Brain Dev Trauma

7/29/2019 Brain Dev Trauma

1/24

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Childrens Bureau

Child Welfare Information GatewayChildrens Bureau/ACYF1250 Maryland Avenue, SWEighth FloorWashington, DC 20024703.385.7565 or 800.394.3366Email: [email protected]://www.childwelfare.gov

BULLETIN FOR

PROFESSIONALS

August 2011Use your smartphone to

access this bulletin online.

Supporting Brain

Development

in Traumatized

Children and Youth

Whats Inside:

Understanding trauma andbrain development

Identication andassessment

Ages and stages Helping caregivers

promote healthy braindevelopment

Working with other serviceproviders

Creating a trauma-informedchild welfare system

References

As a child welfare professional, you may haveconcerns about the impact of maltreatment ona childs growth and development, and for goodreason: A growing body of evidence indicatesmaltreatment can alter brain functioning andconsequently affect mental, emotional, andbehavioral development (often called socio-emotional development). You and the families you

serve can benet from knowledge of childrensdevelopmental stages and the signs and symptomsof developmental delays. This bulletin summarizeswhat you can do to support the identication and


2/24

Supporting Brain Development in Traumatized Children and Youth http://www.childwelfare.gov

2This material may be freely reproduced and distributed. However, when doing so, please credit Child WelfareInformation Gateway. Available online at http://www.childwelfare.gov/pubs/braindevtrauma.cfm

assessment of the impact of maltreatment andtrauma on brain development; how to workeffectively with children, youth, and familiesto support healthy brain development; andhow to improve services through cross-systemcollaboration and trauma-informed practice.

This bulletin is a companion pieceto Information Gateways issuebriefUnderstanding the Effects ofMaltreatment on Brain Development(http://www.childwelfare.gov/pubs/issue_

briefs/brain_development). The issuebrief provides basic information on braindevelopment and helps professionalsunderstand the emotional, mental, andbehavioral impact of early abuse andneglect in children who come to theattention of the child welfare system.

Understanding Traumaand Brain Development

Research indicates that newborns brains havedeveloped enough to interact with the worldaround them, even in the earliest days oflife. They can recognize their mothers voiceand smell, and they have some capacity toself-regulate and self-soothe. As amazingas these early abilities are, the majority of

brain development occurs during the childsearly months and years, and higher functionscontinue to develop throughout adolescenceinto early adulthood. The brain developsin response to experiences with caregivers,

family, and the community, and the quality ofthose experiences affects whether the childwill develop a strong or weak foundationfor all future learning, behavior, and health(Center on the Developing Child at HarvardUniversity, 2007).

A traumatic experience such as abuse orneglect can profoundly impact a childs braindevelopment. Trauma may occur when achild feels intensely threatened by an event inwhich he or she is involved or witnesses, andit is often followed by serious injury or harm(National Child Traumatic Stress Network,2005). A child may experience a single

traumatic event or chronic trauma (occurringrepeatedly over time). Other types oftraumatic events include witnessing domesticor community violence; surviving a seriousillness, war, or terrorism; or grieving the deathof a loved one. A growing body of evidencedocuments that brain functioning is affectedwhen a child experiences trauma and thatcognitive, physical, emotional, social, health,and developmental problems can result.

Research overwhelmingly points to thebenets of supporting children and familiesat an early age to prevent maltreatment andits negative effects on brain developmentbefore they occur. In addition, cost-benetanalyses demonstrate the stronger return oninvestments that result from strengtheningfamilies, supporting development, andpreventing maltreatment during childhoodand adolescence rather than fundingtreatment programs later in life (Center on the

Developing Child at Harvard University, 2007).
http://www.childwelfare.gov/pubs/issue_briefs/brain_developmenthttp://www.childwelfare.gov/pubs/issue_briefs/brain_developmenthttp://www.childwelfare.gov/pubs/issue_briefs/brain_developmenthttp://www.childwelfare.gov/pubs/issue_briefs/brain_development


3/24



Identicationand Assessment

As a child welfare professional, you arein a unique position to identify childrensdevelopmental concerns early and helpfamilies receive the support they need toreduce any long-term effects. In working withat-risk children and families, you may assessrisk factors and indications of developmentaldelays resulting from maltreatment or traumaas well as protective factors and indicators of

resiliency that may help reduce the stressors.

Risk Factors

Research indicates that the following child,parent, and family factors may increase achilds risk for developmental delay. While thepresence of one risk factor does not mean thechild will have a developmental delay, multiplerisk factors should increase the cause forconcern:

Biomedical risk conditions in a child (suchas low birthweight, physical deformities, orchronic heart or respiratory problems)

Child maltreatment, particularly beforeage 3

Parental substance use or mental healthproblem

Single and/or teenage parent

Low educational attainment of parent

Four or more children in the home

Family poverty or domestic violence

Involvement with the child welfare system(Barth et al., 2007; Administration forChildren and Families, 2007)

Throughout this bulletin, the vignettes tellthe story of Billys traumatic experiencesin early childhood and the efforts of hisfamily, child welfare services, and relatedprofessionals to address the effects on hisbehavior and development.

Billy is a 6-year-old boy placed withhis maternal grandmother by the childwelfare system. Although his motherstated that she never used drugs

while she was pregnant, Billy was bornprematurely. His mother did not have ahome or regular income, and they movedfrom place to place for several years.Billy slept wherever he could nd a spot,and he ate only sporadically. Billy did notcause much trouble because he rarelyspoke.

BILLYS STORY: INTRODUCTION

Indications of Delay

During your interactions with families, observethe behaviors of children and youth for anyindications of developmental delay. (See theAges and Stages section later in this bulletin.)Because parents know their children best, askthem if they have concerns about their childsbehavior so they can help identify issues. Ifthere are causes for concern, refer the familyto early intervention services or to a health-

care provider or youth specialist so the childcan be fully assessed by a trained professional.

The Keeping Children and Families Safe Actof 2003 (P.L. 108-36) required State childwelfare agencies to develop provisions and


4/24



procedures for referral of a child under age3 who is involved in a substantiated case ofchild abuse or neglect to early interventionservices funded under Part C of the Individualswith Disabilities Education Improvement Act( 106(b)(2)(A)(xxi)). Doing so helps ensurethat the developmental needs of childrenwho are abused or neglected are addressedand families receive the support they needto promote optimal child development. Formore information, see Information GatewaysAddressing the Needs of Young Children inChild Welfare: Part C Early InterventionServices(http://www.childwelfare.gov/pubs/

partc).

After Billy was removed from his motherscare due to abandonment, he was placedin foster care until his grandmother couldbe located. Billys grandmother becameconcerned about his behavior and

development while caring for him over thelast 6 months. Billy hid food in his pocketsand in his room, and his teacher reportedhe was stealing food at school. Billy alsoslept on the oor. Because he was soquiet, it took some time for Billys teacherto notice he had difculty speaking andinteracting in school.

BILLYS STORY: PART 2

ASSESSMENT TOOLS FOR CHILD

AND YOUTH DEVELOPMENT

Measures Review DatabaseNational Child Traumatic Stress Networkhttp://www.nctsnet.org/resources/online-research/measures-reviewPresents a database of tools measuringchildrens experiences of trauma and othermental health-related issues.

