that they come to see their work,not only as a job but as a calling, i.e., anintrinsically valuable way to help rebuild abroken world. What better way to live outone’s days on earth? What important les-sons trauma has to teach us.

Terrorism and traumaThe terror of September 11, and the con-tinuing drama of anthrax, war in Afghani-stan, and security issues on the “homefront”have affected child welfare staff just as theyhave the larger society. In workshops ontrauma and traumatic stress, staff talk freelyabout their new found anxieties. In manyagencies staff have come together for pub-lic discussions. They speak of how suddenlythey are aware of the dangers in the largerworld; how they feel they are citizens of theworld overnight. What a terrorist is doingthousands of miles away affects them in thestreets of Baltimore or in a Maryland sub-urb. In the Washington, DC area manyworkers with small children wonder“should I remain in the primary target zoneduring the coming months and years ofbattle with terrorists?” Older workers near-ing retirement speak in anger and fear abouttheir retirement funds having been cut inhalf since the stock market’s precipitousdrop and their need to work more yearsthan they had anticipated. Air travel is aworry, and many staff won’t fly.

But … in the long run, many staff

feel that these challenges have

helped them mature…They often

say that they come to see their work

not only as a job but as a calling—an

intrinsically valuable way to help

rebuild a broken world.

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Staff who are of Middle Eastern back-ground or who are practicing Muslimsworry aloud about being discriminatedagainst or blamed for the recent events.One Muslim social worker talks throughher tears about how important it is thather co-workers accept and trust her andunderstand her love for America and herfear for family still in Pakistan. Many talkof how their innocent faith in the worldhas been shattered, and how sad they arethat their children must now grow up infear of world violence and war.

The heightened anxiety followingSeptember 11 has made staff all the morevulnerable to traumatic stress from work.Now, not only as social workers, but asAmerican citizens, parents, and humanbeings, they feel attacked and fearful.Their resilience, ability to concentrate, andhopefulness about life is challenged on abroader scale.

Client families are often so over-whelmed by their immediate daily crisesthat they seem oblivious to September 11.It reminds many workers of how isolatedthey are from their clients, of what a dif-ferent world they live in from the familiesthey serve who may be homeless or on thebrink of collapse or disaster in the innercity. In child welfare agencies, the terror-ism has made for an emotional environ-ment that is even more intense, isolating,and in need of group cohesion.

Healing responses: Traumasupport programs andactivitiesMany agencies and state systems are de-veloping and implementing trauma sup-port programs that will be responsive tothe traumatic stress of work and addedanxieties of a world filled with terrorism.There are several important dimensionsto these efforts: education; trauma de-briefing and group support; unit-level sup-port for casework; and agency-wide com-mitment to human resources. First, edu-cation about traumatic stress and itssources and signs is needed for all directservice and administrative staff. This is notjust “training,” but rather an effort tobring staff together to talk about the per-sonal impact of their work and gain somenew language and understandings abouthow trauma affects them as people. Thiseducation involves a sea change in theculture of many social service agencies.

Historically, child welfare workershave survived traumatic stress through grit,stoicism, and humor. Those who couldn’t“handle it” left or stayed on in demoral-ized careers. Truly heroic workers survived

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No matter how skilled or experienced, when helpers work in

close proximity to major trauma they will be impacted by it.

The goal is not how to inoculate ourselves from traumatic

stress, but rather how to develop individual and group sup-

ports that help us live with this pain and find ways to learn

from it and renew ourselves.

but more on their own fortitudethan on any support they receivedfrom colleagues or the agency. Amodel of practice has been taughtin child welfare that emphasizedthat mature and competent socialworkers should not react emo-tionally to client situations. If aworker was traumatized by a situ-ation then this was a sign ofcounter-transference, lack of ex-perience, or personal immaturity.

