Trauma Informed Care in a System of Care Approach

Innovative Conversations Session 2 – Recorded July 2018

Guest: Bobbi Beale, PhD, Trauma Informed Care Treatment Trainer/Senior Consultant, Center for Innovative Practices/Begun Center, CWRU

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Listen below to Trauma and Trauma Informed Care in a System of Care Approach

Childhood trauma can range from incidents and experiences that can make individuals – notably, in this case, children – feel like they are going to die.

This can include dangerous and serious aggressive behaviors such as assault and various forms of emotional, physical, psychological, and sexual abuse. Big T trauma versus Little T trauma.

Traumatic stress can involve abuse and neglect of all sorts and can also include daily, ongoing pressure – stresses that are unrelenting and woven into family lives that include, among many other things, poverty, discrimination, incarceration, substance use, bullying, parents’ divorce that creates significant household dysfunction, things that threaten you in one way or another, but ultimately from which you feel that you cannot escape. –

There can even be genetic residual trauma that is passed along through generations and which manifest in individual brain mechanisms that can trigger accentuated freeze, flight, or fight responses to seeming ordinary situations.
Even natural disasters can create traumatic stress and the after-effects that can create any combination of the aforementioned problems.

“In a report by Child Trends, one in ten children have experienced three or more adverse experiences placing them in the high-risk category. In Ohio, that rate is one in seven children.”

Fight. Flight. Or Freeze: The innate survival responses to perceived threats. The ‘freeze’ response is the most common and most prominent in children. Freeze is what comes first to mind when children are confronted with danger, before fight and flight are learned.

The ACE Study
The ACE Study – Adverse Childhood Experiences – was developed and authored by Vincent Faletti and Robert Anda. It recognized the pattern of similar childhood experiences in youth with medical, behavioral, mental health, substance use, obesity, and self-harm challenges

Learn More About the ACE Study

Bobbi Beale: “Trauma is enshrouded in pain and shame and people have a very difficult time talking about them, if they can even access those memories at all, as they have tried to suppress them in order to survive, emotionally and otherwise.”

One of the biggest facets about the ACE Study has been that it has illustrated the prevalence of trauma, especially in the clinical population, where youth in all likelihood having three or more instances of trauma by age 18. The numbers increase with clinical patients where 50-75% have experienced trauma.

What Is Trauma-Informed Care
The big question in Trauma Informed Care is, How do we accommodate for traumatic stress while dealing with and trying to help youth with these traumas?

Trauma-Informed Care is applying the knowledge of trauma to your field, to your practice, to your organization and its intervention, treatment, and recovery mission.

In Ohio, Trauma-Informed Care and the awareness surrounding it has been in place for approximately five years. In the life of a system or organization, five years is a very short time and thus this is a good sign of progress that so much has happened in that relatively short amount of time.

Ohio’s leadership in this Trauma-Informed Care approach encompasses initiatives in law enforcement, the juvenile justice system, education, and health care, among others.

The Wraparound Systems of Care Perspective in Terms of Trauma:
When kids are dealing with trauma, behavioral problems and juvenile justice issues occur because the things that happen in a young brain when adjusting to being on-guard against trauma all the time – which we call a ‘hyper-vigilance ’ – is that one naturally becomes more aggressive, more impulsive, more self-centered.

That’s what fight, flight and freeze can ultimately lead to: A chronic propensity toward hypervigilance, not the ‘choice behaviors’ we want to see in kids, the propensities toward aggressiveness, impulsiveness, and self-centeredness.

And while you get punished in the elementary school for those behaviors, by the time you get to middle school, you might be tipping toward the juvenile justice system.

Then, by high school, there is no tolerance for that type of behavior at all because the mission is to prepare you to be a functional adult.  And a lot of incarceration involves people who have experienced trauma and who have developed these trauma responses.

ADDITIONAL RESOURCES: is presented by The Center for Innovative Practices (CIP)
and the Child and Adolescent Behavioral Health Center of Excellence (CABH COE)
Part of the Begun Center for Violence Prevention
at Case Western Reserve University’s
Mandel School of Applied Social Services
Campus Location: 11235 Bellflower Road Room 375  |
Cleveland, OH 44106 Mailing Address: 10900 Euclid Avenue |
Cleveland, OH 44106-7164
Telephone: 216-368-6293 | email:
© 2018 Center for Innovative Practices, Cleveland, Ohio 44106