Trauma Assessment Pathway (TAP)ModelChadwick Center for Children and

Families, Rady Childrens Hospital, SanDiegohttp://www.taptraining.netOffers a framework to build and sustainan assessment-based treatment programand provides a guide for individualizedtreatment for children who suffer complextrauma.

Early Childhood Measures ProlesChild Trendshttp://aspe.hhs.gov/hsp/ECMeasures04Compiles assessment tools measuringlanguage and literacy, cognition,mathematics, social-emotionalcompetency, and approaches to learning.

Screening, Evaluation, and AssessmentNational Early Childhood TechnicalAssistance Centerhttp://nectac.org/topics/earlyid/screeneval.aspReferences numerous publications and

organizations professionals may consultregarding developmental assessments.
http://www.childwelfare.gov/pubs/partchttp://www.childwelfare.gov/pubs/partchttp://www.nctsnet.org/resources/online-research/measures-reviewhttp://www.nctsnet.org/resources/online-research/measures-reviewhttp://www.taptraining.net/http://aspe.hhs.gov/hsp/ECMeasures04http://nectac.org/topics/earlyid/screeneval.asphttp://nectac.org/topics/earlyid/screeneval.asphttp://nectac.org/topics/earlyid/screeneval.asphttp://nectac.org/topics/earlyid/screeneval.asphttp://aspe.hhs.gov/hsp/ECMeasures04http://www.taptraining.net/http://www.nctsnet.org/resources/online-research/measures-reviewhttp://www.nctsnet.org/resources/online-research/measures-reviewhttp://www.childwelfare.gov/pubs/partchttp://www.childwelfare.gov/pubs/partc


5/24



Ages and Stages

There are sensitive periods for developingcertain abilities (such as when infants formattachments with their parents) that, ifunachieved, could impair later development.Every child grows at his or her own pace,but most children achieve developmentalmilestones within the same general timeline.Keep in mind that the impact of abuse orneglect may cause children to develop at aslower rate (Perry, 2006) and that children bornprematurely may also achieve milestones at

different times, depending on the degree ofprematurity.

The chart on the next page provides generalguidance on developmentally appropriate

behavior in children, behaviors of the child orparent that may be a cause for concern, andpositive parenting strategies. You may wantto adjust your expectations according to thechilds needs and the parents situation. Inaddition, the presence of a cause for concerndoes not always mean the child is at risk fordevelopmental delay; however, the presenceof multiple concerns increases that risk.

Note: This chart should not replace amore thorough screening or assessmentby a qualied professional. Child welfareprofessionals may use this informationto observe the behaviors of children and

youth and refer families to a developmentalprofessional when appropriate.


6/24



Child Development, Parenting Strategies, and Causes for Concern, 018 years1

1 Adaptedfrom:Chamberlain,2009;Gabriel,n.d.;Mayer,Anastasi,&Clark,2006;NationalCenteronBirthDefectsandDevelopmental

Disabilities,2010;NationalResearchCouncilandInstituteofMedicine,2009;NewYorkCityAdministrationforChildrensServices,2005;

ParentFurther,2010;ZEROTOTHREE,2007.

Child Parent

AgeDevelopmentally

appropriatebehavior

Causesfor concern

Parentingstrategies

Causesfor concern

03months

Reacts and turnstoward sound

Watches faces andfollows objects

Coos and babbles

Becomes moreexpressive anddevelops a socialsmile

Develops a generalroutine of sleep/wake times

Is unable tomove each limbseparately from theothers

Has difcultytracking light orfaces

Regularly cries forhours at a time and

is very hard to calm

Dont be afraid ofspoiling yourbaby; hold, cuddle,and comfort himoften

Respond to yourbabys cries andprovide the comforthe needs (rocking,feeding, diaperchanging)

Give the baby lotsof attention (talk,sing, read, play),and read the cuesto recognize whenhe needs a break

Have conversationswith your babyacting as if youunderstand each

other Allow the baby to

explore throughmovement, taste,and touch, but setsafe limits

Provide time onthe oor for sitting,rolling, and crawling

Does not knowwhen to feed ortries to keep thebaby on a rigidschedule

Feels too muchattention or holdingwill spoil the baby

Has trouble

knowing when thebaby is hungry,needs attention, orneeds quiet time

Gets upset everytime the baby cries

Allows the baby tocry for a long timewithout trying tocomfort

Doesnt enjoy timewith the baby or

feel the babyspersonality ts inwith family

47months

Babbles chains ofsounds

Responds to othersexpressions ofemotions

Grasps and holdsobjects

Regards ownhand and exploresobjects with handand mouth

Sits with, and thenwithout, support onhands

Cannot hold headup or roll over

Does not makesounds in responseto attention

Consistently resistsall efforts to hold orcomfort

Shows little interestin exploration

Strongly resists aroutine of sleep andawake time


7/24



Child Parent

AgeDevelopmentally

appropriatebehavior

Causesfor concern

Parentingstrategies

Causesfor concern

812months

Changes tone whenbabbling

Says dada andmama and usesexclamations

Imitates sounds andgestures

Explores in manyways (shaking,

dropping, banging,poking)

Pulls self up tostand and may walkbriey without help

Is not able to calmhimself sometimes

Does not babbleor make simplegestures

Fails to respondto name or simpleverbal requests

Does not crawl or

explore the area

Has little or noreaction whenparent(s) leave theroom or return

Continued fromprevious page


2 years Says several singlewords and two- orthree-word phrases

Follows simpleinstructions

Points to things

when named Finds hidden

objects

Scribbles

Stands alone andwalks well

Knows no singlewords

Does not walkeasily

Does not seem toknow or respond to

family members Does not amuse

himself for shortperiods of time

Offer a variety ofsensory experiencesand follow thetoddlers lead inplay

Encourage, but

dont rush, motordevelopmentprovide plenty ofsafe, low places towalk and climb

Create predictableroutines and rituals

Is cold andunresponsivetoward the child

Rarely praises thechild or showsaffection

Has trouble dealingwith own or thechilds anger

Focuses more onthe childs negativebehaviors

Child Development, Parenting Strategies, and Causes for Concern, 018 years (Continued)


8/24



Child Parent

AgeDevelopmentally

appropriatebehavior

Causesfor concern

Parentingstrategies

Causesfor concern

3 years Uses four- to ve-word sentences

Follows two-or three-partinstructions

Recognizes andidenties mostcommon objects

Draws simple

straight or circularlines

Climbs well, walksup and down stairs,runs

No two-wordspontaneousphrases

Has troubleexpressingemotions

Often refuses to dosimple tasks

Seems overly

fearful, even in safesituations


Be a safe, reliablebase as the childexplores the worldaround him

Tell stories and talkwith the child aboutwhat they see, hear,

and do Listen and try to

understand whatthe child is saying

Take the childsemotions seriouslyand help him makesense of them

Support interactionwith peers; providestructure butotherwise let him

negotiate playtimeon his own


Frequently yellsat the child orpunishes accidentsharshly

Describes the childas having hostileintentions, i.e., He

doesnt like me orHe knows better

Pushes the childtoo hard to do toomany activities and/or nds it hard tolet the child trythings by himself