What is becoming clearer isthat no matter how skilled or ex-perienced, when helpers work inclose proximity to major traumathey will be impacted by it. Thegoal is not to inoculate ourselvesfrom traumatic stress, but ratherto develop individual and groupsupports that help us live with thispain and find ways to learn fromit and renew ourselves. This modelof practice normalizes the emo-tional and personal intensity ofchild welfare work and challengesindividuals, units, and agencies toorganize themselves in ways thathonor these new understandings.

A second area of trauma sup-port is developing the capacity toprovide debriefing services toworkers within 24 hours of their

traumatic experience. Thesedebriefings are adapted from Criti-cal Incident Debriefing protocols(see the International Critical In-cident Foundation at www.icisf.org) used in disaster relief andin medical emergency and policesettings. The debriefing is a struc-tured interview, where workersdescribe the trauma in detail andtalk about the emotional and cog-nitive impact the incident is hav-ing on them. The worker is giveninformation about the expectedeffects of trauma and suggestionsfor renewal. The worker is askedto identify immediate resourcesand activities that can help him orher cope more effectively.

Legal and casework reviewsare important following traumaticincidents, but they cannot takethe place of this personal worker-centered debreifing process. Re-search and clinical evidence pointto the value of providing staff anopportunity to discuss the per-sonal impact of their experienceand to discuss how they can helpthemselves through it in a non-judgmental atmosphere.

These debriefings can be doneby a trained peer support staff, by

external crisis counselors, or byemployee assistance programcounselors. The challenge is to setup a system that is easily accessed,confidential, and has little or nostigma for workers attached to it.Peer support teams have been agood way to address these issues,but the agency needs to providesome training and organizationalhelp to make this work.

In addition to debriefing ser-vices, many agencies are starting bi-weekly trauma support groupsthat are open for anyone to attend,occur at the same time twice amonth, and focus on discussion oftraumatic stress in the lives ofworkers. Some meetings may haveonly two or three participantswhile at other times, like after Sep-tember 11, 40 staff attended.

At the unit level, trauma sup-port is crucial. In most child wel-fare agencies, staff identity is basedon the unit and service to whichyou belong, and the closest rela-tionships you have are with co-workers in your unit. Units thatare supportive in times of traumaspend time at meetings talkingabout the personal side of work;staff are comfortable disclosinghow traumatized they might feel.Co-workers offer to help withpaperwork or to join others onhome visits during particularlytraumatic periods. Work schedulesneed to be flexible including“mental health” leave or daysspent in the office and not mak-

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ing field visits. Workers need notbe best friends, but they need toknow what is going on that isstressful in each other’s lives andbe expected to respond with sup-port when traumatic work eventsoccur. Though supervisors can fa-cilitate this, it is really a matter ofteam education and team support.Trauma cannot be carried alone;it demands collective action.

Finally, an agency commit-ment from the top down is veryimportant if this change in cul-ture is to happen. In some pro-grams, directors have led division-wide meetings to discuss the ef-fects of September 11, or to grievetogether the death of a child or aterminal illness of a fellow worker.These are painful moments, butwhen the administration of anagency supports these behaviors,it helps supervisors and direct ser-vice staff to follow. Senior man-agement support helps everyonefind the resilience and hope to con-tinue. The agency as a commu-nity of helpers is an importantconcept to establish by seniorleadership. As a community, staffsupport each other a great deal,not only in their technical workbut also in those areas of personalpain that are related to the workwith trauma. In meetings andtrainings with senior administra-tors, it is important to emphasizetheir role as emotional leaders andchampions of resilience and hopein the organization. It is impor-

tant for them to think about howthey can model these values forall staff.

One of the organizationalproblems in child welfare is thatno department or administrationis designated to manage traumasupport efforts. In large and smallchild welfare agencies, seldom isthere a human resources depart-ment. Whatever formal supportis given to staff is often diffusedor delegated to a county person-nel officer or to an already over-worked administrative or super-visory staff. It may be crucial forsome agencies to create a traumasupport manager, explore grantfunding, or make special requestsfor a staff position that can coor-dinate trauma education and de-briefing services. In some agencies,these initiatives could be incorpo-rated into worker task forces orContinuous Performance Im-provement committees.