Has trouble settingconsistent rules andsafe limits

4 years Uses ve- to six-word sentences,tells stories

Understandscounting andmay know some

numbers Identies four or

more colors

Copies or drawssimple shapes

Walks/runs forwardand backward withbalance

Is unable to run,jump, or climbeasily

Is extremelyaggressive andhostile toward

peers Clings and gets

very upset whenparent leaves



9/24



Child Parent

AgeDevelopmentally

appropriatebehavior

Causesfor concern

Parentingstrategies

Causesfor concern

5 years Speaks in fullsentences, tellslonger stories

Draws circles andsquares, begins tocopy letters

Climbs, hops,swings, and mayskip

Tries to solveproblems froma single point ofview and identifysolutions toconicts

More likely to agreeto rules

Does not speak fullsentences or speakclearly enoughfor strangers tounderstand

Seems shy and veryfearful with otherchildren

Never shares or

takes turns Regularly has

difculty caring forown toilet needs

Help child take onnew responsibilities

Teach reasonablerisks and safe limits

Handle angerconstructively

Create a safeenvironment whereyour child can feel

comfortable talkingabout a widerange of issues andemotions

Share feelingsand stories abouthow to deal withproblems and facefears

Support healthyfriendshipsand encourage

appropriate socialactivities

Regularly nds thechilds behaviorunmanageable

Does not see theneed for the childto socialize withothers

Thinks the child istoo aggressive or

too dependent Often criticizes or

blames the child

Seems excessivelyanxious about theresponsibilities ofbeing a parent

Leaves the childalone for extendedperiods of time

Is not involved with

school or with otherparents of childrenthe same age

67years

Reads short wordsand sentences

Draws person or

animal Takes pride

and pleasure inmastering new skills

Has more internalcontrol overemotions andbehaviors

Shows growingawareness of goodand bad

Is frequently sad,worried, afraid, orwithdrawn

Is easily hurt bypeers

Bullies otherchildren

Develops unrealisticfears (phobias)



10/24




Child Parent

AgeDevelopmentally

appropriatebehavior

Causesfor concern

Parentingstrategies

Causesfor concern

810years

Reads well

Multiplies numbers

Expresses a uniquepersonality whenrelating to others

Solves conicts bytalking, not ghting

Is able to bounce

back from mostdisappointments

Returns to baby-likeor silly behaviors

Is preoccupied withviolent movies, TV,video games

Is fearful withfamiliar adults, ortoo friendly withstrangers



1114years

May have frequentmood swings orchanges in feelings

Gradually developsown taste, sense ofstyle, and identity

Has a hobby, sport,or activity

Learns to acceptdisappointmentsand overcomefailures

Has one or morebest friends andpositive relationshipswith others the sameage

Eats or sleeps less(or more) thanbefore

Has strong negativethoughts or opinionsof himself

Has an extremeneed for approvaland social support

Has highly conictedrelationships orregularly causesfamily conicts

Is alone most ofthe time and seemshappier alone thanwith others

Establish fair andconsistent rules

Provideopportunities fornew, challengingexperiences

Address thepotentialconsequences ofrisky behaviors

Help teensresolve conicts,solve problems,and understandchanging emotions

Encourage goalsfor the future andhelp create systemsfor time and taskmanagement

Discuss the physicalchanges in pubertythat affect height,weight, and bodyshape

Worries that thechild is maturingvery early or verylate

Doesnt setreasonable limits forthe childs behavior

Is uninterestedin helping thechild address

overwhelmingemotions orsituations

Expects the childto adhere to strictrules and severelypunishes mistakes

Often has conictsand loses temperwith the child

Frequently criticizes,nags, or judges thechild


11/24




Child Parent

AgeDevelopmentally

appropriatebehavior

Causesfor concern

Parentingstrategies

Causesfor concern

1518years

Begins to developan identity and self-worth beyond bodyimage and physicalappearance

Is able to calm downand handle anger

Sets goals and workstoward achieving

them Accepts family

rules, completeschores and otherresponsibilities

Needs time foremotions andreasoning skills tocatch up with rapidphysical changes

Feels hopeless,unable to makethings better

Withdraws fromfamily or friends

Often gives into negative peerpressure

Becomes violent or

abusive

Drives aggressively,speeds, drinks anddrives

Has a favorableattitude toward druguse

Diets excessively,even when notoverweight


Be available for helpand advice whenneeded

Tolerate (withinreason) teensdeveloping likes anddislikes in clothes,

hairstyles, and music


Doesnt provide thechild any privacyand nds it overlydifcult to let goas he becomes moreindependent


12/24



Helping CaregiversPromote HealthyBrain Development

Most scientists agree that children needpositive relationships, rich learningopportunities, and safe environments tosupport their healthy brain development(Center on the Developing Child atHarvard University, 2007). As a professionalworking with children and youth affected

by maltreatment and with their parents orcaregivers, you can help to improve childrenschances for these positive experiences. Thoseopportunities exist at many points in the childwelfare continuum, including prevention,family strengthening, and treatment.

Preventing Trauma

Professionals who work with families can helpparents create safe and loving environments

for their children to prevent abuse or neglectbefore it occurs. Efforts to support optimalbrain development should start as early aspregnancy, when mother and child formtheir rst attachments. The babys prenataldevelopment is more than simple maturation;it involves complex interactions among themother, baby, prenatal environment, and earlyexperiences. Because babies begin to developall ve senses before birth, even experiencesin the womb can affect their development

(Klein, Gilkerson, & Davis, 2008). You can helpparents focus on their childs developmentbefore birth by teaching the mother to beaware of babys movements and to embracea positive lifestyle by avoiding alcohol, drugs,or cigarettes, eating nutritious meals, and

practicing good hygiene. You may also wantto link families to services such as homevisiting or Early Head Start programs designedfor at-risk expectant families.2

After the baby is born, parents can continueto receive help as needed through familysupport programs such as parent educationand home visiting. Recent prevention resourceguides from the U.S. Department of Healthand Human Services Childrens Bureau (ChildWelfare Information Gateway et al., 2011)encourage professionals to promote veprotective factors that strengthen families andhelp prevent abuse and neglect, which serve

to promote healthy brain development:

Nurturing and attachment

Knowledge of parenting and of child andyouth development

Parental resilience

Social connections

Concrete supports for parents

Parents can also support their babys brain

development by understanding and practicingthe strategies to promote healthy braindevelopment described below.

Building Relationships

One of the most important factors in a childsdevelopment is the support of a parent orcaregiver who gives consistent love andsupport. This importance is underscoredby the Centers for Disease Control and

Preventions (CDCs) effort to promote safe,stable, and nurturing relationships between

2 ReadaboutEarlyHeadStartservicesandlocateprogramson

theEarlyChildhoodLearningandKnowledgeCenterwebsite:

http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/Early%20

Head%20Start.
http://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/Early%20Head%20Starthttp://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/Early%20Head%20Starthttp://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/Early%20Head%20Starthttp://eclkc.ohs.acf.hhs.gov/hslc/tta-system/ehsnrc/Early%20Head%20Start


13/24



children and parents. Because youngchildren experience the world through theirrelationships with parents and caregivers,those relationships are fundamental to thehealthy development of the brain and ofphysical, emotional, social, behavioral, andintellectual capabilities (National Center forInjury Prevention and Control, 2009).

Researchers use the idea of serve andreturn, as in a game of tennis, to describeparent-child interactions. If a child attemptsto interact with a parent (for instance, bybabbling or making faces), but the parentdoes not respond appropriately, then

the childs learning process is incomplete(FrameWorks Institute, 2009). You can helpthe parent or caregiver recognize cueswhen the child wants to eat, sleep, play, orengage in other activities. Over time, thecaregivers awareness of and response to thechilds needs will lead to easier interactionsbetween the two and, ultimately, a strongerrelationship.

Whether a child is at home or has been placed

with a relative caregiver or foster parent,you should focus on ensuring the child has asecure relationship with at least one importantperson in his or her life. Training relativecaregivers and foster parents on meeting thechilds emotional and behavioral needs canhelp them form a healthy relationship thatsupports the childs growth. If the child mustbe placed in out-of-home care, strive to makethe rst placement the last. The importanceof stable attachment relationships for young

childrens healthy development cannot beoverstated. In addition, if the child has beenplaced in out-of-home care, you can supportparent-child attachment, when appropriate,by coordinating a visit soon after placement

and helping the parent maintain a schedule offrequent and extensive visits (Dicker, 2009).

Child Welfare Information Gatewaypartnered with the National ResourceCenter for Permanency and FamilyConnections, a service of the ChildrensBureau, to develop an online trainingon parent-child visits that may helpworkers enhance efforts toward familyreunication. View the free training on theInformation Gateway website:http://training.childwelfare.gov

Establishing Nurturing Routines

The predictability of a daily routine helpschildren understand the world is a safe placewhere they can learn and grow without fear.Routines also help establish and maintain anattachment between the child and caregiver(Hammond, 2010). You can help caregiversunderstand the importance of routines and

create a plan that meets the childs needs.

Children need to feel that their caregiver isin control. The caregiver should discuss anychanges to the routine with the child beforethey occur and give the child age-appropriateopportunities to make decisions about dailyactivities (Perry, 2002). Routines can alsohelp the caregiver establish clear and logicallimits for inappropriate behavior and developdisciplinary strategies that take the childs past

experiences into consideration. When caringfor a traumatized child, these rules should beapplied consistently but fairly (National ChildTraumatic Stress Network Schools Committee,2008).
http://training.childwelfare.gov/http://training.childwelfare.gov/


14/24



Enhancing Parent-Child Interactions

Research shows that babies prefer humaninteraction more than anything else (ZERO TO

THREE, 2008). The connections babies formwith their caregivers and the experiences theyshare are essential to promoting healthy braindevelopment. Because many parents worrythat they dont know how to support theirbabys development, you can teach them basicparenting skills (touching, holding, comforting,rocking, singing, and talking to) and explainthat these simple interactions are some of thebest stimulation a baby can receive (ZERO TOTHREE, 2008).

Prepare caregivers to support childdevelopment and provide appropriatelearning opportunities by describing thestages of child development and the timelinefor milestones they can expect their childrento achieve. Children build upon skills overtime as they accomplish increasingly difcultand varied tasks (National Scientic Councilon the Developing Child, 2007). Caregiversshould understand that children do not learn

faster if they are forced to attempt activitiesthey are not developmentally ready for yet. Inaddition, explain to caregivers of maltreatedchildren the negative developmentaloutcomes that may result from maltreatment.Because the childs developmental age maybe younger than his or her chronological age,the caregiver should adjust expectations andmodify learning activities to meet the childsdevelopmental needs (Perry, 2006).

Use the parent section of the chart beginning

on page 6 to guide a discussion of parentingstrategies with caregivers, or locate resourcesfor caregivers about UnderstandingDevelopmental Stages on the Child WelfareInformation Gateway website: http://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfm

Billys grandmother asked for help fromhis caseworker, who referred him to amental health therapist for evaluation.After letting Billy speak openly abouthis past experiences, the therapistdetermined Billys tendencies to stealfood and sleep on the oor were adaptivebehaviors he developed while livingwith his motherskills that helped himsurvive but are no longer appropriategiven his current, more stable situation.

Building on the therapists advice andtaking Billys unique situation intoconsideration, the caseworker helped hisgrandmother establish regular routines,such as mealtimes and bedtimes, andgave her ideas for activities Billy and hisgrandmother could share to enhance thebond between them. The caseworker alsoconnected the grandmother to a supportgroup where she could meet othergrandparents raising their grandchildren.


Supporting Teenage

Brain Development

Trauma and its effects are not limited to youngchildren. Although the rst few years of lifeare critical to supporting brain development,it is important to remember that our brainscontinue growing into young adulthood.

Right before puberty, the adolescent brainexperiences a growth spurt in the areas thataffect planning, reasoning, impulse control,and emotions.

You can help caregivers and other importantadults in a teens life understand how theteenage brain develops and equip them with
http://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfmhttp://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfmhttp://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfmhttp://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfmhttp://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfmhttp://www.childwelfare.gov/preventing/promoting/parenting/understanding.cfm


15/24



strategies to optimize that development.Teens benet from quality time with theircaregivers and adult mentors who help them:

Organize tasks and set priorities

Practice making decisions

Master new skills

Seek healthy adventures and take positiverisks

Minimize stress

Adopt healthy lifestyles and allow time forplenty of sleep (Chamberlain, 2009)

While all teens need adults in their lives whocan help them gain new experiences andsupport them through adolescence, teens whohave suffered from trauma caused by abuse orneglect can benet especially from caregiverswho encourage their growing independencewhile also offering a safety net when theyneed help.

Read more about adolescent and teen braindevelopment, as well as the impact of trauma,

in The Amazing Brain series on the Institutefor Safe Families website, which providesinformation for parents and caregivers:http://www.instituteforsafefamilies.org/the_amazing_brain_materials.php

Addressing the Effects of Trauma

No two children are affected by trauma inthe same way. Depending on the age atwhich a child experienced a traumatic eventor ongoing trauma, the initial response may

range from hyperarousal (ght or ight) todissociation (freeze and surrender), or acombination of the two (Perry, 2002). It isnormal for children to process their feelings

after a traumatic event. Common emotionalresponses include:

Making sense of the event

Creating memories

Re-experiencing the trauma

Avoiding reminders of the event

Experiencing anxiety or sleep problems

Acting impulsively (Perry, 2002)

Caregivers should not pressure the child totalk about the traumatic event but shouldbe prepared to discuss it when the child is

ready. Children who sense their caregiver isuncomfortable with or upset about the eventmay avoid talking about it. When the childbegins talking, the caregiver should listen,avoid overreacting, answer questions, andprovide comfort and support (Perry, 2002).