Building the capacity of agen-cies to better cope with the trau-matic stress of their staff is animportant part of the agenda forthe future of child welfare. It isan essential and often missingelement in strategies for organi-zational development, recruit-ment, and retention of staff inpublic social services. The culturalshift in understanding how clienttrauma inevitably affects thehelper is an important next stepin professional education and so-cialization of social workers in

child welfare. The social traumaour society experienced on Sep-tember 11, and the continuingstruggle to battle with terrorismin an increasingly smaller world,makes these challenges in childwelfare all the more urgent.

Roger Friedman, Ph.D., LCSW,has been a consultant for state andcounty child welfare programsacross the country for the past 20years. He focuses on helping agen-cies enhance clinical services, be-come more family-centered andcommunity-based, and build ca-pacity to cope with secondary trau-matic stress. Dr. Friedman serveson the Editorial Board of The Pres-ervation Journal, is Adjunct Fac-ulty for the University of MarylandSchool of Social Work, and main-tains a clinical practice in SilverSpring, Maryland. He can bereached at RSF9826@aol.com or301.588.4442.

References

Figley, Charles (Editor). Compas-sion Fatigue: Coping with Second-ary Traumatic Stress Disorder inThose Who Treat the Traumatized.New York: Brunner/Mazel, 1995.

Stamm, B. H. (Editor). Second-ary Traumatic Stress: Self-careIssues for Clinicians, Researchers,and Educators. Lutherville, MD:Sidran Press, 1995.

Best Practice/Next Practice

22 ◆ Winter 2002

BooksGarbarino, James. Lost Boys: Why Our Sons Turn Violent and How We can Save Them. NY: Simon &Schuster, 1999. 278 pp. ISBN 0684859084 (hard cover); ISBN 0385499329 (soft cover).

James Garbarino has made a career of probing the causesand consequences of violence in young people, particu-larly in young boys. It is a particularly important serviceto us, because—as a country and as a culture—we havefew constructive ways to understand the subjects he ex-plores. The American obsession with firearms is commonknowledge worldwide. Gun sales have dramaticallyincreased since September 11, bringing us all closer tolethal force than ever before. At the same time, youngpeople are, for every generation, frightening and strange.Under the most benign circumstances, the rebelliousnessand search for identity so characteristic of adolescenceleaves us feeling defensive and out of control. When ado-lescents are troubled or violent we create categories forthem, like “superpredators.” These labels carry such de-humanizing stigma that it justifies the harshest of treat-ment of teenagers: trial as adults, imprisonment with hard-ened criminals (despite their abuse and exploitation thatis common knowledge under such circumstances), evenexecution. In doing so we indulge, at the level of thestate, a longing for righteous revenge that we hope willclose Pandora’s box. In reality, such practice deepens thepatterns of social reproduction within which violencethrives.

It is here that Garbarino performs a great service. Hetries to understand young people and violence, not throughcultural stereotype, but through dialogue and research.Through his approach of seeking to understand the “childinside the killer” we can come to a fuller and more sys-

Resources—Building a Five-Foot BookshelfBest Practice/Next Practice hopes to help readers sort through the many resources that are related to family-centeredpractice. As a part of this process, we will be building a “five-foot bookshelf ” of important resources, old and new, byreviewing new books, videos, and other resources, and recommending older, “classics.” Look for the symbol on thefollowing pages to indicate “highly recommended—add it to your list.”

temic understanding of how to cope with youth violence.The book is rich, synthetic, and resists summary. For ex-ample, Garbarino identifies “ten facts of life for violentboys” that need to be considered in any kind of full reha-bilitation program. These ten characteristics describe earlytrauma, abuse, and rejection that lead to the boys’ harshand anti-social efforts at survival. This survival takes theform of violent self-preservation that violent boys per-ceive as a form of rough justice in their world devoid ofmeaning other than self-serving, short-term gain. Withinsuch a world view, a “crime and punishment” social re-sponse only confirms what such people have known allalong: what the famous political philosopher refers to asthe “war of each against all.”