Children who continue to experienceheightened emotional responses forlonger than 1 month may be experiencingposttraumatic stress disorder (PTSD) (Perry,

2002).The next section discusses different types ofservices and how to access them for childrensuffering from trauma caused by maltreatment.
http://www.instituteforsafefamilies.org/the_amazing_brain_materials.phphttp://www.instituteforsafefamilies.org/the_amazing_brain_materials.phphttp://www.instituteforsafefamilies.org/the_amazing_brain_materials.phphttp://www.instituteforsafefamilies.org/the_amazing_brain_materials.php


16/24



Surviving Childhood: An Introduction tothe Impact of TraumaChild Trauma Academyhttp://www.childtraumaacademy.com/surviving_childhoodDiscusses the impact of negativeexperiences on the developing brain andreviews public policy and preventativeapproaches to address childrens healthand development.

PTSD in Children and AdolescentsNational Center for PTSDhttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.aspProvides information on events that maycause PTSD, how many children areaffected, risk factors, symptoms, andtreatment.

PTSD IN CHILDREN AND YOUTH

Working With OtherService Providers

Because no single system can address all theissues a child and family may experience,child welfare professionals should strive toform collaborative relationships with otherservice providers to improve access to andcoordination of services. Key services forchildren affected by trauma and their familiesare summarized below.

Early Intervention

Each State has an early intervention program(EIP) that provides specialized health,

educational, and therapeutic services toinfants and toddlers who have an identieddevelopmental delay or disability and theirfamilies. Some States may also serve childrenwho are considered to be at risk of developingsubstantial delays (National DisseminationCenter for Children With Disabilities, 2010).EIPs are administered by lead agencies ineach State (including departments of health,developmental disability, social services,children and families, or education). As

described earlier, State child welfare agenciesare required to refer a child under age 3 whois involved in a substantiated case of abuse orneglect to the EIP.

Early intervention programs can serve as asource of support to help families addresstheir childrens development and, whennecessary, provide services to minimize oreliminate developmental delays. In addition,EIPs may provide a variety of services

to caregivers to help them support theirchildrens development, such as parenttraining, home visitation, or respite care.Once a family is referred to the EIP, an EIPservice coordinator will work with the familyto develop an Individual Family Services Plan(IFPS) and coordinate with the child welfaresystem to ensure the child and familys needsare being met. For more information, seeInformation Gateways Addressing the Needsof Young Children in Child Welfare: Part C

Early Intervention Services(http://www.childwelfare.gov/pubs/partc).
http://www.childtraumaacademy.com/surviving_childhoodhttp://www.childtraumaacademy.com/surviving_childhoodhttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asphttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asphttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asphttp://www.childwelfare.gov/pubs/partchttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asphttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asphttp://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asphttp://www.childtraumaacademy.com/surviving_childhoodhttp://www.childtraumaacademy.com/surviving_childhoodhttp://www.childwelfare.gov/pubs/partc


17/24



Early Care and Education

Because children often spend time awayfrom home in early care and education (ECE)

settings, professionals serving very youngchildren are critical partners in supportinghealthy development. ECE programs thatprovide rich learning environments forchildren and work to strengthen familiescan reduce the effects of an unfavorablehome environment (Stepleton, Mcintosh, &Corrington, 2010). ECE professionals alsoobserve the childs behavior in a variety ofsocial and educational situations and maybe among the rst to recognize the signs

of developmental delay. ECE programsthat encourage regular communication withfamilies allow professionals to address anyconcerns as they arise and help connectfamilies to needed services.

When child welfare and ECE professionalsmaintain open communication with thefamilies they serve, everyone can contributeto the decision-making process to determinewhat actions are in the best interests of

the child. This collaboration also facilitatesthe familys ability to access services andallows limited resources to be used moreefciently and effectively (Stepleton et al.,2010). For more information, read the tutorialRecognizing and Addressing Trauma inInfants, Young Children, and Their Familiesfrom the Center for Early Childhood MentalHealth Consultation: http://www.ecmhc.org/tutorials/trauma

Health and NutritionA mothers nutrition during pregnancy affectsher babys birth weight and brain size, andthe quality of a childs nutrition continuesto affect brain development, especially

during the rst 2 years of life (ZERO TOTHREE, 2008). Helping a family gain accessto quality, affordable health care and makehealthy decisions regarding diet and nutritionare important for supporting a childs braindevelopment both before and after birth. Inaddition, when children regularly attend well-child visits, their primary care provider is betterable to assess growth over time, identifydelays early, and make referrals for treatmentor services (Center on the Developing Child atHarvard University, 2007). You should ensurefamilies follow the recommended schedule forwell-child visits and have the means to attend

those visits.The Federal Early and Periodic Screening,Diagnostic, and Treatment (EPSDT) programprovides comprehensive health services forindividuals under age 21 enrolled in Medicaid.Among other requirements, EPSDT programsmust provide services to children such ascomprehensive health and developmentalassessments, physical examinations, vision,hearing, and dental services, and diagnosisand treatment. A health-care provider can

assess the familys eligibility and help themaccess these services. For more information,visit the EPSDT Services in MedicaidKnowledge Path from the Maternal and ChildHealth Library:http://www.mchlibrary.info/knowledgepaths/kp_epsdt.html

Mental Health

When children are affected by a traumaticevent, they may experience a variety of

emotions or display behavioral problemsthat indicate the attention of a mental healthprofessional is needed. The nature of theevent, factors such as the age or sex of thechild, and the childs previous experiences canall affect how he or she responds to trauma
http://www.ecmhc.org/tutorials/traumahttp://www.ecmhc.org/tutorials/traumahttp://www.mchlibrary.info/knowledgepaths/kp_epsdt.htmlhttp://www.mchlibrary.info/knowledgepaths/kp_epsdt.htmlhttp://www.ecmhc.org/tutorials/traumahttp://www.ecmhc.org/tutorials/traumahttp://www.mchlibrary.info/knowledgepaths/kp_epsdt.htmlhttp://www.mchlibrary.info/knowledgepaths/kp_epsdt.html


18/24



(Perry, 2002). An assessment by a trainedprofessional can help determine if individualor group therapy would be benecial for thechild to address the impact of the trauma.

There are a number of points to considerwhen working with older youth who maybenet from mental health services:

Youth should be involved in decisions abouttheir mental health care whenever possible.

It is critical to keep the option open foryouth to request mental health servicesbecause they may be resistant initially butchange their mind later.

Workers should strive to reduce any stigmaattached to mental health services.

As with all clients, workers must respect andprotect the privacy of youth who may ormay not choose mental health services.

Keep in mind that parental stress andunresolved trauma from the parents childhoodmay lead to intergenerational traumaimpacting both the parent and childs mental

health. In such cases, services for both theparent and child may be necessary to fullyaddress the effects of trauma.

You can help families receive appropriatemental health services by explaining thebenets to caregivers, connecting them withservice providers that match their needs, andensuring they follow through with treatmentrecommendations. Visit the Mental Healthsection of the Child Welfare InformationGateway website for more information onmental health services for children, youth, andfamilies involved with the child welfare system:http://www.childwelfare.gov/systemwide/mentalhealth

To address Billys problems in school,his caseworker sought the help of theschools psychologist as well as a speechpathologist. Initial tests indicated Billyhad attention-decit/hyperactivitydisorder (ADHD); with parental consent,Billy was prescribed medicine to addressthe issue. The speech pathologist alsobegan working with Billy and gave hisgrandmother exercises to do with himat home. Several months later, when

Billys grandmother and teacher feltthe medicine was not working, Billysmental health therapist was consultedagain. The therapist advised that Billysproblems are more likely caused bysymptoms of posttraumatic stress disorder(PTSD) resulting from his earlier traumaticexperiences. Under the therapistssupervision, Billy stopped taking themedicine, and his treatment plan wasrevised to include more trauma-focusedtherapies, such as play and art therapy, tohelp Billy work through his feelings.


Schools and Communities

The physical and emotional distress thattraumatized children experience may leadto behavioral problems in school andpoor academic performance. Potentialdevelopmental delays may worsen thesituation as children fall behind their peersacademically and have difculty makingsocial connections. You can reach out to theeducators of the children you serve to informthem of each childs unique needs and support
http://www.childwelfare.gov/systemwide/mentalhealthhttp://www.childwelfare.gov/systemwide/mentalhealthhttp://www.childwelfare.gov/systemwide/mentalhealthhttp://www.childwelfare.gov/systemwide/mentalhealth


19/24



any accommodations necessary to ensurethe childs educational success. In particular,school professionals may benet from specialtraining on the impact of trauma and how towork with traumatized children and youth.The larger community and the opportunitiesit provides for social connections can alsoimpact the childs ability to recover fromtrauma.

The status of the childs emotional or physicalhealth may require the school to developan Individualized Education Program (IEP)in collaboration with the childs family andother professionals involved in the childs life.

The IEP should describe the specic servicesand support the childs needs to meet his orher educational goals. For more informationon the role of educators in supportingtraumatized children and youth, visit theNational Child Traumatic Stress NetworksChild Trauma Toolkit for Educators:http://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkit

Collaborating With Service Providers

Strategies to improve collaboration amongthese systems include:

Establish cross-training opportunities forprofessionals to understand the basicprinciples of other systems

Ensure adequate mechanisms for referralsto other systems and follow up on thosereferrals

Invite all providers serving the child

or family to regularly scheduled teammeetings

Engage community-based services andformal and informal community networks aspart of the support system for families

Involve related service systems duringsystemic performance reviews or qualityimprovement efforts (Stepleton et al., 2010)

The Child Welfare Information Gatewaywebsite offers resources for Collaboration forService Delivery at http://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfm

Creating a Trauma-Informed ChildWelfare System

For children and youth involved withchild welfare, especially those who havebeen placed in out-of-home care, someexperiences with the child welfare system mayunintentionally cause additional trauma. Beinginterviewed as part of a child abuse or neglectinvestigation, separated from family members,or moved among multiple placements cancontribute to the trauma the child may have

already experienced. The key to makingchild- and youth-serving systems more trauma-informed is professionals who understandthe impact of trauma on child developmentand can address trauma and minimize anyadditional negative effects.

According to the National Child TraumaticStress Network (2008b), essential activities ofchild welfare trauma-informed practice are:

Maximize the childs sense of safety

Assist children in reducing overwhelmingemotion

Help children make new meaning of theirtrauma history and current experiences
http://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfmhttp://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfmhttp://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfmhttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfmhttp://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfmhttp://www.childwelfare.gov/management/practice_improvement/collaboration/service.cfm


20/24



Address the impact of trauma andsubsequent changes in the childs behavior,development, and relationships

Coordinate services with other agencies

Use comprehensive assessment of thechilds trauma experiences and their impacton the childs development and behavior toguide services

Support and promote positive and stablerelationships in the life of the child

Provide support and guidance to the childsfamily and caregivers

Manage professional and personal stress,often called vicarious or secondary trauma

Child welfare agencies across the countryare realizing the benets of trauma-informedpractice for children, families, and theirworkforce, and are building upon existingpolicies and practices to make their servicesmore trauma-informed. For example, since itslaunch in 2007, the Multiplying Connectionsinitiative in Philadelphia has taken great strides

to improve public child and family servicesystems in ways that will promote higherquality connections between children andcaring adults that in turn lay the foundation foroptimal brain development. The following aresome strategies used by the initiative to createmore trauma-informed services:

Revise mission statements, policies andprotocols, and core competencies toinclude trauma-informed practices andvalues

Implement professional developmentactivities and create training cohorts amongstaff to promote collaboration and sharedlearning opportunities

Strengthen organizational partnerships byholding joint meetings and sharing fundingwhen possible

Incorporate trauma-informed practice goalsinto evaluation activities (Lieberman &Cairns, 2009)

For more information on trauma-informedpractice, access the National Child TraumaticStress Networks Child Welfare Trauma TrainingToolkit: http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008, orvisit the website of Philadelphias MultiplyingConnections initiative:

http://www.multiplyingconnections.org

Conclusion

To create an effective trauma-informedchild welfare system, it is critical that theprofessionals who regularly interact withfamilies are familiar with and can respond tothe issues surrounding trauma and its effecton brain development. Efforts should beginwith prevention, when families can learnparenting strategies to promote healthy brain

development and prevent abuse or neglect.Many of the same preventive strategies canalso be taught to parents involved with childwelfare, foster parents, relative caregivers,and other out-of-home care providers tosupport the development of a traumatizedchild or youth and minimize the effects oftrauma. Professionals who know the stagesof development and the warning signs fordevelopmental delays can work with familiesto identify concerns and connect them to

needed services. Ultimately, coordinated child-and youth-serving systems that are rooted intrauma-informed practices can have a positiveimpact on outcomes for children, youth, andfamilies involved in the child welfare system.
http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008http://www.multiplyingconnections.org/http://www.multiplyingconnections.org/http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008http://www.nctsnet.org/products/child-welfare-trauma-training-toolkit-2008


21/24



BILLYS STORY: CONCLUSION

In order to improve communicationand avoid overlapping efforts, Billyscaseworker scheduled a multidisciplinaryteam meeting for the adults in Billys life.The long-term plan that resulted fromthe meeting included a number of actionitems:

Billys therapy sessions will continue; hisgrandmother will attend on occasionto support his progress and learn new

activities and exercises to do with himat home.

At school, Billys teacher will follow thenewly created individual education plan(IEP) to help him succeed academicallyand will create a weekly progress report.Billys speech pathologist scheduledseveral more sessions to track hisimprovements.

Billys grandmother will continue to

attend monthly grandparent supportmeetings to make connections andreceive support from other communitymembers.

Billys caseworker will help hisgrandmother become a foster parentand seek nancial support while shecares for Billy. If Billys father or motheris unwilling or unable to care forhim, the grandmother will apply for

subsidized guardianship to give Billy amore permanent home.

Suggested Citation:

Child Welfare Information Gateway(2011). Supporting brain development

in traumatized children and youth.Washington, DC: U.S. Department ofHealth and Human Services, ChildrensBureau.