Garbarino proposes that we build and strengthen so-cial, psychological, and spiritual anchors for young people,both to rehabilitate those who have been damaged and toenhance resilience for those living in frayed communities,which increasingly are everywhere.

Lost Boys is humane and thoughtful. It contains a greatdeal of hope. But it is also alarming. If we fail to learn thelessons of this work, we could face a “tipping point” into acycle of escalating violence. In the United States, socialviolence is determinedly de-politicized to emphasize per-sonal choice and individual responsibility. But if we allowourselves to see the creeping accession to violence as terror-ism undermining the fabric of everyday life, we can see thegreat urgency of the solutions Garbarino advocates.

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Osofsky, Joy D. (Editor). Children in a Violent Society. NY: Guilford Press, 1997. 338 pp. ISBN 157230183X(hard cover); ISBN 1572303875 (soft cover).

Other ResourcesSafe Havens Training Project: Helping Teachers and Child Care Providers Support Children and Families WhoWitness Violence in their Communities, Pittsburgh, PA: Family Communications, Inc., 1998.

For too many young children and families, violencein their school, community, playground, or home hasbeen an ongoing reality. Child welfare workers, kinfamilies, families (biological, foster, adoptive) can pro-vide vital help by creating an environment where chil-dren feel cared for and protected. As agencies respondto the variety of needs and reactions of the children intheir care, it becomes apparent that the best way tohelp young children restore their sense of security, well-being, and competence is to maximize the power oftheir relationships with them. In the coming months,these programs and agencies will have to be preparedto deal with the aftermath of the September 11 trag-edy—including financial and physical security, familymembers and/or co-workers as part of the militaryresponse, children’s internalized anxiety that may re-sult in challenging behaviors, and the need to workcollaboratively with staff and families from diverse cul-tural backgrounds.

The Safe Havens Training Project is a three-part,video-based training program designed to providefamilies and other caregivers of young children withthe support they need to help children feel safe. Thevideos are mini-documentaries about children andviolence. The workshops teach about children’s re-sponses to violence and offer practical strategies forsupporting children and staff.

The first video/workshop, The Violence that Chil-dren Can See, identifies the impact that witnessing vio-lence has on young children. It offers strategies to help thecommunity as a whole work together in support of chil-dren who are coping with violence. The second video/workshop, The Power of Our Relationships, provides ex-amples of the kinds of language, limit-setting, and rela-tionship-building that enable children to gain trust andself-confidence. The third video/workshop, The Need ToBe Heard, explores ways to create a more supportive workenvironment for staff who are affected by violence.

The Safe Havens Training Project was developedby Family Communications, Inc., producers of Mis-ter Rogers’ Neighborhood, in conjunction with theChild Witness to Violence Project at Boston MedicalCenter and the Allegheny Intermediate Unit/EarlyChildhood and Family Support Services.

The National Child Welfare Resource Center forFamily-Centered Practice, in partnership with FamilyCommunications, Inc., the New York Head Start Col-laboration Project, and the New York University RegionII Head Start Quality Improvement Center, is assistingearly childhood, child welfare, homeless shelters, and otherchild serving programs respond to the needs of staff, fami-lies, and children through the Safe Havens TrainingProject. Visit the Safe Haven’s Web site at www.fci.org/early_care/violence_main.asp or call 412.687.2990.

Although it has been available for several years, Osofsky’sbook is very timely now. This edited collection brings to-gether the work of a broad array of 26 experts in the field ofyouth violence. The work is multidisciplinary and practical.It addresses a broad range of topics such as “neurodevelop-mental,” and psycho-social factors involved in violent behav-ior. The role of firearms in youth violence is examined as well

as what can be learned from descriptive accounts of commu-nities given over to violence in the form of “war zones.” Afterdetailing the scope of the problem thoroughly, the book ex-plores a full range of prevention and intervention programs.This broad scope should be interesting to social workers whooften experience, and hence must understand, the issue ofviolence from numerous points of view.

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