22/24



References

Administration for Children and Families, Ofce of Planning, Research and Evaluation. (2007).Special health care needs among children in child welfare. NSCAW Research Brief No. 7.Washington, DC: Author. Retrieved January 2011 from http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/special_health/special_health.html

Barth, R. P., Scarborough, A., Lloyd, E. C., Losby, J., Casanueva, C., & Mann, T. (2007).Developmental status and early intervention service needs of maltreated children. Washington,DC: U.S. Department of Health and Human Services, Ofce of the Assistant Secretary forPlanning and Evaluation. Retrieved January 2011 from http://aspe.hhs.gov/hsp/08/devneeds

Center on the Developing Child at Harvard University. (2007). A science-based framework for earlychildhood policy: Using evidence to improve outcomes in learning, behavior, and health forvulnerable children. Retrieved September 2010 from http://developingchild.harvard.edu/library/reports_and_working_papers/policy_framework

Chamberlain, L. B. (2009). The amazing adolescent brain: What every educator, youth servingprofessional, and healthcare provider needs to know. Institute for Safe Families, MultiplyingConnections, and Advocates for Youth. Retrieved September 2010 from http://www.multiplyingconnections.org/sites/default/les/Teen%20Provider%20article%20(2)_0.pdf

Child Welfare Information Gateway, Childrens Bureau, FRIENDS National Resource Center forCommunity-Based Child Abuse Prevention, and the Center for the Study of Social Policy-Strengthening Families. (2011). Strengthening families and communities: 2011 resource guide.Washington, DC: U.S. Department of Health and Human Services, Childrens Bureau. RetrievedApril 2011 from http://www.childwelfare.gov/preventing/preventionmonth/guide2011

Dicker, S. (2009). Reversing the odds: Improving outcomes for babies in the child welfare system.Baltimore: Brookes Publishing Co.

FrameWorks Institute. (2009). Child abuse prevention toolkit: Elements of the core story.Retrieved September 2010 from the Prevent Child Abuse America website at http://www.

preventchildabuse.org/canp/resources/pdf/Child_Abuse_Toolkit_Core_Story.pdf

Gabriel, G. (n.d.). Child and brain: The stages of development. BrainConnection.com. RetrievedSeptember 2010 from http://brainconnection.positscience.com/topics/?main=fa/child-brain
http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/special_health/special_health.htmlhttp://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/special_health/special_health.htmlhttp://aspe.hhs.gov/hsp/08/devneedshttp://developingchild.harvard.edu/library/reports_and_working_papers/policy_frameworkhttp://developingchild.harvard.edu/library/reports_and_working_papers/policy_frameworkhttp://www.multiplyingconnections.org/sites/default/files/Teen%20Provider%20article%20(2)_0.pdfhttp://www.multiplyingconnections.org/sites/default/files/Teen%20Provider%20article%20(2)_0.pdfhttp://www.childwelfare.gov/preventing/preventionmonth/guide2011http://www.preventchildabuse.org/canp/resources/pdf/Child_Abuse_Toolkit_Core_Story.pdfhttp://www.preventchildabuse.org/canp/resources/pdf/Child_Abuse_Toolkit_Core_Story.pdfhttp://brainconnection.positscience.com/topics/?main=fa/child-brainhttp://brainconnection.positscience.com/topics/?main=fa/child-brainhttp://www.preventchildabuse.org/canp/resources/pdf/Child_Abuse_Toolkit_Core_Story.pdfhttp://www.preventchildabuse.org/canp/resources/pdf/Child_Abuse_Toolkit_Core_Story.pdfhttp://www.childwelfare.gov/preventing/preventionmonth/guide2011http://www.multiplyingconnections.org/sites/default/files/Teen%20Provider%20article%20(2)_0.pdfhttp://www.multiplyingconnections.org/sites/default/files/Teen%20Provider%20article%20(2)_0.pdfhttp://developingchild.harvard.edu/library/reports_and_working_papers/policy_frameworkhttp://developingchild.harvard.edu/library/reports_and_working_papers/policy_frameworkhttp://aspe.hhs.gov/hsp/08/devneedshttp://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/special_health/special_health.htmlhttp://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/special_health/special_health.html


23/24



Hammond, R. A. (2010). Round the clock routines. In Respecting babies: A new look at MagdaGerbers RIE approach. Washington, DC: ZERO TO THREE. Retrieved September 2010 fromhttp://main.zerotothree.org/site/DocServer/Hammond_2.pdf?docID=11381

Klein, R., Gilkerson, L., & Davis, E. (2008). Prenatal development. In L. Gilkerson & R. Klein (Eds.),Early development and the brain: Teaching resources for educators. Washington, DC: ZERO TOTHREE. Retrieved September 2010 from http://main.zerotothree.org/site/DocServer/EarlyBrain_Unit2.pdf?docID=4461

Lieberman, L. & Cairns, J. (2009). Addressing the impact of childhood trauma on braindevelopment. Retrieved September 2010 from the Multiplying Connections website athttp://www.multiplyingconnections.org/sites/default/les/Addressing%20the%20Impact%20of%20Childhood%20Trauma%20on%20Brain%20Development.pdf

Mayer, R., Anastasi, J. M., & Clark, E. M. (2006). What to expect and when to seek help: A brightfutures tool for families and providers. Washington, DC: National Technical Assistance Centerfor Childrens Mental Health, Georgetown University Center for Child and Human Development,in collaboration with the National Center for Education in Maternal and Child Health. RetrievedSeptember 2010 from http://www.brightfutures.org/tools

National Center for Injury Prevention and Control. (2009). Strategic direction for child maltreatmentprevention: Preventing child maltreatment through the promotion of safe, stable, and nurturingrelationships between children and caregivers. Washington, DC: Centers for Disease Controland Prevention, U.S. Department of Health and Human Services. Retrieved September 2010from http://www.cdc.gov/ViolencePrevention/pdf/CM_Strategic_Direction--Long-a.pdf

National Center on Birth Defects and Developmental Disabilities. (2010). Developmentalmilestones. Centers for Disease Control and Prevention. Retrieved September 2010 fromhttp://www.cdc.gov/ncbddd/actearly/milestones

National Child Traumatic Stress Network. (2005). Understanding child traumatic stress. RetrievedJanuary 2011 from http://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-29-05.pdf

National Child Traumatic Stress Network. (2008). The essential elements of trauma-informed childwelfare practice. In Child welfare trauma training toolkit. Retrieved May 2011 fromhttp://www.nctsnet.org/sites/default/les/assets/pdfs/cwt3_SHO_EEs.pdf

National Child Traumatic Stress Network Schools Committee. (2008). Child trauma toolkit foreducators. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.Retrieved May 2011 from http://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkit
http://main.zerotothree.org/site/DocServer/Hammond_2.pdf?docID=11381http://main.zerotothree.org/site/DocServer/EarlyBrain_Unit2.pdf?docID=4461http://main.zerotothree.org/site/DocServer/EarlyBrain_Unit2.pdf?docID=4461http://www.multiplyingconnections.org/sites/default/files/Addressing%20the%20Impact%20of%20Childhood%20Trauma%20on%20Brain%20Development.pdfhttp://www.multiplyingconnections.org/sites/default/files/Addressing%20the%20Impact%20of%20Childhood%20Trauma%20on%20Brain%20Development.pdfhttp://www.brightfutures.org/toolshttp://www.cdc.gov/ViolencePrevention/pdf/CM_Strategic_Direction--Long-a.pdfhttp://www.cdc.gov/ncbddd/actearly/milestoneshttp://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-29-05.pdfhttp://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-29-05.pdfhttp://www.nctsnet.org/sites/default/files/assets/pdfs/cwt3_SHO_EEs.pdfhttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.nctsnet.org/resources/audiences/school-personnel/trauma-toolkithttp://www.nctsnet.org/sites/default/files/assets/pdfs/cwt3_SHO_EEs.pdfhttp://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-29-05.pdfhttp://www.nctsn.org/nctsn_assets/pdfs/edu_materials/Understanding_Child_Traumatic_Stress_Brochure_9-29-05.pdfhttp://www.cdc.gov/ncbddd/actearly/milestoneshttp://www.cdc.gov/ViolencePrevention/pdf/CM_Strategic_Direction--Long-a.pdfhttp://www.brightfutures.org/toolshttp://www.multiplyingconnections.org/sites/default/files/Addressing%20the%20Impact%20of%20Childhood%20Trauma%20on%20Brain%20Development.pdfhttp://www.multiplyingconnections.org/sites/default/files/Addressing%20the%20Impact%20of%20Childhood%20Trauma%20on%20Brain%20Development.pdfhttp://main.zerotothree.org/site/DocServer/EarlyBrain_Unit2.pdf?docID=4461http://main.zerotothree.org/site/DocServer/EarlyBrain_Unit2.pdf?docID=4461http://main.zerotothree.org/site/DocServer/Hammond_2.pdf?docID=11381


24/24


National Dissemination Center for Children With Disabilities. (2010). Overview of early intervention.Retrieved September 2010 from http://www.nichcy.org/babies/overview

National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, andbehavioral disorders among young people: Progress and possibilities. Washington, DC: TheNational Academies Press. Retrieved January 2011 fromhttp://clientportal.omni.org/d/dbh/Lists/SAP%20Block%20Grant/Attachments/17/IOM_Matrix_8%205x11_FINAL.pdf

National Scientic Council on the Developing Child. (2007). The timing and quality of earlyexperiences combine to shape brain architecture: Working paper #5. Retrieved September 2010from http://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp5/

New York City Administration for Childrens Services. (2005). Handbook for healthy developmentof children and youth (3rd ed.). New York City Administration for Childrens Services, Ofce ofChild and Family Health and Graphics. Retrieved September 2010 fromhttp://home2.nyc.gov/html/acs/downloads/pdf/Handbook%20for%20Healthy%20ENG.pdf

ParentFurther. (2010). Ages and stages. Search Institute. Retrieved September 2010 fromhttp://www.parentfurther.com/ages-stages

Perry, B. D. (2002). Surviving childhood: An introduction to the impact of trauma. ChildTrauma Academy. Retrieved September 2010 from http://www.childtraumaacademy.com/surviving_childhood

Perry, B. D. (2006). Applying principles of neurodevelopment to clinical work with maltreated andtraumatized children: The neurosequential model of therapeutics. In N. B. Webb (Ed.), Workingwith traumatized youth in child welfare (pp. 27-52). New York: The Guilford Press. RetrievedSeptember 2010 from the Child Trauma Academy website at http://childtraumaacademy.org/Documents/NeurosequentialModel_06.pdf

Stepleton, K., Mcintosh, J., & Corrington, B. (2010). Allied for better outcomes: Child welfare andearly childhood. Center for the Study of Social Policy. Retrieved September 2010 fromhttp://www.strengtheningfamilies.net/images/uploads/images/(1.1)_Allied_for_Better_Outcomes_(draft)_.pdf

ZERO TO THREE. (2007). Baby brain map. Retrieved September 2010 from http://www.zerotothree.org/baby-brain-map.html

ZERO TO THREE. (2008). Frequently asked questions: Brain development. Retrieved September2010 from http://main.zerotothree.org/site/DocServer/Brain_FAQ.pdf?docID=11561
http://www.nichcy.org/babies/overviewhttp://clientportal.omni.org/d/dbh/Lists/SAP%20Block%20Grant/Attachments/17/IOM_Matrix_8%205x11_FINAL.pdfhttp://clientportal.omni.org/d/dbh/Lists/SAP%20Block%20Grant/Attachments/17/IOM_Matrix_8%205x11_FINAL.pdfhttp://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp5/http://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp5/http://home2.nyc.gov/html/acs/downloads/pdf/Handbook%20for%20Healthy%20ENG.pdfhttp://home2.nyc.gov/html/acs/downloads/pdf/Handbook%20for%20Healthy%20ENG.pdfhttp://www.parentfurther.com/ages-stageshttp://www.childtraumaacademy.com/surviving_childhoodhttp://www.childtraumaacademy.com/surviving_childhoodhttp://childtraumaacademy.org/Documents/NeurosequentialModel_06.pdfhttp://childtraumaacademy.org/Documents/NeurosequentialModel_06.pdfhttp://www.strengtheningfamilies.net/images/uploads/images/(1.1)_Allied_for_Better_Outcomes_(draft)_.pdfhttp://www.strengtheningfamilies.net/images/uploads/images/(1.1)_Allied_for_Better_Outcomes_(draft)_.pdfhttp://www.zerotothree.org/baby-brain-map.htmlhttp://www.zerotothree.org/baby-brain-map.htmlhttp://main.zerotothree.org/site/DocServer/Brain_FAQ.pdf?docID=11561http://main.zerotothree.org/site/DocServer/Brain_FAQ.pdf?docID=11561http://www.zerotothree.org/baby-brain-map.htmlhttp://www.zerotothree.org/baby-brain-map.htmlhttp://www.strengtheningfamilies.net/images/uploads/images/(1.1)_Allied_for_Better_Outcomes_(draft)_.pdfhttp://www.strengtheningfamilies.net/images/uploads/images/(1.1)_Allied_for_Better_Outcomes_(draft)_.pdfhttp://childtraumaacademy.org/Documents/NeurosequentialModel_06.pdfhttp://childtraumaacademy.org/Documents/NeurosequentialModel_06.pdfhttp://www.childtraumaacademy.com/surviving_childhoodhttp://www.childtraumaacademy.com/surviving_childhoodhttp://www.parentfurther.com/ages-stageshttp://www.nyc.gov/html/acs/downloads/pdf/Handbook%20for%20Healthy%20ENG.pdfhttp://home2.nyc.gov/html/acs/downloads/pdf/Handbook%20for%20Healthy%20ENG.pdfhttp://home2.nyc.gov/html/acs/downloads/pdf/Handbook%20for%20Healthy%20ENG.pdfhttp://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp5/http://developingchild.harvard.edu/library/reports_and_working_papers/working_papers/wp5/http://clientportal.omni.org/d/dbh/Lists/SAP%20Block%20Grant/Attachments/17/IOM_Matrix_8%205x11_FINAL.pdfhttp://clientportal.omni.org/d/dbh/Lists/SAP%20Block%20Grant/Attachments/17/IOM_Matrix_8%205x11_FINAL.pdfhttp://www.nichcy.org/babies/overview